When Clients Bring AI to Therapy: Working with ChatGPT, Sycophancy, and the New Third Wheel in the Room
Clients are bringing AI into therapy, from ChatGPT chat logs handed over as homework to AI companions that never disagree, and therapists need a clinical response.
Curt Widhalm, LMFT, and Katie Vernoy, LMFT dig into what happens when clients bring their own AI into the therapy room. The profession built ethics guidance for when therapists send clients toward AI, but it largely sidestepped the reality already showing up in sessions: clients processing the same issues with ChatGPT between appointments, using chatbots to interpret and respond to relationships, and increasingly offloading their social and dating lives onto AI companions.
Drawing on emerging research about chatbot use, loneliness, emotional dependence, and sycophancy, Curt and Katie make the case that concern is more useful than alarm. Clients are already using these tools, so the clinical task is to assess how and why they are using them, provide psychoeducation on sycophancy, confidentiality, and safety, and separate the healthy, adaptive uses from the problematic ones.
They also share concrete in-session moves: entering the opposite position to expose how a chatbot validates any side, reframing how clients use AI for medical and diagnostic questions, and recognizing when AI has become a client's primary support system, along with how to begin weaning a client back toward real-world connection.
In this episode, we discuss:
- The three main ways clients are bringing AI into the therapy room
- Why a client's AI use can be a clinical opportunity, not only a risk
- How to assess the function and pattern of a client's AI use
- What the research suggests about chatbot use, loneliness, and sycophancy
- How to teach critical thinking and protect client confidentiality
- What to do when a client has become dependent on AI
Timestamps:
00:15 - AI as the new "third wheel" in the therapy room
04:15 - Three ways AI is showing up in clients' lives
05:55 - What the research suggests: loneliness, dependence, and sycophancy
10:24 - Why client AI use can be a clinical opportunity
13:24 - Assessing use and treating chatbots as public spaces
18:17 - Explaining AI's mechanics: it is not an objective third party
20:14 - A critical-thinking exercise: enter the opposite position
24:47 - Using AI for medical and diagnostic questions
30:53 - When a client is already dependent on AI
Full show notes and resources: mtsgpodcast.com
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Voice Over by DW McCann: https://www.facebook.com/McCannDW/
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