Concern 573 · Working draft · editorial review in progress
AI therapy substitutes
An AI therapy substitute is a chatbot used in place of mental-health care without adequate evidence, safeguards or professional support.
Understanding the concern
A reassuring conversation can feel therapeutic, but that does not establish that the service can assess risk or provide appropriate treatment. General-purpose and companion bots differ from tools designed and tested for a specific clinical purpose. The distinction matters when someone is distressed or needs more than a supportive reply.
Research includes both promising trials of carefully developed tools and evaluations finding unsafe responses from other systems. Neither result should be generalized to all chatbots. People need clear information about the service's role, evidence, privacy and limits, including how it connects them to human care when necessary.
An example
A person assumes a friendly app offers the same protections and competence as a qualified mental-health provider.
Illustrative unless identified as a documented case.
Words in plain English
- AI
- Software that learns patterns from examples or uses rules to perform tasks such as recognizing images or generating text. It can make mistakes and does not understand every situation as a person would.
Evidence and its limits
The trial evaluated one expert-developed tool against a waitlist; safety tests examined other systems. These are not interchangeable products or proof of equivalence to human therapy.
NEJM AI · 2025 · Randomized controlled trial
Randomized Trial of a Generative AI Chatbot for Mental Health Treatment ↗ (opens in a new tab)Expert-developed Therabot compared with a waitlist; results do not validate all consumer chatbots or establish equivalence to human therapy.
Moore and colleagues · FAccT 2025 · Safety evaluation
Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers ↗ (opens in a new tab)Tests stigma and responses to clinical scenarios; identifies failures without estimating population rates of injury.
Broader frameworks and background
These resources provide context. They do not establish every claim in this concern.
A question to discuss
What evidence and support should be required before a chatbot is presented as treatment?
Keep track of different views, what needs checking, and any next step in your own discussion notes.
Open discussion notes →Principles for the conversation
Before you finish · reflect together
Virtues and principles to consider
Virtues are qualities we practice in how we treat people and make choices. They are not scores for judging someone. Use these ideas to explore what a thoughtful response could look like.
Dignity
Dignity means recognizing each person's worth regardless of usefulness, status, or a system's score. People deserve respect and a voice in matters that affect them.
Explain important decisions, avoid humiliating treatment, and keep room for a person's story. Do not treat a prediction as a complete account of who someone is.
Ask together: Does this use treat each person as someone whose experience matters?
Listening
Listening means trying to understand someone's experience before preparing an answer. People who use a service, work with it, or are judged by it may notice problems its designers miss.
Invite people to describe what happened in their own words. Repeat back what you understood and let them correct it. A quiet person or a complaint that is hard to measure may still reveal something important.
Ask together: Whose experience have we not heard yet?
Seeing potential
Seeing potential means recognizing people's capacity to learn, contribute, and grow. It resists reducing someone to a score or to the tasks a machine can perform faster.
Use tools to support people's development. Give learners time, feedback, and real opportunities to practice. A prediction about someone's performance should not close off their future.
Ask together: How could this help people develop abilities they value?
Editorial ratings
These are editorial judgments from the register, not measured probabilities or predictions about your situation.
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