Recently, I watched Sophie Barthes' thought-provoking film 'The Pod Generation' (2023), where an AI therapist named Eliza appears as a giant eye embedded in the wall of a therapy pod - omnipresent yet fundamentally disembodied. The striking image of Eliza's watchful eye has inspired me to reflect on the current state of mental healthcare, particularly with the rise of AI therapists. These AI therapists are always available to users, which raises important questions about the nature of therapeutic relationships. As Harville Hendrix reminds us, 'We are born in relationship, we are wounded in relationship, and we can be healed in relationship' - but what form of relationship truly facilitates healing?

Dreams and the Digital Therapist: What AI Cannot See

The film highlights a telling limitation of AI therapy through Eliza's inability to work with dreams. While AI can recognise patterns and offer responses, it cannot truly enter the rich territory of dream interpretation that is so vital to psychodynamic work. As Freud famously described dreams as 'the royal road to the unconscious', they speak in a language that requires more than data analysis to understand. Dreams communicate through symbols, emotions, and personal meanings that emerge in the therapeutic relationship. 

When working with dreams, meaning unfolds through what Bion called the therapist's capacity for 'reverie' - a state of receptive attunement that no algorithm, however sophisticated, can replicate. Indeed, Bion's invitation for psychoanalysts to work 'without memory and desire' highlights another fundamental limitation of AI: while artificial intelligence is programmed to remember everything perfectly, human therapists' selective forgetting can itself be meaningful. When certain elements from previous sessions suddenly surface in the therapist's mind, this 'forgetting and remembering' often signals important unconscious communications. This living, breathing, feeling presence is what makes human therapy uniquely powerful, especially when exploring the depths of our unconscious through dreams.

Nature's Attunement

The capacity for connection, understanding and healing through relationships begins in early life. The (m)other and baby engage in an intricate dance of mutual attention, their gazes meeting and parting in rhythmic exchanges that lay the foundation for emotional regulation and secure attachment. This primal form of communication operates beneath conscious awareness, through micro-adjustments in facial expression, vocal tone, and bodily tension - what Trevarthen (1979, as cited in Ammaniti, 2018) termed 'primary intersubjectivity.' This innate capacity for embodied emotional resonance forms the basis of all meaningful human connection, including the therapeutic relationship.

The Embodied Therapeutic Space

A skilled therapist attuned to their client notices communication that extends far beyond words. A slight shift in posture, a deep sigh or a moment of shared silence may offer valuable information about the client's inner world and the therapeutic relationship. As Alessandra Lemma emphasises in her book, 'The Digital Age on the Couch', therapists work as much with their own embodied countertransference as with their cognitive understanding, sensing through their own bodily responses what words alone might miss.

The Covid-19 pandemic provided an unprecedented natural experiment in what happens when this embodied connection is mediated through screens. While Zoom allowed therapeutic work to continue, many clients expressed a profound sense of loss. The return to in-person sessions revealed what had been missing, with clients often speaking of feeling 'held' again in a way that transcended words.

Attachment and Boundaries in the Digital Age

The constant availability of AI support raises important questions about attachment and dependency. Psychodynamic therapeutic boundaries - the weekly session, the contained space, the predictable rhythm of meeting and parting - serve essential psychological functions. Boundaries create a holding environment that can safely contain connection and separation and allow clients to develop internal resources for emotional regulation.

The Rhythm of Human Healing

In contrast to the 24/7 support of AI therapy, the weekly cadence of psychodynamic therapy creates a container for psychological growth, allowing time for integration and processing between sessions. This echoes the natural rhythm of the early mother-infant relationship, where periods of engagement alternate with necessary disengagement, fostering the development of self-regulation and the development of the infant's inner world.

The Future of Therapy

The future of therapeutic practice lies not in choosing between human and artificial intelligence, but in understanding their distinct contributions to mental health care. AI therapists, like the fictional Eliza, can offer valuable support through their accessibility and constant availability - particularly in crisis situations or for those feeling very alone and overwhelmed about taking the first steps toward seeking help. They may, in fact, serve as bridges to human connection rather than replacements for it.

However, as our Covid experience and return to in-person therapy has shown, there remains something irreplaceable about the embodied therapeutic encounter. Just as an infant's development requires actual physical presence and attunement of their caregiver, deep therapeutic work often demands the full richness of human-to-human contact. We know that the body speaks its own language of healing that no algorithm, however sophisticated, can fully replicate.

As Lemma suggests, we must neither turn our backs on technological advancement nor abandon our understanding of what makes human connection transformative. The challenge ahead lies in how we learn to integrate these new tools while preserving the essential wisdom of embodied therapeutic relationships. In doing so, we honour both innovation and the ancient, embodied human healing that begins in our earliest moments and continues throughout our lives.

A Personal Position: The Primacy of Presence

As a psychodynamic psychotherapist and EMDR therapist specialising in body image and attachment trauma, my clinical experience has led me to prioritise in-person therapeutic work. The nature of attachment trauma demands the full spectrum of embodied communication - the subtle shifts in energy, the unspoken somatic dialogues, the shared field of emotional resonance that can only exist when two people share physical space.

Therapeutic work around body image, in particular, requires a level of attunement and containment that is difficult to achieve through digital means. When clients struggle with their embodied experience, the therapist's physical presence serves as a vital anchor for the work. The therapy room becomes a secure container where clients can gradually reconnect with their bodily experiences, thoughts and feelings. This process is supported by the therapist's embodied presence and right brain to right brain attunement.

While I acknowledge the valuable role of digital tools and AI support in the broader mental health landscape, my specialised work with body image and attachment trauma has reinforced my commitment to in-person therapeutic relationships. For these clients, the journey toward healing fundamentally requires a dialogue that unfolds not just through words, but through the profound intimacy of shared embodied presence in the therapeutic space.

© Yvette Vuaran 2025

References:

Abadi, S. (2003). Between the frontier and the network: Notes for a metapsychology of freedom. International Journal of Psychoanalysis, 84(2), 221-234.

Ammaniti, M. (2018). Implicit knowledge from infancy to the psychotherapeutic relationship: The contribution of Daniel Stern. Psychoanalytic Inquiry, 38(2), 138-147.

Freud, S. (2010). The interpretation of dreams (J. Strachey, Trans.). New York, NY: Basic Books. 

Mawson, C. (Ed.). (2018). Three papers of W.R. Bion. Routledge. 

Lemma, A. (2017). The digital age on the couch: Psychoanalytic practice and new media. Routledge.

Sayers, J. (2021). Online psychotherapy: Transference and countertransference issues. British Journal of Psychotherapy, 37(2), 223-233.