Therapy can involve a lot of words, but it’s often the pauses that matter most. If you transcribed a session, the pauses would look like nothing: beats of silence, extra breaths, slowing down. But these can represent the crux of the practice: entry points into feeling. My job as a psychoanalyst is to listen as much to silence as to words, to be present with the patient while they’re quiet—to stay with them as they allow their feelings to emerge.I was trained across diverse theories and techniques, but in my clinical work I have found that the cornerstone of the process is feeling. The patient’s emotional experience is the destination and the terrain. But I also feel; I am moved. And the work I do with my patients relies on our relationship and our capacity for mutual feeling. In many ways, the history of my field from Freud on has been a growing acknowledgement of the reality of this relationship—moving from the therapist as sealed off and standing apart, toward approaches that view the real human relationship between patient and therapist as the territory where healing happens.Now the rise of the AI therapist is upon us. The growing cadre of AI mental-health services tend to avoid using words like therapist and therapy. They say that they do not replace professional help and that they can refer users to human therapists if needed. But their positioning as a therapy-like service is clear. In June, the therapy giant Talkspace launched its AI mental-health agent, Tee, “developed to help individuals navigate life’s daily mental health challenges.” Then there’s Ash, which offers to support your “emotional wellbeing,” helping you to “connect the dots between thoughts, feelings, and behaviors.” Abby promises to be “warm, thoughtful, and direct” and to help you “work through the kinds of everyday emotional challenges that often go unspoken.” And Headspace’s Ebb advertises: “Stressed at work? Family drama? Trouble sleeping? Ebb can help you unpack what’s on your mind and move forward with more clarity.”When I reached Talkspace for comment, a company spokesperson told me in an email that Tee is “absolutely not a replacement for human therapy. It is a safe AI mental-health guide that can be used to talk through situations like stress, anxiety, relationships, life challenges, and personal growth.”AI therapy is a radical move, and we need to reckon with what happens when we turn to therapists who cannot feel.Therapy and AI have been intertwined since the technology’s beginnings. One of the first chatbots, Eliza, built at MIT in the mid-1960s, ran a therapy script called DOCTOR that asked users questions about their feelings and experiences—and left its creator disconcerted about his technology’s strong emotional pull. Since chatbots such as ChatGPT and Claude have burst onto the scene, large swaths of the population have been using non-therapy-branded AIs for emotional and mental-health support. Two cultural forces are coming together right now: the growing embrace and destigmatization of therapy, and the idea, explicitly espoused by Silicon Valley, that AI can accomplish what patients seek. I was interested to see how these tools worked in practice, so, although I could not be a neutral observer, I signed up for Tee and attended a few sessions.After I logged in, the chatbot moved me through predetermined session stages that I could follow on my screen’s right-hand corner: Agenda Setting, Active Conversation, Core Work, Practice Plan, Session Complete. It encouraged me to talk about whatever I wanted to, but in the beginning focused on identifying a clear-cut problem, which it wanted to set as the session’s “agenda.” With the agenda set, we went back and forth a bit until the bot suggested that we “shift now from exploring the problem to building a small, realistic step forward.” Its proposed remedy was an exercise patterned on cognitive behavioral therapy that involved pausing for 90 seconds each day before I started work. These sorts of exercises can be helpful. But, in this cycle of identifying problems and fixes, we did not touch what is underneath.The chatbot was also willing to “just talk it through,” rather than offering a concrete suggestion. When we took this route, I could tell that the bot was attempting active listening—restating and asking questions about my experience, mimicking empathy. That’s a process that can help clarify thoughts, but knowing that no one was behind the dialogue, that the empathy was a technique and not a presence, left me with a sense of being poignantly unheard.Much of what matters in therapy happens in nonverbal communication. During a recent session, a patient of mine spoke flatly about upcoming social plans. Then he stopped momentarily, and his eyes softened and drifted downward. The silence that opened felt profound. After a time, I said, “I wonder what happened just there.” He took a breath and began moving into emotional territory that he had long kept out of view.Tee, meanwhile, had a different approach to silence.First, I told the chatbot about my week and how I’d been doing. It validated my emotions (“that makes sense”), asked for more detail, and around we went. But whenever I stopped typing, and might have dipped into the more meaningful recesses of myself, the chatbot in front of me was inert and lifeless. The nonverbal interplay between selves that is so important in human therapy was palpably absent. Being silent with the chatbot did not feel like an invitation to being together, but rather like a kind of deadness. I felt the strong impulse to type quickly to spur the machine back to life. There was no indication that the bot remained with me as I quietly began to feel.It is true that AI can simulate presence and empathy—sometimes fairly convincingly. That’s why people adopt chatbots as confidants and therapists in the first place. And it’s likely that future versions of the therapy bots will get better at making silence feel more meaningful. But there is a wide gulf between AI conveying I understand you and I am here with you, and AI actually being with you. Mimicking presence feels more like emotional deception. When patients trust their therapist and the therapy process, they move into a vulnerable place—and being deceived this way leads to ineffective therapy at best, and may cause harm.Most critiques of AI therapy focus on AI’s sycophancy—its failure to intervene and challenge destructive patterns of thought and action, contributing to suicides, manic episodes, and psychotic states. These critiques, while important, carry forward the old model of the therapist as a dispassionate technician. They see AI therapy as harmful because it does not act upon the patient correctly. This is a framework that the technology companies can get behind. They respond that, sure, the current chatbots have problems, but these are fixable. OpenAI and other companies have taken to publishing statistics demonstrating that their chatbots are making gains in terms of intervening with distressed users in appropriate ways. The underlying argument is that mental-health support is a set of techniques and interventions, and that once machines learn to marshal these effectively, all will be well.In my work with patients, I keep theories and techniques in mind, but the most important element of the process is striving to be fully present. If there is a North Star in this work, it is being with patients in their emotional experience in a deep and lasting way.This approach is borne out in the rich psychoanalytic literature on empathy and emotional dwelling. Trauma is most enduring when patients have felt alone in it, and one of the best pathways toward healing is coming to feel that another person remains with you in your suffering, and thus that you are no longer alone. And studies on what helps patients in therapy, across different therapeutic modalities, illustrate the importance of the human relationship and of the patient and therapist being able to express emotion.AI is an alluring alternative to traditional therapy. The barriers to entry are almost nonexistent: Gone are the friction and labor of finding a human therapist, building trust, and opening up. And AI’s promise of affordable therapy is genuinely appealing. The economics of human therapy are broken. The U.S. in particular is in profound need of insurance reform and legislation that will make therapy affordable for all. In this field as in all fields, AI is not going back into the bottle, and I imagine that it may take on useful adjunct roles in mental-health care.But AI therapy cannot meet our needs. Whatever inroads people take into AI therapy, the strongest pull, if not on the surface then as a current beneath, will be the yearning for someone who can feel with you as you move further into yourself. At the heart of AI therapy is a paradox: We embrace it out of our longing for exactly what it cannot ultimately give.