AI and the Future of Psychoanalysis: From the ‘Outsourced Ego’ to Reclaiming Humanity

ABSTRACT Introduction Anxiety is central to the psychotherapy process, yet psychotherapists routinely infer a client's anxiety intensity from observable behaviour rather than from formal measurement, with no widely accepted framework to organise which observable markers indicate which levels of anxiety. This exploratory study examined how therapists make such classifications. Method Ninety‐one mental health professionals were randomly assigned to classify 41 text‐described behavioural and physiological markers using either a 5‐level or a simplified 3‐level category system, both derived from an integrated model of state anxiety in psychotherapy. Results Response distributions departed significantly from uniformity for nearly all markers in both formats, and the rank ordering of markers by intensity was highly consistent across formats, suggesting that therapists may share broad intuitions about relative marker intensity. Which markers elicited agreement, however, was far less reproducible, depending substantially on the response format. Convergence also depended on where the agreement criterion was set, declining from 90.2% to 51.2% of markers in the 3‐level format and from 63.4% to 22.0% in the 5‐level format as the criterion rose from > 0.50 to > 0.70. The 3‐level format yielded more classifiable markers at every criterion, although this advantage was not consistent across indices, whereas the 5‐level format elicited fewer ‘Insufficient to Determine’ responses. Markers placed at the highest intensity levels were classified most consistently. Discussion These findings offer preliminary groundwork for research on marker operationalisation, contextualised rating tasks and the development of training materials for psychotherapy process research.

Abstract Background Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration ClinicalTrials.gov NCT05946382 registered July 14, 2023.

Psychotherapy is supported by evidence across several psychological conditions, yet its value cannot be understood solely through symptom change. This thematic integrative review examines psychotherapy as both an intervention and a relational setting in which psychological safety, trust, collaboration, and self-understanding may support change. Literature discussed in the source synopsis is organized around three themes: psychotherapy outcomes across mood, anxiety, trauma-related, and personality difficulties; the therapeutic alliance and safety; and adapted, neurodiversity-affirming support for autistic people. Meta-analytic and theoretical literature generally supports psychotherapy effectiveness, while alliance research identifies the therapeutic relationship as a robust correlate of outcomes. Work on autistic youth suggests that adapted interventions can be beneficial, although outcomes and methods vary. Across these areas, the review identifies a need to connect clinical outcomes with clients? lived experience of safety, identity, accessibility, and agency. The review is integrative rather than systematic: the source material does not document reproducible database searches, screening counts, or formal quality appraisal. Accordingly, conclusions are interpretive and should not be treated as a comprehensive estimate of treatment effects. The paper argues for therapeutic spaces that combine evidence-informed care with collaborative, individualized, and affirming relationships.

Anxiety symptoms can cause distress and interfere with social, occupational, and everyday functioning. Cognitive behavioural therapy (CBT) is a structured psychological intervention widely used in the treatment of anxiety disorders. This manuscript is based on the dissertation titled "A Study to Assess the Effectiveness of Cognitive Behavioural Therapy Among Patients with Severe Anxiety Disorder". The dissertation reports Beck Anxiety Inventory (BAI) results for 20 participants: 12 (60%) were in the minimal or "not at all" category, five (25%) in the mild category, two (10%) in the moderate category, and one (5%) in the severe category. These findings describe the anxiety-severity profile of the sample. The available results do not include verified pre-treatment and post-treatment scores, a comparison-group analysis, or inferential statistics sufficient to establish CBT effectiveness. The reported data therefore cannot demonstrate that CBT reduced anxiety in this sample. Findings should be interpreted cautiously because of the small sample and limited information about recruitment, participant characteristics, and intervention delivery.

Counselling researchers have spent decades arguing about why counselling works. One philosophical camp locates the active ingredient in specific techniques tied to specific disorders. The other locates it in factors common to all bona fide therapies, chiefly the relationship between counsellor and client. This article develops a process-based perspective on the debate, examining how relational and technical elements are used within an unfolding therapeutic interaction. Drawing on the equivalence findings, the contemporary alliance literature, the unresolved question of causal mediation, the routine outcome monitoring evidence, and Australian decolonising scholarship, I propose a culturally situated responsive calibration model. The model reframes the therapist’s continuous, feedback-informed adjustment of relational and technical elements, made within the client’s cultural frame of wellbeing, as a proposed proximal mechanism of change. Calibration is not a new observation about good practice. Building on established responsiveness theory, the proposed contribution is to organise testable episodes of clinical judgement around feedback, action, and the client’s definition of wellbeing. Four testable propositions are advanced, including tests of whether calibration adds explanatory value beyond established process and treatment measures. Implications for practice, training, and measurement are outlined. The model is offered as a conceptual framework awaiting empirical testing, not as an established finding.