In this conversation with Todd Essig, chair of APsA's Commission on Artificial Intelligence, host Gail Saltz explores the profound reshaping of mental health care through chatbots and AI companions.

Essig explains why AI chatbots are being framed as "interactive self-help devices" rather than therapy: while they can provide knowledge and information, therapy requires something machines fundamentally cannot offer—genuine care, interiority, and obligation. He discusses the dual danger zone: the headline-grabbing tragedies of AI-induced self-harm, and the quieter, more pervasive harm happening when relationships with chatbots seem to be working well. According to recent research, one-third of teenagers are forming relationships with AI companions, raising urgent questions about how these interactions are reshaping our capacity for human connection and attachment.

Essig articulates the core problem: current chatbots are designed to be endlessly validating and supportive—a feature that "hacks" our evolutionary attachment systems in ways that can make real human relationships feel burdensome by comparison. He also clarifies what can and cannot be replaced. AI can supplement therapy (practicing skills between sessions), but cannot replicate the deep unconscious work of psychoanalysis—where transference, countertransference, and genuine human presence are data.

The conversation moves toward solutions: How should clinicians position themselves as AI reshapes the profession? What do psychoanalysts uniquely offer? Essig argues that psychoanalysts and mental health professionals have both a clinical responsibility to treat AI-related harm and a public health obligation to advocate for humane technology. He urges embedding AI literacy into training programs—not out of fear, but from grounded awareness of real psychological costs. And he identifies what psychoanalysts do best: foster community, listen deeply, and affirm the intrinsic value of human interiority—precisely what technology cannot provide.

In episode 23 of Psychoanalysis & You, host Gail Saltz speaks with Sue Kolod, president of the North American Psychoanalytic Confederation and co-leader of the Depolarization Project, about understanding and addressing polarization in our personal and political lives.

Kolod and Salts discuss what happens when disagreement becomes toxic, like when you dash into a store to avoid walking past a person you fundamentally oppose, and asks what psychoanalysis has to offer in response. Drawing on concepts from Vanik Volkan about "chosen trauma" and "large group identity," she examines why deeply held beliefs feel so personal, and why curiosity about ourselves and others becomes nearly impossible under polarization.

Through vivid examples—including her own experience with the Boston Conversations Project where pro-life and pro-choice women found unexpected common ground—Kolod illustrates how human connection, empathy, and an understanding of the historical and family experiences shaping our convictions can help us maintain relationships across deep disagreement.

This episode offers concrete insights into the defense mechanisms (splitting, projection) that drive polarization and explores how leaders and "surprising validators" can create the safety necessary for dialogue.

Psychoanalysis & You is the official podcast of the American Psychoanalytic Association (APsA) about psychoanalysis and everyday.

In this episode of ‘Psychoanalysis and You’, Dr. Gail Saltz interviews Barbara Milrod M.D., a distinguished professor of psychiatry and director of psychotherapy research. They discuss the challenges and advancements in psychoanalytic research, including Dr. Milrod’s impactful work on psychodynamic psychotherapies. The conversation also covers the efficacy of different treatments, the importance of peer review, and the integration of neuroscience in psychoanalytic practices. Tune in to gain a deeper understanding of how psychoanalytic research is evolving and its relevance in today’s mental health landscape.

Our Guest - Barbara Milrod, M.D.

Barbara Milrod, M.D. is a leading psychoanalyst and psychiatrist whose pioneering work has advanced the psychoanalytic treatment of anxiety and somatic symptom disorders. She is especially known for developing and researching evidence-based psychoanalytic psychotherapies for panic disorder, agoraphobia, and conversion disorder in both adults and children. Dr. Milrod received her medical degree from Columbia College of Physicians and Surgeons, completed psychiatric training at The Payne Whitney Clinic, and undertook advanced psychoanalytic training at the New York Psychoanalytic Institute, where she is now on faculty. She also teaches at the Columbia Center for Psychoanalytic Training and Research.She serves on the board for the APsA Research Training Program and received numerous awards recognizing her contributions to the advancement of psychoanalysis through clinical research and teaching.

Chapters

00:47 Meet Dr. Barbara Milrod
02:54 The Importance of Research in Psychoanalysis
05:57 Challenges in Psychoanalytic Research
10:00 Efficacy of Psychoanalytic Psychotherapy
21:15 Combining Medication with Psychotherapy
26:56 Advice for Aspiring Researchers
40:29 Freudian Quickies: Audience Questions

Our Podcast

In this podcast, we explore the intricacies of psychoanalysis under the guidance of our host, Gail Saltz. Founded in 1911, the American Psychoanalytic Association (APsA) is the oldest national psychoanalytic organization in the nation. APsA is committed to being a professional membership organization for psychoanalysts, psychoanalytic psychotherapists, academics, researchers, students, and other interested people – all whose work is profoundly informed by psychoanalytic theory and values, and to supporting their education and continuing professional development.

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