June 6, 2025

⁂ Psyche as Open World Game

⁂ Why AI Therapy’s Infinite Conversations May Be Missing the Point

As a technophile with 30 years of clinical practice, I’m genuinely excited about AI’s potential in mental health. I’ve helped clients explore ChatGPT-enhanced therapy and seen real breakthroughs.

But I’m also increasingly concerned we’re missing something fundamental about what makes therapy actually work.

⁂ The “Open World” Problem

Think of modern video games: linear games guide you through structured challenges with clear objectives and satisfying completion. Open world games offer infinite exploration, endless side quests, and no real ending.

AI therapy resembles that open world experience—infinite psychological territories to explore, endless conversations to have, countless emotional rabbit holes to dive into, with no clear path toward resolution or growth.

For some clients, this feels liberating. “I can explore anything, anytime!” But for many others, it becomes overwhelming and counterproductive—like wandering aimlessly in a vast digital landscape without map, compass, or destination.

I’ve watched clients:

→ Spend hours in circular conversations seeking reassurance that never satisfies

→ Explore trauma without structure, integration time, or therapeutic pacing

→ Become dependent on endless validation that bypasses developing internal resources

→ Get lost in psychological “side quests” that feel important but lead nowhere

The human psyche as an open world game can be paralyzing rather than healing.

Just as some gamers report feeling overwhelmed and directionless in open world games, clients often describe feeling “lost” in unlimited AI conversations. The very freedom that seems appealing becomes a source of anxiety and confusion.

⁂ What Traditional Therapy Gets Right: The Power of Linear Progression

Psychodynamic theory teaches us that the therapeutic frame—those careful boundaries of time, space, and relationship—creates what’s essentially a “linear game” experience.

It’s structured progression toward clear therapeutic objectives.

Like a well-designed linear game, traditional therapy has:

→ Clear levels (treatment phases)

→ Specific challenges to master (therapeutic goals)

→ Built-in pacing (weekly sessions with integration time)

→ Satisfying completion states (symptom resolution, insight, behavior change)

The 50-minute hour forces integration—like a game checkpoint where you must process what you’ve learned before moving forward. Scheduled gaps between sessions require clients to “play” in the real world, testing new skills and developing internal resources.

When someone with anxiety can access AI reassurance at 3 AM, we’ve essentially given them cheat codes that bypass the level progression. Are we providing support or enabling avoidance of the very challenges that build psychological resilience?

⁂ My Clinical Experience with AI Integration

Working with appropriate clients on AI-enhanced therapy has taught me several things:

It’s not all smooth sailing. Clients often become overwhelmed by AI’s infinite availability, reporting feeling “addicted” to asking for help.

Clinical management is essential. Left unstructured, AI conversations can reinforce problematic patterns rather than challenging them.

Integration requires human guidance. Clients need help processing AI interactions and maintaining appropriate boundaries.

⁂ Practical Guidelines for Clinicians

For therapists considering AI integration:

✓ Establish clear boundaries upfront - Discuss when AI use helps vs. interferes with therapy goals

✓ Review AI interactions in session - Use these conversations as material for therapeutic exploration

✓ Focus on integration, not endless exploration - Help clients recognize productive vs. circular conversations

✓ Maintain the therapeutic frame - AI should supplement, not replace, boundaried therapeutic relationships

✓ Monitor for dependency patterns - Watch for compulsive validation-seeking behaviors

⁂ A Structured Alternative: Interactive Therapeutic Stories

In response to these concerns, I’ve been developing interactive stories using Ink script by Inkle, with a light infusion of AI API integration. These create what I call “guided open world” experiences—offering meaningful choices and personalization while maintaining therapeutic structure.

Unlike unlimited AI conversations, these interactive stories:

→ Have clear beginnings, middles, and endings

→ Offer curated choices that lead to therapeutically meaningful outcomes

→ Include built-in reflection points and integration time

→ Use AI enhancement sparingly—for personalization, not endless generation

→ Maintain the “linear progression” benefits while honoring client agency

This approach contains the “open world” risks while preserving what makes both therapy and interactive media effective: structured choice within meaningful boundaries.

⁂ The Both/And Approach

I’m not anti-AI in therapy. I’ve seen it help clients articulate thoughts, explore perspectives, and access crisis support.

But I am concerned about replacing essential therapeutic structure with infinite, boundary-less conversation.

Perhaps the future of digital mental health isn’t about making AI more human, but about creating digital tools that understand what makes therapy actually work: structured progression, appropriate challenge levels, built-in integration time, and clear completion states.

The therapeutic frame isn’t a limitation—it’s the game design that makes psychological growth possible.

What’s your experience with AI in therapeutic contexts? Are we gaining more than we’re losing when we remove the traditional boundaries that have guided effective therapy for decades?

Note: I used Claude AI to help structure and refine this piece, but the thoughts, opinions, outline, and final editing are mine. My writing process itself reflects my attempt to form a thoughtful partnership with AI—leveraging its capabilities while maintaining human judgment, boundaries, and clinical wisdom.

#MentalHealth #AI #Therapy #DigitalHealth #Psychology #ClinicalPractice