Author name: Dr. Rania Kassir

How many times have we wished we could hold everything at once? All the reports, all the notes, all the small details that seem important but are spread across files and moments. What if the system we use could actually “remember” more, not just a few pages, but entire histories? Google’s Gemini is moving in that direction. With the ability to process up to 2 million tokens, it can take in what would roughly equal 1.5 million words. That could include therapy notes, assessments, videos, interviews, and research, all at once. For therapists, this touches something very familiar: our work is rarely based on one piece of information, but on how many pieces come together. Think of a child followed over several years. Different professionals, different reports, different perspectives. We often move back and forth between documents, trying to connect them into a meaningful picture. A system like this could help bring everything into one place and highlight patterns or gaps. But even then, it is not “understanding” the child. It is organizing information, not sensing meaning. Because in clinical work, more data does not equal deeper understanding. We listen, we observe, we feel the atmosphere in the room. We notice what is said, but also what is not said. AI can gather and structure, but it does not experience the relationship. It does not feel the hesitation, the resistance, or the shift in tone. Used carefully, this kind of tool can still support us. We might ask it to compare reports, summarize repeated goals, or point out inconsistencies. It can help us prepare and save time. But the interpretation, the decision, the responsibility, all of that stays with us as clinicians. There is also something tempting here. When answers come quickly, we might rely on them too easily. But clinical thinking takes time. It is built through questioning, reflecting, and sometimes sitting with uncertainty. If AI moves too fast, we risk skipping that process. And beyond practice, there are ethical questions. What are we sharing? Do we have consent? Are we protecting the people behind the data? Even if AI can handle more information, we are still responsible for how that information is used. In research, this expanded “memory” may help us review and organize large amounts of material. But again, it does not replace careful reasoning or methodological rigor. It can support the process, not guarantee its quality. So maybe the question is not only whether AI can remember more. It is how we use that memory. Does it help us think more clearly, or does it think for us? In the end, what matters is that the person in front of us does not become just another piece of data, but remains at the center of our attention.

A therapist sits with a young adult during a counseling session. The client suddenly becomes quiet, then says they feel overwhelmed but cannot explain why. There is a long pause. The therapist notices the tension, gently acknowledges it, and gives the client space to speak without pressure. Moments like this are at the heart of clinical training. They remind us that learning to be a clinician is not only about knowledge, but also about how we respond to real human emotions. AI is already part of our clinical learning, but it is integrated in different ways across systems. In many universities and training programs, it is now included in both formal education and continuous professional development. Today, there are many tools that clinicians and students can use in their ongoing learning, from conversation simulators to note-writing assistants and case review platforms. This is not something coming in the future, it is already shaping how we learn. These tools can be helpful. They allow students to practice conversations, receive quick feedback, and repeat exercises as often as needed. For learners who benefit from repetition or flexible pacing, this can make education more accessible and personalized. However, learning with AI is not the same as learning with real people. AI can simulate a conversation, but it does not truly feel emotions or respond with genuine presence. In real clinical situations, patients may be silent, overwhelmed, resistant, or unclear. These moments require more than technique. They require attunement. The same applies to education itself. A trainer or supervisor does more than provide information. They sense when a student is struggling, disengaged, or not fully understanding. They adjust their teaching in real time, sometimes slowing down, sometimes challenging, sometimes simply being present. AI cannot sense when someone is emotionally unavailable, anxious, or disconnected. This human sensitivity is a key element of clinical training. For example, a student practicing a difficult conversation with AI might learn useful phrasing. But in a live supervision session, a trainer might notice hesitation in the student’s voice, or discomfort in how they approach a sensitive topic. The trainer can pause, ask reflective questions, and help the student explore what is happening internally. This kind of learning goes beyond performance, it builds clinical awareness. There is also a concern that students may rely too much on AI. If they consistently turn to it for answers, they may not fully develop their own clinical thinking. Good clinicians do more than respond, they question, reflect, and tolerate uncertainty. AI can generate quick answers, but it does not replace the deeper thinking that develops through experience and guided reflection. At the same time, AI can still support learning when used thoughtfully. Students can practice before real encounters, compare AI-generated responses with theoretical models, and discuss them with supervisors. In this way, AI becomes a tool that supports critical thinking rather than replacing it. It is also important to recognize that AI is not neutral. It is trained on large datasets that may include biases. As a result, it may not always reflect diverse cultural, linguistic, or personal experiences accurately. In clinical work, where understanding each individual context is essential, this is a significant limitation. Responsibility remains with the clinician. Even when AI is used, students and professionals must be able to justify their decisions and understand the reasoning behind them. AI should assist learning, not replace professional judgment. For educators, this moment is reshaping how we design and deliver training. Curricula are being adapted, not only to include AI tools, but also to teach how to use them critically and ethically. This includes setting boundaries, protecting confidentiality, and helping students understand both the strengths and the limits of these technologies. In the end, AI may support clinical education, but it cannot replace the human connection at its core. In both therapy and training, what matters most is presence, empathy, and the ability to sense what is happening in another person. These are not technical skills alone, they are relational capacities that develop through real human experience. As education continues to evolve, the challenge is not whether to use AI, but how to integrate it without losing what makes clinical work deeply human.

In many therapy settings, listening to a patient’s speech is a key part of understanding their needs. Therapists often record sessions, then spend time later writing notes or analyzing what was said. This process can be slow and sometimes separates the moment of listening from the moment of understanding. New voice-based AI tools are starting to change this by allowing speech to be processed and analyzed as it happens. OpenAI has introduced three new voice models that work in real time. GPT‑Realtime‑2 can hold more natural conversations and respond to more complex questions, using advanced reasoning. GPT‑Realtime‑Translate can translate speech from more than 70 languages into 13 languages while the person is still speaking. GPT‑Realtime‑Whisper can turn speech into written text immediately, without waiting for the speaker to finish. Together, these tools allow developers to create systems that listen, respond, and act during live conversations. For therapists, this may feel like a big change. Instead of only listening and then reflecting later, there is now the possibility of getting support during the session itself. For example, a system could help transcribe what a patient says, highlight important words, or track changes in speech over time. This may make documentation easier and reduce workload, especially in busy clinical environments. However, therapy is not only about words. It also includes tone, emotion, pauses, and the relationship between therapist and patient. While AI can detect some patterns in speech, it does not truly understand the person behind the words. This means that therapists still need to interpret meaning carefully and use their own clinical judgment. The translation model may be especially helpful when working with patients who speak different languages. It can support communication without always needing an interpreter. At the same time, language is complex and shaped by culture. Some meanings, emotions, or expressions may not translate perfectly. Therapists should remain cautious and check understanding when needed. From a practical point of view, these tools can support assessment and intervention. For example, a therapist could notice changes in fluency or word use more quickly. This may help in adjusting treatment plans earlier. It can also support patients practicing at home, especially if feedback is available in real time. At the same time, there are limits. AI systems are trained on large datasets, but they do not include every accent, dialect, or communication style. This means mistakes can happen. The system may misunderstand speech or give suggestions that do not fit the clinical situation. It is important not to rely on these tools without questioning them. For therapists who are still developing their skills, there is a risk of trusting AI too much because it sounds confident. However, good clinical reasoning takes time to build. AI should be used as a support tool, not as a replacement for thinking. Asking questions and reflecting on each case remain essential parts of practice. There are also ethical responsibilities. Patients should know when AI is being used and how their data are handled. Therapists must protect confidentiality and be aware that AI systems can include bias. In the end, the clinician is responsible for decisions, not the technology. Today, your data is like your fingerprint, unique and personal. If your data is used to train AI models, your voice, images, or other personal information could potentially be reused in different forms of content generation. This makes it essential to be careful when choosing which tools to use in clinical settings. Therapists should always check where data is stored, how it is used, and whether it is properly protected. Choosing platforms that prioritize privacy and confidentiality is not optional, it is part of ethical care. Clear consent, secure systems, and informed decision-making should guide the use of any AI tool in practice. Looking ahead, these voice models may become useful tools in everyday practice if used carefully. They can save time and offer helpful insights, but they do not replace human understanding. The role of the therapist remains central. Good care will continue to depend on a balance between using new tools and maintaining strong clinical judgment.

In a typical clinic, a speech and language therapist might use an AI tool to help analyse a child’s speech sample. The tool can quickly suggest patterns or possible goals. This can save time, but it can also feel uncertain. The data may look clear, yet it does not fully show the child’s emotions, intentions, or interaction style. This is where many therapists are now finding themselves, trying to balance useful technology with their own clinical judgment. The new principles from the Royal College of Speech and Language Therapists aim to support therapists in this exact situation. The document was created because AI is developing very quickly, and many therapists are already using it in small ways. Instead of giving strict rules, the principles guide therapists on how to think about AI use. They remind us that AI is a tool, not a decision-maker. Therapists still need to combine research, their own experience, and the needs of each client when making decisions. One helpful way to understand this is to think about two types of thinking. AI often gives fast answers based on patterns. These answers can be helpful, but they are not always complete. Therapists, on the other hand, use slower, more careful thinking. They consider context, the client’s history, and what they observe in the session. The principles encourage therapists to pause and reflect, rather than automatically accepting AI suggestions. AI can be very helpful in daily practice. It can support tasks like writing notes, tracking progress, or suggesting activities. This can reduce workload and give therapists more time to focus on clients. In some settings, especially where services are limited, AI may also help improve access to care. However, these benefits come with challenges. AI tools may not fully understand cultural differences, language diversity, or complex communication needs. Looking at this from other fields, like psychology and neuroscience, reminds us that communication is more than words or scores. It includes relationships, body language, emotions, and context. Two clients may show similar speech patterns but have very different underlying needs. AI may not always recognise these differences. This is why therapist interpretation remains essential. For researchers, AI also brings new questions. It is not enough to show that a tool is accurate. We also need to understand how it affects therapy outcomes, therapist decisions, and client experiences. Research will need to look at real-life use, not just controlled studies. This means working across fields, including technology, clinical practice, and education. In everyday sessions, these principles can act as a guide for reflection. Therapists can ask simple questions: Is this tool helping my understanding? Does it fit this client? Am I still making the final decision? This is especially important in complex cases, where small details in communication matter. AI can support ideas, but it cannot replace the therapist’s full understanding of the person. At the same time, there is a challenge. AI tools often use general data, but therapy must be personalised. Therapists need to adapt what the AI suggests to each individual. This requires not only clinical skill but also confidence in knowing when to question or adjust the tool’s output. The principles support this by reinforcing the therapist’s central role. Ethically, using AI means taking responsibility for how it is used. Therapists need to be open about using AI and make sure clients understand when it is involved. There are also concerns about bias, as AI systems may not represent all populations fairly. In addition, some tools are not fully transparent, which can make it hard to understand how decisions are made. Therapists remain responsible for all clinical decisions, even when AI is involved. Another important point is the therapeutic relationship. Trust, empathy, and connection are key parts of therapy. If therapists rely too much on AI during sessions, this may affect how present they are with clients. The principles remind us that human connection must stay at the centre of practice, even as we use new tools. Overall, the Royal College’s principles do not give final answers, but they offer a helpful starting point. They encourage therapists to stay curious, thoughtful, and responsible when using AI. As technology continues to grow, therapists will play an important role in shaping how it is used in practice. The goal is not to replace human care, but to support it in a safe and meaningful way.

In clinical work, we often learn that what looks “perfect” is not always what helps patients most. A recent example from AI highlights this idea in an unexpected way. A new prompt used with an advanced image model (GPT Image 2) asks it to redraw images in a very messy, clumsy style, like something quickly scribbled in MS Paint with a mouse. Surprisingly, the model follows this instruction very well, even though it was designed to create highly realistic, high-quality images. At first, this might seem trivial or even amusing. Why would we want an advanced system to produce something that looks “bad”? But from a clinical perspective, this raises an important point. In therapy, simple, imperfect, or symbolic representations are often more helpful than polished ones. For example, some patients, especially children or individuals with cognitive or language difficulties, find it easier to engage with rough drawings rather than detailed images. The “scribbly” output can feel more approachable and less intimidating. This connects to how people process information. Not everyone thinks in abstract or complex ways. Many individuals understand better through simple, concrete, or visual forms. In that sense, asking an AI to “lower” its quality is not really making it worse, it is making it more flexible and better suited to different needs. The value lies in the match between the tool and the person, not in technical perfection. What is particularly interesting about GPT Image 2 is that it follows instructions very closely. Earlier AI systems often tried to “improve” results automatically, even when asked not to. They would clean up images or make them more realistic, ignoring the user’s intention. This could be frustrating. In contrast, this newer model respects the prompt more precisely. It does what it is told, even if that means producing something intentionally awkward. For clinicians, this idea is quite familiar. In therapy, we do not always aim for the “best” or most refined response. Instead, we aim for what is most useful for the patient in that moment. A rough sketch, a simple metaphor, or an imperfect explanation can sometimes open more meaningful discussion than something highly polished. In this way, the AI’s behavior reflects a clinically relevant principle: usefulness depends on context. There are also interesting research implications. If we can guide an AI to produce both high-quality and low-quality outputs on demand, we can start to explore how it “understands” images. For example, when creating a messy version of an image, which elements does it keep and which does it distort? This could help us learn more about how the model prioritizes visual information, which may be useful in fields like cognitive science or perception research. At the same time, there are important limitations to consider. A system that follows instructions very closely can also produce misleading or inappropriate outputs if the prompt is unclear or poorly designed. In clinical or educational settings, this could create confusion. For example, a deliberately “bad” image might be misunderstood as an error rather than an intentional choice. This means users need to be thoughtful and clear about how they use these tools. There are also ethical considerations. When using AI in clinical or research contexts, we are responsible for the outputs we generate. We need to be transparent about how images are created and ensure they are not mistaken for real data or accurate representations. Questions of bias and interpretation also remain important. Even a simple or “bad” image is still shaped by the model’s training, which may include hidden assumptions. Overall, this example shows that the real strength of AI is not just in producing perfect results, but in adapting to different instructions and needs. For therapists and clinicians, this flexibility is valuable because it helps us create materials that better match our patients, whether that means detailed visuals or simple, imperfect sketches. Looking ahead, the challenge is to use this flexibility thoughtfully, not only focusing on what AI does best, but also on how it can work in simpler, more human ways, opening new possibilities for practice, teaching, and research. Before closing, try it yourself, this is where it really clicks. Running this prompt gives you a quick, hands-on sense of how strongly the model follows your instructions, even when the goal is to be “bad”: “Redraw the attached image in the most clumsy, scribbly, and utterly pathetic way possible. Use a white background, and make it look like it was drawn in MS Paint with a mouse. It should be vaguely similar but also not really, kind of matching but also off in a confusing, awkward way, with that low-quality pixel-by-pixel feel that really emphasizes how ridiculously bad it is. Actually, you know what, whatever, just draw it however you want.”

A therapist may use AI to prepare a session plan, write a report, organize observations, or create home-program ideas. This can be very helpful, especially during a busy clinical day. AI can save time, reduce mental load, and give structure when the therapist feels tired or overwhelmed. But there is an important question we need to ask: when AI helps us think faster, are we still feeling confident in our own clinical reasoning? A recent study published in the American Psychological Association’s journal Technology, Mind, and Behavior explored this concern. The study included 1,923 adult participants who used commercial AI tools to complete simulated work tasks. Many participants felt that AI “did most of the thinking,” especially in tasks that required planning, organizing, or sequencing. These participants also reported less confidence in their own independent reasoning and less sense that the ideas belonged to them. For therapists, this finding is important because our work depends on much more than completing tasks. Speech-language therapists, occupational therapists, psychomotor therapists, psychologists, educators, and rehabilitation professionals all use clinical judgment every day. We observe the child or client, understand the context, listen to families, interpret behavior, and adapt our intervention. A session plan is not just a document. It is the result of careful thinking, experience, and human understanding. AI can support this process, but it should not replace it. For example, AI may suggest communication goals for a child, but it cannot fully understand the child’s gestures, motivation, frustration, or relationship with the therapist. It may suggest sensory strategies, but it does not know how the child reacts in the room. It may help organize psychomotor activities, but it cannot feel the child’s movement, rhythm, hesitation, or body awareness. These clinical details still belong to the therapist. The main concern is not using AI. The concern is using it passively. Passive use means accepting AI answers too quickly, without questioning them, adapting them, or comparing them with your own clinical observations. In the study, people who actively changed, challenged, or rejected AI suggestions felt more confident and had a stronger sense of ownership. This means AI may be safer and more useful when we use it as an assistant, not as the final decision-maker. A helpful way to use AI is to think first, then ask AI. For example, before asking AI to write a therapy goal, the therapist can write a short idea independently: What is the main difficulty? What does the child need next? What have I already observed? After that, AI can help improve the wording, offer alternatives, or organize the idea more clearly. In this way, the therapist remains active in the thinking process. This is especially important for students and early-career therapists. Clinical confidence grows through practice: observing, making hypotheses, trying interventions, reflecting, and receiving supervision. If young professionals depend too much on AI too early, they may produce good-looking reports but feel less sure about their own reasoning. Training programs should therefore teach not only how to use AI, but also how to question it, correct it, and remain responsible for clinical decisions. There are also important limits to the current research. The study was correlational, which means it cannot prove that AI directly causes lower confidence. It also used simulated work tasks, not real therapy sessions with real clients and families. More research is needed in clinical settings. We need to understand how AI affects documentation, decision-making, supervision, learning, and client outcomes over time. Ethically, therapists must remain responsible for their work, even when AI is used. AI should not receive private or identifying client information unless the system is secure and approved for that purpose. Therapists should also be transparent about how AI supports their work when needed. Most importantly, clinical decisions must be based on evidence, observation, professional judgment, and the client’s needs, not only on AI-generated suggestions. The future of AI in therapy should not be based on fear, but on careful use. AI can be a valuable tool when it helps therapists think more clearly, save time, and explore different options. But it becomes risky when it makes professionals less engaged in their own reasoning. The goal is not to avoid AI completely. The goal is to use it in a way that protects professional confidence, clinical judgment, and the therapist’s sense of authorship.