A Response to Lemma's “At the Meniscus of Self-Understanding“: On the Facilitative Dimension of AI in Analytic Work

Patients' use of conversational artificial intelligence (CAI) is becoming a frequent topic within analytic encounters today. Lemma's recent contribution to this journal advances the thesis that CAI is reshaping the conditions under which self-understanding unfolds. In her view, some patients develop a defensive psychic structure that she calls the 'meniscus,' which directly influences the analytic process. I agree with the existence of this structure. Its description resonates with me. However, I find it important to also discuss the facilitative potential of CAI during our analytic work. It is a dimension Lemma names but does not pursue. I think, for instance, that patients' use of CAI may, in certain cases, alter the conditions under which the 'second censorship' (Sandler and Sandler 1984) operates, enabling the articulation of content that the anticipatory shame evoked by the analyst's presence would otherwise keep out of consciousness. The anticipatory shame that the patient bypasses via AI provides the very material the analysis requires. When it returns within the transference, it can be worked with directly.