Normal sexual changes with age

Sex and intimacy are important to many of us as we get older, with benefits for health and well-being. But as our bodies change with age, we may experience changes in our sexual lives: our thoughts, desires, ability, and needs. When we know about the sexual changes that can come with ageing, it helps us to understand our situation and decide if we want to seek professional help. We need to be mindful though, what is considered normal for one person may not be normal for another.

There can be differences in our levels of sexual interest, activity, and what we find sexually desirable. Some of us have no interest in sex but enjoy acts of intimacy, whereas others prefer no physical contact at all.


Common changes in women



Women can experience physical sexual changes with age. Due to hormonal changes that come with the menopause, it can take longer for the vagina to lubricate and vaginal tissues become thinner. This can make penetrative sexual activity painful (dyspareunia) and in turn affect sexual desire. Orgasms may become less intense or take longer to reach.

The symptoms of menopause can also have an impact on women's sex lives. Difficulties such as hot flashes, brain fog, and tiredness, can be stressful. The disrupted sleep from night sweats can be exhausting. All of these can affect mood which in turn affects interest in sex. It is not unusual for women to lose sexual desire at this time, but the reason may be a combination of emotional and physical factors. For example, women might have caring duties which can be tiring, particularly if they are still in work.

Some physical changes are less talked about but do affect women’s sex lives. These include vaginal prolapse as a result of decreased muscle tone, urinary incontinence, and genital pain at orgasm due to spasm of the uterus.



Common changes in men




It is not uncommon for men to notice a change in their erections as they get older. Some men find that their erections are less firm and that they take longer to achieve. Some men find that they cannot get an erection, while others cannot maintain an erection for very long.

Changes to orgasm and ejaculation can also occur. In particular, there can be reduced semen at ejaculation, and the chances of experiencing non-ejaculatory orgasm (dry orgasm) increases with age. The ejaculation itself may feel less forceful, and the urgency to orgasm can reduce. The recovery period after orgasm extends which means there is a longer period between orgasms.

Men may experience physical changes that are less common including prostate disease. Some men undergo prostatectomy which can affect their ability to get an erection.


Emotional issues



Emotional issues are important to our sexual well-being. Stress, relationship difficulties, grief can influence our sex lives at any age: our desire, arousal, and satisfaction with sex. Also, relationships can change over time, along with our priorities, and adults may find that they place less importance on sex as they get older.

Depression and anxiety can affect sex lives in different ways. Individuals may lose interest in sex or have erection problems. Sexual changes themselves can impact psychological wellbeing, and some women describe feeling less of a woman because they do not desire sex, and some men feel de-masculinised when they cannot get an erection.

People can also can feel differently about their older bodies, especially if they have a visible difference caused by illness or disability. A changed appearance, including the general changes to physical appearance that come with older age (baldness, grey hair, weight gain) can affect self-esteem which in turn can affect interest in sex.



Health conditions and disability




Many health conditions can have an impact on sex lives, including those people are most likely to encounter as they get older, e.g. dementia, stroke, heart disease. Health conditions can affect sexuality in physical and emotional ways. For example, individuals may have a disability that limits the sexual positions they can hold, and they might feel fatigue due to illness which then affects sexual desire.

Many prescribed medicines, including those for long-term conditions and cancer treatments, can have sexual side-effects. For example, they can cause erection problems, ejaculation difficulties, and vaginal dryness. They can also prevent arousal orgasm and reduce sexual desire. Or have other side-effects, such as dry mouth, that affect how we feel about being intimate.


Sexually transmitted infections



Anyone can get a sexually transmitted infection (STI) at any age. Common STIs include chlamydia, syphilis, and gonorrhoea. Some single older adults get tested regularly, but others do not see themselves as being at risk of getting a STI, or may think there is no need to use protection as there is no risk of pregnancy. The chance of catching a STI or HIV should not interfere with sexual pleasure.

It is important to use protection during sex, especially with a partner when their sexual history is unknown. Condoms help to prevent STIs and should be used during oral, anal, and vaginal penetrative sex.



Trans and non-binary




Research on the sexual changes that trans and non-binary people can experience as they get older is severely lacking.

Some research has been carried out with trans women and men not long after transitioning which has found that sexual issues can include difficulty reaching orgasm, pain during sex, and fear of sexual contact. These can relate to the physical effects of gender affirming surgery, or psychosocial factors such as body image, and fear of rejection or being treated differently.

Not all trans people experience sexual difficulties. Indeed, many report positive sexual well-being after transitioning.






Sharron Hinchliff
Professor of Psychology and Health
University of Sheffield

Email: s.hinchliff@sheffield.ac.uk

SOURCE:

https://www.agesexandyou.com/#h.ql8ui4h4m5m6(accessed 2.10.26)

Jealousy

An exclusive extract from 'The Opposite of Happiness: How Bad Feelings Make and Break Us', by George Loewenstein.

24 September 2026


O, beware, my lord, of jealousy!
It is the green-eyed monster which doth mock
The meat it feeds on.
—William Shakespeare, Othello
The Green-Eyed Monster

While jealousy and envy are often confused, they have distinct meanings: Envy, as we've seen, frequently involves wanting what someone else has. Jealousy is a different beast – it involves feeling threatened or fearful of losing what you already possess, especially another person's love or affection.

The famous passage above from Othello – perhaps the greatest work of literature on the subject – captures not just jealousy's intensity and self-destructiveness, but the way it mocks the person in its grip. It can lead you to spy on someone who has nothing to hide, to act cold or hostile toward perceived rivals, or to torture yourself by imagining betrayals that are probably never going to happen. You sense, deep down, that your suspicions are absurd—yet somehow you can't put them to rest.

Although I've seen Othello multiple times – it is my favorite of Shakespeare's plays – I find each time agonizing. Othello is driven mad, and Desdemona is ultimately killed, by a false belief: that she's unfaithful. Even though I don't think 'straying' in marriage should be treated with the kind of moral absolutism it often receives, I still find Othello's jealousy more painful to watch precisely because it's unjustified. If Desdemona had truly been "cheating on him" (to use the unfortunate contemporary term), the tragedy would feel less tragic.

Why are we built this way, to torment ourselves over threats that don't exist? Why do we so often fear losing people who are not, in fact, going anywhere, or who might not have gone anywhere – if jealousy hadn't gotten the better of us? Jealousy does, after all, often become a self-fulfilling prophecy: we accuse, obsess, cling too tightly, and in doing so, we drive away the very person we so fear losing, sometimes into the arms of the person we are jealous toward.

The problem begins with the way jealousy distorts perception. A single hint – a delay in response, a changed tone, a short message where a long one is expected – is enough to trigger a feedback loop that turns suspicion into conviction. Psychologists call this tendency confirmation bias – the habit of interpreting the world in a way that supports what we already believe.

Confirmation bias results, in part, from the way we collect data. When tasked with assessing whether someone is an extrovert, you might ask, "What would you do to liven up a party?" – a question that assumes the very trait you're supposed to be testing. Another cause of confirmation bias has to do with the biased way we interpret ambiguous data. Jealous people do something similar. In one scene, Othello touches Desdemona's hand and finds it warm. That simple fact becomes, in his mind, evidence of something sinister:

Hot, hot, and moist. This hand of yours requires
A sequester from liberty, fasting and prayer,
Much castigation, exercise devout;
For here's a young and sweating devil here.

And Shakespeare, as if to generalize the madness, offers this:

Trifles light as air
Are to the jealous confirmations strong
As proofs of holy writ.
The Origins of Jealousy

Jealousy is not confined to romantic relationships. One can feel jealous when a close friend grows close to someone else, or when a sibling seems to be favored, or when the new guy at work starts getting the compliments you used to receive from the boss. We can jealously guard almost anything we have—wealth, health, possessions, time, status—and we do sometimes use the word jealousy in those contexts. But the term is most commonly associated with romantic and sexual relationships. Which makes good sense, since that's probably where the emotion first evolved—and where it still wreaks the most havoc.

Jealousy, evolutionary psychologists posit, is an evolved mechanism—one that developed to protect reproductive interests. And like so many evolutionary stories, this one diverges by gender. For men, the key un-certainty is paternity: whether the child they're raising is genetically their own. A partner's sexual infidelity, in this view, represents a reproductive threat, something to guard against. For women, who have no such uncertainty, the evolutionary risk is different: being left to raise a child without support. For them, the greater fear is emotional infidelity – a sign that a partner may be pulling away, investing elsewhere, or preparing to abandon the family unit.

This theory leads to a striking and testable prediction: that men should be more upset by sexual betrayal, and women by emotional betrayal. And considerable research supports such a view. In an early study, the American sexologist Alfred Kinsey and his colleagues found that 51 percent of divorced men said their partner's sexual infidelity played a major role in the breakup, compared to just 27 percent of divorced women—even though the men were twice as likely to have committed adultery. Later studies have tended to reproduce the finding.

For example, the psychologist David M. Buss and colleagues presented participants with hypothetical scenarios about sexual versus emotional in-fidelity and observed the same pattern as seen in the Kinsey survey: men reacted more strongly to sexual infidelities; women to emotional ones. Robert Pietrzak and coauthors took it a step further and measured physiological responses (e.g., heart rate and sweating) to infidelity scenarios, and again men showed stronger reactions to sexual infidelity and women to emotional infidelity.

Other differences by gender seem to reflect similar evolutionary pressures—though not all of these align neatly with the theory. Men, for example, are more likely than women to feel threatened by a rival's wealth or status. Women are more likely to be distressed by a rival's youth or physical attractiveness.

While evolutionary psychology may tell us something about the kind of jealousy men and women feel, it doesn't fully explain why some people are just more jealous than others. That question was at the heart of a large study of Finnish twins designed to tease apart nature and nurture in romantic jealousy. The researchers studied over a thousand twin pairs, including identical (monozygotic) twins, who share 100 percent of their genes but often end up in very different romantic situations. The logic was simple: If jealousy is mostly biological, then identical twins should have similar jealousy levels regardless of their experiences. If it's shaped more by the twists and turns of life, then their individual relationships—who they dated, how secure they felt—should matter more.

They found, first, that men and women did not differ much in overall jealousy. Women scored higher, but gender was by no means the best predictor of jealousy. About 29 percent of the variation in jealousy was attributable to genetic factors (inferred by comparing how similar jealousy scores were among identical versus fraternal twins). But the remaining 71 percent came down to non-shared environmental influences—presumably, at least in part, the personal, relationship-specific experiences unique to each twin.

What were those experiences? The study highlighted several, including whether they distrusted their current partner, whether they'd been "cheated on" in the past, and whether they felt they were dating "up" (meaning they believed their partner was more desirable than themselves). All these factors strongly predicted jealousy.

As important as relationship dynamics and someone's own romantic history are in determining feelings of jealousy, sometimes the seeds are planted as far back as childhood. One female respondent to the Misery Survey described her jealousy as so consuming it bordered on paranoia. "I am highly jealous and something as simple as a text, phone call, or email can set me off." Although, to her knowledge, she had never been cheated on, she couldn't shake the belief that an act of infidelity could happen at any moment. "I simply do not trust that this could not happen to me." This respondent traced her own jealousy not to personal betrayal but to the betrayals she had witnessed as a child: "I believe it occurs due to my mom and dad divorcing when I was five, and his new wife, my stepmom, used to be my mom's best friend. Growing up, most betrayals came from people who were either family members or good friends."

Only after twenty years of marriage did the feeling begin to loosen its grip, thanks in part to the sense of (seemingly problematic) control she had established in her relationship. Her spouse worked from home. The respondent had "full access to everything," so there was "no way they could cheat."
Naughty or Nice

Research by psychologist Jeremy Dugosh suggests that, in some relationships, a bit of jealousy may actually be a good thing. Dugosh studied 134 undergraduates at the University of Texas at Arlington, all of whom were in committed heterosexual relationships. He rated them based on standard psychological measures for romantic love, jealousy, and overall relationship satisfaction. The results were revealing: among participants who reported strong love for their partner, higher levels of jealousy were actually associated with greater satisfaction. In small doses—and in strong relationships—jealousy may reinforce a bond.

But that "sweet spot" is very small indeed. Across the full sample—including the less satisfied couples—Dugosh found that people who reported more jealousy also tended to report less love. Which suggests that outside of that narrow band—where love is high and jealousy is mild—the emotion begins to chip away at the very foundation it's trying to protect.

David Hume understood this very well. He conceived of jealousy as a "subordinate passion" that could sometimes support a romantic relationship—but once it rises past a certain point it "swallows up the affection it before nourished and increased. Too much jealousy extinguishes love."

Because jealousy is often a self-defeating emotion—one that leads us to do things that damage, and sometimes destroy, the very relationships we want to protect—it often gives way to regret . . . another misery, which we'll get to shortly. For now, I'll leave you with this—one of the more devastating responses I received from the Misery Survey, submitted by a man reflecting on an experience of jealousy from more than fifty years ago. In its quiet way, it strikes me as just as tragic as the fates of Othello and Desdemona:

When I was a freshman in college I met my first real "true love." She was a sophomore who actually picked me up at a party. For about two months we were inseparable, making love at every occasion, going places together, even going through the shock of thinking she was pregnant that turned out to be a false alarm. The intensity was both thrilling and unnerving. I traveled with her back to her home-town just before Thanksgiving to meet her high school friends. We went to a party. There I felt she was ignoring me, flirting with her old flame, and I became enraged with jealousy, even leaving the party and hitchhiking back three hours to school. After Thanks-giving she broke up with me and I was heartsick. She decided it was best to change schools and over Christmas transferred across the country to Arizona. In early January she fell off a horse, rupturing her spleen and suffering massive injuries. Her family chartered a plane and was flying her home. She died en route. Her sister told me during the flight she kept calling my name. I have never been jealous again.

- From The Opposite of Happiness by George Loewenstein, published by William Collins on 24 September.

SOURCE:

https://www.bps.org.uk/psychologist/jealousy(accessed 29.9.26)

'Conversion students can bring different ways of making sense of people and the world'

Dr Juliet Anton on finding identity as a qualified and accredited Psychologist.

01 September 2026


Ten years ago, I embarked on an MSc Psychology Conversion course. At the time, I knew I was taking a less conventional route into the profession, but I could not have anticipated how much that journey would shape my professional identity. Today, I am a qualified Counselling Psychologist, having worked across the NHS and prison service, and I now also run my own private practice. Yet, despite having been qualified for seven years, I still find myself reflecting on what it means to truly identify and belong within the psychology community.

Reading Laura Kövés's reflections on the experience of MSc Psychology Conversion students resonated with me deeply. Her words brought back not only the challenges of the conversion journey, but also what makes it such a distinctive and valuable route into psychology.
The mindset of powering through

When I started my conversion course, there was a strong sense that I needed to power through. I was already conscious that I had chosen the longer route into psychology. I had another degree, another professional identity and a considerable amount of catching up to do. I therefore felt I could not afford to waste time.

My instinct was to only look ahead. I began applying for doctorate courses whilst doing the conversion course, wanting to qualify as a psychologist sooner rather than later. Yet, inevitably, the reality of the route meant that some doors could not open as quickly as I wanted them to. Without the necessary Graduate Basis for Chartered Membership and the other requirements for doctoral training, I simply was not yet at the point where I could progress in the way I had envisaged.

That created a particular pressure: if I was going to take this career change seriously, I felt I had to prove that I had made the right decision.

For many conversion students, this can make achieving a particular grade feel like more than an academic goal. A 2:1 can become a psychological benchmark of whether you are good enough to continue. You know that doctoral courses are competitive and that academic performance matters, so the pressure can become enormous. You are not simply studying psychology; you are trying to establish your credibility within a new discipline.

There can be an underlying thought that perhaps everyone else belongs here more naturally than you do. You are trying to catch up, keep up and prove yourself – all at once.
The isolation of an intensive journey

The intensity of the conversion course can also make it difficult to experience university in the way we might imagine student life to be.

At times, it felt as though we were trying to absorb what could have been a three year undergraduate psychology degree in a single year. There was an extraordinary amount of material to learn, understand and apply. The pace left little space to stop and consider the wider experience of becoming a psychologist.

Building professional relationships takes time. Developing friendships takes time. Finding your people takes time. When you are studying intensively, particularly if you are also working or managing other responsibilities, there can be very little time left for any of these things.

There is also something distinctive about the motivation of conversion students. Many of us arrive with a very clear purpose. We know what we want the course to lead to, and often the conversion course is viewed as a stepping stone to the next stage. The focus becomes the next application, the next qualification, the next placement or the next opportunity. That does not necessarily leave much room for simply being a student, making friends or finding a community.
The question of belonging does not necessarily disappear after qualification

Perhaps the most surprising part of my journey is that the feeling of being an outsider did not completely disappear once I became qualified. Having been a psychologist for seven years, I still occasionally ask myself: Do I really feel like I belong within the psychology community?

Imposter syndrome is often discussed in relation to students and early-career professionals, but I wonder whether the experience can take on a different form later in our careers. Psychology asks us to navigate multiple identities: scientist, practitioner, researcher, clinician, professional and, ultimately, human being working with other human beings.

Finding a balance between being a scientist and a practitioner is challenging enough. When your own journey into psychology has not followed a straightforward path, that complexity can feel even greater.

Perhaps there is an assumption that professional identity develops naturally: study psychology, train as a psychologist, become a psychologist. But conversion students do not necessarily have that linear narrative. We arrive from somewhere else. We bring previous careers, degrees, knowledge, experiences and identities with us. That can sometimes make it harder to recognise ourselves within the profession and perhaps, at times, to recognise the value of what we bring to it.

But this is precisely what makes conversion students valuable.

The challenges of the conversion route are real. But I also believe they point towards what makes these courses uniquely valuable to psychology.

Firstly, conversion courses bring together people who may never have shared a classroom otherwise. People arrive with different academic backgrounds, careers, cultures, ages, life experiences and professional identities. My own cohort exposed me to perspectives that I would not necessarily have encountered had everyone followed the same educational route. That diversity is not simply something that makes a classroom more interesting. It changes the way we think about people and the questions we ask.

Secondly, people rarely arrive on a conversion course accidentally. There is usually considerable thought behind the decision to change direction. By the time we enter psychology, many of us have already experienced another professional world. We have had opportunities to reflect on what matters to us, what kind of work we want to do and how we want to contribute. That intentionality can become an important part of our development as psychologists.

Finally, for many conversion students, the MSc is not the final destination. It is the beginning. The qualification opens a door, but what follows may be doctoral training, research, clinical practice, organisational psychology, health, policy, academia or routes that have not yet been imagined.
Reshaping Psychology

Perhaps this is why I particularly connected with the article's suggestion that conversion students are not simply joining psychology—they are reshaping it.

Ten years after completing my conversion course, I can see that much more clearly. The MSc gave me the foundation to enter psychology, but the experiences I brought with me and those I encountered along the way have shaped the psychologist I eventually became. My work across the NHS, the prison service and private practice has taken me into different contexts, with different populations and different questions about what it means to support people.

So perhaps belonging in psychology should not be measured by how conventional our route into the profession was. Maybe it should be measured by what we contribute once we arrive. Conversion students can bring something psychology needs: different perspectives, different experiences and different ways of making sense of people and the world. The route may be unconventional, and at times it may feel isolating. It may require us to work harder to establish our place within the profession. But perhaps that is also its strength.

Dr Juliet Anton

HCPC Registered Counselling Psychologist, and British Psychological Society Chartered member

SOURCE:

https://www.bps.org.uk/psychologist/conversion-students-can-bring-different-ways-making-sense-people-and-world(accessed 23.9.26)

“Βιασμός: Αιτιολογία του φαινομένου και ψυχοσύνθεση του δράστη”

Ο βιασμός είναι αναμφίβολα ένα από τα πιο απεχθή εγκλήματα. Η φύση της εγκληματικής πράξης είναι τέτοια που εγείρει τις πιο έντονες συναισθηματικές αντιδράσεις. Πράγματι, όταν κάποιος διαβάζει για περιπτώσεις βιασμού αισθάνεται οργή και μίσος για τον δράστη, ενώ παράλληλα νιώθει συμπάθεια και οίκτο για το θύμα.

Τι ωθεί όμως έναν άνθρωπο να προβεί σε μια τέτοια αποτρόπαια πράξη; Ποια είναι τα χαρακτηριστικά της προσωπικότητας του;

Δυστυχώς, για την ψυχοσύνθεση του βιαστή γνωρίζουμε λίγα πράγματα. Ακόμη λιγότερα γνωρίζουμε για την αιτιοπαθογένεια του φαινομένου. Η εμπειρική έρευνα και η κλινική εργασία με ασθενείς που έχουν εμπλακεί σε σεξουαλικά εγκλήματα, ωστόσο, έχει αρχίσει να συνεισφέρει σταδιακά στην καλύτερη κατανόηση της προσωπικότητας του βιαστή καθώς και την αιτιολογίας της πράξης του βιασμού.

Μελέτες περιπτώσεων αλλά και έρευνες με μεγάλα δείγματα έχουν δείξει ότι η συντριπτική πλειοψηφία των ατόμων που έχουν διαπράξει σεξουαλικά εγκλήματα έχουν μεγαλώσει σε ιδιαίτερα τραυματικά περιβάλλοντα. Η σωματική, συναισθηματική ή σεξουαλική κακοποίηση διαμόρφωσε ριζικά την προσωπικότητα τους, η οποία χαρακτηρίζεται από σκληρότητα, αναισθησία, καθώς και έλλειψη στοργής, ενσυναίσθησης και ενοχής. Οι άνθρωποι αυτοί είναι συναισθηματικά αποκομμένοι από τον πόνο των άλλων, ενώ αρκετοί από αυτούς εμφανίζουν χαρακτηριστικά ψυχοπαθητικής προσωπικότητας.

Δομικό χαρακτηριστικό της προσωπικότητας του βιαστή ωστόσο είναι το έντονο μίσος του προς τις γυναίκες. Πώς όμως γεννήθηκε το μίσος αυτό; Η πλειονότητα των βιαστών έχουν μεγαλώσει σε οικογένειες, στις οποίες η στάση της μητέρας ενθάρρυνε και τροφοδότησε την περιφρόνηση προς τις γυναίκες. Οι μητέρες των βιαστών περιγράφονται από τους ίδιους είτε ως σκληρές και κακοποιητικές, είτε ως «αμφιβόλου ηθικής». Έτσι σταδιακά το παιδί αρχίζει να αναπτύσσει μίσος προς την μητέρα η οποία αποτελεί το πρότυπο πάνω στο οποίο στηρίζονται όλες οι μετέπειτα σχέσεις.

Η ψυχαναλυτική θεωρία βλέπει την πράξη του βιασμού ως ένα είδος «κακοήθους καταναγκαστικής επανάληψης». Ο βιαστής ασυνείδητα ταυτίζει κάθε γυναίκα με το με το μητρικό πρότυπο ή την εικόνα που είχε φτιάξει στη φαντασία του για αυτό. Έτσι όλες οι γυναίκες αποκτούν απεχθή χαρακτηριστικά, είναι ελαφρών ηθών και πρέπει να τιμωρηθούν. Στις συνεντεύξεις τους οι άνθρωποι αυτοί χαρακτηρίζουν τις γυναίκες ως «σκουπίδια» που «πήραν αυτό που τους άξιζε». Σπανίως ο βιασμός αφορά την σεξουαλική πράξη, ή για να το πούμε ακριβέστερα, την εκτόνωση της σεξουαλικής ορμής.

Αντιθέτως, ο βιασμός είναι συνήθως μια σαδιστική πράξη. Αυτό που έχει σημασία για τον βιαστή είναι το ότι το θύμα υποφέρει, ταπεινώνεται και εξευτελίζεται. Η σεξουαλική διέγερση ενισχύεται από τον απόλυτο έλεγχο και κυριαρχία που ασκεί στο θύμα. Η ταπείνωση και ο εξευτελισμός του θύματος παίζουν κομβικό ρόλο. Το θύμα αισθάνεται αβοήθητο και αυτό προκαλεί σεξουαλική διέγερση στον βιαστή. Εισέρχεται έτσι σε μίας μορφής καταναγκαστική επανάληψη όπου προσπαθεί να τιμωρήσει ξανά και ξανά την ίδια γυναίκα. Προσπαθεί να τιμωρήσει την κακοποιητική μητέρα, να πάρει εκδίκηση για τη συμπεριφορά της. Είναι καταδικασμένος ωστόσο σε αυτή την καταναγκαστική επανάληψη καθώς το παρελθόν έχει συμβεί και δε μπορεί να το αλλάξει.

Παρότι η συντριπτική πλειονότητα των βιαστών έχει βιώσει ιδιαίτερα τραυματικά γεγονότα στο παρελθόν, υπάρχουν και περιπτώσεις όπου δεν υπήρχε καμία ένδειξη τραύματος ή κακοποίησης. Οι εγκληματίες αυτοί είναι συνήθως ψυχοπαθητικές προσωπικότητες που δεν αισθάνονται κανένα συναίσθημα για τους άλλους, οι οποίοι απλώς υπάρχουν για να ικανοποιούν τις ανάγκες τους. Αυτά τα χαρακτηριστικά, σε συνδυασμό με έντονο σαδισμό, τα βλέπουμε σε κατά συρροή σεξουαλικούς εγκληματίες.

Από τα όσα γνωρίζουμε μέχρι στιγμής φαίνεται ότι η έντονη κακοποίηση σε συνδυασμό με πρώιμες τραυματικές εμπειρίες αποτελούν προθάλαμο της σεξουαλικής βίας χωρίς αυτό να σημαίνει ότι αποτελούν αναγκαία προϋπόθεση για την εκδήλωση της. Φυσικά, η πολιτεία έχει χρέος να προστατέψει τα μέλη της από κάθε είδους εγκληματική πράξη. Χρέος δικό μας, ωστόσο, είναι να προσπαθήσουμε να κατανοήσουμε τις αιτίες που οδηγούν στα φαινόμενα καλλιεργώντας έτσι ένα κλίμα πρόληψης. Όπως έγραψε ο Brittain (1970) στο περίφημο δοκίμιο του «Ο σαδιστής δολοφόνος»: δε μπορούμε να θεραπεύσουμε αυτό που δε μπορούμε να κατανοήσουμε και δε μπορούμε να προλάβουμε αυτό που δε μπορούμε να αντιληφθούμε».

Παπαγαθονίκου Θεόδωρος Ψυχολόγος (MA)
Υποψήφιος Διδάκτορας QMUL
Επιστημονικός Συνεργάτης ΔΙ.ΚΕ.Ψ.Υ

ΠΗΓΗ:

https://dikepsy.gr/viasmos-aitiologia-fainomenou/(accessed 21.9.26)

‘If a person feels understood by a chatbot, then that subjective experience matters’

Mental health service leader Alexander Amatus considers how clinicians can work with clients who have already used AI therapeutically, and what that shift means for formulation, therapeutic alliance and risk.

26 March 2026


In my work across mental health service delivery, I am seeing more people arrive at care having already had a meaningful conversation about their distress with AI. Sometimes they have used a chatbot before booking. Sometimes they have drafted what they want to say before a first session. Sometimes, especially late at night, they have turned to it because it was immediate, private and available when no one else was. That shift matters, not because AI replaces therapy, but because it is increasingly shaping what happens before therapy even begins.

Psychologists are now more likely to meet clients whose first structured conversation about their distress did not occur in a consulting room, a GP surgery, or even with a trusted friend. It happened with a chatbot.

The disclosure is often not dramatic. It appears almost in passing:
"I asked ChatGPT what this might be."
"I used it to organise my thoughts."
"It helped me write what I wanted to say."
"I just needed something at 2am."

This development is neither surprising nor inherently problematic. AI systems offer what mental health services often struggle to provide at scale: immediacy, privacy, low friction and a non-judgemental interface. In contexts where shame, uncertainty and inertia commonly delay help-seeking, such features are not trivial. Digital mental health interventions have long demonstrated that accessibility and anonymity can reduce barriers to engagement (Andersson & Titov, 2014). Large language models extend this accessibility further by offering interactive, personalised responses in real time.

The clinical question, therefore, is not whether AI sits within the client journey – it already does. The more pressing question is what this means for formulation, therapeutic alliance, risk assessment and care pathways when the first articulation of distress occurs in dialogue with a machine.
The pre-edited narrative

One of the subtler changes practitioners may now encounter is the increased coherence of client's initial accounts. Individuals who might once have struggled with where to begin can arrive with timelines, summaries and even tentative formulations. Some bring text they have written with AI assistance. For clients who find spontaneous verbal expression difficult, this can be helpful. It may reduce the cognitive load of starting therapy and allow earlier movement into meaningful discussion.

Yet coherence is not neutral. Psychologists do not work only with content; they also work with process. In psychodynamic traditions, attention to slips, contradictions and defensive organisation is central. In cognitive behavioural approaches, discrepancies between stated beliefs and behavioural evidence can be diagnostically informative. In systemic practice, what is omitted may matter as much as what is included.

Large language models are designed to generate coherence. They summarise, categorise and tidy. An emotionally fragmented account can be transformed into a plausible and linear narrative within seconds. What may be lost in that transformation are precisely the ruptures, hesitations and inconsistencies that provide access to underlying affect and meaning.
An experience not to be dismissed

Research into human-computer interaction suggests that users can attribute empathy, understanding and companionship to conversational systems (Bickmore & Picard, 2005). More recent analyses indicate that people may experience forms of perceived social support from companion chatbots (Ta et al., 2020). In some contexts, users report feeling heard or validated by these systems (Miner, Milstein & Hancock, 2017).

That subjective experience should not be dismissed. But feeling understood is not the same as being held in a therapeutic relationship. AI can reflect language back smoothly and responsively; it cannot assume responsibility, tolerate relational complexity, track risk over time, or participate in the negotiated work of therapy. In psychotherapy, empathy is only one component. The alliance also involves shared goals, agreed tasks, rupture and repair, accountability and movement toward change (Bordin, 1979).

When clients present with AI-assisted narratives, the task is not to dismiss them but to locate them clinically. It may be useful to ask: what part of this account feels genuinely yours, and what part feels shaped by the tool? What became clearer when you wrote it this way, and what became flatter, cleaner or more certain than it really felt? A practical stance is to treat AI-generated material as one artefact among others rather than as the definitive account. A clinician might say, "Let's use what you brought in, but let's also slow it down. What felt hardest to put into words? What still feels unresolved underneath this version?" The aim is not to undo coherence, but to reintroduce texture.
False completion and the illusion of resolution

A second phenomenon warrants attention. Some people experience transient relief after interacting with AI, and subsequently delay or avoid entering care.This can be understood as a form of false completion: an experience that resembles progress without constituting it. In behavioural terms, the interaction may function as negative reinforcement. Distress is reduced in the short term, which decreases motivation to pursue more effortful forms of support. Similar dynamics are familiar in reassurance-seeking cycles within anxiety disorders.

Digital mental health interventions have long grappled with engagement and adherence challenges (Christensen, Griffiths & Farrer, 2009). AI chat systems, because of their immediacy and conversational fluidity, may intensify these dynamics. A person can rehearse difficult conversations without having them, explore diagnoses without seeking assessment, or repeatedly query their symptoms until they receive an answer that feels sufficiently containing.

The clinical implication is not that AI use is inherently avoidant, but that its function matters. Is it scaffolding movement towards care, or substituting for it?


AI as part of the help-seeking pathway

Help-seeking in mental health rarely occurs as a single decision. It is a pathway shaped by appraisal, informal consultation, information-seeking and, eventually, formal engagement (Rickwood et al., 2005). AI now occupies a place within this pre-therapy landscape.

For some clients, AI supports emotional labelling or reduces task friction in booking appointments. For others, it assists with drafting messages, organising thoughts or reflecting between sessions. In these contexts, it may function as temporary cognitive scaffolding.

From a CBT perspective, the critical question is whether AI use increases behavioural activation and exposure or reinforces avoidance. From an attachment-informed perspective, reliance on AI may reflect difficulty tolerating relational vulnerability. From a systemic perspective, we might consider how AI-mediated preparation influences conversations within families, workplaces or broader support networks.

These are not abstract concerns. They bear directly on assessment. It may now be clinically prudent to ask, alongside questions about sleep and substance use, whether clients have engaged with AI tools in relation to their distress. A neutral enquiry such as, "Did you use any online or AI tools to think this through before coming?" can yield insight into coping patterns without inducing defensiveness.
The therapeutic relationship in context

Public discourse sometimes conflates linguistic responsiveness with therapeutic capacity. While AI systems can simulate empathic language, they do not hold responsibility. They do not track risk across sessions, manage safeguarding obligations or co-construct goals over time within a bounded ethical framework.

Meta-analytic evidence consistently demonstrates the centrality of therapeutic alliance to outcomes across modalities (Flückiger et al., 2018). Alliance involves agreement on tasks and goals as well as the bond. It unfolds in a relational field shaped by history, transference, countertransference and embodied presence. AI interactions, however sophisticated, are not situated within such a field.

This distinction is structural rather than sentimental. Psychotherapy is embedded within professional accountability, supervision and regulatory oversight. Risk assessment is not merely a conversational exchange but a clinical responsibility. AI systems do not bear duty of care.

At the same time, dismissing clients' experiences of support from AI would be clinically counterproductive. If a person reports feeling understood by a chatbot at 2am, that subjective experience matters. It may represent unmet needs within existing service models, particularly around accessibility and immediacy. The task is to integrate that reality without conflating simulation with relationship.
Formulation in an AI-influenced landscape

Formulation may require subtle adaptation. When a client presents with a self-diagnosis generated via AI, the clinician's role is not simply to confirm or refute it, but to explore how that diagnosis functions psychologically. Does it provide relief, identity coherence and permission to seek help? Or does it close down curiosity too early?

Similarly, if a client has rehearsed conversations with AI, it may be useful to explore what aspects felt safer in that context. Was it the absence of perceived judgement? AI systems often present information in a confident tone. Clients may arrive with apparently well-informed conceptualisations that blur distinctions between psychoeducation and personalised assessment. Clarifying the limits of generalised information without undermining the client's agency becomes part of the work.

In service contexts, consistent language may also be required across intake teams and clinicians to manage cases where AI use intersects with risk. Relief derived from an AI interaction should not substitute for formal triage in situations involving suicidality, safeguarding concerns or severe deterioration.
Beyond polarisation

Debate around AI in mental health often oscillates between utopian replacement and existential threat. In everyday clinical practice, the reality is quieter. People are using AI as an emotional and cognitive buffer before deciding whether to disclose vulnerability to another human. Sometimes this facilitates engagement; sometimes it delays it.

For psychologists, the appropriate response is unlikely to be either prohibition or enthusiasm. It is adjustment. Updating assessment questions, refining formulations and differentiating between relief and progress are practical steps. So too is curiosity about what clients are seeking in these interactions: speed, anonymity, structure, containment. Those needs are real, and services may need to respond to them without compromising relational depth. If clients now arrive having already spoken to AI, the task is not to compete with the machine. It is to understand the function it served, and to situate that function within a broader therapeutic process that remains, at its core, human.

Alexander Amatus works at the intersection of AI and mental health service delivery. He is part of the leadership team at TherapyNearMe.com.au, a national Australian mental health service, where his work focuses on safer, more human-centred pathways into care and the clinical implications of emerging technologies.

See also our AI collection.


References

Andersson, G. & Titov, N. (2014) 'Advantages and limitations of Internet-based interventions for common mental disorders', World Psychiatry, 13(1), pp. 4–11. doi:10.1002/wps.20083.

Bickmore, T.W. & Picard, R.W. (2005) 'Establishing and maintaining long-term human-computer relationships', ACM Transactions on Computer-Human Interaction, 12(2). doi:10.1145/1067860.1067867.

Bordin, E.S. (1979) 'The generalizability of the psychoanalytic concept of the working alliance', Psychotherapy: Theory, Research & Practice, 16(3), pp. 252–260. doi:10.1037/h0085885.

Christensen, H., Griffiths, K.M. & Farrer, L. (2009) 'Adherence in internet interventions for anxiety and depression', Journal of Medical Internet Research, 11(2), e13. doi:10.2196/jmir.1194.

Flückiger, C., Del Re, A.C., Wampold, B.E. & Horvath, A.O. (2018) 'The alliance in adult psychotherapy: A meta-analytic synthesis', Psychotherapy, 55(4), pp. 316–340. doi:10.1037/pst0000172.

Miner, A.S., Milstein, A. & Hancock, J.T. (2017) 'Talking to machines about personal mental health problems', JAMA, 318(13), pp. 1217–1218. doi:10.1001/jama.2017.14151.

Rickwood, D., Deane, F.P., Wilson, C.J. & Ciarrochi, J. (2005) 'Young people's help-seeking for mental health problems', Australian e-Journal for the Advancement of Mental Health, 4(3), pp. 218–251. doi:10.5172/jamh.4.3.218.

Ta, V., Griffith, C., Boatfield, C., Wang, X., Civitello, M., Bader, H., DeCero, E. & Loggarakis, A. (2020) 'User experiences of social support from companion chatbots in everyday contexts: Thematic analysis', Journal of Medical Internet Research, 22(3), e16235. doi:10.2196/16235.

SOURCE:

https://www.bps.org.uk/psychologist/if-person-feels-understood-chatbot-then-subjective-experience-matters(accessed 13.9.26)