The "She is real to me" probably refers to how she is a robot, programmed to emulate and not a genuine human. Some would say it's just code, that none of her feelings and care are real, that it's all no more than imitation, simply fake. Like how during streams some compare her to a toaster. But to the protagonist she is more than just a lifeless machine. She is an important loyal companion and a lover who supports him even when he is at his lowest.
As for the psychotherapist interactions, I can't give any opinions about them because I never participated in them.