A theoretical framework of the processes of change in mental health interventions delivered by artificial therapists

The question of whether artificial therapists (i.e., conversational agents such as chatbots and digital avatars tasked with delivering psychotherapeutic interventions) can replace human therapists has received notable attention following the recent launch of large language models. However, little is known about the clinical change processes associated with artificial therapists. To facilitate hypothesis-development and stimulate scientific debate, the present article offers a theoretical framework of the processes of change in mental health interventions delivered by artificial therapists. The theoretical framework rests upon a conceptual analysis of what active ingredients may be inherently linked to the presence of human psychotherapists. We propose that human therapists’ ontological status as human beings and sociocultural status as socially sanctioned healthcare professionals play crucial roles in promoting treatment outcomes. We introduce the concepts of the genuineness gap and credibility gap to anticipate how the absence of human therapists’ ontological and sociocultural status may influence psychotherapeutic change processes. Based on these propositions, we propose avenues for scientific investigations and practical applications of artificial therapists. We also highlight the intricate agentic nature of artificial therapists and discuss how this complicates endeavors to establish universally applicable propositions regarding clinical change processes.