Computational and ethical considerations for using large language models in psychotherapy

Large language models (LLMs) hold great potential for augmenting psychotherapy by enhancing accessibility, personalization and engagement. However, a systematic understanding of the roles that LLMs can play in psychotherapy remains underexplored. In this Perspective, we propose a taxonomy of LLM roles in psychotherapy that delineates six specific roles of LLMs across two key dimensions: artificial intelligence autonomy and emotional engagement. We discuss key computational and ethical challenges, such as emotion recognition, memory retention, privacy and emotional dependency, and offer recommendations to address these challenges. Large language models (LLMs) offer promising ways to enhance psychotherapy through greater accessibility, personalization and engagement. This Perspective introduces a typology that categorizes the roles of LLMs in psychotherapy along two critical dimensions: autonomy and emotional engagement.