A Theoretical Framework of the Processes of Change in Psychotherapy Delivered by Artificial Agents

The question of whether artificial agents (e.g., chatbots and social robots) can replace human therapists has received notable attention following the recent launch of large language models. However, little is known about the processes of change in psychotherapy delivered by artificial agents. To facilitate hypothesis development and stimulate scientific debate, the present article offers the first theoretical framework of the processes of change in psychotherapy delivered by artificial agents. The theoretical framework rests upon a conceptual analysis of what active ingredients may be inherently linked to the presence of human therapists. 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. In the absence of the ontological and sociocultural status of human therapists, we propose what we coin the genuineness gap and credibility gap can emerge and undermine key processes of change in psychotherapy. Based on these propositions, we propose avenues for scientific investigations and practical applications aimed at leveraging the strengths of artificial agents and human therapists respectively. We also highlight the intricate agentic nature of artificial agents and discuss how this complicates endeavors to establish universally applicable propositions regarding the processes of change in these interventions.