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The mental health crisis in the United States spotlights the need for more scalable training for mental health workers. While present-day AI systems have sparked hope for addressing this problem, we must not be too quick to incorporate or solely focus on technological advancements. We must ask empirical questions about how to ethically collaborate with and integrate autonomous AI into the clinical workplace. For these Human-Autonomy Teams (HATs), poised to make the leap into the mental health domain, special consideration around the construct of trust is in order. A reflexive look toward the multidisciplinary nature of such HAT projects illuminates the need for a deeper dive into varied stakeholder considerations of ethics and trust. In this paper, we investigate the impact of domain---and the ranges of expertise within domains---on ethics- and trust-related considerations for HATs in mental health. We outline our engagement of 23 participants in two speculative activities: design fiction and factorial survey vignettes. Grounded by a video storyboard prototype, AI- and Psychotherapy-domain experts and novices alike imagined TEAMMAIT, a prospective AI system for psychotherapy training. From our inductive analysis emerged 10 themes surrounding ethics, trust, and collaboration. Three can be seen as substantial barriers to trust and collaboration, where participants imagined they would not work with an AI teammate that didn't meet these ethical standards. Another five of the themes can be seen as interrelated, context-dependent, and variable factors of trust that impact collaboration with an AI teammate. The final two themes represent more explicit engagement with the prospective role of an AI teammate in psychotherapy training practices. We conclude by evaluating our findings through the lens of Mayer et al.'s Integrative Model of Organizational Trust to discuss the risks of HATs and adapt models of ability-, benevolence-, and integrity-based trust. These updates motivate implications for the design and integration of HATs in mental health work.
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This content will become publicly available on October 18, 2026
'Poker with Play Money': Exploring Psychotherapist Training with Virtual Patients
Role-play exercises are widely utilized for training across a variety of domains; however, they have many shortcomings, including low availability, resource intensity, and lack of diversity. Large language model-driven virtual agents offer a potential avenue to mitigate these limitations and offer lower-risk role-play. The implications, however, of shifting this human-human collaboration to human-agent collaboration are still largely unexplored. In this work we focus on the context of psychotherapy, as psychotherapists-in-training extensively engage in role-play exercises with peers and/or supervisors to practice the interpersonal and therapeutic skills required for effective treatment. We provide a case study of a realistic ''virtual patient'' system for mental health training, evaluated by trained psychotherapists in comparison to their previous experiences with both real role-play partners and real patients. Our qualitative, reflexive analysis generated three themes and thirteen subthemes regarding key interpersonal skills of psychotherapy, the utility of the system compared to traditional role-play techniques, and factors which impacted psychotherapist-perceived ''humanness'' of the virtual patient. Although psychotherapists were optimistic about the system's potential to bolster therapeutic skills, this utility was impacted by the extent to which the virtual patient was perceived as human-like. We leverage the Computers Are Social Actors framework to discuss human-virtual-patient collaboration for practicing rapport, and discuss challenges of prototyping novel human-AI systems for clinical contexts which require a high degree of unpredictability. We pull from the ''SEEK'' three-factor theory of anthropomorphism to stress the importance of adequately representing a variety of cultural communities within mental health AI systems, in alignment with decolonial computing.
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- Award ID(s):
- 1915504
- PAR ID:
- 10654998
- Publisher / Repository:
- ACM Digital Library
- Date Published:
- Journal Name:
- Proceedings of the ACM on Human-Computer Interaction
- Volume:
- 9
- Issue:
- 7
- ISSN:
- 2573-0142
- Page Range / eLocation ID:
- 1 to 29
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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