Ethical Guidelines and Stakeholder Perspectives on the Use of Conversational AI in Psychotherapy - A Scoping Review

Abstract

The global burden of mental health disorders has created considerable demand for mental health professionals and long waiting periods for affected individuals. Due to advancements in generative Artificial Intelligence (AI) in recent years, it is now considered capable of simulating meaningful social interaction. Hence, a growing amount of research has investigated the use of conversational AI in the area of mental health to complement the work of therapists and increase access to care. To mitigate the risks that come with using AI in psychotherapy, a broad variety of ethical considerations from different fields have been introduced; however, stakeholder perspectives regarding this development still remain under-researched. Therefore, we first break down broad theoretical and empirical research to facilitate ethical design for developers and identify six overarching ethical principles: Beneficence, Risk and Harm Avoidance, Data Autonomy, Fairness, Involvement, and Responsibility. Second, we review 74 papers (2018-2025) discussing the evaluation of stakeholder perspectives in the current literature. Lastly, we merge our findings and provide stakeholder-focused implications for the human-centered ethical development of AI in psychotherapy.