{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:02:20Z","timestamp":1790787740612,"version":"4.1.0"},"reference-count":35,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR AI"],"abstract":"<jats:p>AI is already in the mental health consulting room, whether clinicians invite it or not. OpenAI reports more than 800 million regular users of ChatGPT and more than 40 million people turning to the platform daily for health questions, yet the evidence remains limited on the clinical efficacy of large language model\u2013based mental health chatbots. Professional guidance and regulation remain fragmented. Clinicians are therefore practicing in a gap between a patient reality that cannot be ignored and a professional infrastructure not yet built. We argue that neither enthusiastic adoption nor principled abstention is sufficient in the current environment. The clinician who refuses to discuss clinically material patient AI use is not preventing that use; they may lose visibility into a factor materially affecting the therapeutic process. The clinician who adopts AI without structured evaluation exposes patients and practice to avoidable harm. The stance we propose is structured harm reduction within the therapeutic relationship: inviting discussion at intake, integrating material use into case formulation, discussing benefits and limits, establishing crisis boundaries, monitoring throughout treatment, and addressing termination planning. Clinician-initiated use is a separate choice requiring evidence, consent when applicable, privacy safeguards, and accountability. We propose a phased clinical framework spanning preintake to termination anchored by the gather, understand, inform, document, and evaluate (GUIDE) mnemonic as an operational wrapper for daily practice. GUIDE and the phased framework are conceptual, unvalidated proposals. We distinguish ethical recommendations, established legal duties, and predicted standards; scope the legal discussion to the United States; integrate equity and subgroup performance; and offer proportionate implementation. The patients who seek care in an AI-saturated world deserve professional infrastructure capable of holding innovation and patient protection in informed balance.<\/jats:p>","DOI":"10.2196\/101942","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:30:06Z","timestamp":1789057806000},"page":"e101942","source":"Crossref","is-referenced-by-count":0,"title":["Navigating AI in Mental Health Care and Psychotherapy: Proposing the GUIDE Framework"],"prefix":"10.2196","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6498-9529","authenticated-orcid":false,"given":"Grant H","family":"Brenner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3769-5323","authenticated-orcid":false,"given":"Timothy","family":"Gutwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4824-1827","authenticated-orcid":false,"given":"Jacqueline","family":"Ourman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2312-309X","authenticated-orcid":false,"given":"Rachel","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","unstructured":"AI as a healthcare ally: how Americans are navigating the system with ChatGPTOpenAI20262026-08-08https:\/\/cdn.openai.com\/pdf\/2cb29276-68cd-4ec6-a5f4-c01c5e7a36e9\/OpenAI-AI-as-a-Healthcare-Ally-Jan-2026.pdf"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.2196\/54781"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21352"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.04.057"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1080\/10503307.2026.2615388"},{"key":"ref6","unstructured":"Ethical guidance for AI in the professional practice of health service psychologyAmerican Psychological Association2025072026-08-08https:\/\/www.apa.org\/topics\/artificial-intelligence-machine-learning\/ethical-guidance-professional-practice.pdf"},{"key":"ref7","unstructured":"The app evaluation modelAmerican Psychiatric Association2026-08-08https:\/\/www.psychiatry.org\/psychiatrists\/practice\/mental-health-apps\/the-app-evaluation-model"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.2196\/80739"},{"key":"ref9","unstructured":"Wellness and Oversight for Psychological Resources Act, Public Act 104-0054, 104th General Assembly (Ill 2025)2026-08-08https:\/\/www.ilga.gov\/legislation\/PublicActs\/View\/104-0054"},{"key":"ref10","unstructured":"New Mexico Register \/ Volume XXXVI, Issue 22 \/ November 18, 2025New Mexico Register2026-08-08https:\/\/prod-rf-lambda.rtssaas.com\/PublicFiles\/d89c47bd0d70402dba89b03a22bda6d1\/fbd4065b-5220-4331-a62c-3f5634396333\/16.27.18amend.pdf"},{"key":"ref11","unstructured":"Best practices for the use of artificial intelligence by mental health therapistsUtah Department of Commerce2025042026-08-08https:\/\/commerce.utah.gov\/wp-content\/uploads\/2025\/04\/Best-Practices-Mental-Health-Therapists.pdf"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2025.1679324"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.44720"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1177\/14614448221142007"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231183542"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2024.1281037"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.2196\/79156"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbac038"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2026.1729175"},{"key":"ref20","unstructured":"Use of generative AI chatbots and wellness applications for mental health: an APA health advisoryAmerican Psychological Association2026-08-08https:\/\/www.apa.org\/topics\/artificial-intelligence-machine-learning\/health-advisory-chatbots-wellness-apps"},{"key":"ref21","author":"Brenner, GH","year":"2025","journal-title":"Neuromodec J"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291725101311"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01772-9"},{"key":"ref24","unstructured":"Turner-Scott v. OpenAI Found., No. CGC-26-636801 (Cal. Super. Ct. San Francisco Cnty. filed May 12, 2026)Tech Justice Law20262026-08-08https:\/\/techjusticelaw.org\/wp-content\/uploads\/2026\/05\/FINAL-Nelson-Complaint.pdf"},{"key":"ref25","unstructured":"eCFR:: 45 CFR Part 164 -- security and privacyCode of Federal Regulations2026-08-08https:\/\/www.ecfr.gov\/current\/title-45\/subtitle-A\/subchapter-C\/part-164"},{"key":"ref26","unstructured":"Jose A. Saucedo v. Sharp HealthCare, et al., No. 25CU063632C (Cal. Super. Ct., San Diego Cnty. filed Nov. 26, 2025)DocumentCloud20252026-09-22https:\/\/www.documentcloud.org\/documents\/26367643-20251122-sharp-complaint-saucedo\/"},{"key":"ref27","unstructured":"Regulation (EU) 2024\/1689 of the European Parliament and of the Council of 13 June 2024 laying down harmonised rules on artificial intelligence and amending Regulations (EC) No 300\/2008, (EU) No 167\/2013, (EU) No 168\/2013, (EU) 2018\/858, (EU) 2018\/1139 and (EU) 2019\/2144 and Directives 2014\/90\/EU, (EU) 2016\/797 and (EU) 2020\/1828 (Artificial Intelligence Act)European Union20242026-08-08https:\/\/eur-lex.europa.eu\/legal-content\/EN\/TXT\/?uri=CELEX:32024R1689"},{"key":"ref28","unstructured":"Software and artificial intelligence (AI) as a medical deviceUnited Kingdom Government202502032026-08-08https:\/\/tinyurl.com\/3b3ejyun"},{"key":"ref29","unstructured":"Pre-market guidance for machine learning-enabled medical devicesGovernment of Canada2026412026-08-08https:\/\/tinyurl.com\/3c8e4ktp"},{"key":"ref30","unstructured":"Meeting your professional obligations when using artificial intelligence in healthcareAustralian Health Practitioner Regulation Agency and National Boards2024082026-08-08https:\/\/www.ahpra.gov.au\/Resources\/Artificial-Intelligence-in-healthcare.aspx"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2025.10496"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.4914"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2503232"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2106356"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.75.3.475"}],"container-title":["JMIR AI"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ai.jmir.org\/2026\/1\/e101942","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:25:08Z","timestamp":1790785508000},"score":1,"resource":{"primary":{"URL":"https:\/\/ai.jmir.org\/2026\/1\/e101942"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":35,"URL":"https:\/\/doi.org\/10.2196\/101942","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.101942","asserted-by":"object"}]},"ISSN":["2817-1705"],"issn-type":[{"value":"2817-1705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}