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These functions include therapeutic challenge, use of the therapeutic relationship as a mechanism of change, rupture detection and repair, bearing witness to suffering, calibration of pace and treatment burden, and clinical judgment under uncertainty across the broader care pathway. Drawing on psychotherapy theory, digital mental health research, the declarative-procedural-reflective model by Bennett-Levy, and our clinical experience, we propose a clinically informed, hypothesis-generating, relational-adaptive-accountability framework. This framework is intended to support further empirical testing and may have implications for workforce development, supervision, training, and service design.<\/jats:p>","DOI":"10.2196\/103712","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:30:05Z","timestamp":1787322605000},"page":"e103712-e103712","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Therapy in the Age of Large Language Models: Framework for Therapist-Delivered and AI-Supported Functions"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5413-8342","authenticated-orcid":false,"given":"Shane","family":"Cross","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-729X","authenticated-orcid":false,"given":"Nickolai","family":"Titov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9324-3092","authenticated-orcid":false,"given":"Blake","family":"Dear","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7969-492X","authenticated-orcid":false,"given":"John","family":"Gleeson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3535-9086","authenticated-orcid":false,"given":"Mario","family":"Alvarez-Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1145\/365153.365168","article-title":"ELIZA\u2014a computer program for the study of natural language communication between man and machine","volume":"9","author":"Weizenbaum","journal-title":"Commun ACM"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1038\/s44184-024-00056-z","article-title":"Large language models could change the future of behavioral healthcare: a proposal for responsible development and evaluation","volume":"3","author":"Stade","journal-title":"Npj Ment Health Res"},{"key":"R3","unstructured":"Strengthening ChatGPT\u2019s responses in sensitive conversations. 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