{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:18:08Z","timestamp":1790709488188,"version":"4.1.0"},"reference-count":51,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Generative artificial intelligence (GenAI) is increasingly used in mental health care, from client-facing chatbots to clinician-facing documentation aids. Psychotherapists\u2019 willingness to rely on\u2014or withhold reliance from\u2014these tools has significant implications for care quality, yet little is known about how practicing clinicians calibrate trust and distrust in GenAI across tasks and contexts. Given that the therapeutic relationship is central to psychotherapy outcomes, understanding how GenAI intersects with this relational foundation is essential for responsible integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to examine (1) psychotherapists\u2019 experiences with, perceptions of, and trust or distrust in GenAI in therapeutic contexts and (2) how they perceive the role of GenAI within the therapeutic relationship and how their perceptions shape their trust and distrust in GenAI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative interview study using semistructured interviews with 18 actively practicing psychotherapists in the United States between January and May 2025. Participants were recruited through professional mailing lists, social media, and snowball sampling. Interviews (\u224860 min each) were conducted via Zoom and explored psychotherapists\u2019 experiences with, perceptions of, and trust or distrust in GenAI in therapeutic contexts. Data were analyzed using the general inductive approach, with iterative coding and team-based interpretation to identify themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our findings show that psychotherapists\u2019 GenAI adoption was highly individualized and contingent on maintaining professional role integrity\u2014not merely technical oversight. Trust was sustained when GenAI operated in clinician-supervised, supportive roles for low-stakes tasks (eg, documentation and brainstorming), but diminished when control shifted, tasks involved high-stakes clinical judgment, or GenAI threatened to encroach on the authentic human connection central to therapy. Participants articulated conditions for trust that went beyond \u201chuman-in-the-loop\u201d monitoring to include preservation of interpretive authority, ethical responsibility, and relational primacy. Distrust also extended to the broader sociotechnical ecosystem, including concerns about commercial incentives, insurance pressures, and the absence of clear organizational guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychotherapists\u2019 perspectives offer critical insights into GenAI\u2019s current usages in their professional practices and the conditions under which they are willing to trust and distrust GenAI tools. Their experiences highlight the importance of maintaining clinician control, ensuring contextual appropriateness, and preserving the human connection central to psychotherapy. Future work should further examine how therapeutic orientation, professional experience, and client characteristics shape trust and distrust in GenAI. As GenAI becomes more embedded in mental health care, research is also needed to explore how specific GenAI system features can be responsibly designed to support clinical workflows and enhance therapeutic relationships. Organizational and policy frameworks will be essential to ensure responsible, ethically aligned, and human-centered GenAI deployment in psychotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/88932","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T21:20:07Z","timestamp":1771881607000},"page":"e88932-e88932","source":"Crossref","is-referenced-by-count":7,"title":["Psychotherapists\u2019 Trust, Distrust, and Generative AI Practices in Psychotherapy: Qualitative Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6636-4766","authenticated-orcid":false,"given":"Jinyan","family":"Kuang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7525-7853","authenticated-orcid":false,"given":"Amber L","family":"Pope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7412-4669","authenticated-orcid":false,"given":"Yixuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.2196\/44357","article-title":"Ethical implications of artificial intelligence in population health and the public\u2019s role in its governance: perspectives from a citizen and expert panel","volume":"25","author":"Couture","journal-title":"J Med Internet Res"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-54294-4","article-title":"Understanding how personality traits, experiences, and attitudes shape negative bias toward AI-generated artworks","volume":"14","author":"Grassini","journal-title":"Sci Rep"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1145\/3706598.3713244","article-title":"Understanding adolescents\u2019 perceptions of benefits and risks in health AI technologies through design fiction","author":"Lee","journal-title":"CHI 2025"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2025.109271","article-title":"Exploring the influence of privacy concerns, AI literacy, and perceived health stigma on AI chatbot use in healthcare: an uncertainty reduction approach","volume":"140","author":"Liu","journal-title":"Patient Educ Couns"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.2196\/72412","article-title":"Using large language models to assess the consistency of randomized controlled trials on AI interventions with CONSORT-AI: cross-sectional survey","volume":"27","author":"Luo","journal-title":"J Med Internet Res"},{"key":"R6","unstructured":"Abrams Z . 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