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Updated May 27, 2026 Reviewed by Monica Vilhauer Ph.D.
Increasingly, artificial intelligence (AI) large language models (LLMs) are being integrated into the mental health industry for counseling, therapy, and companionship. A recent Brown University study shows how LLM counselors routinely breach mental health ethical standards such as the American Psychological Association (APA) professional codes of conduct.
“We argue that mental health support, especially psychotherapy, cannot be approached as a formulaic computational task, as it demands strict adherence to ethical standards and professional codes of conduct, something LLMs are prone to violating in real-world practice,” wrote lead author Zainab Iftikhar with co-authors Amy Xiao, Sean Ransom, Jeff Huang, and Harini Suresh.
AI-powered mental health care is a growth industry. Smartphone-enabled therapy chatbots offer convenience, and real-time support to users. Pioneering companies in AI mental health include Woebot Health, Limbic, Rocket Health, Slingshot AI, HEADSPACE HEALTH, Wysa Ltd, Kintsugi Mindful Wellness, Inc, Aiberry, Ellipsis Health, Spring Care, Inc., and Lyra Health, Inc. By 2033, the market size of AI in mental health is expected to grow to an estimated USD 9.12 billion, which represents 23% compound annual growth rate from the USD 1.71 billion market size in 2025 according to Grand View Research.
People around the world are opening up to the idea of consulting LLMs such as ChatGPT for mental health support. A February 2026 study published in AI & Society of 31,000 adults from 35 countries by Yankouskaya et al. shows that 42% of American respondents, 41% of UK respondents, 56% of Italian respondents, 61% of South African respondents, 63% Japanese respondents, and 86% of Chinese respondents would use AI as a mental health advisor.
Given these rapid technology adoption trends, it is important to understand the capabilities of LLMs to provide mental health care. Brown University researchers sought to uncover the risks of using LLM counselors for psychotherapy and how these can be incorporated into a framework for mental health codes of conduct.
In a period spanning 18 months, the study participants consisting of seven trained peer counselors and three clinically licensed psychologists helped evaluate the conduct of LLM counselors. The study includes a variety of LLMs, including OpenAI’s GPT-4, GPT-3.5, and GPT-3.0, Meta’s Llama 3.2 and 3.1, and Anthropic’s Claude 3 Haiku and Claude 3 Sonnet.
From a data pool gathered from 137 sessions, the researchers created a guideline consisting of five categories and 15 ethical violations grouped by five major areas: 1) Lack of Contextual Understanding, 2) Poor Therapeutic Collaboration, 3) Deceptive Empathy, 4) Unfair Discrimination, and 5) Lack of Safety & Crisis Management.
“Through ethnographic observations, session evaluations, and interviews with peer counselors and licensed clinical psychologists, we found that LLMs, even the ones prompted to follow evidence-based treatments, breach multiple codes of conduct by generalizing lived experiences (e.g. minimizing identity groups), dominating therapeutic collaboration (e.g., gaslighting users), exploiting user vulnerability through deceptive displays of empathy, unfair discrimination against non-dominant identities, and exhibiting serious limitations in competence, especially when navigating sensitive issues such as trauma, abuse, and suicidal ideation,” the researchers wrote.
The researchers warn that their study illustrates the risks of AI therapists and call for legal guidelines and regulations to minimize potential harm to clients.
“Reflecting on these findings through a practitioner-informed lens, we argue that reducing psychotherapy—a deeply meaningful and relational process—to a language generation task can have serious and harmful implications in practice,” concluded the researchers.
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Cami Rosso writes about science, technology, innovation, and leadership.
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The best way to begin something new—in love, work, and life.
Self Tests are all about you. Are you outgoing or introverted? Are you a narcissist? Does perfectionism hold you back? Find out the answers to these questions and more with Psychology Today.