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PurposeThis report describes the views of front-line health professionals who participated in a randomised controlled trial examining a model of care in which depressed cancer patients received a brief psychosocial intervention. Health professionals from four cancer centres received focused training, skill development and clinical supervision in order to deliver the intervention.MethodsWe interviewed 20 health professionals asking them about their perceptions of participation in the study and their views about more widespread implementation of this model of care.ResultsParticipants strongly advocated for widespread implementation of this model of care; however, their ability to deliver the intervention varied depending on clinical roles and responsibilities. Many oncology nurses expressed conflict about delivering a psychosocial intervention when their clinical unit was busy. Finding a private area in which to talk was a frequent barrier in busy clinical units. Participants reported that they applied the skills and insights acquired in the study in their routine clinical work. Supervision was highly valued and was feasible to provide in clinical settings.ConclusionPsychosocial care can be provided by a range of health professionals if they receive focused training and have access to supervision, but competing clinical demands are likely to limit their ability to routinely provide psychosocial care. This suggests that training should target professionals who have greater autonomy and flexibility in their work roles.Trial registration numberANZCTR1260000448044

Research in embodied artificial intelligence (AI) has increasing clinical relevance for therapeutic applications in mental health services. With innovations ranging from 'virtual psychotherapists' to social robots in dementia care and autism disorder, to robots for sexual disorders, artificially intelligent virtual and robotic agents are increasingly taking on high-level therapeutic interventions that used to be offered exclusively by highly trained, skilled health professionals. In order to enable responsible clinical implementation, ethical and social implications of the increasing use of embodied AI in mental health need to be identified and addressed. This paper assesses the ethical and social implications of translating embodied AI applications into mental health care across the fields of Psychiatry, Psychology and Psychotherapy. Building on this analysis, it develops a set of preliminary recommendations on how to address ethical and social challenges in current and future applications of embodied AI. Based on a thematic literature search and established principles of medical ethics, an analysis of the ethical and social aspects of currently embodied AI applications was conducted across the fields of Psychiatry, Psychology, and Psychotherapy. To enable a comprehensive evaluation, the analysis was structured around the following three steps: assessment of potential benefits; analysis of overarching ethical issues and concerns; discussion of specific ethical and social issues of the interventions. From an ethical perspective, important benefits of embodied AI applications in mental health include new modes of treatment, opportunities to engage hard-to-reach populations, better patient response, and freeing up time for physicians. Overarching ethical issues and concerns include: harm prevention and various questions of data ethics; a lack of guidance on development of AI applications, their clinical integration and training of health professionals; 'gaps' in ethical and regulatory frameworks; the potential for misuse including using the technologies to replace established services, thereby potentially exacerbating existing health inequalities. Specific challenges identified and discussed in the application of embodied AI include: matters of risk-assessment, referrals, and supervision; the need to respect and protect patient autonomy; the role of non-human therapy; transparency in the use of algorithms; and specific concerns regarding long-term effects of these applications on understandings of illness and the human condition. We argue that embodied AI is a promising approach across the field of mental health; however, further research is needed to address the broader ethical and societal concerns of these technologies to negotiate best research and medical practices in innovative mental health care. We conclude by indicating areas of future research and developing recommendations for high-priority areas in need of concrete ethical guidance.

Background In large health care systems, decision regarding broad implementation of psychotherapies for inpatients with psychosis require substantial evidence regarding effectiveness and feasibility for implementation. It is important to recognize challenges in conducting research to inform such decisions, including difficulties in obtaining consent from and engaging inpatients with psychosis in research. We set out to conduct a feasibility and effectiveness Hybrid Type I pilot randomized controlled trial of acceptance and commitment therapy (ACT) and a semi-formative evaluation of barriers and facilitators to implementation. Findings We developed a training protocol and refined an ACT treatment manual for inpatient treatment of psychosis for use at the Veterans Health Administration. While our findings on feasibility were mixed, we obtained supportive evidence of the acceptability and safety of ACT. Identified strengths of ACT included a focus on achievement of valued goals rather than symptoms. Weaknesses included that symptoms may limit patient’s understanding of ACT. Facilitators included building trust and multi-stage informed consent processes. Barriers included restrictive eligibility criteria, rigid use of a manualized protocol, and individual therapy format. Conclusions are limited by our randomization of only 18 patient participants (with nine completing all aspects of the study) out of 80 planned. Conclusions Future studies should include (1) multi-stage informed consent processes to build trust and alleviate patient fears, (2) relaxation of restrictions associated with obtaining efficacy/effectiveness data, and (3) use of Hybrid Type II and III designs.

Our technologies are progressively developing into algorithmic devices that seamlessly interface with digital personhood. This text discusses the ways in which technology is increasingly becoming a part of personhood and the resulting ethical issues. It extends upon the framework for a brain-based cyberpsychology outlined by the author's earlier book 'Cyberpsychology and the Brain: The Interaction of Neuroscience and Affective Computing' (Parsons, 2017; Cambridge University Press). Using this framework, Thomas D. Parsons investigates the ethical issues involved in cyberpsychology research and praxes, which emerge in algorithmically coupled people and technologies. The ethical implications of these ideas are important as we consider the cognitive enhancements that can be afforded by our technologies. If people are intimately linked to their technologies, then removing or damaging the technology could be tantamount to a personal attack. On the other hand, algorithmic devices may threaten autonomy and privacy. This book reviews these and other issues.

Developing and maintaining a secure framework for professional practice is a core part of any counselling and psychotherapy training, as all therapists need to understand the key values, ethics and laws that underpin the profession today. But what does being a member of a ‘profession’ actually mean, and what does being a ‘professional’ actually involve? Structured around the BACP Core Curriculum, and with the help of exercises, case studies and tips for further reading this book covers everything from the requirements of the BACP Ethical Framework to broader perspectives on good professional practice. It includes:  • Practising as a therapist in different roles and organizational contexts  • Working with key issues, including difference, vulnerable clients and risk  • Understanding the law and relevant legal frameworks for practice  • Working ethically, including contrasting models and approaches to ethics.

Deepfakes are hyper-realistic but fabricated videos created with the use of artificial intelligence. In the context of psychotherapy, the first studies on using deepfake technology are emerging, with potential applications including grief counselling and treatment for sexual violence-related trauma. This paper explores these applications from the perspective of medical ethics and health law. First, we question whether deepfake therapy can truly constitute good care. Important risks are dangerous situations or ‘triggers’ to the patient during data collection for the creation of a deepfake, and when deepfake therapy is started, there are risks of overattachment and blurring of reality, which can complicate the grieving process or alter perceptions of perpetrators. Therapists must mitigate these risks, but more research is needed to evaluate deepfake therapy’s efficacy before it can be used at all. Second, we address the implications for the person depicted in the deepfake. We describe how privacy and portrait law apply and argue that the legitimate interests of those receiving therapy should outweigh the interests of the depicted, as long as the therapy is an effective and ‘last resort’ treatment option, overseen by a therapist and the deepfakes are handled carefully. We suggest specific preventative measures that can be taken to protect the depicted person’s privacy. Finally, we call for qualitative research with patients and therapists to explore dependencies and other unintended consequences. In conclusion, while deepfake therapy holds promise, the competing interests and ethicolegal complexities demand careful consideration and further investigation alongside the development and implementation of this technology.

During the COVID-19 pandemic, mental health professionals were forced to find an appropriate way of working with patients that would ensure the continuity of therapy while considering the restrictions aimed at counteracting the spread of the virus. Online therapy has become an increasingly popular and common form of psychotherapeutic work. Emerging scientific studies have confirmed the positive effects of remote psychotherapeutic work. Nevertheless, modifying traditional and well-known forms of therapy or introducing completely new forms of remote therapy have been associated with several ethical concerns and challenges for psychotherapists. Due to the COVID-19 pandemic and the emerging epidemiological restrictions and recommendations, as well as new recommendations from psychotherapeutic associations, this study aimed to investigate the following: (1) Have psychotherapists experienced ethical dilemmas related to working online and face-to-face during the COVID-19 pandemic? (2) Was the occurrence of these dilemmas related to the therapists' personal characteristics, such as age, sex, professional experience, or therapeutic approach? (3) What specific ethical dilemmas do psychotherapists point to in conducting online and face-to-face therapy during the COVID-19 pandemic? We conducted an international study with 177 psychotherapists from 4 European countries (Sweden, Poland, Germany, and Portugal) using a web-based survey. The psychotherapeutic approaches represented in the sample were cognitive-behavioral, integrative, psychodynamic-psychoanalytic, systemic, existential and gestalt, and Ericksonian therapy, among others. An interview comprising closed and open questions was used to collect data on psychotherapists' personal characteristics, professional functioning, and ethical dilemmas encountered during online and face-to-face therapy. Ethical dilemmas related to online therapy were reported by 58.7% (104/177) of therapists, while dilemmas related to face-to-face therapy were reported by 61% (108/177). The study showed that these dilemmas were independent of the personal and professional characteristics of therapists. Dilemmas related to online therapy were concern about online therapy, the issue of privacy and confidentiality of sessions, the effectiveness of online therapy, the issue of limitations that may hinder clinical work, and concerns related to the broader systemic and institutional context. In contrast, for the face-to-face form, ethical dilemmas mainly concerned health and safety, limitations in communication and quality of relationships due to wearing masks, and technical and logistical limitations. The issues considered here have not lost their relevance, because despite the lifting of restrictions related to the pandemic, some of the described dilemmas are similar to those related to coping with the risk and transmission of infection during face-to-face meetings. Moreover, the spread of online therapy means that the related ethical dilemmas are still relevant. The results indicate the direction of further consideration, the outcome of which should be specific ethical and legal guidelines that consider the concerns and dilemmas reported.