What mental health professionals need to know about LLM search
In the last five years, the use of technology in the therapy room has exploded (in the same way it has exploded in many fields). During the pandemic, the popularity of telehealth took off in ways that were unforeseen, which was the beginning of a more significant integration of using all kinds of technology for therapeutic purposes both in and out of sessions.
Today, therapists use technology via telehealth appointments, through apps for distress tolerance and mood tracking, and even augmented reality for exposure therapy for conditions like obsessive-compulsive disorder.
The potential benefits of telehealth are substantial. It can be done when a kid is sick, a client is traveling (within their state), or for someone in a rural area without access to therapists in their town. Similarly, the obvious benefits of having tools for tracking moods and providing psychoeducation in real time have real value.
While all of these technological changes have the potential for real positive change in the therapy world, it’s important to simultaneously think about this evolution with an open and critical mind. Understanding how technology is reshaping the therapeutic alliance is an important part of this conversation, as digital tools continue to change how therapists and clients connect, communicate, and build trust.
While many therapists believe that telehealth services have benefited those with access to care issues, research has shown that most people utilizing telehealth services are not the disadvantaged. According to a 2025 study published in the JAMA Psychiatry journal, the recent rise in psychotherapy use—driven largely by the expansion of teletherapy—has disproportionately benefited socioeconomically advantaged adults with mild to moderate distress, while access gains for people with more serious psychological distress have lagged behind.
As we look at and discuss the benefits of technology in therapy, it’s important that we consider who benefits and why. Are the advances in technology really helping everyone, or is it just the privileged?
The rise of AI-powered chatbots marketed for emotional support has also raised new ethical concerns, underscoring why clinicians should approach any AI-adjacent tool with caution and clear professional boundaries.
As technology becomes more integrated into mental health care, therapists must consider how technology is reshaping the therapeutic alliance and what that means for connection, trust, and empathy in treatment.
Building therapeutic rapport, alliance, and empathy online
As technology reshapes the therapeutic alliance, building rapport remains essential for strong digital therapy relationships, but online therapy introduces new factors that can influence connection and trust.
Questions to ask when building rapport online are:
What indicators or practices must an online therapist demonstrate to convey attunement and focused presence?
How does the therapist have boundaries around distraction?
How does a therapist measure the therapeutic alliance?
The issues of alliance and building rapport online are different from those in-person. When engaging in a video session, a therapist is often getting a close-up of the client’s face. Maintaining eye contact can feel easier and safer for clients, and the context of being in their home with the safety of their pets or family can be soothing. All of these things can aid in the sense of trust and connection being established, building strong digital therapy relationships.
The therapist often also has a peek into the “natural surroundings” of the client. Seeing a client’s home or office can give clinical insights into how they are living and can allow for talking points and moments of connection that would otherwise be inaccessible.
As clinicians think about rapport and alliance, the way that they show empathy in a digital context often needs to be considered. Digital empathy is an emerging concept and clinicians are finding that the ways to show and engage in attunement are different online than in-person.
This can look like verbally checking in around the technology used in therapy, communicating clearly and concisely through messaging, and ensuring explicit communication in situations where body language, facial expressions, or tone cannot be used to help engage in empathy or connection that in-person therapy would allow for.
A small preliminary study from 2021 suggested that some clients perceived their therapists as even more empathetic online than in-person. The study suggested that while therapists may not have done anything statistically significantly different, the clients’ perception was that they were more empathetic. The study cited possible reasons being that clients felt more safe in an environment like their home and this aided in the overall feelings of trust and connection with their therapist.
Boundaries in an online context
No matter how much rapport a clinician has online or in-person, boundaries in therapy are essential in all digital therapy relationships. Understanding and creating boundaries in the constantly evolving world of technology is becoming more and more important.
During telehealth sessions, therapists may encounter clients who are working, driving, or gaming during sessions. There can often be distractions in the home or in the telehealth setting that would not be present in an office setting.
Important questions to ask when establishing boundaries with clients using technology in therapy include:
Are there expectations that need to be set in an online context that would be assumed in an in-person one?
What ways can I and my client limit distractions during this time?
What agreement will my client and I make at the beginning of treatment that will help us set aside this time in an intentional way?
What privacy considerations need to be addressed before online therapy is started?
Starting with questions like these can help set up a strong foundation for digital therapy relationships.
What about screen fatigue?
While considering the many factors of online vs in-person therapy, screen and technology fatigue should not be overlooked. The level of engagement and attunement required to do online video sessions is often more significant than the screen fatigue that occurs with using a computer to write e-mails, fill out forms, or create content.
Some simple, but practical strategies for therapists to be mindful to combat screen fatigue include utilizing blue light glasses, spacing out longer breaks between sessions that allow for “eye breaks”, and setting up “down” time for personal screen use outside of work.
Getting outside and focusing on nature can also help clinicians stay more engaged in sessions throughout the day.
Technology in therapy practice is here to stay. There are ways it can help and harm the therapeutic process. However, the role of the therapist is to use technology as a tool (not a replacement) ethically and responsibly, making the necessary adjustments for themselves and their clients as they learn and build digital therapy relationships.
Sources
Fledermann, K., Chwastiak, L., Fortier, A., Gotham, H., Murphy, A., et al. (2024). Levels of telehealth use, perceived usefulness, and ease of use in behavioral healthcare organizations after the COVID-19 pandemic. J Behav Health Serv Res.
Olfson, M., McClellan, C., Zuvekas, S., et al. (2025). Trends in outpatient psychotherapy among adults in the US. JAMA Psychiatry.
Rajkumar, R. P. (2024). Augmented reality as an aid to behavior therapy for anxiety disorders: A narrative review. Cureus.
Sperandeo, R., Cioffi, V., Mosca, L. L., Longabardi, T., Moretto, E., et al. (2021) Exploring the question: “Does empathy work in the same way in online and in-person therapeutic settings?”. Front. Psychol.
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