Relational Mediators: LLM Chatbots as Boundary Objects in Psychotherapy

Abstract

As large language models (LLMs) are embedded into mental health technologies, they are often framed either as tools assisting therapists or autonomous therapeutic systems. Such perspectives overlook their potential to mediate relational complexities in therapy, particularly for systemically marginalized clients. Drawing on in-depth interviews with 12 therapists and 12 marginalized clients in China, including LGBTQ+ individuals or those from other marginalized backgrounds, we identify enduring relational challenges: difficulties building trust amid institutional barriers, the burden clients carry in educating therapists about marginalized identities, and challenges sustaining authentic self-disclosure across therapy and daily life. We argue that addressing these challenges requires AI systems capable of actively mediating underlying knowledge gaps, power asymmetries, and contextual disconnects. To this end, we propose the Dynamic Boundary Mediation Framework, which reconceptualizes LLM-enhanced systems as adaptive boundary objects that shift mediating roles across therapeutic stages. The framework delineates three forms of mediation: Epistemic (reducing knowledge asymmetries), Relational (rebalancing power dynamics), and Contextual (bridging therapy-life discontinuities). This framework offers a pathway toward designing relationally accountable AI systems that center the lived realities of marginalized users and more effectively support therapeutic relationships.