AI-Powered Virtual Clients for Psychotherapy Training: A Scoping Review

Condition or domain being studied Psychotherapy Training; Immersive Conversational Technology; AI‑Driven Simulation; Virtual Clients; Clinical Skill Development; Generative AI An Immersive Conversational Technology (ICT) refers to an interactive, technology-mediated training system that assists psychotherapy trainees and practitioners through engagement in experiential, real-time therapeutic conversations with simulated patients or agents, thereby recreating key features of clinical encounters for educational purposes. ICT may include virtual, augmented, or mixed-reality environments, as well as screen-based or voice-based conversational simulations: most importantly for our focus, we are interested in ICTs that are powered by artificial intelligence (AI), provided that they support immersive, dialogical interaction aimed at psychotherapeutic training. This scoping review investigates how AI-powered ICTs are being applied to psychotherapy training for healthcare professionals, including psychotherapists, counselors, social workers, psychiatrists, physicians, nurses, and students/trainees learning psychotherapy skills. This review focuses on empirical, peer‑reviewed studies that evaluate the use of conversational simulations using AI‑driven virtual clients as training tools for participants to practice using psychotherapeutic skills. By synthesizing research that examines training outcomes, skill acquisition, competency development, supervision enhancement, and decision‑making support, alongside studies describing feasibility and proof-of-concept testing of AI virtual clients, the review aims to clarify how these emerging technologies contribute to professional development in psychotherapy and therapeutic skills. This work addresses a growing but fragmented literature by identifying how especially AI-powered ICTs are being used to strengthen clinical training, highlighting evidence‑based benefits, limitations, and opportunities for improving educational design and supervisory practices. Non‑empirical papers and purely technical development studies without training applications are excluded to ensure the review centers on applied, training‑focused evidence. Rationale for the review ICTs are increasingly used to enhance psychotherapy training, offering new ways to support experiential learning and clinical skill development, particularly with the emergence and widespread dissemination of conversational artificial intelligence over the recent years. This technological shift has led to a growing number of training tools and simulation-based applications, developed across diverse platforms and educational contexts. However, evidence on how these tools function in training contexts remains scattered, with much of the literature focused on technical development or therapeutic use with patients rather than on training psychotherapists and trainees. This review addresses that gap by mapping peer‑reviewed empirical studies that evaluate immersive simulations, including VR, AR, mixed reality, and especially AI‑driven conversational agents, used specifically for psychotherapy training. By focusing on outcomes related to feasibility, self-efficacy, skill acquisition, competency development, supervision enhancement, and decision‑making, the review aims to clarify how these technologies contribute to professional preparation. Given the likely continuation of rapid expansion of this area and the diversity of technologies, training settings, and outcome measures, a scoping review is warranted to capture the breadth and nature of current research and to identify areas requiring further study. Review objectives This scoping review aims to synthesize empirical, peer‑reviewed research on the use of ICTs in psychotherapy training. Specifically, it will address: (1) How immersive, conversational, or AI‑driven simulations (including VR, AR, mixed reality, and other virtual agents) are being applied within psychotherapy training contexts to model realistic client conversations; (2) the training outcomes most consistently associated with these technologies, including self-efficacy, skill acquisition, competency development, decision‑making support, and or supervision enhancement; (3) the characteristics of ICT-based training environments that appear to facilitate effective learning for psychotherapists, trainees, counselors, mental‑health clinicians, and healthcare professionals in general; (4) the methodological approaches used to evaluate these technologies, including study designs, outcome measures, and assessment tools; (5) the populations studied, with attention to training level, professional background, and context of use; and (6) the implications of these findings for improving psychotherapy education, guiding the integration of immersive technologies, and identifying gaps requiring further empirical investigation. Keywords Psychotherapy training; immersive conversational technologies; conversational AI; generative AI; AI‑driven simulation; conversational agents; virtual patients; simulated patients; clinical skill development; competency training; experiential learning; deliberate practice; digital training tools; therapist education; mental‑health training; simulation‑based learning; training outcomes; technology‑enhanced learning; psychotherapy pedagogy; trainee experience; training effectiveness; decision‑making support; supervision enhancement; professional development; training evaluation; evidence‑based training; digital learning environments; AI‑supported education; psychotherapy curriculum innovation; therapist training standards; applied simulation research. Country Spain ELIGIBILITY CRITERIA Population Included This review will include studies involving mental and physical healthcare workers, including psychotherapists, psychotherapy trainees, counselors, social workers, psychiatrists, physicians, nurses, and students in psychotherapy training programs who are engaged in structured training activities. Eligible populations must be participating in educational, supervisory, or skills‑development contexts where ICT‑based tools are used to support psychotherapeutic training by roleplaying as a client during psychotherapeutic skills practice. Excluded Studies will be excluded if they do not involve individuals training for or practicing psychotherapy. This includes research with general populations, unrelated health professions, or studies that do not incorporate a training or educational component relevant to psychotherapeutic skill development. Intervention(s) or exposure(s) Included This review will include studies that evaluate the use of ICTs in psychotherapy training. Eligible interventions include virtual reality (VR), augmented reality (AR), and mixed‑reality environments, as well as conversational simulations, and AI‑driven virtual agents, that allow trainees to engage in real-time, dialogical interactions resembling psychotherapy conversations with simulated patients used to support the development of psychotherapeutic competencies. Studies must examine training‑related outcomes such as self-efficacy, clinical skill acquisition, competency development, supervision enhancement, decision‑making support, or the suitability-for-purpose of the ICT itself. Only empirical, peer‑reviewed research in which these technologies are applied directly to psychotherapy training contexts will be included. Excluded Studies will be excluded if they do not involve ICTs or if the technology is used solely for therapy delivery to patients rather than for training therapists. Also excluded are purely technical development papers without a training application, theoretical or conceptual articles without empirical data, and studies lacking a training‑related outcome (e.g., general e‑learning, non‑interactive modules, or institutional‑level evaluations unrelated to psychotherapeutic skill development). Comparator(s) or control(s) Included Not applicable / Studies with and without a comparator will be included. Study design Both randomized and nonrandomized study types will be included. Included The review will include: Empirical quantitative studies evaluating immersive or AI‑based technologies used in psychotherapy training Study designs such as randomized controlled trials (RCTs), quasi‑experimental studies, cross‑sectional surveys, feasibility or pilot evaluations, and other empirical designs reporting training‑related outcomes Mixed‑methods studies, but only when quantitative findings relevant to psychotherapy training are clearly reported and extractable Excluded The review will exclude: Case reports, expert opinions, editorials, commentaries, and conference abstracts without full empirical results Reviews, meta‑analyses, or theoretical papers that do not present original data Conference papers, dissertations, or technical reports, unless published as peer‑reviewed journal articles Purely technical VR/AI development papers with no training application Studies where participants are not psychotherapists, trainees, counselors, psychiatrists, or mental‑health clinicians Studies using VR/AI for patient treatment rather than for professional training Studies that do not involve ICTs (e.g., standard e‑learning, non‑interactive video modules, live roleplay simulations) Context This scoping review examines how immersive and AI‑based technologies are used in psychotherapy training across different mental‑health disciplines and educational settings. SEARCHING AND SCREENING Search for unpublished studies Both published and unpublished studies will be sought. Main bibliographic databases that will be searched This study will examine articles indexed in Scopus, Web of Science, PubMed, and ProQuest Search language restrictions The review will only include studies published in English. Search date restrictions The review is limited to studies published from 2019 onward, corresponding to the e