Therapists' Professional Roles in Guided Internet-Delivered Cognitive Behavioral Therapy in Specialized Mental Health Care: Interview and Observational Study With Health Care Professionals.

Background: Therapist-guided internet-delivered cognitive behavioral therapy (guided iCBT) is increasingly implemented in routine mental health care to expand access to evidence-based treatments. Although the clinical effectiveness and patient acceptability of guided iCBT for common mental health disorders are well established, less is known about how introducing such digitally mediated interventions reshapes therapists' everyday work practices and professional roles. Existing research has primarily focused on treatment outcomes, service uptake, and organizational implementation challenges, leaving therapists' lived professional experiences and role enactment in routine practice underexplored. Objective: This study aimed to explore how the introduction of guided iCBT in routine clinical practice influences mental health care professionals' perceptions and enactment of their professional roles, and to examine how these roles are shaped by interactions between technology and health care professionals. Methods: We conducted an exploratory qualitative study using semistructured interviews and observations with 31 health care professionals who delivered guided iCBT in specialized mental health care settings between January and December 2022. Participants were recruited through purposive and snowball sampling, and data were analyzed using reflexive thematic analysis. The study was theoretically informed by actor-network theory and sociological perspectives on professional roles, enabling a sociotechnical interpretation of how professional work is shaped through interactions between human and nonhuman actors. Results: Two overarching themes described how guided iCBT reconfigures therapeutic work. First, participants reported increased professional agency through enhanced flexibility and autonomy, including greater control over work schedules and opportunities to tailor standardized treatment elements to individual patients. Second, the therapist's role expanded beyond traditional clinical tasks, encompassing increased administrative responsibilities ("the administrative therapist") and expectations to actively promote and legitimize guided iCBT to patients ("the professional salesperson"). While guided iCBT enabled more flexible and individualized care, it also introduced new constraints through standardized protocols, digital platforms, and organizational expectations, resulting in professional discretion and authority being actively negotiated rather than simply reduced or maintained. Conclusions: This study offers a practice-oriented, sociotechnical account of how guided iCBT is implemented in routine care. The findings show how therapists' roles are shaped by everyday clinical workflows, in which responsibility, decision-making, and clinical judgment are distributed among therapists, patients, digital platforms, treatment protocols, and organizational arrangements. The concept of distributed therapeutic authority offers a useful lens for understanding how therapeutic work is reorganized in digitally mediated care without implying a loss of professional expertise. Professional judgment remains central but is exercised in interaction with digital tools and standardized treatment structures. These findings underscore the importance of aligning digital systems, clinical routines, and professional roles when implementing guided iCBT to support both access to care and the quality of therapeutic practice.