Recent advancements in large language models (LLMs) have shown their potential across both general and domain-specific tasks. However, there is a growing concern regarding their lack of sensitivity, factual incorrectness in responses, inconsistent expressions of empathy, bias, hallucinations, and overall inability to capture the depth and complexity of human understanding, especially in low-resource and sensitive domains such as psychology. To address these challenges, our study employs a mixed-methods approach to evaluate the efficacy of LLMs in psychotherapy. We use LLMs to generate precise summaries of motivational interviewing (MI) dialogues and design a two-stage annotation scheme based on key components of the Motivational Interviewing Treatment Integrity (MITI) framework, namely evocation, collaboration, autonomy, direction, empathy, and a non-judgmental attitude. Using expert-annotated MI dialogues as ground truth, we formulate multi-class classification tasks to assess model performance under progressive prompting techniques, incorporating one-shot and few-shot prompting. Our results offer insights into LLMs' capacity for understanding complex psychological constructs and highlight best practices to mitigate ``semantic drift" in therapeutic settings. Our work contributes not only to the MI community by providing a high-quality annotated dataset to address data scarcity in low-resource domains but also critical insights for using LLMs for precise contextual interpretation in complex behavioral therapy.

Automatically analyzing dialogue can help understand and guide behavior in domains such as counseling, where interactions are largely mediated by conversation. In this paper, we study modeling behavioral codes used to asses a psychotherapy treatment style called Motivational Interviewing (MI), which is effective for addressing substance abuse and related problems. Specifically, we address the problem of providing real-time guidance to therapists with a dialogue observer that (1) categorizes therapist and client MI behavioral codes and, (2) forecasts codes for upcoming utterances to help guide the conversation and potentially alert the therapist. For both tasks, we define neural network models that build upon recent successes in dialogue modeling. Our experiments demonstrate that our models can outperform several baselines for both tasks. We also report the results of a careful analysis that reveals the impact of the various network design tradeoffs for modeling therapy dialogue.

The conversational capabilities of Large Language Models (LLMs) suggest that they may be able to perform as automated talk therapists. It is crucial to know if these systems would be effective and adhere to known standards. We present a counsellor chatbot that focuses on motivating tobacco smokers to quit smoking. It uses a state-of-the-art LLM and a widely applied therapeutic approach called Motivational Interviewing (MI), and was evolved in collaboration with clinician-scientists with expertise in MI. We also describe and validate an automated assessment of both the chatbot's adherence to MI and client responses. The chatbot was tested on 106 participants, and their confidence that they could succeed in quitting smoking was measured before the conversation and one week later. Participants' confidence increased by an average of 1.7 on a 0-10 scale. The automated assessment of the chatbot showed adherence to MI standards in 98% of utterances, higher than human counsellors. The chatbot scored well on a participant-reported metric of perceived empathy but lower than typical human counsellors. Furthermore, participants' language indicated a good level of motivation to change, a key goal in MI. These results suggest that the automation of talk therapy with a modern LLM has promise.

Large language models (LLMs) have been actively applied in the mental health field. Recent research shows the promise of LLMs in applying psychotherapy, especially motivational interviewing (MI). However, there is a lack of studies investigating how language models understand MI ethics. Given the risks that malicious actors can use language models to apply MI for unethical purposes, it is important to evaluate their capability of differentiating ethical and unethical MI practices. Thus, this study investigates the ethical awareness of LLMs in MI with multiple experiments. Our findings show that LLMs have a moderate to strong level of knowledge in MI. However, their ethical standards are not aligned with the MI spirit, as they generated unethical responses and performed poorly in detecting unethical responses. We proposed a Chain-of-Ethic prompt to mitigate those risks and improve safety. Finally, our proposed strategy effectively improved ethical MI response generation and detection performance. These findings highlight the need for safety evaluations and guidelines for building ethical LLM-powered psychotherapy.

Learning therapeutic counseling involves significant role-play experience with mock patients, with current manual training methods providing only intermittent granular feedback. We seek to accelerate and optimize counselor training by providing frequent, detailed feedback to trainees as they interact with a simulated patient. Our first application domain involves training motivational interviewing skills for counselors. Motivational interviewing is a collaborative counseling style in which patients are guided to talk about changing their behavior, with empathetic counseling an essential ingredient. We developed and evaluated an LLM-powered training system that features a simulated patient and visualizations of turn-by-turn performance feedback tailored to the needs of counselors learning motivational interviewing. We conducted an evaluation study with professional and student counselors, demonstrating high usability and satisfaction with the system. We present design implications for the development of automated systems that train users in counseling skills and their generalizability to other types of social skills training.

The increasing demand for mental health services has led to the rise of AI-driven mental health chatbots, though challenges related to privacy, data collection, and expertise persist. Motivational Interviewing (MI) is gaining attention as a theoretical basis for boosting expertise in the development of these chatbots. However, existing datasets are showing limitations for training chatbots, leading to a substantial demand for publicly available resources in the field of MI and psychotherapy. These challenges are even more pronounced in non-English languages, where they receive less attention. In this paper, we propose a novel framework that simulates MI sessions enriched with the expertise of professional therapists. We train an MI forecaster model that mimics the behavioral choices of professional therapists and employ Large Language Models (LLMs) to generate utterances through prompt engineering. Then, we present KMI, the first synthetic dataset theoretically grounded in MI, containing 1,000 high-quality Korean Motivational Interviewing dialogues. Through an extensive expert evaluation of the generated dataset and the dialogue model trained on it, we demonstrate the quality, expertise, and practicality of KMI. We also introduce novel metrics derived from MI theory in order to evaluate dialogues from the perspective of MI.

Large language models (LLMs) have shown promising capabilities in healthcare analysis but face several challenges like hallucinations, parroting, and bias manifestation. These challenges are exacerbated in complex, sensitive, and low-resource domains. Therefore, in this work we introduce IC-AnnoMI, an expert-annotated motivational interviewing (MI) dataset built upon AnnoMI by generating in-context conversational dialogues leveraging LLMs, particularly ChatGPT. IC-AnnoMI employs targeted prompts accurately engineered through cues and tailored information, taking into account therapy style (empathy, reflection), contextual relevance, and false semantic change. Subsequently, the dialogues are annotated by experts, strictly adhering to the Motivational Interviewing Skills Code (MISC), focusing on both the psychological and linguistic dimensions of MI dialogues. We comprehensively evaluate the IC-AnnoMI dataset and ChatGPT's emotional reasoning ability and understanding of domain intricacies by modeling novel classification tasks employing several classical machine learning and current state-of-the-art transformer approaches. Finally, we discuss the effects of progressive prompting strategies and the impact of augmented data in mitigating the biases manifested in IC-AnnoM. Our contributions provide the MI community with not only a comprehensive dataset but also valuable insights for using LLMs in empathetic text generation for conversational therapy in supervised settings.

In recent years, computational improvements have allowed for more nuanced, data-driven and geographically explicit agent-based simulations. So far, simulations have struggled to adequately represent the attributes that motivate the actions of the agents. In fact, existing population synthesis frameworks generate agent profiles limited to socio-demographic attributes. In this paper, we introduce a novel value-enriched population synthesis framework that integrates a motivational layer with the traditional individual and household socio-demographic layers. Our research highlights the significance of extending the profile of agents in synthetic populations by incorporating data on values, ideologies, opinions and vital priorities, which motivate the agents' behaviour. This motivational layer can help us develop a more nuanced decision-making mechanism for the agents in social simulation settings. Our methodology integrates microdata and macrodata within different Bayesian network structures. This contribution allows to generate synthetic populations with integrated value systems that preserve the inherent socio-demographic distributions of the real population in any specific region.

Recent advancements in large language models (LLMs) have shown promise in generating psychotherapeutic dialogues, especially in Motivational Interviewing (MI). However, how to employ strategies, a set of motivational interviewing (MI) skills, to generate therapeutic-adherent conversations with explainability is underexplored. We propose an approach called strategy-aware dialogue generation with Chain-of-Strategy (CoS) planning, which first predicts MI strategies as reasoning and utilizes these strategies to guide the subsequent dialogue generation. It brings the potential for controllable and explainable generation in psychotherapy by aligning the generated MI dialogues with therapeutic strategies. Extensive experiments including automatic and human evaluations are conducted to validate the effectiveness of the MI strategy. Our findings demonstrate the potential of LLMs in producing strategically aligned dialogues and suggest directions for practical applications in psychotherapeutic settings.

The study of multimodal interaction in therapy can yield a comprehensive understanding of therapist and patient behavior that can be used to develop a multimodal virtual agent supporting therapy. This investigation aims to uncover how therapists skillfully blend therapy's task goal (employing classical steps of Motivational Interviewing) with the social goal (building a trusting relationship and expressing empathy). Furthermore, we seek to categorize patients into various ``types'' requiring tailored therapeutic approaches. To this intent, we present multimodal annotations of a corpus consisting of simulated motivational interviewing conversations, wherein actors portray the roles of patients and therapists. We introduce EMMI, composed of two publicly available MI corpora, AnnoMI and the Motivational Interviewing Dataset, for which we add multimodal annotations. We analyze these annotations to characterize functional behavior for developing a virtual agent performing motivational interviews emphasizing social and empathic behaviors. Our analysis found three clusters of patients expressing significant differences in behavior and adaptation of the therapist's behavior to those types. This shows the importance of a therapist being able to adapt their behavior depending on the current situation within the dialog and the type of user.