# A Computational Framework for Behavioral Assessment of LLM Therapists

arXiv: https://arxiv.org/abs/2401.00820 · HTML: https://mlsanity.com/paper/2401.00820/

## Key facts

- Cited by 62 papers in the map (data through 14 Oct 2026).
- Builds on 19 of its 72 references that are in the map.
- First posted on arXiv 1 Jan 2024.

## Builds on (most cited first, 19 of 19)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Training a Helpful and Harmless Assistant with Reinforcement Learning from Human Feedback](https://mlsanity.com/paper/2204.05862/) (2022)
- [Sparks of Artificial General Intelligence: Early experiments with GPT-4](https://mlsanity.com/paper/2303.12712/) (2023)
- [Towards Understanding Sycophancy in Language Models](https://mlsanity.com/paper/2310.13548/) (2023)
- [Ethical and social risks of harm from Language Models](https://mlsanity.com/paper/2112.04359/) (2021)
- [Whose Opinions Do Language Models Reflect?](https://mlsanity.com/paper/2303.17548/) (2023)
- [Large Language Models Understand and Can be Enhanced by Emotional Stimuli](https://mlsanity.com/paper/2307.11760/) (2023)
- [Cognitive Reframing of Negative Thoughts through Human-Language Model Interaction](https://mlsanity.com/paper/2305.02466/) (2023)
- [Human-AI Collaboration Enables More Empathic Conversations in Text-based Peer-to-Peer Mental Health Support](https://mlsanity.com/paper/2203.15144/) (2022)
- [Facilitating Self-Guided Mental Health Interventions Through Human-Language Model Interaction: A Case Study of Cognitive Restructuring](https://mlsanity.com/paper/2310.15461/) (2023)
- [Grounding Gaps in Language Model Generations](https://mlsanity.com/paper/2311.09144/) (2023)
- [Benefits and Harms of Large Language Models in Digital Mental Health](https://mlsanity.com/paper/2311.14693/) (2023)
- [Speaker and Time-aware Joint Contextual Learning for Dialogue-act Classification in Counselling Conversations](https://mlsanity.com/paper/2111.06647/) (2021)
- [Evaluation of GPT-3.5 and GPT-4 for supporting real-world information needs in healthcare delivery](https://mlsanity.com/paper/2304.13714/) (2023)
- [Observing Dialogue in Therapy: Categorizing and Forecasting Behavioral Codes](https://mlsanity.com/paper/1907.00326/) (2019)
- [Gendered Mental Health Stigma in Masked Language Models](https://mlsanity.com/paper/2210.15144/) (2022)
- [VERVE: Template-based ReflectiVE Rewriting for MotiVational IntErviewing](https://mlsanity.com/paper/2311.08299/) (2023)

## Built on by (most cited first, 30 of 62)

- [Towards a Client-Centered Assessment of LLM Therapists by Client Simulation](https://mlsanity.com/paper/2406.12266/) (2024)
- [The Typing Cure: Experiences with Large Language Model Chatbots for Mental Health Support](https://mlsanity.com/paper/2401.14362/) (2024)
- [MindScape Study: Integrating LLM and Behavioral Sensing for Personalized AI-Driven Journaling Experiences](https://mlsanity.com/paper/2409.09570/) (2024)
- [CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answering](https://mlsanity.com/paper/2506.08584/) (2025)
- [Can AI Relate: Testing Large Language Model Response for Mental Health Support](https://mlsanity.com/paper/2405.12021/) (2024)
- [PATIENT-Psi: Using Large Language Models to Simulate Patients for Training Mental Health Professionals](https://mlsanity.com/paper/2405.19660/) (2024)
- [When Large Language Models are Reliable for Judging Empathic Communication](https://mlsanity.com/paper/2506.10150/) (2025)
- [Do Large Language Models Align with Core Mental Health Counseling Competencies?](https://mlsanity.com/paper/2410.22446/) (2024)
- [Understanding the Therapeutic Relationship between Counselors and Clients in Online Text-based Counseling using LLMs](https://mlsanity.com/paper/2402.11958/) (2024)
- [Multi-Level Feedback Generation with Large Language Models for Empowering Novice Peer Counselors](https://mlsanity.com/paper/2403.15482/) (2024)
- [Social Skill Training with Large Language Models](https://mlsanity.com/paper/2404.04204/) (2024)
- [Contextual AI Journaling: Integrating LLM and Time Series Behavioral Sensing Technology to Promote Self-Reflection and Well-being using the MindScape App](https://mlsanity.com/paper/2404.00487/) (2024)
- [Consistent Client Simulation for Motivational Interviewing-based Counseling](https://mlsanity.com/paper/2502.02802/) (2025)
- [AdvisorQA: Towards Helpful and Harmless Advice-seeking Question Answering with Collective Intelligence](https://mlsanity.com/paper/2404.11826/) (2024)
- [A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions](https://mlsanity.com/paper/2502.11095/) (2025)
- [CAMI: A Counselor Agent Supporting Motivational Interviewing through State Inference and Topic Exploration](https://mlsanity.com/paper/2502.02807/) (2025)
- [AI with Emotions: Exploring Emotional Expressions in Large Language Models](https://mlsanity.com/paper/2504.14706/) (2025)
- [Towards Collaborative Intelligence: Propagating Intentions and Reasoning for Multi-Agent Coordination with Large Language Models](https://mlsanity.com/paper/2407.12532/) (2024)
- [AutoCBT: An Autonomous Multi-agent Framework for Cognitive Behavioral Therapy in Psychological Counseling](https://mlsanity.com/paper/2501.09426/) (2025)
- [Digital Diagnostics: The Potential Of Large Language Models In Recognizing Symptoms Of Common Illnesses](https://mlsanity.com/paper/2405.06712/) (2024)
- [MentalAgora: A Gateway to Advanced Personalized Care in Mental Health through Multi-Agent Debating and Attribute Control](https://mlsanity.com/paper/2407.02736/) (2024)
- [How Real Are Synthetic Therapy Conversations? Evaluating Fidelity in Prolonged Exposure Dialogues](https://mlsanity.com/paper/2504.21800/) (2025)
- [Computational Hermeneutics: Evaluating generative AI as a cultural technology](https://mlsanity.com/paper/2604.16403/) (2026)
- [Multimodal Cognitive Reframing Therapy via Multi-hop Psychotherapeutic Reasoning](https://mlsanity.com/paper/2502.06873/) (2025)
- [Can You Share Your Story? Modeling Clients' Metacognition and Openness for LLM Therapist Evaluation](https://mlsanity.com/paper/2507.19643/) (2025)
- [MAGneT: Coordinated Multi-Agent Generation of Synthetic Multi-Turn Mental Health Counseling Sessions](https://mlsanity.com/paper/2509.04183/) (2025)
- [Behavioral Fingerprinting of Large Language Models](https://mlsanity.com/paper/2509.04504/) (2025)
- [ExploreSelf: Fostering User-driven Exploration and Reflection on Personal Challenges with Adaptive Guidance by Large Language Models](https://mlsanity.com/paper/2409.09662/) (2024)
- [Multi-Session Client-Centered Treatment Outcome Evaluation in Psychotherapy](https://mlsanity.com/paper/2410.05824/) (2024)
- [Reinforcement Learning in the Real World: A Survey of Statistical Challenges and Future Directions](https://mlsanity.com/paper/2601.15353/) (2026)

## Abstract (arXiv)

The emergence of large language models (LLMs) like ChatGPT has increased interest in their use as therapists to address mental health challenges and the widespread lack of access to care. However, experts have emphasized the critical need for systematic evaluation of LLM-based mental health interventions to accurately assess their capabilities and limitations. Here, we propose BOLT, a proof-of-concept computational framework to systematically assess the conversational behavior of LLM therapists. We quantitatively measure LLM behavior across 13 psychotherapeutic approaches with in-context learning methods. Then, we compare the behavior of LLMs against high- and low-quality human therapy. Our analysis based on Motivational Interviewing therapy reveals that LLMs often resemble behaviors more commonly exhibited in low-quality therapy rather than high-quality therapy, such as offering a higher degree of problem-solving advice when clients share emotions. However, unlike low-quality therapy, LLMs reflect significantly more upon clients' needs and strengths. Our findings caution that LLM therapists still require further research for consistent, high-quality care.