# A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions

arXiv: https://arxiv.org/abs/2502.11095 · HTML: https://mlsanity.com/paper/2502.11095/

## Key facts

- Cited by 12 papers in the map (data through 14 Oct 2026).
- Builds on 42 of its 108 references that are in the map.
- First posted on arXiv 16 Feb 2025.

## Builds on (most cited first, 30 of 42)

- [SoulChat: Improving LLMs' Empathy, Listening, and Comfort Abilities through Fine-tuning with Multi-turn Empathy Conversations](https://mlsanity.com/paper/2311.00273/) (2023)
- [CPsyCoun: A Report-based Multi-turn Dialogue Reconstruction and Evaluation Framework for Chinese Psychological Counseling](https://mlsanity.com/paper/2405.16433/) (2024)
- [Cognitive Reframing of Negative Thoughts through Human-Language Model Interaction](https://mlsanity.com/paper/2305.02466/) (2023)
- [Roleplay-doh: Enabling Domain-Experts to Create LLM-simulated Patients via Eliciting and Adhering to Principles](https://mlsanity.com/paper/2407.00870/) (2024)
- [A Computational Framework for Behavioral Assessment of LLM Therapists](https://mlsanity.com/paper/2401.00820/) (2024)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [The opportunities and risks of large language models in mental health](https://mlsanity.com/paper/2403.14814/) (2024)
- [Facilitating Self-Guided Mental Health Interventions Through Human-Language Model Interaction: A Case Study of Cognitive Restructuring](https://mlsanity.com/paper/2310.15461/) (2023)
- [MindfulDiary: Harnessing Large Language Model to Support Psychiatric Patients' Journaling](https://mlsanity.com/paper/2310.05231/) (2023)
- [HealMe: Harnessing Cognitive Reframing in Large Language Models for Psychotherapy](https://mlsanity.com/paper/2403.05574/) (2024)
- [CBT-LLM: A Chinese Large Language Model for Cognitive Behavioral Therapy-based Mental Health Question Answering](https://mlsanity.com/paper/2403.16008/) (2024)
- [When does In-context Learning Fall Short and Why? A Study on Specification-Heavy Tasks](https://mlsanity.com/paper/2311.08993/) (2023)
- [Training Models to Generate, Recognize, and Reframe Unhelpful Thoughts](https://mlsanity.com/paper/2307.02768/) (2023)
- [Empowering Psychotherapy with Large Language Models: Cognitive Distortion Detection through Diagnosis of Thought Prompting](https://mlsanity.com/paper/2310.07146/) (2023)
- [PsychoGAT: A Novel Psychological Measurement Paradigm through Interactive Fiction Games with LLM Agents](https://mlsanity.com/paper/2402.12326/) (2024)
- [The Capability of Large Language Models to Measure Psychiatric Functioning](https://mlsanity.com/paper/2308.01834/) (2023)
- [LLM-based Conversational AI Therapist for Daily Functioning Screening and Psychotherapeutic Intervention via Everyday Smart Devices](https://mlsanity.com/paper/2403.10779/) (2024)
- [Multi-Level Feedback Generation with Large Language Models for Empowering Novice Peer Counselors](https://mlsanity.com/paper/2403.15482/) (2024)
- [Detecting Conversational Mental Manipulation with Intent-Aware Prompting](https://mlsanity.com/paper/2412.08414/) (2024)
- [Boosting Distress Support Dialogue Responses with Motivational Interviewing Strategy](https://mlsanity.com/paper/2305.10195/) (2023)
- [ERD: A Framework for Improving LLM Reasoning for Cognitive Distortion Classification](https://mlsanity.com/paper/2403.14255/) (2024)
- [Depression Diagnosis Dialogue Simulation: Self-improving Psychiatrist with Tertiary Memory](https://mlsanity.com/paper/2409.15084/) (2024)
- [Large Language Models are Capable of Offering Cognitive Reappraisal, if Guided](https://mlsanity.com/paper/2404.01288/) (2024)
- [Diverse Perspectives, Divergent Models: Cross-Cultural Evaluation of Depression Detection on Twitter](https://mlsanity.com/paper/2406.15362/) (2024)
- [Still Not Quite There! Evaluating Large Language Models for Comorbid Mental Health Diagnosis](https://mlsanity.com/paper/2410.03908/) (2024)
- [Document-level Causal Relation Extraction with Knowledge-guided Binary Question Answering](https://mlsanity.com/paper/2410.04752/) (2024)
- [Knowledge Planning in Large Language Models for Domain-Aligned Counseling Summarization](https://mlsanity.com/paper/2409.14907/) (2024)
- [WellDunn: On the Robustness and Explainability of Language Models and Large Language Models in Identifying Wellness Dimensions](https://mlsanity.com/paper/2406.12058/) (2024)
- [PsyGUARD: An Automated System for Suicide Detection and Risk Assessment in Psychological Counseling](https://mlsanity.com/paper/2409.20243/) (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)

## Built on by (most cited first, 12 of 12)

- [Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers](https://mlsanity.com/paper/2504.18412/) (2025)
- [Beyond Empathy: Integrating Diagnostic and Therapeutic Reasoning with Large Language Models for Mental Health Counseling](https://mlsanity.com/paper/2505.15715/) (2025)
- [Preference Learning Unlocks LLMs' Psycho-Counseling Skills](https://mlsanity.com/paper/2502.19731/) (2025)
- [Meaning Is Not A Metric: Using LLMs to make cultural context legible at scale](https://mlsanity.com/paper/2505.23785/) (2025)
- [Trustworthy AI Psychotherapy: Multi-Agent LLM Workflow for Counseling and Explainable Mental Disorder Diagnosis](https://mlsanity.com/paper/2508.11398/) (2025)
- [PsychiatryBench: A Multi-Task Benchmark for LLMs in Psychiatry](https://mlsanity.com/paper/2509.09711/) (2025)
- [Evolution of meta's llama models and parameter-efficient fine-tuning of large language models: a survey](https://mlsanity.com/paper/2510.12178/) (2025)
- [Auditing Stealth Sycophancy in Mental-Health Dialogue: Structured Clinical-State Diagnostics and Clean Matched Benchmarks](https://mlsanity.com/paper/2605.03472/) (2026)
- [DELTA: Deliberative Multi-Agent Reasoning with Reinforcement Learning for Multimodal Psychological Counseling](https://mlsanity.com/paper/2602.04112/) (2026)
- [Psy-Chronicle:A Structured Pipeline for Synthesizing Long-Horizon Campus Psychological Counseling Dialogues](https://mlsanity.com/paper/2605.22140/) (2026)
- [Information Dynamics of Language Communication](https://mlsanity.com/paper/2606.30096/) (2026)
- [From Pattern Recognizers to Personalized Companions: A Survey of Large Language Models in Mental Health](https://mlsanity.com/paper/2609.25186/) (2026)

## Abstract (arXiv)

Mental health is increasingly critical in contemporary healthcare, with psychotherapy demanding dynamic, context-sensitive interactions that traditional NLP methods struggle to capture. Large Language Models (LLMs) offer significant potential for addressing this gap due to their ability to handle extensive context and multi-turn reasoning. This review introduces a conceptual taxonomy dividing psychotherapy into interconnected stages--assessment, diagnosis, and treatment--to systematically examine LLM advancements and challenges. Our comprehensive analysis reveals imbalances in current research, such as a focus on common disorders, linguistic biases, fragmented methods, and limited theoretical integration. We identify critical challenges including capturing dynamic symptom fluctuations, overcoming linguistic and cultural biases, and ensuring diagnostic reliability. Highlighting future directions, we advocate for continuous multi-stage modeling, real-time adaptive systems grounded in psychological theory, and diversified research covering broader mental disorders and therapeutic approaches, aiming toward more holistic and clinically integrated psychotherapy LLMs systems.