# MIRROR: Multimodal Cognitive Reframing Therapy for Rolling with Resistance

arXiv: https://arxiv.org/abs/2504.13211 · HTML: https://mlsanity.com/paper/2504.13211/

## Key facts

- Cited by 13 papers in the map (data through 14 Oct 2026).
- Builds on 29 of its 61 references that are in the map.
- First posted on arXiv 16 Apr 2025.

## Builds on (most cited first, 29 of 29)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Deep Learning Face Attributes in the Wild](https://mlsanity.com/paper/1411.7766/) (2014)
- [SODA: Million-scale Dialogue Distillation with Social Commonsense Contextualization](https://mlsanity.com/paper/2212.10465/) (2022)
- [Having Beer after Prayer? Measuring Cultural Bias in Large Language Models](https://mlsanity.com/paper/2305.14456/) (2023)
- [Investigating Cultural Alignment of Large Language Models](https://mlsanity.com/paper/2402.13231/) (2024)
- [ProsocialDialog: A Prosocial Backbone for Conversational Agents](https://mlsanity.com/paper/2205.12688/) (2022)
- [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)
- [Human Evaluation of Conversations is an Open Problem: comparing the sensitivity of various methods for evaluating dialogue agents](https://mlsanity.com/paper/2201.04723/) (2022)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [SocialCounterfactuals: Probing and Mitigating Intersectional Social Biases in Vision-Language Models with Counterfactual Examples](https://mlsanity.com/paper/2312.00825/) (2023)
- [GANDiffFace: Controllable Generation of Synthetic Datasets for Face Recognition with Realistic Variations](https://mlsanity.com/paper/2305.19962/) (2023)
- [HealMe: Harnessing Cognitive Reframing in Large Language Models for Psychotherapy](https://mlsanity.com/paper/2403.05574/) (2024)
- [Exploring Racial Bias within Face Recognition via per-subject Adversarially-Enabled Data Augmentation](https://mlsanity.com/paper/2004.08945/) (2020)
- [CBT-LLM: A Chinese Large Language Model for Cognitive Behavioral Therapy-based Mental Health Question Answering](https://mlsanity.com/paper/2403.16008/) (2024)
- [Inducing Positive Perspectives with Text Reframing](https://mlsanity.com/paper/2204.02952/) (2022)
- [Training Models to Generate, Recognize, and Reframe Unhelpful Thoughts](https://mlsanity.com/paper/2307.02768/) (2023)
- [Understanding the Therapeutic Relationship between Counselors and Clients in Online Text-based Counseling using LLMs](https://mlsanity.com/paper/2402.11958/) (2024)
- [MEDIC: A Multimodal Empathy Dataset in Counseling](https://mlsanity.com/paper/2305.02842/) (2023)
- [Facial Expressions as a Vulnerability in Face Recognition](https://mlsanity.com/paper/2011.08809/) (2020)
- [Socratic Reasoning Improves Positive Text Rewriting](https://mlsanity.com/paper/2403.03029/) (2024)
- [Exploring Unlabeled Faces for Novel Attribute Discovery](https://mlsanity.com/paper/1912.03085/) (2019)
- [How Does Conversation Length Impact User's Satisfaction? A Case Study of Length-Controlled Conversations with LLM-Powered Chatbots](https://mlsanity.com/paper/2404.17025/) (2024)
- [Stark: Social Long-Term Multi-Modal Conversation with Persona Commonsense Knowledge](https://mlsanity.com/paper/2407.03958/) (2024)
- [Multimodal Cognitive Reframing Therapy via Multi-hop Psychotherapeutic Reasoning](https://mlsanity.com/paper/2502.06873/) (2025)
- [Cross-Cultural and Cultural-Specific Production and Perception of Facial Expressions of Emotion in the Wild](https://mlsanity.com/paper/1808.04399/) (2018)
- [Examining Spanish Counseling with MIDAS: a Motivational Interviewing Dataset in Spanish](https://mlsanity.com/paper/2502.08458/) (2025)
- [Eeyore: Realistic Depression Simulation via Supervised and Preference Optimization](https://mlsanity.com/paper/2503.00018/) (2025)

## Built on by (most cited first, 13 of 13)

- [Crisp: Cognitive Restructuring of Negative Thoughts through Multi-turn Supportive Dialogues](https://mlsanity.com/paper/2504.17238/) (2025)
- [A Comprehensive Review of Datasets for Clinical Mental Health AI Systems](https://mlsanity.com/paper/2508.09809/) (2025)
- [Responsible Evaluation of AI for Mental Health](https://mlsanity.com/paper/2602.00065/) (2026)
- [Graph2Counsel: Clinically Grounded Synthetic Counseling Dialogue Generation from Client Psychological Graphs](https://mlsanity.com/paper/2604.20382/) (2026)
- [PanicToCalm: A Proactive Counseling Agent for Panic Attacks](https://mlsanity.com/paper/2510.21143/) (2025)
- [PsyCLIENT: Client Simulation via Conversational Trajectory Modeling for Trainee Practice and Model Evaluation in Mental Health Counseling](https://mlsanity.com/paper/2601.07312/) (2026)
- [DMT-CBT: Longitudinal Therapeutic State Modeling for CBT Counseling](https://mlsanity.com/paper/2606.03132/) (2026)
- [PSY-STEP: Structuring Therapeutic Targets and Action Sequences for Proactive Counseling Dialogue Systems](https://mlsanity.com/paper/2604.04448/) (2026)
- [EmoTrack: Clinical-Semantic Modeling for Text-Based Depression Severity Estimation](https://mlsanity.com/paper/2605.22286/) (2026)
- [When Clients Stop Following: A Cognitive Conceptualization Diagram-driven Framework for Strategic Counseling](https://mlsanity.com/paper/2606.04389/) (2026)
- [LongCounsel-8: A Benchmark Suite for Longitudinal Depression Tracking from Multi-Session Counseling Dialogues](https://mlsanity.com/paper/2609.03507/) (2026)
- [MOCC-R1: Reinforcing Reasoning-Response Consistency for Multimodal Counselor Response Generation](https://mlsanity.com/paper/2609.17180/) (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)

Recent studies have explored the use of large language models (LLMs) in psychotherapy; however, text-based cognitive behavioral therapy (CBT) models often struggle with client resistance, which can weaken therapeutic alliance. To address this, we propose a multimodal approach that incorporates nonverbal cues, which allows the AI therapist to better align its responses with the client's negative emotional state. Specifically, we introduce a new synthetic dataset, Mirror (Multimodal Interactive Rolling with Resistance), which is a novel synthetic dataset that pairs each client's statements with corresponding facial images. Using this dataset, we train baseline vision language models (VLMs) so that they can analyze facial cues, infer emotions, and generate empathetic responses to effectively manage client resistance. These models are then evaluated in terms of both their counseling skills as a therapist, and the strength of therapeutic alliance in the presence of client resistance. Our results demonstrate that Mirror significantly enhances the AI therapist's ability to handle resistance, which outperforms existing text-based CBT approaches. Human expert evaluations further confirm the effectiveness of our approach in managing client resistance and fostering therapeutic alliance.