# Can LLM-Simulated Practice and Feedback Upskill Human Counselors? A Randomized Study with 90+ Novice Counselors

arXiv: https://arxiv.org/abs/2505.02428 · HTML: https://mlsanity.com/paper/2505.02428/

## Key facts

- Cited by 13 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 5 May 2025.

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

- [OPeRA: A Dataset of Observation, Persona, Rationale, and Action for Evaluating LLMs on Human Online Shopping Behavior Simulation](https://mlsanity.com/paper/2506.05606/) (2025)
- [RecoWorld: Building Simulated Environments for Agentic Recommender Systems](https://mlsanity.com/paper/2509.10397/) (2025)
- [Are LLMs Empathetic to All? Investigating the Influence of Multi-Demographic Personas on a Model's Empathy](https://mlsanity.com/paper/2510.10328/) (2025)
- [PatientHub: A Unified Framework for Patient Simulation](https://mlsanity.com/paper/2602.11684/) (2026)
- [Simulating Human Memory with Language Models](https://mlsanity.com/paper/2605.25680/) (2026)
- [AI-Assisted Moot Courts: Simulating Justice-Specific Questioning in Oral Arguments](https://mlsanity.com/paper/2603.04718/) (2026)
- ["Is This Really a Human Peer Supporter?": Misalignments Between Peer Supporters and Experts in LLM-Supported Interactions](https://mlsanity.com/paper/2506.09354/) (2025)
- [CounselReflect: Opportunities and Challenges for Designing Tools to Support Self-Reflection on Mental Health and Well-Being Conversations with AI](https://mlsanity.com/paper/2603.29429/) (2026)
- [A paradox of AI fluency](https://mlsanity.com/paper/2604.25905/) (2026)
- [Adapting from Downturns: Prediction of Long-Term Conversational-Skill Development in Mental-Health Crisis Counselors](https://mlsanity.com/paper/2609.04350/) (2026)
- [PeerPen: AI-Assisted Writing for Online Mental Health Peer Support](https://mlsanity.com/paper/2609.14886/) (2026)
- [From Pattern Recognizers to Personalized Companions: A Survey of Large Language Models in Mental Health](https://mlsanity.com/paper/2609.25186/) (2026)
- [Empath: Tracing Multi-Level Emotion Dynamics in Crisis Counseling Dialogues](https://mlsanity.com/paper/2609.29056/) (2026)

## Abstract (arXiv)

The growing demand for accessible mental health support requires training more counselors, yet existing approaches remain resource-intensive and difficult to scale. LLMs can realistically simulate patients and generate actionable feedback for training, but their actual impact on novice counselor skill development remains unknown. We developed an LLM-simulated practice and feedback system and conducted a randomized study with 94 novice counselors, comparing practice alone versus practice with feedback. We evaluated behavioral performance, self-efficacy, and qualitative reflections. Results showed the practice-and-feedback group improved in client-centered microskills (reflections, questions), while the practice-alone group showed no improvements. For empathy, the practice-alone group declined over time and performed significantly worse than the feedback group. Qualitative interviews reinforced these findings: feedback helped participants adopt a client-centered listening approach, while practice-alone participants remained solution-oriented. These results suggest LLM-based training systems can promote effective skill development, and combining simulated practice with structured feedback is critical for meaningful improvement.