Scaling Therapy Supervision: Assessing Psychotherapy Fidelity Using Large Language Models

Computer Science > Computation and Language

[Submitted on 20 Oct 2026]

Title:Scaling Therapy Supervision: Assessing Psychotherapy Fidelity Using Large Language Models

View PDF HTML (experimental)Abstract:Psychotherapy fidelity assessment measures how faithfully a therapist adheres to a treatment protocol, a critical determinant of positive patient outcomes. However, fidelity assessment is bottlenecked by manual expert review, rendering the process labor-intensive and unscalable. To scale therapy supervision and support clinician self-learning, we present an integrated application of large language models (LLMs) that automates psychotherapy fidelity workflows and generates actionable supervisory feedback from authentic, long-form clinical transcripts. We evaluate three open-weight models across multiple task decomposition configurations and reasoning strategies, demonstrating that evidence-first reasoning improves fidelity estimation. Furthermore, we establish the framework's external construct validity on an independent randomized controlled trial (RCT), where it reliably distinguishes Cognitive Behavioral Therapy (CBT) from non-CBT sessions across core therapeutic skills. Through a user study that evaluates the generated feedback, mental health experts indicate that the pipeline synthesizes actionable clinical feedback. Ultimately, our work offers a practical, scalable solution toward bridging the community mental health supervision gap.

Additional Features

References & Citations

Loading...

Bibliographic and Citation Tools

Bibliographic Explorer (What is the Explorer?)

Connected Papers (What is Connected Papers?)

Litmaps (What is Litmaps?)

scite Smart Citations (What are Smart Citations?)

Code, Data and Media Associated with this Article

alphaXiv (What is alphaXiv?)

CatalyzeX Code Finder for Papers (What is CatalyzeX?)

DagsHub (What is DagsHub?)

Gotit.pub (What is GotitPub?)

Hugging Face (What is Huggingface?)

ScienceCast (What is ScienceCast?)

Demos

Recommenders and Search Tools

Influence Flower (What are Influence Flowers?)

CORE Recommender (What is CORE?)

arXivLabs: experimental projects with community collaborators

arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.

Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.

Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.