Psychological defenses are strategies, often automatic, that people use to manage distress. Rigid use or overuse of defenses is negatively linked to mental health and shapes what speakers disclose and how they accept or resist help. However, defenses are complex and difficult to reliably measure, particularly in clinical dialogues. We introduce PsyDefConv, a dialogue corpus with help seeker utterances labeled for defense level, and DMRS Co-Pilot, a four-stage pipeline that provides evidence-based pre-annotations. The corpus contains 200 dialogues and 4,709 utterances, including 2,336 help seeker turns, with double-blind labeling reaching Cohen’s kappa of 0.639. In a counterbalanced study, the co-pilot reduced average annotation time by 24.0%. In expert review, it averaged 4.62 for evidence supportiveness, 4.44 for clinical plausibility, and 4.40 for insight on a seven-point scale. Benchmarks with strong large language models (LLMs) in zero-shot and fine-tuning settings demonstrate clear headroom, with the best macro F1-score around 30% and a tendency to overpredict mature defenses. Corpus analyses confirm that mature defenses are most common and reveal emotion-specific deviations. We release the corpus, annotations, code, and prompts to support research on defensive functioning in language.

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.