The increasing use of large language models in mental health applications calls for principled evaluation frameworks that assess alignment with psychotherapeutic best practices beyond surface-level fluency. While recent systems exhibit conversational competence, they lack structured mechanisms to evaluate adherence to core therapeutic principles. In this paper, we study the problem of evaluating AI-generated therapist-like responses for clinically grounded appropriateness and effectiveness. We assess each therapists utterance along six therapeutic principles: non-judgmental acceptance, warmth, respect for autonomy, active listening, reflective understanding, and situational appropriateness using a fine-grained ordinal scale. We introduce FAITH-M, a benchmark annotated with expert-assigned ordinal ratings, and propose CARE, a multi-stage evaluation framework that integrates intra-dialogue context, contrastive exemplar retrieval, and knowledge-distilled chain-of-thought reasoning. Experiments show that CARE achieves an F-1 score of 63.34 versus the strong baseline Qwen3 F-1 score of 38.56 which is a 64.26% improvement, which also serves as its backbone, indicating that gains arise from structured reasoning and contextual modeling rather than backbone capacity alone. Expert assessment and external dataset evaluations further demonstrate robustness under domain shift, while highlighting challenges in modeling implicit clinical nuance. Overall, CARE provides a clinically grounded framework for evaluating therapeutic fidelity in AI mental health systems.

In mental health counseling, condensing dialogues into concise and relevant summaries (aka counseling notes) holds pivotal significance. Large Language Models (LLMs) exhibit remarkable capabilities in various generative tasks; however, their adaptation to domain-specific intricacies remains challenging, especially within mental health contexts. Unlike standard LLMs, mental health experts first plan to apply domain knowledge in writing summaries. Our work enhances LLMs’ ability by introducing a novel planning engine to orchestrate structuring knowledge alignment. To achieve high-order planning, we divide knowledge encapsulation into two major phases: (i) holding dialogue structure and (ii) incorporating domain-specific knowledge. We employ a planning engine on Llama-2, resulting in a novel framework, PIECE. Our proposed system employs knowledge filtering-cum-scaffolding to encapsulate domain knowledge. Additionally, PIECE leverages sheaf convolution learning to enhance its understanding of the dialogue’s structural nuances. We compare PIECE with 14 baseline methods and observe a significant improvement across ROUGE and Bleurt scores. Further, expert evaluation and analyses validate the generation quality to be effective, sometimes even surpassing the gold standard. We further benchmark PIECE with other LLMs and report improvement, including Llama-2 (+2.72%), Mistral (+2.04%), and Zephyr (+1.59%), to justify the generalizability of the planning engine.