abstract Large language models (LLMs) have shown promising capabilities in healthcare analysis but face several challenges like hallucinations, parroting, and bias manifestation. These challenges are exacerbated in complex, sensitive, and low-resource domains. Therefore, in this work, we introduce IC-AnnoMI, an expert-annotated motivational interviewing (MI) dataset built upon AnnoMI, by generating in-context conversational dialogues leveraging LLMs, particularly ChatGPT. IC-AnnoMI employs targeted prompts accurately engineered through cues and tailored information, taking into account therapy style (empathy, reflection), contextual relevance, and false semantic change. Subsequently, the dialogues are annotated by experts, strictly adhering to the Motivational Interviewing Skills Code (MISC), focusing on both the psychological and linguistic dimensions of MI dialogues. We comprehensively evaluate the IC-AnnoMI dataset and ChatGPT’s emotional reasoning ability and understanding of domain intricacies by modeling novel classification tasks employing several classical machine learning and current state-of-the-art transformer approaches. Finally, we discuss the effects of progressive prompting strategies and the impact of augmented data in mitigating the biases manifested in IC-AnnoM. Our contributions provide the MI community with not only a comprehensive dataset but also valuable insights for using LLMs in empathetic text generation for conversational therapy in supervised settings.

Reflection is a crucial counselling skill where the therapist conveys to the client their interpretation of what the client said. Language models have recently been used to generate reflections automatically, but human evaluation is challenging, particularly due to the cost of hiring experts. Laypeople-based evaluation is less expensive and easier to scale, but its quality is unknown for reflections. Therefore, we explore whether laypeople can be an alternative to experts in evaluating a fundamental quality aspect: coherence and context-consistency. We do so by asking a group of laypeople and a group of experts to annotate both synthetic reflections and human reflections from actual therapists. We find that both laypeople and experts are reliable annotators and that they have moderate-to-strong inter-group correlation, which shows that laypeople can be trusted for such evaluations. We also discover that GPT-3 mostly produces coherent and consistent reflections, and we explore changes in evaluation results when the source of synthetic reflections changes to GPT-3 from the less powerful GPT-2.

Reflection is an essential counselling strategy, where the therapist listens actively and responds with their own interpretation of the client’s words. Recent work leveraged pre-trained language models (PLMs) to approach reflection generation as a promising tool to aid counsellor training. However, those studies used limited dialogue context for modelling and simplistic error analysis for human evaluation. In this work, we take the first step towards addressing those limitations. First, we fine-tune PLMs on longer dialogue contexts for reflection generation. Then, we collect free-text error descriptions from non-experts about generated reflections, identify common patterns among them, and accordingly establish discrete error categories using thematic analysis. Based on this scheme, we plan for future work a mass non-expert error annotation phase for generated reflections followed by an expert-based validation phase, namely “whether a coherent and consistent response is a good reflection”.

Gauging therapist empathy in counselling is an important component of understanding counselling quality. While session-level empathy assessment based on machine learning has been investigated extensively, it relies on relatively large amounts of well-annotated dialogue data, and real-time evaluation has been overlooked in the past. In this paper, we focus on the task of low-resource utterance-level binary empathy assessment. We train deep learning models on heuristically constructed empathy vs. non-empathy contrast in general conversations, and apply the models directly to therapeutic dialogues, assuming correlation between empathy manifested in those two domains. We show that such training yields poor performance in general, probe its causes, and examine the actual effect of learning from empathy contrast in general conversation.