Multi-Objective Alignment of Language Models for Personalized Psychotherapy

Large language models show promise for mental health support, yet therapeutic quality improves only when evaluation functions as an actionable control signal rather than a passive metric. We introduce a framework that formulates therapeutic response generation as a decision-refinement problem driven by multi-dimensional, human-aligned evaluation. In Stage I, we introduce TheraJudge, an open-source therapeutic evaluator trained via preference-based optimization on human-annotated data to produce reliable judgments across 7 psychological dimensions. In Stage II, we introduce TheraAgent, which operationalizes TheraJudge's evaluations through a coordinated refinement process with specialized Critic, Coach, and Therapist roles that translate evaluative signals into targeted response revisions. Empirically, TheraJudge achieves strong agreement with clinician ratings, with intraclass correlation coefficients (ICC = 0.87-0.95), surpassing supervised baselines and strong closed-source judges, particularly on critical dimensions such as Safety, Relevance, and Empathy. Acting on these evaluations, TheraAgent yields a +0.43 improvement in human-rated therapeutic quality (on a 5-point scale) under blind evaluation, with 96% clinician inter-rater reliability. Low-quality responses ($\leq 3$) improve by +2.45 points with a 94% recovery rate, demonstrating targeted correction of unsafe outputs. Overall, our results indicate that effective alignment of mental-health LLMs stems from acting on human-aligned evaluation, rather than relying solely on stronger generation. We release code at https://github.com/vis-nlp/TheraAlign.

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 modelling implicit clinical nuance. Overall, CARE provides a clinically grounded framework for evaluating therapeutic fidelity in AI mental health systems.

In the realm of multi-objective alignment for large language models, balancing disparate human preferences often manifests as a zero-sum conflict. Specifically, the intrinsic tension between competing goals dictates that aggressively optimizing for one metric (e.g., helpfulness) frequently incurs a substantial penalty on another (e.g., harmlessness). While prior work mainly focuses on data selection, parameter merging, or algorithmic balancing during training, these approaches merely force compromises between divergent preferences along a fixed Pareto frontier, failing to fundamentally resolve the inherent trade-off. In this work, we approach this problem from a novel perspective of multi-dimensional rewards. By scaling up the model's rollouts and analyzing the outputs across different reward dimensions, we arrive at a critical conclusion: the conflict among multiple objectives stems from the fact that the prompt itself inherently restricts the achievable multi-dimensional rewards. Based on this core observation, we propose MORA: Multi-Objective Reward Assimilation. Specifically, MORA isolates single-reward prompts through pre-sampling and expands their reward diversity by rewriting the original questions to incorporate multi-dimensional intents. Extensive experiments demonstrate that: (1) in sequential alignment, MORA achieves single-preference improvements ranging from 5% to 12.4%, with exceptional gains in harmlessness, after multiple-preference alignment across helpful, harmless, and truthful dimensions. (2) In simultaneous alignment, MORA achieves an average overall reward improvement of 4.6%. Our codes are available at https://github.com/Shiying-Huang/MORA-MPA.