Rolling With Resistance: Preference-Optimized LLM Counselors Can Trade Goal Persistence for Relational Attunement in Motivational Interviewing
Authors: Weiying Chen, Junlong Shen, Zhexuan Tang
Organizations: University of Alberta · University of Shanghai for Science and Technology
Abstract
In Motivational Interviewing (MI), a client's sustain talk (arguments for the status quo) calls for the counselor to roll with resistance, a move that can fail in two opposite ways: capitulation (abandoning the change agenda to preserve rapport) or confrontation (arguing or directing, overriding the client's autonomy). We introduce a two-axis evaluation of counselor responses, anchored in the Motivational Interviewing Treatment Integrity (MITI) code, Goal Persistence (GP) and Relational Attunement (RA), yielding a four-quadrant framing in which rolling with resistance is high on both, and we ask whether penalizing one failure through preference optimization teaches rolling with resistance or provokes its opposite. From the expert-annotated AnnoMI corpus we build topic-disjoint Direct Preference Optimization data whose preference sets differ only in which failure is rejected, using on-policy negatives. An automatic judge, validated against AnnoMI's expert labels and rechecked by trained human coders, scores blind pairwise win-rates against each base under a firewall in which disjoint model families generate, label, and judge. Across three aligned instruction models spanning the Qwen and Llama families, penalizing confrontation reliably lowers goal persistence below parity, on every base and in every seed run, a robust cost, whereas the attunement gain is base-dependent, present on two of the three bases but absent on the third. Penalizing capitulation is inert, because these models rarely capitulate on-policy, so the trade is gated by each base's failure profile. A prompt-only control raises attunement without the goal-persistence cost, locating the cost in the optimization rather than in attunement itself.
Reasoning large language models (LLMs) have recently made much progress in complex problem-solving, leveraging internal reasoning (or thought) to guide their solution generation. However, existing LLM-based counseling agents, including those using Motivational Interviewing (MI), generate responses without explicitly aligning thoughts with counseling techniques, limiting their effectiveness. We propose MIThinker, a lightweight thinking model that generates therapeutic thoughts to guide MI counseling agents in strategy selection and response generation. To overcome the lack of annotated thought data, we introduce AugR1-MI, an automated pipeline that reverse-engineers counselor's thoughts from observed responses. Through two-stage training combining supervised fine-tuning and reinforcement learning, MIThinker demonstrates improved theory-of-mind assessment and strategy alignment. Comprehensive evaluations show that MindfulMI, our agent leveraging MIThinker, achieves MI competency comparable to state-of-the-art systems with an order of magnitude less computation.
Large Language Models (LLMs) show promise in psychological counseling, yet existing benchmarks rely heavily on highly cooperative simulated clients. We observe a critical counselor-following phenomenon: these clients often rapidly shift from resistance to compliance after only a few turns, creating an illusion of therapeutic progress and inflating scores under current evaluation protocols through superficial empathy. To address this evaluation mismatch, we propose a Cognitive Behavioral Therapy (CBT)-grounded resistance-aware framework. We introduce CARS, a client simulator that explicitly models dynamic resistance via Cognitive Conceptualization Diagrams (CCDs). We present STREAMS, a dual-module framework that decouples strategic reasoning (Thinker) from response generation (Presenter) and optimizes it via reinforcement learning. We further propose EWTS-MI, an entropy-weighted metric for evaluating responsiveness under high-friction interactions. Experiments across resistant and non-resistant counseling settings validate our findings on evaluation mismatch and demonstrate the effectiveness of resistance-aware training for improving strategic robustness under challenging counseling interactions.
Large language models (LLMs) can generate fluent dialogue, but prior works lack situational grounding, dynamic strategy control, and evaluation aligned with clinical standards in motivational interviewing (MI). We introduce StoryMI, a multi-LLM agent framework for controllable MI dialogue generation, where questionnaire-based client profiles are expanded into situational stories that provide narrative context for the dialogue. Therapist and client agents generate MI-coded utterances guided by MI codes selected by the interaction agent, while an interaction agent dynamically coordinates exchanges to control MI strategies during a multi-turn conversation. We propose a two-level evaluation protocol: lexical metrics and MI-specific measures of macro-level counseling strategies, alongside LLM-as-judge and human expert assessments. We construct a dataset of 6K simulated MI dialogues grounded in 1K questionnaire-story pairs, covering 12 MI codes and 13 symptom domains, and benchmark six open- and closed-source LLMs. Our results show that situational grounding and macro-level control can improve MI adherence and clinical plausibility, demonstrating the effectiveness of a structured multi-agent workflow for psychotherapy dialogue generation. We provide code and data for reproducibility.