CAIA in Practice: Field Evaluation of an AI-Assisted Support System for Text-Based Online Counselling

Client perceptions of the therapeutic alliance are critical for counseling effectiveness. Accurately capturing these perceptions remains challenging, as traditional post-session questionnaires are burdensome and often delayed, while existing computational approaches produce coarse scores, lack interpretable rationales, and fail to model holistic session context. We present CARE, an LLM-based framework to automatically predict multi-dimensional alliance scores and generate interpretable rationales from counseling transcripts. Built on the CounselingWAI dataset and enriched with 9,516 expert-curated rationales, CARE is fine-tuned using rationale-augmented supervision with the LLaMA-3.1-8B-Instruct backbone. Experiments show that CARE outperforms leading LLMs and substantially reduces the gap between counselor evaluations and client-perceived alliance, achieving over 70% higher Pearson correlation with client ratings. Rationale-augmented supervision further improves predictive accuracy. CARE also produces high-quality, contextually grounded rationales, validated by both automatic and human evaluations. Applied to real-world Chinese online counseling sessions, CARE uncovers common alliance-building challenges, illustrates how interaction patterns shape alliance development, and provides actionable insights, demonstrating its potential as an AI-assisted tool for supporting mental health care.

AI is increasingly used for mental health and well-being support, creating an urgent need for safer engagement, while design, evaluation, and governance take time to develop. We explore a complementary approach: helping users critically reflect on their own AI conversations. We introduce CounselReflect, a tool that translates literature-grounded counseling quality metrics into a user-facing reflection framework. Using CounselReflect as a study probe, we interviewed 21 users of AI for mental health and well-being support. Although most participants did not routinely reflect on their conversations, they articulated concrete questions they would want reflection to address. Tool-assisted reflection also revealed challenges: participants selectively sought evidence confirming existing perceptions of AI and prioritized dimensions they already valued. We argue that reflection tools should surface blind spots and scaffold more holistic examination of AI interactions. Finally, overcoming emotional barriers to revisiting tense conversations remains a major design challenge and warrants input from future work.

While AI-assisted text-based counseling is gaining attention, it remains empirically unclear which counselor behaviors are associated with higher dialogue quality. Existing research often focuses heavily on Reflection, borrowing frameworks from Motivational Interviewing. To address this gap, we conduct a multi-layered analysis using KokoroChat, a large-scale Japanese text counseling dataset conducted by professional counselors and trainees, newly annotated with counselor strategy tags and client distress levels. Our results show that, under the quality indicators used in this study, Affirmation is more consistently associated with session quality than Reflection among the analyzed strategies. Cross-dataset transfer experiments further suggest that this quality signal can be observed to some extent on ESConv, an English dataset with non-expert supporters. These findings provide empirical implications for counselor training and emotional support system design. We release the additional KokoroChat annotations and experimental source code at https://github.com/UEC-InabaLab/BeyondReflection.