Adapting from Downturns: Prediction of Long-Term Conversational-Skill Development in Mental-Health Crisis Counselors

Mental health disorders affect a substantial proportion of the global population, yet a persistent shortage of trained practitioners leaves the majority without adequate care. Large language model (LLM)-based counselors present a promising direction for delivering scalable conversational psychological support. Offline model training alone leaves limited room to adapt to individual clients or to learn from ongoing therapeutic interaction at test time. We introduce PsyEvo, an LLM-based counseling framework that enables both client-specific personalization and response-policy improvement at test time through three components: Hierarchical Bayesian Skill Policy (HBSP) personalizes what intervention to apply by maintaining a per-client skill posterior updated from session feedback; Inter-session Listwise Preference Optimization (LiPO) improves how the selected skill is expressed by updating a shared response adapter from cross-client preference evidence; and State-conditioned Ordinal Credit Assignment (SOCA) supplies candidate preferences and trajectory credit to the two components through consistency-checked comparisons and ordinal projection. In simulated-client evaluation with shared online cohort adaptation, PsyEvo obtains 7.684 Overall on PsychEval and exceeds every component variant in each of three matched runs. Removing individual components lowers mean overall score by 0.138--0.171 under the shared configuration, supporting conditional contributions within the complete scaffold. Our code is available at https://github.com/Lingxi-mental-health/PsyEvo

Real-world crisis intervention is inherently conversational, yet existing research largely focuses on static texts. When applied to multi-turn dialogues, current models exhibit significant performance degradation, struggling to track risk signals that emerge as context evolves. To address this gap, we introduce CRADLE-Dialogue, a clinician-annotated benchmark for turn-level crisis detection in conversational settings. The dataset features 600 dialogues with multi-label annotations across clinically grounded risks, including suicide ideation, self-harm, and child abuse, distinguishing past from ongoing risk. We further propose an Alert-Confirm evaluation protocol that distinguishes early warning signals (Alert) from turns where a specific crisis becomes explicitly identifiable (Confirm), reflecting the clinical need to intervene before risk becomes explicit. Experiments show that identifying when risk emerges is much harder than recognizing that it exists: models achieve only mid-40% to high-60% Micro F1. Additionally, we release a synthetic training corpus and a 32B-parameter model that substantially outperforms existing open-source models and achieves competitive or superior results against proprietary models across turn-level, dialogue-level, and confirm-only evaluation settings.

Cognitive Behavioral Therapy (CBT) aims to identify and restructure automatic negative thoughts pertaining to involuntary interpretations of events, yet existing counseling agents struggle to identify and address them in dialogue settings. To bridge this gap, we introduce STEP, a dataset that models CBT counseling by explicitly reflecting automatic thoughts alongside dynamic, action-level counseling sequences. Using this dataset, we train STEPPER, a counseling agent that proactively elicits automatic thoughts and executes cognitively grounded interventions. To further enhance both decision accuracy and empathic responsiveness, we refine STEPPER through preference learning based on simulated, synthesized counseling sessions. Extensive CBT-aligned evaluations show that STEPPER delivers more clinically grounded, coherent, and personalized counseling compared to other strong baseline models, and achieves higher counselor competence without inducing emotional disruption.