Multi-Objective Aligned Small Language Model Framework for SUD Patient Dialogue Generation

In-person cognitive assessment is both a test and an interaction. Clinicians explain tasks, repair misunderstandings, and adapt to patient responses, while patients may hesitate, seek clarification, or disengage. Yet clinical dialogue resources rarely label the interaction structure needed to study these behaviors at scale. We present an de-identified corpus of 33 cognitive assessment conversations with 8,250 utterances annotated for three speaker roles and 56 dialogue acts. We use this corpus to benchmark large language models on fine-grained dialogue-act classification and next-patient-utterance generation. We also test whether out-of-domain instruction data and explanation-augmented training transfer to this clinical setting. Instruction tuning produces the strongest patient-utterance reference matching and improves classification accuracy. Reasoning-aware fine-tuning produces the strongest classification results among the LLaMA-3.1-8B variants. However, even the best models struggle to separate closely related dialogue acts, showing that broad conversational intent is easier to recognize than fine-grained communicative function. The corpus and benchmark make interaction structure measurable in cognitive assessments and support follow-up work on conversational markers, clinician education, and carefully validated simulated patients. This work does not make diagnostic claims. Instead, it provides the data and evaluation framework needed to study these applications.

Rising demand for mental health support has increased interest in using Large Language Models (LLMs) for counseling, but adapting them to this safety-critical domain is hindered by limited real-world data due to privacy constraints. Synthetic datasets provide a promising alternative, but existing approaches often rely on unstructured or semi-structured text inputs and overlook structural dependencies between a client's cognitive, emotional, and behavioral states, leading to psychologically inconsistent and less realistic interactions. We introduce Graph2Counsel, a framework for generating synthetic counseling sessions grounded in Client Psychological Graphs (CPGs) that encode relationships among clients' thoughts, emotions, and behaviors. Graph2Counsel uses a structured prompting pipeline guided by counselor strategies and CPG, and explores prompting strategies including CoT and Multi-Agent Feedback. It produces 760 sessions from 76 CPGs across diverse client profiles. In expert evaluation, our dataset outperforms prior datasets on specificity, counselor competence, authenticity, conversational flow, and safety (Krippendorff's $α$ = 0.70). Fine-tuning an open-source model on this dataset improves performance on several metrics on CounselingBench and CounselBench, while matching baselines on others. We further introduce Therapy-Eval, a multi-turn evaluation framework, and demonstrate the effectiveness of our fine-tuned model in realistic therapeutic conversations. We make our code, data and fine-tuned model public.

Mental health challenges are increasing worldwide, straining emotional support services and leading to counselor overload. This can result in delayed responses during critical situations, such as suicidal ideation, where timely intervention is essential. While large language models (LLMs) have shown strong generative capabilities, their application in low-resource languages, especially in sensitive domains like mental health, remains underexplored. Furthermore, existing LLM-based agents often struggle to replicate the supportive language and intervention strategies used by professionals due to a lack of training on large-scale, real-world datasets. To address this, we propose CARE (Counselor-Aligned Response Engine), a GenAI framework that assists counselors by generating real-time, psychologically aligned response recommendations. CARE fine-tunes open-source LLMs separately for Hebrew and Arabic using curated subsets of real-world crisis conversations. The training data consists of sessions rated as highly effective by professional counselors, enabling the models to capture interaction patterns associated with successful de-escalation. By training on complete conversation histories, CARE maintains the evolving emotional context and dynamic structure of counselor-help-seeker dialogue. In experimental settings, CARE demonstrates stronger semantic and strategic alignment with gold-standard counselor responses compared to non-specialized LLMs. These findings suggest that domain-specific fine-tuning on expert-validated data can significantly support counselor workflows and improve care quality in low-resource language contexts.