[Submitted on 20 Oct 2026]
Title:Scaling Therapy Supervision: Assessing Psychotherapy Fidelity Using Large Language Models
View a PDF of the paper titled Scaling Therapy Supervision: Assessing Psychotherapy Fidelity Using Large Language Models, by Arvind Pillai and 13 other authors
View PDF HTML (experimental)
Abstract:Psychotherapy fidelity assessment measures how faithfully a therapist adheres to a treatment protocol, a critical determinant of positive patient outcomes. However, fidelity assessment is bottlenecked by manual expert review, rendering the process labor-intensive and unscalable. To scale therapy supervision and support clinician self-learning, we present an integrated application of large language models (LLMs) that automates psychotherapy fidelity workflows and generates actionable supervisory feedback from authentic, long-form clinical transcripts. We evaluate three open-weight models across multiple task decomposition configurations and reasoning strategies, demonstrating that evidence-first reasoning improves fidelity estimation. Furthermore, we establish the framework's external construct validity on an independent randomized controlled trial (RCT), where it reliably distinguishes Cognitive Behavioral Therapy (CBT) from non-CBT sessions across core therapeutic skills. Through a user study that evaluates the generated feedback, mental health experts indicate that the pipeline synthesizes actionable clinical feedback. Ultimately, our work offers a practical, scalable solution toward bridging the community mental health supervision gap.
Comments: 24 pages, under review
Subjects:
Computation and Language (cs.CL); Human-Computer Interaction (cs.HC)
Cite as: arXiv:2610.28772 [cs.CL]
(or arXiv:2610.28772v1 [cs.CL] for this version)
https://doi.org/10.48550/arXiv.2610.28772
arXiv-issued DOI via DataCite (pending registration)
Submission history
From: Arvind Pillai [view email] [v1] Tue, 20 Oct 2026 18:09:44 UTC (244 KB)
Full-text links:
Access Paper:
View a PDF of the paper titled Scaling Therapy Supervision: Assessing Psychotherapy Fidelity Using Large Language Models, by Arvind Pillai and 13 other authors
View PDF
HTML (experimental)
TeX Source
view license
Additional Features
Audio Summary
Current browse context:
cs.CL
new | recent | 2026-10
Change to browse by:
cs cs.HC
References & Citations
SciX
Google Scholar
Semantic Scholar
Loading...
Data provided by:
Bibliographic Tools
Bibliographic and Citation Tools
Bibliographic Explorer Toggle
Bibliographic Explorer (What is the Explorer?)
Connected Papers Toggle
Connected Papers (What is Connected Papers?)
Litmaps Toggle
Litmaps (What is Litmaps?)
scite.ai Toggle
scite Smart Citations (What are Smart Citations?)
Code, Data, Media
Code, Data and Media Associated with this Article
alphaXiv Toggle
alphaXiv (What is alphaXiv?)
Links to Code Toggle
CatalyzeX Code Finder for Papers (What is CatalyzeX?)
DagsHub Toggle
DagsHub (What is DagsHub?)
GotitPub Toggle
Gotit.pub (What is GotitPub?)
Huggingface Toggle
Hugging Face (What is Huggingface?)
ScienceCast Toggle
ScienceCast (What is ScienceCast?)
Demos
Demos
Replicate Toggle
Replicate (What is Replicate?)
Spaces Toggle
Hugging Face Spaces (What is Spaces?)
Spaces Toggle
TXYZ.AI (What is TXYZ.AI?)
Related Papers
Recommenders and Search Tools
Link to Influence Flower
Influence Flower (What are Influence Flowers?)
Core recommender toggle
CORE Recommender (What is CORE?)
Author
Venue
Institution
Topic
About arXivLabs
arXivLabs: experimental projects with community collaborators
arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.
Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.
Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.
Which authors of this paper are endorsers? | Disable MathJax (What is MathJax?)