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Psychodynamic conflicts are persistent, often unconscious themes that shape a person’s behaviour and experiences. Accurate diagnosis of psychodynamic conflicts is crucial for effective patient treatment and is commonly done via long, manually scored semi-structured interviews. Existing automated solutions for psychiatric diagnosis tend to focus on the recognition of broad disorder categories such as depression, and it is unclear to what extent psychodynamic conflicts which even the patient themselves may not have conscious access to could be automatically recognised from conversation. In this paper, we propose AutoPsyC, the first method for recognising the presence and significance of psychodynamic conflicts from full-length Operationalized Psychodynamic Diagnostics (OPD) interviews using Large Language Models (LLMs). Our approach combines recent advances in parameter-efficient fine-tuning and Retrieval-Augmented Generation (RAG) with a summarisation strategy to effectively process entire 90 minute long conversations. In evaluations on a dataset of 141 diagnostic interviews we show that AutoPsyC consistently outperforms all baselines and ablation conditions on the recognition of four highly relevant psychodynamic conflicts.

NAACL 2025

AutoPsyC: Automatic Recognition of Psychodynamic Conflicts from Semi-structured Interviews with Large Language Models

intrapsychic conflicts

semi-structured interviews

large language models

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### Welcome to 2025 Annual Conference of the Nations of the Americas Chapter of the Association for Computational Linguistics

Welcome to the 2025 meeting of the Nations of the Americas Chapter of the Association for Computational Linguistics! I am proud to help organize the first NAACL conference to carry the new name of our organization, one that emphasizes inclusion for all of the Americas. I am also pleased to welcome you to Albuquerque, New Mexico, a state whose unique blend of cultural influences will make for an excellent backdrop for NAACL 2025, especially with this year’s special theme on NLP in a Multicultural World. 
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Welcome to 2025 Annual Conference of the Nations of the Americas Chapter of the Association for Computational Linguistics

The increasing demand for mental health services has highlighted the need for innovative solutions, particularly in the realm of psychological conversational AI, where the availability of sensitive data is scarce. In this work, we explored the development of a system tailored for mental health support with a novel approach to psychological assessment based on explainable emotional profiles in combination with empathetic conversational models, offering a promising tool for augmenting traditional care, particularly where immediate expertise is unavailable. Our work can be divided into two main parts, intrinsecaly connected to each other. First, we present RACLETTE, a conversational system that demonstrates superior emotional accuracy compared to considered benchmarks in both understanding users’ emotional states and generating empathetic responses during conversations, while progressively building an emotional profile of the user through their interactions. Second, we show how the emotional profiles of a user can be used as interpretable markers for mental health assessment. These profiles can be compared with characteristic emotional patterns associated with different mental disorders, providing a novel approach to preliminary screening and support.

The Emotional Spectrum of LLMs: Leveraging Empathy and Emotion-Based Markers for Mental Health Support

Depression is a highly prevalent and disabling condition that incurs substantial personal and societal costs. Current depression diagnosis involves determining the depression severity of a person through self-reported questionnaires or interviews conducted by clinicians. This often leads to delayed treatment and involves substantial human resources. Thus, several works try to automate the process using multimodal data. However, they usually overlook the following: i) The variable contribution of each modality for each question in the questionnaire and ii) Using ordinal classification for the task. This results in sub-optimal fusion and training methods. In this work, we propose a novel Question-wise Modality Fusion (QuestMF) framework trained with a novel Imbalanced Ordinal Log-Loss (ImbOLL) function to tackle these issues. The performance of our framework is comparable to the current state-of-the-art models on the E-DAIC dataset and enhances interpretability by predicting scores for each question. This will help clinicians identify an individual’s symptoms, allowing them to customise their interventions accordingly. We also make the code for the QuestMF framework publicly available.

Enhancing Depression Detection via Question-wise Modality Fusion

Recent work has suggested detection of cognitive distortions as an impactful task for NLP in the clinical space, but the connection between language-detected distortions and validated mental health outcomes has been elusive. In this work, we evaluate the co-occurrence of (a) 10 distortions derived from language-based detectors trained over two common distortion datasets with (b) 12 mental health outcomes contained within two new language-to-mental-health datasets: DS4UD and iHiTOP. We find higher rates of distortions for those with greater mental health condition severity (ranging from r = 0.16 for thought disorders to r = 0.46 for depressed mood), and that the specific distortions of should statements and fortune telling were associated with a depressed mood and being emotionally drained, respectively. This suggested that language-based assessments of cognitive distortion could play a significant role in detection and monitoring of mental health conditions.

Linking Language-based Distortion Detection to Mental Health Outcomes

Computational mental health research develops models to predict and understand psychological phenomena, but often relies on inappropriate measures of psychopathology constructs, undermining validity. We identify three key issues: (1) reliance on unvalidated measures (e.g., self-declared diagnosis) over validated ones (e.g., diagnosis by clinician); (2) treating mental health constructs as categorical rather than dimensional; and (3) focusing on disorder-specific constructs instead of transdiagnostic ones. We outline the benefits of using validated, dimensional, and transdiagnostic measures and offer practical recommendations for practitioners. Using valid measures that reflect the nature and structure of psychopathology is essential for computational mental health research.

Measuring Mental Health Variables in Computational Research: Toward Validated, Dimensional, and Transdiagnostic Approaches

A rigorous psychometric approach is crucial for the accurate measurement of mind-reading abilities. Traditional scoring methods for such tests, which involve lengthy free-text responses, require considerable time and human effort. This study investigates the use of large language models (LLMs) to automate the scoring of psychometric tests. Data were collected from participants aged 13 to 30 years and scored by trained human coders to establish a benchmark. We evaluated multiple LLMs against human assessments, exploring various prompting strate- gies to optimize performance and fine-tuning the models using a subset of the collected data to enhance accuracy. Our results demonstrate that LLMs can assess advanced mind-reading abilities with over 90% accuracy on average. Notably, in most test items, the LLMs achieved higher Kappa agreement with the lead coder than two trained human coders, highlighting their potential to reliably score open-response psychometric tests.

Automatic Scoring of an Open-Response Measure of Advanced Mind-Reading Using Large Language Models

Disorganized thinking is a key diagnostic indicator of schizophrenia-spectrum disorders. Recently, clinical estimates of the severity of disorganized thinking have been shown to correlate with measures of how difficult speech transcripts would be for large language models (LLMs) to predict. However, LLMs’ deployment challenges – including privacy concerns, computational and financial costs, and lack of transparency of training data – limit their clinical utility. We investigate whether smaller neural language models can serve as effective alternatives for detecting positive formal thought disorder, using the same sliding window based perplexity measurements that proved effective with larger models. Surprisingly, our results show that smaller models are more sensitive to linguistic differences associated with formal thought disorder than their larger counterparts. Detection capability declines beyond a certain model size and context length, challenging the common assumption of “bigger is better” for LLM-based applications. Our findings generalize across audio diaries and clinical interview speech samples from individuals with psychotic symptoms, suggesting a promising direction for developing efficient, cost-effective, and privacy-preserving screening tools that can be deployed in both clinical and naturalistic settings.

Bigger But Not Better: Small Neural Language Models Outperform LLMs in Detection of Thought Disorder

Common factors and microcounseling skills are critical to the effectiveness of psychotherapy. Understanding and measuring these elements provides valuable insights into therapeutic processes and outcomes. However, automatic identification of these change principles from textual data remains challenging due to the nuanced and context-dependent nature of therapeutic dialogue. This paper introduces CFiCS, a hierarchical classification framework integrating graph machine learning with pre-trained contextual embeddings. We represent common factors, intervention concepts, and microcounseling skills as a heterogeneous graph, where textual information from ClinicalBERT enriches each node. This structure captures both the hierarchical relationships (e.g., skill-level nodes linking to broad factors) and the semantic properties of therapeutic concepts. By leveraging graph neural networks, CFiCS learns inductive node embeddings that generalize to unseen text samples lacking explicit connections. Our results demonstrate that integrating ClinicalBERT node features and graph structure significantly improves classification performance, especially in fine-grained skill prediction. CFiCS achieves substantial gains in both micro and macro F1 scores across all tasks compared to baselines, including random forests, BERT-based multi-task models, and graph-based methods.

CFiCS: Graph-Based Classification of Common Factors and Microcounseling Skills

Depression is the most common mental health disorder, and its prevalence increased during the COVID-19 pandemic. As one of the most extensively researched psychological conditions, recent research has increasingly focused on leveraging social media data to enhance traditional methods of depression screening. This paper addresses the growing interest in interdisciplinary research on depression, and aims to support early-career researchers by providing a comprehensive and up-to-date list of datasets for analyzing and predicting depression through social media data. We present an overview of datasets published between 2019 and 2024. We also make the comprehensive list of datasets available online as a continuously updated resource, with the hope that it will facilitate further interdisciplinary research into the linguistic expressions of depression on social media.

Datasets for Depression Modeling in Social Media: An Overview

In recent years, there has been growing interest in studying cognitive distortions and emotional appraisals from both computational and psychological perspectives. Despite considerable similarities between emotional reappraisal and cognitive reframing as emotion regulation techniques, these concepts have largely been examined in isolation. This research explores the relationship between cognitive distortions and emotional appraisal dimensions, examining their potential connections and relevance for future interdisciplinary studies. Under this pretext, we conduct an exploratory computational study, aimed at investigating the relationship between cognitive distortion and emotional appraisals. We show that the patterns of statistically significant relationships between cognitive distortions and appraisal dimensions vary across different distortion categories, giving rise to distinct appraisal profiles for individual distortion classes. Additionally, we analyze the impact of cognitive restructuring on appraisal dimensions, exemplifying the emotion regulation aspect of cognitive restructuring.

Exploratory Study into Relations between Cognitive Distortions and Emotional Appraisals

Natural language processing (NLP) holds potential for analyzing psychotherapy transcripts. Nonetheless, gathering the necessary data to train NLP models for clinical tasks is a challenging process due to patient confidentiality regulations that restrict data sharing. To overcome this obstacle, we propose leveraging large language models (LLMs) to create synthetic psychotherapy dialogues that can be used to train NLP models for downstream clinical tasks. To evaluate the quality of our synthetic data, we trained three multi-task RoBERTa-based bi-encoder models, originally developed by Sharma et al., to detect empathy in dialogues. These models, initially trained on Reddit data, were developed alongside EPITOME, a framework designed to characterize empathetic communication in conversations. We collected and annotated 579 therapeutic interactions between therapists and patients using the EPITOME framework. Additionally, we generated 10,464 synthetic therapeutic dialogues using various LLMs and prompting techniques, all of which were annotated following the EPITOME framework. We conducted two experiments: one where we augmented the original dataset with synthetic data and another where we replaced the Reddit dataset with synthetic data. Our first experiment showed that incorporating synthetic data can improve the F1 score of empathy detection by up to 10%. The second experiment revealed no substantial differences between organic and synthetic data, as their performance remained on par when substituted.

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