作为NLP任务的治疗：比较LLM与人类同伴在CBT会话中的行为
Therapy as an NLP Task: Comparing LLMs and Human Peers Behaviors in CBT Sessions
AI总结：
本研究比较人类同伴与LLM在多轮CBT会话中的行为，发现人类擅长关系建立但结构弱，LLM方法遵循强但存在轮流发言和欺骗性共情问题。
摘要：
大型语言模型（LLMs）正越来越多地被用作临时治疗师。虽然先前研究发现LLMs在生成单轮共情回应方面优于人类咨询师，但较少研究比较它们在多轮会话中的行为。在本研究中，我们比较了人类同伴咨询师与LLM在会话层面的行为，两者均基于同一手册接受训练，以提供多轮、单次会话的认知行为疗法（CBT）。我们的三阶段混合方法研究包括：（a）对一个同伴支持平台进行为期18个月的民族志研究，其中七名咨询师通过110次自我咨询会话和60次每周焦点小组迭代完善CBT提示；（b）一种新颖的会话生成方法，允许在匹配条件下对人类和LLM咨询师进行直接、受控的比较——客户回应取自公开可用的人类主导的CBT会话，而咨询师回应由CBT提示的LLM生成；（c）由三名持照临床心理学家进行的专家评估。通过数据三角验证，我们的结果显示出一种权衡。人类同伴咨询师使用关系技术来解读微妙线索，将CBT适应用户的价值观和文化背景，并使用诸如闲聊和情境相关的自我披露等策略来建立融洽关系并引导会话，但往往以牺牲会话结构和治疗焦点为代价。相比之下，LLM咨询师表现出对CBT技术更强的方法论遵循，但在维持轮流发言方面存在困难，经常无法区分临床重要与琐碎内容，并且更倾向于说教和强加解决方案。LLM咨询师还倾向于产生“欺骗性共情”，即过度拟人化的回应，这可能抬高用户对真正人类关怀的期望。
英文摘要：
Large language models (LLMs) are increasingly being used as ad hoc therapists. While prior research has found that LLMs outperform human counselors in generating single-turn empathetic responses, fewer studies have compared their behaviors across multi-turn sessions. In this study, we compare the session-level behaviors of human peer counselors with those of an LLM, both trained on the same manual to deliver multi-turn, single-session Cognitive Behavioral Therapy (CBT). Our three-phase, mixed-methods study involved: (a) an 18-month ethnography of a peer support platform, where seven counselors iteratively refined CBT prompts through 110 self-counseling sessions and 60 weekly focus groups; (b) a novel session generation method that allows direct, controlled comparison of human and LLM counselors under matched conditions---client responses were drawn from publicly available human-led CBT sessions while counselor responses were generated by a CBT-prompted LLM; and (c) expert evaluations conducted by three licensed clinical psychologists. Through data triangulation, our results show a trade-off. Human peer counselors use relational techniques to interpret subtle cues, adapt CBT to users' values and cultural contexts, and use strategies such as small talk and contextually relevant self-disclosure to build rapport and guide the session, but often at the expense of session structure and therapeutic focus. LLM counselors, on the other hand, demonstrate greater methodological adherence to CBT techniques, but struggle to sustain turn-taking, frequently fail to distinguish between clinically important and trivial content, and are more prone to lecturing and imposing solutions. LLM counselors also tend to produce ``deceptive empathy'', excessively anthropomorphic responses that can inflate user expectations of genuine human care.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
