Adam C. Frank | Search arXiv

arXiv2026

CounselReflect: Opportunities and Challenges for Designing Tools to Support Self-Reflection on Mental Health and Well-Being Conversations with AI

AI is increasingly used for mental health and well-being support, creating an urgent need for safer engagement, while design, evaluation, and governance take time to develop. We explore a complementary approach: helping users critically reflect on their own AI conversations. We introduce CounselReflect, a tool that translates literature-grounded counseling quality metrics into a user-facing reflection framework. Using CounselReflect as a study probe, we interviewed 21 users of AI for mental health and well-being support. Although most participants did not routinely reflect on their conversations, they articulated concrete questions they would want reflection to address. Tool-assisted reflection also revealed challenges: participants selectively sought evidence confirming existing perceptions of AI and prioritized dimensions they already valued. We argue that reflection tools should surface blind spots and scaffold more holistic examination of AI interactions. Finally, overcoming emotional barriers to revisiting tense conversations remains a major design challenge and warrants input from future work.

cs.CL↗

arXiv2026

CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answering

Medical question answering (QA) benchmarks often focus on multiple-choice or fact-based tasks, leaving open-ended answers to real patient questions underexplored. This gap is particularly critical in mental health, where patient questions often mix symptoms, treatment concerns, and emotional needs, requiring answers that balance clinical caution with contextual sensitivity. We present CounselBench, a large-scale benchmark developed with 100 mental health professionals to evaluate and stress-test large language models (LLMs) in realistic help-seeking scenarios. The first component, CounselBench-EVAL, contains 2,000 expert evaluations of answers from GPT-4, LLaMA 3, Gemini, and online human therapists on patient questions from the public forum CounselChat. Each answer is rated across six clinically grounded dimensions, with span-level annotations and written rationales. Expert evaluations show that while LLMs achieve high scores on several dimensions, they also exhibit recurring issues, including unconstructive feedback, overgeneralization, and limited personalization or relevance. Responses were frequently flagged for safety risks, most notably unauthorized medical advice. Follow-up experiments show that LLM judges systematically overrate model responses and overlook safety concerns identified by human experts. To probe failure modes more directly, we construct CounselBench-Adv, an adversarial dataset of 120 expert-authored mental health questions designed to trigger specific model issues. Expert evaluation of 1,080 responses from nine LLMs reveals consistent, model-specific failure patterns. Together, CounselBench establishes a clinically grounded framework for benchmarking LLMs in mental health QA.

cs.CL↗