Alignment of Large Language Model Responses With Human Therapists in Motivational Interviewing

Can a large language model (LLM) generate therapist responses that align with human therapist turns in motivational interviewing (MI)–oriented conversations?In this cross-sectional study of 154 high-fidelity MI sessions (3706 therapist turns), the LLM showed low semantic similarity to therapist responses but higher contextual appropriateness. Alignment was significantly higher in sessions with greater therapist topic consistency and declined modestly over longer conversations.The findings suggest LLMs can produce contextually appropriate MI-consistent responses, but limitations in coherence and stylistic alignment highlight the need for further validation before clinical use.

Corresponding Author: Venkat Bhat, MD, MSc, Interventional Psychiatry Program, St Michael’s Hospital, Unity Health Toronto, 193 Yonge St, 6-012, Toronto, ON M5B 1M4, Canada (venkat.bhat@utoronto.ca).

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