How Well Can Large Language Models Reflect? A Human Evaluation of LLM-generated Reflections for Motivational Interviewing Dialogues

Erkan Basar, Xin Sun, Iris Hendrickx, Jan de Wit, Tibor Bosse, Gert-Jan De Bruijn, Jos A. Bosch, Emiel Krahmer


Abstract
Motivational Interviewing (MI) is a counseling technique that promotes behavioral change through reflective responses to mirror or refine client statements. While advanced Large Language Models (LLMs) can generate engaging dialogues, challenges remain for applying them in a sensitive context such as MI. This work assesses the potential of LLMs to generate MI reflections via three LLMs: GPT-4, Llama-2, and BLOOM, and explores the effect of dialogue context size and integration of MI strategies for reflection generation by LLMs. We conduct evaluations using both automatic metrics and human judges on four criteria: appropriateness, relevance, engagement, and naturalness, to assess whether these LLMs can accurately generate the nuanced therapeutic communication required in MI. While we demonstrate LLMs’ potential in generating MI reflections comparable to human therapists, content analysis shows that significant challenges remain. By identifying the strengths and limitations of LLMs in generating empathetic and contextually appropriate reflections in MI, this work contributes to the ongoing dialogue in enhancing LLM’s role in therapeutic counseling.
Anthology ID:
2025.coling-main.135
Volume:
Proceedings of the 31st International Conference on Computational Linguistics
Month:
January
Year:
2025
Address:
Abu Dhabi, UAE
Editors:
Owen Rambow, Leo Wanner, Marianna Apidianaki, Hend Al-Khalifa, Barbara Di Eugenio, Steven Schockaert
Venue:
COLING
SIG:
Publisher:
Association for Computational Linguistics
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Pages:
1964–1982
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URL:
https://aclanthology.org/2025.coling-main.135/
DOI:
Bibkey:
Cite (ACL):
Erkan Basar, Xin Sun, Iris Hendrickx, Jan de Wit, Tibor Bosse, Gert-Jan De Bruijn, Jos A. Bosch, and Emiel Krahmer. 2025. How Well Can Large Language Models Reflect? A Human Evaluation of LLM-generated Reflections for Motivational Interviewing Dialogues. In Proceedings of the 31st International Conference on Computational Linguistics, pages 1964–1982, Abu Dhabi, UAE. Association for Computational Linguistics.
Cite (Informal):
How Well Can Large Language Models Reflect? A Human Evaluation of LLM-generated Reflections for Motivational Interviewing Dialogues (Basar et al., COLING 2025)
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PDF:
https://aclanthology.org/2025.coling-main.135.pdf