The critical therapist shortage demands scalable training solutions. Standardized Patients, the gold standard, are scarce and costly. Current LLM-based approaches focus on patient simulation for conversational realism but lack pedagogical rigor as Virtual Standardized Patients, lacking faithful reactions to clinical errors and explainable feedback. To bridge this gap, we propose PUPPET, the first neural-symbolic Virtual Standardized Patient governed by an OBSERVE-THINK-BEHAVE architecture. PUPPET externalizes LLM reasoning into a symbolic system where experts implant causal associations between intervention logic (propositional logic) and patient mental states (state machine). This allows PUPPET to behave coherently with controllable and explainable psychological dynamics: intervention logic (OBSERVE) → state transition (THINK) → response (BEHAVE). Our PUPPET-TRAINER further leverages this chain to educate trainees about intervention consequences, standardizing and scaling mental health training. Experiments across three clinical scenarios confirm that PUPPET outperforms baselines in clinical faithfulness and pedagogical value.

Large language models show potential for scalable mental-health support by simulating Cognitive Behavioral Therapy (CBT) counselors. However, existing methods often rely on static cognitive profiles and omniscient single-agent simulation, failing to capture the dynamic, information-asymmetric nature of real therapy. We introduce CCD-CBT, a multi-agent framework that shifts CBT simulation along two axes: 1) from a static to a dynamically reconstructed Cognitive Conceptualization Diagram (CCD), updated by a dedicated Control Agent, and 2) from omniscient to information-asymmetric interaction, where the Therapist Agent must reason from inferred client states. We release CCDChat, a synthetic multi-turn CBT dataset generated under this framework. Evaluations with clinical scales and expert therapists show that models fine-tuned on CCDChat outperform strong baselines in both counseling fidelity and positive-affect enhancement, with ablations validating dynamic CCD guidance and diagnostic analysis supporting asymmetric interaction design. Our work offers a new paradigm for building theory-grounded, clinically-plausible conversational agents.