The increasing use of large language models (LLMs) in mental healthcare raises safety concerns in high-stakes therapeutic interactions. A key challenge is distinguishing therapeutic empathy from maladaptive validation, where supportive responses may inadvertently reinforce harmful beliefs or behaviors in multi-turn conversations. This risk is largely overlooked by existing red-teaming frameworks, which focus mainly on generic harms or optimization-based attacks. To address this gap, we introduce Persona-based Client Simulation Attack (PCSA), the first red-teaming framework that simulates clients in psychological counseling through coherent, persona-driven client dialogues to expose vulnerabilities in psychological safety alignment. Experiments on eight general and mental health-specialized LLMs show that PCSA substantially outperforms four competitive baselines. Perplexity analysis and human inspection further indicate that PCSA generates more natural and realistic dialogues. Our results reveal that current LLMs remain vulnerable to domain-specific adversarial tactics, providing unauthorized medical advice, reinforcing delusions, and implicitly encouraging risky actions.

Large audio-language models (LALMs) increasingly use explicit reasoning traces for complex audio understanding, yet the evaluation of reasoning quality remains underexplored. Although process-level benchmarks for process reward models (PRMs) have advanced reasoning evaluation in text and multi-modal domains, comparable evaluation for audio reasoning remains limited. In this paper, we present AudioProcessBench, a comprehensive benchmark for step-level process error identification in audio reasoning. AudioProcessBench contains diverse reasoning traces generated by 6 audio and omni language models. Each trace is segmented into discrete reasoning steps and annotated with binary step correctness and fine-grained error types. Our benchmark evaluates models under three complementary paradigms: (1) step correctness identification, (2) error-type-conditioned detection for diagnosing audio-specific verifier capacities, and (3) chain-level aggregation, where verifiers select or aggregate among multiple reasoning traces for the same question. This design enables a systematic analysis of whether current models can detect process errors, whether their weaknesses differ across audio-specific error types, and whether process verification translates into improved answer selection. AudioProcessBench provides a testbed for future research on audio reasoning verifiers, process reward models, and reliable omni-modal reasoning.

Personalized Large Language Models (PLLMs) aim to tailor responses to individual users, where a central challenge is preference reasoning: inferring query-relevant preferences from user-related history. Existing benchmarks, however, largely assume that such preference can be retrieved from semantically related history. We study an underexplored but practically important regime, profile-preference conceptual misalignment (PRCM), where observable profile cues and query-specific preferences lie in different concept spaces, making semantic retrieval inconsistent for personalization. We introduce Vibe-Bench, a benchmark with two psychology-grounded tasks, 3,504 personas and 12,239 dialogues, including a manually verified gold test set, and requires cross-concept preference reasoning beyond surface semantic overlap. Experiments with several personalization methods show that current PLLMs largely rely on shallow semantic correlations and fail to acquire robust cross-concept mappings. These findings establish PRCM as a distinct failure regime in PLLMs and position Vibe-Bench as a focused testbed for advancing preference reasoning beyond semantic matching.

The increasing integration of large language models (LLMs) into mental health applications necessitates robust frameworks for evaluating professional safety alignment. Current evaluative approaches primarily rely on refusal-based safety signals, which offer limited insight into the nuanced behaviors required in clinical practice. In mental health, clinically inadequate refusals can be perceived as unempathetic and discourage help-seeking. To address this gap, we move beyond refusal-centric metrics and introduce PsychEthicsBench, the first principle-grounded benchmark based on Australian psychology and psychiatry guidelines, designed to evaluate LLMs’ ethical knowledge and behavioral responses through multiple-choice and open-ended tasks with fine-grained ethicality annotations. Empirical results across 14 models reveal that refusal rates are poor indicators of ethical behavior, revealing a significant divergence between safety triggers and clinical appropriateness. Notably, we find that domain-specific fine-tuning can degrade ethical robustness, as several specialized models underperform their base backbones in ethical alignment. PsychEthicsBench provides a foundation for systematic, jurisdiction-aware evaluation of LLMs in mental health, encouraging more responsible development in this domain.

Recent advancements in large language models have revolutionized the field of psychological counseling, especially in the context of Cognitive Behavioral Therapy (CBT). While the success of CBT relies heavily on dynamic decision-making informed by the client’s real-time mental state, this aspect has often been overlooked in current research, limiting both flexibility and therapeutic outcomes. In this paper, we introduce StratCBT, a dataset specifically designed for psychological counseling conversations with CBT Strategies, consisting of 9,688 sessions and around 256K utterances, with each counselor’s response aligned with one of eight distinct strategies. The creation of StratCBT involves modeling clients based on their negative thoughts and generating high-quality counseling conversations through self-chat, incorporating realistic sessions as guidance, thereby significantly surpassing existing datasets in both general counseling and CBT-specific skills. We conduct extensive experiments to demonstrate the effectiveness of strategy-aligned generation and evaluate its efficacy in delivering professional and effective counseling with LLM-simulated clients to reflect real-world scenarios. The dataset can be obtained from https://github.com/zimuwangnlp/StratCBT.

Large Language Models (LLMs) are increasingly used in advice seeking and decision making that may affect social judgements. Despite stigma’s profound effects on people and communities, benchmarks remain scarce. Existing general-domain evaluations typically rely on static prompts and fixed-format tasks, overlooking conversational contexts and audience effects in everyday communication. To address these gaps, we introduce SDARE-Bench, the first scenario-based benchmark evaluating both stigma detection and open-ended response generation in LLMs, comprising 1,138 dyadic queries and 1,388 group dialogues. Empirical results across 8 LLMs consistently demonstrate poor identification of stigma components, especially in group dialogues. In open-ended response generation, stigma expression was substantially higher in group settings than in dyadic, with weaker resistance to stigma and more unrealistic advice. Responses were evaluated using a classifier trained on 1,392 human annotated responses. In constructed group pressure settings, stigma expression rates further increased to a striking average of 97.5%. Our findings identify stigma response as a recurring LLM safety vulnerability, especially in socially complex conversational contexts.

The medical adoption of NLP tools requires interpretability by end users, yet traditional explainable AI (XAI) methods are misaligned with clinical reasoning and lack clinician input. We introduce CHiRPE (Clinical High-Risk Prediction with Explainability), an NLP pipeline that takes transcribed semi-structured clinical interviews to: (i) predict psychosis risk; and (ii) generate novel SHAP explanation formats co-developed with clinicians. Trained on 944 semi-structured interview transcripts across 24 international clinics of the AMP-SCZ study, the CHiRPE pipeline integrates symptom-domain mapping, LLM summarisation, and BERT classification. CHiRPE achieved over 90% accuracy across three BERT variants and outperformed baseline models. Explanation formats were evaluated by 28 clinical experts who indicated a strong preference for our novel concept-guided explanations, especially hybrid graph-and-text summary formats. CHiRPE demonstrates that clinically-guided model development produces both accurate and interpretable results. Our next step is focused on real-world testing across our 24 international sites.

Multimodal Large Language Models (MLLMs) have shown promise in visual-textual reasoning, with Multimodal Chain-of-Thought (MCoT) prompting significantly enhancing interpretability. However, existing MCoT methods rely on rationale-rich datasets and largely focus on inter-object reasoning, overlooking the intra-object understanding crucial for image classification. To address this gap, we propose WISE, a Weak-supervision-guided Step-by-step Explanation method that augments any image classification dataset with MCoTs by reformulating the concept-based representations from Concept Bottleneck Models (CBMs) into concise, interpretable reasoning chains under weak supervision. Experiments across ten datasets show that our generated MCoTs not only improve interpretability by 37% but also lead to gains in classification accuracy when used to fine-tune MLLMs. Our work bridges concept-based interpretability and generative MCoT reasoning, providing a generalizable framework for enhancing MLLMs in fine-grained visual understanding.

Concept Bottleneck Models (CBMs) decompose image classification into a process governed by interpretable, human-readable concepts. Recent advances in CBMs have used Large Language Models (LLMs) to generate candidate concepts. However, a critical question remains: What is the optimal number of concepts to use? Current concept banks suffer from redundancy or insufficient coverage. To address this issue, we introduce a dynamic, agent-based approach that adjusts the concept bank in response to environmental feedback, optimizing the number of concepts for sufficiency yet concise coverage. Moreover, we propose Conditional Concept Bottleneck Models (CoCoBMs) to overcome the limitations in traditional CBMs’ concept scoring mechanisms. It enhances the accuracy of assessing each concept’s contribution to classification tasks and feature an editable matrix that allows LLMs to correct concept scores that conflict with their internal knowledge. Our evaluations across 6 datasets show that our method not only improves classification accuracy by 6% but also enhances interpretability assessments by 30%.