Script-Strategy Aligned Generation: Aligning LLMs with Expert-Crafted Dialogue Scripts and Therapeutic Strategies for Psychotherapy

Chatbots or conversational agents (CAs) are increasingly used to improve access to digital psychotherapy. Many current systems rely on rigid, rule-based designs, heavily dependent on expert-crafted dialogue scripts for guiding therapeutic conversations. Although recent advances in large language models (LLMs) offer the potential for more flexible interactions, their lack of controllability and transparency poses significant challenges in sensitive areas like psychotherapy. In this work, we explored how aligning LLMs with expert-crafted scripts can enhance psychotherapeutic chatbot performance. Our comparative study showed that LLMs aligned with expert-crafted scripts through prompting and fine-tuning significantly outperformed both pure LLMs and rule-based chatbots, achieving a more effective balance between dialogue flexibility and adherence to therapeutic principles. Building on findings, we proposed ``Script-Strategy Aligned Generation (SSAG)'', a flexible alignment approach that reduces reliance on fully scripted content while enhancing LLMs' therapeutic adherence and controllability. In a 10-day field study, SSAG demonstrated performance comparable to full script alignment and outperformed rule-based chatbots, empirically supporting SSAG as an efficient approach for aligning LLMs with domain expertise. Our work advances LLM applications in psychotherapy by providing a controllable, adaptable, and scalable solution for digital interventions, reducing reliance on expert effort. It also provides a collaborative framework for domain experts and developers to efficiently build expertise-aligned chatbots, broadening access to psychotherapy and behavioral interventions.