Understanding Why Youths Do (and Don’t) Use Therapy Skills In Real Life Situations with Large Language Models

We analyzed 2,249 psychotherapy sessions from 198 youths using GPT-4o and found that youths were most motivated to use skills that felt intrinsically rewarding and provided symptom relief. Greater out-of-session skill use predicted significantly fewer internalizing and externalizing symptoms. We discuss the reliability and clinical utility of large language models