CALM-IT: Generating Realistic Long-Form Motivational Interviewing Dialogues with Dual-Actor Conversational Dynamics Tracking

Abstract

Large Language Models (LLMs) are increasingly used in mental health-related settings, yet they struggle to sustain realistic, goal-directed dialogue over extended interactions. While LLMs generate fluent responses, they optimize locally for the next turn rather than maintaining a coherent model of therapeutic progress, leading to brittleness and long-horizon drift. We introduce CALM-IT, a framework for generating and evaluating long-form Motivational Interviewing (MI) dialogues that explicitly models dual-actor conversational dynamics. CALM-IT represents therapist-client interaction as a bidirectional state-space process, in which both agents continuously update inferred alignment, mental states, and short-term goals to guide strategy selection and utterance generation. Across large-scale evaluations, CALM-IT consistently outperforms strong baselines in Effectiveness and Goal Alignment and remains substantially more stable as conversation length increases. Although CALM-IT initiates fewer therapist redirections, it achieves the highest client acceptance rate (64.3%), indicating more precise and therapeutically aligned intervention timing. Overall, CALM-IT provides evidence for modeling evolving conversational state being essential for generating high-quality long-form synthetic conversations.