“Poker with Play Money”: Exploring Psychotherapist Training with Virtual Patients

Role-play exercises are widely utilized for training across a variety of domains; however, they have many shortcomings, including low availability, resource intensity, and lack of diversity. Large language model-driven virtual agents offer a potential avenue to mitigate these limitations and offer lower-risk role-play. The implications, however, of shifting this human-human collaboration to human-agent collaboration are still largely unexplored. In this work we focus on the context of psychotherapy, as psychotherapists-in-training extensively engage in role-play exercises with peers and/or supervisors to practice the interpersonal and therapeutic skills required for effective treatment. We provide a case study of a realistic ``virtual patient'' system for mental health training, evaluated by trained psychotherapists in comparison to their previous experiences with both real role-play partners and real patients. Our qualitative, reflexive analysis generated three themes and thirteen subthemes regarding key interpersonal skills of psychotherapy, the utility of the system compared to traditional role-play techniques, and factors which impacted psychotherapist-perceived ``humanness'' of the virtual patient. Although psychotherapists were optimistic about the system's potential to bolster therapeutic skills, this utility was impacted by the extent to which the virtual patient was perceived as human-like. We leverage the Computers Are Social Actors framework to discuss human--virtual-patient collaboration for practicing rapport, and discuss challenges of prototyping novel human-AI systems for clinical contexts which require a high degree of unpredictability. We pull from the ``SEEK'' three-factor theory of anthropomorphism to stress the importance of adequately representing a variety of cultural communities within mental health AI systems, in alignment with decolonial computing.