Taking a turn for the better: Conversation redirection throughout the course of mental-health therapy

TL;DR

This study introduces a probabilistic measure to analyze conversation redirection in mental-health therapy, revealing how control dynamics evolve and relate to relationship satisfaction over multiple online sessions.

Contribution

The paper presents a novel probabilistic measure for conversation redirection and applies it to large-scale online therapy data to study relationship development.

Findings

Patient control increases over time.

Less initial control predicts dissatisfaction and termination.

Redirection patterns correlate with relationship quality.

Abstract

Mental-health therapy involves a complex conversation flow in which patients and therapists continuously negotiate what should be talked about next. For example, therapists might try to shift the conversation's direction to keep the therapeutic process on track and avoid stagnation, or patients might push the discussion towards issues they want to focus on. How do such patient and therapist redirections relate to the development and quality of their relationship? To answer this question, we introduce a probabilistic measure of the extent to which a certain utterance immediately redirects the flow of the conversation, accounting for both the intention and the actual realization of such a change. We apply this new measure to characterize the development of patient-therapist relationships over multiple sessions in a very large, widely-used online therapy platform. Our analysis reveals that (1) patient control of the conversation's direction generally increases relative to that of the therapist as their relationship progresses; and (2) patients who have less control in the first few sessions are significantly more likely to eventually express dissatisfaction with their therapist and terminate the relationship.