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

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.

Figures (4)

• Figure 1: Top: Examples of attempted redirection, both realized (left) and unrealized (right). Bottom: Example where redirection is not attempted. $T_k$ and $C_k$ refer to the therapist's and patient's $k^{\rm th}$ utterance, respectively. Note that in general, both parties can redirect.
• Figure 2: Average redirection across the first 5 and last 5 sessions. Throughout, error bars indicate 95% confidence intervals estimated through bootstrap sampling.
• Figure 3: Patient redirection relative to that of the therapist across the first 5 and last 5 sessions.
• Figure 4: Number of sessions per $N$ from 10,000 random conversations.