Hanging in the Balance: Pivotal Moments in Crisis Counseling Conversations

During a conversation, there can come certain moments where its outcome hangs in the balance. In these pivotal moments, how one responds can put the conversation on substantially different trajectories leading to significantly different outcomes. Systems that can detect when such moments arise could assist conversationalists in domains with highly consequential outcomes, such as mental health crisis counseling. In this work, we introduce an unsupervised computational method for detecting such pivotal moments as they happen, in an online fashion. Our approach relies on the intuition that a moment is pivotal if our expectation of the outcome varies widely depending on what might be said next. By applying our method to crisis counseling conversations, we first validate it by showing that it aligns with human perception -- counselors take significantly longer to respond during moments detected by our method -- and with the eventual conversational trajectory -- which is more likely to change course at these times. We then use our framework to explore the relation of the counselor's response during pivotal moments with the eventual outcome of the session.

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

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.