Toward Causal Understanding of Therapist-Client Relationships: A Study of Language Modality and Social Entrainment.

The relationship between a therapist and their client is one of the most critical determinants of successful therapy. The working alliance is a multifaceted concept capturing the collaborative aspect of the therapist-client relationship; a strong working alliance has been extensively linked to many positive therapeutic outcomes. Although therapy sessions are decidedly multimodal interactions, the language modality is of particular interest given its recognized relationship to similar dyadic concepts such as rapport, cooperation, and affiliation. Specifically, in this work we study language entrainment, which measures how much the therapist and client adapt toward each other's use of language over time. Despite the growing body of work in this area, however, relatively few studies examine causal relationships between human behavior and these relationship metrics: does an individual's perception of their partner affect how they speak, or does how they speak affect their perception? We explore these questions in this work through the use of structural equation modeling (SEM) techniques, which allow for both multilevel and temporal modeling of the relationship between the quality of the therapist-client working alliance and the participants' language entrainment. In our first experiment, we demonstrate that these techniques perform well in comparison to other common machine learning models, with the added benefits of interpretability and causal analysis. In our second analysis, we interpret the learned models to examine the relationship between working alliance and language entrainment and address our exploratory research questions. The results reveal that a therapist's language entrainment can have a significant impact on the client's perception of the working alliance, and that the client's language entrainment is a strong indicator of their perception of the working alliance. We discuss the implications of these results and consider several directions for future work in multimodality.

Computational analysis of spoken language in acute psychosis and mania.

OBJECTIVES: This study aimed to (1) determine the feasibility of collecting behavioral data from participants hospitalized with acute psychosis and (2) begin to evaluate the clinical information that can be computationally derived from such data. METHODS: Behavioral data was collected across 99 sessions from 38 participants recruited from an inpatient psychiatric unit. Each session started with a semi-structured interview modeled on a typical "clinical rounds" encounter and included administration of the Positive and Negative Syndrome Scale (PANSS). ANALYSIS: We quantified aspects of participants' verbal behavior during the interview using lexical, coherence, and disfluency features. We then used two complementary approaches to explore our second objective. The first approach used predictive models to estimate participants' PANSS scores from their language features. Our second approach used inferential models to quantify the relationships between individual language features and symptom measures. RESULTS: Our predictive models showed promise but lacked sufficient data to achieve clinically useful accuracy. Our inferential models identified statistically significant relationships between numerous language features and symptom domains. CONCLUSION: Our interview recording procedures were well-tolerated and produced adequate data for transcription and analysis. The results of our inferential modeling suggest that automatic measurements of expressive language contain signals highly relevant to the assessment of psychosis. These findings establish the potential of measuring language during a clinical interview in a naturalistic setting and generate specific hypotheses that can be tested in future studies. This, in turn, will lead to more accurate modeling and better understanding of the relationships between expressive language and psychosis.

Goals, Tasks, and Bonds: Toward the Computational Assessment of Therapist Versus Client Perception of Working Alliance.

Early client dropout is one of the most significant challenges facing psychotherapy: recent studies suggest that at least one in five clients will leave treatment prematurely. Clients may terminate therapy for various reasons, but one of the most common causes is the lack of a strong working alliance. The concept of working alliance captures the collaborative relationship between a client and their therapist when working toward the progress and recovery of the client seeking treatment. Unfortunately, clients are often unwilling to directly express dissatisfaction in care until they have already decided to terminate therapy. On the other side, therapists may miss subtle signs of client discontent during treatment before it is too late. In this work, we demonstrate that nonverbal behavior analysis may aid in bridging this gap. The present study focuses primarily on the head gestures of both the client and therapist, contextualized within conversational turn-taking actions between the pair during psychotherapy sessions. We identify multiple behavior patterns suggestive of an individual's perspective on the working alliance; interestingly, these patterns also differ between the client and the therapist. These patterns inform the development of predictive models for self-reported ratings of working alliance, which demonstrate significant predictive power for both client and therapist ratings. Future applications of such models may stimulate preemptive intervention to strengthen a weak working alliance, whether explicitly attempting to repair the existing alliance or establishing a more suitable client-therapist pairing, to ensure that clients encounter fewer barriers to receiving the treatment they need.