Distinguished Speaker Series: Lillian Lee (Cornell)- Taking a turn for the better? Pivoting and pivotal moments in mental-health counseling conversations

Abstract: So much of human interaction occurs as conversations, and it is both fascinating and imperative to analyze them. Recently, my co-authors and I have turned to texting-based conversations between mental-health therapists or crisis counselors and their clients, seeking to identify “key” moments in these exchanges:

(1) A “pivoting” moment corresponds to a *redirection* of the conversation introduced by one party that is accepted/followed by the other. We develop a probabilistic measure of how much an utterance immediately redirects the flow of the conversation, accounting for both the intention and the actual realization of such a change.

(2) In a *pivotal* moment, the conversation’s outcome hangs in the balance: how one responds can put the conversation on substantially diverging trajectories leading to significantly different results. We formalize this intuition by estimating the variance in expectation of outcome depending on what might be said next.

We find significant correlates of our measures in real human conversations on widely-used platforms. For example, the patients in our longer-term mental-health-therapy data who redirected less in their first few sessions were significantly more likely to eventually express dissatisfaction with their therapist and terminate the relationship; and the staff responses in our crisis-counseling data had greater estimated impact on disengagement rates during pivotal moments than in non-.

Joint work with Vivian Nguyen, Cristian Danescu-Niculescu-Mizil, Thomas D. Hull, and Sang Min (Dave) Jung.