Suicide is a major public health concern, underscoring the importance of understanding communication practices used in crisis intervention. Text-based crisis services are increasingly used, yet little is known about how counselors construct messages across encounters. One understudied feature of this setting is counselor text reuse, or the repeated use of identical or highly similar message content across different clients. Although reuse may support efficiency and consistency, it may raise questions about how personalised responses are across counselors. This study provides a descriptive analysis of counselor text reuse in a large dataset of 4.7 million messages of real-time text-based crisis counseling conversations. Across 136 counselors, mean message similarity was very low, indicating little overall text reuse for most counselors. However, 103 counselors showed at least one instance of detected reuse, and a smaller subset demonstrated more consistent reuse. Reuse was also positively associated with counselor encounter volume across measures of reuse. Frequently reused longer passages primarily involved structured coping-oriented or psychoeducational content, such as coping strategies, grounding exercises, self-care tips, and relaxation techniques. The findings suggest that counselor text reuse increased with encounter volume, but average levels of reuse were low across counselors and they provide a foundation for future work examining associations with service delivery and client outcomes.

Ensuring the effectiveness of text-based crisis counseling requires observing ongoing conversations and providing feedback, both labor-intensive tasks. Automatic analysis of conversations—at the full chat and utterance levels—may help support counselors and provide better care. While some session-level training data (e.g., rating of patient risk) is often available from counselors, labeling utterances requires expensive post hoc annotation. But the latter can not only provide insights about conversation dynamics, but can also serve to support quality assurance efforts for counselors. In this paper, we examine if inexpensive—and potentially noisy—session-level annotation can help improve label utterances. To this end, we propose a logic-based indirect supervision approach that exploits declaratively stated structural dependencies between both levels of annotation to improve utterance modeling. We show that adding these rules gives an improvement of 3.5% f-score over a strong multi-task baseline for utterance-level predictions. We demonstrate via ablation studies how indirect supervision via logic rules also improves the consistency and robustness of the system.

In psychotherapy interactions, the quality of a session is assessed by codifying the communicative behaviors of participants during the conversation through manual observation and annotation. Developing computational approaches for automated behavioral coding can reduce the burden on human coders and facilitate the objective evaluation of the intervention. In the real world, however, implementing such algorithms is associated with data sparsity challenges since privacy concerns lead to limited available in-domain data. In this paper, we leverage a publicly available conversation-based dataset and transfer knowledge to the low-resource behavioral coding task by performing an intermediate language model training via meta-learning. We introduce a task augmentation method to produce a large number of “analogy tasks” — tasks similar to the target one — and demonstrate that the proposed framework predicts target behaviors more accurately than all the other baseline models.

There are many different forms of psychotherapy. Itemized inventories of psychotherapeutic interventions provide a mechanism for evaluating the quality of care received by clients and for conducting research on how psychotherapy helps. However, evaluations such as these are slow, expensive, and are rarely used outside of well-funded research studies. Natural language processing research has progressed to allow automating such tasks. Yet, NLP work in this area has been restricted to evaluating a single approach to treatment, when prior research indicates therapists used a wide variety of interventions with their clients, often in the same session. In this paper, we frame this scenario as a multi-label classification task, and develop a group of models aimed at predicting a wide variety of therapist talk-turn level orientations. Our models achieve F1 macro scores of 0.5, with the class F1 ranging from 0.36 to 0.67. We present analyses which offer insights into the capability of such models to capture psychotherapy approaches, and which may complement human judgment.

Automatically analyzing dialogue can help understand and guide behavior in domains such as counseling, where interactions are largely mediated by conversation. In this paper, we study modeling behavioral codes used to asses a psychotherapy treatment style called Motivational Interviewing (MI), which is effective for addressing substance abuse and related problems. Specifically, we address the problem of providing real-time guidance to therapists with a dialogue observer that (1) categorizes therapist and client MI behavioral codes and, (2) forecasts codes for upcoming utterances to help guide the conversation and potentially alert the therapist. For both tasks, we define neural network models that build upon recent successes in dialogue modeling. Our experiments demonstrate that our models can outperform several baselines for both tasks. We also report the results of a careful analysis that reveals the impact of the various network design tradeoffs for modeling therapy dialogue.