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Study of texting aims to improve crisis counseling

Stanford researchers find core language techniques among the most successful counselors

What a counselor says -- or doesn't say -- during a crisis counseling session can make a big difference in whether a client goes away better able to cope, according to a new study by Stanford University researchers.

The study is an example of how social-media technology is helping to revolutionize research into mental health services. The Stanford research is the largest study to date in counseling conversation strategies. Instead of evaluating voice transcripts of conversations, which are typically small samplings, the researchers used data from an SMS texting-based counseling service, through which people with issues such as depression, self-harm, suicidal thoughts and anxiety engaged in therapeutic conversations with counselors. The data set had millions of messages from 80,000 counseling conversations conducted by hundreds of counselors over the course of a year. The researchers analyzed 660,000 anonymous text messages from 15,000 crisis counseling sessions.

"We find that there are significant, quantifiable differences between more successful and less successful counselors in how they conduct conversations," the researchers wrote.

The study was published in the August issue of "Transactions of the Association for Computational Linguistics" by researchers Jure Leskovec, associate professor of computer sciences at Stanford, and graduate students Tim Althoff and Kevin Clark. The trio developed their own computational discourse-analysis methods.

They analyzed words and phrases used by counselors to determine whether they helped distressed people who texted to feel better at the end of the conversation.

Successful counselors were more sensitive to the trajectory of a conversation and reacted accordingly; clarified ambiguity by writing more; reflected back to check that they are understanding what the client was saying; and made the client more comfortable through affirmation. The counselors responded in more creative ways without templates or generic responses, and they understood the core issue faster and moved on to collaboratively solve the problem. They also used language to change perspective.

"We find that people in distress are more likely to be more positive, think about the future, and consider others when the counselors bring up these concepts," they wrote. This perspective change is also associated with better conversation outcomes in depressed patients, they found.

The researchers were able to predict the outcomes of conversations, a useful tool that could help develop better counseling practices, they said.

Steering the conversation away from ambiguity also played an important role in the conversations that were more successful. Those counselors wrote back to clients almost as much as the clients wrote. They asked more detailed questions and paraphrased the responses back to the client to confirm they re understood the issue. They asked "check questions" -- statements that tell the conversation partner that they understood them while avoiding any opinion or advice -- such as checking for suicidal thoughts early and thanking the texter for having the courage to talk to them.

Successful counselors moved quickly past early stages of conversation, such as the introduction and the framing of the problem, to exploring the issue and problem solving. They had more "power" in the conversation and were able to move it forward, the study found.

Texters also explained their issue largely based on the past and present. Subtle changes in language could put clients in a better frame of mind, such as talking about the future or speaking positively.

The researchers hope to eventually help develop conversation applications to support counselors during training and conversations, they said.

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Any person who is feeling depressed, troubled or suicidal is urged to call 1-800-784-2433 to speak with a crisis counselor. People in Santa Clara County can also call 1-855-278-4204.

People can also reach trained Crisis Text Line counselors by texting "HELLO" to 741741.

Links below provide more resources where one can receive help:

Resources: How to help those in crisis

Guest opinion: How to help those in crisis

Q&A about mental health: Local experts offer their advice, guidance

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Comments

19 people like this
Posted by Yikes
a resident of Midtown
on Aug 26, 2016 at 1:48 pm

Yikes is a registered user.

Seriously? Texting? Language and voice can give comfort and assurance, but texting does not account for facial expression or voice inflections and tone.

Sounds like another Stanford joke!


6 people like this
Posted by Sarah1000
a resident of Los Altos
on Aug 27, 2016 at 2:27 pm

Yikes- There is a service called The Crisis Text Line (Web Link) that is very popular with youth. You can text anything to 741741 to start a texting conversation with a trained counselor. Although I agree that it's not a replacement for in-person therapy, it is good for linking people in crisis with services that can help them. It also has the advantage of being available 24/7.


Posted by america is racist
a resident of South of Midtown

on Aug 28, 2016 at 3:38 pm


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8 people like this
Posted by Former Stanford Dean
a resident of Ventura
on Aug 29, 2016 at 11:22 am

In my years of counseling at Stanford, I found that many times students in crisis prefer to "hide" behind texting rather than talk on the phone or come in to meet in person. When a person is in crisis is important to recognize their needs at the moment and use any means of communication available.


2 people like this
Posted by Sally Bemus
a resident of Community Center
on Aug 29, 2016 at 11:25 am

@ Sarah1000

Thanks for clarifying how a texting service can lead to face to face conversations. Our youth have been asking for this type of service for years and some have attempted to launch their own crisis text line. As this article points out the challenge is having trained people 24/7 on the receiving end of the text with the ability to connect, help and refer the person in need to local services.

Crisis Text Line will be presenting at the next community Project Safety Net meeting, Wednesday September 28th,4-6pm at the Rinconada Library Embarcadero Room, 1213 Newell Rd. Palo Alto. All are welcome to join. RSVP @ Web Link


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