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.
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: