# Taking a turn for the better: Conversation redirection throughout the course of mental-health therapy

arXiv: https://arxiv.org/abs/2410.07147 · HTML: https://mlsanity.com/paper/2410.07147/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 10 of its 44 references that are in the map.
- First posted on arXiv 9 Oct 2024.

## Builds on (most cited first, 10 of 10)

- [A Computational Approach to Understanding Empathy Expressed in Text-Based Mental Health Support](https://mlsanity.com/paper/2009.08441/) (2020)
- [ConvoKit: A Toolkit for the Analysis of Conversations](https://mlsanity.com/paper/2005.04246/) (2020)
- [Measuring Conversational Uptake: A Case Study on Student-Teacher Interactions](https://mlsanity.com/paper/2106.03873/) (2021)
- [Two-Level Transformer and Auxiliary Coherence Modeling for Improved Text Segmentation](https://mlsanity.com/paper/2001.00891/) (2020)
- [TIAGE: A Benchmark for Topic-Shift Aware Dialog Modeling](https://mlsanity.com/paper/2109.04562/) (2021)
- [Balancing Objectives in Counseling Conversations: Advancing Forwards or Looking Backwards](https://mlsanity.com/paper/2005.04245/) (2020)
- [SuperDialseg: A Large-scale Dataset for Supervised Dialogue Segmentation](https://mlsanity.com/paper/2305.08371/) (2023)
- [Conversation Model Fine-Tuning for Classifying Client Utterances in Counseling Dialogues](https://mlsanity.com/paper/1904.00350/) (2019)
- [Modeling Interpersonal Linguistic Coordination in Conversations using Word Mover's Distance](https://mlsanity.com/paper/1904.06002/) (2019)
- [Bursts of Activity: Temporal Patterns of Help-Seeking and Support in Online Mental Health Forums](https://mlsanity.com/paper/2004.10330/) (2020)

## Built on by (most cited first, 5 of 5)

- [A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions](https://mlsanity.com/paper/2502.11095/) (2025)
- [Hanging in the Balance: Pivotal Moments in Crisis Counseling Conversations](https://mlsanity.com/paper/2506.03941/) (2025)
- [CALM-IT: Enhancing Synthetic Motivational Interviewing Dialogue Quality with Conversational Dynamics](https://mlsanity.com/paper/2601.10085/) (2026)
- [Responsible Evaluation of AI for Mental Health](https://mlsanity.com/paper/2602.00065/) (2026)
- [Discourse Diversity in Multi-Turn Empathic Dialogue](https://mlsanity.com/paper/2604.11742/) (2026)

## Abstract (arXiv)

Mental-health therapy involves a complex conversation flow in which patients and therapists continuously negotiate what should be talked about next. For example, therapists might try to shift the conversation's direction to keep the therapeutic process on track and avoid stagnation, or patients might push the discussion towards issues they want to focus on. How do such patient and therapist redirections relate to the development and quality of their relationship? To answer this question, we introduce a probabilistic measure of the extent to which a certain utterance immediately redirects the flow of the conversation, accounting for both the intention and the actual realization of such a change. We apply this new measure to characterize the development of patient-therapist relationships over multiple sessions in a very large, widely-used online therapy platform. Our analysis reveals that (1) patient control of the conversation's direction generally increases relative to that of the therapist as their relationship progresses; and (2) patients who have less control in the first few sessions are significantly more likely to eventually express dissatisfaction with their therapist and terminate the relationship.