JMIR Publications

ABSTRACT

Background:

Building therapeutic relationships and social presence are challenging in digital services and may be even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations.

Objective:

Using conversation transcripts from the text- and chat-arms of the National Child Abuse Hotline, this study aims to categorize crisis counselors’ efforts to build rapport and attend to the emotional dynamics of written conversations. Using these categories, we identify patterns of responses associated with positive outcomes, as reported by help-seekers.

Methods:

The sample consists of transcripts from 314 purposely selected conversations out of the 1,153 text and chat conversations during July 2020. Hotline users answered a pre-conversation survey (i.e., demographics) and a post-conversation survey (i.e., their perceptions of the conversation). Although we analyzed all the conversations, we were particularly interested in the 45 instances where help-seekers reported that the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress. We used qualitative content analysis to process the conversations.

Results:

Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with negatively-perceived conversations, positive conversations tended to include fewer statements that attend to the emotional dynamics, particularly apologies, paraphrasing, and open questions (Table 3). Beyond differences in the number of emotional attending statements, there were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailored their comments to the situation.

Conclusions:

Building therapeutic relationships and social presence are essential components of digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates ways to do so effectively. Future research must identify and evaluate effective ways to train providers to use these techniques.