Psychotherapy Computational Psychotherapy Research: Scaling up the Evaluation of Patient–Provider Interactions

In psychotherapy, the patient–provider interaction contains the treatment's active ingredients. However, the technology for analyzing the content of this interaction has not fundamentally changed in decades, limiting both the scale and specificity of psychotherapy research. New methods are required to " scale up " to larger evaluation tasks and " drill down " into the raw linguistic data of patient–therapist interactions. In the current article, we demonstrate the utility of statistical text analysis models called topic models for discovering the underlying linguistic structure in psychotherapy. Topic models identify semantic themes (or topics) in a collection of documents (here, transcripts). We used topic models to summarize and visualize 1,553 psychotherapy and drug therapy (i.e., medication management) transcripts. Results showed that topic models identified clinically relevant content, including affective, relational, and intervention related topics. In addition, topic models learned to identify specific types of therapist statements associated with treatment-related codes (e.g., different treatment approaches, patient–therapist discussions about the therapeutic relationship). Visualizations of semantic similarity across sessions indicate that topic models identify content that discriminates between broad classes of therapy (e.g., cognitive– behavioral therapy vs. psychodynamic therapy). Finally, predictive modeling demonstrated that topic model-derived features can classify therapy type with a high degree of accuracy. Computational psychotherapy research has the potential to scale up the study of psychotherapy to thousands of sessions at a time. We conclude by discussing the implications of computational methods such as topic models for the future of psychotherapy research and practice. I believe that some aspects of psychoanalytic theory are not presently researchable because the intermediate technology required. .. does not exist. I mean auxiliaries and methods such as a souped-up, highly developed science of psycholinguistics, and the kind of mathematics that is needed to conduct a rigorous but clinically sensitive and psychoanalytically realistic job of theme tracing in the analytic protocol (Meehl, 1978, p. 830). Advances in technology have revolutionized research in much of psychology and health care, including major developments in pharmacology, neuroscience, and genetics. Yet, the science of patient–therapist interactions—the core of psychotherapy process research— has remained fundamentally unchanged for 70 years. Patients fill out surveys, or human coders rate some aspect of the interaction. Thus, although psychiatric and psychological guidelines recommend psychotherapy as a first line treatment for a number of mental disorders (American Psychiatric Association, 2006), we still know relatively little about how psychotherapy works. As Meehl noted, existing research methods remain limited …