COMPASS: Computational Mapping of Patient-Therapist Alliance Strategies with Language Modeling

The therapeutic working alliance is a critical factor in predicting the success of psychotherapy treatment. Traditionally, working alliance assessment relies on questionnaires completed by both therapists and patients. In this paper, we present COMPASS, a novel framework to directly infer the therapeutic working alliance from the natural language used in psychotherapy sessions. Our approach utilizes advanced large language models (LLMs) to analyze transcripts of psychotherapy sessions and compare them with distributed representations of statements in the working alliance inventory. Analyzing a dataset of over 950 sessions covering diverse psychiatric conditions including anxiety, depression, schizophrenia, and suicidal tendencies, we demonstrate the effectiveness of our method in providing fine-grained mapping of patient-therapist alignment trajectories and offering interpretability for clinical psychiatry and in identifying emerging patterns related to the condition being treated. By employing various deep learning-based topic modeling techniques in combination with prompting generative language models, we analyze the topical characteristics of different psychiatric conditions and their evolution at a turn-level resolution. This combined framework enhances the understanding of therapeutic interactions, enabling timely feedback for therapists regarding the quality of therapeutic relationships and providing interpretable insights to improve the effectiveness of psychotherapy.