Toward Causal Understanding of Therapist-Client Relationships: A Study of Language Modality and Social Entrainment

The relationship between a therapist and their client is one of the most critical determinants of successful therapy. The working alliance is a multifaceted concept capturing the collaborative aspect of the therapist-client relationship; a strong working alliance has been extensively linked to many positive therapeutic outcomes. Although therapy sessions are decidedly multimodal interactions, the language modality is of particular interest given its recognized relationship to similar dyadic concepts such as rapport, cooperation, and affiliation. Specifically, in this work we study language entrainment, which measures how much the therapist and client adapt toward each other’s use of language over time. Despite the growing body of work in this area, however, relatively few studies examine causal relationships between human behavior and these relationship metrics: does an individual’s perception of their partner affect how they speak, or does how they speak affect their perception? We explore these questions in this work through the use of structural equation modeling (SEM) techniques, which allow for both multilevel and temporal modeling of the relationship between the quality of the therapist-client working alliance and the participants’ language entrainment. In our first experiment, we demonstrate that these techniques perform well in comparison to other common machine learning models, with the added benefits of interpretability and causal analysis. In our second analysis, we interpret the learned models to examine the relationship between working alliance and language entrainment and address our exploratory research questions. The results reveal that a therapist’s language entrainment can have a significant impact on the client’s perception of the working alliance, and that the client’s language entrainment is a strong indicator of their perception of the working alliance. We discuss the implications of these results and consider several directions for future work in multimodality.