Rapport Building in Written Crisis Services: Qualitative Content Analysis

Area of Science:

• Digital mental health interventions
• Human-computer interaction in counseling
• Crisis support services

Background:

• Building therapeutic relationships and social presence is challenging in digital and written services.
• In-person care may not always be feasible or accessible.
• Written communication presents unique difficulties for establishing rapport.

Purpose of the Study:

• To categorize crisis counselors' rapport-building efforts in written conversations.
• To identify characteristics of successful written crisis support interactions.
• To inform the development of effective digital mental health interventions.

Main Methods:

• Qualitative content analysis of deidentified text and chat transcripts from the National Child Abuse Hotline.
• Analysis of 314 selected conversations from July 2020.
• Utilized pre- and post-conversation surveys from help-seekers.

Main Results:

• Active listening (e.g., paraphrasing, reflecting feelings) and validation were common counselor techniques.
• Successful conversations featured fewer statements on emotional dynamics and were more specific and tailored.
• Counselors used techniques like unconditional positive regard, praise, and apologies.

Conclusions:

• Therapeutic relationships are crucial for digital mental health interventions.
• Characteristics of successful written conversations can be adopted in other digital help-seeking services.
• Tailored and specific communication enhances the effectiveness of written crisis support.