Mental-health therapy involves a complex conversation flow in which patients and therapists continuously negotiate what should be talked about next. For example, therapists might try to shift the conversation’s direction to keep the therapeutic process on track and avoid stagnation, or patients might push the discussion towards issues they want to focus on. How do such patient and therapist redirections relate to the development and quality of their relationship? In this thesis, we introduce a probabilistic measure of the extent to which a certain utterance immediately redirects the flow of the conversation, accounting for both the intention and the actual realization of such a change. We apply this new measure to characterize the development of patient-therapist relationships over multiple sessions in a very large, widely used online therapy platform. We draw correspondences between the interactional behaviors and the relationship’s progression and eventual success. We then conclude with directions for future work as well as an initial exploration of how our framework can be broadly applied in other domains beyond therapy.