Working alliance is of particular importance in the treatment of hoarding due to high levels of stigma surrounding the diagnosis and low levels of insight in patients. Furthermore, clinician experiences of frustration when treating individuals with hoarding disorder may be a barrier to creating the necessary working alliance. However, evaluation of clinician experiences has been limited to self-reports or qualitative methods. Sentiment analysis of clinical case notes related to hoarding treatment may provide useful information on the relationship between clinician attitudes and patient outcomes. Sentiment analysis involves computerized scanning of text and subsequent ratings of emotional valence for each text string. The purpose of the current study was to use sentiment analysis to analyze clinical case notes from 41 participants who were enrolled in a clinical trial for hoarding disorder. When analyzed as a whole, sentiments spanned almost the entire possible range of values and showed insignificant changes over time, suggesting a stability in clinicians’ overall sentiment towards patients. However, time emerged as a significant effect in specific categories, such that clinician sentiment became more negative across treatment sessions for notes relevant to barriers, successes, and concerns, and more positive for notes describing observations and assessments across sessions. The current study indicated that sentiment analysis of treatment notes is feasible; however, conclusions about working alliance are limited without additional input from clinicians (e.g., follow-up interviews). Future research should investigate which clinical interactions are reflected in clinical note sentiment, and whether change in clinician sentiment is associated with treatment outcomes.
