The Brave New World of Virtual Therapy

You're sitting with your therapist in a lovely green park, telling him about a disturbing dream you had the other night. When he asks you to describe it, you decide to first change your appearance, dim the sun and then begin your story.

No, it's not the real world, but a kind of therapy that Kate Anthony, a London-based therapist, and others envision for the near future.

In virtual, computer enhanced therapy, the therapist and patient engage in healthy discussions through computer animated characters that represent themselves. The patient chooses his or her appearance, as well as the appearance of the therapist and the setting where their session takes place.

"Often when clients sit face to face with someone, they can find it embarrassing and too emotional," explained Anthony, who is also an online counseling consultant. "By communicating with virtual reality characters, people have more freedom to discuss their problems. The experience is more vivid than typewritten exchanges, but it doesn't impose the white noise of face to face interaction."

Virtual technology that immerses a person in a computer animated world has already been put to wide use in the field of psychology. The most common applications are helping people overcome a wide range of phobias — from flying to public speaking to claustrophobia — by exposing them to virtual versions of what scares them in a controlled setting with a counselor. Other programs help people get over addictions like smoking and gambling by placing them in a virtual world of temptation and helping them learn to resist.

But therapists and computer programmers are busy working on broader ways to use the technology, from offering virtual counseling sessions, like the one Anthony describes, to creating virtual patients or even virtual symptoms that could interact with therapists and psychologists to help them better understand and train for real patients.

"I don't think technology will ever replace face to face technology," said Anthony, who conducts both face to face and online therapy sessions. "But it has opened up the world of therapy to a whole new group of people who wouldn't otherwise access it."

The concept may be cutting edge, but it's also controversial. Many in the field argue counseling through such technology is problematic because it misses out on key aspects inherent in face to face therapy.

"The value of the therapy to the patient is generally directly related to the amount of work put into it," said Daniel Lieberman, director of the Clinical Psychiatric Research Center at George Washington University in Washington, D.C. "Making this task easier by allowing the patient to 'hide' behind an avatar [a computer generated icon] seems to me to promote the fiction that personal change can be accomplished without great effort and endurance."

Advantages of Fantasy

Despite such concerns, virtual therapy holds at least one clear advantage — it's unbound by geography. For example, there might be just a handful of people who are seeking counseling about their fear of, say, organized sock drawers and only one therapist who specializes in the particular phobia. But, in the virtual world, all of these people can sit together in a virtual room to participate in guided group therapy sessions with that expert.

The technology to conduct such virtual sessions is already here. In the computer game, The Sims, for example, people choose and create life-like characters and then try and keep them happy as they interact with others in their virtual suburban community. The online chat room known as The Palace, lets people adopt self-designed virtual characters (called Avatars) and then interact with others in a virtual setting.

In a virtual counseling version, a therapist talks with patients as they express themselves through similar virtual characters.

"The most powerful application of virtual reality will be the clinician's ability to create an interactive environment that addresses the personality and cognitive style of the particular client or clients," said John Suler, a psychologist at the Rider University in Lawrenceville, N.J., who has long promoted the concept of using Avatars in therapy.

Body-length photography booths, meanwhile, can scan a person's image to generate a more realistic computer animated version of themselves for therapy sessions. This means a virtual session could be even more life-like, but Anthony cautions that might take away from the free, fantasy-like aspect of virtual counseling.

"I think if you're going to go down that road, you may as well go face to face," she said.

There are areas of research, however, where making the virtual world more realistic is just the point.

Virtual Psychosis

Researchers at the University of Queensland in Australia have written software designed to animate hallucinations of psychotic patients. The hope is by creating computer generated, three-dimensional versions of the hallucinations, psychologists, friends and family can gain a better understanding of what the person is going through.

Sandy Jeffs, an Australian poet who has had disturbing hallucinations involving an abusive Virgin Mary, was among the first patients to describe her visions to the researchers. The team created a virtual version of the hallucination and asked her to assess the animation. Jeffs reports the virtual environment was "interesting to say the least," and the audio of the Virgin Mary speaking was similar to what she heard in her hallucinations. But, she adds, the graphics "weren't real enough to make it real."

Still, Jeffs said she can see some value in the program.

"I see it more as an educational tool," she said. "A tool which will help the public understand what happens in psychosis."

Eventually the Australian team hopes to build a "library" of hallucinations by interviewing more patients so clinicians might re-create hallucinations described by their patients by piecing together existing visions in the library.

Meanwhile, computer programmers are working on technology to animate virtual patients to help psychologists train for sessions with the real thing.

The Perfect Patient?

When Larry Hodges walks into his Future Computing lab at the University of North Carolina, an animated, life-sized head named Rama recognizes and greets him and tells him any messages that have been left for him. Hodges and his students are working on refining digital people like Rama to boost their intelligence and complexity so they might serve as training tools.

"In training, you need someone to role play with you," Hodges said. "Digital humans can do an interview over and over — as long as it takes to help you get better."

Of course, there's nothing like actual experience to help make a therapist better. And some worry the growing role of technology and virtual reality in psychology may ultimately take away critical human aspects of counseling.

"I think it's fair to say that, in general, the effects of computer generated interactions don't yet measure up to human ones," said Gregory Simon, an investigator with the Center for Health Studies in Seattle's Group Health Cooperative.

Still, Anthony argues, it's better to accept the concept, understand it and control it than try and resist it.

"I think if the profession as a whole has at least an awareness that these advances will happen, then they won't be surprised when they do happen."