Therapist Brenda Bryan asks everyone in her anger-management group to teleport to a volcano. She explains that the volcano is a reminder that emotional eruptions have fallout. Bryan isn’t your typical therapist. She’s a virtual-world therapist practicing at Preferred Family Healthcare Center in Kirksville, Missouri. So-called avatar therapy transplants standard counseling into virtual settings, in this case, private scenes custom-built using code from Second Life, the online multiplayer game. Avatar therapy has been gaining popularity and credibility recently, with several hundred patients now seeing virtual counselors.
Early research suggests that patients are more likely to show up for virtual therapy sessions than real-world ones. Preferred Family Healthcare is about two years into a three-year study following 70 adolescents with substance-abuse problems. So far, 95 percent of those in Bryan’s virtual-world program have completed or are attending their sessions, versus only 37 percent of patients being treated face-to-face. Previous studies show that attending counseling can greatly reduce the risk of relapse. Researchers cite convenience and less social anxiety as possible explanations for the encouraging results.
“Our virtual clients attend four times as many therapy sessions as people do in real life,” says Dick Dillon, a senior vice president at the center who initiated the research. “We find that people spend more time in session if they don’t have to spend time getting there.” Virtual treatment could expand access to care for people who travel frequently, live in rural areas, or have physical disabilities that prevent them from maintaining a regular therapy schedule.
Some conditions are less amenable to this treatment, however. For example, people suffering from disorders that make it difficult to tell reality from fantasy might not be good candidates.
The virtual setting presents challenges even for treating ideal patients. Dillon and Bryan admit that treating an avatar can be difficult because you can’t read body language or hear someone’s tone of voice. But they say that, overall, patients’ increased openness improves progress. “In virtual therapy I’m comfortable. I can let things out that I can’t normally say in real-life therapy,” says Ginnie Murphy, one of Bryan’s patients. “I probably would have relapsed if I hadn’t had this to keep me stable.”
Five amazing, clean technologies that will set us free, in this month's energy-focused issue. Also: how to build a better bomb detector, the robotic toys that are raising your children, a human catapult, the world's smallest arcade, and much more.


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This is a great article but it does not touch on the ethics of Avatar Therapy- cybertherapy~ and the vast learning curve for many therapists interested in setting up their virtual practice. The therapeutic possibilitites are endless but with cautionary notes. Above all, mental health practitioners interested in adding this therapy to their work should receive the proper training.
I see great potential here for treating avatars who suffer from SecondLife addiction. You could spend endless hours on their treatment and you would never have problems getting them to come to their therapy. ;-)
Mental health information and resources have been shared in the Second Life environment since at least 2006 - Wellness Island, Guiding Lights peer support training, the Mental Health Network, Medical Ethics, and much more. Unfortunately there is no accountability for practitioners at this time - it's more of an honor system based on following your own licensing Board's ethics and proceeding with great awareness of "do no harm". Providing consumer education is vital, since anyone can create an account, snag some materials from a legitimate entity, and call themselves a therapist. Support groups are one wonderful aspect of SL, and Dick Dillon is the real deal when it comes to making this happen. As a RL clinician and a SL user, I am not sure the possibilities are quite endless, as face to face client contact is still invaluable for many, but there is much to explore in these realms.
Excellent article. The power of virtual worlds is just beginning to surface. Training is indeed needed before professionals embark on any new form of treatment, whether in doing step-family counseling, alcohol rehab work or using a specialized technology platform like Second Life.
The issue isn't that there are no ethical codes in virtual worlds -- or on the Internet or telephone. The problem is that practitioners forget that the existing codes apply because they haven't thought through the issues carefully enough. That's where training comes into the picture.
Dr. Marlene Maheu