therapies such as Skype, phone or emailing. Herbert, for
instance, has conducted a pilot study showing that Skype
produced even bigger effect sizes in helping people overcome
social anxiety than avatar therapy did in other studies.
Critics have bigger concerns, as well. Among them are patient confidentiality and safety, which can be problems in an
environment like Second Life, where people can adopt any persona via an avatar and easily enter a wide range of sites and
situations. In addition, there are no uniform guidelines for
teletherapy, so psychologists must learn the current state of the
field to avoid a range of legal and ethical pitfalls (see article,
On the business side, psychologists have been hampered
by a fear of learning new technology and the lack of a good
business model that can provide potential clients with the
information they need to sort through quality offerings versus
ineffective or harmful ones. Still another concern is the use
of avatars themselves: Are there ways that donning alternate
persona, even those that may resemble you, change the way you
act in therapy?
Psychologists and businesses are figuring out ways to
address at least some of these concerns. For one, they’re
developing secure, HIPAA-compliant platforms in which
patient privacy and confidentiality are well-protected. Some
entities, such as the Online Therapy Institute (see sidebar),
are creating informal guidelines for using these technologies
in therapy, addressing issues such as the proper way to obtain
informed consent and how to deal with patients’ tendency to
reveal potentially traumatic information too quickly in such
environments, says institute co-founder DeeAnna Nagel.
Meanwhile, some psychologists are talking about ways to
make these types of therapy more sustainable in a business
sense. Wexler and Roff-Wexler, for instance, discuss these
topics through their organization and website Metaverse+
(formerly Psychology 21C), and they welcome other
psychologists’ input as well (see sidebar).
And while many are slow to adopt such technology, using
it is getting easier all the time, and technology quality is
improving, others add. “We’re getting to the point where you
can completely cut through all the prerequisite learning and
technical stuff that has been in the way,” says Stone. One major
breakthrough: A Microsoft gaming program called “Kinect”
is now enabling users to create avatars that mirror a person’s
looks, facial expression and gestures.
And despite lingering uncertainties, it seems likely that
these technologies will keep growing as people figure out
business and other applications for them. “The future is
going to come,” says Wexler, “but which future? Part of our
responsibility as psychologists is to understand how these
techniques affect human behavior, and to make sure we use
them for the good of the client.” n
Here’s a sampling of companies that offer
clinically related software, training and HIPAA-
compliant virtual spaces.
• The Online Therapy Institute (www.
onlinetherapyinstitute.com), one of the first
companies to bring mental health services to
the virtual world, offers a variety of training
programs on legal, ethical and practice issues of
such practice. The institute also hosts a 40-hour
intensive avatar-therapy class for $1,500 that
offers a certificate of completion. In addition, five-hour courses are available for $90 and payment
plans are available for all classes and courses.
• Metaverse+ ( www.metaverseplus.com), an
organization and website run by psychologists
Richard H. Wexler, PhD, and Suzanne Roff-Wexler, PhD, provides information, training and
research summaries for psychologists who want
to learn how virtual reality and other interactive
communications technology can be applied to
organizational, consulting and clinical psychology.
The service is free.
• Thrive Research ( www.thriveresearch.
com) provides training in and access to HIPAA-compliant behavioral wellness platforms that
include secure virtual environments. Annual user
fee is $5,000.
• Virtually Better, Inc. ( www.virtuallybetter.com).
This research and development company has a
range of peer-reviewed virtual products for purchase, including Virtual Iraq™, which helps soldiers and veterans overcome post-traumatic stress
disorder, and products that address such phobias
as fear of flying, speaking, heights and storms.
Products range from $8,000 to $40,000, with subscription arrangements available for some of them.
• WorldWired (http://
augmentedrealitytherapy.com), a company
headed by psychologist David E. Stone, PhD,
licenses “off-the-shelf” 3D immersive graphic
and video environments for therapeutic and
educational purposes. The company also
provides clinical and technical consulting,
customized scenarios and environments, and
training. Clinical and technical training is $150/
hour; virtual classes are $300; and using the
company’s “Immersive Iraq Environment” is
$150 per month, including six months of
support as needed at $50/hour.