Cybertherapy Is Cyber, But Is It Therapy?

A recent New York Times headline boasts of a potentially dramatic medical discovery -- not colon cleanse, male enhancement, or even cancer-sniffing dogs. "Cybertherapy," the headline says, in which "Avatars Assist with Healing."

Now, I treasure cyber-space as much as the next neurotic. Google shines like a memory-restoring virtual sun, always glad to remind me of what happened in the book I just read. I've cyber-shopped and cyber-swapped. Best of all, cyber-dating introduced me to my significant other. But cyber-therapy? I don't think so.

Cyber-therapy here is not to be confused with the practice, widely advertised in cyber-space, of treatment with a real cyber shrink over the Internet or via phone. The lengthy Times piece describes it as a practice in which "digital worlds with autonomous, virtual humans...can evoke the same tensions as in real-life encounters" -- and suggests cyber-therapy may be ready for its close-up, for better or worse.

There's a burgeoning body of research to support claims for cyber-therapy's efficacy in certain situations, a growing list of practical applications, arcane journals and books and an international organization that holds yearly conventions.

In the service of cyber-treatment, researchers around the world are busily populating digital worlds with "autonomous, virtual humans" -- what you and I call "people" -- and publishing results that appear to reveal benefits for those suffering from such conditions as PTSD, anxiety disorders and depression.

"The remarkable thing is how little a virtual human has to do to produce fairly large effects on behavior," said Dr. Jeremy Bailenson, director of the Virtual Human Interaction Lab at Stanford, whose book Infinite Reality, co-authored by James Blascovich, is set for 2011 release.
Bailenson and Nick Yee at the Palo Alto Research Center did a study which revealed that subjects who took on the bodies of tall avatars behaved more aggressively than their "shorter" virtual counterparts.

An empathic avatar named "Angelina" was used as a sounding board for patients with social anxiety in a recent experiment at USC, where researchers concluded that subjects revealed more about their problems to virtual figures than to actual therapists.

Weirdness creeps in when The Times describes how, at the University of Quebec, patients interact with a virtual but tiny Dr. Stephane Bouchard, who asks questions like, "What is the best experience you've ever had?". The doctor calls his avatar "Mini-Me." Alas, all Mini-Me can do at the moment is cock its head and nod.

Then there's a University of Barcelona computer scientist named Mel Slater, who led a project that induced "body-transfer illusion, showing that men will mentally take on the body of a woman, for instance, if that's the body it appears they're walking around in virtually. Meaningful therapy, nonsense or sex kink? The Times reports, you decide.

Where weird, fringy trends promise battlefield advantages, the military is just plain weird. (See Men Who Stare at Goats.) So make what you will of the fact that the U.S. Army now spends some $4 million taxpayer dollars each year on programs in which avatar agents train officers and treat post-traumatic stress reactions.

There's no denying that these encounters are cyber. But are they therapy in the best sense?

A therapist friend doesn't think so, saying, "I have always thought there is something important about the physicality of two bodies present together and negotiating that co-presence that is fundamental to psychotherapy."

Los Angeles-based psychoanalyst and author David James Fisher adds, "At bottom, I find this approach manipulative toward the human being who is the suffering patient, dismissive of the origins and meanings of the symptoms and lastly rather destructive toward the patient's own dignity and freedom to choose. Attacking the symptom can be cruel and destructive to individuals in pain; it may re-traumatize them, make them feel unsafe and uncared for by the therapist, even if it is a supposedly virtual environment. I don't believe there are short cuts or stunts for those of us engaged in doing dynamic therapy."

And it's not just therapists who are skeptical of cyber-therapy. Jaron Lanier, author of the terrific book You Are Not a Gadget: A Manifesto (Knopf, 2010), warns that "in some scenarios I would worry about defining humans down: defining what's normal based on what we can model in virtual environments."

To me, adding avatars to the mix may threaten the most deeply healing aspect of therapy: the implicit trust forged by the mysterious bond between therapist and patient; the ineffable, intersubjective world in which profound discoveries, and life changes, are facilitated. In my own treatment, knowing I had the full, empathic attention of my doctor -- with no one else, and certainly not an avatar, in the mix -- was as important as her degrees and her smarts.

If cyber-therapy catches on, how might the culture reflect it? Will avatars themselves become therapists? Write best-selling books? Train and analyze each other? Can Twitter/cyber treatment be far behind? Most important, will HBO have to replace its brilliant series In Treatment with a James Cameron 4-D extravaganza, Avatar II -- the Analyst?