Virtual reality (VR) and psychotherapy: opportunities and challenges.

Virtual reality technology is now being used to provide exposure and desensitization for a number of phobic conditions. In this paper, we first review these current applications and discuss the work needed to refine and expand these applications to phobias. We then comment briefly on some preliminary applications of VR technology to mental-health problems outside the domain of phobias. Finally, we consider ways in which VR might be used to further enhance psychotherapy and assist in the treatment of a wide variety of disorders. Various possible interventions are discussed, along with the technological developments needed to make them possible.

Sex therapy with dissociative disorders: a protocol.

Female victims of childhood sexual abuse who develop dissociative disorders often suffer from sexual dysfunction but do not receive sex therapy as often as might be expected due to the problems created by dissociative defenses. A modification of standard sex therapy techniques is proposed as a step toward restoring sexual function to this population. Key elements of the protocol are Eriksonian utilization of dissociative defenses, reduced expectations, and careful preparation of the male partner.

Relaxation and merging in the treatment of personality disorders.

A behavioral intervention specifically designed to merge split self-representations was found helpful as an adjunct to the psychotherapy of personality-disordered patients. The method, which is introduced only after signs of split self-representation have been identified through exploratory psychotherapy, consists of a series of steps. Patients are first taught a relaxation technique and are asked to practice at home. Once they are able to relax in the session, they are asked for visual images of first one and then another of the conflicting self-representations. After clear images have been elicited and discussed, they are encouraged to merge them. Finally, they are asked "Who's watching" or some similar question designed to elicit a statement about a unified self. Twenty-four of 27 patients meeting criteria for personality disorders in Clusters B and C of DSM-III-R responded with greater compliance, reduced resistance, and improved relationships at work and elsewhere. Comparison is made to the merging intervention commonly used in the treatment of Multiple Personality Disorder.

The use of relaxation exercises in the treatment of reading disability.

An adult nonreader, in therapy for serious emotional problems, began to read, at first during the therapy sessions, and then on his own, following treatment that involved a mix of psychodynamic exploration and behavioral interventions. The inability to read was addressed directly, first by having him imagine reading, and then by having him attempt to read, after achieving a state of increased relaxation through the use of muscle and breathing exercises. This result suggests that relaxation exercises should be tried in cases of reading disability at least whenever they are associated with emotional problems. Furthermore, inasmuch as anxiety and stress do not always manifest themselves in ways that are obvious to an observer, the case raises the possibility that relaxation exercises might be helpful even when there are no obvious symptoms of emotional disorder.