The Therapeutic Potentials Of Text-Based Virtual RealityABSTRACTThis paper explores the therapeutic potentials of text based virtual environments. Existing research is examined and comparisons are made between the social climates fostered by MUDs and those fostered within certain face to face therapeutic models. The proposition is put forth that MUDs may be well suited to the practice of on-line psychotherapy, or as adjuncts to face to face therapy, particularly for those that seek to incorporate group oriented methods of treatment. INTRODUCTIONThis paper is intended to highlight the quasi-therapeutic nature of MUDs as reported by various members of the MUD community and as documented by a number of researchers (including myself). This in turn, leads to speculation concerning the therapeutic potentials of MUDs in view of these findings and considers some of the implications of purposefully augmenting and utilizing these environments to that end. This paper is not in intended to be interpreted as a working framework for the design of therapeutic MUDs, nor is it intended to address all of the numerous problems, challenges and outcomes associated with such a hypothetical application. The author is well aware of the technical, legal, ethical, theoretical and practical challenges (e.g. Holmes, 1996; Suler, 1996) that such a proposition entails (insofar as our limited present perspective on such issues allows). However, given that important debates surrounding the issue of on-line therapy are well under way in the psychological community, it seems reasonable to assume that eventually MUDs (or MUD-like counterparts), being one of the more wide spread and accessible forms of telepresence, will sooner or later come under consideration. It is with an eye towards this eventuality, as well as the realization that in all probability on-line therapy will in one form or another continue to grow, that this paper attempts to introduce an optimistic perspective concerning the potentials of utilizing MUDs for such beneficial purposes. There has been much anecdotal evidence to suggest that MUDs may serve as therapeutic environments for many of their members. Although the exact nature and degree of the therapeutic benefits of such environments are ill-defined, the claim runs consistently through various observational studies of MUD groups (Bruckman, 1992, Rheingold, 1993, Turkle, 1995, Sempsey, 1997) as well as through many self-reports. These reports typically center around the themes of members having attained a heightened sense of self-actualization:
MUDs are a workshop for the concept of identity. Many players
notice that they are somehow different on the net than off, and
this leads them to reflect on who they are in real life. It helps
people to understand the concept of identity and the ways in which
we construct ourselves. (Bruckman, 1992, p 22).
You can completely redefine yourself if you want. ...You can be
whoever you want, really, whoever you have the capacity to be.
(Turkle, 1995, p. 184).
The disembodied social atmosphere acts as a safety net for people
to express themselves. ...where people can express their true
personality (not the general facade most people display in order to
gain the approval of others)... They (members) become active since
their fear of rejection and judgment from their peers is removed to
an extent, providing them with a clean slate from which to grow and
expand. (Sempsey, 1997, p. 196).
and social inter-relation/support:
Although a lot of players don't like to talk about their real
lives, others are quite willing to talk about who they really are
and often only want to talk about their real lives. ... It can be
very useful to have someone completely outside of your normal life,
to whom you can tell what's bothering you, because the people who
are in your life are often the cause of what's bothering you. ...
It offers a relief from the stresses of their normal life.
(Rosenberg, 1992).
I don't care how much people say they are, muds are not just games,
they are *real*!!! My mud friends are my best friends, their the
people who like me most in the entire world. Maybe the only people
who do... They are my family, they are not just some dumb game.
(Reid, 1994).
Of course, many people come here for the social life as well. Its
interesting to note the changes in people's lives as time goes on,
and I've been here long enough to see people's live change quite a
bit. (Sempsey, 1997, p. 198).
In addition to these testimonials and observations, there is evidence to suggest that MUD environments indeed promote the types of social climates that are positively associated with established and successful forms of psychotherapy and the formation of close relationships (Roberts, Smith, & Pollock, 1996; Parks & Roberts, 1997; Sempsey, 1997). LITERATURE REVIEWTwo important climactic conditions traditionally associated with successful psychotherapeutic environments are an unencumbered or enhanced sense of self expression/disclosure and a reliable and trusted social support mechanism. Evidence from both MUD based research as well as from the general CMC literature suggests that these conditions are fostered in many on-line environments. It has been demonstrated that CMC in general tends to promote disinhibition as compared to face to face groups (Kiesler, Siegal, & McGuire, 1984; Hiltz, Johnson, & Turoff, 1986; Phillips, 1996). Although this effect can sometimes lead to negative behaviors such as flaming, spaming, and general hostility (Lea, O'Shea, Fung, & Spears, 1992; Sproull & Kiesler, 1986; Thompsen & Ahn, 1992), it can just as often promote positive disinhibitions such as increased friendliness and intimacy (Reid, 1994; Turkle, 1995; Walther, 1996). Likewise, it has been demonstrated that CMC tends to promote greater equality of participation among group members than normally found in face to face groups (Hiltz, Johnson, & Turoff, 1986; Sproull & Kiesler, 1986; Dubrovsky, Kiesler, & Sethna, 1991; Weisband, 1992), and although the extent and contextual foundation of CMC equalization effects have been questioned within the literature (Adrianson & Hjelmquist, 1991; Mantovani, 1994; Spears & Lea, 1994; Jaffe, Lee, Huang, & Oshagan, 1995), the evidence at least suggests that, given the proper context, CMC can positively facilitate this aspect of group functionality. It has also been argued that CMC promotes lower degrees of group conformity (McGuire, Kiesler, & Siegal, 1987; Weisband, 1992; Daly, 1993). Though again the contextual foundation for these claims have been questioned by some (Mantovani, 1994; Spears & Lea, 1994; Jaffe, Lee, Huang, & Oshagan, 1995), the evidence still supports the notion that these virtual environments are capable of fostering lower degrees of group conformity (which can be of therapeutic utility) given conducive circumstances. Turning our attention to MUDs specifically, it has been shown that positive forms of disinhibition, as with other forms of CMC, have been observed (Bruckman, 1992; Carlstrom, 1992; Rosenberg, 1992; Reid, 1994; Mateas & Lewis, 1996). In addition, it has been demonstrated that MUD groups allow for a heightened degree of self expression (Parks & Roberts, 1997; Sempsey, 1997), promote diversity and change in their internal functions and activities (Sempsey, 1997; Bruckman, 1998), are tolerant of independent action (Sempsey, 1997; Bruckman, 1998) and are more open and encouraging in matters concerning personal problems (Roberts, Smith, & Pollock, 1996, Sempsey, 1997). All of these positive attributes seem to have emerged within the social structure of MUDs without purposeful intention by the systems' designers, except perhaps in the case of Bruckman's (1998) MOOSE Crossing, and without the direct guidance of psychological professionals. The possible causes for some of these conditions have already been pondered by some researchers, attributing them to either the lack of regulating social context cues (e.g. body language, tone of voice, etc...) with the lack of such cues read as an obscuring of the boundaries which delineate the forms of behavior which are deemed acceptable or unacceptable (Kiesler, Siegal, & McGuire, 1984), personal anonymity (Cutler, 1994; Barrett & Wallace, 1994), or immunity from physical reprisal (Serpentelli, 1993, Rheingold, 1993). It should be noted however, that although plausible, these hypotheses have never been directly tested and there is some evidence to suggest that there may be flaws in these assumptions. For example, in an experiment conducted by Sturgill, Lentini, and Gay (1995), subjects were placed in groups that they had not previously worked with and were given tasks that required information sharing and cooperation. Certain groups interacted via a computer system utilizing live video and audio as well as interactive text and drawing, and were compared to groups that used a system without the video but with the other features. A comparison of the group process variables between the two found there to be no significant difference between them in terms of trust, satisfaction or feeling of group cohesiveness. So although it can be demonstrated that MUD social climates often differ from face to face climates in key areas, it is still far from certain what constitutes the causal factors. Indeed, social interaction can be quite complex and asserting that any of the above mentioned phenomenon can be clearly and consistently attributed to some overarching set of technical attributes of the medium may be an oversimplification of the matter. In fact, advocates of social identity theory and de-individuation processes (the SIDE model) showed that in particular conditions CMC behavior can be even more social and normative than face-to-face interaction (Spears & Lea, 1992). THE THERAPEUTIC POTENTIAL OF MUDS IN RELATION TO MODELS OF GROUP THERAPYCausal factors aside, it is clear that further investigation is warranted given the positive social attributes and therapeutic potentials of MUDs as indicated throughout the literature. Although computer mediated environments, including MUDs, have been used successfully in the past for certain psychotherapeutic applications, such as providing mutual support workshops for victims of various distress or disabilities and in the treatment of agoraphobia (Cutter, 1996; Goldberg, 1997), no systematic analysis of the therapeutic potentials and applications of MUDs in particular has ever been undertaken. One means to begin the assessment of such applications would be to compare MUD environments to previously researched therapeutic systems which appear to have many elements in common with MUD social climates. Finding and examining such analogs from face to face therapeutic models would be an important first step in not only helping to outline the procedural elements of what would constitute MUD based therapy, but might also shed light upon some of the previously mentioned causal factors of MUD psycho/social dynamics. BIBLIOTHERAPYGiven that MUD interaction is primarily text based, contains elements of fantasy and role playing and is social interactional in nature, three well researched therapeutic models appear to correspond well to these elements and MUD social dynamics. The first, emphasizing the textual nature of MUDs, is bibliotherapy. Bibliotherapy involves the use of selected reading materials as therapeutic aids to help people solve their personal problems, enhance their emotional development and facilitate personal growth. Typically the process can be broken down into five steps: 1) Identification with a character portrayed in the written materials; 2) Catharsis through the sharing of motivations, conflicts and emotions of the character and actively releasing emotions either first hand or vicariously; 3) Insight as the reader transfers understanding of the character's personality and motivations to his or her own life, 4) Self understanding/Universalization as the reader recognizes that he or she shares some of the same problems facing the character and is therefore not alone, and 5) Evaluation and positive change in attitudes beliefs or behavior (Stephens, 1981). Given that one of the first things that a newbie does upon joining a MUD is to "create a character" which is expected to grow in skill and mastery of the environment, it is easy to see how psychological transference to the character could take place in this situation similar to that experienced through bibliotherapy. Indeed, not only is the character taking part in an interactive novel (an analogy often made with regard to MUDs) but has the opportunity to actually change the course of events throughout the adventure. Taking into account the needs and proclivities of the particular patient, careful selection of the setting and environmental variables, and guided "character" development, it is conceivable that purposefully constructed MUD environments could not only serve as a viable therapeutic adjunct, but also afford opportunities for growth, exploration and social interaction that were never possible with traditional bibliotherapeutic techniques. PSYCHODRAMATaking into consideration the role playing aspects of Mudding, the second therapeutic model to consider is known as Psychodrama. Psychodrama is a group therapeutic approach intended to elicit the expression of feelings and attitudes that underlie personal problems through the use of spontaneous dramatic role playing. The most important goal of the method is to assist subjects to relive and re-evaluate their problems in dramatic form in order to enable them to face their concerns directly and immediately in the present (Shaffer & Galinsky, 1989). Participants in the psychodrama temporarily take on roles such as the patient-protagonist (sometimes this role is shared by several people at once), auxiliary egos (to represent important figures in the protagonist's life, or at times different aspects of the protagonist's self), and the non-participating audience members. Setting (at least the psychological perception of setting) is also important in psychodrama since the proper backdrop will help to better evoke the suspension of disbelief necessary for the protagonist's motivations and feelings to emerge. Again, just as with bibliotherapy, one of the main objectives here is to create a sense of identification with the character, followed by a cathartic experience and insight. The patient's goal is to actively participate in the drama in order to gain perspective on their own motivations and feelings and to practice working through these problems within a safe and supportive social context. MUD environments seem well suited to this sort of cathartic play acting and, if properly contexted, there should be no less therapeutic value to such on-line exercises as would be in face to face situations. In fact, the propensity for greater self expression and participation in MUD groups might foster a higher degree of motivation and participation in such scenarios. In addition, the ability on the part of the therapist to custom design the actual environment for patient needs might promote a heightened sense of realism to the drama and make possible the creation of "artificial" auxiliary egos that are custom suited to patient temperaments and help to avoid negative transferencial experiences between live participants. T-GROUPThe third model to consider emphasizes the social interactional factors of MUD environments. This model, known as the T-group, is alternately known as sensitivity training or the human relations workshop. The T-group is intended as ..."an intensive experience in interpersonal self-study and as a method of learning how to improve interpersonal skills and to understand the phenomena of group dynamics by participation in a group." (Shaffer & Galinsky, 1989). The specific aims of the T-group experience are: 1) Learning how to learn - Though most of us are taught to look to experts for accepted knowledge, the T-group experience emphasizes the recognition and power of one's own abilities of observation, particularly as they relate to one's self and interpersonal experiences. There is no correct "objective" view out there to determine how one should perceive and be perceived by others in social situations. Every new group encounter is a new learning experience; 2) Self-knowledge- Increased self-knowledge, self-awareness or insight is gained by participation in and careful observation of one's own reactions, behavior and one's effect on others in an atmosphere of open communication and feedback; 3) Effective participation in group functioning - through constant feedback concerning how one is perceived, participants learn how they can effectively contribute to group activities, the different group roles they play from time to time, and how they impact and "fit in to" the group as a whole; 4) Leadership techniques experience in T-groups is designed to help members become more responsive to the needs of others - both subordinate and superordinate by developing a leadership style that is nonauthoritarian, responsive, caring and attentive to the needs and desires of others and, 5) Impact on organization - to learn to have a positive impact on the quality of human relationships in both small groups and larger organizations by realizing the influence and importance of group attitudes and individual member roles. All of the above goals are promoted through placement of emphasis on particular orientations towards the group such as maintaining a "here and now" focus (i.e. what is actually happening in the group at any present time as opposed to dwelling on past issues), encouraging people to free themselves from their standard ways of behaving and viewing themselves and others in interpersonal situations, creating an atmosphere of trust and cooperation, promoting self-disclosure, the sharing of honest and constructive feedback, and development of recognized group norms of behavior. Of the three therapeutic approaches outlined, the T-group is the least structured and in many respects MUDs can be said to already foster much of what T-groups aim to achieve by design. However, the important difference is that T-groups are recognized by their participants as having a purposeful design oriented towards bettering group relations and that they are overseen by experienced trainers that can help to guide members when things become difficult (such as when group conflicts arise). With just a little augmentation, MUD environments could be purposefully oriented to foster group awareness and be used as experiential laboratories by those wishing to gain greater interpersonal skills and insight into their social behavior. Although many of the benefits of T-groups appear to arise spontaneously in MUDs, the effectiveness of the experience could possibly be amplified through selective changes in communications strategies and guidance from professionals. CONSIDERATIONSAll of the above is premised upon behaviors that have been observed in either rpg or social MUDs. It is possible that the behavior of individuals in a MUD specifically set up for therapeutic purposes may differ. However, this does not necessarily exclude the possibility that such MUDs could provide major benefits. Bruckman (1998) has demonstrated, at least partially, that a MUD environment designed to foster and achieve specific psychological and social outcomes can be successful. In addition, though such hypothesized therapeutic MUDs might differ in certain respects from their rpg/social counterparts, there is no reason to conclude at present that at least some of these positive attributes will not become manifest within a well designed and purposefully constructed MUD, provided that the new environment does not deviate grossly from its predecessors and that care is given to observe the effects of gradual augmentation over time. How will lessons/behaviors/issues worked through in the text-based environment of MUDs be transferred to behavior in off-line settings? If MUDs are used as an adjunct to face-to-face therapy, this may not be a major issue. However, it remains to be seen whether working through ones problems on-line will have any lasting effect in face to face reality. On the other hand, there is no evidence to suggest that it will not transfer, at least to some extent. Theoretically, according to Lewin's (1936) field theory, successful group member roles from previously experienced contexts will tend to be transferred (and indeed expected) within new group environments. Thus, learned strategies for coping with social situations encountered in MUD environments should stand a chance of being applied to non-MUD group situations if certain key social dynamic elements are perceived to be correlational. Anecdotally, numerous self-reports of MUDers who claim to have experienced just this type of transference have been documented (Bruckman, 1992; Turkle, 1995; Sempsey, 1997). In face to face therapeutic environments, anonymity has never been a factor. Most likely, therapists in MUD environments will insist upon knowing the identity of their clients beyond their virtual self-representations. This in turn may effect the social climate of these MUDs since, as it is hypothesized, anonymity may be a contributing factor to on-line disinhibition. However, this does not have to be considered a severely limiting factor. As mentioned previously, role playing within psychodrama has therapeutic effects despite the fact that the therapist "knows" the "true" identity of the actor and such knowledge does not seem to overtly inhibit the participant's ability to role play and benefit from the experience. In addition, over a third of the participants in the Parks and Roberts (1997) study reported that they had met face to face with their relational partners with no reported adverse effects concerning the quality of their on-line relationships, which may indicate that anonymity, although it may play some role in the initiation of MUD relationships, is not necessary in the continuation of those relationships. Lastly, if MUD based therapy were used as an adjunct to face to face therapy, it might be deemed unnecessary by the therapist to demand identity disclosure during the on-line sessions, preferring instead to utilize the benefits of the medium as virtual "field experiences" and then allow the participants to reflect upon and recount their experiences during the face to face sessions. If therapists and clients access a MUD environment from different off-line locations, it is possible that the clients' control over self-presentation, combined with the therapist's inability to view the non-verbal behavior of clients, may reduce the therapist's ability to judge how individual clients are coping emotionally with the group process. In addition, it may prove difficult for the therapist to keep track of group interactions given the tendency for simultaneous cross-talk and private messaging within MUDs. Indeed, these are probably just a few of the potential difficulties therapists might encounter in such environments. However, it may be possible to compensate for some of these potential problems through the implementation of specialized behavior and verbal tracking software that might serve to cue the therapist to specified key events (just as current therapists are cued by specific face to face group events). In addition, new therapeutic observational techniques may evolve over time or certain MUD detectable behaviors may take on added importance to give therapists alternative means to assess these situations. For example, closer study of techniques employed by visually impaired therapists might indicate some possible orientations towards these challenges. Frankly, I do not claim to have all of the answers at hand, particularly in light of the fact that many of the relevant questions have undoubtedly yet to be asked. However, since this paper is not intended to definitively outline the implementation and consequences of MUD based therapeutic environments, but merely intended to promote consideration of the potential benefits, I believe that it would be rather presumptuous of me to propose how all future MUD therapy situations could or should be addressed. If these environments ever are utilized towards these ends, I would have to contend that the individual professionals and practitioners involved would likely develop solutions that were better thought out and workable than anything I could propose from a purely hypothetical perspective. What would be the legal and ethical ramifications of MUD based therapy? Internet based therapy issues are currently being debated in various forums (on-line and off) and clear guidelines have yet to be established. Obstacles such as maintaining client confidentiality in light of unencrypted internet communications, licensing and cross jurisdictional legalities, limitations and differences in bandwidth capabilities that might diminish traditional means of assessing client status, and the difficulties of intervening in client crises situations (e.g. suicide, homicidal threats, etc.) are among the issues that are currently under consideration (Holmes, 1996). Obviously these are important challenges, but they are not insurmountable. Certain dilemmas, such as maintaining client confidentiality and bandwidth limitations could be at least partially resolved through a combination of technical solutions (e.g. encryption, increased bandwidth/data compression, etc.) and well thought out safe practice guidelines. Others might be handled through reevaluation of existing legal and licensing procedures. At one point in time, similar issues for new forms of face to face practice had to be considered and resolved. However, the recognition and debate of these former considerations eventually led to the improvement of guidelines and psychological practices for all therapists and patients. In this case, I would contend, the issues are essentially the same. Resolution of these issues will come about with the willingness to recognize and resolve the challenges (foreseen and unforeseen) that inevitably arise with the advent of such new technologies. Setting up MUD based therapy environments will inevitably require time for development and involve certain costs. Physically there are the costs of computer hardware, on-line connection fees, and associated software. Practically, involved therapists will have to spend time developing these environments, spend time in these environments with clients - which may take more time than face to face sessions given the current textual nature of most MUDs, decide how they are to be compensated for these additional time and monetary expenditures, etc. What advantages could possibly prompt therapists to invest such time and effort? Similar issues have been debated in the distance education and training fields. Many of the justifications relevant there are also applicable in this situation. As advanced by Dr. John Suler, author of The Psychology of Cyberspace website:
While in-person therapy in most cases is preferred, there may be
possible advantages to online sessions. For example, some people
who would balk at seeing a therapist in-person may be more willing
to seek help online due to the anonymity it offers. Online therapy
(could) be an important initial step in the establishment of what
could become an ongoing, in-person therapy. People who are unable
to visit psychotherapists for geographical or physical reasons can
be reached through cyberspace. Finally, the opportunity for keeping
a permanent record of online therapy sessions also may prove to be
a valuable asset to both the clinician and client. (Suler, 1996)
The above implies that on-line therapy might encourage many that might not ordinarily seek or be able to take advantage of psychological services to participate. This should result in additional opportunities for practitioners, which in turn should compensate them for the extra efforts associated with MUD therapy. In addition, hard to find specialists in particular fields of practice that might only reside in populated urban areas would become more readily available to prospective clients, thus enabling them to serve a greater number of people in need. Likewise, these are only a few of the potential advantages. Essentially, psychotherapy is a form of information exchange. As such, any advantages that can be conferred via technological improvements to communication should translate either directly or indirectly to those practitioners who choose to take advantage of the new developments. CONCLUSION
All technology has a behavioral impact on the folkways of those
who adopt the particular tool. We have witnessed technology
changes that would have startled Jules Verne and the other
science fiction writers of yesterday; certainly inconceivable to
our parents, and our selves in our youth, or even ten years ago.
All of this says, that we need to suspend judgment about what can
occur and to be more ready to enjoy what is already possible on
the net. Psychotherapies; such as group, individual, psychodrama
or play therapy are possible on the net. Mental health
professionals are conservative and thus slow to accept most
changes until well established. (Cutter, 1996)
With interest in delivering psychotherapeutic services over the internet on the rise, it seems essential that we more closely examine the various options available to therapists and prospective patients to better determine the most effective means of practice. Since MUDs, except perhaps in the case of some educational applications, are still largely considered as "gaming" environments, it is quite possible that their potentials for more serious applications might easily be overlooked. However, strip away the game-like elements of MUDs and what you are left with is a highly developed computer mediated social space. Just as with physical spaces, what transpires within them is more a function of the intent of the participants than of original design. Since therapeutic experiences already seem to be taking place within certain MUD contexts, perhaps what is called for next is simply the attention of the psychological community. REFERENCESAdrianson, L., & Hjelmquist, E. (1991). 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