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Psychotherapy in a Changing World


Journal of Psychiatric Practice®: November 2012 - Volume 18 - Issue 6 - p 393
doi: 10.1097/01.pra.0000422736.64624.78


November, 2012. Psychiatrists and behavioral health clinicians have been studying the effectiveness of psy- chotherapy for years. Published randomized controlled trials are piling up demonstrating the effectiveness of many types of therapy, from cognitive to behavior to psychodynamic and more, for conditions ranging from mood and anxiety disorders to personality disorders. Yet far at the other end of the spectrum, often under the same heading of “therapy,” untested strategies are proliferating, especially in today’s Internet world. While some of these offerings may help some who are suffering, others may be frankly ineffective, unethical, or the psychological equivalent of snake oil. What to do? The world is changing very fast, and the worldwide web is a main engine of change. The development of web-based therapy was inevitable, and new video-link technolo- gy makes “face-to-face” treatment available to remote areas where in-person resources are scarce. We need to get on board with the technology of tomorrow, taking an active role in harnessing its potential, so that more people who need it can get valid, legitimate help in new and non-traditional ways.

Not long ago, in a TIME Healthland blog, Alan Kazdin responded to questions in a posting with the unfor- tunate title “Q&A: A Yale Psychologist Calls for the End of Individual Psychotherapy.”1 I found the title puz- zling and misleading, since Kazdin acknowledged, in a thoughtful article referred to in the blog,2 that there is strong evidence for the effectiveness of psychotherapy to treat many psychiatric conditions. Kazdin’s concern was that the percentage of people really needing this treatment who actually receive it is extremely low. He urged us to develop new and different ways to provide treatment, in order to reach more people—and I agree, as long as the new strategies are developed by well trained professionals and are eventually incorporated into carefully designed research studies.

In this issue of the Journal, Debra Quackenbush presents an interesting clinical case illustrating one of these new forms of psychotherapy, called “avatar therapy,” an example of the rapidly evolving field of cyber- medicine. Carried out in a virtual world called “Second Life,” this treatment linked a therapist in the United States with a patient in a developing nation, through the use of multiple “avatars.” In his discussion of the case, Aaron Krasner reviews the growth of virtual reality psychotherapy, emphasizing the professional, pro- cedural, and practical challenges involved, and the importance of carefully documented cases such as this one, as we explore this new world in a responsible and ethical way.

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1. Szalavitz M Q &A: A Yale psychologist calls for radical change in therapy (updated version of blog titled Q&A: A Yale psychologist calls for the end of individual psychotherapy). TIME healthland blog (available at, accessed November 5, 2012)
2. Kazdin AE, Blase SL. Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science. 2011;6:21–37
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