Are services in the virtual world near?

At any given hour of the day, around 50,000 people are exploring, learning, interacting, and being entertained in the three-dimensional virtual world of Second Life, arguably the most advanced of the online virtual platforms in existence. A Missouri addiction and mental health services agency is preparing for a day on the horizon when it will encourage its clients to participate in Second Life as part of the recovery experience in their everyday existence.

For Dick Dillon, senior vice president of planning and development at Preferred Family Healthcare and the manager who is leading the way to this new technological application for his agency, the experience of researching and participating in Second Life has been both professionally stimulating and personally enriching.

One of the first observations Dillon made upon downloading the Second Life software was that many nonprofit organizations in various fields had already carved out a place in the virtual world. The 16 million individuals who have downloaded the Second Life software, developed by San Francisco-based Linden Lab, have the ability to exchange virtual currency and to purchase land—essentially, server space—in the virtual community, and some organizations have established a formal presence as well.

“It turns out that the National Council for Community Behavioral Healthcare has an office about two doors down from me in Second Life,” Dillon says. “When I noticed them, I thought, ‘Hey, I belong to you.’”

The persona, or “avatar,” that Dillon created for himself in Second Life took up surfing, an activity that had always intrigued real-world Dillon. Being exposed to this experience in the online world convinced him to take actual surfing lessons. This example might sound like it has no relevance to Dillon's organization, but it sheds light on why Preferred Family Healthcare believes online virtual communities could ultimately serve as an important tool in treatment.

“One's experience in a well-crafted virtual environment is essentially indistinguishable from real-life interaction,” Dillon says. So, for instance, if a person sees his virtual persona exercising in the virtual world, he might be more likely to visit his own neighborhood gym and enhance his overall well-being.

So could that idea be extended to other recovery-affirming activities? For instance, could a person who has been in treatment and who fears what could happen when he is back in his traditional environment practice refusal skills and other coping mechanisms online first? Dillon thinks so, and says there are researchers out there trying to prove it—one has even created the concept of a “virtual crack house.”

“There are a lot of people who get residential care from us but return to their geographic areas where it is tough for them to get continuing care,” Dillon says. Preferred believes the virtual world could offer an important aftercare element for its client population, about two-thirds of whom have reported to the agency that they have access to a computer and an Internet connection.

Preferred's plans

Preferred's efforts in Second Life thus far have been relatively modest, as Dillon says the organization has spent no more than a couple thousand dollars in the endeavor (it is a Second Life “landowner”). Dillon said he does not yet come across other behavioral health provider agencies with a direct presence in Second Life, although the nonprofit world in general is well-represented with groups such as relief organizations, animal shelters, and environmental advocates.

Preferred has conducted several online lectures in Second Life, but generally has spent most of its time strategizing on how it could apply the virtual setting to the provision of direct services. At one point in its analysis the management team believed Second Life could help the organization promote its services to non-clients, but Dillon says it is now looking at the issue differently.

“We think we should bring people into the virtual world from our real-life setup,” such as in continuing care, Dillon says. Dillon and his colleagues believe Second Life could help Preferred maintain important contact with clients as they try to cope with relapse triggers and other barriers to long-term recovery. “The potential cost savings are such that it could be possible to buy people computers if we needed to,” he says.

The agency is working toward establishing a three-year budget in which it would seek to serve 100 clients a year through Second Life. It then would collect data on the effort to determine where it eventually would want to be with these services, Dillon says.

Benefits and drawbacks

Dillon says the reactions he receives when making presentations to field colleagues about Second Life range from “This could be used as a substitute for face-to-face therapy” to “You could never do good therapy this way.” He believes that the more realistic a virtual site is—and he says Second Life is the “big dog” at present—the more it can work for users in modeling situations that occur in real life.

During a workshop presentation at the State Associations of Addiction Services (SAAS) annual conference in June, held in conjunction with the Network for the Improvement of Addiction Treatment (NIATx), Dillon summarized to a relatively small but receptive audience that “the actual delivery of services, via patient and clinician avatars, is possible.”

Besides the possibility of saving costs in face-to-face therapy, this type of activity has been shown in some studies to generate more honest responses than what might happen during in-person interaction, Dillon says. Other possible applications of the technology besides virtual counseling include virtual conferencing and staff training opportunities, he says.

Preferred does remain concerned about a few potential disadvantages to working with clients in this way, such as the possibility that someone at a remote location could allow another person to go online and pretend he/she was the client. “Things like this could happen when you don't see the actual person,” Dillon says. “Then again, we're used to people telling us a lot in conventional therapy that we don't hire a private investigator to check out.”

Other possible concerns include the loss of the more subtle clues to a client's mood, such as body language, when the client is not in the same room. Yet agencies such as Preferred already have experience working through those challenges with the telepsychiatry services they offer, and Dillon says the realistic three-dimensional images in Second Life do capture avatar movements that can be telling. All in all, Preferred believes that the virtual world merits a great deal of further exploration, and other provider agencies soon will see that as well.