Virtual Reality in Evidence - Based Psychotherapy

In his 1957 Annual Review of Psychology article, Winder defines psychotherapy as an interpersonal relationship characterized by the following attributes (p. 309): (1) at least one of the participants (i.e., therapist) is an expert in human relationships; (2) at least one of the participants (i.e., client) displays intrapersonal or interpersonal adjustment problems; (3) the objective of the relationship is to change these maladaptive intrapersonal and interpersonal patterns. Psychotherapy thus circumscribes a group of psychological procedures that are applicable and delivered to individuals with emotional, behavioral and somatic pathology severe enough to be included in clinical diagnostic categories (e.g., the Diagnostic and Statistical Manual of Mental Disorders), and more generic strategies targeted at promoting growth and personal development (David, 2006; Huppert et al., 2006). Based on their underlying theory of mental health and illness, and on theoretically derived treatment strategies, there are three major paradigms in psychotherapy: the cognitivebehavioral approach, the psychodynamic approach and the humanistic-existential approach; each of these paradigms, in its turn, encompasses a number of theoretically and procedurally individualized schools. Regardless of paradigm, the therapeutic process involves several distinct components, generally described as (David, 2006): (1) assessment; (2) conceptualization; (3) treatment (intervention); (4) therapeutic alliance (relationship). Over the last years, there has been a dramatic interest in and expansion of psychotherapy research. A large number of studies have focused on the process and outcomes of psychotherapy, approaching them either from the point of view of theoretical and practical elements specific to a particular type of psychotherapy (e.g., cognitive-behavioral psychotherapy) (see Butler et al., 2005) or from a “common factors” view, looking at the non-specific ingredients which make psychotherapy, in general, work (Lambert, 1992; Lambert & Ogles, 2004). This focus on research and its results have led to the justification of psychotherapy as a legitimate practice. Indeed, hundreds of studies show that psychotherapy works better than no intervention (Kopta et al., 1999), with some forms (e.g., cognitive-behavioral therapy) faring somewhat better than others (see, for example, the National Institute for Health and Clinical Excellence – NICE – guidelines for evidence-based treatments).