Struggling together in a safe place: therapists’ perspectives on the therapeutic relationship in gameChange VR therapy

Abstract

GameChange is an automated virtual reality (VR) application for people with psychosis who struggle with anxious avoidance in everyday situations. The VROslo trial sought to assess the feasibility of gameChange in a Norwegian healthcare context. The therapeutic relationship is an important predictor of treatment outcomes, yet little is known about how therapists experience their alliance and clinical decision making when treatment is mediated by VR applications like gameChange. All therapists involved in the VROslo study were invited to take part in this qualitative sub-study. A semi-structured interview guide was developed, and data from 13 participants were utilized. Interviews were conducted at participants’ workplaces. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Data analysis yielded three major themes. “Interacting with the virtual coach” captured therapists’ reports of both pros and cons of working alongside Nic, the automated virtual coach. “Facing the unknown” comprised experiences of establishing therapeutic alignment with patients while simultaneously learning to integrate a new technology into clinical practice. Finally, “Making adjustments” encompassed therapists’ views that VR was a novel and engaging therapy modality that nonetheless required continuous in-session adjustments to manage the complex interplay of the therapist role and patients’ responses to the virtual environment. Previous research has highlighted substantial variability in therapists’ perspectives on the therapeutic relationships within VR platforms. Our findings refine this discourse by indicating that VR-based therapy is experienced as both promising and potentially alliance-building, yet contingent on careful preparation and in-session adaptation.