#928: Play Therapy in VR with Virtual Sandtray & Dr. Jessica Stone

Dr. Jessica Stone is a licensed psychologist and registered play therapist who has been experimenting with integrating technologies into her therapeutic practice specializing in working with children. She and her husband developed a Virtual Sandtray application for the iPad, which allows her clients to build virtual worlds that becomes an archetypal representation of the dynamics of their inner psyche. After seeing the initial success of this tool, then she requested that her husband create a version that would work with a PC VR and HTC Vive so that her clients could be completely immersed within the worlds that they’re creating for therapeutic insights.

Dr. Stone has found this virtual sandtray technique to be highly effective to allow her clients to communicate in a non-verbal, metaphoric, and symbolic way to go a lot deeper than using words alone.

I had a chance to talk to Dr. Stone at the Greenlight Strategy Conference about her journey into VR, and some of the early lessons she’s been learning from using VR within a psychologically therapeutic context. She’s currently exploring distribution options for the VR version of the virtual sandtray, and adding more remote session capability into the iOS version. She’s also been digesting her insights about the intersection of technology and therapy in a couple of books with Integrating Technology in Modern Therapies, 1st Edition released March 5, 2019, as well as the Digital Play Therapy, which was just released on July 16, 2020.

As more therapeutic applications are developed for VR, then we’ll likely see new design theories, theoretical frameworks, and metrics for success that primarily focus on the psychological wellness and well being of the patients. It’s still very early days of therapeutic VR and experiential medicine in general, and Dr. Stone is doing a lot of important foundational work that could continue to develop into new industry verticals for VR.


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Music: Fatality

Rough Transcript

[00:00:05.452] Kent Bye: The Voices of VR Podcast. Hello, my name is Kent Bye, and welcome to The Voices of VR Podcast. So in today's episode, we're going to be looking at some of the therapeutic applications of virtual reality. Specifically, we're going to be talking to Dr. Jessica Stone. She's a licensed psychologist and registered play therapist. So she works with kids and she tries to find new ways to communicate with some of her demographic that may have difficulty and be able to express themselves. And so she's actually doing some really interesting pioneering work of using virtual reality as a communication medium, but also using world building as a therapeutic device. And so she'll be talking about some of the applications she's been building with the virtual sand tray application that she has an iPad app, and she created a virtual reality version of that as well. And she's also written some books about integrating technology into modern therapies, as well as digital play therapy, which actually just came out on July 16th, 2020. So that's what we're covering on today's episode of the Voices of VR podcast. So this interview with Dr. Jessica Stone happened on Thursday, October 17th, 2017 at the Greenlight Strategy Conference in San Francisco, California. So with that, let's go ahead and dive right in.

[00:01:19.691] Jessica Stone: My name is Dr. Jessica Stone, and I'm a licensed psychologist and registered play therapist. So I'm trained to work with all ages, but I do specialize in working with children and adolescents. And what I'm doing is, within my practice, I'm integrating a number of digital tools, including VR, into actual work within the session and finding therapeutic value in the interactions that you can have with using these tools.

[00:01:48.713] Kent Bye: So maybe you could give me a bit more context as to your background and journey into VR.

[00:01:54.840] Jessica Stone: So, I don't know. I mean, my journey into VR really came from the fundamental idea that in therapy it's important to speak your client's language, whatever that is. It could be as overt as, we're speaking English. If you spoke a different language, such as Spanish or German, and I don't speak one of those languages, we could have a problem because we can't communicate, right? But then it also comes down to vernacular and cadence and words people use, how they use them, and being able to create an environment that is comfortable for the client so that you can speak each other's language and communicate well. So when you're talking about younger people, that often has to do with the things that they're interested in. So for instance, I don't know, 15 years ago I was teaching courses and I would bring up Pokemon cards. And I would have a collective groan in the room of all the therapists going, oh, I heard one more thing about Pokemon cards from my clients, you know, really complaining about it. And I said, well, wait a minute, let's think of the value here. So if we learn about Pokemon, and I'm not a person who personally is very interested in Pokemon, but my clients are. So if I learn about Pokemon, the evolutions, the different types, the strengths, the weaknesses, which ones they're attracted to, that's telling me a lot about them, right? So then when we get into this digital age of kids and teenagers really coming in with a lot of that content, now first of all, they are spending a lot of time with people who dislike or somehow dismiss what it is they're doing. So they don't have a lot of people besides their peers to discuss these things with. And if I as their therapist am another person who dismisses it, That's a whole portion of my client, their life, their experience that I'm not having any piece of. And they're not going to open up to me. That's a problem, right? Because now I'm not working with my whole client. And I think it's my ethical responsibility to enter into their world. So now we get to the point of not only having these discussions, but also integrating some of these tools into the actual session where I can really get a great window into their world, their experience, their environment, their interests, their dislikes, everything. And it's not about them just coming in and playing a game, if you will, it's me learning their frustration tolerance, their coping skills, coping styles, their strategic abilities or not. You know, there's a whole list of things that I can get out of those kinds of interactions.

[00:04:42.342] Kent Bye: And so when did you start integrating VR into this whole equation of what you're doing with your clients with being able to speak their language? So when did VR come into the picture?

[00:04:51.836] Jessica Stone: So VR came in a couple of years ago. So another area is that in about 2011, and there's a reason why I bring that up, but 2011, the tsunami hit in Japan, right? And I had a very good friend and colleague who was ground zero basically in trying to work with people. We have this technique in psychology called a sand tray. And it's a projective technique, which means basically you take the inside emotions and experience and you're projecting it out onto something else. So a lot of people have heard of the Rorschach inkblot. It's in a lot of movies and whatnot. So that's a projective technique. Whereas some people are like, oh, it's a bat, it's a butterfly. And then some people will project an entire story onto this inkblot that to everybody else doesn't look anything like what that person's describing. But again, it's that person's inner experience. So sand tray is a way of using that projective technique in a potentially non-verbal way. So if I've had experiences, emotional experiences, or actual ones, or imagined ones, or dream, or anything, I can non-verbally express that by creating the world in the sand tray. So you have the tray and sand, and then you have a bunch of miniatures that then you'd put into the sand to make a world. And it's very popular in Japan. And I said to my husband, how are they going to do Santre in the middle of this tsunami when they're trying to work with all these people who have been highly traumatized and lost so many things and people and everything? And I said, we need it to be portable. Oh, it needs to be on an iPad. So we created it for iPad, and it's fantastic, and it's wonderful. And right when my husband probably thought we were pretty done with that project and we have this beautiful thing, I said, we need it for VR. And so he's like, OK. And so then he created it for me in VR. It's made with Unity. So thankfully, it wasn't too horrible of a process to transfer it over into VR. and then putting that into VR, and then entering into that world of immersion, and really experiencing that not only is it visual and wonderful, but the immersive qualities of it. And I know so many people talk about that, but if you just think about it, if I say to you, okay, let's imagine that you are in this place, and there's the beach, and mountains, and water, and I'm saying that to you, and I want you to really visualize it, That is so much different than everything in your body, all your senses telling you that you are actually at the beach. And so instead of taking so much time and energy to try to create this environment, I can have you in that environment, in VR, and then we can be working within that environment and interacting with it on a whole other level. So it's not just about time, but it's also about your body just really believing that you're in it. So then I started to explore, just like with Pokemon, what other kinds of games that are commercially available, not just our program which is specific for therapeutic use with a professional, but what other games and programs would be useful, have therapeutic value, just like the Pokemon does or whatever else is out there.

[00:08:04.337] Kent Bye: So are you having these sessions where you're putting people into these virtual sand trays and being able to actually have them create different aspects that are happening in their lives then?

[00:08:14.725] Jessica Stone: Oh, absolutely. So they can create, we have almost 6,000 3D models available. So they can paint the sand and dig in the sand and put models in and manipulate them to make them big or small. If you want a family of elephants, You put down 15 elephants and you can make them bigger, smaller, turn them around, knock them over like they're sleeping or whatever it is. You can bury them. So I don't pre-populate the worlds. It is possible. A therapist could pre-populate the world. depending on what the client's needs were. Typically, I don't do that. I have them create their world. If a child or adolescent is going to go, or even an adult for that matter, is going to go into court, you can set up the courtroom and say, OK, this is where the judge is going to sit. This is where you're going to sit. We can literally walk through it. right? And experience that prior to going into it. So the possibilities are really, I say they're virtually endless because you can create so many different scenarios and different moods. That's what makes it such a powerful tool because you can either recreate something or you can create something from scratch from your imagination, whatever it is you need.

[00:09:27.460] Kent Bye: So what have you been finding so far in using technology? What's sort of the anecdotal feedback that you're getting for how they're responding to this technique?

[00:09:36.267] Jessica Stone: I think there's a number of layers to that. And I'm probably not going to touch on all of them, because I'll think of them after we're done talking. But I think the primary ones are, one, I think there's a lot of value in speaking your client's language. So the fact that I'm even engaging with them about these topics really opens up so many more conversations, so much more comfort. Really, as human beings, we want to be heard, seen, and understood, and accepted, right? And that may not be by everybody in the whole world, but by certain people. And if you go to a therapist, you certainly want to be heard, seen, understood, and accepted. Because you're basically there to open yourself up in vulnerable ways. And you want to do that with someone who you feel comfortable with. So, just even in accepting and allowing these things into the process, I think, speaks volumes. Then you have the additional part of it that you have these therapeutic components that I'm not sure in some cases I would really get to the same arenas in traditional ways. For instance, I work a lot with people who are gifted. And a lot of times people who are gifted are very intellectualized. They're really a lot in their head and not necessarily, these are generalizations of course, but not necessarily that connected with their emotional experiences. And so I can sit there and talk with them all for the hour every week for months and months and have a difficulty in getting them to, I call it dropping down like from your head to your heart. So drop down into a more emotional experience and conversation. But what I found is, and I'm thinking of a case with the virtual sand tray, what I found was that One particular client that comes to mind, I couldn't, no matter how many side doors I tried to go through to get to something with him, it was always an intellectual process. And so when I gave him the virtual sand tray to do, he created a world that was really basically his life. It was all these mazes that went around and a building in the middle that couldn't be accessed. And there are other components that obviously I can't share because it's private information, but really what it came down to is me understanding from him that no matter how hard he tries to get out or people try to get into him, there's no access because he doesn't have the skills. And he was not able to tell me that in an intellectualized kind of way. But when I could work with him in a nonverbal way, I was able to understand that from him because he showed it to me. And it was huge.

[00:12:22.577] Kent Bye: I had a similar experience at Tribeca this year where Sutu, he's an artist from Australia, he had worked with a number of Aboriginal youth and he had a piece there called Future Dreaming where he had them create these scenes of what their life was going to be a week from now, five years, and like ten years from now. And I was able to step into the dreams of these youth and really get this really rich experience of the fundamental nature of their character, of who they are, what they imagined what their future was going to be. And I did the experience, I talked to Sutu about his whole process, and then I had this interview with the youth, and I found it so difficult to connect or to have a conversation about it. Like, I felt like I got more information about who they were by stepping into their dreams created in VR than I could with trying to mediate a conversation with me just meeting them for the first time. Like, I felt like I had so much more intimate information about them that at the end of it I felt like oh wow just the communication power of where VR is going to be able to go and use this what I think of is like symbolic or metaphor communication where they're able to you know in your case with the sand tray create these metaphors that are able to communicate these interconnected dynamics that are really like hard to articulate what it is but you can kind of feel it when you're in the spatial experience and so to then for you as a therapist try to see what the architecture of these relationships may be and then chart to maybe in an interactive way interrogate or ask questions or have an experience that then you could use as the common context to be able to connect with rather than starting from scratch and kind of a blank slate.

[00:14:00.118] Jessica Stone: Right. Absolutely. And that example is so powerful that you just gave because it really is. It sounds so simple, right? You're putting some things in the sand or in the VR, you're putting some things in the world. And yet what it reveals is so intimate and so powerful. Like you're saying, you're stepping into these people's dreams and their worlds. And so that's why this is a therapeutic tool, because It could be just fine that there's a world and someone's not particularly vulnerable or it wasn't a topic that was particularly difficult, et cetera, and it doesn't trigger a lot of things for them and that's fine. But when it does, it's important to have a professional around to be able to help that person work with that, figure out how it's affecting their life and how to integrate either some understanding or some change or something into the other parts of their life. And so, on one hand, it seems so simplistic, and on the other hand, it's so powerful and not simplistic. So, I love your example of that. And as far as questions and things like that, there are a number of different theories of how people work with the information that is found and comes through with Santre, whether it's virtual or traditional. And so, there's so many different ways to go about it, but really, it's about that creation, and then it's about interpreting that information in a way that helps your client move forward in whatever it is that's troubling them or troubling others about them in their life or whatever it is.

[00:15:37.998] Kent Bye: Well, as you're talking about this, I start to think about what the theoretical foundation for this process is and how to articulate what's happening. Things like embodied cognition or moving your body or someone like Carl Jung and looking at, you know, dream interpretation as an example, you know, looking at how there may be a scenes or dreams but has deeper symbolic meaning, but there seems to be a block of trying to quantify or measure or assess what this is actually doing and what the best practices would be for how to actually do it. So how do you go from where you're at now where you've innovated in terms of the technology of being able to have these interactions that have never been done before, but then how do you go back and then try to contribute this back to the community because usually they want to have like some sort of evidence-based research into trying to either understand or quantify or what's the next steps for this? to be able to either prove it out or get more insight as to what the mechanics are for you as a therapist, what the process is for how to do it, or how to show it to the wider world and do some larger quantification or assessment of this process.

[00:16:41.684] Jessica Stone: So I kind of think that goes in two different directions, but one is that this is a technique that's been around since the 1930s. Margaret Lowenfeld started it, the traditional obviously, and It's broken out into a number of different theories and ways to use it, and there's San Tre, and there's San Play. San Play is more heavily based on Jungian, so archetypes and whatnot, although that's also in San Tre. So you can go in a lot of different directions, and that's probably at least a week-long course all day, every day, for us to get into all of the details of that. So what I'll say is that it is a true and tried technique in therapy, and our program is based on the principles and tenets of Santre, of that traditional process. It's another way to do the creations, but it's based on those tried-and-true tenets. So there's that. And then, as far as our programs go, we do have some studies happening. We had one study in a child life department happen in Australia, so that was pretty exciting. And child life is the professional to work with particularly the pediatric population within hospitals. They're either long-term care and they have chronic things going on or different procedures, surgeries, you know, whatever it is that they're going through. And then we also had a study in schools and go through the University of South Dakota and with our program. And currently we have a study going on with the University of Alabama, their children's hospital they're affiliated with, with pediatric burn patients. So what we're trying to show is that, one, some evidence-based information regarding the creation and the use of Santre in general, and then also the properties of being able to not only have a highly engaging, highly motivating activity because it's fun, but also be able to glean psychosocial information, psychological information in a non-verbal way. There can be verbal components, but they don't have to have verbal components. And be able to gather that information for the good of the client. In a medical situation, you're also looking at the reduction of need for pain medication, increased compliance, and a way for the whole process of being, say, in the hospital to be less difficult. So I think there's a number of arenas that all this can be used. I mean, you can think of crisis situations. You can think of skills. We can think of social skills. I mean, really, again, it's virtually endless of what we can do. And more and more research is going to make it that much more robust.

[00:19:33.920] Kent Bye: And so is this application available for people to download and use if they wanted to use this technique in their own practice?

[00:19:41.202] Jessica Stone: So we have our tablet version for iPad available on the App Store. And our VR version isn't commercially available at this point. And it's ready. It's been ready. The reason why we don't have it out yet is we can't quite figure out where to put it, because it's not a game. so we're not going to put it on Steam or something like that. It's a professional program for use within session, right? So then we have all these programs out there and a lot of the conversation here at XRS Week has been talking about we have multiple platforms and certain platforms that only run certain programs and they don't necessarily play well with the other ones and then a place would have potentially 10 different headsets from 10 different places trying to meet all these different needs. And for us, it's like, well, we don't want to have our own headset for this because we would rather have it be something that many, many, many people can access. So really the bottom line is we don't know where to put it and we're looking for the right place. And I've had some conversations this week here at this conference about that and trying to really vet these different companies to say, hmm, what is your focus and what is your approach and do we fit well together? And I don't know that I have the answer yet, but I do have some leads and I'm excited to see where it's going to go.

[00:21:11.617] Kent Bye: Yeah, I don't see why you can't put it on Steam. The challenge with Steam is that Steam is probably the most open of all the distribution platforms in terms of, like, it has the most of all the VR experiences, but there does seem to be a high gaming focus, so you have someone like Nani de la Peña who did put her Syria experience up on Steam, and then with people having all these opinions about refugees, then you have review bombs that happen. So, like, as long as it's, like, set out with a clear context, like, this is a medical application, the other options are the Oculus Home to either be on the Quest or the Go or the Rift S, and so they have their whole vetting process that you have to go through, but getting onto the Quest is higher threshold, so there's the side Quest, so you can put stuff up so it's sort of like a side-loaded application so people have the quest and you want to get it to them then you can have that and you know charging money for it becomes a little bit of like I don't necessarily think that's going to be a long-term solution to be able to bypass the normal distribution channels of Oculus but that is an option and then there's like Viveport which is a little bit more of narrative and gaming, but more of a subscription model to make stuff available, but that's out there. And then there's itch.io where a lot of the indie games end up. But to have like professional grade, like there's nobody out there doing like either education or medical applications as their pure focus. So in some ways Steam is the best outlet, but then it becomes a matter of you doing your own promotion And you're not getting any inherent benefit of having people Random foot traffic of people discovering it But if you wanted to make it available for people to be able to access Steam tends to be for people who have gaming ready PCs So if you're targeting something like the mobile headsets, then going through Oculus' channel seems to be the better route. But if you want to make it available generally for anybody who wants to run it on their gaming PC and have all the technology already, that is already a sub-market of a sub-market. Yeah, it's sort of like a reflection of the overall state of VR industries, this problem. But for me, from just like the pure distribution aspect, you can get it out there into people's hands. It's just the marketing aspect is, you know, that burden is put onto you to make sure that people know about it, and then all the stuff that they need to have access to. But the kind of general reaction, there's no stopping of people from looking at it and reviewing it and doing things like that. But I think more and more, I would like to see, just as somebody who's covering the industry, not be prevented from having something like that on Steam. Because I think it sounds like a useful tool, and that people would want to have access to it. It's just them learning about it. We're doing a podcast about it, so if people want to get access to it, that's part of the thing that I think about. Yeah, so that's my assessment of what the current VR distribution situation is.

[00:23:56.612] Jessica Stone: Right, and I agree, and we do have, it's a heavy program, like, we have over 5,000, almost 6,000 3D models in there, and the abilities to have clients have their own accounts within the program, and so it's a pretty heavy program, which means that the Snapdragon 835 and the all-in-one headsets isn't, powerful enough to run it at this point we could cut some things out so that it could be but we don't want to cut things out because Again, it's based off of the therapeutic tenants. And if we cut those out then Now we don't have the basic therapeutic tenants, you know, so we're just kind of looking at trying to figure out Not only what's the best for it to run on, and right now it's a tethered headset, Vive and Rift we have it programmed for. We like how it runs on the Vive better at this point. We are currently seeing what we can do with the Rift S as well, and we're looking at a lot of different things. but it's also another barrier, if you will, I don't really like to use that, it feels so negative, but is a lot of mental health professionals don't have the gaming computer, don't have the headset, don't, don't, don't, you know, and are just starting to warm up to the idea that these tools can be used in therapeutic ways, and so that's a whole nother component of the arena that I'm functioning in in a psychological world. of trying to to figure out how to provide a very high quality experience so that it is worthy of the therapeutic process and also have it be as accessible as possible and trying to figure how to maintain both of those.

[00:25:50.605] Kent Bye: Yeah, I think in the long run trying to optimize it so it works on the mobile headsets is probably the way to go because I do think it is a pretty high barrier to expect the therapeutic crowd to have a HTC Vive and a gaming PC and set it all up. Yeah, it's just a lot of barriers. It's a niche within a niche within a niche. I'm curious to hear a little bit more about what has the reaction been, these clients that you have, to this whole experience? Because I imagine this may be, for a lot of them, the first time they've ever experienced VR at all. So just curious what their reactions to be able to get to see the technology but to use it in a therapeutic sense has been.

[00:26:25.477] Jessica Stone: Right. My clients really love it, you know. And the other side of that conversation is that a lot of, I think, therapists are concerned that if I have something like that in my office, it's all anybody's ever going to want to do. And really, that's not my experience, whether that's with the iPad or the Nintendo Switch I have in my office, or even the VR. It initially is very exciting, and especially for people who have not ever used it before. It's like, wow, I want to do that again. I want to be in there. But that level's off, and so when we have things that come up that are specific to what we can do in VR, we use the VR. And when we have things that come up that's specific to using the tablet, we use the tablet. I would say initially super excited about just even the idea of being able to use VR because a lot of people haven't. I think it's important to front load the conversation, especially when you're working with minors, so you're talking to their caregivers, their parents, whoever it is. I even, as much as I can, try to get their caregivers in a headset as well so that they can see this is what your child's experiencing. And I also cast it so that we can watch on the screen if a parent or caregiver is actually in the session with us or I'm watching on the screen so that I can be involved and see what they're doing. But I'd say most of the time it has leveled out and we use it as needed, as is appropriate within the therapeutic process.

[00:27:56.184] Kent Bye: And are you able to be in the experience with them, like have a virtual representation of yourself or be actually in VR with them together?

[00:28:04.069] Jessica Stone: So in some games, absolutely. You know, you can do that in some things. In the virtual Sanctuary, we haven't yet. And we've talked about it quite a bit. My husband, Chris and I, we've talked about it. So the conversation tends to go, OK, that would be great. We don't want to have an avatar representation because the creation of the world is sacred to what they're creating and my presence or another person's presence is going to alter that. Okay. So if I'm in there, it would only be as an observer, not an interactor whatsoever. And they can create and choose an avatar. We have these great avatars that you can change their skin color, their hair color, their, their hairstyle, their clothes, all that stuff, really customizable kids in there. So they can choose something or somebody to represent themselves, but they don't show up in the virtual sand tray as an avatar. They don't see their hands. There's no representation, it's just a creation. So when we talk about, okay, so am I gonna be in there as an observer? Well, then we get back to the conversation about equipment. So now we're gonna ask therapists not only to have One headset, but now they have to have two headsets. And so at this point, it's watching on a screen on a monitor. But I think there's value to it, and it is a part of our big plan. We have a lot of big plans. So it's part of the big plan to be able to do that, along with we have a real focus on accessibility. So if you can imagine, if you have the traditional tray and you have it on a stand, so you have this heavy wood box with heavy sand in it on some sort of a sand table, a tray, any sort of a table or cabinet or something. And then you have all these shelves with all this stuff on it. If I'm in a wheelchair, I had a client who is in a wheelchair, and if I'm trying to get up to the tray, if I go forward, my knees are going to get to there before the rest of me, right? And then I have to lean over in an awkward way to try to reach that. If I go to the side, then I'm twisting in an awkward way. I may or may not have the motor capabilities to move my arms in ways that I'm going to be able to get the miniatures off the shelf, or I'm not even going to be able to reach them or access them. So I started thinking about how important accessibility was. And not only for someone in a wheelchair, but all sorts of things. Also people who don't want to touch the sand. Sensory experiences can trigger someone who's been highly traumatized. All of a sudden now they can be triggered into other experiences and now you're dealing with that. So if someone's not ready for that, you don't want them to touch these sensory products. People on the autism spectrum often don't like the sensory experience of sand or tags on their clothes or all sorts of things, right? So people with OCD, I'm not touching that sand. You know, how do you clean sand? People try to clean sand. I don't know how you clean sand. So there's a lot of things about the traditional that cuts out a lot of people to even be able to use it, never mind the portability like we were talking about earlier. So in making it into a digital form, you're also increasing the ability for people to use it. And we're in the process already of programming it for voice recognition, so voice control, so that if someone doesn't have the mobility of their hands or able to use the controllers or want to, they can voice control, eye tracking of course, and we need it to get a little bit more nuanced than it is at the moment, at least the ones we've tried. But accessibility is so important to us and in this process so that really we can get this amazing tool out to as many people in as many places as possible.

[00:31:55.148] Kent Bye: And so for you, what are some of the either biggest open questions you're trying to answer or open problems you're trying to solve?

[00:32:04.396] Jessica Stone: I really think that fundamentally, I would like mental health treatment to move in the direction of, as we talked about in the beginning, speaking the client's language and really understanding that there is value even if it's not traditional methods, one. And two, also, the possibilities that are out there are just so vast. I mean, we don't even know what we're going to get into in this realm and that's going to take a lot of care and ethical importance and understanding and there's so many pieces of it but for me it's the expansion of what we're doing and being able to help our clients in ways that we never have before and if we think about it the people who are coming up into the professional ranks at this point to young people and then also the people who are born They've never known life without this, right? We've got the digital natives. And so this is very normal and natural to many, many people. And these are the professionals who are coming as well. And I think it's important for us to be exploring this. It's not going away. So I have the passion for accessibility. I have the passion for expansion of our fields and exploration of what's good what's not and you know those are loaded statements for sure because it changes depending on who you are and what you believe and where you come from but I just see the possibility and it makes me really excited and passionate.

[00:33:40.828] Kent Bye: Great and and finally what do you think the ultimate potential of all these immersive technologies might be and what they might be able to enable?

[00:33:51.740] Jessica Stone: I think my overarching answer is I don't know. And I think that's because we don't know what's coming. And that's part of the excitement of all of this. And I can say that I want to be part of it. But I think we have, especially in mental health, we have training possibilities and we have treatment possibilities. And the accessibility piece of it is also about people who can't make it to treatment. And right now we do have telehealth and that's a great thing and I think that's going to expand. I think it's just going to get bigger and bigger and better and better. And again, we need to have regulations and rules and all that to be careful about what we're doing. But I think in training we have therapists, as Dr. Rizzo was saying today in a panel I was in, he was talking about we in graduate school when we're learning how to be psychologists, we go through some classes and read some books and then all of a sudden here's a client, you know, and you're sitting with somebody and you've never done it before and you may or may not have a bug in your ear device to have someone feeding you what you're supposed to do. but wouldn't it be fantastic if we were able to practice with a not real person first, who had the qualities of a real client, but you were able to really get some more experience under your belt before you were with a real person, with real feelings and real issues and real concerns. So I think in training, there's so many places to go with this. Empathy, we talk a lot about that in other realms, but with regards to mental health, Schizophrenia. I could tell you all sorts of things about schizophrenia and I've heard a lot of things about schizophrenia from my clients and the experiences, but wouldn't it be amazing to put a headset on and understand and experience a hallucination? I think that would be really powerful for somebody to really understand what that's like for someone. And granted, you can't program something that's going to be the same as everybody experiences, but even getting a flavor of it. So I think in training, it's huge. I think in supervision, it's going to be huge. And I think in the actual treatment, it will be. So I'm excited to see what happens.

[00:35:55.785] Kent Bye: Yeah, I just wanted to add something on that in just the sense that it feels like right now we have a lot of mental health taboos. And even it's very subtle, like when you say something is crazy, it can be a number of things. It can mean that it's crazy good, like it's really amazing, but it's also a way of dismissing people, like that person is crazy. and I feel like there's a certain amount of like the DSM-IV where it can be this label where people take it on and really have that larger mental health taboo and you can lose jobs or lose access and like giving an immersive experience for people to understand the nuances of mental health but also like to address the deeper mental health taboos that we have and to find out how people are more complex than that what some philosophers call epistemic closure which is like once you have a label on something you don't need any more information about them because you know everything that you need to know and I feel like mental health is that realm where we have some serious like taboos in the culture around mental health.

[00:36:54.132] Jessica Stone: I think that's absolutely true and I I have a love-hate relationship with the DSM. I don't even know, I'll have a sort of tolerate and hate relationship with it. I think that the old adage that gets tossed around a lot is you meet one person with X diagnosis, whatever it is, you've met one person with X diagnosis, right? Because even the way it's categorized, you have a list of criteria in different groupings, and you have to have two out of these five, and three out of this seven, and that together, if you meet those criteria, then you have the diagnosis. So that means that it can look very, very different for very different people, right? And so you have the society view of what it means to be X diagnosis, and then you have the personal view of what that means, and everything in between, so. So when I say I have a tolerate and hate relationship with it, I think it's important that we can have common language to at least narrow down the conversation, but that's not where the conversation ends. And it's much, much more complex than that. And if I can do away with us needing to do that, I would. It's not in my power and I don't know what else we would do. So I don't have good answers, but I know that the system is one that I don't like. So for those reasons that you're saying, both for someone to conceptualize themselves and to be conceptualized by others, and even when we're talking about medication, and I say this to my clients all the time, so if somebody has a thyroid issue and they have to take thyroid medicine for the rest of their lives, There doesn't seem to be much stigma about that. You have an issue and you're making too much or not enough of what needs to be made, the chemicals in your body, and therefore you take a medication to bring that into the proper range. Right? People don't question that. It's, okay, I got to take my thyroid medication. It's just, that's at the base of the brain. Like you just go a little bit north and all of a sudden you're into the brain and oh my goodness, you need a medication to regulate whatever it is that is going on with you and now there's stigma attached and now it's an issue. It's very frustrating for me as a professional, and I'm actually really conservative when it comes to medications, and I don't prescribe. I'm a psychologist, not a psychiatrist. But even when I'm recommending it, I'm very conservative about that. But I do see that stigma, and it's very frustrating. So when you're talking about diagnoses of any type, and then also the medications and mental health in general. The stigma that's attached really does create a system that's counterproductive in a lot of ways for people to get what they need.

[00:39:30.941] Kent Bye: A lot of that seems driven towards trying to use the pharmaceutical solution, but I do feel like, as you were saying, the different categories and the comorbidity of the different things. I feel like in the future VR could help do assessments of being able to help really dial in and try to see different behaviors in different social contexts, but to maybe get a little bit more context and information of those and to use VR as an assessment tool and then maybe have experiential medicine. I know that Adam Ghazali is doing a video game to be able to be approved by the FDA to be able to be, instead of prescribing drugs, you can just prescribe a video game. So I feel like this whole future of experiential medicine, of being able to not only assess what is really happening for people, but to be able to actually prescribe experiential medicine as well. So for me, that's what I get excited about. If everything's being driven by an existing market dynamic of pharmaceuticals as the only option, I feel like VR is actually opening up all these new options, and I feel like a lot of work that you're doing, it may be opening up the doorway for other ways to address some of these issues as well.

[00:40:32.825] Jessica Stone: Right, I absolutely agree and I hope that we can get a lot of traction in that because, as I said, I'm conservative when it comes to meds. I think there are situations where it can really improve someone's life, but I also think that There are so many other possible solutions and ways to manage and ways to learn and ways to integrate and deal with things. And if we can do that in a way such as through VR, and I'm a big proponent of the use of the VR along with a professional, because I think it's a combo platter. I think it's one or the other can be lacking in some things, but together it's a really powerful team. And so I'm in complete agreement with you.

[00:41:15.381] Kent Bye: Is there anything else that's left unsaid that you'd like to say to the immersive community?

[00:41:20.144] Jessica Stone: I don't think so. I'm just really excited about talking with you and about being here and doing the number of conferences that I've been doing and writing about it. I have an edited book that came out last March, Integrating Technology into Modern Therapies. And I have another book, Digital Play Therapy, that's coming out soon. I have to finish it. And then another version of the integrating book has kind of come out because, of course, I couldn't put everything in one book, right? There's just so much and everything changes so quickly. So I'm just having... a lot of fun and interest in exploring all of this, learning as much as I can and moving forward with it as it goes. So I am always interested in collaborating. I want to be involved in things. I'd love to be a consultant on companies that are working to produce some of this information and these games and these programs because of course I I can't do it all by myself. And I wouldn't ask my husband to continue to write every single idea that comes into my head, because that's not fair to him either. So I'm excited to be part of all of this.

[00:42:23.411] Kent Bye: Yeah, well, speaking the language of your clients, video games and immersive technology is certainly going to be a big part of the future. So yeah, it's fascinating to hear about your story and everything that you're working on. So I just wanted to thank you for sitting down and telling your story and sharing all that you're doing with this virtual SandTree technology. So thank you.

[00:42:40.785] Jessica Stone: Thank you for your time. I appreciate it.

[00:42:42.946] Kent Bye: So that was Dr. Jessica Stone. She's a licensed psychologist and registered plate therapist, and she's been developing a number of different applications, a virtual sanitary application, also an iPad version of that as well. And she's written a couple of books, including Integrating Technology in Modern Therapies. It was released March 5th, 2019, as well as Digital Plate Therapy, which was released on July 16th, 2020. So I have a number of different takeaways about this interview is that, first of all, well, I find this whole concept completely fascinating that you could use the virtual reality medium to be able to express different aspects of your experience through these world-building metaphors of what is coming from an established practice and play therapy from Margaret Lowenfield, pioneer this back in the 1930s, the sand tray and sand play, using symbolic representations to be able to express what's happening in your inner psyche. And I think this is absolutely fascinating because I think it's tapping into a realm where people like Carl Jung looking at aspects of the unconscious and, you know, looking at dream analysis, there's a therapeutic benefit for whatever these approaches are, where, you know, we're projecting ourselves into the world all the time, nonstop. So there's like workstock inkblot test where you would project a story into it, and it's really what you see in it. And. This is a very similar where you're able to, in the actual SandTray experience, you would have sand and these different figures, and you would create scenes that are trying to describe what's happening in your lived experience. And what was fascinating is just to hear what's been opening up with being able to do that with the virtual SandTray application, who are maybe a little bit more intellectualized, have a hard time going from their head and dropping down into the heart and need lots of different modalities to be able to express themselves. This is a further continuation of looking at virtual reality as a communications technology. And it really did remind me of this experience that I did at Tribeca of 2019 called Future Dreaming. And I hope to dive into those conversations soon because I think it's something similar, which is like using the medium of virtual reality to do world building with that world building being an archetypal representation of either what's happening in the conflicts in your lives or aspects about your fundamental character of who you are. and thinking about in the future how we are going to be building worlds, these virtual worlds, to be able to express the most intimate aspects of our lives. And how sometimes just trying to put things into words is very difficult, but we can put people into an experience with virtually mediated technologies and be able to tap in a lot deeper into what's happening. And so this is just a whole field that I think as virtual reality is pulling in all these different disciplines, you know, the licensed psychologist and the psychotherapies and these archetypal approaches, these play therapies are going to be start to be integrated into the technologies and I reached out to Dr. Jessica Stone just to hear a little bit more of an update as to what's happening. And she said that actually, you know, with the COVID-19, there's a lot more interest of using these different digitally mediated technologies to be able to facilitate therapy sessions when you can't actually physically meet in may have to do it over zoom and you know there's something that's lost there and so being able to use some sort of embodied experience that is either in an iPad or in a virtual reality technology to be able to go a lot deeper and so she's been actually working on the tablet version and expanding that that's available on the app store folks are interested in some of the continued evolution and integration of the remote sessions that she's been integrating And then she's also got a virtual sanitary application. And we talked about in this interview and also followed up an email, just trying to find a good distribution option for that. And she's actually in the process of trying to find a good home for the virtual sanitary application. And she's looking for perhaps collaborations with other virtual therapy products to be able to have either a bundled or distributor, or just to have something that is able to have a location for people to go to, to be able to get access to these different types of applications. I know that in talking to Oculus that they've been really focused on games and talking to Colin Slevin, he's talking about how they're trying to develop other industry verticals other than gaming, then they're using Oculus TV to be able to start to curate immersive storytelling applications. somatic bruce is now actually working at oculus helping to work with different aspects in the store and he had mentioned that there's actually going to be a couple of new store options coming up probably in 2021 one for enterprise clients and so having new channels for if people are selling specific tools to enterprise clients and that's going to be one option but that seems to be a little bit more for if you're actually buying the enterprise edition and being able to push applications and sell specific software to enterprise applications. So that's a whole other distribution channel. And they're also thinking about something that's equivalent to like the SideQuest that is going to be a way for game developers to push out builds and give access to something that's a little bit less refined than a full completed project, kind of like the Oculus Share 2.0 that should be coming out probably at some point, either at the end of the year or next year. Hopefully learn a little bit more information about that at Oculus Connect 7. But the point is that there's just a need to be able to cultivate other distribution options. And so Jessica is talking about how she's looking for the right home to provide a location for like-minded professionals and developers to offer powerful, immersive, and therapeutic XR. So just some other takeaways from this conversation is that when you're in therapy, the things that you want to have is to be heard, seen, understood, and accepted. And she's a huge advocate for trying to, as much as possible, have a shared language and shared cultural references with her clientele, which means that she will often look at the different Pokemon and learn about the different evolution tracks, different characters, and that, you know, she says she can actually learn a lot about somebody by what type of Pokemon characters that they're attracted to. And that she's able to take that type of information and to learn about stuff like their frustration tolerances, their coping skills or coping styles and strategic abilities. And so the more that she's able to speak the same common language with her clientele, then the more that she's able to cultivate a deeper intimate connections with them and to help them be heard, seen, understood, and accepted. In the future, she sees a lot of possibilities for training and treatment, potentially even with AI virtual beings to be able to help train the practitioners and potentially using the same virtual reality technologies for treatment. She's doing the virtual sand tray applications and I'm sure there'll be other iterations when it comes to experiential medicine. I know that Adam Ghazali went through the process to getting a video game approved by the FDA to be prescribed. And so instead of being prescribed medicine, you'd be prescribed an experience. So I expect to see a lot more of this type of experiential medicine as we move forward. And I'd be very curious to see what the limits of that are, but also the diagnosis of being able to put folks into different contexts to be able to see what is happening with different mental health issues that they may have. And that the distribution of this has raised all sorts of different interesting challenges. One is that most therapists don't have gaming PCs. And so there's a technological limitation such that it's hard enough for a lot of the people that would be using this to even have a single high-end virtual reality machine, but then to actually have two to be able to have them in the virtual world at the same time, perhaps with the way things are going with the global pandemic, maybe there'll be an increase of more people having gaming PCs, but I don't expect that to happen as much as for people to adapt to the Oculus quest, because that's just a lot easier. And it's a lot more likely for folks to have an Oculus quest than it would be for folks to have like a whole gaming PC. So just in terms of accessibility, it's a little bit more accessible, but it's still got a long ways for us to go through the technology diffusion process to be able to have mass ubiquity to all this, but. accessibility and being able to think about the limitations of the existing SAN tray application and how a virtual SAN tray could solve some of those accessibility issues. But then as you move to the virtual technologies, then there are certain accessibility limitations that are embedded within the technology itself. And so there's further iterations that still have to happen in terms of, you know, really creating a universally accessible versions of these immersive technologies, independent of how able bodied you are. And then finally, I just wanted to make a point that, you know, there's this evolution that Simon Wardley identifies these different phases of an idea, which is like the duct tape prototype, to then an enterprise application, to then a consumer application, to then mass ubiquity. And so this concept of using virtual reality technologies in this type of therapeutic context is really at the prototype idea phase. It's really at the very beginning of where all this could end up going. And we're potentially moving into this phase of enterprise application as she tries to find ways to distribute these different types of virtual sand tray applications. And then eventually perhaps we'll get to the point where it's available for anybody to have access to it. And then what's that mean to be able to use some of these different insights of blurring in together a whole other design discipline, which is creating an immersive experiences that have a real therapeutic output, where you're judging the success of an experience based upon whether or not people are actually feeling better. So I think there is going to be a huge insight for different types of processes and play therapy and the theoretical grounding from either Margaret Lowenfield, who helped pioneer a lot of these play therapy technologies, or folks like Carl Young, who's talking a lot about the archetypal dynamics. And, you know, as I talk about this specific experience, there's actually an experience called Collider, the Tribeca of 2019, as well as InfoDocLab in 2018. I had a chance to do that experience a couple of times, and they actually use this sand tray where they ask you to think of a memory of you either having someone have power over you or you have power over someone else, and then you create this memory, and then you do this actual sand tray where you're projecting your life experience into this scene, and then that really sticks with you, and they play with that memory in a very visceral and embodied way throughout the course of that experience. And so this concept of using the sand tray is something that I've already started to see start to bleed into some of the immersive storytelling experiences that I've seen on the film festival circuit. So I expect to see a lot more of this, even if you're the only one that understands it, but you're able to create your own memory palace or representation of your direct embodied experiences and allow either a therapist or other people to get a lot more deeper insight into what you've gone through and ultimately help you to feel heard, seen, understood, and accepted. So, that's all that I have for today, and I just wanted to thank you for listening to the Voices of VR podcast. And if you enjoyed the podcast, then please do spread the word, tell your friends, and consider becoming a member of the Patreon. This is a message-supported podcast, and so I do rely upon donations from people like yourself in order to continue to bring you this coverage. So, you can become a member and donate today at patreon.com slash voicesofvr. Thanks for listening.

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