Kate Anthony (OnlineCounsellors.co.

uk) 10/5/02
Matt Lawson (www.btexact.com) Draft D

The Use of Innovative Avatar and Virtual Environment

Technology for Counselling and Psychotherapy
Kate Anthony (OnlineCounsellors.co.uk) and Matt Lawson (BTExact Technologies)

Abstract
Current use of Information Technology within the actual process of conducting therapy centers
around three distinct areas - Online Text Therapy (e-mail and Internet Relay Chat),
Video/Telephone Therapy, and Stand Alone CD-ROM software. This paper examines four further
innovative radical technological developments currently being developed for Mental Health
provision.

Introduction
The concept of using innovative technology for Mental Health provision has been forthcoming
since it became apparent that clients are not only willing to use technology to gain therapy
services but in many cases actually prefer it (Anthony, 2000). Development of sophisticated
computer generated representations of the self is the work of BTExacts Radical Multimedia Lab,
and the application of this to the world of therapy has been developed in conjunction with
OnlineCounsellors.co.uk. There are four distinct areas of development in progress, based on the
premise that some clients find the idea of anonymous, safe, comfortable and readily available
service provision empowering and preferable to traditional (usually face-to-face) therapy.

The use of natural language scripts provides a Mental Health information service that creates a
realistic question and answer session that appears to be a dialogue between two people, when in
fact the client is interacting with a piece of software. The creation of an electronic version of the
head and face of a therapist an avatar - combines the positive distancing aspect of the
relationship so that clients can easily access an online therapist. The representation of a human
being facilitates a more open therapeutic relationship, working towards the clients mental well
being while bypassing the usual constraints of a face-to-face relationship (physical bias or having
to look someone in the eye while revealing sensitive material). Full-body avatars, whether actual
representations of the person or not, can mean that groups can meet from anywhere in the world
and hold a session in complete anonymity and genuine safety. Put these avatars into specific
relaxing environments, and we can lose the impersonal waiting room or austere consulting room
altogether. The positive use of a therapeutic virtual environment for adolescents facing
hemodialysis has already been piloted and found to be a way for patients to distance themselves
from the harshness of their medical condition (Bers et al, 2001).

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Avatars
The word Avatar comes from Hindu Sanskrit term3 meaning A deity in visible earthly form. In
science fiction4 the word has been used to mean the visible representation of a human appearing
in a computer generated world. This word has then been applied in the IT industry with the same
definition A graphical representation of a human being in a computer graphical environment5.
Avatars come in many shapes and forms [Fig.1] and in the past their appearance has been
limited by the graphical processing power of computer technology.

Figure 1. A range of avatars, past and present

Very basic humanoid figures Simple geometric style avatar representations

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Cartoon Style 3D avatars Full body human representations

The explosive growth of widely available and cheap PC graphics power in recent years has led
to the current state of the art in avatar technology photorealism. This is the ability to create
avatars that have the same on screen appearance as the physical appearance of a real human
being [Fig.2]. These are usually created using 3D graphics and can be a representation of the
head only, head and shoulders, upper body or full body of the human subject upon which it is
based.

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Figure 2. A selection of photoreal avatars

full body photoreal avatar with wire frame head only avatar compared with human subject

The avatar is created by deforming a polygonal wire mesh structure to match the proportions
and appearance of the human subject. Texture information captured from high resolution digital
photography is then overlaid on the mesh to provide the avatars skin. An underlying bone
structure is then applied to the avatar to enable it to animate. This includes a simple skeleton for
limb, body and head movement and a bone structure for the mouth to enable the avatar to talk.

Figure 3. The process of creating an avatar12

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This process can either be implemented by a graphics designer using desktop avatar building
tools6 [Fig.4] or by using a special avatar scanning booth7,8 [Fig.4], which captures the information
in an automated process and then builds the avatar.

Figure 4. Desktop Tool and Avatar Scanning Booth

Avatar Booth captures subject proportions and textures

Desktop tool for avatar head creation

The avatar is given a voice by means of a text to speech (TTS) engine or by synchronizing its lips
to a real human voice like a virtual ventriloquists doll. This can be done dynamically or by using
pre-recorded speech samples. Animation can be applied to the avatars facial features so that it
is capable of facial expression [Fig.5] and emotional responses such as surprise, interest,
empathy, the need for clarification, etc

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Figure 5. Images of avatar facial expressions

Neutral Happy Sad Annoyed

Once created, a remote therapist can control the avatar in a real time on-line Counselling
session, speaking through the avatar to the client. This overcomes some of the problems
associated with video conferencing such as low bandwidth availability and lack of eye contact.
Alternatively the avatar can be configured to act as a virtual host on a web site or CD ROM and
provide a human style interface to an automated Counselling system such as the original 1966
Weizenbaum creation ELIZA9 (see http://www-ai.ijs.si/eliza/eliza.html). In this case the avatar
needs to act independently and as such needs a form of virtual intelligence and knowledge. A
natural language engine combined with a knowledge database provides this.

Natural Language Scripts and Knowledge Data Base

In order to interact effectively with the client, the therapist avatar will need two parts to its virtual
intelligence 10. The first part is a large store of information on the issues the client is likely to
discuss, how those issues relate to each other and to the client, and what a sensible and correct
response to those issues might be. We call this a knowledge database, which is the sum of the
avatars understanding in the required topic areas. The second part of the virtual intelligence is
the ability of the avatar to communicate meaningfully with the client. Most importantly this is the
ability to understand the clients questions and comments, and then structure and deliver a
meaningful response.

Knowledge Database

The larger and more in depth the information store on the required topics the more informed the
avatar will be and the more capable it will be of providing a useful and effective response to the
client. By tightly defining the topics to be covered but providing great depth of information and
linkage between the pieces of information, it is possible for the avatar to give very intelligent
responses to the client.

Natural Language Engine

A natural language engine is a powerful tool. Not only does it understand the individual words
being provided by the client (in spoken or text format) but it also understands the context of the
words, how they relate to each other and the implication of those words when placed in that
particular order. A simple example would be as follows:

The client opens the discussion with the following comment:

I feel really down about what has happened

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It is OK for a speech recognition application to detect these words and perhaps even provide their
individual meanings but that is not enough information for the avatar to be able to help the client.
E.g.

Word Individual Meaning

I Personal Pronoun
Feel To examine by touch
Really In fact
Down A lower position or state

The natural language engine goes much further than this. It is able to understand that the client
is having a strong feeling of depression or gloom and that this feeling has been caused by some
yet to be defined event (what has happened).

Word Individual Meaning

I Personal Pronoun
Feel Emotion
Really Emphasis (strong)
Down Depressed

As a result it can refer to the knowledge store and structure a sensible response. E.g.

What has happened and why is it making you feel so down?

The knowledge store may even be dynamically updated as the avatar learns about the client. So
in a past session it may have learnt that the client was going through a divorce. In which case the
avatar might respond with.

Is it the divorce that is making you feel this way?

The process might be described in the following way [Fig.6]

Figure 6. Virtual Intelligence process for the Avatar Counsellor

1. Input
comment or 2. Interpret /
question Understand Knowledge
Question Database
3. Query &
Update
Question / Knowledge
Comment Database
Natural Topic 2
Language Topic 3
Engine
4. Gather
Provide relevant
Response Data and
Topic 1
information
6. Response!
5. Structure
most
appropriate
response

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Group Meetings
It is possible to take the use of avatar technology one stage further by also representing the client
as an avatar along with the Counsellor and visualizing both from a 3rd person perspective in a
virtual environment (see next section). This is not limited to only two avatars. Any number of
client avatars can be placed together in the virtual environment and controlled in real time by the
clients from their remote workstations. This allows us to create a virtual group therapy
experience in the same way in which a virtual business conference might occur. Interaction
between the participants can be through a number of methods:

Text chat where the avatars provide a spatial and more realistic visual connection with
the other participants
Voice conference call where each avatars lip movements are synchronized to that of the
participant it represents
Animation can be applied to the avatars through tracking the body movements of the
clients at their desk by using simple screen top video cameras and applying the
movement data to the avatars. Similarly, facial expression can be given to the avatars by
tracking the facial expression of the client at their desktop.
Alternatively where video tracking facilities are not available, animation and facial
expression can be triggered by the clients pressing preprogrammed hot keys on their
keyboard or by using the text emoticons commonly used in SMS messaging.

Figure 7. A virtual group therapy session using avatars12

An avatar enters the virtual room The virtual session begins

Virtual Environments
A virtual environment can be defined as A simulation of a physical space using 3D graphics.
The space can be based on a real world location or can be purely the product of someone's
Imagination.

Virtual environments are created in a similar process to avatars. The proportions and dimensions
of the space, usually acquired from plan drawings, are then visualised in a 3D wire-frame or
mesh format. Texture information is then acquired either by taking digital photographs of real
world locations to provide a photoreal experience or the textures can be created by the designer.
These textures are then applied in the correct way to create the finished virtual environment.
Lighting effects, shadows and other details can then be added, such as furniture, curtains,
exteriors, etc.

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Figure 8. Process for creating an example 3D environment (in this case a new theatre) 12

1. Plan drawings 2. 3D wire-frame model

3. Application of textures 4. Finished virtual environment with detail

The virtual environment provides a context in which meetings such as group therapy sessions
using avatars can take place. In the case of the image shown in Figure 7 this is a fairly standard
3D model of a conferencing room. As in the definition above this could be based on a real world
conference room that the client is familiar with or generated by the therapist to suit his or her
taste.

Virtual environments are extremely flexible and as a result can be tailored to the needs of the
client(s). It is not necessary for the client to receive therapy in a room that looks like a traditional
Counselling room. Rather the client can be offered a venue that best facilitates the discussion or
choose from a range of available rooms. In special cases the client could specify the
environment themselves. Examples of where this might be useful include:

Child therapy in a room filled with toys and looking like a play room, perhaps including
interactive multimedia games to facilitate the discussion
Re-living an experience where having the correct environment helps the client to recall
details such as a crime scene
Neuro-Linguistic Programming techniques can use manipulation of environments to
change their emotional meaning to the client
Helping a client to relax by using a familiar leisure location such as their local pub or a
tranquil garden from their local park

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Figure 9. Different client tailored virtual Counselling environments12

Childs play room tranquil garden

Conclusion The future of Avatar and Virtual Technology in Therapy

There are many areas of research within these concepts that need to be explored and examined,
from a theoretical, practical and of course ethical point of view. This is innovative use of
technology at its best the combination of computer technology with the human soul, previously
satirized by society as at best impossible and at worst a danger.

But the advantages of using Avatars for Online and automated therapy are many. Avatar
Therapy provides a more intuitive and human interface than the current purely text-based
systems. Clients who are restricted by geography have instant access to specialists by means of
a virtual session where bandwidth provision doesnt allow for videoconferencing. A virtual
environment can be the choice of the client to maximize their comfort and facilitate the
therapeutic work.

Think of a place in Cyberspace where clients can select their Counsellor from a range of Avatars,
an image that they can relate to completely by gender, colour and appeal. The human soul
behind the Avatar is real the physical representation need not be. Add a virtual environment
that has no physical restrictions on any level not even being bound to the Planet Earth, or
indeed to any reality. Let the client remain anonymous by changing their identity through their
Avatar, and then use that choice of physical representation within the therapeutic work to explore
role-play, identity management and the clients true perception of the real self.

Then, think of the future of technology haptic bodysuits that allow people to occupy the same
space while many miles apart total immersion in a virtual environment with tactile feedback.
And how far away is the possibility of beaming a hologrammatic therapist into our living rooms?
In the year 1999, when OnlineCounsellors.co.uk started offering workshops on IT in Therapy
this concept was offered as a lighthearted look at the realms of possibility. Now, just three years
later, it is very much offered as a serious and likely development within our lifetimes.

Contacts:

Kate Anthony: 020 8317 9954, [email protected]

Matt Lawson: 01473 632249, [email protected]

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References

1. Anthony, K. (2000). "Counselling in Cyberspace". Counselling Journal, 11 (10) 625 -

627. Also available online at www.onlinecounsellors.co.uk or www.kateanthony.co.uk

2. Bers,M., Gonzalez-Heydrich,G., DeMaso, D. (2001) "Identity Construction Environments:

Supporting a Virtual Therapeutic Community of Pediatric Patients Undergoing Dialysis" In
Proceedings of Computer-Human Interaction (CHI'01) ACM.

3. E M Kirkpatrick, Chambers 20th Century Dictionary, 1983 Edition, Pg 84, Definition of Avatar

4. Neal Stephenson, Snow Crash, October 1994, ISBN: 0140232923

5. Matt Lawson, Entering Cyberspace at the Millennium Dome. UCL Library, Aug 2000. Pg 10

6. Biovirtual web site, www.biovirtual.co.uk

7. D Ballin, M Lawson, MA Lumkin, J Osborne, Personal Virtual Humans inhabiting the

Talkzone and beyond, BT Technology Journal, Vol 20 No 1. Jan 2002

8. Practical, Reliable, Repeatable: Scanning Avatars in the Millennium Dome, Daniel Ballin,
Matthew Lawson, Stephen Crampton, Tim Child, Adrian Hilton, Virtual Human Modelling,
Scanning 2001, Paris.

9. J. Weizenbaum. ELIZA -- A computer program for the study of natural language

communications between men and machines. Communications of the Association for Computing
Machinery, 9:36--45, 1966

10. Intelligent Virtual Agents, Proceedings of third workshop on Intelligent Virtual Agents,
Angelica de Antonio, Ruth Aylett, and Daniel Ballin (Eds), Springer Lecture Notes in Science
2001

11. Artwork from Theatre Of Work Enabling Relationships, EU 5th Framework project,
http://tower.gmd.de, Amanda Oldroyd et al

12. Artwork and 3D images by Mick Lockwood, Radical Multimedia Lab, BT Exact Technologies

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