Beyond Traditional Methods: Avatar Role-Play for Healing Relationship Challenges

By Elana Ben Amir

Clinical Psychologist, Rizolv

Relationships are central to mental health.Supportive human connections enhance resilience, emotional regulation, and a sense of meaning. On the other hand, chronic relational stress - conflict, isolation, abandonment - has been strongly linked to the development of depression, anxiety, PTSD, and even physical health decline [1][2][3].

In fact, relationship struggles are among the most common reasons people seek therapy [4]. Whether it's healing from past wounds, resolving current interpersonal tension, or learning to form healthier attachments, the relational domain remains a cornerstone of clinical work.

The good news? Modern psychotherapy offers effective, evidence-based methods to support relational healing.

Thanks to the brain’s neuroplasticity - its ability to change structure and function through repeated experience - new patterns of connection, empathy, communication, and boundary-setting can be formed at any age. But for that to happen, emotional experiences in therapy must feel real, safe, and meaningful.

In this blog, we’ll explore the strengths and limitations of current methods for relational healing - and introduce an exciting new tool that helps bring these methods to life in a deeper and more embodied way.

Evidence-Based Tools for Healing Relationships

Contemporary psychotherapies offer diverse methods for working with relationship issues. These approaches are grounded in decades of research and have been shown to enhance emotional regulation, empathy, and interpersonal functioning:

• Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Therapy (IPT): Help clients reframe distorted thoughts, manage emotional reactivity, and build communication and conflict-resolution skills.

• Psychodynamic and attachment-based therapies: Explore unconscious relational patterns formed in early life and offer insight into recurring dynamics in adult relationships.

• Experiential techniques (e.g., chair work, role-play, guided imagery): Enable clients to practice assertiveness, express unspoken feelings, and achieve emotional closure with significant others (whether alive or not).

Each of these modalities has shown significant clinical benefits. For example, DBT has proven particularly effective in improving interpersonal functioning among individuals with borderline traits, while experiential exercises have been shown to accelerate emotional processing and trauma integration [5][6].

Where These Approaches Fall Short

Despite their strengths, traditional approaches often face engagement challenges - especially when it comes to emotionally charged relational issues:

• Role-play can feel artificial making it hard for clients to fully “drop in” emotionally.

• Symbolic methods like the empty chair require a high degree of imagination that may not feel authentic or accessible to all clients.

• Transference work takes time to develop and may not resemble real-life relational figures.

• Clients may resist or intellectually disengage from exercises they perceive as abstract or “just pretend.”

Put simply: We need tools that allow clients feel the experience - not just talk about it.

Immersive Role-Play with Avatars: A New Bridge

What if clients could rehearse a real conversation with a parent, revisit a rupture with an ex, or confront their inner critic - not just in imagination, but in an emotionally immersive, interactive space?

That’s exactly what avatar-based therapy enables.

Powered by real-time, emotionally responsive avatars, this technology allows clients to interact with lifelike representations of key relational figures within a safe, guided therapeutic container. The therapist remains fully in control, guiding the session dynamically, while the avatar becomes a tool for emotional embodiment.

What can clients do with avatars?

✅ Rehearse difficult conversations with a loved one

✅ Engage with a childhood version of themselves

✅ Confront an internalized part like a “critical voice”

✅ Explore forgiveness or grief with someone they’ve lost

These interactions draw on the same mechanisms activated by traditional experiential therapies - but enhance them with a sense of presence, embodiment, and realism. According to recent studies, clients reported higher emotional honesty, more insight, and lower resistance when using avatar interfaces compared to verbal-only therapy [7][8].

What the Research Shows

Recent studies support the clinical promise of avatar-assisted relational therapy:

• A 2025 randomized trial published in the Journal of Telehealth Psychology found that participants in avatar-guided sessions reported high emotional engagement, increased honesty, and lower resistance - factors that may support relational processing in therapy contexts [9][11]. 

• Clients using emotionally intelligent avatars experienced increased affective engagement and retention of insights across multiple sessions [10].

• The therapy enabled the participant to explore the meaning and purpose of the voices in relation to past trauma and personal relationships, suggesting a potential for deeper relational processing [11]. 

• AVATAR therapy, when combined with treatment as usual (TAU), led to significant reductions in voice-related distress compared to TAU alone [12].

These tools leverage neuroplasticity and embodied cognition, helping the brain “re-map” relational experiences in ways that are harder to access through words alone.

Clinical Considerations for Implementation

Avatar-assisted therapy is not meant to replace traditional methods - but to enhance them. To implement effectively:

• Begin with clear intention: Identify the relationship theme and prepare the client emotionally.

• Use guided scripts and clinical protocols: Ensure emotional safety and therapeutic containment.

• Process the experience in real-time: Follow the avatar work with debriefing, integration, and insight-building.

• Adapt for client readiness: Some clients may benefit from starting with less emotionally charged figures before approaching more intense avatars.

Therapists can use avatars across screens, mobile, or immersive formats—making the approach flexible and accessible.

The Road Ahead: From Abstract to Embodied Healing

As therapy evolves, our tools must evolve with it. Traditional techniques like chair work and transference remain powerful - but avatar-based role-play offers a bridge between imagination and experience. It brings the emotional core of relationship healing into sharper focus.

Therapists interested in this modality should begin exploring training, case studies, and collaborative pilots. It’s a promising frontier - not just for innovation, but for deep, transformative healing.

Because at the heart of therapy lies one timeless truth: Healing happens through connection. And connection, when made vivid and real, can change everything.

References

1. Thomas PA. (2016). The Impact of Relationship-Specific Support and Strain on Depressive Symptoms Across the Life Course. J Aging Health.;28(2):363-82. https://pmc.ncbi.nlm.nih.gov/articles/PMC9013430/ 

2. McFarlane A. C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World psychiatry : official journal of the World Psychiatric Association (WPA), 9(1), 3–10. https://doi.org/10.1002/j.2051-5545.2010.tb00254.x 

3. Raggatt, P. T. F. et al. (2022). Meaningful Relationships in Community and Clinical Samples: Psychological and Social Implications. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2022.832520

4. https://www.mentalhealth.org.uk/explore-mental-health/statistics/relationships-community-statistics 

5. Hernandez-Bustamante, M. et al. (2024). Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials. Iranian journal of psychiatry, 19(1), 119–129. https://doi.org/10.18502/ijps.v19i1.14347 

6. Kuhfuß, M. et al. (2021). Somatic experiencing - effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European journal of psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2021.1929023 

7. Ward, T. et al. (2020). AVATAR Therapy for Distressing Voices: A Comprehensive Account of Therapeutic Targets. Schizophrenia bulletin, 46(5), 1038–1044. https://doi.org/10.1093/schbul/sbaa061 

8. JMIR Human Factors. (2025). Avatar-Based Psychotherapy: User Experience and Engagement. https://humanfactors.jmir.org/2025/1/e66158

9. PMC. (2025). Exploring User Experience and the Therapeutic Relationship of Avatar-Based Psychotherapy. Journal of Telehealth Psychology, 18(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830452 

10. Jang B. et al. (2025). Exploring User Experience and the Therapeutic Relationship of Short-Term Avatar-Based Psychotherapy: Qualitative Pilot Study. JMIR Hum Factors URL: https://humanfactors.jmir.org/2025/1/e66158 

11. Rus-Calafell et al. (2025). Using Virtual Reality Social Environments to Promote Outcomes' Generalization of AVATAR Therapy for Distressing Voices: A Case Study. Journal of clinical psychology, 10.1002/jclp. https://doi.org/10.1002/jclp.23785 

12. Garety, P.A. et al. (2024), Digital AVATAR therapy for distressing voices in psychosis: the phase 2/3 AVATAR2 trial. Nat Med 30, 3658–3668. https://doi.org/10.1038/s41591-024-03252-8