Hypothetical active voicing in AVATAR therapy

This paper explores AVATAR therapy, an innovative therapeutic intervention for people experiencing auditory verbal hallucinations (AVH) where participants interact with their ‘voice’ in the form of a co-designed visual representation of their voice. Previous research has found AVATAR therapy to be successful in its aim to initiate change in the participant’s relationship to and experience of their voice, but no study has explored the interactional practices employed as they unfold in this complex multi-party interaction between therapist, participant and avatar voiced by the therapist. We build on previous research and question what it is about this innovative, interactional technique that might be contributing to the efficacy of this therapy? Using Conversation Analysis, we examine the therapist’s use of “Hypothetical Active Voicing” (HAV), where the therapist formulates a proposed turn at talk in their interaction with the participant for the participant to reformulate in their next turn with the avatar. We show how, unlike in traditional dyadic therapeutic settings, participants are immediately able to enact the therapist suggested dialogue. We find that as the therapist increases their assertiveness, control, and precision in the delivery of HAV, so does the participant increase their assertiveness towards the avatar, thus contributing to the aims of the therapy.