Contributed: Reimagining therapeutic cornerstones for the immersive age

Clients have long used traditional tools such as journals, metaphor, movement and artwork to express what words alone could not capture. Today, immersive technologies offer new ways to explore and externalize the internal experience, building on those foundations while enabling more nuanced, embodied and precise forms of expression. 

Individuals can construct symbolic environments that reflect emotional landscapes too complex or layered for language alone. Both approaches, analog and digital, serve the same purpose: to make the unseen seen; the unheard heard; the unknown known.

As technology continues to reshape how one engages in mental healthcare, a truth remains constant – what clinicians do may evolve, but why clinicians do it must remain grounded in intention and therapeutic presence. 

Clinicians are being asked, implicitly and explicitly, to integrate new tools into their practices. Some approach these advances with curiosity, others with hesitation, and many with both. 

Immersive technologies like virtual reality (VR), mixed reality (MR), augmented reality (AR) and spatial computing promise new avenues of access, engagement and insight. But they also raise a crucial question: How does one ensure clinical integrity in an unfamiliar medium?

Why cornerstones matter in the age of innovation

Psychology has historically been slow to change, and for good reason. The modern version of the Hippocratic Oath, to “do no harm”, is not a suggestion; it is the bedrock of ethical practice. 

Clinicians are trained to assess new approaches cautiously and adopt them intentionally. The concern, especially with digital tools, is that the medium will dictate the method instead of the other way around.

But rejecting technology outright also carries harm. It ignores the lived experiences of clients, especially younger generations, for whom digital environments are not novelties but realities. The task is not to abandon our clinical roots, but to apply them wisely and fluently in new terrain. That is where the concept of cornerstones comes in.

Each cornerstone represents a transferable aspect of therapeutic presence and process. When identified and honored, these elements offer a roadmap for ethical, effective work within immersive platforms.

Translating cornerstones to immersive technologies

Below are six cornerstones one can use to evaluate and integrate immersive tools within clinical work:

1. Regulation and safety

Traditional Role: Safety is a precondition for therapy. Whether it’s emotional, relational or physiological, a client must feel secure to engage meaningfully.

Neurobiological insight: The autonomic nervous system (ANS) governs states of arousal and calm. Clinicians’ work often focuses on helping clients stay within their “Window of Tolerance,” balancing sympathetic and parasympathetic activity.

Immersive translation: Immersive environments can support co-regulation through guided breathing apps, ambient worlds that promote parasympathetic activation, or wearable hardware that reflects heart rate in real time. The environment becomes both a mirror and an intervention.

2. Embodied awareness

Traditional role: Therapy invites clients to become aware of their internal states: what they feel, where they feel it and what it means.

Neurobiological insight: The insular cortex plays a central role in interoception and self-awareness. Disruption here can impact emotional insight and social attunement.

Immersive translation: In VR, clients can engage with avatars that reflect real-time physiological input, draw on body mapping tools or use spatial interfaces to externalize what is happening internally. These are not gimmicks, but invitations to notice – a window into their world.

3. Meaning-making and narrative identity

Traditional role: Clients construct, deconstruct and reconstruct the stories they tell about themselves and their world.

Neurobiological insight: The hippocampus and prefrontal cortex work together to reconstruct memories, not simply retrieve them. This active process shapes identity and emotion.

Immersive translation: Digital storytelling platforms allow clients to re-narrate difficult experiences, simulate future selves, or walk through moments with new perspectives. These interventions become powerful tools for integrating memory and meaning.

4. Symbolic expression and projective engagement

Traditional role: Symbolism is the language of the unconscious. From sand tray to metaphor, symbolic play offers access to material that is hard to verbalize.

Neurobiological insight: Limbic structures are deeply involved in emotional learning, attachment, and symbolic expression. When words fall short, images and metaphor can carry weight.

Immersive translation: VR sandbox worlds, expressive drawing programs or open-ended gameplay provide space for projective work. Clients often reveal relational themes and internal conflicts through interaction rather than explanation.

5. Relational insight and perspective-taking

Traditional role: Understanding the self in relation to others is at the heart of many therapeutic models.

Neurobiological insight: The temporal-parietal junction (TPJ) is central to Theory of Mind and social cognition; skills that are often shaped in therapy.

Immersive translation: Perspective-switching experiences, where a client can inhabit different avatars or roles, can surface new empathy and insight. Multiplayer VR sessions can also reveal real-time relational dynamics, making implicit patterns explicit.

6. Reflective and cognitive balance

Traditional role: Therapy often oscillates between doing and being; between executive function and introspective awareness.

Neurobiological insight: The Default Mode Network (DMN) supports self-reflection, while the Central Executive Network (CEN) supports goal-directed action. Balance between these networks promotes well-being.

Immersive translation: Mindfulness VR apps quiet DMN overactivity. Task-based VR can activate goal orientation for clients stuck in rumination. Used intentionally, these tools can help clients shift states.

Ethical and clinical guardrails

The integration of immersive tools must be guided by intentionality. The technology should never replace the therapeutic relationship; it should support it. Clinicians’ job is not to master every platform, but to understand what each tool offers and how it aligns with one’s goals.

Clinicians must also attend to cultural humility, developmental appropriateness and client consent in digital spaces. For neurodivergent clients or trauma survivors, immersive tools can be empowering or overwhelming. It is the clinician’s responsibility to know the difference. Supervision, consultation and continuing education are critical. Ethical integration is not about tech fluency; it is about clinical clarity.

Grounded expansion

Immersive technologies are not inherently therapeutic. They are mirrors, maps and microphones; tools that reflect, guide and amplify the work clinicians already know how to do.

When cornerstones are translated – regulation, embodiment, identification, representation, narrative, symbolism, relationship and reflection – into new formats, clinicians do not lose fidelity; they deepen it.

Clinicians do not need to become technologists. They must remain translators. And in doing so, ensure that the future of mental healthcare remains not only innovative, but deeply human.

Clients have long used traditional tools such as journals, metaphor, movement and artwork to express what words alone could not capture. Today, immersive technologies offer new ways to explore and externalize the internal experience, building on those foundations while enabling more nuanced, embodied and precise forms of expression. 

Individuals can construct symbolic environments that reflect emotional landscapes too complex or layered for language alone. Both approaches, analog and digital, serve the same purpose: to make the unseen seen; the unheard heard; the unknown known.

As technology continues to reshape how one engages in mental healthcare, a truth remains constant – what clinicians do may evolve, but why clinicians do it must remain grounded in intention and therapeutic presence. 

Clinicians are being asked, implicitly and explicitly, to integrate new tools into their practices. Some approach these advances with curiosity, others with hesitation, and many with both. 

Immersive technologies like virtual reality (VR), mixed reality (MR), augmented reality (AR) and spatial computing promise new avenues of access, engagement and insight. But they also raise a crucial question: How does one ensure clinical integrity in an unfamiliar medium?

Why cornerstones matter in the age of innovation

Psychology has historically been slow to change, and for good reason. The modern version of the Hippocratic Oath, to “do no harm”, is not a suggestion; it is the bedrock of ethical practice. 

Clinicians are trained to assess new approaches cautiously and adopt them intentionally. The concern, especially with digital tools, is that the medium will dictate the method instead of the other way around.

But rejecting technology outright also carries harm. It ignores the lived experiences of clients, especially younger generations, for whom digital environments are not novelties but realities. The task is not to abandon our clinical roots, but to apply them wisely and fluently in new terrain. That is where the concept of cornerstones comes in.

Each cornerstone represents a transferable aspect of therapeutic presence and process. When identified and honored, these elements offer a roadmap for ethical, effective work within immersive platforms.

Translating cornerstones to immersive technologies

Below are six cornerstones one can use to evaluate and integrate immersive tools within clinical work:

1. Regulation and safety

Traditional Role: Safety is a precondition for therapy. Whether it’s emotional, relational or physiological, a client must feel secure to engage meaningfully.

Neurobiological insight: The autonomic nervous system (ANS) governs states of arousal and calm. Clinicians’ work often focuses on helping clients stay within their “Window of Tolerance,” balancing sympathetic and parasympathetic activity.

Immersive translation: Immersive environments can support co-regulation through guided breathing apps, ambient worlds that promote parasympathetic activation, or wearable hardware that reflects heart rate in real time. The environment becomes both a mirror and an intervention.

2. Embodied awareness

Traditional role: Therapy invites clients to become aware of their internal states: what they feel, where they feel it and what it means.

Neurobiological insight: The insular cortex plays a central role in interoception and self-awareness. Disruption here can impact emotional insight and social attunement.

Immersive translation: In VR, clients can engage with avatars that reflect real-time physiological input, draw on body mapping tools or use spatial interfaces to externalize what is happening internally. These are not gimmicks, but invitations to notice – a window into their world.

3. Meaning-making and narrative identity

Traditional role: Clients construct, deconstruct and reconstruct the stories they tell about themselves and their world.

Neurobiological insight: The hippocampus and prefrontal cortex work together to reconstruct memories, not simply retrieve them. This active process shapes identity and emotion.

Immersive translation: Digital storytelling platforms allow clients to re-narrate difficult experiences, simulate future selves, or walk through moments with new perspectives. These interventions become powerful tools for integrating memory and meaning.

4. Symbolic expression and projective engagement

Traditional role: Symbolism is the language of the unconscious. From sand tray to metaphor, symbolic play offers access to material that is hard to verbalize.

Neurobiological insight: Limbic structures are deeply involved in emotional learning, attachment, and symbolic expression. When words fall short, images and metaphor can carry weight.

Immersive translation: VR sandbox worlds, expressive drawing programs or open-ended gameplay provide space for projective work. Clients often reveal relational themes and internal conflicts through interaction rather than explanation.

5. Relational insight and perspective-taking

Traditional role: Understanding the self in relation to others is at the heart of many therapeutic models.

Neurobiological insight: The temporal-parietal junction (TPJ) is central to Theory of Mind and social cognition; skills that are often shaped in therapy.

Immersive translation: Perspective-switching experiences, where a client can inhabit different avatars or roles, can surface new empathy and insight. Multiplayer VR sessions can also reveal real-time relational dynamics, making implicit patterns explicit.

6. Reflective and cognitive balance

Traditional role: Therapy often oscillates between doing and being; between executive function and introspective awareness.

Neurobiological insight: The Default Mode Network (DMN) supports self-reflection, while the Central Executive Network (CEN) supports goal-directed action. Balance between these networks promotes well-being.

Immersive translation: Mindfulness VR apps quiet DMN overactivity. Task-based VR can activate goal orientation for clients stuck in rumination. Used intentionally, these tools can help clients shift states.

Ethical and clinical guardrails

The integration of immersive tools must be guided by intentionality. The technology should never replace the therapeutic relationship; it should support it. Clinicians’ job is not to master every platform, but to understand what each tool offers and how it aligns with one’s goals.

Clinicians must also attend to cultural humility, developmental appropriateness and client consent in digital spaces. For neurodivergent clients or trauma survivors, immersive tools can be empowering or overwhelming. It is the clinician’s responsibility to know the difference. Supervision, consultation and continuing education are critical. Ethical integration is not about tech fluency; it is about clinical clarity.

Grounded expansion

Immersive technologies are not inherently therapeutic. They are mirrors, maps and microphones; tools that reflect, guide and amplify the work clinicians already know how to do.

When cornerstones are translated – regulation, embodiment, identification, representation, narrative, symbolism, relationship and reflection – into new formats, clinicians do not lose fidelity; they deepen it.

Clinicians do not need to become technologists. They must remain translators. And in doing so, ensure that the future of mental healthcare remains not only innovative, but deeply human.