Immersive Virtual Reality as a Psychoanalytic Setting: Epistemic Safeguards, Clinical Technique, and Human-in-the-Loop Governance
Vincenzo Maria Romeo *
Department of Culture and Society, University of Palermo, Viale delle Scienze, Building 15, 90128 Palermo, Italy, School of Psychoanalytic and Groupanalytic Psychotherapy (S.P.P.G.), Via Fontana 1, 89131 Reggio Calabria, Italy and Neurosinc, Via Paolo Bentivoglio 62, 95125 Catania, Italy.
*Author to whom correspondence should be addressed.
Abstract
Immersive virtual reality (IVR) is becoming a clinically credible medium for mental-health assessment and intervention, but most validated applications remain grounded in exposure, cognitive-behavioural, rehabilitation, or skills-training paradigms. A previous article by the author proposed a three-layer psychoanalytic IVR architecture integrating somatic sensing, symbolic-narrative modulation, and relational interaction. The present book chapter addresses a different question: how can an adaptive IVR environment be governed clinically without converting physiological correlates, behavioural traces, or algorithmic classifications into claims about unconscious meaning? To answer this question, the chapter proposes a set of translational safeguards rather than a new biomarker model. Four design principles are developed: an epistemic firewall separating machine state estimation from psychodynamic interpretation; minimum-necessary adaptation, which limits automated environmental changes to containment and safety functions; interpretive latency, which protects time for association and reflective elaboration before meaning is assigned; and dual-loop human-machine governance, in which the technical loop regulates the environment while the clinician-patient loop retains authority over formulation, interpretation, and therapeutic direction. The framework is extended to embodiment, presence, avatar-mediated transference, countertransference, source-memory confusion, suggestibility, clinician dashboards, privacy, and derived psychological data. A staged session protocol and an empirical measurement battery are proposed using established instruments for presence, embodiment, reflective functioning, therapeutic alliance, and simulator sickness, together with system-level safety and override metrics. The framework is conceptual and has not been empirically validated as an integrated package; its feasibility, safety, and clinical utility therefore remain to be established in prospective studies. The chapter does not claim that biosignals reveal unconscious content or that psychoanalytic IVR is an established treatment. Its purpose is to define conditions under which the earlier architecture can be tested without sacrificing uncertainty, subjectivity, relational accountability, or patient autonomy.
Keywords: Immersive virtual reality, psychoanalysis, psychodynamic psychotherapy, affective computing, human-in-the-loop, embodiment, interoception, physiological sensing, biosensors, digital phenotyping, algorithmic bias, transference, source memory, clinical governance