Theories of dyadic attachment are based on the premise that the parents’ personality structure as well as the parent–child relationship can affect the child’s behavioral traits and emotional needs (Bornstein et al., 2022). Kaplan (2019) stressed that the therapist can play a key role in assessing relationships through parent–child interactions in a clinical setting. In this context, the therapist is considered the analytic third, who experiences their interactions as they unfold explicitly and implicitly in the ‘here and now’. These interactions within the parent, child, and therapist triangle contain reconstructed contents from previous relationships that mutually influence one another.

Art-based dyadic methods have increasingly been used to enhance relational dynamics since they can provide a shared creative medium for both parents and children. These art-based approaches presents opportunities for both verbal and non-verbal communication, encourages symbolic play and projection, and creates a joint space where attachment patterns can be observed, reenacted, and potentially reshaped (Gavron and Mayseless, 2015; Shamri-Zeevi and Kedem-Sarrabia, 2023). Art therapy combines artmaking with emotional expression and psychotherapy. It enables clients to explore their mental processes and may contribute to resolving personal and interpersonal conflicts that can lead to greater wellbeing (Malchiodi, 2012; Rubin, 2010). The art therapist suggests specific art-based interventions with dedicated materials and techniques that allow for conscious and unconscious expression in the dyadic relationship (Shamri-Zeevi and Regev, 2021). Gavron (2017) emphasized the importance of identifying the child’s emotional needs in the dyadic relationship through observations of the creative processes and the dyadic product that are considered symbolic expressions that reflect the pillars of the child–parent relationship (Gavron, 2013, 2017; Shamri-Zeevi et al., 2015).

Parent–child nonverbal interactions during painting can also reveal the implicit aspects of the relationship. This diagnostic information is embodied in the artmaking itself and in the symbolic visual contents that arise from it. Joint artmaking both reflects and affects the relationship dynamics, while at the same time providing a safe space for self-expression where the participants can reflect on their relationships creatively and in real time (Gavron et al., 2022). Gavron’s Joint Painting Procedure (JPP) is an arts-based guide to the assessment of nonverbal expressions of the parent–child relationship during joint painting activities (Gavron and Mayseless, 2015). The JPP is designed to document each participant’s individual inner representations, as well as the relationship between parent and child as manifested in the artmaking process and product.

Recent technological developments now allow these art-based methods to be extended to immersive virtual environments, thus opening new avenues for the for assessment and therapy of parent–child relationships. VR constitutes a technological and interactive three-dimensional (3D) environment where multiple participants can share a virtual space generated by stereoscopic 3D displays that create a realistic 360-degree sense of depth and immersion (Alsem et al., 2023). This technology makes it possible to experience a different reality by creating an illusion where what the person sees, and sometimes also hears and feels, is replaced by a visual simulation of a realistic or imaginary digital environment (Piryankova, 2015).

VR in art therapy thus constitutes a cutting-edge approach to mental health therapy that offers unique opportunities for technology-based creative expression and therapeutic interventions (Hadjipanayi et al., 2023; Perez, 2024). VR-based artmaking encompasses a wide range of creative possibilities that include 3D techniques, as well as realistic or imaginary elements from the world of art, thus combining elements such as line, form, patch, and color from painting and sculpture “classically” used in art therapy sessions with digital elements (Hadjipanayi et al., 2023; Kaimal et al., 2020; Shamri-Zeevi, 2021). Artmaking in the digital medium involves virtual rather than physical material. The painting is created in 3D, so that it can be viewed from multiple angles, including from within the work. The virtual space allows “unrealistic” features, since the artwork is not subject to the laws of physics, and the material can include elements that move in infinite space. When difficult emotional materials emerge, the client can control the situation by removing the VR headset (Shamri-Zeevi, 2021).

Previous studies have shown that VR can foster creativity in three-dimensional painting environments and expand opportunities for symbolic expression (Haeyen et al., 2021b; Kaimal et al., 2020). In clinical contexts, VR-based art therapy has been associated with reduced anxiety, improved emotional processing, and enhanced engagement in treatment (Hacmun et al., 2018; Shamri-Zeevi, 2021). More recent work has highlighted the potential of multi-user VR environments in strengthening the therapeutic presence and relational engagement (Jans et al., 2025; Li and Shen, 2022). Systematic reviews have emphasized the importance of developing accessible and low-cost VR applications for wider therapeutic use (Best et al., 2022).

To date however, few studies have explored the use of VR in mother-daughter art therapy. The present study addressed this gap by adapting the Joint Painting Procedure (JPP) to a virtual reality format, thereby contributing to the emerging literature on dyadic art-based interventions.

This study was based on interviews conducted with 16 mothers of daughters aged 9 to 12. They were recruited through social media, parent groups, and personal networking. This exploratory study examined nonclinical participants functioning within the normal range. The only inclusion criterion was the daughters’ age (9–12 years) (see Table 1). The participants were all from central Israel, and in their 40s (M = 40), with a bachelor’s degree as their mean level of education. The mean age of the daughters was 10 (M = 10.28). On average, the mothers had little or no prior experience with VR, and their daughters had engaged in VR sessions 2–3 times gaming previously.

This qualitative study was based on semi-structured interviews with mothers after they took part in the VR JPP. The questions were formulated in advance but were written to be open-ended enough to permit the respondents to expand on content in response to queries from the researcher.

Mother-daughter dyads (a non-clinical sample of daughters aged 9 to 12) were recruited and provided their formal written consent to participate in the study. The dyadic encounter took place in a specially designated space. The participants completed a short demographic questionnaire, and the researcher provided an explanation on how the VR tool is used. The familiarization with the VR technique was followed by the structured VR-JPP procedure. This procedure was recorded in video, audio and still images through the VR headset (Bauer and Gaskell, 2000). After the experience, semi-structured interviews were held with the mothers. During the art-based experience in the virtual space, while wearing the VR headset, the participants were represented by motion avatars that used their voice and could be identified by their movements. The avatars were identical, with different names for the mother, daughter, and researcher. No eye contact could be established, and no facial expression could identify the avatars. The avatar’s height was adjusted to the participant, to easily differentiate between mother and daughter. Note as well that the therapeutic setting during the VR-JPP procedure provided a secure and controlled environment with double boundaries: the physical boundaries of the room, and the virtual boundaries defined by what is known as the Guardian system. The Guardian system, which is integrated into VR headsets such as Meta Quest, allows users to establish virtual boundaries in their physical space. These boundaries appear visually when users approach the edges of their predefined VR area and help prevent collisions with physical objects or walls (XR Today, 2023).

Data analysis was based on a narrative and a phenomenological approach (Kapitan, 2010; Spector-Mersel, 2010). This approach, known as inter-coder reliability, reduces individual bias and ensures the consistency of the findings (O’Connor and Joffe, 2020). Triangulation was achieved by integrating the three data sources (VR session recordings, still images of the artworks, and mothers’ interviews). In this study, the researcher’s dual role as both a participant within the VR environment and the primary data analyst was actively managed through strategies including ongoing reflexive journaling and external supervision. These methods were critical to ensuring that personal involvement did not compromise the objectivity or integrity of the findings. The interviews were analyzed following the principles of thematic analysis, to identify and define major themes, ideas, and interventions (Charmaz, 2006). The data analysis was based on the three stages recommended by Strauss and Corbin (1990). In the first stage of the analysis, the open coding stage, where the meaning categories are extracted from the data, the transcripts were read several times to enhance familiarity with the text, and the major themes were marked. In the second, axial coding stage, the categories were processed several times until they contained all the information arising from the interviews. In the final selective coding stage, where the “story” was extracted, all the interviews were read once again to reexamine the compatibility of the information units with the major themes and organize them into a structure where each category was linked to the others (Sabar-Ben Yehoshua, 2016). The analysis of the VR experience was made up of a comprehensive observation of explicit (verbal interaction) and implicit components (body gestures, use of textures, colors, common elements, and others) as described in the Findings section.

This study was carried out with sensitivity with respect to the interviewees and their relationship. The participants were guaranteed that their personal information would be kept fully confidential to protect their privacy. The participants signed an informed consent form and gave their consent to use the interviews, video recordings, audio recordings, and photographs for research purposes in all stages of the study. This study was approved by the Ethics Committee of the Academic College of Society and the Arts, No. ASA00645 (June 2023).

Mother-daughter communication in the virtual space included conscious (explicit) verbal communication, as well as 3D auditory-movement artistic expression. The shared 3D VR space that included the researcher made it possible to observe the dynamics of the mothers’ and daughters’ movements toward and away each other in real time. The dyads spoke and used gestures continually throughout the VR experience, which enriched the interaction.

The VR tool can generate infinite forms of expression and communication through representations that move in space, and an unlimited range of colors and textures. In this study, the MultiBrush application afforded considerable self-expression using diverse techniques. Note, however, that the content of the paintings was examined mainly from a phenomenological perspective in terms of the recurring elements, such as representations of a house, the images in the paintings, and the use of text.

The VR environment allows for the generation of an innovative therapeutic space where the therapist is inside the space with the dyad. The therapist can move and come close to the dyad, observe different angles and sizes, and experience the immersive experience together with the dyad. In the earlier versions of VR, the therapist observed the dyad through a two-dimensional screen, with no direct eye contact. In more recent applications, therapists can be in the physical world of the therapy room and in the virtual world. In dyadic therapy, the ability to enter a shared virtual therapeutic space in this case transformed the therapist from an observing participant into a 360-degree experiencing therapist (Figure 13).

Despite the presence of the immersive researcher in virtual space as the third avatar, most of the participants did not seem to notice her existence. The directions given by the researcher for transitioning between the stages of the procedure were experienced at times by the participants as interference or “awakening from a dream”; i.e., from their total experience. When asked in the interviews whether they felt the presence of the researcher or whether her presence had bothered them, one mother (Dyad 12) answered: …yours? No, not at all, we could only see within the frame and not look out, be inside… focus inwards….”.

Some of the participants interpreted the directions provided by the therapist and the reminders to transition from stage to stage as a warning that the procedure was about to end or as a concern that they might have to erase what they had already painted. For example, one of the dyads said that despite the researcher’s recurring directions, they disregarded them, and the mother only noticed that the instruction was aimed at them when the researcher raised her voice (Dyad 6): “One moment… Aya (the researcher) is talking to us.” The deep immersion in the virtual experience seems to have allowed the participants to focus on their relationship without being influenced by the researcher’s presence, for instance in Dyad 2:

When the immersive researcher was with the dyad in the 3D virtual space and observing their interactions, she felt the increased identification and transference. These feelings surfaced despite the absence of eye contact, since the participants were wearing VR headsets that prevented them from seeing one another. In the virtual dimension, the participants were represented as identical avatars, which bore no resemblance to their actual appearances, thus further precluding traditional visual interaction.

The researcher noted in her journal that:

Thus, the researcher’s presence in the shared space with the dyad, as a facilitator and observer, appeared to have evoked intense projective material.

In the VR space, the participants were present in the physical and virtual space at the same time. In the virtual space the interaction took place with no eye or physical (tactile) contact with each other. The absence of physical contact in the mother-daughter dyads allowed them to focus on their emotional and creative expression with no physical distractions. However, the dyads tried to make contact, such as hugs through their avatars (Hadjipanayi et al., 2023; Zhang et al., 2023). The virtual space allowed more freedom for creative and emotional expression through images and movement (Bakk, 2023).

Wearing the VR headset and manipulating the avatars enabled the dyads to interact, with no need for direct gaze. The headsets set the participants apart. The absence of physical eye contact reduced the potential sense of exposure, embarrassment, and judgmentalism that may have eliminated some of the psychological barriers and enabled more authentic “here and now” emotional expressions (Blascovich and Bailenson, 2011; Nowak and Biocca, 2003; Bailenson et al., 2008). This seems to have been facilitated by communication through the avatars that encouraged a sense of presence, and greater self-identification (Freeman et al., 2020). The participants treated the avatars as their actual bodies, as manifested in the movements and interactions they made that resembled reality, including movement in the space – at times even dancing. This suggests that virtual space may allow for freer physical expression. The transition between physical space to virtual space in the art-based intervention (VR-JPP) brought the dynamics of the mother-daughter relations typical of middle childhood to the fore, as the mothers appeared to note in the interviews.

Middle childhood is characterized by complex interactions with the environment and a desire for social independence, alongside varied emotional challenges (Beyers and Goossens, 2008; Wong and Nadeem, 2013). The findings here suggested that virtual space allowed for powerful, rapid, and authentic expression of the mother-daughter relationship dynamics. The auditory segments emphasized the importance of verbal communication for connecting and coordinating between the mothers and daughters. At the beginning of the intervention, slightly regressive verbal communication was observed. The mothers and daughters used their voices to mediate the new space through short dialogs focused on conveying technical information and to orient themselves, while expressing enthusiastic and liberating comments. Later, the discourse developed to include terms expressing closeness and affectionate phrases by the mothers, while the daughters used a small set of short words, mainly “Mom,” The mothers’ verbal communication focused on verifying that their daughters were indeed managing to carry out the task; specifically, painting the boundary line required in the first stage of the experience. This boundary served as a physical representation in the virtual environment and as a metaphorical concept.

Subsequently, there was a drop in verbal communication when both participants turned their focus inward to immerse themselves in their painting. This was accompanied by an increase in mumbling, singing, and self-talk. The absence of direct eye contact in the virtual space may have reduced feelings of exposure and judgment, thus making it easier for the participants to concentrate on themselves. Thus, there was a clear disparity between the emotional and experiential discourse within the virtual space that allowed for intuitive and less structured communication, and the cognitive, more deliberate discourse typically observed outside the virtual experience. VR may thus encourage more intuitive and authentic emotional expression that is less controlled, which may result from the sense of security provided by the virtual environment, and in particular the absence of actual physical interaction (Shen, 2023; Stallmann et al., 2022). Studies have found that virtual space can provide a secure space for dealing with emotional conflicts in family dyads and makes it possible to express feelings more experientially than in the traditional physical space (Stallmann et al., 2022).

The implicit (non-verbal) communication that took place in the virtual space through artmaking and movement might be indicative of the daughters’ desire for a personal space and their need for independence. In most of the dyads, the virtual experience evolved from initial closeness and connection to distancing and separateness. The closeness began with virtual hugs; the daughters sought virtual physical closeness “like being a baby again,” while the mothers experienced it at times as intrusive and as crossing boundaries. However, at times, this gradually transitioned to painting back-to-back. Some of the daughters created enclosed shapes around themselves or around their mothers with scribbling or bubbles, thus generating a private disconnected space. Others erased the boundaries and used the teleport tool to distance themselves from the shared space. Painting fences around the artwork, erasing the mother’s paintings, and the hide-and-seek games where the mothers had to look for their daughters may have reflected a desire for separateness and control of the personal space (Raz, 2022). The complexity of the dyadic dynamics and the daughters’ need to develop independence were also conspicuous at the end of the virtual experience, when most of the daughters continued to paint on their own, whereas most of the mothers chose to stop. This may be illustrative of middle childhood as a stage of transition from dependency to independence, where the daughters expressed their aspiration for social independence (Wong and Nadeem, 2013).

The VR tool constituted a play environment that could be viewed as serving as a type of “transitional space” (Winnicott, 1971) forming a bridge between the participants’ inner worlds and the external world. The intermediate space, according to Winnicott, constitutes an area of subjective experience, where personal meaning is constructed in interaction with external reality. This allows for simultaneous separation and nearness to the world and the other through play and artmaking. At times, the virtual space also appeared to serve as a potential arena reflecting the power relations within the dyad (Liu and Chang, 2018), where the conflicts between the mothers and daughters were manifested in “playful artmaking.” The virtual space seemed to have allowed them to express their feelings more freely and securely through play and creativity.

This environment enabled articulations and behaviors that are impossible in the real world and thus provided new opportunities for exploring relationship dynamics. The use of visual techniques and tools such as erasing, creating peek holes, transparent materials, and producing scribbles and both transparent and opaque withdrawals provided a channel for expressing complex emotional needs. For example, one of the daughters was concerned that “holes” would appear in the shared fence. This may be suggestive of conflicting needs for protection and security, and fear of intrusion vs. a loss of independence. The daughters tangibly reflected the tension between the need for closeness and the urge for autonomy (Beyers and Goossens, 2008) through virtual transparent materials such as smoke, clouds, stars, and transparent virtual shapes. This allowed them to produce a personal space but still maintain “avatar eye contact” in the virtual space, which seemed to serve as a bridge between the need for separateness and the desire to maintain an emotional relationship and a sense of closeness and security between mother and daughter.

Scribbling and withdrawing into oneself could have also been a way to express the need for separateness and a mechanism for emotion regulation. The daughters created “scribbled bubbles” that allowed them to observe their mothers from a protected space while maintaining separateness. Winnicott suggested that scribbling may express unconscious urges and a transitional space where children combine their inner world with external reality (Winnicott, 2005). For the daughters, scribbling may have been a type of play that provided active escapism so that they could enter a regressive state within the play experience. The scribbling seems to have led spontaneously to primary games such as hide-and-seek that intensified rapidly at the pace of the immersive world. While playing, the daughters could express the desire to hide and to reveal themselves while dealing with the conflict between the wish to be exposed and concerns over it. Scribbling, like the “peek-a-boo” game, could have provided an opportunity to experience a sense of control over the external world, thus allowing the daughters to examine the boundaries between separateness and closeness.

The mother-daughter relations tended to include power struggles, where the mother attempted to maintain closeness and control while the daughter sought to define separate limits for herself (Friedman A., 2013) The “confining” of one of the mothers within a shape may represent a radical example of the desire to control the mother or restrict her. This may have reflected the daughter’s unconscious fear that her mother could take over her personal space.

Overall, the findings in this non-clinical sample may suggest that virtual space could enhance and accelerate the clinical treatment of the dynamics of closeness and distance in dyadic parent–child relationships. The artwork and the interviews both demonstrate the potential of VR-based therapy, which enables safe and creative transitional space for forming relationships and the visual expression of internal processes (Hacmun et al., 2021). The findings showed that the daughters tried to navigate between the need for closeness and support and the desire for separateness from their mothers. The erasure tool seems to have created the technological possibility to “erase the mother,” a conflict that is at the heart of the mother-daughter relations in middle childhood and expressed conflicts. The daughters used it not only to erase parts of their paintings but also as a way of getting attention and expressing frustration or resistance. For example, one of the daughters declared herself the “queen of erasures” and consistently erased parts of her mother’s painting while the mother repeatedly tried to paint. This behavior reflects a struggle for autonomy and separateness and is consistent with Gavron’s (2019) argument that joint artmaking encourages psychological processes and the acquisition of insights as also noted by Hacmun et al. (2021).

Previous studies using the Joint Painting Procedure have demonstrated that implicit dyadic expressions such as mutual recognition and low role confusion predict children’s social and academic adjustment, thus underscoring the value of capturing non-verbal relational processes (Gavron and Mayseless, 2015). Research has also shown that joint art-making generates relational dynamics such as mutual regulation, mentalization, and transformation, highlighting therapeutic-affective dimensions (Gavron and Mayseless, 2018). The VR adaptation here extends these findings by demonstrating how virtual environments can amplify such implicit processes through enhanced spatial manipulation and immersive presence.

The body positions utilized in the virtual space provided interesting insights into the dyads’ relationship dynamics. Two main positions were observed while painting: face-to-face and back-to-back, and most of the dyads painted standing up. The face-to-face position allowed continuous successive communication, particularly when planning the joint space. The feeling of “virtual eye contact” (despite the lack of physical contact) seems to have enabled cooperation that resulted in a positive experience, and a smoother and more creative flow in the phases of the JPP, as well as “quality time,” as noted by one of the mothers. In contrast, although some of the dyads who stood face-to-face experienced a sense of security and unthreatening presence, the encounter at times led to two-way exchanges with many challenging questions and answers.

The back-to-back position appears to have reflected a need for disconnecting and distancing, sometimes as of the beginning of the JPP when defining personal boundaries in the intervention. This attitude mostly indicated complications and limited communication in the dyad and was often accompanied by aggressive reactions and defensiveness on the part of the daughters (Kedem et al., 2021). These findings may point to the value of VR as a tool for exploring parent–child relationships. In contrast to the external world, virtual space allows more flexible mother-daughter distance and movement. The choice of different body positions may provide insights into the emotional and communication needs of the dyad by reflecting and perhaps influencing the quality of the mother-daughter interactions and communication. In addition, it provides new insights into their relationship dynamics, which often cannot be observed in the real world (Kedem and Regev, 2021).

The three-dimensional painting in VR gave the dyads an opportunity to evaluate implicit components of their mother-daughter relations. Most daughters made a house when painting in the personal space, first in 2D and then in 3D so that they could enter it. The 3D house may have expressed a desire for separateness and autonomy, a process compatible with development in middle childhood (Gilmore and Meersand, 2014; Winnicott, 1971).

The findings also revealed recurring elements such as flowers, rainbows, suns, and hearts, which appeared in nearly all the dyads’ paintings and were further accentuated by special effects such as twinkling and movement (unique features of the VR environment). At the start of the intervention, the daughters had little confidence in their painting and tended to emulate their mothers. This was also evident when the daughters’ experienced difficulties with their painting, that prompted them to copy elements from their mothers’ drawings. This might reflect the attachment dynamics, where children tend to emulate their attachment figures, in this case the mother, as part of building confidence and connections (Rodgers et al., 2020b).

The daughters made the most use of text, at the beginning and end of the virtual experience; this seems to have been used to instill a sense of belonging and pride. At the beginning, the daughters wrote their names in large letters, and at the end gave a title to the joint painting. This use of text appears to have reflected independence and control of the dyadic relationship, but in some dyads, it also led to power struggles, particularly related to the choice of a title for the joint painting (Becht et al., 2019).

VR technology forms an innovative therapeutic space where the researcher is assimilated into the same virtual space as the dyad. The findings showed that the presence of the therapist, represented as an avatar in the VR environment in addition to the dyad, did not disturb the interaction between the participants, who reported a deep and authentic experience despite her presence. Previous studies have indicated that the lack of physical contact and direct eye contact in the virtual space reduces feelings such as embarrassment and social pressure and contributes to enabling and exposed freedom of emotional expression (Blascovich and Bailenson, 2011; Nowak and Biocca, 2003).

The immersive therapist, who was “invisible,” did not interfere with the projective material that surfaced in the dyadic relationship. It was clear from the researcher’s later comments that her presence in virtual space also allowed her to experience transference and countertransference differently than in traditional therapy. Specifically, despite being an observer, the researcher experienced transference in a direct and emotionally enhanced way, thus raising the possibility that her presence as an avatar, rather than as a physical figure, allowed her to remain neutral, since she was perceived as a virtual avatar rather than a physical figure. This allowed her to participate in space passively, without interfering in the transference occurring between mother and daughter. This immersive presence underscores the importance of neutrality in the transference that occurs in therapy where the therapist’s physical presence can affect the emotional dynamics (Ogden, 1994; Gabbard, 2001).

These observations align with emerging research on group-based VR therapy, where the therapist’s presence in virtual spaces has been found to maintain therapeutic efficacy while reducing social pressure. Studies on VR group therapy have shown that avatar-mediated anonymity can increase participants’ willingness to disclose and can improve group cohesion (Dilgul et al., 2020). Similarly, studies on multi-user VR experiences have reported greater effectiveness in improving mental health outcomes among adolescents in terms of higher engagement rates and the formation of meaningful social connections (Li and Shen, 2022). These findings suggest that the immersive therapist role, as examined in VR-JPP, may extend beyond dyadic interventions and could inform future development of group-based and community VR applications in art therapy. Recent work in HCI further points to the potential of multi-user VR for both assessment and therapy, by highlighting how shared virtual environments can enhance therapeutic presence and dyadic as well as group-level engagement (Haeyen et al., 2021a).