Dulas is a computer-generated character created by Julia Borbolla, a Mexican child psychologist. It is one of several “emotional agents” Borbolla has invented that are being recognized in Mexico City as capable of gaining rare access into the inner lives of children. Dulas, like all of these characters, comes from a planet called Antenopolis and knows nothing about life on earth, not even what a mother or father is. He looks like a pointy-headed M&M with big eyes and radio antennas. He is red, the color children associate with burns, and wears bunny rabbit slippers because he remains in a hospital – so children can count on his companionship.
A therapist named Rafael Mateos Ortiz took the boy to Dulas's room, which was decorated with stars, planets and children's art. In the corner a TV screen was set inside a cutout of a 1950s-style spaceship, with mailbox slots for children to place notes or drawings. Mateos explained to the boy that Dulas doesn't like to interact with adults – so he would only come out after he left the room. Mateos went to an adjacent room and Dulas appeared on the screen. Speaking through Dulas in a software-altered cartoony voice, Mateos used keyboard strokes to make him move and express emotions.
When I visited Mateos recently at the Tacubaya hospital, he told me that, within 30 minutes: “[The boy] told Dulas that he was living in a shelter, that his parents had died, that he had been abused, that he had been burned by his uncle and aunt.” Mateos added: “It was a major step – beginning to talk about his feelings.” Now the therapists had insights they could work with and the boy said he wanted to speak with Dulas again.
Over the past five years, Borbolla's characters have been used to assist 2,000 children from 3 to 14 years old, and have been employed in three Mexico City hospitals and a center for disabilities in another city, Morelia. The characters collectively go by the name Antenas because they all have antennas and come from Antenopolis (Borbolla's original character also goes by the name Antenas.). The psychologists I spoke with said the tool creates an environment of trust and empathy that enables them to understand children's issues more quickly than they imagined possible, and enhances the effectiveness of their work by providing a context in which children find it easier to discover and express their feelings — which carries over to therapy. “In my practice, if I needed four or five visits with a child to understand what really happened — with Antenas I need 10 or 15 minutes, maybe two sessions,” said Borbolla.
Antenas por los Ninos
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The original Antenas. |
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Therapists have been using puppets to help children unearth and process their feelings for decades. But Borbolla, who has been working with children for 30 years, has taken this kind of work a step further, assembling elements that haven't been put together before. To begin with, the children interact with the characters (or cyber-puppets) in a room without adults present (therapists monitor with cameras). The characters also have attributes and stories that are both designed to build rapport and make it easy for children to project their feelings upon them.
Because they come from a planet that is different from Earth (but may have similar aspects), they are able to credibly ask naïve questions, like “What is a family?” or “What is a school?” that can elicit revealing answers. Like many children, they prefer not to interact with adults. “Children are drawn to that kind of complicity,” comments Borbolla.
Perhaps most important, therapists must undergo several months of training and practice, under observation, before they can use the tool. Not all therapists receive certification, Borbolla says. It takes a good ear and a light touch - playful, enthusiastic, funny at times, but not too funny - to understand how to follow the child's lead and make the characters come alive in a way that respects the child's feelings and is believable enough to work. |
Borbolla originally got the idea to use a drawing of an animated character to communicate with children when she was working as a school psychologist in the 1980s. Years later, in private practice, she worked with a cyber-puppet maker to develop a software version. She spent six years refining the tool. “This is the fruit of many years' experience and many adjustments,” she told me. In 2005, she established a nonprofit foundation, Antenas Por Los Ninos, supported by grants, to disseminate the work. The impetus was a comment made by her daughter Juli, who is now 27 and is also a clinical psychologist. Juli had been born without a right ventricle in her heart, and as an infant and child she had undergone repeated surgeries and hospitalizations. Borbolla recalled: “She told me, ‘If I had had Antenas in the hospital, I would have asked the character many things I never asked because I was afraid of saying things that might hurt you or my father. I wanted to know if I was going to die. I wanted to know what else was going to happen to me.' ”
Antenas por los Ninos
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Bompi |
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Antenas characters have been used to assist children who are experiencing a range of difficulties. Therapists in Tacubaya use them in pre- and post-operative therapy and burn rehabilitation. In Morelia, one character, Bompi, is employed to assist children with disabilities. (Bompi says that all humans have disabilities because they don't have antennas.) The program is being used to provide emotional support to children with heart disease and cancer, teach children how to protect themselves from potential abuse, and, at the government's request, learn about children's experiences in public day care centers. In a pilot project being conducted by the Pediatric Hospital of Iztapalapa in conjunction with four government agencies, children's interactions with another character are carefully being reviewed as potential legal evidence in cases of violence or abuse.
One of the first times Borbolla used the Antenas character was with a five-year-old girl whose parents brought her in because she had been wetting her bed. Antenas asked the girl, “Who do you live with?” She replied: “My father, my mother, my little brother, and the maid.” When Antenas asked: “What's a maid?” the girl replied “It's a woman who helps mother with the house and when your father goes out, she hurts you.” Another time Antenas asked a young boy, “What's a driver?” and the boy said that a driver is a man who uses the car and touches you in the guest bathroom when your parents go out. Borbolla explained that these disclosures - spontaneous responses to general questions - are highly reliable, especially when they come from young children. But therapists also follow up with the child and the family to confirm facts. |
In such cases, therapists have to handle the information carefully. One principle of the work is that a therapist must not reveal that she knows something that was said to an Antenas character privately. The character must first ask permission of children to share any information with a “good adult.” This preserves the trust and integrity of the child's relationship with the character. In the case of the boy and the driver above, Antenas said he should tell what he said to “Julia, that lady who brought you here.” The boy replied, “If I tell someone the driver will kill my mother.” Antenas said, “She will know how to protect you and your mother.” The boy gave permission for Antenas to tell Julia and she made sure the child's parents, who happened to be wealthy, came directly to her office to pick up the boy (the driver was waiting for him outside) to deal with the matter. Over the years, Borbolla has gained insights into children simply by having a character ask basic questions like “What is a mother?” or “What is a father?” With children in hospitals, the character may ask: ‘What is a doctor?' If the child responds - as many do, in effect - “A mean person who makes you suffer,” then Antenas can help the child handle his fears and adapt to his treatment.
The psychologists I spoke and emailed with said they loved the tool. Ana Zarina Fiorentini Cañedo, who supervises the psychological program at Tacubaya, wrote that she highly recommends the program for hospitals because of its efficacy in helping children heal from the emotional pain of illness. Some psychologists have concerns about children being deceived into thinking they are confiding with a character when they are in fact talking to human adults. Borbolla acknowledges it, but says that it's an extension of the established practice of using puppets. And she is careful to add that Antenas is no substitute for therapy. (She likes to limit its use to six sessions.) “It is a simple tool, but it can be enriched with the personality of each expert,” she says.
To date, Antenas hasn't been rigorously studied, and Borbolla is working to engage researchers to examine its impact. She is developing an Internet-based application to reach children who are immobile. And she dreams of having the resources to bring the tool into disaster areas, like Haiti. “After an earthquake, everybody thinks of food and blankets, but what are the children feeling? How are they faring?” Her biggest fear is that the tool will be co-opted for negative purposes. “I see how powerful it is,” she told me. “It can be used to get into the souls of children.”
On Saturday, I'll provide more examples of the Antenas characters' interactions with children and respond to reader comments about the idea. (see article below)
http://opinionator.blogs.nytimes.com/2010/11/22/a-safe-haven-in-cartoon-confidantes/
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EDITOR'S NOTE: Here's the follow-up article, which appeared on Saturday, 11/27/10:
Secrets Shared Must Be Handled With Care
OPINION
by David Bornstein
New York Times
November 27, 2010
When I was in Mexico City last month doing research on the Antenas program – the subject of my Fixes column earlier this week (see article above) — I had the opportunity to sit in Antenas' room and have a conversation with the animated character used by psychotherapists to communicate with children. I found the effect surprising. Antenas, guided by a therapist named Elsa Molina in the next room, began by asking me simple questions, as he does with all children. Antenas asked: “Why did you come to Mexico City?” I replied, “I'm a writer and I'm doing research.” Antenas asked: ‘What is a writer?'
“A wonderful way to reach children, as long as it doesn't get into insensitive hands.”
I knew that Antenas came from another planet, so I didn't want to say “Someone who writes books and articles,” because he wouldn't know what those things were. Instead, I said that a writer was someone who puts his thoughts into strings of words to make them transmittable to others so that different people's minds can be connected. As I spoke it, I realized that I hadn't thought about writing this way before. And talking with Antenas, I could see how the character — so curious and devoid of the prejudgments of a human being — and bearing no resemblance to my mother or father or fourth grade classmates! — could act like a Rorschach test in which I could not only place my thoughts, but see them in a fresh light.
This can be powerful stuff especially when used with young children. And readers' comments reflected this concern. Many noted that it was critical that such a tool be used responsibly. Vyule, from Melbourne, wrote: “This is a wonderful way to reach children, as long as it doesn't get into insensitive hands.” Kim, from Pasadena, Calif., observed that “the children's inexperience and willingness to believe is being carefully exploited to obtain information that they refused to provide to the adult,” adding that one can only justify the deception if it clearly benefits the child. And Mabi, from California, inquired if the program's founder, Julia Borbolla, performs “background checks on the therapists that apply to use her techniques.”
Borbolla and her daughter, Juli Niño de Rivera, a psychologist who focuses on children who have health problems, work together overseeing the dissemination of Antenas and the training of therapists. Both are cautious about certifying others to use the tool. They have chosen to proceed slowly and deliberately — videotaping and reviewing every session in which the tool is used and, to date, certifying less than 50 therapists. They're also careful to restrict the use of Antenas characters to particular situations, as well. “We have not used the tool with children who have trouble distinguishing fantasy from reality,” Borbolla explained.
Readers seemed to agree that psychologists are justified in engaging in controlled deception to assist children, who would otherwise harbor secrets that could perpetuate harm. Hen3ry, from New York, wrote: “Children, particularly those who have been abused, are suspicious of adults, all adults. I remember how I felt as a child. I couldn't tell anyone anything because I was afraid of it getting back to my parents. Growing up was hard because I thought that I'd be beaten as an adult the same way I was as a child … If the laws had been different when I was child and this robot had been around I might have had a better childhood. I hope that that is the case for children today.” Clayton Rossner, from New Jersey, added that “[Children] are so naive that they don't know that it is O.K. to talk about uncomfortable or harmful situations and feelings.” And M. Little from Pomona, N.J., added: “[W]hen younger children are getting abused, the person that is abusing them tells them not to reveal it — but the children want to tell someone.”
Talking to animated Antenas characters may help adults as well as children.
The column concentrated on how this tool is used in hospitals and in cases of child abuse. But in her private practice, Borbolla has used the Antenas character with hundreds of children in a wide range of situations. Sometimes, he can help locate sources of anxiety that adults cannot imagine. For example, two parents came to Borbolla concerned that their five-year-old daughter had reverted to wetting the bed, a common sign of anxiety in children. “The parents were healthy and happy,” said Borbolla. “We didn't know what was happening with this girl. She was always afraid.”
When the girl was with Antenas, the conversation got around to bed wetting and Antenas asked: “What kind of things have to happen for a girl to wet the bed at night?” And the girl began talking about her fear that Mexico City was going to collapse.
The girl's father had recently explained to her that Mexico City was built on a lake and that the land underground is sinking. The father was also involved in the stock market and the girl often overheard him saying things like, “It went down today … ” She made the association. “That's why she was afraid,” Borbolla said. “She thought she was going to come home from school and find her house underground. She didn't think she had to explain this to me because all the adults knew about it. Her father knew about it. But she explained it to Antenas.”
Some children get angry with Antenas. A child who seems placid outside the room may start hitting the screen once Antenas comes on. One boy threw a chair at Antenas. Afterwards, the therapist asked: “So what happened in there?” and the boy said: “Nothing.” Some children tell Antenas characters: “You look stupid.” These may be examples of children acting out things that have been done to them or saying things that have been said to them.
Readers inquired about whether the tool was being used in other countries (not presently), or in other contexts, such as with autistic children (it hasn't been). Clarissa, from Chicago, suggested that it could become part of “children-centered recovery relief units” in disaster areas or war zones. And Mary Mary, from Washington, DC, commented: “I see no reason why these techniques need be limited to children.”
Borbolla has, in fact, had positive experiences using the tool with teenagers. From my conversations with psychologists and short experience with the character, I imagine that it could help facilitate communication with adults, as well. Even though adults know that a therapist is behind the character, having a nonhuman layer of separation makes communication easier. Studies have shown, for example, that adults will reveal more information in a hospital intake interview when it's being conducted by a computer than a human being. And Thomas, from Watertown, Mass., noted that the 1970s computer program ELIZA, which, like Antenas, used the mirroring techniques of Rogerian psychotherapy, produced “astonishing” results. “[E]ven adults were ready to divulge secrets, thinking the program was a psychotherapist,” he wrote.
Borbolla isn't trained to work with adults. But she has had some unexpected experiences. One of her patient's mothers insisted on speaking with Antenas. During the conversation, Antenas said, “I talk to children because I don't want them to keep secrets that hurt.” And the woman replied: “I understand this. I have so many secrets.” She then told Antenas about having been abused by the father of her best friend when she was young. The woman broke down and said she had never told anyone before. “I wasn't prepared for that,” Borbolla told me. She referred the woman to another therapist. Now the woman wants to help finance the use of Antenas in adult psychotherapy.
Juli Niño de Rivera, Borbolla's daughter, who was the inspiration for the Antenas project (as a child she underwent repeated heart surgeries) and is now its primary fundraiser, dreams of being able to donate the tool to therapists at the Mayo Clinic, in Rochester, Minn. — the hospital whose surgeons saved her life. “I want to donate this tool to them — because I know how much the children need it.”
http://opinionator.blogs.nytimes.com/2010/11/26/secrets-shared-must-be-handled-with-care/ |
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David Bornstein is the author of “How to Change the World,” which has been published
in 20 languages, and “The Price of a Dream: The Story of the Grameen Bank,” and is
co-author of “Social Entrepreneurship: What Everyone Needs to Know.” He is the
founder of dowser.org, a media site that reports on social innovation.
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