Using Gaming & Gamification in Clinical Practice

What does “gamification” mean, and what is its relevance to mental health practice?  In this video of a conversation I had at University at Buffalo with Charles Syms, I take a stab at answering those questions.  This is just a start, and hopefully by the end of the video you can begin to see how applying principles of game design could be therapeutic for people dealing with issues ranging from trauma to executive functioning challenges to substance abuse and beyond.

 

 

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Gamer-Affirmative Practice: Today’s Play Therapy

image

The importance of play is universal, and in many ways the nature of play is timeless.  That said, there is a lot to learn about video games as 21st-century play, especially if you are a play therapist.  Adding 21st-century forms of play to your repertoire can be daunting.  With so many naysayers in the mental health profession, avoidance of learning the new takes the form of contempt prior to investigation.  With video games being low-hanging fruit for political arguments ranging from gun control to teen bullying, many social workers, psychologists and counselors give in to the media hype and spend far more time demonizing or ignoring this form of play than they do understanding it.

Recently my colleagues at the University at Buffalo made it a point to take a gamer-affirmative stance and offer a beginning piece of continuing education on integrating video games as play therapy in the form of a podcast.  In it my friend, colleague, and yes, fellow video game player Anthony Guzman and I have a beginning conversation about just that.  Have a listen:

inSocialWork® Episode 144 – Michael Langlois: Gamer-Affirmative Practice: Today’s Play Therapy

 

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Bringing Emerging Technology into the Clinical Process: Implications for Engagement and Treatment

If you have ever wondered how to begin attending to, listening for, and asking questions about a patient’s use of technology, this video might give you some ideas.  In it my colleague Lesa Fichte, LMSW, University at Buffalo School of Social Work, and I, discuss the role of technology, people’s relationship with technology, and how to integrate it into the treatment process by listening, inquiring, and learning.

 

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The Relationship Between Emerging Technology & Psychodynamic Theory

Often when I present, people are surprised that I teach on both emerging technologies such as social media and video games, and classic psychodynamic theories.  Although it may initially seem counterintuitive, especially to classically trained psychotherapists and social workers, I see a strong connection between the two.  Here is the first in a series of posts featuring work I am doing with the University at Buffalo, in which Charles Syms and I discuss the relationship between the two.

 

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Social Justice & Technology Revisited

mccormick_reaper

I have written before about how technology often makes life easier for a large number of the population while simultaneously disenfranchising others.  The good news is that this does not have to be the case.

The example I used in the past was the Starbucks App which allows customers to use, gain rewards for, and reload their account on their smartphone, while making it more cumbersome and difficult to tip baristas.  This again does not have to be an inevitability, but requires Starbucks to enhance the functionality of its App.

So I was pleased to discover (special thanks to my student Marissa for bringing this to my attention) this week that come Wednesday March 19th, Starbucks will be rolling out an update to their smartphone App which allows just that.  You can read more about it at Forbes here.  You will be able to download the update from places like iTunes, and include your tip easily.

While some may dismiss this as a first-world problem, I cannot emphasize how powerful a shift I consider this to be in terms of workers’ rights in the service sector.  I am convinced it comes in part as a result of advocacy by and for workers, and sets the bar higher and yet attainable for corporations to maximize their value to customers while not disenfranchising their employees.

How can you help advocate for social justice in the technology you use?  First, simply by mindful usage.  Take a few minutes today to open your smartphone and make note of the Apps you use most frequently.  Next, ask yourself, who, if anyone is disadvantaged by my using this App?  Just thinking about the connections can be a powerful mental exercise.  Notice how complicated it can get fairly quickly:  If I use Evernote frequently, I am less likely to write things down on paper, which may be good for the environment but may also disenfranchise industrial workers in paper mills.  Hold on, did I say that you had to stop using Evernote or lobby for paper mills?  No, I’m asking us to sit with the complexity of a problem here for a minute to see the larger systems at play.  Technology has always resulted in job loss for some even as it may provide workplace improvements or quality of life for others.  It’s when we don’t think about these things in a more complex way that we stop innovating social justice itself.

Part of what I’m trying to encourage us to see is that social justice, workers’ rights, unions, and any person or group committed to social justice needs to keep pace with innovation and in fact keep innovating themselves.  Technology always runs the risk of disenfranchising people, especially workers.  If the McCormick reaper in a few hours does the day’s job of three workers, what happens to those three workers?  We are still living in a capitalist society in the US, and it is unlikely that as technology improves and reduces the need for human workers that all of these people will be able to afford to turn their minds and lives to the pursuit of art and culture.  Everything isn’t always getting better for everyone in the current system, and we are seeing overcrowding in occupations ranging from factory to legal work.

If social justice advocates, and social workers are to continue to help the disenfranchised, they are going to need to keep pace with technological developments and continue to think innovatively about 21st century equity in complex and sustained ways.  And by the way, thinking, “the gap is just going to get wider, the social fabric is unraveling,” is not an example of innovative thinking, but defeatism that exempts us from the work of innovation.

This brings me back to my social work colleagues, and my continued urging for them to keep pace with emerging technologies, especially if you are touting the concept of social innovation.  Social innovation without leveraging emerging technology will ultimately lead to future disenfranchisement.  If you have a social innovation department in your social work program that doesn’t leverage technology you are not being socially innovative.  I certainly don’t have all the answers, but I know that the answer to social injustice will inevitably need to integrate emerging technology into it.

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Crusades

Crusader Man(1)

Recently, and frequently, I have heard colleagues describe me as being on “a crusade” about video games and technology.  On no occasion has it been used in an attempt to speak positively about my work, but it did get me reflecting on crusades in general.

In many ways, the term Crusade has always been used with an air of critique and generalization.  The most famous “Crusade” in medieval Europe was actually never named that by the people living in it; the term crusader began to be used 400 years after the fact.  Some famous crusades, such as the Children’s Crusade, may actually never have happened.  Additionally, there were actually numerous Crusades spanning 200 years rather than just one long one and they had both positive and negative far-reaching impacts on the world.  They fostered both genocide and the arts, opened trade routes and disease vectors, and were in short as complex, violent, and impacting as most human endeavors.

I have had some difficulty embracing the identity of crusader when used by colleagues, because it is often a passive aggressive dig at my work.  They can’t quite get away with calling me militant or intolerant in polite circles, but they do float out these ideas when considering my take on video games, technology and therapy “unbalanced” and “evangelical.”  Lately I have been reminded that it is not just me who has to deal with this–for some reason many mental health professionals tend to single out any one of us who gets too “passionate” about one element of the work.  I had a consultee recently begin to describe his practice vision, grow very excited and then check himself with me as if somehow that excitement was an unseemly thing in a therapist.  Here he was describing something that made him revolutionary and special, and that was somewhat suspect.

The mental health and education systems in the United States beat down many, patients and therapists, alike.  Rather than an expansive fount of creativity, the mind is seen as a widget traveling on a conveyor belt with hundreds of other widgets to be stamped with a DSM-V label or pathology so insurance companies will dole out money and providers dole out care.  I have overheard young clinicians spend hours talking with each other about what code to use and not once mention what it feels like to sit in the room with a patient or wonder what is going on in their inner world.  And when we do talk about mindfulness, we often talk about it in an over-scripted way that implies a specific time, place and type of activity that is “mindful,” rather than see that mindfulness is a stance we can take with any activity, including, yes, video games.

One of the reasons that social media is so powerful is that each of us experiences the feeling of being alone in life. It is this, our yearning for the imagined other, that makes social media so compelling. Whether we feel alone in our sadness, bewilderment, pride or confusion, we long to call out to the other. The parent wondering if she is doing a good enough job, the adolescent unnerved by the changes in his very body, the student who just aced her exam, the toddler who just fell and is looking up to his parent: Each of us at some time needs to call out to the imagined other to help us know how we are in the world, and help us realize ourselves.  So, yes, I am passionate and on several crusades, and since this is my blog I get to write about them.  They are varied in size and scope and sometimes tangentially connected.  Here are a few soundbites from the Crusade:

Video Games and Play Therapy.  I tell as many clinicians I can that if you want to do play therapy in the 21st century, start using 21st century play.

Video Games are Social Media, and Everyone is Playing.  The only reason you don’t have patients who tell you they game is because you don’t ask them.  Young, old, male, female, Xbox, smartphone, the overwhelming majority of people play something several times a week, often online and in highly social ways.

Let Smartphones and Laptops in Your Office.  If you want to meet your clients where they are at, let them show you their life in social media.  Bemoaning that Facebook is unraveling the fabric of society doesn’t change the reality that the majority of your patients use it.

Education Needs to Change.  We need to make more room for the quirky student, the adult distance learner, and the team player.  We are training people to work in the 20th Century, and then blaming them when they function poorly in the 21st.

Starting Your Own Business is Risky and Rewarding.  Therapists are often unwilling to spend any time or money to launch their own practice, and buy into what I call the “hazing” model:  Work long hours for low pay at your “main” job, sublet a tiny space, and when you’ve had enough lumps you too will get to have a private practice.

Not All Ideas are Great, But ANYONE Can Have a Great Idea.  Years of working with children and adults who learn differently has taught me that this is possible.  Anyone, regardless of race, class, orientation, learning ability, or past history is capable of having a great idea.  To rule someone out is a violence you do to their very humanity.  So stop it.

Look, we live in such an exciting and enriching time, and we could so much more with our lives if we could embrace more of that.  Sure it means change and fear, and yes, there are lots of obstacles.  We have a lot of work to do.  But let’s stop siloing down in our own little offices or classrooms regurgitating the same old APA-style blah blah, and let’s stop training future generations to be automatons of despair.  Let’s stop peer-reviewing everything and privileging those few who play the academic game with expertise.  Of course we don’t have to do away with everything in academia and health care but we can certainly make room for diversity, passion, and expansive thinking.  And if you can’t do that, the least you can do is not rain on the parades of those of us who are taking risks, the crusades we are on aren’t of the genocidal variety.

I don’t like being the recipient of these sorts of microaggressions, but I am so grateful that I have things I care passionately about.  My life of the mind and soul is so important to me, and ultimately it is not for me to decide whether my ideas are great or my crusade is just.  You can call me a crusader, but as Maya Angelou said,

my description cannot
fit your tongue, for
I have a certain way of being in this world

What about you?  What crusade are you on?  What makes you passionate?  Who is the next right person to talk about it with?

 

Interested in setting up a consult for your practice?  I have some openings come March.  Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Works, Life and Marshmallows: Iterative Design

marshmallow

They say the journey of a thousand miles begins with a single marshmallow.  Ok, I say that, and more specifically I am talking about your life, job or relationship rather than a journey.  I am coming back to my practice from a brief sabbatical, and have been noticing that while many things are going to stay the same, a few are changing as well.  I’ll get back to the marshmallow in a minute.

One thing I learned on my sabbatical is that I definitely want to continue my therapy practice.  As I said to some friends on Facebook this week, “You know, I’m kind of grateful that I get to challenge the self-hatred of others for a living.”  As a clinical social worker and psychotherapist I get paid to do that.  One thing I also decided on my leave was to withdraw from the last managed care insurance panel I was on.  It made no sense to continue to decrease the time I could be seeing people due to paperwork and bureaucratic hassles, and it made no financial sense to have a waiting list of people who are willing to pay my full fee and also deserve treatment just so I could work at half my rate.  I have always built pro bono or sliding scale slots into my practice because I have a commitment to serving a diverse population, so why was I doing that and letting an insurance company slide the remaining hours of my week?

Part of the answer to this and most “why-have-I-been-doing-this-this-way-when-it-doesn’t-work-in-my-favor?” questions is fear. Most of us are afraid of change.  Whether we are staying in an abusive relationship, having difficulty getting sober, flunking out of college or missing days at work, most of us have moments when we see what we are doing to ourselves and ask the above question.  And then we often resume whatever the pattern is, leaving an interesting question unanswered and instead turning it into self-recrimination, which is really just evasion.  Another part of the answer is that we often act is if we only get one shot at answering the question of life satisfaction.  Here comes the marshmallow.

Invented by Peter Skillman of Palm, Inc. and popularized by Tom Wujec of Autodesk, the Marshmallow Challenge may be familiar to some of you:  “It involves the task of constructing the highest possible free-standing structure with a marshmallow on top. The structure must be completed within 18-minutes using only 20 sticks of spaghetti, one yard of tape, and one yard of string.” (per Wikipedia)  You can call it an exercise, or play, but in either event the creators of the challenge have observed something very interesting about how different groups tend to approach it.  Children tend to make a first structure, stick the marshmallow on top, and then repeat the process over and over, refining it as they go.  Adults tend to engage in group discussions, arguments, power plays and plans to produce one structure built once to which the marshmallow is added.  In other words they tend to approach it derivatively rather than iteratively.

Iterative design is a method of creating a thing or addressing a problem by making a prototype (first attempt,) testing it, analyzing the prototype, and then refining it.  Rinse and repeat.  Iterative design isn’t good for everything: As parents know, often there is not time in the world for everything to get done in 18 minutes or before the school bus gets here.  But a life built on derivative design alone is destined for stagnation and rigidity.

Derivative design, as the name suggests, takes something from a pre-existing something-else, whether it be a rule, materials, social construction or interpretation of the something-else.  When you psychoanalyze a patient’s dream and interpret it as a manifestation of their Oedipus Complex, you are deriving your interpretation and their dream from the something-else of Freud, who in turn derived his Oedipal Conflict theory from the something-else of Greek mythology.  Derivative design can save time and effort in many important ways, by collapsing cultural memes and thinking and transmitting them forward through time from Sophocles to your office.  But as feminist thinkers and cultural critics have shown us, we might have arrived at a different “complex” if Audre Lord et al had been in on the prototyping of it.

Derivative thinking left unchecked can get you in a rut.  One of my most recent examples of this comes from The Little Prince, where he encounters the drunkard:
“- Why are you drinking? – the little prince asked.
- In order to forget – replied the drunkard.
- To forget what? – enquired the little prince, who was already feeling sorry for him.
- To forget that I am ashamed – the drunkard confessed, hanging his head.
- Ashamed of what? – asked the little prince who wanted to help him.
- Ashamed of drinking! – concluded the drunkard, withdrawing into total silence.
And the little prince went away, puzzled.
‘Grown-ups really are very, very odd’, he said to himself as he continued his journey.”

Everything derives from the previous thing, but in the end it sometimes gets us nowhere.

We all get in these difficult spirals.  A good therapist or supervisor can point them out to us and then encourage us to become iterative in our design:

  1. So what are you going to do this time?
  2. How did that work out?
  3. So what are you going to do differently?

Therapists starting their private practices also come to see me, often stuck in derivative thinking:

-I need my NPI number.
-Ok, why?
-To get on Medicare.
-Ok, because?
-So I can get on insurance panels.
-Ok, why?
-So I can get patients who will pay me so I can rent an office so I can have an address to register for my NPI.

If you are one of my consultees reading this rest assured I am NOT talking about you in particular:  I have had this conversation a hundred times with people.  We get indoctrinated into the world of managed care and get, well, managed.  In this case, I usually recommend the consultee start by imagining what kind of office space they want.  Answers have varied and included: Sunny, exposed beams, plants, yellow paint, toys, music system, waiting room with receptionist, friendly colleagues in suite, accessible to public transportation, elevator, warm colors, cool colors, and all sorts of other iterations.

Once you have a mental prototype you can either build or design your office, or find and rent it.  Again I tell folks to walk around the areas they want to work in, find buildings that look interesting to them, then walk inside and ask to speak with someone about seeing a unit.  Testing involves going to see several spaces.  Then they can analyze the results: Does the space look like it would become what they imagine it to be furnished? Are there things about their ideal that need to be discarded? Do they now realize that they could be even more wild in their expectations?

This is just one example of the ways that iterative design can open up possibilities.  But be warned, iterative design can be daunting for many of us raised in our current education system.  We have been trained to create one product presented in final form with the expectation that we will be graded on that product alone. Everything becomes about that one paper or exam, which is often more about regurgitation rather than innovation.

I have colleagues who take my breath away with the number of projects and ideas they are consistently throwing out there to see what happens:  It takes guts to do that.  I myself often am afraid that the Project Police are going to pop out and say, “What happened to your idea of a Minecraft group?  Shame on you for proposing it and not completing that project!  You are not allowed any more ideas until you show us you can carry that one out.”

Sound ridiculous? Of course it is, but does it sound familiar to you as well?  If it does, go out and buy yourself some spaghetti, tape and marshmallows:  The quality of your job, relationship and life may depend on it.

Interested in setting up a consult for your practice?  I have some openings come March.  Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

No Matter How You Feel, You Still Failed

Game_Over

Psychotherapists are often people who prefer to deal with feelings in their workings with people.  Feelings are important, and being empathically attuned to how patients are feeling is equally important.  We are taught to explore the patient’s feelings, imagine ourselves into their lived experience, and validate that experience.

This is often where we become disconnected from other professionals we collaborate with, such as educators.  Be it Pre-K or graduate school, educators are charged with working with students to learn and grow as a whole person.  It’s not that they aren’t concerned with feelings, they just can’t get hung up on them to the exclusion of everything else.

To be fair, psychotherapy has a long history of taking a broader view on the individual as well.  A famous psychoanalyst, Winnicott, once responded to a patient of his who was expressing feelings of hopelessness by saying something to the effect of “sometimes when I am sitting with you I feel hopeless too, but I’m not going to let that get in the way of continuing to work with you.”

But often in the past decade or two, feelings have held sway over everything.  Students don’t complete their assignments because they felt overwhelmed and still expect to pass the course.  Adults feel emotionally exhausted and miss work or are late to it.  Children feel angry at the injustice of chores and don’t do them but still want their allowance.

A criticism I often hear toward video games is that they encourage people to believe that they can always just reset, do over and have another shot.  But implicit in this criticism is the fact of something I feel video games actually do better than many of us sometimes:  They acknowledge the reality of failure.

When we play video games, we are failing 80% of the time.  Failing in the sense of Merriam Webster’s definitions including:

  • to not succeed : to end without success
  • to not do (something that you should do or are expected to do)
  • to fall short <failed in his duty>
  • to be or become absent or inadequate
  • to be unsuccessful

In video games the reality of this is driven home to us by a screenshot:

minecraft71

 

 

warcraft

 

 

pac man

 

You can feel any way you’d like about it, angry, sad, annoyed, blase, frustrated with a touch of determination.  But no matter how you feel you still failed.

In life outside games, many of us have a hard time accepting the reality principle when it comes to failing at something.  We think we can talk, think, or feel our way out of failing to meet expectations.  My own predilection is that of a thinker, which is probably why I became a psychodynamic psychotherapist and educator.  I often waste a lot of time trying to think (or argue) myself into a new reality, which just boils down to not accepting the reality principle.  I notice the same with patients, colleagues and students, who miss deadlines, avoid work, come late to class and then try their best to think or feel their way out of it.

The first class each semester I tell my students, who are studying to be social workers and psychotherapists, that the most frequent complaint I get as an instructor is “I feel put on the spot by him.”  I assure them that this is a valid feeling and actually reflects the reality that I will put each and every one of them on the spot.  I will ask them tough questions, I will point out that they are coming late to class, I will disagree with ideas that seem erroneous to me.  Because if they think it is ok to be late or avoid thinking through a problem or confrontation in class, how in the world will they ever be a decent psychotherapist or social worker?  If the single mother you are working with wants to know how to apply for WIC, and you say you feel put on the spot by her question, that is a valid feeling AND you are useless to her.  If your therapist was 15 minutes late every week I hope you’d fire him.  And when you are conducting a family session and someone discloses abuse it is unprofessional to say “I’m feeling overwhelmed and sad right now, can you ask somebody else to go next?”

These sort of disconnects doesn’t happen overnight.  It comes from years of being enabled by well-intentioned parents and yes, mental health providers who focus on feelings to the exclusion of cognition and behavior, and worse, try to ensure that their children grow to adulthood feeling a constant sense of success.  When I hear self psychology-oriented folks talk it is almost always about mirroring and idealizing, and never about optimal frustration.  And I suspect that this is because we have become so focused on feelings and success that we are preventing people from experiencing optimal frustration at all.

The novelist John Hersey has said “Learning starts with failure; the first failure is the beginning of education.”  We commence to learn because reality has shown us that we lack knowledge or understanding.  That’s the good news.  We’ve woken up!  In this light I regard video games as one of the most consistent learning tools available to us.  When that fail happens and that screen goes up you can try to persuade it to cut you some slack, flatter or bully it, weep pleadingly for it to change to a win, but no matter how you feel, you still failed.  And because that reality is so starkly there, and because the XBox or PS3/4 doesn’t get engaged in your drama, that feeling will eventually dissipate and you will either try again, or give up.

Because that is in a lot of ways the conflict we’re trying to avoid isn’t it?  We want to avoid looking reality square in the face and taking responsibility for what comes next.  We want to keep the feelings flowing, the drama going, and we are willing to take entire groups of people and systems with us.  If we are lucky they put their feet down, but more often then not they want to avoid conflict too, and the problem just continues.

So here’s a confession:  I have failed at things.  I have ended a task without success.  I have not done things I was expected to do.  I have fallen short, been inadequate and been unsuccessful at stuff.  And nobody took away my birthday.  I’m still around doing other things, often iterations of the previous failures, quite successfully.

If you are a parent or educator please take a lesson from video games.  Start saying “Game Over” to those in your care sometimes.  If they can try again great.  If they want to read up on some strategy guides or videos to learn how to do it better, awesome.  But please stop capitulating to their desire to escape reality on the illusory lifeboats of emotional expression, rationalization or verbal arguments.  As Mrs. Smeal says in “Benny and Joon,” “when a boat runs ashore, the sea has spoken.”  Reality testing is probably the most important ego function you can help someone develop, please don’t avoid opportunities to do so.

Nobody likes to experience failure, I know it feels awful.  But to move through it to new realizations can be very liberating, and in time become more easily bearable.  And I truly believe that success without past failures feels pretty hollow.  When I play through a video game from start to finish without a fail I don’t feel like a winner.  I feel cheated.

 

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Reality Testing & The 7 Billion Rule

In this video, I discuss the ego function of reality testing, how it affects us, and ways to cope with distortions in it.  This is also another example of how I use technology, in particular YouTube as a transitional object for patients, allowing them to continue to remember our work together without compromising any of their personal health information.

This will be the last post for 2013, have a good end of the year and I’ll see you sometime in late January!

 

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Obama, Selfies, Projections & Death

In this video Mike Langlois, LICSW gives an analysis of what the furor around President Obama’s selfie at Mandela’s funeral could say, not about him, but us.

 

 

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