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

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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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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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The Changing Landscape of Social Work

TrekWorld_Nicholas-Roerich_Kanchendzonga-1944

Recently I had the great opportunity to be a scholar-in-residence at The University at Buffalo’s School of Social Work.  For three days I met with students, faculty and staff to speak about emerging technologies ranging from Twitter to video games.  During one morning, Dean Nancy Smyth and I sat down for a series of informal discussions around various topics, and the University was kind enough to let me share these videos with you.  If you want to learn more about how I can come to your institution to do the same thing, please contact me.

How to Use Social Media and Technology to Develop a Personal Learning Network:

 

 

If I Don’t Use Social Media and Technology in Social Work Practice What Am I Missing?

 

 

Social Work is Changing:  Integrating Social Media and Technology Into Social Work Practice

 

 

 

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The Internet Is Not A Meritocracy, That’s Why You Hate It

lightbulb

Recently, I had a discussion with a student about social media, and the fact that I usually start off a comment on a blog with “great post!”  She noted two things:  First, that it rang false to her initially, making her wonder if I even read the posts people write; and second, that despite this initial impression she found herself commenting anyway.  So let me define what a great post is.

A great post is one that captures your interest and keeps the thoughtful discourse going.

Now many of my academic readers are going to vehemently disagree.  They may disagree with this blog post entirely, and you know what?  If they comment on it, I’ll publish the comment.  Because the comment keeps the discourse going.

Also recently, I was explaining my pedagogy to colleagues who were questioning my choice to assign a whole-class group assignment for 25% of the student grade.  The concern was that by giving the class a grade as a whole I would run the risk of grade inflation.  This is a real concern for many of my peers in academia and I respect that, and as someone who believes in collaboration I intend to balance advocating for my pedagogical view with integrating the group’s discerning comments and suggestions.  In my blog however, let me share my unbridled opinion on this.

I don’t care about grade inflation.

Really, I don’t.  I went to a graduate school which didn’t have grades, but had plenty of intellectual rigor.  I am more concerned with everyone having a chance to think and discuss than ranking everyone in order.  That is my bias, and that is one reason I like the internet so much.

The old model of education is a meritocracy, which according to OED is:

Government or the holding of power by people chosen on the basis of merit (as opposed to wealth, social class, etc.); a society governed by such people or in which such people hold power; a ruling, powerful, or influential class of educated or able people.

 

I think that Education 2.0 has many of us rethinking this.  Many of our students were indoctrinated into that view of education that is decidedly meritocratic.  I suspect this was part of what was behind my student’s skepticism about “great post!”  My role as an educator in a meritocracy is to evaluate the merit of these comments and ideas, rank them and award high praise only to those which truly deserve it.  By great posting everything I demean student endeavors.

One of my colleagues Katie McKinnis-Dietrich frequently talks about “finding the A in the student.”  This interests me more than the finite game of grading.  Don’t get me wrong, I do offer students choices about how to earn highest marks in our work together, I do require things of them; but I try hard to focus more on the content and discourse rather than grades.

I frequently hear from internet curmudgeons that the internet is dumbing down the conversation.  The internet isn’t dumbing down the conversation:  The internet is widening it.  Just as post-Gutenberg society allowed literacy to become part of the general population, Web 2.0 has allowed more and more human beings to have access to the marketplace of ideas.  We are at an historic point in the marketplace of ideas, where more intellectual wares are being bought and sold.  More discernment is certainly required, but the democratization of the internet has also revealed the internalized academic privilege we often take for granted.  Every ivory tower now has WiFi, and so we can experience more incidents of our sneering at someone’s grammar and picking apart their spelling.  What is revealed is not just the poor grammar and spelling of the other, but our own meritocratic tendencies.

Detractors will pointedly ask me if I would undergo surgery performed by someone who had never been to medical school, and I will readily admit that I will not.  But how can we reconcile that with the story of Jack Andraka, a 15 year-old who with no formal training in medicine created a test for pancreatic cancer that is 100 Times More Sensitive & 26,000 Times Cheaper than Current Tests.  In fact, if you listen to his TED talk, Jack implicitly tells the story of how only one of the many universities he contacted took him seriously enough to help him take this discovery to the next level.  Meritocracy in this case slowed down the process of early intervention with pancreatic cancer.  One side of this story is that this test will save countless lives; the darker side is how many lives were lost because the meritocracy refused to believe that someone who hadn’t been educated in the Scholastic tradition could have a real good idea.

I am urgently concerned with moving education further in the direction of democracy and innovation.  Any post that gets me thinking and interacting thoughtfully with others is a great post.  On a good day I remember this.

But like many academics and therapists and educators and human beings brought up in a meritocracy, I have my bad days.  Like many of you, I fear becoming irrelevant.  I resist change, whether it be the latest iOS or social mores.  Last night I caught myself reprimanding (internally) the guy wearing a baseball cap to dinner in the restaurant I was in.

We still live in a world where only students with “special needs” have individualized education plans– quite frankly, I think that everyone should have an individualized education plan.  I think our days of A’s being important are numbered.  There are too many “A students” unemployed or underemployed, too many untenured professors per slot to give the same level of privilege in our educational meritocracy.  Digital literacy is the new frontier, and I hope our goal is going to be maximizing the human potential of everyone for everyone’s sake.  Yes this is a populist vision, I think the educational “shining city on the hill” needs to be a TARDIS, with room for the inclusion of all.  I also think that those of us who have benefited from scholastic privilege will not give this privilege up easily.  We desperately want to remain relevant.

I know it is risky business putting this out in the world where my colleagues could see it.  I know this will diminish my academic standing in the eyes of many.  I know my students may read it and co-opt my argument to try to persuade me to give the highest grade.  But if I believe in discourse and collaboration I’ll have to endure that and walk the walk.

I’m not saying that every idea is a good one.  What I am saying, what I believe that has changed my life for the better is something I find more humbling and amazing about the human being:  Not every idea is a good one, but anyone, anyone at all, can have a good idea.

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