Dear Rejection,

Dear Rejection,

Thank you for visiting me this week. I’m sorry I didn’t greet you kindly when you first arrived. I had been busy making other plans, expecting great things, and then there you were.

Thank you for reminding me of my family and friends, their love and presence as I became absorbed in trying to entertain you. They groaned at my self-pity, sat quietly with me as I grieved a little over a future that swung shut a little. Even the dogs noticed my sadness at your arrival. Warm eyes and muzzles, a rump plopped solidly on me as I struggled valiantly under the covers to stay in bed and feel sorry for myself. My companions would not let me slump: there were walks to be had and games to be played, and a slow steady stroke of the fur that led me to be present.

Thank you for reminding me of my privilege, Rejection. Although you visit everyone, you come to see me rarely, and you never stay long. Yet, each time I am surprised and insulted that I have failed or lacked or not been chosen. As if I didn’t have more than I need, as if I was above failure and you. I treat you as a mugger and murderer as if my life were really in danger. Yes, you break things when you visit, but you have never broken me.

But mostly, thank you for reminding me that I had been waiting on others’ approval, when I should have been busy being myself. I had been scanning the horizon for so long for someone to come and say I was ok that I’d forgotten my eyes were mine. I’d strained my vision filling out so many applications, reading for signs, until it seemed that I was just a hungry gaze waiting for some email or letter or message on social media would what—make me solid?

The gift you always bring instead, ultimately, is resilience. You connect me with my humanity and my strength, urge me on to new creativity and challenge me to settle into myself. You remind me that I am already a wonder. I hope I will remember this for a while.

Even though you are already packing to leave I know you will be back. You have so many of my neighbors to visit each day, and I wish I could pin this letter to your lapel for them to read, with an note on the envelope that says “Please Welcome Rejection, They Want To Remind You.” Maybe if we did that we could take up better residence in ourselves and the world.

Collegial Conversation with Diana Clark

In this collegial conversation with Diana Clark I discuss video games, flow states & the power of gaming for our mental health.

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Race and Psychotherapy: The Interior Lives of Blacks and whites

For those of you who missed it, this is part one in a series I am producing with CIBER, the Center for Innovations in Behavioral Health and Education Research at Simmons University. This training discusses the interplay of race and mental health in the treatment room and in a world amplified and accelerated by technology. Dr. Johnnie Hamilton-Mason and I engage in a dialogue informed by their individual practice experiences, interpretations of theory from differing racial perspectives, and their shared interests in internalized racism and subjectivity, psychological liberation and resistance.

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An Open Letter to Parents, Teachers & Administrators Now That School Is Officially Closed

The following is a letter I wrote in response to Massachusetts’ School Closures Due to COVID19. It may or may not be applicable to your school system.
Hello all,
I decided to jot down a few thoughts, which you can take or leave with a grain of salt, as someone who has been a teacher, special educator, school social worker, psychotherapist, special needs foster parent and researcher over the past quarter of a century. I have been a Gen Xer since birth. I have heard how stressed parents have been getting trying to deal with online learning and although I can’t dispense clinical advice online, I have some informed opinions. This may not be what you want to hear, but here goes nothing:
For parents:
1) Please stop trying to be so productive. Our country is obsessed with productivity, it is part of what makes so many kids and adults so anxious. Let your kids eat untoasted pop tarts, sit and watch their iphones, hum to themselves, whatever.
2) Do not cook for your children all the time. Color code microwave speed buttons and have the oldest learn to “cook” for the youngest when possible. Leave out bread and some plastic knives and forks and materials for PBJs. They will be fine if they only drink milk for a day or three. They are in home quarantine not on a cruise ship, and you are not “the help.” If you refuse to let them fend for themselves and become resentful it is ON YOU.
3) Stop worrying about online learning, schools are going to need to assess kids’ academic baseline when school commences in September and reteach anyway. I give you permission to ignore the constant emails from school. They are anxious too. Consider sending your teacher a courteous email saying that your family has determined that your family’s emotional health and domestic harmony takes precedence over math and science facts, but that you may have your kiddo record a brief Youtube explaining a principle in Physics they learned playing Portal 2, or the concept of sequencing as evidenced in Plants Vs. Zombies. Assure their history teacher they will do the same for someone in Assassin’s creed. What are they going to do, suspend your child? THERE’S. NO. SCHOOL. Please don’t worry about this. If your child is an overachiever and feels more secure or relevant doing all assignments disregard the above. If your child had frequent suspensions or school phobia because education WAS their primary stressor please do not try to recreate the stress at home, but instead embrace this divine gift for the next few months.
4) Try to throw money at problems if at all possible. If everyone is online at home invest in the highest speed internet plan available. Get an extra iPad or PC or if possible get one for everyone. For every article about too much screen time I can send you two that discuss the benefits of screen time. If you all can Netflix/game/chat simultaneously without lag you will get along much much better.
5) Please don’t worry about screen time. Please don’t worry about video games causing violence. That is a moral panic and poorly correlated research concept. In fact, more of us have been on screens/gaming this year than ever, and it is the first March in 18 years we haven’t had a school shooting in the U.S. There are lots of articles which can show you how to use video games for educational purposes I can share with you: This is only to calm you down—play is inherently beneficial to cognitive development, so ideally you would just let kids play the games they like.
6) That said, if your family wants to sleep in the traditional fashion, i.e., at night, please switch from visual things (screens, reading, staring contests) to auditory ones (Audible stories, music, campfire songs) 90 minutes or so before your target bedtimes. When our eyes are working they tell our brains to stay awake. Listening to talking puts them to sleep—you probably know this already if you still attempt talking to your teenager.
1) Be subversive. Please try to avoid passing on institutional expectations if you think they are performance-based. If you are still a fan of performance-based expectations at this time please seek out therapy. The rest of you make silly videos of yourselves that showcase the creativity that got you into education in the first place. Dig deep I know it is there, I have worked with many of you and know that most of you don’t hold to the old adage “never let them see you smile before Christmas Break.”
2) Take care of yourselves. Meet colleagues online for coffee via Zoom and complain about the children or your families or whatever just like you used to during your 5 minutes of unscheduled time. Revel in the new freedom that comes from being able to use the bathroom whenever you want without worrying about 25 people waiting for you in your classroom. Do not assign any homework that you are not looking forward to reviewing 30 times while your spouse is playing the television too loudly. Remember those headaches, they haven’t been there for several weeks have they? Take the hint, don’t assign any homework at all.
3) Focus on your student’s parents more than the students. They don’t know how to be you, most of them weren’t trained to be you. Try not to point out that this demonstrates how you do more than childcare and deserve the summers off. Don’t go there. Please just reassure them that they are doing enough to keep their children safe and psychologically sound, and that their children will not be unemployed and living in a cardboard box at the airport, or worse still at home, when they are 30 because school stopped early this year.
4) Create a filter for email from your school admins. Do not look at it more than once a day. They are so overwhelmed they will not notice. They may have children at home they are feeding pop tarts to. They are probably dealing with budgets now. They are definitely giggling inappropriately sometimes.
School Administrators:
1) Please don’t be defensive. I know, nobody understands what you do, and they never call you unless there is a problem. It is lonely at the top, and now the top has multiple abandoned buildings that still are falling apart. It is also true that the Bureau of Special Education Appeals is forging ahead with zoom like the rest of us, so no respite there. And even though you all look (and are) tough I know you feel responsible for every single adult, adolescent and child in your district for everything. You aren’t but I know you feel that way. Try to remember that every one of the 200 emails/calls you got today doesn’t know about the other 199. Only you do, and it is exhausting. So breathe—getting defensive will only make it worse.
2) Model Self-Care. Mention loudly to your teachers and principals and assistant principals that you are in therapy, have a zoom peer group, whatever you are doing to keep yourself from going off the deep end. Limit your exciting emails about resources to one digest a day at the end of the day. (They won’t be reading them until the next morning anyway, see Teachers, 4, above.)
3) Encourage silliness wherever possible. Anticipate filling out state waivers for EVERYTHING this summer. Kick every can that has “MCAS,” “Curriculum Frameworks” or other bureaucratic jargon down the road you can. Be aware that you are demonstrating unprecedented leadership in our recent history. Did Churchill talk about “standards-based assessment” during the Blitz? I think not.
4) Plan to pivot. There are many reasons to believe that there will be another round of this in the Fall/Winter. Use the current closure to plan intentionally with your colleagues. Develop a district-wide pandemic plan if you don’t have one. But only do work “work” a few hours a day. The rest of the time have fun or be outrageous. Stream you and a few students playing Call of Duty on Twitch for the District. Pioneer using Tik Tok for Social Emotional Learning (SEL in 20 second increments? How can that NOT fit somewhere in the middle school schedule?)
There, I know that none of you may have wanted to hear that, and you may not agree, but I thought I’d give it a shot. I’ve been hearing too many of you being way too hard on yourselves during this pandemic, confusing “need for structure” with “maintaining standards.” This is not Lord of the Flies: Society will not fall into chaos if we relax our educational and parenting goals for a few months, but we might be able to lower the incidences of domestic violence and substance abuse if we can reorder our priorities a wee bit. Thanks for reading.

So Now What? : Education During a Pandemic

Parents, Educators and School Administrators are beginning to realize that this isn’t a break or a blizzard. Many of them are hitting the ground running, some are laying as low as possible this week and hoping things will settle, a few are immobilized. And every teacher I know or talk to is trying to figure out a strategies. Teachers, you know it is true: You LOVE strategies. And I love you for it. But these are strange times, and if your strategies or lack of them are making you feel stuck, maybe some of this will help. I have my two cents and then a list of resources for you.

First, my two cents, based on working in special education, public education, higher education and clinically over the past 25 years. The most important thing right now for kids right now is to stay calm, connected and establish new flexible routines at home. No homework packets, no busy work to keep them “occupied.” As tempting as this may be to administrators, educators and parents, that does not really lend to good learning, in fact it is this adherence to the status quo that partly got us into this problem to begin with.

  1. Play is OK. There is a wealth of research out there on the benefits of physical and digital play on cognition, visuospatiomotor skills, social emotional learning, and more. Allowing kids to engage in stress-relieving fun will make them better learners, keep them in contact with their peers, & feel mastery at a time when all of us are feeling little.
  2. Look for the embedded learning in the activity. This is different than trying to structure learning too much. When you are able to focus on your child between other things you are doing as a parent or online educator, try to identify what learning is happening with the play activity and maybe share it when the child is done. I say maybe because first and foremost this is for you to reassure you and calm your anxiety that your child or student is falling behind and will end up living in a cardboard box on the highway because they are playing Portal 2 rather than doing math sheets. Instead, watch the game a bit, and ask yourselves, are there things about physics embedded in the game? Does Plants Vs. Zombies have an opportunity to discuss task planning, sequencing, or math skills (hint, it does: all of the above.) Try to see the things that kids are always learning in play. Now don’t interrupt and ruin it.

Ok, I know that’s not enough for many of you. So here’s a list of some things educational innovators are offering for parents, kids and schools as resources for online learning:

From Continuity with Care to Zoom Memes for Self Quaranteens–My Internet Responds to COVID-19

Parenting (in RL) during a pandemic

Resources For Teaching and Learning During This Period of Social Distancing

THE COLLECTION :Explore thousands of artworks in the museum’s wide-ranging collection—from our world-renowned icons to lesser-known gems from every corner of the globe—as well as our books, writings, reference materials, and other resources.

Educators can also join one of my free Zoom groups (download free software at ( )

Thursdays 3-4 EST

COVID19 Educator Support: Not tech support. This meeting is to provide psychoeducation and collegial support for educators adjusting their teaching to COVID19

Meeting ID: 906-040-691

Password: 02554

Coping With COVID19: Advice for Parents & Educators

As anticipated, I’ve begun to receive a few communications from therapists, parents and educators about the social distancing impact on them and their children. The first question I get usually is something like “I’m worried about my kid playing too much video games, should I be setting limits on this with them?” I’m going to give you an answer that you may not want to here, but may actually improve mental health.

First, as I mentioned earlier this week, we are all going through an adjustment reaction to a rapidly emerging situation that is impacting everyone you know at the same time. This alone is rare in that usually some of us are not dealing with psychological upheaval when some others are. But this time, whether you are denying, minimizing, remaining guardedly calm, scared, or overreacting, you too are on the same continuum that we all are. So welcome. 😊

Local governments and schools, comprised of similarly recalibrating individuals are doing what they can to get ready for the wave of shut-downs, and this includes for many teachers and kids a break for 2 or more weeks and then perhaps online learning. Many workplaces are closing and reducing hours, which means that families are about to spend more time together in closer quarters with less emotional and financial resources than usual.

So, what can you do?

Here are my suggestions which are based on my work, research and thinking about psychology and technology over the past 25 years:


  1. Focus on social distancing (skip ahead if you already have embraced this idea.) This is the most important way we have to #FlattentheCurve and mitigate against higher more rapid infectivity. As has been written at the concept of self-quarantine works to mitigate the spread of infectious diseases. We have known this since the 1400s. This is hard on social creatures, and can start to evoke guilt in caregivers. Compassionate ideas like visiting elderly shut-ins in person; babysitting groups and play-dates; local support gatherings are all bad ideas when it comes to a pandemic.
  2. Anticipate but don’t panic. It is very likely that more disturbing information and misinformation will happen in the next several days. If you note the way COVID19 is trending things are going to worse and scarier pretty quickly. Remember this is happening at a pace that is quicker than you may be used to and be prepared to change your mind and recalibrate family rules and limits much more rapidly and often. Be prepared to say, “I know I said X but now that I have more information it is Y, and I’m sorry that we keep changing the rules on you. Building that understanding with your child that things are moving quickly is part of the overarching message “I love you, I’m listening and I’m going to keep you safe.”
  3. Let kids play their games. I have mentioned elsewhere and will include below several posts debunking the common misconceptions that demonize video games. But here let me put it a different way: 2 or more weeks is a long time to be in your home nonstop with your children in a state of embattlement. Video games are a great way to practice social distancing: Kids can talk with their friends online, escape the heightened stress at home or in our communities, and feel a sense of being in control of something. It also provides you with the respite you know you are going to need after a couple of days. Lift restrictions if your authoritative parenting style can handle it. One exception here is helping kids build in 5 minute movement breaks every 45 minutes or so.
  4. Try to see it from their point of view. No matter how much your child or teen loves you, they are used to having several hours a day away from you too. Like you, they find being distracted from family life by work and friends reinvigorating, so please don’t frame this as an opportunity for more quality time. It’s disingenuous and sets everyone up to feel like a failure when the reality of quarantine sets in. Of course if they are open to spend time with you, accept the invitation as they deliver it: Now may be the perfect time for you to finally learn how to play Fortnite with them.
  5. No, YOU go outside and play. Often parents find themselves exhorting kids to go outside when they are secretly yearning for escape themselves. If your child can be left alone safely for a bit, go outside and take a walk, get some fresh air and calm down. You already believe that exercise will do you good, so focus on the one you can control, you! Of course, if your family walks/hikes/runs together and you are not looking for alone time, definitely invite them along with you.
  6. Get in the habit of zooming, calling, texting with others regularly. Your kids may be experts at this, but older family members may need help with the habit or technology. Or you might. Learn how to use Zoom, which is being offered for free for most kids. Call and help other folks learn how to set it up and test drive it. This week is the week to get practice before things get more hectic.
  7. Practice mindfulness games and meditation when possible. My colleague Chris Willard has some excellent suggestions on this here. Don’t force kids to do this though, as it will turn them off. If anything, trust that if they are intently playing a video game they may be engaging in a form of concentration meditation which isn’t bad either.
  8. Confront and redirect the inadvertent demonization of touch. This one is huge. This past week many have become acutely aware of how often they touch their face, or others without asking permission. To control the spread of infection this is crucial, and yet we need to also resist the urge to begin to perceive touch as unnecessary or lethal. Touch and reaching is a part of healthy infant development (Beebee, 2016.) It plays a significant role in focusing attention and attachment security in adolescence (Ito-Jager, 2017.) Children need to touch themselves as part of learning motor imagery (Conson, 2011) body ownership (Hara, 2015) and the assembly of “self” (Salomon, 2017.) Research has shown that adolescents in America already touch each other less and are more aggressive to peers than in another country sampled (Field, 1999); and for all of us touch quite probably helps us with emotional self-regulation (Grunwald, 2014.) Self-touch is a cornerstone of mindfulness and compassion meditation practices. Practice everyday precautions while at the same time but remember that touch is necessary for basic neurological and psychological well-being. Find adaptive ways to continue giving yourselves touch so we do not become a planetwide Harlow monkey experiment.
  9. Special note to educators: Relax your curriculum and pedagogy. Please push back on your administrators on this one. You are all home because there is a global pandemic with all its increased stress and uncertainty; this is not a snow day or break. Kids should be focused on social connection, play and reduced stress. You aren’t going to hit your benchmarks this semester. There, someone finally said it. You can encourage your parents to read to kids, spend more time together, offer fun reading lists or math sites, but please let go of your own overarching expectations and resist any arbitrary ones placed on you as much as possible. If someone starts talking about lesson plans, say “this is a pandemic.” If someone starts talking about kids’ grades, say, “this is a pandemic.” Part of your job as an educator is to educate kids and their families about adjusting in reaction to events, I’m sorry you got stuck with this event, but there you have it.
  10. Pick one or two trusted sources to keep yourself and your kids informed. Two much information overloads kids and adults alike. Most of us don’t need to know what JCPenney or Walmart have to say about COVID19. On the other hand, I have found the info from Harvard very helpful. The Joan Ganz Cooney Center has some great thinking and writing for education and child development. Your Teen Magazine is very accessible to parents. Dr. Kristin Moffitt from Boston Children’s has a short but useful interview on how to talk to your kids about COVID19


If after all that you are STILL focused on screen time, please check out these items for your consideration:


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Treating Psychotherapy Patients in the Era of Coronavirus

As I write this, human beings are in the midst of mobilizing public health and psychological defenses against what will most likely be declared a pandemic by the World Health Organization this week. WHO and the CDC as well as state and local governments have issued guidelines, countries have begun self-quarantine, and as I write this Harvard just made the decision to move to virtual classes until further notice.

On a interpersonal and sociological level, we have begun to see the signs of adjustment reaction in conversations with others and on social media. The Nieman Foundation for Journalism has a page on Covering Pandemics which is very salient to us all in explaining adjustment reaction. It refers to the ways people attempt to recalibrate themselves psychologically during such traumatic and disruptive events, vacillating between overreaction and underreaction, minimizing and denial vs panic in their attempts to master confusion and anxiety in ways both adaptive and maladaptive. Perhaps you have noticed that (to paraphrase a comic I saw this week) all of your friends on Facebook who were constitutional scholars last month are now epidemiologists.

Recently I was seeing a longterm patient of mine, I’ll call her Randi*. Randi is 65, and began seeing me 10 years ago for help with dual diagnosis addiction and major depression. She also has a chronic pulmonary condition. I’ve been seeing her online for the past several years, most recently from her home in Costa Rica. This session was full of uncertainty and questions: She was scheduled to return to the US to renew her visa, should she come? Should she be holding hands at AA meetings? Should she be attending them? She has begun to follow the CDC recommendation of social distancing, and was worried about the impact of this on her mental health.

The guidelines we are being issued by public agencies are as clear as they can be during a time where data is still changing and community responses are fluctuating. At this time several suggestions are consistent from the CDC and can be found here.

As clinicians it is not our responsibility to learn epidemiology or get a degree in public health. However, we have a very important part to play in addressing the mental health issues that will accompany and/or be exacerbated by COVID19. I am listing the ones I have seen emerging in the hopes that we can help provide ancillary support for the mental health and behavioral health of our patients. If you are a therapist, please consider these. If you are a lay person, these are for you too.

  1. Reality-testing requires research. One of the main goals a therapist provides to the patient is supporting accurate reality testing. As mentioned above, reaction adjustment impacts our reality testing. Patients may present minimizing or panicking. To intervene, we need to know what the research as it is current says. Currently the mortality rate is 3.4% so yes, it is more lethal than the flu. We also do not know how this figure will change when more people are tested. But that is what we know. So the therapist needs to model both an not-knowing stance and assert what is currently known. This includes implicit communications (hand sanitizer in waiting room, offering teleheath sessions) as well as explicit ones (confronting extreme statements on either end, sharing what you know and verifying the source of your information.) Keeping abreast of the research allows you to help patients who are in higher risk populations shift their thinking and behavior to the new situation, while reassuring patients in lower risk populations understand their risk. Pointing out overreacting and under-reacting requires us to know what it is possible to know at this time, as well as manage our own countertransference response as we go through our own period of adjustment reaction. As this is all in flux be prepared to have discussions that are in flux.
  2. Address the needs that public health agencies aren’t in regards to social distancing. While it is becoming clear that more people are being advised to practice social distancing, the impacts of that on mental health are not being adequately discussed. This is absolutely understandable as the primary goal of public health in is to reduce infections to increase population survival. But helping the individual person-in-the-environment is where we come in as therapists. We know the importance of decreasing isolation for good mental health. We need to anticipate an increase in depressive symptoms, anxiety, and substance relapse may occur if the psychological impact of isolation is not addressed. We will need to help patients explore how to renegotiate boundaries as they rethink whether to hold hands at an AA meeting or a second date. We will need to help people shift to online therapy and self-help groups rather than avoid them. Social connection will need to be more planned and intentional, more technologically dependent for many. We may need to assert that immunocompromised individuals stay out of our physical offices for their safety, and explore the feelings this evokes for them.
  3. Support patients in preparation for managing their psychopharmacological needs. Help them anticipate pharmacy delays and encourage them to follow the recommendation that they get 2 months worth of prescriptions whenever possible. Be prepared to offer more case management with them as they negotiate resistance with health insurance companies.
  4. Confront and redirect the inadvertent demonization of touch. This one is huge. This past week many have become acutely aware of how often they touch their face, or others without asking permission. To control the spread of infection this is crucial, and yet we need to also resist the urge to begin to perceive touch as unnecessary or lethal. Touch and reaching is a part of healthy infant development (Beebee, 2016.) It plays a significant role in focusing attention and attachment security in adolescence (Ito-Jager, 2017.) Children need to touch themselves as part of learning motor imagery (Conson, 2011) body ownership (Hara, 2015) and the assembly of “self” (Salomon, 2017.) Research has shown that adolescents in America already touch each other less and are more aggressive to peers than in another country sampled (Field, 1999); and for all of us touch quite probably helps us with emotional self-regulation (Grunwald, 2014.) Self-touch is a cornerstone of mindfulness and compassion meditation practices. Therapists need to help patients and their families practice everyday precautions while at the same time reminding them of the necessity of touch for basic neurological and psychological well-being. We need to anticipate that we may be asking people to do something which conflicts with adaptive self-soothing responses to distress. We may be unintentionally causing a reenactment of a trauma survivor’s bodily domination by the abuser when we start telling her what she can and cannot do with her body. We may be taking away a kid with ADHD’s main way of focusing. So the goal of therapy becomes the reduction of shame and irrational demonization of touch, and the development of adaptive ways to continue giving ourselves touch so we do not become a planetwide Harlow monkey experiment.
  5. Last but not least, hold the therapeutic frame. The majority of our patients were working on things in therapy before the events of the past two weeks. I have asked each in the last portion of the session “what do you imagine you would have been talking about in therapy if you hadn’t been discussing the coronavirus.” In the case of Randi, that question prompted her to remember that someone had attempted to break into the apartment where she lived alone, itself a pretty distressing event! Another patient, a 30 year-old male with Dysthymia, had made two major and difficult behavioral changes that week, a success that would have been crowded out by COVID-19 if we hadn’t paused to discuss earlier events. We need to keep an eye on the ongoing work, how the patient’s neurotic styles vis a vis pandemics are often in keeping with their style overall,and what other events have occurred in their week.

These are some of the most important “new” responsibilities I see us having as therapists when dealing with the emerging coronavirus crisis. I imagine more will be revealed, and I imagine that at some indeterminate time in the future it will become more clear what the psychological impacts of adjustment reaction, social distancing and touch aversion had on human development. In the meantime, please consider sharing this with your colleagues and patients so that they do not lose sight of important impacts on their mental health caused by necessary public health precautions.

Such interventions and frame maintenance model an adaptive stance in that they are hopeful: That there is a lot of work to be done is always an expression of hope, never despair.

*patient identification changed to protect privacy


Beebe, B., Messinger, D., Bahrick, L. E., Margolis, A., Buck, K. A., & Chen, H. (2016). A Systems View of Mother–Infant Face-to-Face Communication. Developmental Psychology, 52(4), 556–571.

Conson, M., Mazzarella, E., & Trojano, L. (2011). Self-touch affects motor imagery: a study on posture interference effect. Experimental Brain Research, 215(2), 115–122.
Field, T. (1999). American adolescents touch each other less and are more aggressive toward their peers as compared with French adolescents. Adolescence, 34(136), 753–758.

Grunwald, M., Weiss, T., Mueller, S., & Rall, L. (2014). EEG changes caused by spontaneous facial self-touch may represent emotion regulating processes and working memory maintenance. Brain Research, 1557, 111–126.

Hara, M., Pozeg, P., Rognini, G., Higuchi, T., Fukuhara, K., Yamamoto, A., Higuchi, T., Blanke, O., & Salomon, R. (2015). Voluntary self-touch increases body ownership.(Brief article)(Author abstract). Frontiers in Psychology, 6.

Ito-Jäger, S., Howard, A. R., Purvis, K. B., & Cross, D. R. (2017). Attention focus and self-touch in toddlers: The moderating effect of attachment security. Infant Behavior and Development, 48(Pt B), 114–123.

Salomon, R. (2017). The Assembly of the Self from Sensory and Motor Foundations. Social Cognition, 35(2), 87–106.

Triscoli, C., Olausson, H., Sailer, U., Ignell, H., & Croy, I. (2013). CT-optimized skin stroking delivered by hand or robot is comparable. Frontiers in Behavioral Neuroscience.

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Video Games & Meditation

Let me start by saying I’m a huge fan of meditation. I’ve done certificate trainings in mindfulness and clinical practice, classes on guided imagery and visualization, and meditation to enhance neurological development. I’ve seen the research on how meditation positively impacts the brain in general and specifically white matter connectivity as we age. More personally I have been a lifelong student and practitioner of meditation in various forms: I’ve chanted in ashrams, done walking meditation, participated in Dzogchen talks and practice, engaged in mindfulness practice, Benson’s relaxation response, yoga, the Eight Gates of Spontaneous presence, and many more. That’s a lot of meditation! I don’t do it as consistently as I wish, but I have a healthy respect for the various forms of meditation, and refer patients to it regularly.

This is one reason why I find it troubling how so many fans of meditation hate on video games and gaming. The same folks who are speaking about compassion and mindfulness and calm sound like raging fundamentalists when they start speaking about “screens” and the spurious research that video games are adversely affecting our lives and neurology. They seem to think that meditation has to occur on a bamboo mat in a candlelit rock garden to be meditation. Cultural misappropriation aside, this really limits the potential audience who could benefit from meditation.

Part of this is due to the recent popularity of mindfulness meditation, which made DBT sexy and available to the mainstream, much as psychoanalysis expanded from treating hysterics to the general population with our neurotic styles. This is wonderful, mindfulness meditation is very useful and effective. And it is only one form of meditation. Less talked about nowadays are the focusing or concentration meditations, and guided visualization meditation. But when we do remember those, the impulse for many is to imagine that the object of focus has to be something low tech. We think candles and mandalas, but what if video games could also be objects of focus? In fact, what if playing video games is a form of concentration meditation?

Recently, I decided that I wanted to do my part to make meditation more available and gamer affirmative. In particular, I have developed a guided visualization meditation called “Your Powerful Video Game Avatar.” Through the support of Insight Timer, I am now happy to share it with you. I hope you will find it of benefit. If you are a gamer new to meditation, I hope this may be the Welcome mat that invites you to try meditating. If you are not a fan of video games, I hope this deepens your insight and compassion into that art form. Mostly, I hope it brings maximum playfulness and status bar boosts to all sentient beings. 😊

Your Powerful Video Game Avatar

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Streaming, Path of Exile & The Repetition Compulsion

As many of you know I have begun streaming. My goal in doing this is to both have some fun, and reach a wider audience when talking about psychodynamic concepts. This is my latest attempt, in which I talk about the Repetition Compulsion in terms of farming for a unique sword in the game Path of Exile. Keep in mind that the conversation about the repetition compulsion during the stream if for a general audience, and should not be substituted for seeking out medical advice or a mental health professional. My hope is that you’ll share it with the gamers in your life, therapy practice, class, etc. And of course if you sign up to follow my Twitch channel I’d be delighted!

Find this post interesting? I can speak in person too:  Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book. 🙂


Why Kids With Autism Should Stream

Like many therapists who work with adolescents with autism, I frequently get asked for guidance on improving peer relationships as they get older. Contrary to the stereotype, autistic kids do often crave peer relationships, dating, and popularity. It can make adolescence especially poignant as kids with ASD want to establish more independence from parents and gain the esteem of other teens but don’t know how to connect with their peers yet. They can experience heightened social anxiety, and retreat into coping mechanisms which help self-soothe but make them stick out when they very much want to blend in. There can be an uptick in depression, which increases hopelessness and decreases self-care. Decreased self-care leads to poorer hygiene, which makes teens even less popular. Parents, sound familiar?

So how do we interrupt this vicious cycle?

One way is to get your kids streaming online. Streaming, or live-streaming, is the broadcast of content over the internet on platforms such as Twitch or YouTube. The content can include commentary while playing or watching a video game, discussing a television series, plays, presentations on topics of interest, music, etc. You’re probably thinking “Riiiight, what does streaming have to do with helping kids on the spectrum become popular?”

Ok, stay with me here and I’ll give you some reasons:

1. Streaming promotes theory of mind

Anyone who has ever watched a streamer has had the experience of being in the audience. By empowering a teen to stream, we also create an opportunity for them to imagine the other out there watching. Even if they have few viewers to start with, we encourage them to act “as if” they were in a social setting where others have minds and feelings like they do and could respond to them. This reinforces the concepts of theory of mind and empathy, both in the streaming act and later in reviewing recordings.

2. Streaming is a very normative adolescent medium

Whether it be gaming, unboxing, critiquing videos or talking fashion, a majority of teens are now consumers of streaming culture, watching thousands of streams every day. It can be very empowering to let adolescents with autism know that they can be creators of streaming culture as well. Also, it takes the edge off of poor hygiene: In cyberspace everyone smells just fine.

3. Streaming can allow for 21st century social scripting and role play

Children and teens with autism are often being trained in social pragmatics, which has three general components: The ability to use language for different purposes (requesting things, greeting people, passing on information;) the ability to adapt language to changes in listener or environment (speak louder in noisy settings, speak differently to child or adult, give more or less information as needed;) and following unspoken norms or rules of conversation (taking turns speaking, gauging for interest, emphasizing points or emotions.) One way youth with autism can build mastery in social pragmatics is through the use of social scripts, practicing the rules and formula in low-stress environments where the social stakes aren’t as high or immediate. Streaming can provide such a place to do so, where teens can practice greeting viewers, looking directly at camera, pausing to view chat or take Discord questions, enthusiastically thanking viewers for watching, and ask what they might want to see next time, etc.)

4. Streaming allows for review

Streaming can usually be recorded, both the stream and the video recording of the streamer. This can provide the adolescent the opportunity to review and refine their social pragmatics with or without adult feedback. I ask my patients if they want me to watch at any point, and tell them I won’t be offended if they don’t want me to watch. After a stream, ask your teen how they felt when they were doing it. Were they able to forget they were being watched? Did knowing they were streaming live effect their speech or behavior in any way? How did they deal with questions or comments? What did they notice about their viewers? Do they feel energized or depleted afterwards? It can also be important to normalize their reluctance to view the recordings–many of us dislike seeing ourselves on camera, no matter how useful it could be.

5. Streaming allows the teen to behaviorally say “Hey, I want to put myself out there.”

No one starts streaming by accident, but starting a streaming channel can help teens overcome their social reluctance by embedding social engagement in content that they find enjoyable and invigorating. Have you noticed that it can be more invigorating to talk with people about topics that are interesting to you? Autistic kids think so too! The challenge is that a lot of times they are afraid to put themselves out there because they have had years of well-meaning adults talking about their “perseverating” on topics. As I have mentioned elsewhere, this concept is pathologizing and highly subjective: If you talk to me about football for more than 20 seconds, I’ll start to get bored think you’re perseverating. That said, many people can feel overwhelmed and ambivalent in the face of an enthusiastic person going on for a length of time. You know they are trying to engage and want to support that, and yet it feels too much! Streaming lowers the pressure on that for the listener, who can pause or take time off from watching if it gets too much for them, while still being engaged overall. Yes, part of the problem is the interest deficit in the neurotypical person–the problem doesn’t reside solely in the neuro-atypical one!

6. Streaming makes affinity groups larger and more accessible

Many teens on the spectrum have interests and intensity of interests that place them in the minority. This can lead to isolation and lower self-esteem, because they have fewer opportunities for mirroring from peers and their community. There are probably a whole bunch more people in Boston and Atlanta who spent February 3rd, 2019 watching football than My Little Pony, which can make the Bronies out there feel less-than. However, at any given time in the world, there is probably a larger group of MLP fans, and streaming helps flatten the world. Streaming, like technology in general, amplifies things and breaks down barriers. Don’t have anyone to talk My Little Pony or anime with? Start streaming narrations and discussions of episodes, and before you know it, you may have 1,800 people to connect with! There’s something for everyone, even those craving an online marathon of Mr. Rogers episodes..

7. Streaming can help kids develop other life skills

Been struggling with your child to get a job? Take a month or two off from the struggle. Help them set up a streaming channel. Then subscribe to Patreon, a platform that allows creators to accept income from people who want to foster their art. Maybe you can prime the pump a bit, to reinforce the work/income connection. I can’t tell you how many parents send mixed messages about money and work to their kids. Kids think a $50 bill they got in a birthday card from Aunt Mable is “my money” that they earned, when in reality it is a gift. Allowances may or may not be connected to chores, which are often a source of added conflict. Instead, why not have Aunt Mabel become a patron and donate $4 a month for the year to the teen’s streaming channel? That way, there really is a connection between work and income, and Aunt Mabel supports the arts? (Parents may want to self-check here to see if they are biased about their children and the arts. If you think art is not real work or valuable, that only a unique few can make a living from it, or that talent is entirely innate and you have it or don’t, then you are biased about your children and the arts.)

To get started, I recommend using Open Broadcaster Software, which is free and well-supported. Tom’s Hardware has a good reference for getting started here, just keep in mind you can stream much much more than video games, although doing that is cool too!

I do want to acknowledge that encouraging teens to put themselves out there has some real risks. Some of the streams and videos may be pretty quirky, and nothing vanishes completely on the internet. They may encounter hate speech or hurtful comments during the stream or afterwards, just like they may encounter it in life. They may feel very self-conscious after reviewing the stream. But I do think that for many teens with autism (or neurotypical kids for that matter) the rewards can outweigh the risk. Parents want to check for their own tech biases here: Do you support your youngster playing a sport? Risky. How about having them join martial arts, drama club, or run for student office? All risky. So why not encourage them to stream about something they like?

Curating an online presence for others, real and imagined, is actually a component of digital literacy we all need to do sooner or later, online streaming about a topic or activity of interest may give children and teens with autism some valuable practice and sheltered learning. It may also help them meet people in the wider world who share their interests, think they’re cool, and increase their popularity. That seems like a substantial reward to me.

Find this post interesting? I can speak in person too:  Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book. 🙂