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

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:
- 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 https://staythefuckhome.com/sfw/ 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.
- 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.”
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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:
- Yeah? Tell That to Squirtle: The Fallacy of “Screen Time”
- Dopey About Dopamine: Video Games, Drugs, & Addiction
- Improving Our Aim: A Psychotherapist’s Take On Video Games & Violence
- The Internet & Real Relationships
- 10 Nonviolent Video Games
- Innovation is Dangerous & Gaming Causes Asperger’s
- Finally! A Mindfulness Approach to Video Games for Play-Based Social-Emotional Learning, Just in Time for the Holidays
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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!
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Can’t We All Just Game Along?
I had a powerful reminder about the prosocial nature of video games this week, and it was nowhere near a console screen. I was on my way home and ran into a Dunkin’ Donuts, in a town I’d never been to before and was unfamiliar with. I ended up waiting in a rather lengthy line and was a bit grumpy. I happened to be wearing a T-Shirt which said this:
I hadn’t worn it for ages, and had forgotten in fact I was wearing it until the cashier called out to me, “I love your shirt.” Cue the endorphins.
“Thank you,” I said, and smiled (which thanks to state bound learning probably cued my body to produce even more endorphins.) Waiting in the line seemed much more pleasant by this point. I ordered my coffee and sandwich and while waiting for them received another compliment from a customer walking by.
The third person to compliment me was a man in his 40s, scruffy and in jeans and t-shirt. “I love that game,” he said. “I haven’t played it in a while though.”
By now I was in a mood that allowed me to initiate conversations, so I asked “What are you playing nowadays.”
He proceeded to tell me that his 14 year-old daughter had gotten him into Fortnite. She had enjoyed it initially for the crafting, he said, because she really enjoyed Minecraft; but now that they were playing together she was enjoying the combat as well. His face lit up as he recounted how much fun they were having together. I told him about a study that had been done by Brigham Young that indicated increased levels of protective factors against depression. He smiled at that, and we both went on our way.
We spend so much time debating the neurological impact of playing video games that we often lose sight of another dimension; that of talking about playing video games. Talking about arts and culture is a powerful social adhesive. It identifies commonalities, allows for compliments and increased levels of engagement with others, allows us to recall exciting moments and share them. All of these activities in turn facilitate attachment, and increase a sense of well-being on the neurological level. That was the best line I’ve waited in a ages!
We need to find a way to get that message to Salty Sally the Social Worker and Morose Martin the Mental Health Counselor, whose eyes grow dull at the mention of gaming when their patients bring it up. “How much time are you playing Candy Crush?” they say, in uninviting tones, and eye such T-shirts as a clear sign of video game addiction. The next patient, who comes in with a T-Shirt of Monet’s “Water Lilies,” will get a compliment on it and no such screening for an Impressionist Art Addiction. In fact, the WHO didn’t include Art Disorder this go round at all, unless you include the art form of the video game.
In this current political climate, where we are so polarized, I wonder how many bridges (Minecraft or other) might be built if we paused to ask strangers in line if they play any games? I imagine Republicans, Democrats and Independents alike play something.
If Teams Valor, Instinct, and Mystic can all get along together raiding in Pokemon Go, perhaps we can too..
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Taking Leaps: Fortnite, HIPAA & Psychotherapy
“You keep dying,” Sam* said. The annoyance in the 9 year old’s voice was palpable. I looked at my avatar lying face down on the screen. Another of the 100 players in the game, appearing as a brunette woman in sweats sporting a ponytail, was doing a victory dance with her rifle over me. Sam was nowhere to be seen on the screen, but I knew he was hiding somewhere in the game, and seething.
“You’re disappointed in me,” I said calmly. A moment of quiet.
“Yeah.”
“You were hoping I’d be better at this, as good as you or maybe better, and it’s frustrating.”
“Yeah… Can we try again?”
And so we tried again and again, and while we did I talked with Sam about the other adults who were disappointments to him, who kept leaving or letting him down. And I guessed that we were also talking about his frustration and disappointment in himself. And at the end of our appointment I promised I would practice Fortnite, the game we had been playing. We had turned on our webcams again so we could see each other to finish the session, so I could see that he brightened at this idea.
“Nice to see you again,” I said. He smiled faintly.
“You too.” His screen went dark.
As I reflect on the work I do with patients, meeting them where they are at, I am struck by the same issues, opportunities, and conversations that can happen in an online play therapy session. I only wish more of my colleagues would try it. What gets in the way? For some it is a dismissal of emerging technologies which masquerades a fear of trying something new. For others it is a worry about running afoul of HIPAA and being sued. If you are one of those people who wonders about how to integrate video games online into your therapy practice, read on.
* * * * *
Quick, without Googling it; what does the “P” in HIPAA stand for?
If you are a psychotherapist or other health provider, you probably guessed “privacy.” At least that’s often the consensus when I ask this question at my talks. It would be understandable if this was your guess. You’d be wrong.
The correct answer is “portability,” the basic premise that individuals have the right to healthcare treatment that moves with them as they go through the vicissitudes of life and work. That is also where technology comes in– electronic health records, telemedicine, etc., are ways that technology increases portability by collapsing time and space so that the patient and the healthcare professional can get to work.
In therapy, that work traditional has happened in an office setting. And in the case of children and youth especially, that meant play therapy which was bounded by the space and time of a physical office. From Uno to Sandtrays to the infamous “Talking Feeling Doing Game,” we have often assumed that play therapy needs to be the games of our own childhoods. But 21st century play can, and I maintain should, include 21st century play. That’s where video games come in.
In the days of the Atari 2600, there was no worry about patient privacy, because the system was hooked up directly to a television that didn’t even need to be connected to cable. But nowadays with SmartTVs, PCs and PS4s, video games are often played online with many other people and seamlessly connected to voice chat. This can be a concern for the psychotherapist who is unfamiliar with newer technology, especially with games like Fortnite, which boast Battle Royales having as many as 100 players at a time in the same game instance.
Videoconferencing programs and online therapy using video/audio chat have been around long enough to have specifications that adapt to HIPAA’s privacy requirements, largely because there is market force behind developing products that can be sold to the healthcare industry. Video games and their platforms, on the other hand, do not have a similar demand to give them an incentive to supply. Games like World of Warcraft, Platforms like STEAM, and streaming services like Twitch were designed for gamers, not therapists, and it is unlikely they will go through the technical and legal procedures to become HIPAA compliant anytime soon.
Some therapists have begun developing their own video games, which, like most therapy games are dismally boring. They are thinly veiled therapy interventions that are disguised as play, but lack any of the true qualities of play. True, they are more likely private; but they are also boring, and easily recognizable as “not playful” by patients. Mainstream games have broader appeal, critical user mass, and better graphics and gameplay in many cases, and are more immediately relevant to the patient’s life. But they are definitely not HIPAA-compliant. So what to do?
* * * * *
My solution, which I’m sharing as an example that has not been reviewed by policy experts, lawyers or the like, has two parts:
- Due Diligence– Research the existing privacy settings and technologies to maximize benefit and minimize risk to patient privacy. So for example, I structure the “talk” part of therapy to happen over HIPAA-compliant software like Zoom or GoToMeeting. We start on that platform with video camera on, until we begin playing. Then we, turn off the camera to save on bandwidth and talk over this software, not the game. Previously, I will have sent the patient or their parent a snapshot of the settings of the game we are using with the voicechat disabled if possible. We also want to lower or turn off the game sound so we can hear each other. So in the case of Fortnite, the settings would look like this:
2. Limited HIPAA Waiver- This is the part most therapists overlook as even being a possibility. You can ask patients to sign a release waiving in a limited capacity their HIPAA rights in order to use noncompliant technology. It is entirely voluntary and I’ve yet to have a patient decline. I use a informed consent form that I developed that looks like this:
These are examples of how to engage with online technologies in a clinical way that is thoughtful yet forward-moving.
* * * * *
Whether you love Freud or hate him, most experts agree that he was one of the fathers of modern psychiatry. He was also an early adopter. He based his hydraulic model of the drives on steam technology of his era. His concept of the “mental apparatus” was likewise integrated from the advances in mechanics and his formulation of ego defenses such as projection occurred simultaneously with the Lumiere brothers’ creation and screenings of motion pictures. Regulatory concerns aside, therapists can be early adopters. Doing so would probably help our patients no end, and definitely cut down on my waitlist.
* “Sam” is based on several patients whose identifying information has been disguised to protect patient privacy.
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The Crisis Behind Crises
So far in 2018 alone, I have worked nationwide with the aftermath of one homicide/suicide in a video game server community; one threat issued over another; and 3 new requests for consultations from clinicians on how to improve their work with families and individuals related to online technology. Schools are now fielding multiple incidents of threatening language in chat rooms that get brought to their attention, and not necessarily handling them well. Multiple arraignments in district courts are pending because someone expressed violent language on gaming servers that was deemed threatening. Youth are ending up on probation for this.
I know, you’re probably thinking that I’m about to blame the technology, the erosion of family values, the rise of violence or some other social ill. I’m not. As I reflect over several of these cases, the common symptom I see is not mental illness or family dysfunction, but a crisis in digital literacy.
What all of these cases have in common is that before they got to the emergent stage, there were several opportunities for kids to solve their own problems; for educators to teach; for parents to engage or for therapists to help; if they’d seen the opportunities and had some education in digital literacy. Too often we see the end result of our dismissing or demonizing tech use. “Just leave the server, or Facebook,” we say, unintentionally further isolating kids. “You need to stop playing so many video games,” we opine, citing sketchy research to take away the one thing a person may experience some competency doing.
As a therapist and educator who has worked for the past twenty-five years with emerging technologies in mental health, I have been helping schools, clinics and workplaces identify vulnerabilities before, during and after crises. I assure you that before is the most useful and least utilized. I’m hoping you and your administrators will consider doing this differently. I have started offering custom educational offerings on Healthy Boundaries in the Digital Age, and you can find out more about it here. I’m still doing my other presentations as well.
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Mindfulness, Minecraft & The I Ching
Video Games can be a form of mindfulness meditation, both playing and watching them. The Grokcraft Staff take you on a meditative creative session as we begin to build our I Ching Sculpture Park. Watch, listen, and enjoy..
For more info on joining the Grokcraft project, go to http://grokcraft.com . We are launching Grokcraft with an introductory subscription of $9.99 a month, & subscribers who join now will be locked in at that rate for as long as they are subscribed. If any of this appeals to you, please check out our new site at http://grokcraft.com & please spread the word to anyone you think might find this resource useful!
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Avatars & The Curated Self
If I ever meet James Cameron, I hope I will remember to ask him if it was a coincidence that he chose to the make the aliens blue. His movie, Avatar, garnered 3 Academy Awards for it’s epic tale of humanity’s encounter with the Na’Vi, largely through the creation of avatars, body forms that humans beam their consciousness into so they can mingle and fraternize with the locals.
The concept of the avatar comes originally from Hinduism, and refers to the concept of a God or Supreme Being deliberately descending to earth in a manifest form. One of the most popular gods for doing this is Vishnu, also blue. The concept of avatar in Hinduism is more complicated than this, but the piece of it that pertains to this post is the general concept of the attempt of a supreme being to incarnate part of itself to enter the world. There is an inherent diminution or derivative quality to it.
If you are more familiar with video games than Hinduism, you are probably more familiar with the concept of an avatar meaning the graphical representation of the player’s character in the game. When we play Pac-Man, our avatar manifests in the video game as a little yellow circle with a mouth that races around gobbling dots. Over the decades games and graphics have become capable of more sophisticated avatars ranging from the Viking-like Nords of Skyrim to the soldiers of Call Of Duty. As these video game worlds proliferate, players descend into them with avatars of many shapes, sizes and species. Some games, like Eve Online, allow you to customize the features of your avatar extensively; others allow you to pick from a limited number. We are always diminished by the process of taking on an avatar. Even if the powers an avatar has in the video game world are immense, it is derivative of the complexity of being human.
What is interesting is that most of us use avatars every day online, we just never realize it. Video games are just one form of social media, and avatars abound in all of them. The graphic may be as simple as our picture next to a blog post or comment, or a video on Youtube. But in the 21st century most of us are digital citizens and use one form of avatar or another. Some people in the world will only ever know us through our avatar in a video game or Second Life. And yet we know something of each other.
I think more and more of us are becoming aware of the connection between the avatar and the curated self, the aspects of our psychological self we choose to represent online. The curated self is the part of ourselves we have some ability to shape, by what we disclose, what graphics we choose, and how we respond to others. Like an avatar, the curated self at its best is deliberate. I say at its best, because although the curated self is in our care, we can also be careless with it.
Recently I posted a video of myself on my YouTube channel entitled “Should Therapists & Social Workers Post Videos Of Themselves On YouTube?” In making the video I chose to wear a bike helmet, and by the end of the post was using the bike helmet as an example of the risks we take when we opt to attempt innovation of our curated self. The video was designed to inspire critical discussion and thinking, and it did just that. In some groups where it appeared people described the video and points it was illustrating as “brilliant.” Other groups interpreted it as an instructional video on how to advertise your therapy practice and lambasted it. There was a myriad of responses, and I’m sure even more from people who opted not to comment on it. I received a number of likes of it, and a number of dislikes.
What I think is important and instructional here was how people began to comment through their avatars as if they were addressing the whole person I am rather than an avatar. And they made incorrect assumptions ranging from my age to my motives. The bike helmet and my posture on the video became the target for some incredible nastiness disguised as constructive criticism. From the safety of their own avatars they hurled some invectives at who they thought I was and what they thought I was doing in front of an audience of other avatars who alternately joined in, were silent, emailed me privately to offer words of support, or publicly commented on what they saw. The irony to me was that people began to demonstrate all of the roles we encounter in “cyberbullying,” which was part of what the video also touched on. In a perhaps not surpising parallel process, we got to see and play out the sorts of dynamics that our patients and children experience all the time.
We need to remember that every avatar is a derivative of the person. It is connected enough that we have attachments and responses to it. We can feel proud or ashamed, hurt or healed through our avatars. In fact, research from Nick Yee on “The Proteus Effect” has shown that playing a game with a powerful avatar for 90 seconds can give the player increased self-confidence that persists for up to 6 hours. It stands to reason that if someone experiences their avatar as weak or socially unacceptable for a brief time there may be lasting effects as well. Behind the guy in a bike helmet is someone else. He may be a faculty member at Harvard, a sensitive fellow, a father, a student, a man who just lost his partner, a person with a criminal record, or any, all or none of these. But he is always more than the derivative of his avatar. We need to practice being mindful of this and model it as we train others to be digital citizens. It is counterproductive to sound off on cyberbullying to our children or grandchildren, when they can Google us online and see us doing it ourselves.
We also need to help our patients, their families, and colleagues understand the active role we need to take in curating ourselves online. We need to understand what may happen when we put certain things out there. For therapists this includes the dilemma of putting out a curated self that resembles what kind of work you would do, while not disclosing or conveying more than you want the world to know. The example I always use with students and consultees is how I talk about my family but never who they are in particular. This is deliberate, because it is no big disclosure that I have a family, everyone on the planet has one of sorts with the possible exception of Dolly the cloned sheep. But beyond that I curate a private self, and let folks project what they may. If we put out comments describing patients or coleagues as “screwed up,” we are also curating ourself, I suggest poorly. We need to be mindful that most groups we participate online in are open and searchable. Many of my colleagues became therapists at least in part because they didn’t want to be known and thought the best defense was a good offense (“We’re here to talk about you, not me.”) They’re used to sharing the gallows humor with the team, and think the same applies to online. I’m with Rilke on this one: “for here there is no place/that does not see you. You must change your life.”
To paraphrase Wittgenstein, “our self is everything that is the case,” not just one avatar, blog, string of emails or video; not even the composite of all of them. Nor is our curated self everything that is the case. We’re more than our Facebook likes or our Twitter following. Human beings are so much more, much more wondrous and tragic than the curated self. We descend into the Internet and are diminished, but do bring some deliberate part of ourselves along. We will only ever know hints and glimmers of ourselves and each other online. As for the rest:
“Whereof one cannot speak, thereof one must be silent.” –Wittgenstein
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Bio Breaks
If you’re a therapist looking to join a group of innovative colleagues for supervision, you may want to take advantage of this. Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info. Subscribe to the Epic Newsletter!
Unplanned Obsolescence: Rethinking Play Therapy
Recently I ordered a copy of Call Of Duty: Modern Warfare 3, which I plan to try this week. As I have mentioned in a previous post, I am not easily interested by first-person shooters, but as a gamer-affirmative therapist I can’t let my low interest get in the way of educating myself.
I once calculated that by a conservative estimate I had played approximately 27,000 games of Uno in my decade working in a public school as a clinical social worker. I drove around with a ton of board games and a sand tray as well. I had learned the value of play therapy at the first placement I ever had as an intern, from Winnicott’s squiggle game to the infamous Talking, Feeling, Doing Game. This is all a roundabout way of establishing my “street cred” for valuing play therapy.
Back then, I would go home from work, and many times play Legend of Zelda: Majora’s Mask on the Nintendo 64. My roommate at the time liked to hang out with me while I played and we chatted about life, education (he was a teacher) and politics. He also liked to imitate the fairy guide in the game, and would often cry out, “Listen!” and offer a couple of tips.
In all those years, it never occurred to me that I could have played those games at school if I’d had an office (and some years I did) or that there was a disconnect between what I was doing with the students (card playing) and what they were talking about (Nintendo, XBox, Playstation.) I could hold a conversation with them about these things because I played them in my spare time, but the idea of playing them with my students didn’t register as, well, therapeutic.
I am not alone in this. Many if not most play therapists are not inclined to play video games with their patients, and it is time to rethink this. When 97% of the boys and 94% of the girls we work with play video games, it is no longer an outlier. But there are a few fallacies which I think get in the way of play therapists integrating play therapy into the 21st century.
One I hear frequently is that video games don’t require imagination, or offer projections to explore. But I think this is contempt prior to investigation for the most part. The proliferation of video games is itself the best evidence that there is imagination going into each generation of games, which are produced by imaginative people who must have been able to develop their imagination in part through video games. And we don’t start each session making our children build their own dolls and dollhouse from scratch. We use available tools that do to an extent always structure and limit the imagination. For example, why does the dollhouse have a pointy roof and two floors? This is limiting, and in fact didn’t represent 90% of the urban population I worked with at all. And few play therapists would avoid using Elmo puppets on the grounds that it limits the imagination of the child, even though Elmo is clearly an icon of popular culture.
In fact, play has often had its inception in the popular culture of the time. We may take chess for granted now, but when it came into being it was a reflection of a medieval monarchy, with kings, queens, and bishops. Yet play therapists often fall prey to nostalgia, if not luddism, and maintain that there are certain games and play that are relational and therapeutic, and others, usually the modern ones, are not.
This brings me to what I suspect is another reason we resist using video games in play therapy, which is the therapist’s fear of being incompetent or failing at the unfamiliar. Years of training in a traditional educational model have taught us to silo down in our area of “expertise” as soon as we can. We “major” in psychology or social work, go to graduate school for advanced specialization, and basically get to a point where we can work in a routine and structured environment. For years we get in the habit of certain forms of play therapy: Candy Land, Chutes and Ladders, cards, chess, dollhouses and telephones. These are easy and portable, but more importantly perhaps, we know how to play them, so we can not be “distracted” by the game, or lose by design if we want to build the kids self-esteem, and otherwise feel in control of the play situation.
It’s time we work through this resistance. People can and do have conversations while they play video games, and video games are in themselves social media. There are plenty of metaphors to explore in and after video gameplay. Angry Birds is rife with themes of anger, different abilities, and protecting the innocent and defenseless. Call of Duty can give rise to expression of competition, drives, and the hunger for destruction or cooperation. And a recent (to me) favorite, Demon Souls, is a tone poem on isolation, yearning to connect, and persistence in the face of despair.
I’m sure I’ll get comments arguing that video games are inherently violent as well. To which I would respond, just like Battleship and the card game War are inherently violent. We have become insulated to the violence in them, and it may not have the graphic sophistication of video games. But the next time you play Battleship ask yourself what you think happened to all the people on the battleships that sunk? The game doesn’t come with little lifeboats, you’re drowning people. Play therapy does not avoid violence in its expression.
Virginia Axline, one of the founders of modern play therapy, had 8 guiding principles for play therapists:
- The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
- The therapist accepts the child exactly as he is.
- The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
- The therapist is alert to recognise the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behaviour.
- The therapist maintains a deep respect for the child’s ability to resolve his own problems if given an opportunity to do so. The responsibility to make choices and to institute changes is the child’s.
- The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.
- The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognised as such by the therapist.
- The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship.
Nowhere in there does it say, the therapist sticks with the tried and true games s/he grew up with. To my colleagues who are ready to decry the death of the imagination and lesser play of video games, I think Axline said it best: “The child leads the way: the therapist follows.”
Following in the 21st century means having Gameboys and Playstations in our repertoire. If we don’t keep learning and using technology in our play therapy, we may find ourselves in a state of unplanned obsolesence. Am I saying we should stop playing Jenga and Uno? No. But if our patients are looking for video games amongst the chess sets and dollhouses, perhaps they are telling us something we need to pay attention to. Just because we don’t know how to play a game doesn’t exempt us from learning it. And what a gift it can be for an adolescent to experience themselves as more competent and talented by an adult! So many of them come to us having been labeled as “failed learners,” and we have the potential to help them experience themselves as successful teachers, of us.
Those of us working in agencies and schools need to resist the temptation whenever possible to use the excuse of needing to be mobile or budgetary constraints. Video games are now as portable as a Nintendo DS PSVita or Smartphone. And the price of a video game system is not so prohibitive as to be a given. The real reason we often don’t advocate for video games at the agency or school is our own bias that they are somehow less valuable as therapeutic play media.
I anticipate that this will meet with resounding criticisms from the “play-is-going-to-hell-in-a-hand-basket” crowd, but I’m really interested in hearing from colleagues who have managed to successfully integrate video games into their play therapy. What are your success stories? What have been some challenges you’ve had to overcome? Do you schedule online play sessions? How do you manage the noise in an office suite? I’m really interested in your experiences.
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Harriet At Forty-Eight
If you never read the novel Harriet the Spy, I hope you will ASAP. My hope is that most children, parents and therapists have had a chance to read it already, because it has a lot to teach us about digital citizenship. You can get it on Amazon here.
Harriet spends a lot of time writing down things in her notebook. Truthful things. Unflattering things. And one day the notebook falls into the hands of her classmates, who read these things, and respond to her with anger. What I find interesting is the way Harriet’s friends, teachers, and parents respond. Their initial response is to take, or try to take, Harriet’s notebook. Of course Harriet gets another one. That’s not the problem.
Harriet the Spy was published in 1964. According to Wikipedia, at least one variation of the technology of the notebook had been around since 1888, and there are examples of its common usage in the early 1900s. This technology was prevalent long before the 1960s. No one says to Harriet that she has a “notebook addiction,” although her usage of it becomes problematic. In fact, her redemption in the book also comes from the same technology of the written word.
One of my favorite moments in Harriet the Spy comes in Chapter 14, when Harriet has her initial appointment with a psychiatrist. As they settle down to play a game, the psychiatrist takes out his analytic pad:
Harriet stared at the notebook. “What’s that?”
“A notebook.”
“I KNOW that,” she shouted.
I just take a few notes now and then. You don’t mind, do you?”
“Depends on what they are.”
“What do you mean?”
“Are they mean, nasty notes, or just ordinary notes?”
“Why?”
“Well, I just thought I’d warn you. Nasty ones are pretty hard to get by these days.”
“Oh I see what you mean. Thank you for the advice. No, they’re quite ordinary notes.”
“Nobody ever takes it away from you, I bet, do they?”
This vignette illustrates how the clinician is not above or apart from technology. Harriet’s psychiatrist uses it himself. And his response to her struggle and worry about using technology is an approach I’ve come to see as key: He doesn’t try to restrict her from using the technology, he engages her around its use and thinking about its use. He actually gives her a notebook, and then respects her usage of it when he lets her leave the office without taking it back or asking to see it.
He then recommends that her parents talk to the school about allowing her to use technology to amplify her thoughts and expression there, via the school newspaper. He also suggests that they use technology in the form of a letter written by Harriet’s old nanny to give her some advice and connection. Many will say that Ole Golly’s letter is the pivot point for Harriet in the story, but I’d suggest that the pivotal moment comes when the mental health practitioner doesn’t demonize technology (the notebook) or pathologize its usage, but rather leans on technology as an avenue into the patient’s forward edge transference.
Technology, as Howard Rheingold reminds us, is a mind amplifier. It can be used to amplify our memory in the form of notes, for example. It can also be a voice amplifier, for better or for worse.
If Harriet was around today, I imagine she would be on LiveJournal, perhaps with her settings on private, but on LiveJournal nevertheless. In fact, her LiveJournal notebook would probably be more secure than a notebook carried around on her person without encryption. But maybe she’d also be on Facebook, Twitter, and Tumblr. And unless she had parents or teachers who talked to her about digital literacy, she might not know or care about privacy settings or mindful use of technology.
Every day, on Facebook or Twitter or other social media, people young and old post, and “drop their notebook” to be read by hundreds or thousands of people, who can amplify the notebook even further by liking, pasting, sharing or tweeting it. By comparison, Harriet’s class of 10-15 students seems paltry. When an adolescent complains about her ADHD medication on her status, or when a parent tweets how proud he is of his Asperger’s child, these nuggets of information, of expression, of identity formation are sent out into the world and amplified. Our work as therapists needs to be to help our patients understand the significance of what they are about to do to themselves and others when that happens. And to do that we need to understand the technology ourselves.
Few of us would consider giving Harriet a notebook as “feeding her addiction,” or giving her a hair of the dog that bit her. Yet, we level such technophobic claims on the social media and technology of our time, trying to focus on technology as an addictive substance rather than as a tool, and pathologizing its use far too quickly and easily. And we often join technophobia with adultism, when we try to intrude or control the use of technology by children and adolescents (note that I said “often,” not “always”)
When you look at some of the stories Harriet prints in the school newspaper, you have to marvel at the bravery of the educators in that school! How many of school administrators would allow entries like “JACK PETERS (LAURA PETER’S FATHER) WAS STONED OUT OF HIS MIND AT THE PETERS’ PARTY LAST SATURDAY NIGHT. MILLY ANDREWS (CARRIE ANDREWS’ MOTHER) JUST SMILED AT HIM LIKE AN IDIOT.” Can you imagine the parental phone calls, even though the parents were both the behavioral and quoted source for this story? Can you imagine kids being allowed to experience communication and learning with this minimal form of adult curation? But also, can you imagine parents saying that the problem is allowing access to the technology of writing a newspaper, and that the idea of a school paper should be abolished?
When you think about it, we live in an amazing era of the amplification of human thought and expression. Our children will need to learn how to manage that amplification in a way we still struggle to understand ourselves. I remember one notebook I dropped, when I was managing a staff of guidance counselors. I was very frustrated with the response of one of them to something, and wanted to share that with my supervisor. I thought it would be important to share my emotional response to this with someone I understood to have the role of helping me sort this stuff out, and I was being impulsive and cranky. I ended up sending the email to the staff instead. Boy, did that torpedo those relationships. But I did learn a lot about how to pay more attention to the power of technology, and that part of being a good digital citizen requires thoughtful use of ampliying your words and ideas!
Most of us probably have a notebook-we-dropped story we’d rather forget, but we need to remember them and share those stories with the up and coming generations as cautionary tales, and examples of good and poor digital citizenship. Ole Golly tells us, “Remember that writing is to put love in the world, not to use against your friends.” Writing, a technology we have come to understand a bit better since Gutenberg, can be used for good or ill; but we don’t ban it. Now we are all learning, albeit uncomfortably at times, how to handle the newer technologies of social media, digital communication, and video games. It may be a bit utopian to suggest that texting/tweeting/gaming/Facebook/blogging is to put love in the world. But the alternative seems to be that while some of us ignore, avoid or fear it, other people, governments and corporations will learn how to use it against our friends.
Embedded in Harriet the Spy is a quote from Lewis Carroll, which aptly describes where we find ourselves in the 21st century of social media: “‘The time has come,’ the Walrus said,/’To talk of many things:” Indeed, the chatter can be deafening, impulsive, hurtful and confusing. But the solution is to choose our words carefully, not to stop talking altogether.
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Attention, Distraction & Creepers, Oh My!
Why Therapy Is Like A Game
Game-playing often has negative connotations in the field of psychiatry. We have all sorts of erudite ways of describing what laypeople call “mind games.” A great example is in the language of Axis II personality disorders. People are borderline, dependent, avoidant, narcissistic, antisocial, and the most FABULOUS of them all, histrionic. These words attempt to describe the psychological conditions which motivate problematic behaviors. Serious business indeed.
But come right out and say that therapy is like a game, even a kind of game, and that gets a lot of hackles up. Therapy is serious business, and games are anything but serious, right? Wrong.
To describe something as a game is not to minimize it or take it less seriously, but I suggest to describe what Bernard Suits calls the “lusory attitude.” This is the state of mind, the psychological attitude, required of any player when they play a game. The most succinct way Suits describes the lusory attitude is to say that it allows the “voluntary attempt to overcome unnecessary obstacles”
An example of this, not mine originally, is that of golf. The activity is directed at achieving the goal of getting a ball into a hole. But instead of just creating an activity where we find a ball and drop it into a big hole, we take the hole, make it small, say you can’t use your hands to drop the ball in but must use a metal club, and start you off hundreds of feet away from the hole. That’s golf, and it is so full of unnecessary obstacles! There is no reason to make it so challenging, EXCEPT that that challenge is what makes it fun, and frustrating, and more fun. And nobody drags you into the wilderness, gives you a golf club and points a gun at your head to golf. It is a voluntary act. People love to, choose to, spend hours with sticks hitting balls from great distances with the hope of getting them into little holes. Why choose to do something so weird and difficult? Because they are playing. They have voluntarily attempted to overcome unnecessary obstacles. They have adopted a lusory attitude.
Life is hard. And for many of therapy patients, life has been extremely hard, and cruel. And yet, how often do we notice that they are making life even harder on themselves in some ways? Perhaps unconsciously, perhaps subtly, but more difficult nevertheless. That neurosis, the reenactment of the past, is what I would suggest is the unnecessary obstacle.
For example let us take PTSD-precipitated by child abuse. The abuse was serious, hurtful, sadistic, real. It happened. But in the case of the adult patient, the abuser is no longer there. The introjects, the learned stuff, the unconscious stuff, that is all there, but the perpetrator has fled the seen of the crime long ago. They were real obstacles, but trauma recreates them as unnecessary obstacles in the here and now.
Another example would be a phobia. Why not be fearful of everything? Spiders aren’t the only thing that we could fear: There’s death, and hurricanes, and black cats, and dirt, and blindness, and the next presidential election. But we don’t fear everything in the world that is or is perceived as harmful to us. Phobias are very specific, that is why there are so many clever names for them. They are again, unnecessarily specific obstacles.
Again, I want to stress that by calling these unnecessary obstacles that I am not at all saying that phobias or PTSD or not serious, painful, debilitating, conditions. What I am saying is that they are unnecessary to the life of the patient. Even as compromise solutions they have outlived their usefulness if the patient is in the here and now experiencing distress as a result of trying to defend against or cope with the past encroaching on their present. The repetition compulsion is a game of both danger and optimism. We do the same things over and over, often with disastrous results, true; but we keep doing it because on some level there is an urge to get it right. And like a video game, the repetition compulsion doesn’t just get defeated one day; rather we get progressively further in the game, acquire new levels and skills.
When our patients arrive at our office, they are in a state of lusory attitude, they are really trying to resolve the problems the best they can, and they have sought out our help to that end. If they are mandated to treatment, this is less likely to happen. But for a majority of patients, they choose to show up. And from a psychological point of view, showing up must be voluntary for therapy to work.
In order to do therapy, we also have to adopt together a lusory attitude. Both therapist and patient volunteer to work together to overcome the unnecessary obstacles. The therapy time and space are in some ways unnecessary obstacles: we choose to limit the session to the 45-50 mins, in a specific office, with only two “players” if it is individual therapy. These may be the warp and woof of therapy but they are also arbitrary distinctions that create unnecessary obstacles. We could rotate different therapists in, or meet for varying times whenever we both want, and hang out at Dunkins, but that would be therapy in the sense we are talking about would it? No, therapy, like games, must have agreed-upon rules.
Although I’m speaking in clearly psychodynamic terms here, doesn’t it seem that more behavioral approaches would find the concept of lusory attitude applicable as well? Surely we don’t try to extinguish behaviors we think are necessary. The behavioral approach also implies that the obstacle (behavior) is unnecessary and tries to over come it.
Having a lusory attitude is not always about being lighthearted, although it can be, but it is about taking play very seriously, engaging in it and often having an immersive experience. Psychotherapists who engage in play therapy with children often have an easier time understanding this than those who do adult psychotherapy. There is a general tone from our profession of, “we need to be taken seriously,” which I think has lots of its roots in the tendency of the medical profession in the past to have considered it less important. And somehow being taken seriously becomes equated with being important or being valuable.
I often supervise interns who repress any sense of enjoyment that comes from making an interpretation that moves a patient forward, or seeing theoretical elements manifest in the treatment, and try to help them see that enjoying the process of learning psychotherapy and learning about the patient is not the same as having fun at her/his expense. As Sutton-Smith says, “The opposite of play isn’t work. It’s depression.” In this regard I agree with him: When engaging in a lusory attitude with patients we are working with them. Removing those obstacles is very hard, dangerous work, and it is deeply and seriously playful.
To add gamers and video games into the mix, I would suggest that approaching video games as an addiction is a step in the wrong direction. This is not to say that I don’t think that some people play video games to the detriment of their lives and relationships. I do think that happens, just like I think people engage in a number of activities at times to the detriment of their lives and relationships. But to label them as pathological is to miss the point. Even if we rule out the cultural incompetency of the clinician around video games which often masquerades as dismissal or villainization, we need to understand that we are in essence asking the patient to adopt the same lusory attitude with us that is often there already for them with video games. We are saying, “don’t play that game, play this game of therapy instead.”
(Unless you have this view of psychotherapy:
Psychotherapy needs to stop taking the lusory attitude for granted. What if we became more mindful of our lusory attitude? We all have them, over coffee with a colleague when we look at each other and say, “this is such a weird profession!” It’s like golf in that respect, it seems; so intricate and complicated with rules we take for granted that make a particular human relationship much more complicated than it has to be. Try that on the next time you are trying to discuss your fee with someone: “I charge you $150 an hour because this is a weird relationship that has intricate rules and is much more complicated than human relationships have to be.”
I think that there are strong parallels between therapy, neurosis, and games, and that the thread that links them together may be the lusory attitude. In games, the design always boils down to a voluntary attempt to overcome and unnecessary obstacle. In neurosis, the attempt to repress intolerable conflicts and feelings creates an unnecessary obstacle even as the patient tries to remove the unnecessary obstacle of those same conflicts and feelings. (Game designers may recognize an interesting resemblance to the concept of iterative design here.) Finally, in therapy, the neurosis or symptom becomes the unnecessary obstacle that the therapist and patient voluntarily attempt to overcome.
What do you think? Does this jibe with your experience as a therapist, patient, gamer or game designer?
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How To Have An Epic Holiday With Your Child Or Teen & Video Games
As I write this, those of us in the US have 4 shopping days until Christmas. So I wanted to share a few tips on both games to consider but also how to connect with the gamer in your life during this time of year:
1. Play with your child. If it is a multiplayer game, join in. If it is a single-player, ask to take a turn.
2. Sit and watch your child play, and ask them to teach you how to play a game.
3. For adolescents, don’t take no for an answer. If they don’t want to show you how to play at that time, make an “appointment” with them for later.
4. Encourage boys and girls equally. A recent study showed that girls who play video games with their fathers endorse fewer symptoms of depression. Ask your children if there are different games they like.
5. Remember that multiplayer games are forms of social media and community. Your child may be having a chat while they are playing without you even knowing it. Be patient with them and ask if you are interrupting something. This is good training for when they are interrupting you. Remember social skills are a two-way street, and just because you don’t think something is important doesn’t mean they feel the same way.
6. Pay attention to ESRB ratings. They aren’t perfect, but they can give you a good idea of what ages and levels of maturity are the best fit for your child.
7. Vet the online community. If they want to join a server for Minecraft, search together for one that requires children apply and requires parental approval. Ask the adult moderators questions about what kind of activities and conversations happen in-world. Discuss how privacy is handled.
8. Sit with your child as they sign up for a game. Discuss whether they should answer questions about where they live and their age. If these are required, email the moderator if you don’t feel comfortable with that. Your child’s digital footprint starts here, and will last for decades to come, so be careful and thoughtful about it.
9. That said, don’t evoke a sense of anxiety and paranoia with your children. There are plenty of normal or healthy people online, and they may be making lifelong friends. If they want to chat or Skype with peers, don’t forbid it, but ask to have a brief introductory call with their parent, and have a week probationary period where all chat is audible before the headphones go on.
10. Have fun! Video games can improve your mood, sharpen your wits and fine motor skills, and even give you exercise. But the most benefit for you and your child will occur if you take an interest and try to play yourself.
Ok, so now for some suggestions. This is by no means exhaustive, and if you want to recommend others please comment below!
Multiplayer Games
These can often have a subscription, but sometimes they are free. A good family game for younger children is Wizard101, which takes place in a world of wizard schools and magic duels. Combat is turn-based card game style. If your children like Magic: The Gathering, chances are they’ll love this.
Another great one is Minecraft, which costs a one-time price of $26.99. The game allows no end of possibilities, from mining to building to exploring to killing monsters. If you join a multiplayer, the whole family can play together.
World of Warcraft is a perennial favorite of mine. In addition to buying the software, this game has a monthly subscription, and there are lots of servers to choose from. Try searching for child-friendly servers and guilds, there are plenty of them out there.
Eve Online is a MMO that takes place in outer space. If your family is more interested in building and flying spaceships than fighting dragons this may be the game for them. Like WoW there is a monthly subscription in addition to the software purchase.
Console Games
For your older gamers I recommend Dark Souls. This is a very challenging game, which players can expect to last for hours. There will be lots of dying and starting over, and lots of fun failure. This game also has a strong RPG element and a dark mood.
Not quite as dark, but very challenging, is the new Elder Scrolls: Skyrim. This game puts you in a Nordic-type environment as a “Dragonborn,” and the main quest has you fighting dragons and absorbing their powers. But the fun thing about this game is that you don’t have to do any one quest if you don’t want to. Players can focus on exploring, crafting, learning marriage or picking locks! The graphics are beautiful, and the music is fun too.
If you are more interested in a game with a puzzle-solving element, check out Portal 2. You wake up in an abandoned lab with only a wormhole gun to your name. In order to escape players will need to strategize and learn a lot about physics on the way. There’s a lot of fun humor in the game as well.
All of the above games are available for Xbox, PS3 and the PC.
For Xbox, you can also bring a bit of meditation to the family with Deepak Chopra’s Leela. This game uses the Kinnect, and you’ll your whole body playing games to both actively exercise and stimulate the chakras or energy centers in the body; or meditate and keep an eye on your posture. The game is easy to learn and very colorful, and you can even design your own mandala.
Also for the Kinnect and PS3 is Child of Eden. This full body game has you trying to same the AI Lumi from a computer virus. It’s a fast-moving game with some rocking music from the virtual band Genki Rockets.
As far as the Wii goes, there’s only one I want to recommend at the moment, and that’s Legend of Zelda: Skyward Sword. This latest addition to the classic Zelda series will take you back to history before the Ocarina of Time, and up into the clouds of Skyloft, as you help Link take wing to save his kidnapped friend Zelda.
iPad
Last but not least I want to direct your attention to a couple of games on the iPad. Infinity Blade II. This game is not for the faint of heart, there is a lot of melee combat, and a lot of dying. If you like swordplay and battling monsters this is the game for you. The world is 3D and dynamic, and there are lots of different weapons and armors to try. Be warned, there is an option to “buy” more gold, so have a talk with your child about whether and how to do that.
A more playful game for all ages is Windosill from Vectorpark. This is a short game, but the dreamlike quality and graphics make it feel more like having fallen into a picture book than playing a video game. Get your whimsy on with this one.
These are only some suggestions, and are based on games I have test-driven. For example, I haven’t recommended any Nintendo DS games because I haven’t played any lately. I’m not affiliated with any of the above companies. Have some other game suggestions? Let us know below. Have a great holiday!
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Dings & Grats
I am convinced that if more people played video games, in particular massively-multiplayer online games, the human race would become kinder and self-confident. Here’s one reason why:
In MMOs like Warcraft, you have a social chat text window that is in the lower corner of your screen, constantly streaming messages. These messages are color coated so you can identify those you want to be reading, and screen out or hide those you don’t. For example, I usually have my guild chat “on” so I can talk and listen to guildies, but I rarely have the world “Trade” chat on, because I’m not a big shopper.
As you progress through the game, you level up. And when you level up, that’s an accomplishment. So you type into guild chat: “Ding!”
Ding, reminscent of the bell on a game show, is a way of calling attention to the fact that you have accomplished something. It’s tooting your own horn. But in gaming, dinging is socially acceptable! So when you announce over chat, “Ding!” You usually get a stream of “Grats!”
Grats, you may have guessed, is short for “Congratulations!” It is the public acknowledgement in gamer culture of your achievements. And if you are in a big guild and there are a lot of people online, you will sometimes get a stream of 50 or more “Grats.” This also means that if you are logging on or only half-paying attention you will catch on that somebody just achieved something.
Since everyone goes through the same levels, everyone recalls what a sense of accomplishment they often had when they dinged, and they pay it back or forward because they know how great it felt to get those grats. What emerges is a culture where achievements are announced and mirrored, which makes for a heightened sense of community and self-esteem.
When gamer patients announce they’ve hit level 85, or downed a major boss, or rolled and won on a piece of Epic loot, I am often quick to Grats them. I also encourage some coaching clients to get better at dinging when they have hit an achievement. “I finally rented my own office, Ding!” “I have 10 new patients, Ding!” Each of these is worthy of a quick energetic announcement of accomplishment.
By now some of the naysayers are probably thinking, “How corny.” And who has time to congratulate someone for every little achievement? We’ll just end up raising a generation of narcisists who overstate every accomplishment.
Obviously I disagree. First off, you don’t have to Ding on world chat, so to speak. Who is your guild? What group of people form your supportive circle that want to know when you’ve accomplished something. Second, there is always some self-regulation when Dinging. I don’t ding every time I mine some ore or pick an herb in WoW, but when I hit level 85 you bet I Dinged.
Third, when did we get so miserly with compliments? Is it some sort of holdover from the Pilgrims and the dour work ethic? It takes a second to Ding and the same to Grats. What is lost in that second pales in comparison to the affective shift in our psyche and the change in our neurochemistry. Think about any day you went into a job you hated, and the number of decision moves you made to do it even though you didn’t want to. If that didn’t deserve a Ding as you passed a co-worker’s cubicle, I don’t know what does.
Lately I have been trying to increase my Grats as well. Whenever a colleague posts on Twitter that they published a book, or finished a course, or got their license, I try to retweet with a big “Grats!” I try to amplify their achievement, not ignore it or dismiss it. One of the great powers of social media is how it can amplify things. And one thing many of us need practice with is unlearning a depressive stance, where we only see the negative. Now I am not a positive thinker, in fact positive thinkers make me feel uncomfortable, because I think they’re a bit deluded. But that doesn’t mean that I can’t get better at noticing and acknowledging the achievements and positive contributions others make.
I’m sure you can begin to see how this is applicable to therapy. Help your couples patients practice dinging and gratsing. Work with school staff to set up a Ding and Grats system in their classroom. Can you imagine how amazing it would have felt in middle school to finish your presentation with a “Ding!” instead of “The End,” and hearing 25 voices say “Grats!”
Dinging and Gratsing are expressions of enthusiasm, and sometimes it seems to me that there is some silent war being waged on enthusiasm. We’re supposed to play it cool, be “laid back,” and never indicate we care that strongly about anything. Is that really the apathetic and guarded culture we want to pass on? Let’s get off Plymouth Rock for goodness sake, and start calling out with some enthusiasm!
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Defeating the Boss: Overcoming Your “Big Bad”
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What Google+ Could Mean For Therapy
Every technology reveals the hand that shaped it. The technology of the 21st Century is no exception: Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms. And the explosion of access to information was detonated by our own curiosity.
For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it. Listservs are a great example: They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level. Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.
And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board. The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them. The online world expanded exponentially, and in fact that interactivity and information became overwhleming.
Which brings us to Google+.
For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media. Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds. If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it. But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.
So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.
Circles
The Google+ system of circles is as powerful as it is flexible. Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”
The interface let’s you drag the name and image of different people located on the top to one or more of the circles below. When you mouse over the circle it expands to give you an idea of who you have put in it. And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself. For example, I have a circle for “Minions.” I’ve always wanted minions.
This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life. This can be especially useful with patients on the autistic spectrum. We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of. Who goes where? Is everyone a friend? Can we put people in more than one circle? Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”? What sort of circles might we want to create that Google+ didn’t give us?
People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful. Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be. Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further. Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention. We could help them explore and decide how to set up their own personal boundaries and affectional investment.
Or imagine for a second you are working on emotional regulation issues with a patient. You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle. Do some people go in more than one circle of affect? Do they notice that they are taking people in and out of circles frequently, or never?
Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to. They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those. And all of a sudden they also have a visual list of who they can call when they are trying to socialize.
Last example, working with trauma and/or substance abuse. Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc. Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis. It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one? What do you think you could do about that?”
So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.
Streams
In Google+ circles go hand in hand with your Stream or Streams. A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles. It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back. And you can set each circle to have different levels of access to your posts. In other words, circles and streams together allow you to learn and set boundaries. Here’s what a Stream can look like:
This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes. Much like Twitter, or like life. If we had to pay attention to everyone all the time in the same way, we would become very fatigued. Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times. Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them. But it gets even more interesting.
If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc. Now if you click on any of those circles, the Stream changes. Specifically, it changes to list only the posts from the people in any given circle clicked. This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.
Imagine working with an adolescent and reviewing their streams together. What sorts of media, comments, and concerns are streaming through their lives at any given moment? And what is the consequence of having 500 “friends” in their friend circle? Do they feel intimate or able to attend to all of these friends? Or are there some times that they may be more interested in attending to some friends than others? If so, why? Might it be time to start to rethink what it means to be a friend? Is it ok to select who they attend to at certain times? Do they really find the content they get from A interesting? And if it is consistently uninteresting, does that say anything about their relationship? Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.
For a second example, let’s return to the patient with ADHD. Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way. That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor. If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done. Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do. But these types of decisions and focussing techniques may be crucial to staying on task. (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment. It’s not always just “playing on the computer” now.)
Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles. Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?” Maybe they’d rather tune into a steady Stream from their “Supports” circle instead? And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways? Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?
We make these decisions all the time, we just aren’t always conscious or overt about it. And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves. We need to have boundaries and filters. We need to be able to focus and set limits and values. These needs have begun to be more clearly revealed by the technology of Google+. Knowing about that technology may improve our ability to treat our patients.
Exploring the Mystery of Suicide: Video Book Review of “In Her Wake.”
Save and Continue
Recently I was playing God of War III, and noticing something I take for granted much of the time, the savepoint. This is something that has become so integrated into video games that gamers hardly notice it after we discover what the particular “savepoint” looks like in the game we are playing. The saved game has been around for decades, and has become increasingly important as games have grown in length and complexity. I was reminded recently by Nancy Rappaport, a colleague and attending psychiatrist at Cambridge Health Alliance about how the concept of the saved game may not be taken for granted. I was trying to explain to Nancy during a workshop certain gaming concepts, and she was explaining that her point of reference in playing video games was Pac-Man, and in a general sense video games from an arcade setting that early on didn’t always have savepoints, where the player was asked if they wanted to “Save and Continue.”
This may be useful to remember when you are becoming frustrated with a gamer who is not as concerned with the quantitative time (bedtime, for example) as they are with the qualitative time of getting to the savepoint. But that actually isn’t what this post is going to be about. Instead I want to return to the concept of what makes an Epic Therapist here:
Epic Therapists remember the importance of saving and continuing.
To start with, therapy is in many ways a savepoint. At certain times in their lives or week our patients arrive at our office, pause, and take stock of things. In his 1914 paper “Remembering, Repeating and Working-Through” Freud alludes to this when he remarks that “In these processes it particularly often happens that something is ‘remembered’ which could never have been forgotten because it was never at any time noticed–was never conscious.” Like the savepoint in a game, the patient arrives at the place for the first time, understands how important it is to hold on to that progress, and remembers or saves it from repression. But part of what makes therapy therapy is the therapeutic frame, and at some point the session ends, and the patient goes back out into the rest of their life. They can’t just stay at the savepoint, they have to continue.
Readers have probably noticed by now that I draw frequent parallels to psychoanalytic theory and video games, and this is no exception. Our profession has a rich theoretical history that has grown from individual therapists learning from each other, disagreeing with each other, building on the prior work of each other and diverging from each other. Psychology as a field to flourish has had to frequently “save and continue” by writing these theories down in journals and now blogs, to take stock of what we have learned, but we’ve also had to move forward and continue to challenge pre-existing models. It can never be just save or just continue: To just save would stagnate our thinking and practice, and to just continue would mean we never consider thoughtfully the work we are doing.
In many ways, the problem with healthcare has been few if any savepoints, discouraging providers from taking time between patients to reflect before continuing on to the next patient. Interns in mental health agencies have many no-shows, and with no infrastructure to hold patients responsible to keep their appointments, these interns “continue” through the years where they should be receiving the most training with a fluctuating and diminishing number of patients to practice their craft under supervision.
Ask yourself this: If you were about to have open heart surgery and the doctor told you that he had only had the opportunity in medical school to practice the procedure 3 times because most of his patients cancelled or no-showed, would you feel confident in their ability? And yet we crank our interns through graduate programs based on the number of years rather than skills acquired, because the healthcare system is flawed and and patients are not held accountable for missing/cancelling appointments. This isn’t the interns’ fault, they are trying to get through to their knowledge and experience “savepoint,” but graduate schools and placements inadvertently become the parent shutting off the light because its “bedtime,” and we are producing generation after generation of clinicians who have had inconsistent or insufficient practice. This is continue without the save.
On the other hand, let’s take a look at the radical save mentality that permeates our profession. There are certain parts of the way many of my colleagues practice psychotherapy which have become extremely fixed, and I too fall prey to this at times. The 45-50 hour, a certain therapeutic stance, and my favorite, shunning technology. They bar their adolescent patient’s cellphones at the door rather than exploring who is texting them, refuse to consider Skype as an option let alone suggest it to their patients.
I frequently get referrals emails from several listservs, looking for therapists in Seattle, London, or Singapore. I enjoy practicing in-person therapy immensely, but does it ever occur to these colleagues to consider beginning to practice online as well? Why refer a patient to someone in Taiwan based on location when you could have one of your colleagues whom you know and respect take the patient on? On occasion I reply to these referral requests asking if the patient would be interested in Skype, but for the most part I’ve become reluctant to do that because I am pretty sure it doesn’t go anywhere. In terms of technology these psychotherapists are often in a lock-down save mode, and I foresee that they will resist change as the world continues without them.
My friend and colleague Susan Giurleo and I often find these things frustrating, and I realized today one reason why we may have this in common. We both went to Connecticut College in the late 80s early 90s, between the college presidency of Oakes Ames and Claire Gaudiani. In fact our graduating class became known as “the folks who knew Oakes.” And during this time our college had a motto that was drilled into all of us: Tradition and Innovation. Everywhere we looked, in all the college information and stationary were those words, tradition and innovation. Save and continue.
I have definitely tried to live that in my profession and my life of the mind. I’m a psychodynamically oriented therapist who uses Twitter and plays video games. I teach my students about Freud and Facebook. And I think that perhaps the affinity I find in the fin de siecle of the 19th century is how its denizens struggled to save and continue, to embrace the advances of technology then as we do now in the 21st century. In a recent article at boston.com Chris Brogan alluded to this when he said, ““The excitement for me about [social media] is, it’s gone from ‘Gee whiz!’ to ‘Now what?’ ”
Technology is here to stay and embedded in our lives, and today, like after the Industrial Revolution, we must learn the “now what?” To do this we can’t just rush forward and forget everything we ever knew, but we can’t stay stuck in a mindset from the pre-IBM world. Web 2.0 has arrived, and we need both tradition and innovation if we want to progress.
We must save and continue.
Do Your Dailies
UVN4UFFHFPND
Epic Therapists do their dailies. And if you’re not a therapist, but a gamer or someone else who wants to have a better life, this post may be useful to you also.
At a recent workshop, I began by showing a slide with our “Epic Agenda.” And the first question I got from a therapist was a great one, one that staggered me:
“What does Epic mean?”
Gamers among you may be chuckling now, but try to answer that question, and try to remember back to a time when you didn’t know the difference between green and purple gear. Back then you didn’t know what Epic meant either. So let me offer us a working definition of Epic:
Epic means “the most super amazing over the top of all time.” An Epic Win would be the most super amazing over the top win of all time. An Epic Fail would be the most super amazing over the top fail of all time. Epic is big, Epic is superlative, the most super dooper in history.
We don’t talk about ourselves in epic language much. We tend to think of it as arrogant, unrealistic, and asking to be taken down a peg. The idea of being Epic anything makes us self-conscious, with a lower-case s. And yet, I think it is time we change that.
All over the world you people are being Epic. Right now in Japan, every one of those people is Epic. The people surviving a disaster of multiple phases and historic proportions are Epic. I doubt that any of my readers would argue that. Every person helping those survivors is Epic. Even as we speak the people of Japan are pulling off what will be seen in years to come as one of the biggest Epic Wins in their history. (By the way, if you want to support their Epic Win, go to the Red Cross and take 5 mins to donate. There’s also a great definition of psychosocial support there for you therapist types.)
But you don’t have to be at the epicenter of a disaster to be Epic. Gamers know that there are several ways to get that Epic gear. Sure, one of the ways to do that is to down that boss on heroic mode. But there is another way to get that gear and become Epic: Do your dailies.
Dailies, in WoW, are daily quests that you do to gain XP, gold, or points towards buying Epic gear. And it takes a long time to earn those points. But each day, the game server resets, and you get to run these daily quests again. One of the first things an experienced gamer will tell a “noob” who wants to get better gear is, “Do your dailies.”
Back to you therapists: Epic therapists do their dailies. The most successful therapists I know show up for those mundane tasks every day. They return phone calls every day, respond to emails every day, step back to consider the state of their practice every day. Epic therapists read about their craft regularly. Epic therapists learn about what their patients are talking about regularly. Epic therapists reach out and connect with their colleagues regularly, and Epic therapists take risks to make their business visible regularly.
Last Friday I met a dozen Epic therapists who came to my workshop. They spent time and money to learn about online gaming and gamers. I can’t tell you how moved I was to see these colleagues spend 3.5 hours with me learning how to better understand gamers. They were willing to step beyond the model of addiction and see gaming as a culture they needed to become more competent with. They decided not to dismiss video games as trivial or uninteresting and as a result will be able to meet their patients “where they’re at” more than ever. Less than 50 therapists across the world have ever spent 3.5 hours on a workshop to understand gaming, so these folks are truly Epic!
Am I suggesting you all enroll in my workshop to become Epic? Hardly. But I am suggesting that you do your dailies and when you’re feeling down about your practice, keep doing them. I have noticed that the people who tend to be naysayers in our profession tend to be people who don’t want to take risks or invest extra time on a daily basis. They are hoping for a quick fix or solution, one book or secret that will tell them how to succeed. I think there are a lot of books out there that may help, but I think the secret to becoming an Epic Therapist may just be to do your dailies.
And if you’re one of my gamer readers, this applies to you too. You can be Epic out of the game as well as in it. That same stamina it takes to do your Baradin Hold dailies can be applied to your life outside of Azeroth. Getting up a half hour earlier so that you can get to work without feeling anxious is doing your dailies. Doing every bit of your homework is doing your dailies. Listening to your parents and doing your chores are doing your dailies. Telling your partner that you love them is doing your dailies. Spending an hour in meditation, in therapy or at an AA meeting are examples of doing your dailies. Sometimes these dailies will seem easy and quick. Sometimes they will seem a grind. No matter.
Do your dailies.
UVN4UFFHFPND
The Lessons of Zelda
One of the most popular and longstanding game series in the Nintendo franchise is the Legend of Zelda series. The first game came out in 1986, and there have been 15 games to date. The games almost always revolve around the Hero Link and his attempts to rescue Princess Zelda and/or defeat the evil wizard Ganon. They are a combination of puzzle-solving, exploration and action fighting.
Nearly all of the games make use of the mechanic of transforming oneself or the world in order to win. Link must learn to use an Ocarina to change time in order to access all part of one game. He needs to transform himself into a wolf to complete another. One of the earliest games, and also my favorite, The Legenda of Zelda: A Link to The Past, established the concept of a parallel world that Link needs to shuttle back and forth between in order to ultimately defeat Ganon.
Another key to navigating the game is that the player needs to complete dungeons to get the reward of another item, which are necessary to move further into the game. Until you get the grappling hook, for example, you can’t swing across certain chasms to move on. Or if you don’t have the flaming arrows you can’t melt the ice block obstructing the passage to another dungeon.
Zelda is also famous for its concept of the Triforce, represented by three triangles connected to form a larger one. This force needs to be assembled from smaller parts in order to grant Link or Zelda extra super powers.
All of these elements are challenging yet soothingly familiar each iteration of the game. And all of these elements are useful examples of how therapists and gamers can communicate about strategies for handling real life challenges as well.
Lesson 1. You need to be able to shift between worlds to win in any of them.
People may take my posts, which are clearly pro-gamer, to indicate that I think that life in-game is more important or a replacement for the world outside of it. Nothing could be further from the truth. In fact, the recent research indicates that if you spend more than 3-4 hours a day playing video games, the positive effects of them begin to decline quickly. So this lesson is a good example to use with your gamer patients or friends about the necessity of not getting stuck in the gaming world to the detriment of the outside world. Ultimately that will ruin both worlds for you. If you stay home and don’t go to work you’ll lose your job and money and therefore access to playing.
On the other hand, if we can’t take a break from the outside world we will find that our functioning in it deteriorates as well. We need to be able to take a break on the most visceral level, its one of the reasons our eyes blink. In Ego Psychology this is referred to ARISE, or adaptive regression in service of the ego. Often when people are feeling stuck around a real life problem, playing video games can distract their conscious mind while their unconscious mind continues to work on it. AND the cognitive and emotional boost we get from gaming can actually refuel our brain’s ability to return to the world with renewed vigor. So with video games and real life, it is always both/and that brings success, not either or. With games though that axiom only works for sure for a limited, 3-4 hour period. More than that and all bets are off!
2. We need multiple tools to solve the problem.
Whether in Hyrule or Hoboken, there is no one instrument or approach that solves every problem. You can’t rely on your sword to swing across chasms, and you can’t rely on your intellect to lose 10 lbs. We need to encourage our patients to have as many tools in their toolbox as they can find and not rely on just one. And it is an interesting phenomenon that the acquisition of a tool or skill often brings access to new challenges for every problem it solves. And that’s a good thing! At SXSW this year Seth Priebatsch helped us wonder what education would look like if we unlocked achievements at varied paces rather than moved up grades homogenously (Answer: it would look a lot more fun, interesting and engaging than public education looks today.)
So whether you find yourself using your verbal sword to hack through relationships or your grappling hook to swing from person to person, take a look at all the items in your knapsack. Maybe a soothing ocarina might be a better choice than a flaming arrow when it comes to communicating with your employee. Maybe the opposite is necessary to melt through some rigid thinking. Isn’t it great that you can do both?
Lesson 3: It takes time, patience, and effort to assemble all the parts to succeed.
People often come to therapy looking for a quick fix. Insurance companies bank on this being a continuing trend with short-term therapy or medications. Those are often useful parts of the solution, but just that, parts. Whether you are trying to improve your life, build your practice, or heal a relationship, it is going to take a lot of time, patience and effort. And yes, it will often be redundant! In WoW we often talk about downing a boss using “rinse and repeat,” meaning that we learn the strategies we need, and then have to use them over and over and over to ultimately down the boss.
Rome wasn’t built in a day unless you’re playing Civilization III. It takes time to assemble the pieces of the most powerful parts of our lives. Therapists can remind gamers that they are good at this!! I can’t tell you how many times I have run the same dungeon in a Zelda to get the map to find the compass to find the boss to get the key to unlock the item to cross the obstacle to get the key to down the big boss. Gamers are no stranger to persistence when we’re engaged, and we’re not dissuaded from effort when we have some optimism, that’s how we roll. 🙂
So these are just some of the Lessons of Zelda, lessons that therapists and gamers alike can use to improve their coping and lives. Are there other lessons I’ve missed?
The Gamification of Psychotherapy
In the 19th century Sigmund Freud revolutionized the fields of neurology and psychiatry. Whether you agree or disagree with the particulars, psychoanalytic theory, and the psychodynamic theories that sprang from it changed the way we understand the human mind. Freud pioneered our understanding of the psychosomatic illness, conflicts, drives and the unconscious, to name but a few of the ideas that still influence theory and practice of psychotherapy today.
The way Freud came to understand and then attempt to help us understand these ideas was by applying other theoretical models to our psychology. The industrial revolution, with its steam-powered hydraulics and locomotives powered by internal pressure, heavily influenced his beginning work of trauma affect and drive theories. His famous topographic model of the psyche, with its strata of conscious, preconscious and Unconscious, was inspired by the advances in geology and archaeology of his day. In short, the technological advances of his time informed and shaped the way he thought about and worked with people.
Now we are in the 21st century, which is new enough that saying it still fills us with amazement. The revolutions in technology continue, and I want to begin applying some of these technological advances to my theory and practice. I have blogged a lot about games, and today I want to discuss the application of game theory in understanding the human psychology.
Gamification is the act of using the elements of game design and applying it to other parts of human existence. We have seen gamification begin to be used in businesses like IBM and written about in the Harvard Business Review. MacDonald’s has been using gamification with its’ Monopoly game for years. The Army has been using viedo game technology to gamify our defenses. Socially Serious Games like Against All Odds are being used to educate people about human rights and global conflict. So can gamification be applied to psychotherapy?
I think so.
In her new (and excellent!) book Reality Is Broken, Jane MacGonigal reminds us of the concise yet brilliant description of what a game is according to Bernard Suits. Suits states that “playing a game is the voluntary attempt to overcome unnecessary obstacles” in his book The Grasshopper. An example of would be chess where we agree to use the playing pieces on the board, the unnecessary obstacle is that each type of piece can only move a certain prescribed way, and we attempt to overcome this in order to capture the king of our opponent.
One example of gamifying psychotherapy is if we posit something similar: Psychotherapy is the voluntary attempt to overcome unnecessary obstacles.
Psychotherapy must be voluntary to be successful. If the patient refuses to engage in the process either by physically or mentally absenting himself, therapy will not happen. Yet even people mandated to treatment can benefit from it if they agree subconsciously to engage with us. Adolescents who are dragged to treatment will sit with us in stony silence week after week because they are not there voluntarily. Sometimes we can get a part of them to come out and “play,” i.e. engage with us. And if we don’t want to work with the patient for some reason, it makes treatment next to impossible.
Patients come to us because they are attempting to overcome something. They don’t just drop in because they wanted to read the magazines in the waiting room. Something in their life has caused them pain, sadness, anger, discomfort and they want that to stop. They may have noticed a pattern of bad relationships, they may be having traumatic flashbacks, they may be encopretic. But something in their life outside the therapy office has seemed insurmountable, and they want our help in overcoming it.
Which brings us to the unneccessary obstacle. I would suggest that in many cases the symptom is the unnecessary obstacle. Whatever the behavior might have been in the past it is no longer necessary now. As a child, hiding their body or mind may have been necessary to keep themselves safe from an abusive parent or sibling. As an adult, their tendency to dissociate in meetings and avoid success at work is an unnecessary obstacle. As a teen a patient may try to control an out of control environment in order to feel a sense of self. As an adult they may seek to control their bodies through disordered eating or self-injury for much the same reason. The challenge here is that the patient continues to go through life unconscious of this and acting as if the obstacle was necessary. In a sense they are playing out (albeit very seriously and sometimes fatally) something outside of the playground.
Huizinga referred to the “magic circle” of play, within which the game unfolds. Therapy, with its 45-50 minute hour, office setting and professional boundaries, is such a magic circle. If you don’t take the idea of play seriously, you will probably find this analogy offensive. But in my opinion play is very serious. In psychotherapy, patient and therapist become earnestly engaged in the immediacy of what happens. People become ghosts of other people, monsters appear, and ancient kingdoms rise up from beneath the waves for a day. I believe that most people who have been in treatment will be able to recall the immersive and powerful experiences they have had there, experiences which have felt tragic and heroic. Hopefully the patient leaves the magic circle having changed, the unnecessary obstacle is overcome, and life gets better.
We live, as Freud did, at the threshold between two centuries. We live, as Freud did, in a world story frequently punctuated by war. I imagine that back then things felt as difficult, healing seemed as urgent as it does today. People came to Freud then, and us now, to help them overcome unnecessary obstacles that were ruining their lives. Freud benefited from applying the diverse technologies of hydraulics, geology and archaeology to understand the human condition; and I believe that we can benefit from applying ludology and game theory to the serious business of therapy. Gamification will not be used to “lighten up” treatment but rather deepen it. Patients who play video games may respond better to leveling up than treatment planning, power-ups as opposed to coping strategies. Virtual worlds may serve as practice for real ones, just as therapy has served as practice for other relationships.
Freud was an Epic Therapist. He researched and synthesized what was going on in the art and science of his day in order to do better treatment. Today’s Epic Therapists will need to do the same, and that means having the courage to play with technology, games and ideas. Our resistance to doing so is an unnecessary obstacle we need to overcome, and our success in achieving this will be an Epic Win for our patients and our profession.
Real Life, Ego Defenses & You
Anna Freud, Sigmund Freud’s daughter, greatly expanded on her father’s theories of psychoanalysis. Perhaps one of the most memorable ways she did this was in her exploration and cataloging of the ego’s defenses. In her work “The Ego and the Mechanisms of Defense” in 1937, Anna laid the groundwork for understanding the ways we cope with internal conflicts between the way things are and the way we wish they could be. She initially came up with nine general categories, which I reproduce here from a great resource on www.changingminds.org :
- Denial: claiming/believing that what is true to be actually false.
- Displacement: redirecting emotions to a substitute target.
- Intellectualization: taking an objective viewpoint.
- Projection: attributing uncomfortable feelings to others.
- Rationalization: creating false but credible justifications.
- Reaction Formation: overacting in the opposite way to the fear.
- Regression: going back to acting as a child.
- Repression: pushing uncomfortable thoughts into the subconscious.
- Sublimation: redirecting ‘wrong’ urges into socially acceptable actions.
Ego defenses are numerous, and range from the most primitive (repression) to the most evolved (sublimation.) When I say primitive, I want to convey that they are the earliest we acquire developmentally, not the least useful or most pathological. And it is important to remember that all defenses are useful, and that the ego is using the best resources it has to cope with any given problem. Later thinkers would begin to specify and amend this list, but it was the first attempt to explain how the ego helps the human mind make the unbearable bearable.
When I assess patients who play video games, I am always very interested in which spells or actions they employ when they game. The reason I am so interested is because many of these spells and actions are directly parallel to certain ego defenses. If a warlock uses Fear a lot, I may wonder if they are inclined toward projecting their anxiety onto others, as a result of a world view that sees others as more powerful and scary than they are.
I also like to explain to patients the way they seem to be using their ego defenses in terms of these spells or abilities. For example, if someone always wants another member of the therapy group to go first in checking in, I may explain this displacement in terms of the Hunter’s ability Misdirection. Often gamers can understand the ego depenses exceptionally well, because these defenses are clearly illustrated in the way they play the game. Therapists working with gamers would do well to ask their patients what their class is (Warlock, Hunter) and then the spells or abilities they enjoy or use the most. Likewise, shifts in using different spell rotations or changing class can often indicate large shifts in the ego and character development of the patient.
And now a word about real life.
Real Life, is a concept used by both gamers and therapists. Gamers talk about how they can’t raid because they have a “RL obligation.” Therapists talk about a patient’s reality testing, and their ability to participate in real life. Real life is a useful concept, and like many useful concepts it is often misused.
I often hear therapists describe gamers as people who are trying to avoid “real life” by using games. The implicit judgement in this statement is that games are not a part of reality, and therefore are less than. But this seems like a false dichotomy to me, in many ways similar to the way therapists often talk about how therapy is not real life. Of course it is! Therapy has distinct rules and boundaries, and it is a rarified form of relationship, but it is not of a different substance than that of “real life.” If it were truly a different thing, it is unlikely that patients would gain anything useful from it.
By the same token, games are part of real life. World of Warcraft is inherently social, there are over 12 million real people playing it all over the world. Gamers deploy real skills to solve real problems and their neurological responses to an “Epic Win” or “Fail” are real physiological responses. This is not to say that the gaming part of a patient’s real life can’t get out of balance with other parts. But it is not a given, and it is not different from the way others use their ego defenses. We all use repression and sublimation to cope with the conflicts and anxiety that occur in daily life. I recall a clinical professor of mine who sublimated her murderous impulses by reading murder mysteries. Hurling fireballs in WoW is an excellent way to prevent oneself from hurling objects or insults in real life. The defenses are there for a reason, and they are not inherently bad.
If you are a therapist and you are seeing your patient who games as someone who is not paying attention to their “real life,” ask yourself if you are not perhaps projecting. Many therapists have a great deal of difficulty finding balance in their own lives. They may find it easier to say that a gamer needs to “get a life,” than to realize that they are projecting their own feelings of disregard for themselves onto gamers. By this I mean that therapists often overvalue the work they do in proportion to their family, friends, and other areas of their lives. For example therapists often will see too many patients at a sliding scale fee while their children are impacted by their lower income: They overvalue their therapist role and their parental role suffers. Other therapists may have a difficult time making time for friends or having conversations that go beyond 45 minutes, they may listen but not share of themselves. And still other therapists may neglect exercise and meditation because they don’t have the time, but overbook their work schedules.
Before we can help gamers appreciate the need for balance in their lives, we need to empathize with what they are doing. They are relying on the areas of strength they have in themselves when they game, and are reluctant to go to the areas that need development. We therapists do that too, if you don’t believe me just ask your spouse or child if they ever feel like you are using your therapeutic abilities on them!
Let’s be careful if we have to use the idea of “real life” at all. It is often a veiled judgment, and veiled judgments are often projections. Let’s go with Wittgenstein here, who began his Tractatus Philosophicus by stating “The world is everything that is the case.” Privileging some aspects of life over others is often the first step towards the oppression of others, be it race, gender, orientation, class, or I would suggest, gaming. It certainly won’t help our patients get any better.
And it may just make our own lives worse.
Some Beginning Games for Therapists to Try
This Video Blog was inspired by friend Carolyn Stack, who asked that I recommend a iPhone game to ease her into the world of iPhone gaming. Here are a few of my favorites and why you might want to try them:
Talking the Talk… Or At least Understanding It
Anyone who has worked with adolescents for part of their practice has experienced the sense of speaking a language from an alternate universe, similar to yet quite unlike our own. And anyone who has worked in the field of adolescence for a significant amount of time will from time to time experience a sense of being hopelessly “behind the curve.” Fortunately, there is a resource out there for those of you who want to translate what your clients, or children are saying to you: www.urbandictionary.com . This highly nonclinical dictionary can definitely help, although like anything concerned with youth it is unconventional and preoccupied with some of the traditional categories of teen interest—sex, drugs, and music. Nevertheless it contains just about every phrase, including text-messages, that you’ve ever heard about.
Peer Supervision
A peer supervision group is forming in Harvard Sq. The group welcomes clinicians of various disciplines and theoretical backgrounds. We’re looking for members with 5 or more years of clinical experience, an ongoing interest in learning, and a sense of humor. Current members use psychodynamic, CBT, DBT, and systems theory in their clinical work, and are open to broadening their scope. The group meets Mondays at 12:00 PM, please contact me for more details.