building your business

A New Startup Focusing on Minecraft & Social Emotional Learning

January 4, 2016 by langloimsw 4 Comments

Happy New Year, Gentle Reader!

I wanted to let you know about a new startup project that launches this month that you may find of interest called Grokcraft.

Grokcraft is a Minecraft server, learning lab, & community where parents, kids & professionals engage in playful collaborative social-emotional learning (SEL.) All our members are vetted & for youth require parent permission to participate. Our counselors are available to mentor youth in SEL. Our youth group, Grok Corps, will be open to those who want to be trained in conflict resolution & online moderation. Our vision is that kids will not avoid conflicts as much as learn to resolve them when they arise. We believe that in free play, children & adults can learn mindfulness, empathy & other social skills in a playful environment. You can read more about this in our Manifesto. With both adult and youth groups approaching with complementary educational needs & abilities in SEL & tech skills, there are constant opportunities for collaboration embedded in (most importantly!) fun.

Grokcraft is an educational rather than therapeutic milieu. Based on the educateur model, professionals are encouraged to refer clients who would benefit from play-based social emotional learning. Some examples of people who might refer:

A psychotherapist who has a patient needing to improve mindfulness, relational skills or empathy training beyond the clinical hour
A speech & language therapist who wants to provide a student with more opportunities for social pragmatic skills acquisition
A special educator who with students who need more opportunities to learn & practice SEL
A parent or professional who wants a child in their care to have a Minecraft community that is safe & supportive & vets each member personally

At the same time, Grokcraft provides a high-touch learning environment for adult educators & clinicians to learn how to use Minecraft in their work. Monthly seminars for educators, in-game coaching & instruction are available to give professionals a fun way to learn & practice 21st-century game play & add it to their professional repertoire. Some examples of professionals who may benefit:

A psychotherapist who wants clinical training in online play therapy techniques from experts
A speech & language therapist who wants a place to provide social pragmatics groups
A special educator who wants a secure place to have virtual field trips/project-based learning
A parent who wants parent guidance around digital literacy & SEL
All of the above who want a peer community where they can exchange ideas & develop community that is not technophobic

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!

Find this post interesting? I can speak in person too: Check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, building your business, children, digital literacy, education, game theory, gamers, games, gaming, grokcraft, mindfulness, minecraft, psychodynamic, psychology, social justice, social media, technology, video games, Web 2.0

The Relationship Between Emerging Technology & Psychodynamic Theory

May 23, 2014 by langloimsw Leave a Comment

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

Find this video interesting? I can speak in person too: Check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: activism, building your business, digital literacy, education, emerging technology, Freud, game theory, gamers, games, gaming, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, video gmaes, Web 2.0

Social Justice & Technology Revisited

March 15, 2014 by langloimsw 1 Comment

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

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

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

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

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

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

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

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

Like this post? I can speak in person too: Check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: activism, behavior change, building your business, digital literacy, education, marketing, ROI, social justice, social media, technology, twitter, video games, Web 2.0

Works, Life and Marshmallows: Iterative Design

February 13, 2014 by langloimsw 2 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Filed Under: Gamer Therapy Tagged With: addiction, behavior change, buddhism, building your business, children, education, gamers, games, gaming, marshmallows, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, social justice, technology, therapy, video games, Web 2.0

No Matter How You Feel, You Still Failed

January 14, 2014 by langloimsw 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: addiction, adolescents, behavior change, buddhism, building your business, children, digital literacy, education, ego psychology, failure, Freud, gamers, games, gaming, Kohut, mindfulness, minecraft, optimal frustration, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, reality testing, ROI, self psychology, social justice, social work, stress, technology, therapy, video games

The Changing Landscape of Social Work

November 17, 2013 by langloimsw Leave a Comment

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

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

http://www.youtube.com/watch?v=zb74jYN0k5Y&feature=share&list=UUQG8usDJjq8OjMgtNDQC6fg

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

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

http://youtu.be/FQWUMTxXVus

Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, buddhism, building your business, digital literacy, education, facebook, gamers, marketing, mental health parity, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, twitter, video games, Web 2.0

Evocation and Mindfulness: Or, How to Think Better

October 16, 2013 by langloimsw 2 Comments

Like other art forms, video games can be both a mirror and a candle held up to our culture, at times reflecting it and at times revealing things about it. Normally I direct my posts primarily at people: therapists, gamers, educators, parents. But today I want to include the company that produces World of Warcraft as well. We have a crisis regarding thinking, and although I don’t think WoW created it at all, it has reflected it in a recent game mechanic change.

I am referring to a change mages that happened recently, where the spell Evocation was replaced by Rune of Power. For people not familiar with the game, here’s a simple explanation. Mages cast spells, but spells require an energy called mana, which gets used up gradually as you cast spells. How much mana you start with depends on your character’s intellect, and once you have used up your mana, you can’t cast any more spells until it is replenished. To replenish it you can either wait and it will gradually return (not the greatest idea in combat,) or eat and drink (not possible while you are in combat.) Or you could in the older days cast Evocation, which meant you stood in place as the spell was going, gain 15% of your total mana instantly and another 45% of your total mana over 6 sec. Move or get attacked, and the spell broke.

This recently was replaced with Rune of Power, which places a rune on the ground, which lasts for 1 min. While standing within 5 yds of it, your mana regeneration is increased by 75% and your spell damage is increased by 15%. You have to keep remembering to replace it every minute, but that’s not the problem. It may even be an easier game mechanic, but that’s not the problem either. My problem with it is how it reflects our dysfunctional attitude about thinking, and specifically our tendency to think of thinking as separate from doing something.

We live in a culture where people frequently worry about things, and in fact have ruminations that are intrusive. Many people report feeling hijacked by their minds with worrying or intrusive thoughts. And yet at the same time, few of us seem to mark our time and set it aside specifically for thinking. We schedule appointments to do things, but thinking isn’t one of them. We treat thinking, which is intangible, as if it can occur in the same space as doing other activities that are more observable and tangible. And then we are surprised when our minds rebel and hijack our thinking with thoughts and feelings that come unbidden, when all along we have been failing to cultivate the practice of intentional, mindful thinking about things.

This is where I think Blizzard and Wow initially had it right with Evocation. It was acknowledging an important truth, that Thinking IS doing something, and when done intentionally it occupies time and has benefits. Sure you weren’t able to do other things while casting Evocation, but isn’t that the point? In the real world, when you want to think deeply and seriously about something, you really do need to be intentional about it, and make a space in your day to do it. Rune of power definitely embraces the multitasking model, which encourages you to set up a rune and then go about your other business while keeping half an eye on it to know when to refresh. Multitasking is not inherently a bad thing, but there are times and places that intentional thinking may be more appropriate and less anxiety-provoking.

Part of helping patients learn to manage worrying is often to help them set up a specific time for worrying about things. This “worry time” can be a placeholder in the day or week which the patient uses when an intrusive worry enters into their thinking: They can dismiss it by deciding to put that on the agenda for the scheduled worry time. This is a way of training your mind to be intentional about what you choose to think about and when. But implicit in this is the idea that training your mind to think about things intentionally is a learned skill.

You can apply this to many different aspects of your life and work. If you are growing your private practice, when was the last time you set aside an hour to think deeply about your business plan or clinical focus. I’m not talking about daydreaming here, I’m talking about sustained intentional thought. Clinically, do you set aside supervision time to think deeply about patients? As students do you take 15 minutes after each article to think specifically about the reading? As parents, when was the last time you said to your co-parent, let’s make a time to think together about how our child is doing in life at home and school. Classroom teachers, when was the last time you asked students to take 5 minutes and think quietly about the classroom topic?

Another challenge here is the confusion of tongues around the concept of thinking. Self-help gurus often exhort us to stop thinking about things and JUST DO IT. But I don’t think they are talking about intentional thinking, I think they are talking about reactive or intrusive thinking. Procrastination is reactive thinking, worrying can be intrusive thinking. Those are often roadblocks to success, but the form of thinking I have been referring to is perhaps better described as a form of concentration meditation. Concentration meditation has come to be seen by many of us as concentrating on an image, or a candle, or chanting, or a revered object, but that is not necessarily the case, and in fact it is limiting.

What if your idea is the revered object? What if your thought process about your work, child, patient, class is worthy of your undivided attention? What if you were to schedule a specific time to think about a certain project?

If you are one of those detractors who say, “I just don’t have time to think,” I don’t buy it. Thinking time is not a luxury item, although it may be a learned discipline to set aside a few minutes at a time to do it. So please take a second and schedule a time on your calendar to think about an idea that is important to you. Schedule a time to hold your random worries and thoughts and show up at that appointed time to seriously consider them. I suspect this will free up more mental space and time than you may imagine.

And please Blizzard, bring back Evocation. I miss it, and the important life lesson in mindfulness it has to teach us.

Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, digital literacy, education, game theory, gamers, games, gaming, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, stress, video games, World of Warcraft, wow

Guild Wars: The Conservative Attack on Online Therapy

August 4, 2013 by langloimsw 11 Comments

“European commerce during the Dark Ages was limited and stifled by the existence of a multitude of small kingdoms that were independently regulated and who suppressed the movement of goods across their borders through a confusing and inconsistent morass of taxation, tariff, and regulation. This forced merchants to find another solution to move their goods, one that would avoid the strangulation that resulted from this cumbersome regulatory model. These merchants chose to move their goods by sea without being subject to the problems that were created by this feudal and archaic design, a move that changed the world. The little kingdoms took hundreds of years to catch up.”

–Harris, E., & Younggren, J. N. Risk management in the digital world.

Keeping up with policy is not my favorite thing: But if I am to continue to be a consultant to therapists building their business and an educator on integrating technology into social work practice, it is part of the prep work. So when a recent client asked me a question about licensure and online therapy in our Commonwealth of Massachusetts I surfed on over to our Division of Professional Licensure to take a look. Good thing I did, and a lesson for all of you thought leaders and innovators out there, regardless of what state you live in.

There wasn’t much about technology, except for the interesting fact that the past several Board Meeting minutes made mention of a Committee discussion open to the public on “E-practice policy.” I assumed (correctly it turns out) that this meant that the Social Work Board was formulating a policy, so I reached out to the Division and asked some general questions about what it was going to look like. The answer was prompt and pretty scary.

The representative stated in her email to me that the “Board feels as if the use of electronic means should be employed as a last resort out of absolute necessity and it is not encouraged. The social worker would have the burden of proof that electronic means were employed as a last resort out of absolute necessity.”

I have several concerns about this.

Before elaborating on them, I want to explain that my concerns are informed by my experience as a clinical social worker who has used online therapy successfully for several years, as well as an educator nationwide on the thoughtful use of technology and social work practice. I have had the opportunity to present on this topic at a number of institutions including Harvard Medical School and have created the first graduate course on this topic for social workers at Boston College. In short, this issue is probably the most defining interest and area of study in my career as a social work clinician, educator and public speaker.

I also am a believer in regulation, which is why I have been licensed by the Board of Licensure in Oregon, and am in process of similar applications in several states, including CA, and NY, so that I may practice legitimately in those jurisdictions. I am a very concerned stakeholder in telemedicine and here are only a few of my concerns about a policy of “extenuating-circumstances-only-and-be-ready-to-prove-it:”

E-Therapy is an evidence-based practice. It has been found to be extremely efficacious in a number of peer-reviewed studies, over 100 of which can be found at http://construct.haifa.ac.il/~azy/refthrp.htm . In fact, telemedicine has been found to have comparable efficacy to in-office treatment of eating disorders (Mitchell et al, 2008,) childhood depression (Nelson et al, 2006,) and psychosocial case management of diabetes (Trief et al, 2007) among others. To limit an efficacious modality of treatment by saying it needs to be used only in an “extenuating” circumstance or as a last resort which is discouraged would be a breathtaking reach and troublesome precedent on the part of the Board, which has not been done with any other treatment modality to the best of my knowledge. Telemedicine was also endorsed by the World Health Organization 3 years ago. And as I wrote this post, the University of Zurich released research showing online therapy is as good as traditional face-to-face therapy, and possibly better in some cases (Birgit, 2013.)
To place and require a burden on the individual social worker to account for why this treatment modality is justified by necessity of extenuating circumstances also raises the issues of parity and access. Providers familiar with the issue of mental health parity will hopefully see the parallels here. Clinical social workers for example may become more reluctant to work with patients requiring adaptive technology if they realize that they could be held to a higher level of scrutiny and documentation than their counterparts who do not use online technology. Even though the Board would possibly deem those circumstances “extenuating” it would require an extra layer of process and bureaucracy that could have the side effect of discouraging providers from taking on such patients.
Insurers such as Tricare and the providers in the military are increasingly allowing for reimbursement for telemedicine; and videoconferencing software is becoming more encrypted and in line with HIPAA. While these should not be the reasons that drive telemedicine in social work, we should consider that a growing segment of the population finds it a reputable form of service delivery.
Such policies require input from people with expertise in clinical practice, the law, technology, and the integration of the three. When I asked about whether any members of the Board had experience with the use of different newer technologies in clinical practice or how to integrate them, I was informed that “the Board is comprised of members with diverse backgrounds. They have reviewed the policies and procedures for electronic means for many other jurisdictions as well as the NASW and ASWB Standards for Technology and Social Work Practice in addition to the policies set forth for Psychologists, LMHC’s and LMFT’s in MA.”

The NASW policy which I believe she is referring to was drafted 8 years ago in 2005. For context, it was drafted 5 years before the iPad in 2010, 2 years before the iPhone in 2007, and 4 years before the HITECH act in 2009. In fact, the policy I reference says nothing about limiting technology such as online therapy to “last resort;” rather it encourages more social workers and their clients to have access to and education about it. That professional organizations may be lagging behind the meaningful use and understanding of technology is not the Board’s fault. But to rely on those policies in the face of recent and evidence-based research is concerning. If the Board does wish to be more conservative than innovative in this case, I’d actually encourage it to consider the policy adopted by the Commonwealth’s Board of Allied Mental Health Professionals at http://www.mass.gov/ocabr/licensee/dpl-boards/mh/regulations/board-policies/policy-on-distance-online-and-other.html which in fact does not make any mention of setting a criteria of extenuating circumstances or potentially intimidate providers with the requirement of justification.

I hope the Board listens to my concerns and input of research and experience in the respectful spirit that it is intended. I am aware that I am commenting on a policy that I have not even seen, and I am sure that the discussions have been deep and thoughtful, but I know we can do better. As a lifetime resident of Massachusetts, I know we take pride in being forward thinkers in public policy. Usually we set the standard that other states adopt rather than follow them. I invited the Board to call upon me at any time to assist in helping further the development of this policy, and reached out to state and national NASW as well. I hope they take me up on it, but I am not too hopeful. I had to step down from my last elected NASW position because I refused to remove or change past or future blog posts.

If you practice clinical social work or psychotherapy online, it’s 3:00 AM: Do you know what your licensing boards and professional organizations are doing? Are they crafting policies which are evidence-based and value-neutral about technology, or are they drafting policies based on the feelings and opinions of a few who may not even use technology professionally?

This is a big deal, and you need to be involved, especially if you are pro-technology. The research from Pew Internet Research shows that people age 50-64 use the internet 83% of the time, about 10% less than younger people; and only 56% of people 65 or older do. These older people and digital immigrants are often also the decision-makers who are involved in policy-making and committees.

If you don’t want to practice online, you may bristle at this post. Am I saying that older people are irrelevant? No. Am I saying that traditional psychotherapy in an office is obsolete? Absolutely not. But I am saying that there is a backlash against technology from people who are defensive and scared of becoming irrelevant, and fear does not shape the best policy. Those of us with experience in social justice activism know that sometimes we need to invite ourselves to the party if we want a place at the table.

And with government the table is often concealed behind bureaucracy and pre-digital “we posted notice of this public hearing in the lobby of the State House” protocols. My local government is relatively ahead of the curve by posting minutes online, but I look forward to the day when things are disseminated more digitally, and open to the public means more than showing up at 9:30 AM on a work day. If they allow videoconferencing or teleconferencing I will gladly retract that.

At its heart, divisions of professional licensure are largely about guildcraft: They regulate quality for the good of the whole guild and the consumers who purchase services from guild members. They establish policies and sanction members of the guild as part of establishing and maintaining the imprimatur of “professional” for the entire guild. They develop criteria both to assure quality of services and to regulate the number of providers allowed in the guild with a certain level of privileges at any time: LSWs, LCSWs, and LICSWs are the modern-day versions of Apprenctice, Journeyman and Master Craftsman. This is not to say guilds are bad, but it is to say that we need more of the senior members of the guild to advocate for technology if they are using it.

Too often the terms “technology” and “online therapy” get attached to term “ethics” in a way that implies that using technology is dangerous if not inherently unethical. That’s what I see behind the idea that online therapy should only be used as a “last resort.” We thought something similar about fire once: It was mysterious to us, powerful and scary. So were books, reading and writing at one point: If you knew how to use them you were a monk or a witch.

Technology has always been daunting to the keepers of the status quo, which is why you need to start talking to your policymakers. Find out what your licensing boards are up to, advocate, give them a copy of this post. Just please do something, or you may find your practice shaped in a way that is detrimental to your patients and yourself.

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References

Birgit, W., Horn, A. B., & Andreas, M. (2013). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal Of Affective Disorders, doi:10.1016/j.jad.2013.06.032

Funderburk, B. W., Ware, L. M., Altshuler, E., & Chaffin, M. (2008). Use and feasibility of telemedicine technology in the dissemination of parent-child interaction therapy. Child Maltreatment, 13(4), 377-382.

Harris, E., & Younggren, J. N. (2011). Risk management in the digital world. Professional Psychology: Research And Practice, 42(6), 412-418. doi:10.1037/a0025139

Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., et al. (2008). A randomized trial comparing the efficacy of cognitive–behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour Research & Therapy, 46(5), 581-592.

Nelson, E., Barnard, M., & Cain, S. (2006). Feasibility of telemedicine intervention for childhood depression Routledge.

Trief, P. M., Teresi, J. A., Izquierdo, R., Morin, P. C., Goland, R., Field, L., et al. (2007). Psychosocial outcomes of telemedicine case management for elderly patients with diabetes. Diabetes Care, 30(5), 1266-1268.

Filed Under: Gamer Therapy Tagged With: activism, aswb, behavior change, boards, building your business, digital literacy, e-therapy, education, guilds, HMOs, insurance, licensure, managed care, massachusetts, mental health parity, middle ages, NASW, policy, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, social justice, social media, technology, telemedicine, therapy, Web 2.0

Saving Ideas

July 9, 2013 by langloimsw 2 Comments

Sometime, over 40,000 years ago, someone decided to put images of human hands on the cave pictured above. It turned out to be a good idea. This painting has given scientists information on life in the Upper Paleolithic, raised questions about the capacity of Neandrathal man to create art, and sparked debate about which species in the homo genus created it. Other later cave paintings depict other ideas: Bulls, horses, rhinoceros, people.

I wasn’t there in the Paleotlithic but I doubt that the images we are seeing in caves were the first ones ever drawn. I imagine that drawing images in sand and other less permanent media happened. I suspect that the only reason we have cave paintings is because at some point somebody decided they wanted to be able to save their idea, to keep it longer or perhaps forever.

Every day, 7 billion of us have untold numbers of ideas. So what makes a person decide that an idea is worth saving? What makes us pause and make a note in our Evernote App or Moleskine journal? What inspires us to make a video of our idea on YouTube or write a book? We can’t always be sure that an idea is a “good” one or even what the criteria for a good idea is. It usually comes down to belief.

In the past several centuries, the ability to save ideas was relegated to the few who were deemed skillful or divinely inspired. Books were written in monasteries, then disseminated by printing presses, and as ideas became easier to save, more people saved them. But, and this is very important, saving an idea doesn’t make it a good idea, just a saved one. Somewhere along the line we began to get the notion that only a few select people were capable of having a good idea, because only a few select people were capable of saving them. Even in the 21st century, many mental health professionals and educators cling to the notion that peer-reviewed work published in journals is the apex of quality. If it is written, if it was saved by a select few it must be a good idea. If you have any doubt of what I’m talking about just Google “DSM V.”

With each leap in human technology comes the power to save more ideas and then spread them. People who talk about things going viral often forget that an idea has to be saved first, and that in essence something going viral is really a form of society saving an idea. If anything, technology has improved the democratization of education and ideas.

This makes many of us who grew up in an earlier era nervous and frustrated. We call the younger generation self-absorbed rather than democratizing. We grumble, “what makes you think you should blog about your day, take photos of your food, post links to cute kitten videos?” We may even take smug self-satisfaction that we aren’t contributing to the static. I think that’s a bad idea, although it clearly has been saved from earlier times.

40,000 years from now, our ideas may take on meanings we never anticipated, like cave drawings. Why were kittens so important to them? In the long view I think we remember that people have to believe they have an good idea before they take the leap of faith to save it. The citizens of the future may debate who saved kitten videos and why, but it will be taken as given that they must have been important to many of us.

What if everyone had the confidence to believe that they had an idea worth saving? What if everyone had the willingness to believe that it just might be possible that their idea was brilliant? Each semester I ask the students in my class to raise their hand if they think they can get an A- or higher in the class, and most do. Then I ask them to raise their hand if they think they can come up with in an idea in this class that could change the world. I’ve never had more than 3 hands go up. That’s sad.

This is why I admire the millennials and older groups who take advantage of social media and put their ideas out there. I doubt that they are all good ideas, but I celebrate the implicit faith it takes to save them. Anyone, absolutely anyone at all, can have a good idea. It may not get recognized or appreciated, but now more than ever it can get saved. Saving an idea is an act of agency. It is a political act. Saving an idea is choosing to become just a bit more visible. On the most basic level saving an idea is a celebration and affirmation of the self. Think about that, and dare to jot down, draw, record or otherwise save one of your ideas today. I just did and it feels great. Then maybe you can even share it with someone else.

What makes a person decide an idea is worth saving?

You do.

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Filed Under: Gamer Therapy Tagged With: activism, adolescents, behavior change, buddhism, building your business, cave paintings, children, digital literacy, education, facebook, gamers, gaming, ideas, LGBT, marketing, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, saving, self-promotion, social justice, social media, technology, twitter, video games, Web 2.0

You’re The Reason Building Your Business Is So Hard

May 31, 2013 by langloimsw 22 Comments

Recently I was asked by a student to take some time and talk with her about her career options. She was trying to plan for her career post-graduate school, and struggling some with the vicissitudes of a graduate program in mental health. Such vicissitudes, once you commit to studying in the field of your choice, are out of your control. Students are often told what to learn, how to learn it, where to intern, and what kind of internship they can have. Want to learn psychodynamic theory? Sorry, school X doesn’t believe in it, so if you go there there may be one or no mention of it in your foundation work. Want to work at a leading hospital? Sure, you and 100 other students from the schools in your area; so apply, but don’t count on it. So, in graduate school, students like my student often have to like it or leave it.

This disempowers the budding therapist in many ways, not the least of which is that it conditions her to take her cues from others even beyond graduate school. It is hard to learn that you have the power to build your career and business after having been taught that the schools, placements and agencies are the ones who make the rules.

If you are out of school, you have more power than you think, and therefore more responsibility than you may want.

Many therapists want to avoid taking responsibility for their businesses. No sooner do we get out of a school or agency then we start to recreate an agency of our own devising. We create our own set of disempowering expectations, and there are usually plenty of people around to collude with us in this. I call them disempowermentors.

Disempowermentors in the mental health field are the ones that tell you all sorts of rules about how things work. They’ll tell you you can’t build a practice without being on insurance panels. They’ll tell you you need to work in our field for 10 years to build up a reputation before you can open a practice. They’ll tell you you should sublet a few hours and not jump in to a full-time practice. None of these things are true, but most of them are usually fear-based. They are usually the way the disempowermentors did things, either because they recreated their own inner agency and/or because they listened to disempowermentors themselves. If my student isn’t careful, she’ll end up listening to one of these folks, and set herself and her future business back a few years. She’ll have a structure, but it will be one that restricts her choices rather than increases them.

Take a look at who you are listening to: Are they disempowermentors? (One sure clue is that disempowermentors almost always look more tired than happy, more miserable than inspirational.)

One example of someone whom the disempowermentors would say is doing everything wrong is my consultee Lindsey Walker. Lindsey is going right into private practice after finishing graduate school. Lindsey is working on building a full-time practice. Lindsey isn’t in any insurance networks. And things are starting to happen for her. This is largely because Lindsey is very creative and responsible. She has started a blog, Waking The Image, which combines photography and essays on psychodynamic theory. She also just finished writing her first e-book Love Over Trauma: Healing With Your Partner on helping couples recover when one or both of them has trauma in their past.

None of these projects occur in a separate pocket universe: Lindsey works daily on these projects and other tasks that we come up with in the course of our work together. I send her a list of things she’s committed to, and within the next several days she does them. That is why her work is slowly but surely getting noticed and her practice growing. She isn’t waiting passively in her office sublet for the phone to ring. She isn’t waiting passively for insurance panels to accept her, or accepting the fee they want to pay her. Lindsey knows that she is responsible for the success of her business. She is investing time and money into building it, not subletting 2 hours somewhere cheap and hoping she’ll get a client or two after her “day job.” Lindsey made the decision to make building her business her day job. I should also mention that she is not independently wealthy, and that this venture has been a risky and courageous one.

So take a look at your career. Are you happy with it? Is being safe worth it? Are you investing time and money into building your business? Are you taking risks?

If you answered no to those questions, then you are the reason building your business is so hard. You aren’t in grad school any more. You choose to apply for a job, accept it, or strike out on your own. You choose whether to make building your business your day job and make whatever sacrifices you need to make to do that. You decide whether or not to invest in an office, a consultant, or other business expenses. You decide to wait passively for someone to pay you a fraction of your fee, or actively market and network for hours and days and weeks. You decide whether to contribute a blog, book, talk or idea to the world like Lindsey; or not to contribute anything without permission from somebody else. You decide whether to confuse worry with effort and wishing with doing.

Lots of things are possible for you. Owning your own business is neither easy or safe, but it is possible. It takes lots of effort and doing. It’s risky, but no one is making you do it or holding you back. It’s up to you to decide.

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Filed Under: Gamer Therapy Tagged With: behavior change, building your business, digital literacy, disempowermentors, education, HMOs, insurance, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, therapy

What To Do When Your Therapist Turns Into A Kitten

May 1, 2013 by langloimsw 10 Comments

I have been working with patients online for about 6 years, and even now I have some interesting surprises in the work. Recently I was meeting online with one of my long-term patients for their regular session. I use my laptop but have a better web camera and monitor hooked up to it. The bigger monitor allows me to see the patient’s image, but also keep an eye on my image so I can see what the patient is seeing. The laptop monitor stays dark, and the laptop’s built-in webcam goes unused, at least most of the time. But this particular day the laptop webcam decided to switch on 15 minutes into the appointment, and hijacked the webcam I was using. So from what my patient could see, one minute I was there listening empathically, and the next minute I had disappeared.

Those of you who enjoy object relations theory should be enjoying this story by now. Wait, it gets better.

As I was explaining to my patient why I’d disappeared, I was trying to turn off the laptop’s built-in webcam. Instead I turned on a special program the laptop has that replaces the screen with the image of a kitten, the one seen above in fact. Suddenly I was not invisible, but a kitten. Better yet, the kitten was lip synching and moving its mouth when I spoke. Fortunately this wasn’t happening at a particularly delicate moment in the therapy, and we both had a good laugh at it. I apologized to my patient and said, “you know, I studied a lot of things at grad school, but they never taught me what I’m supposed to do if I turn into a kitten when I’m with a patient.”

Many psychotherapists have the sort of relationship with technology that resembles the folks they treat with Borderline Personality Disorder: They alternately overidealize and devalue tech, often in the same breath. “Skype” will be the way we salvage our dwindling practices, we’ll be able to reach people all over the planet, make our own hours and go completely self-pay because most insurance doesn’t cover it. It will be wonderful. That’s the overidealizing part, the devaluing part is more subtle.

Because I do a growing amount of therapy and supervision online, I often get requests for a consultation session to help therapists who want to do online therapy and “need my help getting on Skype.” At this point I try to explain that Skype is not HIPAA-compliant, and that there is more to it that getting a webcam, but here’s where the devaluing of technology comes in. It’s as if some folks think that the only thing one needs to know in order to be an online therapist is how to download a program and turn on the camera.

Most therapists who decide to get Basic EMDR training wouldn’t bat an eye at needing to go through two weekend trainings and a minimum of 20 didactic and 20 hours of supervised practice in order to be certified. And yet many therapists don’t consider that working online and with emerging technologies requires more than learning how to flick a switch. It’s sort of the way people often treat the IT guy at the workplace: With one breath we describe ourselves to him as “clueless” about technology; and yet we really want him to stay in that basement office until we need him to come up and fix our email.

Graduate programs teach us next to nothing about how to use technology in our practice, except perhaps to warn us to avoid it at all costs. Think about it. Do you know what to do if you disappear in the middle of talking with a patient? Do you know what to do if you turn into a talking kitten? More importantly do you know how to prevent yourself from turning into a talking kitten, or turn yourself back from one if you do? And perhaps most importantly, do you know how to help patients anticipate the glitches with virtual therapy, process the unique empathic failures that can arise, and create a good-enough holding environment online?

People like my colleagues DeeAnna Merz-Nagel and Kate Anthony founded the Online Therapy Institute for just this reason. They offer dozens of different 5 hour courses on various technologies, from video conferencing to text chat to conducting therapy in virtual realities like Second Life. The takeaway here is that there is a lot more to learn about online therapy than downloading Skype.

Look, I am not trying to discourage people from doing online therapy, in fact the opposite. I know that it can be a very effective treatment modality, and easily accessed by a growing global population. I’m not even trying to get you to sign up for consultation with OTI or me or anyone in particular. The point I am trying to make is that it is an additional skill set that needs to be learned and integrated into your clinical repertoire.

Psychotherapists don’t just buy chairs and a couch and start talking. EMDR isn’t just wiggling your fingers in traumatized people’s eyes. Both take time, case supervision and specialized training.

Online therapy, and integrating social technologies into your therapy practice is no different.

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Filed Under: Gamer Therapy Tagged With: avatar, building your business, digital literacy, education, facebook, kitten, mindfulness, online therapy, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, skype, social media, therapy, Web 2.0

Epic Supervision Fail

April 2, 2013 by langloimsw 7 Comments

This past week social work colleagues Ericka Kimball and JaeRan Kim had an article published in Social Work entitled: “Virtual Boundaries: Ethical Considerations for Use of Social Media in Social Work.” It’s a good article, and more importantly it’s a nice start. The article discusses if, when and how to use social media ethically. The authors don’t purport to have a solution to every potential problem that social media poses clinicians, but they have some good suggestions.

I have mixed feelings about the constant yoking of “technology” to “ethics” in our profession. (In general, not specifically the article above.) It always seems to imply that social media and ethical problems go hand-in-hand. No other ethics issue, even patient abuse by psychotherapists, gets as much play in our current professional development course offerings, and the irony is that there is evidence to support the much higher prevalence of the latter than the former. It seems the only way the majority of psychotherapists can get curious about social media is if somebody scares them with the idea of ethical or legal violations.

Is there an ethical dimension to integrating technology into psychotherapy? Absolutely. It’s just not the only dimension. And the problem with always focusing on ethics is it often encourages fear-mongering and contempt prior to investigation. Part of the problem is that most of the people talking about ethics and technology in clinical practice have little to no experience with the technology side of things. And as a result, they can’t engage us with ideas and brainstorming, but instead often adopt the fall-back of “you need to be careful.”

The result is that many clinicians get understandably scared: You told me something is dangerous, and that the only solution is to be careful. So seasoned clinicians often adopt what I call the “just say no” attitude. Firewalls go up. Patients can’t be emailed. Agencies adopt no-Facebook policies, and in general evoke an air of monasticism. I have even heard cases where clinicians are told they need to renounce having personal social media. Though Shalt Not Tweet.

Into this “just say no” milieu come our trainees. Many of them are digital natives, and have been wired for technology in a way we digital immigrants may never be. In many cases they are more digitally literate than we are. They come into their supervision sessions with questions about cell phones in the office, suicide posts on Facebook, and being followed by patients on Twitter.

And they get “just say no.”

So let’s get real a sec here.

The Pew Internet Research Group states that roughly two-thirds of North Americans are on Facebook. It, along with other social media, has become a primary source of communication and shaper of culture for our society. This means that a majority of our trainees and their patients are probably using it. We can’t just say no. We can’t just say, “be careful out there.” Our trainees look to us for supervision, and understanding social media and technology is part of 21st century clinical work.

I can’t tell you how many times I have heard horror stories in my classes about how supervisors fail their students this way. And I get emails detailing, for example, how a young clinician tried to bring up the positive impact of social media to a supervisor: “I thought her head was going to implode.”

Psychotherapy has a past history of using innovations in technologies to enhance our work, and our theoretical models. Freud used the newer technologies of hydraulics to explain drive theory. Similarly, advances in thermodynamic technology helped pave the way for family systems theory. By now, many of the principles and parallels of those technologies have become so commonplace in our lives and understanding that we don’t even connect them with being familiar with technology.

Historically technology creates a period of suspicion and confusion before integration into culture. A favorite example of mine is this:

Prior to the Gutenberg printing press, books were a much rarer technology. In the 8th Century, approximately 12,000 books were published in all of Western Europe; by the 18th century that number had risen to 1 billion. As this technology became cheaper and more easily accessible, literacy rose. But this was also a time when things got overwhelming. When you had a handful of books read by a handful of people, the knowledge in them was much easier to locate. But when the number of books and readers increased, there was an overwhelming amount of information to remember and locate. The book index was the technology we came up with to solve that problem, but we needed to experience the technology as problematic before a solution was necessary.

Today we take indices, books and literacy largely for granted. We know how they work, we aren’t afraid of them. If anyone wanted to hold a workshop on the “Ethical Considerations of Printing” they’d be hard-pressed (heh) to get anyone to attend.

So now we find ourselves faced with a new technology, one as revolutionary in many ways as the printing press. Only this time we are the generations that need to get used to it and confused by it. And it’s risky and scary, because we don’t fully understand its implications yet. But just as we wouldn’t have wanted our ancestors to forbid us to read and write, we need to let our trainees learn how to use the newer technology of social media in our lives and work. And to do that, we need to learn it too.

This takes time, and it takes someone with expertise to teach you. So before you hire a consultant, keynote speaker, or workshop presenter to talk about social media or technology in general, ask yourself, and them, these questions:

1. What do you plan to teach me beyond ethics about technology?

2.What strategies can you help me and my agency deploy besides be careful or “Just say no.”

3.What if any experience do you have with technology? Do you use social media? Professionally? Personally?

Just asking potential consultants those 3 questions could save you or your professional organization a lot of money down the line, as well as make the difference between helping you embrace innovation or stagnation.

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Filed Under: Gamer Therapy Tagged With: activism, building your business, digital literacy, education, facebook, Freud, gaming, gutenberg, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, Web 2.0

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by langloimsw 29 Comments

Mobile applications have a lot to offer therapists. Whether you are looking for games to play with patients, productivity or billing tools, or something to help you research, there’s an app for that. Many supervisees, students and consultees have asked me lately what apps I recommend, so I thought it was about time I gave you a list sampling those I find most helpful and fun. Many are cheap or free, and available for the iPad, iPhone and Android:

1. GoToMeeting

Planning on doing online therapy? Gotomeeting has desktop and app versions of videoconferencing software, which is HIPAA-compliant. The app version allows you to attend meetings, but the meeting needs to be initiated from the desktop version. I use this program for the majority of my online sessions with patients and supervisees.

2. IbisMail

If you are juggling multiple roles or a portfolio career, or simply want better therapeutic boundaries, this is the email program for you. Installed on your iPad or iPhone, this program allows you to set up automatic filters, so you can sort through junk mail. But it also allows you to set up folders for patient emails, so that you can have them all in one place. Then it is up to you to decide when you review your patient communications, rather than have everything coming through one inbox. Supports multiple email accounts.

3. Flipboard

If you are wanting to add value to your twitter followers or consultees, this is a great app. It provides a slick intuitive interface on your mobile device that pulls in stories from feeds you set, from you Facebook account to the Harvard Business Review blog. When you find something you want to share, the app allows seamless sharing on a variety of social media platforms. In a few minutes you can browse and share selected readings and keep up to date on current interests.

4. Bamboo Paper

This app allows you to write notes on your iPad. It is great for note-taking during evaluations, and allows you to send these notes to Evernote as a .pdf or email yourself a copy. NOTE: Doing this is not HIPAA-compliant if you have distinguishing identifying information in the note, so I recommend you refrain from using the cloud-based features if you have any concerns about patient privacy. If you are using it for workshops or other personal uses, however, no worries. And if you keep the notes local to your password-protected device, it can be a great tool.

5. Evernote

I was hesitant to add Evernote due to the recent hack they experienced, but their quick and effective response to this have actually made me more confident that this cloud-based note-taking device is still useful. It is NOT HIPAA-compliant, so I don’t use it for patient notes ever. That said, it is great for dictating notes about workshops, blog ideas, snapping pictures of things for study aids, and a myriad of other useful tasks. The notes synch up between every device you have them on, so you’re always up to date.

6. iAnnotate

One of my favorites. iAnnotate allows you to mark up .pdf files on your mobile device. If you need to sign off on a document someone emails or faxes you, no more scanning, printing, scanning again stuff. And if you are a student or researcher this is a must-have, as it supports highlighting and annotating research articles. Synchs with Mendeley and Dropbox so you can store your research library with notes online.

7. 1Password

How can you make your mobile device more secure and use your web-browser more safely? This may be the answer for you. 1Password installs on your mobile or desktop, and allows you to save and generate extremely long and secure passwords. The level of encryption can be adjusted for the most cautious of password protectors. This program also synchs over the cloud so that you always have the up-to-date passwords on all of your devices. Even more convenient, it can bookmark your sign-in pages. All of this is secured by double-password protection on your iPhone. Stop using the same lame password for everything and start generating unique hard-to-crack ones for true HIPAA-compliance.

8. Mendeley

One part social network, one part research library, Mendeley allows you to store research articles and annotations online and on your device. It allows you to network with other colleagues to see what they are researching, share articles, and store all of your articles in one place. Often it can even pull up the bibliographic entry from the web just by reading the .pdf metatag. Geeky research goodness!

9. PayPal

This is one option for billing patients and paying vendors that is good to have. You can invoice by email, transfer money to your bank account, and keep track of online payments on the website. The app works well in a pinch if you aren’t ready to swipe cradit cards in your office. NOTE, each transaction has a small fee.

10. Prezi

I’d love to see more therapists using this one. This presentation software allows you to create dynamic visual presentations on your computer or mobile device. You could use it to convert boring DBT worksheets to a dynamic online presentation. Prezi supports importation from powerpoint, and provides free online hosting of your prezis as well as tons of templates and tutorials. If you do public speaking, upload some of your prezis on your LinkedIn profile to give potential clients a vivid sense of your work. You can see a sample here, but bear in mind that it would make more sense if I was there giving the talk. 🙂

11. DCU

I haven’t been to a bank in over 2 years, and this app is the reason why. Digital Credit Union’s Mobile Branch PC, allows me to deposit checks from patients via my iphone. Just login, scan the checks, and in 10 minutes you’ve done your deposits for the week. Meanwhile, the online interface allows you to keep track of your spending easily and export to Excel or accounting software if you need to. Great for tax season!

12. Dropbox

Dropbox is a great and free way to store non-private information on the cloud. The app allows you to email items easily, so I use it to email intake instructions to patients, press kits to people inquiring about keynotes, and a number of other items. I also keep all my DBT worksheets on it so that they can be sent quickly and easily to patients should they be feeling in need of extra support between sessions but not acute enough to warrant hospitalization.

13. TED

This app allows you to stay inspired and experience innovation daily, by beaming TED talks to your mobile device from the offical TED site. You can favorite, search, and share your favorite ones, or hit “Inspire me” for random ideas. As I wrote this, I was listening to Amanda Palmer speak on “The art of asking.” This app can allow you access to ideas outside of the filtered professional bubble with therapists often get ourselves stuck in.

14. Line2

Want a second phone line on your iPhone? This app allows you to have one. You can port your practice number to it, and stop carrying two cell phones. At $9.95 a month you can have unlimited US/Canada calling, at $14.95 a month you get a toll-free number and virtual fax.

15. CardMunch

Tired of keeping all those business cards from a shoebox? CardMunch allows you to snap photos of a colleague’s business card and convert it to a digital one which it stores in your contacts. Synchs with LinkedIn.

16. Micromedex

Keeping up-to-date on medications is pretty daunting, but this app, with frequent updates, helps you keep track od a medication, its Black Box warnings, contraindications, drug interactions, adverse effects, alternate names, standard dosages and more.

And now for some games!

17. Plants Vs. Zombies

This game is great for helping patients who want to learn about strategy and pacing. Choose a certain number of plant types to plant in order to stop the zombies from overrunning your backyard.

18. Zombies, Run!

Continuing my zombie kick, this game is better than any pedometer I’ve ever used. The more you walk or run, the further you progress in this game of fleeing zombies. Go on multiple missions, play with friends, and even train for a 5K.

19. Kingdom Rush

This game is a classic tower defense game, which helps patients learn to make choices, control impulse spending as part of a winning strategy, and work on pacing, problem-solving and a host of other cognitive abilities.

20. Minecraft Pocket Edition

This mobile app version of Minecraft is a great way to connect with a patient’s gaming, and the app allows you to play together on a wireless LAN, so you can fight for survival or create an amazing construction right from your office together.

21. Flower Chain

This is a completely nonviolent game that focuses on setting up a chain reaction of flower blooms in order to complete each level. Great eye candy, and a fun game for clearing the mind after a difficult session.

22. Trainyard

This puzzle game requires you to plan out and design multiple railroad tracks. The trick is to set them up and pace them so that they all meet their goals without running into each other. Great prompt for talking with adolescents about how they can learn to negotiate peer relationships in the same way, or learn to compromise with adults in order to get along with them.

23. Lavalanche

This puzzle game is reminiscent of Jenga, in that you have to dismantle a tower without letting the Tiki Idol fall into lava. Another great one for executive function capacity-building around sequencing, planning and problem-solving.

So there you go, give some of these a try and let me know what you think. Have a favorite app that you want to share? Please feel free to comment and include the link.

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: #sworcery, 1Password, adolescents, Apps, Bamboo Paper, behavior change, building your business, CardMunch, children, DCU, Dropbox, education, evernote, Flipboard, Flower Chain, gamers, games, gaming, GoToMeeting, iAnnotate, IbisMail, kingdom rush, Lavalanche, Line2, marketing, Mendeley, Micromedex, Minecraft Pocket Edition, PayPal, plants vs. zombies, prezi, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, TED, therapy, Trainyard, twitter, video games, Web 2.0

What It Means To Make A Referral

January 7, 2013 by langloimsw 4 Comments

To speak with a relative stranger about the most intimate details of one’s life is an incredibly daunting prospect for many psychotherapy patients. No matter how guarded a patient may be, she or he is daring to be incredibly vulnerable as well. Often the only thing that can make this beginning possible is an appropriate therapy referral. And yet never before has it been so easy for us to make a horrible or thoughtless referral to these brave souls.

It was hard enough when managed care began to shape the behavior of therapists to focus on insurance as being the number one or only criteria to make a referral. But now technology has made it even worse. Readers of this blog know that I am a great fan of technology in general and social networking in particular, so it may come as a surprise to hear me say this; an explanation is in order.

Recently I began to get emails from various therapists with the subject heading “Are you accepting new referrals?” or “Referral for you.” In the past I have found those questions a nice compliment. But these emails were actually invitations to join something called Referral Key, a small business referral network. The message went like this:

If you’re taking on new clients, I’d like to include you in my private referral network to send you business leads.

Please accept my invitation below. Thanks!

Here’s the problem, none of the people who sent me these emails knew me in a professional capacity as far as I can tell. We had never shared a patient, attended a fellowship together, worked at the same agency or supervised trainees at the same place. The only qualification these people would know I had if I accepted their invite was that I wanted more business.

That’s not how you make a good referral.

Look, referring a patient to someone is risky enough when you do know the therapist or the patient. Risky because we have never experienced what it is like to sit with the colleague as a patient. But at least we have some other information to go on. The nature of therapy requires that we be as thoughtful about referrals as possible.

In my experience with trainees and consulting to therapists I have come across a lot of marketing information on how to get referrals, but not a lot of clinical info on how to make them. So here are my suggestions on when and how to make a good referral. Keep in mind that these tips are a combination of my experience, opinions and pet peeves. Between emails, listservs, social networks, etc., I see a lot of different ways therapists do it.

1. Don’t treat a referral as a consolation prize. If you get a call from a patient who says they were referred to you by their insurance, and you are not accepting new patients, don’t feel pressured to offer them another name. Ideally, if you have time to offer them an initial consult you may get enough information to make a suitable referral. If they can come in, you can discuss their presenting problems, therapist preferences in terms of gender, experience, etc. If you offer free phone consultations (which I discourage in general,) you can speak with them over the phone at enough length to get a sense of the patient’s needs. For a thoughtful referral, my experience is that this takes 30-45 minutes. looking online and saying, “Jane Doe appears to be in your network and I’ve heard good things about her” may be sufficient to assuage your conscience but is not sufficient to be a solid referral. Jane may be a whiz at adult ADHD, but if the patient was referred to you for your expertise in PSTD you may have no idea whether Jane has interest or expertise in both.

2. Avoid referring to therapists who “do it all.” I never refer to a therapist who treats ages 3-80 for issues ranging the breadth of the DSM-V. The USDA deals with chunks of meat on a conveyor belt, we don’t.

3. Disclose the extent or limitation of your knowledge of the referral to the patient. If you trained with the person and think highly of them from the way they discussed their work, say that. If they are someone who responded to a listserv request you made and you know nothing about them or their work, say that. Patients trust us to give them expert opinions, and if your expertise is limited the burden of disclosing that is on you.

4. When soliciting a referral, keep it brief and salient. Don’t pepper the listserv or discussion boards with identifying information or your subjective impressions. Age, presenting problem and therapist preferences (gender, takes X insurance, CBT) are enough. So often I see referrals for someone seeking a therapist for a patient who is “a lovely, very insightful young man who would be a delight to work with.” This is more of a sales pitch than salient data. None of your colleagues are probably hoping to work with horrid, clueless people who are a misery to work with, now are they? Nor do we really need to know that the referral is for the daughter of a good friend of yours. If this is a referral that will involve collaboration (such as one member of a couple you are seeing) by all means offer to share more information if the referral works out. But in the meantime, just the facts.

5. When possible, get feedback and use it to inform your future referrals. If you referred to a colleague to treat one of your individual patients for couples therapy, ask them how it is going or went. Please take this information seriously and do not dismiss it as transference. It may be transference, but remember your alliance is with the patient and erring on the side of caution. In my time I have had folks give me feedback that the people I referred to didn’t listen, feel asleep during a session, took their spouse’s side, smelled of alcohol, and a myriad of other concerning statements. Do I know for a fact that any of these stories were true? No. Do I plan on risking referring a patient to one of those people again, absolutely not. If the person you refer to is difficult to reach or collaborate with, bear that in mind for future referrals.

6. Talk to your colleagues. Ask them whether they are taking referrals, or what kind of patients they see. Ask them what their expertise is if you are unsure. Send them an email with brief and salient information asking if this sounds like someone they’d enjoy working with. And absolutely send them a note if you give their name as a possible referral.

7. If you don’t have or want to take the time to make a solid referral, then don’t make one at all. Too often our colleagues try to come up with a name rather than say, “I’m sorry I can’t help you.” Our graduate programs rarely train us to say that. But better you say that than misunderstand what a referral truly is. A referral is a thoughtful recommendation to a patient for a clinical treatment of serious concerns. If you don’t have time to give it sustained thought, understand the concerns or help needed, don’t give a referral.

Above all, please keep in mind that social networks are great for many things, and referring patients is not one of them. If the only thing you know about a therapist and their work is that they are in your “network,” what kind of qualification is that? Don’t confuse networking, marketing, or chatting with referring someone to therapy. If you were looking for a therapist and someone said, “I got an email the other day from someone saying they are taking on new patients,” would that be sufficient for you to make an appointment? Just because I’m in your Contacts or LinkedIn group doesn’t mean I am any good at therapy in general or for a patient in particular. I could be a complete wingnut.

Do you really want to take that chance with someone’s mental health care?

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: building your business, digital literacy, insurance, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, social media, technology, therapy

Happy New Year!

January 1, 2013 by langloimsw 1 Comment

As we start the New Year I wanted to share a quote I think applies to you:

“Talent hits a target no one else can hit; Genius hits a target no one else can see.”

— Arthur Schopenhauer

Going into the New Year, entertain the possibility that you are a genius. Whether you are a gamer playing first-person shooters, a therapist trying to build your private practice, an educator trying to reach students, or someone trying to live a good life, ask yourself: What are the targets you can see that other people can’t?

Don’t expect praise, people will think you are crazy for shooting into thin air. You may be bullied, insulted or ignored, but remember you are not alone. Find that person or group who believes in you even though they can’t see your target. Those are true people of faith in your life.

Does this mean you’ll be coasting? Nope. It takes practice allowing yourself to look for things invisible to most. It takes constant effort to hone your talent.

If you play Minecraft, think of 2013 as your new sandbox. 2013 is loaded with things you’ve not discovered yet. Any rock could conceal diamonds or ore. You will encounter creepers when you least expect them, lose things and have setbacks. But you can opt for multiplayer, and build in community. All of the materials are there for you. You may think you are starting with nothing, but you always have the tools to build tools.

If you keep at it you can change the world.

Whether you are a regular visitor or a loyal follower of this blog, thank you. In case you missed them, below are the 5 most popular posts from this year:

Dopey About Dopamine: Video Games, Drugs, & Addiction

Epic Mickey and Frittering

Gamer Therapy

How to Get Taken Seriously as a Mental Health Professional

Skyrim, Stealing & Sadism

Like this post? I can rant in person too, check out the Press Kit for Public Speaking info? And, for only $2.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, education, gamers, games, gaming, marketing, mindfulness, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, video games, Web 2.0

‘Tis The Season For Power Ups

December 3, 2012 by langloimsw 2 Comments

This time of year is for many of us a time of stress and reflection. The days get shorter and much of the time it seems as if we are wandering around in darkness waiting for things to change. We may be pursued by haunting images of past relationships and mistakes we have made. We may feel like we are doing things over and over the same way expecting different results. We may become painfully aware of our repetition compulsion even as we charge around trying to get something to fill us up. We may dread the end and fear death.

You all know I’m talking about Pac-Man, right?

No, seriously, by now everyone on the planet, gamer or not, must know that Pac-Man is not just a fun video game but a compelling spiritual meditation. First off, Pac-Man is walking a labyrinth over and over, focusing on his path, how mindful is that? And then there are the ghosts, don’t even get me started on them. They pursue him constantly, like the specter of death or the ruminating thought that can’t be shaken. They are constantly somewhere on the board with him, yet Pac-Man is essentially alone in the world.

This would all be pretty depressing if it weren’t for the power-ups. Traditionally there are four of them, in the form of larger blinking white dots in the corners of the maze. You probably recall the drill: Pac-Man runs away from the ghosts until he finally eats one of those power-ups. And then everything changes. The ghosts turn blue and run away from him, and he can eat them for more points. Yep, turns out Pac-Man applies good old Buddhist principles to the whole situation: He faces his fears, and moves toward them. As Pema Chodron would say, Pac-Man goes to the places that scare him and leans into the sharp points.

Ok, so back to you and your life, or your business or your family or your health, whatever situation or ghostly thoughts are running around the maze in your head. Let’s do some Pac-meditation on them:

1. Who’s chasing you? Take a moment to stop rushing around and ask yourself what are you worrying about? Are you legitimately busy or being hectic? Remind yourself that in this present moment, the people, places or things you may be avoiding are probably not really there in front of you. If you aren’t physically moving, then remind yourself of that with a breath or two. If you feel like you are moving and you really aren’t, gently remind your mind of that. And if you are moving, try moving like you are walking a labyrinth not running around a maze: purposefully, single mindedly. Mindfulness is the difference between a maze and a labyrinth.

2. Don’t let the bouncing fruit distract you. This time of year especially it is easy to get thrown off course because you can become fixated on one goal: The perfect gift, the perfect holiday dinner, the New Year’s resolution to change X,Y, or Z. Much of it is hype or a collective hysteria. Look again, there isn’t one special dazzling fruit (or pretzel) that you have to have to win. Nope, it’s just ordinary time, the present moment stretching out before you like a string of yummy pellets. Enjoy those quiet unassuming moments where everything is calm and sufficient.

3. Know your ghosts. Take a few minutes now to get to know your four ghosts. This doesn’t need to be all psychoanalytic. Just try to list off 1-4 things that are most pressing to worry about. The ghosts often have less scary identities than you may suspect:

Those are the traditional names, but now let’s have you take your ghosts and put your names on them. For example they could be:

Try to limit the ghosts to four–Remember, this isn’t Space Invaders. What are the most pressing urgent concerns? The goal is to get them down and begin to do what Michael White referred to as “externalizing the problem.”

Now you’re ready for…

4. Identify your power-ups. What are those things that help you feel more powerful, more effective? Some people identify a song that powers them up to go to the gym. A favorite quote can be your power-up. In my office I have one of those Staples Easy Buttons which some people find useful. My own personal power-up is an Iced Venti Americano at Starbucks. Sometimes power-ups are specific to the particular ghost you are dealing with, sometimes one power-up works for many different ones. This is not a new concept, people have been using talismans for years. Object relations folks would probably call power-ups “transitional objects.”

Last, but not least:

5. Use your power-ups. This is not as easy as it sounds. People often forget they have power-ups even after they have identified them. You need to make sure your power-up is ready at hand. If yours is an Easy button, you need to keep it at your workspace in plain view. If it is fresh orange juice you need to make sure there is some in the fridge. If it is a song it needs to be downloaded on all your gadgets. If prayer or meditation is your power-up put the cushion on the floor in front of your bedroom doorway. Enlist your partner or family members to remind you that you have these power-ups. Then use them no matter how silly it feels, no matter how hopeless you feel. Just. Use. Them.

This isn’t the only time of year you can use power-ups, but it is definitely a good time to start. Not because it is the holiday season, but because it is the present. Right now you are awake, so you can reflect and take action. The only person stopping you from logging off and figuring out your ghosts and power-ups is you: Game on!

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!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, building your business, cbt, game theory, gamers, games, gaming, mindfulness, pac-man, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, stress, video games, Web 2.0, winter

Avatars & The Curated Self

November 25, 2012 by langloimsw 2 Comments

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

Filed Under: Gamer Therapy Tagged With: adolescents, avatar, behavior change, building your business, call of duty, curated self, digital citizenship, digital literacy, education, Eve Online, gamers, gaming, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, rilke, second life, self-promotion, Skyrim, video games, Web 2.0, wittgenstein, World of Warcraft

Should Therapists & Social Workers Post Videos of Themselves on YouTube?

November 16, 2012 by langloimsw 2 Comments

http://youtu.be/pWQIbIkOVtY

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, children, education, Liz lasky, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social justice, social work, social workers, technology, therapy, video, Web 2.0, youtube

Taking An Interest

October 14, 2012 by langloimsw 2 Comments

This week I was at the dentist, and the appointment probably took twice as long as it was supposed to. This was because as I was waiting in the dentist chair, I was playing Denki Blocks on my iPhone when the assstant came in. She found the game interesting, and confessed to me that she didn’t know how to download games on her new iPhone. And as I was explaining how to do that, the dentist came in and he talked about how his children weren’t allowed to play games on the iPhone because they discouraged socializing. So then of course I explained that there was research that suggested very differently. He listened quietly and I said, “maybe I shouldn’t be arguing with someone who is about to put a drill in my mouth.”

“No, no,” he said. “It’s just that I’m thinking about what you said, and I haven’t thought about it that way before.” All three of us had an ongoing conversation between all the stages of filling a cavitiy, about smartphones, digital literacy, gaming. And at the end of it I noted how clearly this is a topic for our times if all of us can be talking and listening intently about it for such a long period of time.

In college, one of my creative writing teachers once said, “What interests you is interesting.” I think there is a lot of truth in this in general, and specifically when it comes to psychotherapy and running a business. I feel extremely fortunate to be in a portfolio career that allows me to pursue my interests and take an interest in the psyche and society. Not everybody has an easy or clear path to this in our society. Some self-help gurus make it sound like all you need is a burning interest to become the happy and successful, which is absolutely not true. There are millions of talented people out there that start off with less privilege and opportunity, and more stressors due to race, gender, poverty, or living in an ableist culture. But what I do think my professor was on to was the idea that often what interests you can be a strong motivator to yourself and exciting to others.

A supervisee and I recently were discussing the possible meanings and messages that could be conveyed in leaving a voicemail for a patient. After discussing this for 30 minutes, I interjected by saying, “Can I just take a step back and point out what a weird profession we’re in that we can spend so much time talking about this?” We both laughed at this, and it was true, but the time had gone by so fast because we were mutually interested in the subject.

Enthusiasm, in its original meaning, was taken from the Greek enthousiasmos, which came from enthousiazein, to be possessed from within by a spirit or god. That sense of a powerful force from within that can fill one with energy and ideas and lose track of time is at work in all of the stories above. It is not the only ingredient to having a successful business, but I believe it is an essential one. We need to be able to geek out about what we do, to go on at length about it. Hopefully we can do so in an engaging way, but we need to be able to lose a bit of self-consciousness to be able to focus properly on our patients, our work, and our business.

Frequently I consult with therapists who come to me because they want to grow their practice. A few of them say that, but what they really mean is that they want to make more money and work less. That is not in itself a bad thing, but for some it is an attempt at compromise. For they have grown tired or disinterested in what they are doing. They feel trapped in their work, not interested in it. They are afraid that they are too old to change, or don’t have anything else they can do. Some dream about a time they’ll retire and write a novel. But for now they are consigned to sit silently and voicelessly in their office. They grow bored and resentful of their patients, who if they are lucky, escape. This vicious cycle can go on for years.

The same holds for supervision. I have heard from a lot of supervisees about supervisions where it’s all about the paperwork, or the liability, or the billable hours. I’ve heard supervisors lament how they don’t have time to focus on talking about the dynamics of therapies, as if that was “extra” stuff! My experience is that these comments are voiced midway or at the end of a progression towards burnout. First the supervisor feels overwhelmed by the “musts” of paperwork and filing 51As, and then the supervision shifts to only being about those. Next, the supervision gets defined as merely being about that, so that the supervisee sees the supervisor rushing down the hall or on the phone, pausing to ask, “Anything we need to talk about?” If there is no crisis the student feels pressured and becomes trained to say no, there isn’t. And now that supervision is only about crises and paperwork, it becomes something everyone wants to avoid because it is boring, lifeless. There is no enthusiasm.

I would suggest this is ultimately a setup for malpractice. Supervisees trust supervisors who seem interested in them. Over and over I have heard that supervisees have a hard time connecting or trusting supervisors who are “just business,” or cheerleaders. Yes, supervisees don’t want a supervisor who lets them talk for an hour and then says, “sounds like you handled that well.” This bears saying, because sometimes we unconsciously or consciously try to substitute affirmation for engagement and interest. If you’re a supervisor, don’t do it, because your supervisees can smell it a mile away. If you’re vacant, they know it. If you are filled with the spirit of interest, they know that as well.

I’ve had colleagues tell me how clever I am to have found the niche I have, which drives me crazy frankly. I didn’t choose to focus on technology, gaming and social media in therapy because I saw a vacuum. I was just lucky that there was one. I chose these areas of specialty because I am a total geek about them. I could play or talk about video games for hours. I can’t talk about Twitter or Google+ without getting animated. I see their influence everywhere, read vociferously about them on my “free” time. I wrote a book about it which I charge $2.99 for. When asked to teach a class on clinical practice I declined, and said, “No, but I’ll write a syllabus and teach a class for social work and technology.” Any of you who have taught at the graduate level know that teaching from a pre-existing syllabus is easier and less time-consuming than writing and proposing a pilot course. But I was enthusiastic about the topic, which fueled my work ethic. And this has set up a virtuous cycle, where I get more recommendations for reading or TED Talks than I can handle, and referrals to work with those patients.

I’d be lying if I said I didn’t hope someday to become famous or rich, but it is more likely that I will make a decent living and have a modest reputation. Because as I said there are thousands, no millions of people out there who have talents and interests to share with the world. I’m just grateful I got lucky enough to be one of the ones who got the chance to do it.

Filed Under: Gamer Therapy Tagged With: building your business, education, gamers, games, gaming, interest, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, supervision, technology, therapy, twitter, video games, Web 2.0, World of Warcraft

Contributing

September 27, 2012 by langloimsw Leave a Comment

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Filed Under: Gamer Therapy Tagged With: building your business, extra-life, gamers, gaming, marketing, private practice, social justice, social media, technology, video games

How to Get Taken Seriously as a Mental Health Professional

August 8, 2012 by langloimsw 8 Comments

Many therapists looking to start or grow their private practice often wonder the same question when they are starting out: How do I get referrals? If you can tolerate a mild rant, I may have one answer for you.

Let’s look at this concern through a tried and true mental health paradigm. First, we take a symptom, and then we look at the underlying conflict that the symptom represents.

So what’s the symptom? That’s easy, head on over to LinkedIn and take a look at several profile pictures of colleagues. Go ahead, I’ll wait. What did you see? When I looked I saw some professional headshots, but more of the following:

blank photos
top of head/ chin cut off
people in front of a car
waterfalls
tank tops
the “I’m holding my phone camera at arm’s length” shot
at a party
graduation gown
flower
too dark to see
wearing sunglasses
skiing

If you want to generate referrals, this may be a problem. Some colleagues may have a different opinion or be too diplomatic to say this, but let me not mince words. If you don’t have a professional headshot it is doubtful I will refer to you. I don’t send people to waterfalls for psychotherapy. I suspect people wearing shades of paranoia or vampirism. I envy people who can ski much too much to ever want to help them grow their business. Cars in photos are either nicer than mine or too shabby, triggering too much judgment either way. And party-goers scare me. 😉

My experience as a consultant has been that these headshots are symptomatic of one of two scenarios:

1. You don’t take social media seriously. In this day and age, our potential patients want to see us before they see us. They often do their research by checking out our online presence. If you go on LinkedIn for example, you may find that several people viewed your profile this week. A picture is worth a thousand words. I have seen great head shots in black and white, or even avatars for online therapists, so it doesn’t have to be a standard color shot. But the way technology works now, whatever picture you choose will most likely attach to your emails, tweets, blog comments, posts, and feeds of all kinds. There are exceptions to this, like my colleague Social Jerk, who needs to maintain a tight hold on her anonymity to allow for her to create such creative and satiric posts about social work. But if you are not trying to be a satirist, but rather grow a therapy practice, this will not work for you. And if you’re on Twitter, please don’t be an egg. When I need to jettison followers to follow additional people, the eggs are often the first to go. Accept that social media is the point of professional first contact with your colleagues and customers. Take it seriously.

2. You don’t take yourself as a therapist and businessperson seriously. Anyone that has read this blog or chatted with me at a workshop can probably tell you that I am neither dour nor constantly serious. I certainly think there is a lot of room in our profession for humanity, play and creativity.

That said, we are in the business of providing treatment for serious concerns, working with people who have a range of predicaments. We assess for suicidality, psychosis and trauma. Your patients come to you with vulnerability and hope that you will help them create profound change, recovery and healing in their lives, maybe even help them stay alive. If you think that therapy is just two people in a room chatting, then by all means keep the beach picture.

To get a professional head shot requires investment of your time and money. It is a business expense. If you are unwilling to invest in a professional image to represent your business concern I suspect you are not ready to own and run a business. If you are unwilling to invest the time to look through your existing photographs and select one (if you have it) that presents a professional demeanor online then I suspect you are not ready to own and run a business.

Now I know that the term “professional” photo is vague and subjective. I am not saying that you need to be in a suit and tie. You can be a play therapist and have affect like my colleague Charlotte Reznik. But slapping up a blurry photo of you near a palm tree sends the message that you can’t be bothered to represent yourself or your brand. And in business we need to be concerned about our brands, even as therapists.

Look, I’m not saying these things to hurt your feelings. I really want you to succeed, and I know that there are a lot of people out there who need your help. That’s why I suggest that the photo is the symptom of an underlying issue, which is the difficulty to take either technology or your business seriously. If you have taken time and consulted with trusted colleagues and have come to the conclusion that “I want potential patients to see me as someone blurry whom they could go skiing with” is your brand, and that the head shot is a conscious and intentional image to brand yourself online than you have my blessing.

If not, get thee to a photographer.

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall. You can find out more about it here.

Filed Under: Gamer Therapy Tagged With: building your business, education, linkedin, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, technology, therapy, twitter, Web 2.0

Post to a Young Therapist

August 1, 2012 by langloimsw 3 Comments

I’m a big believer in twofers. When you run your own business, twofers are essential. So when I get several emails about a topic I try to craft a post in response. Recently I have been getting emails from many therapists or therapists in training who want advice on how to pursue a career as a gamer therapist. Many of them grew up playing video games and have a lot more comfort and familiarity with them than their therapists who have been around for a bit.

Take Claire for example, who has graciously allowed me to share an excerpt from her email to me:

For most of my life, both video games and service to others have been passions of mine. I’ve recently been working at a game company in XYZ, and have been immersed in the gaming culture more than ever. The more I see it (and experience it first-hand) the more I see a need for therapists who can address the issues so many gamers face as a result of their passion.

Before today, I had no idea if anyone had pioneered this field of study, of if there was even a place for it. And then I found you. A quick perusal of your website tells me that you and I are very much aligned in our beliefs about how games affect us, and why they matter. Seeing that you have crafted this job for yourself inspires me to look further into the possibility of knitting together these passions of mine.

Note the use of the word “passion” here. I hear from these younger folks how their interest and curiosity around video games and technology in general is met with skepticism and often hostility. Supervisors turn into lawyers before their very eyes and begin every conversation about technology with the words “HIPAA” and “liability.” The only question asked in the exploration of patient’s video game is “how many hours are they on the computer?”

Part of the problem with this disconnect is that many up and coming therapists become inadvertently ashamed of the fact that they are gamers themselves. The implicit or explicit pathologizing of video games and tech use shapes the behavior and expectations about whether discussing gaming, or even using it as an intervention, stops before it begins.

Those of us who have been in the field for a while can often become set in our ways. We can act as if education and the workplace haven’t changed much since we started our practice. Insulated in our office and routine, we stick with the phone, maybe email, and play therapy games that have changed little since the 70s. With this stance we are not prepared to work with patients in the 21st century, let alone supervise 21st century trainees.

If you are training to be a therapist, here’s what I recommend if you want to be a gamer therapist:

1. Start from Within

Repeat after me, “It is okay to experience excitement and enjoyment when I am working with patients.” Somewhere along the line our graduate programs have begun to give you the message that you are supposed to be an evidence-based automaton with little emotional investment in treatment. I have had students who have heard dozens of times in their training ideas like “emotional detachment,” and “inappropriate boundaries;” yet not once has anyone talked to them about feeling excited and enjoyment in their sessions. Even trainees doing play therapy express guilt or fear about getting “caught up” in the play. You’d think we were supposed to spend our entire careers with dull, depressing people! Allowing for a range of emotional experience with patients means the whole range, including excitement and fun. So if you are going to be a gamer therapist, start building your capacity to enjoy yourself in sessions.

2. Create A Gamer-Affirmative Environment

Did you know that research has suggested that 1 out of 4 comic book readers are age 65 or older? Yet how many offices have comic books for their adult patients alongside People and Time? The same is true for video games. Geeking up your office and waiting room sends the message that you don’t equate video games or technology with “toys.” In my waiting room I don’t have comic books currently, but I do have Wired magazine and titles devoted to video games. Many conversations have begun as a result. I also have a Deathwing statue and other game-related memorabilia. Recently someone saw a Post-It I had with the word Katamari on it. I had made a note of the game to remind myself to check it out. That Post-It was all it took to begin a very excited and meaningful conversation about the game (which has a free App, by the way.) The smallest changes to your office can convey that you are interested.

3. Try (and I mean play) lots of different video games

This is the fun part, usually. I have the major game platforms and am always trying one or two new games a week. If a patient mentions a game in a session, I make a note to try it ASAP if I haven’t already. Sometimes this requires discipline, because like most people I don’t like every sort of game. But each game I test out helps me understand the patient better.

4. Have video games in your office

I have always had handheld video game consoles in my office, but in addition I have an XBox 360 as well. I don’t think you can be doing contemporary play therapy well without it.

5. Disclose that you play video games

The fact that you have game consoles probably implies this a bit, but let’s be explicit. Regardless of age, 64% of Americans play video games, and the percentage is much higher under 40. So if you have played video games, disclose that you have. If you have a supervisor who sees that disclosure as more akin to “I smoked pot as a teen” than “Yes, I saw Star Wars” run away. Video games are an art form not a controlled substance, and there is a big difference between those two conversations.

6. That said, be on the lookout for countertransference.

Whether you like or hate, play or avoid, video games, you need to be mindful of the reasons why and when you talk about aspects of it. If your patient is telling you that they managed to fish up the giant sea turtle in WoW, it is an empathic failure to say, “Yeah I got that last week, isn’t it cool,” rather than to reflect to them what that says about their persistence and discipline. Note any feelings of competition you have (or don’t have) and wonder about it.

7. Get good supervision, even if you have to pay for it privately.

One of the downsides of licensure having a (in MA) 2 year post-graduate supervision requirement before you get your independent license is that it inadvertently sends the message to fledgling clinicians that after two years you don’t need it any more. That is not true. I encourage new therapists to consider ongoing supervision of some sort to be a business expense to build right into your practice. I had the opportunity to have weekly supervision for free at my workplace for 12 years. That sort of job benefit has gone the way of the milkman in many places today. This means you’ll need to buy some.

If you buy private supervision, remember that it is a different experience from your earlier or agency experiences with it. This is not your boss, you are hiring them. Hiring people means interviewing them, and screening them for fit. If they are technophobic they are not going to be a good fit for a gamer therapist, so it is important to let them know your pro-technology and gaming stance from the beginning.

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall. You can find out more about it here.

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.
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Filed Under: Gamer Therapy Tagged With: adolescents, building your business, children, education, gamers, games, gaming, katamari, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, video games, Web 2.0

When Wallflowers Attack

July 13, 2012 by langloimsw 10 Comments

Back in graduate school, my group therapy professor once said to me, “early risk-takers are often scapegoated by the group.” This comment came on the heels of yours truly taking a risk in the group, a group of psychotherapists in training. I learned two things in that group class on that day. The first was that early risk-takers are often scapegoated. The second was that we therapists can be just as cruel with our comments as anyone else.

This is something that many of my supervisees encounter when they start to put themselves out there, especially on the interwebs. They are stunned when the blog post they write elicits comments that are sometimes shocking in their nastiness. They are confused as to why this happens, and what to do about it. If you are beginning to use social media to build your psychotherapy practice, write newsletters, prepare a public speaking campaign or just write a blog, this post is for you.

The internet has made it easier to be both impulsive and anonymous, and emboldened some people to hurl invectives. I call these people the wallflowers. These are the people in any given group who are afraid to take risks or stand out, and resent those who are brave enough to do so. They are quietly resentful, and more often than not envious of people who are not quiet. I’m not talking about introverts here, but rather a particular group who stand on the sidelines seething.

These are the people who send you a nasty email at 2:00 AM criticizing your post for a spelling error, or the folks who text really ugly comments to you after you post something on a listserv they don’t like. They’re the people who make personal attacks on your workshop evaluation in the guise of constructive criticism, or bait you in discussion groups by deliberately misconstruing your words. Yes, I’m not making this stuff up, all of these things and worse have come at me by email, Twitter, Facebook, blog comment, and text message. The majority of the time it will be behind the scenes of whatever arena you’re in, so that you can see it and the larger group can’t. Consciously or unconsciously, wallflowers are counting on you not passing these barbs on to the larger group. Nobody likes a tattletale.

So what do you do about them?

First, take a second and calm down, and note that the intensity of your response is probably an indicator that this is out of the ordinary. Next, try to find a trusted friend or family member that you feel comfortable sharing it with, and ask them what they make of it. Supervisors are often really helpful here. Often they will react more strongly then you did, which gives you another clue its a wallflower attack. Your inclination may be to try to learn something from the comment. I’m going to say something that may go against the therapist grain here–Dismiss the comment and the wallflower. Don’t bother trying to make this into a growth opportunity, there are plenty of other growth opportunities out there for you. Don’t give this your energy.

In my experience this is very hard to do, because therapist wallflowers have a lot of skills to hook you. They bring their therapeutic arsenal and try to come at you as a therapist, by analyzing or interpreting you. Don’t fall for it. Just because you both speak the same language doesn’t mean you have to have a conversation with them. Therapy is a specialized and voluntary form of conversation, and anyone who tries to inflict this on you unasked is using their Jedi therapy powers for ill.

This is your reminder.

This is the price you will have to pay for being an innovator and a risk taker. Early risk takers are often scapegoated. You didn’t do anything wrong, you were just putting yourself out there. And every time you do that, you will run the risk of a wallflower attack. Don’t overprocess it, move on. And definitely don’t let it stop you. Remind yourself that the reason they had anything to attack you about is because you’re doing something they wish they could, creating. Anyone can ping off a blog post, or fire off a Tweet in reaction, but it will only be a reaction, not a standalone.

Remind yourself that your ideas are precious. I’m not trying to sound New Agey here. What I mean is that the fact that you had something to put out there is not to be taken for granted or underestimated. You could have not had the inspiration for that workshop or podcast, but you had it. All over the world there are people who have not given awareness to ideas, throughout history millions of good ideas have never been expressed or seen the light of day. Not you. You did it! And if you stop taking risks the wallflowers win, and the prize is one less idea in the world. Yippee.

I know this can be hard to do, trust me. And the technology we have today has made it even easier for wallflowers to attack. It’s sort of like that sense of invincibility drivers get when they are encased in the protection of their cars. Shake it off. Share it with someone you trust for perspective. Dismiss it. Stay focused. You can take time to smell the roses, but don’t get distracted by the wallflowers.

Filed Under: Gamer Therapy Tagged With: buddhism, building your business, facebook, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, twitter, Web 2.0

The Perilous Price of a Good Living

June 30, 2012 by langloimsw 6 Comments

Recently I had the opportunity to talk with a group of young clinicians, and very bright young clinicians at that. We were discussing the role of class in psychotherapy, and how to understand it psychodynamically. I was demonstrating to them how difficult it was for therapists to talk about money, by asking each of them what they would set their fee at. The majority of them were extremely reluctant to give a dollar amount, and it was striking to me that the dollar amount was almost to a penny what a leading insurance company set their allowed fee at. But the most troubling response to me was “enough to make a good living.”

I imagine you’ve heard this phrase frequently–like me, maybe you’ve said it yourself from time to time. It is a throwaway statement, which tells you nothing really about what kind of living a person wants or how much money they need in a capitalist society to make it. Amongst professionals it is the “Whatever” of salary statements.

Pushing folks, I usually get a comment about “having a good home,” “enough to comfortably support my family,” etc. These are similarly throwaway statements, but they indicate to me what continues to be considered socially acceptable when talking about money in mental health. It is ok to want to make money if you only use it to support and shelter your family. Maybe a vacation, but let’s not push it. In her 1994 article “Money , Love, and Hate: Contradiction and Paradox in Countertransference,” Muriel Dimen refers to “Puritanism’s conflict, in which hard work and thrift are valued, but their material rewards may not be enjoyed.” In other words, what most psychotherapists consider a good living.

Often when working with consultees who are giving everyone a sliding scale fee and often acting out in their countertransference as a result of it, I work with this Puritanism, rather than combat it head on. I’ll ask them to take a photo of their children, partner, any loved one who depends on them, and keep it visible to them in their office from where they usually set their fees. These are the people, I tell them, who will go without because you have issues about your fee. You may think you are being noble by sliding down all the time, but these people are bearing the burden of your nobility.

Am I saying you shouldn’t have a sliding scale fee? Well yes and no, actually. I certainly have 2 slots where I slide my fee. Exactly two, because that is what I have determined in my business plan I can afford. And if someone is going to be offered one, I always go over with them their financials. So if you have a business plan, and if you can have a concrete conversation with your patients about how much money they make and expend in their life, you have my blessing, you can have a sliding scale. But if you have not taken a good look at how much YOU need to make, what your plan is to earn money and have pro bono, and if you can’t bring yourself to talk about a patient’s finances, I don’t think you should have a sliding scale. In fact, I’d suggest you should really only work in an agency and/or cap your fee at what Insurance Company A tells you are worth.

Because that in fact is how this got started in many ways. We lament how exploitative insurance and public agencies are, but the reality is they provide us with a buffer from the conflict of having to talk with our patients about money. Many of us make the third party the “bad guy,” because we don’t want to sully our therapeutic conversations with the topic of money. Sex, sure. Incestuous fantasies or homicidal impulses, no problem. But cash? Forget it, that’s too tough to talk about.

Like many of you, I am very pleased that we have passed the Affordable Care Act this year, but I am equally happy that I don’t have to be limited to seeing patients via insurance. This is the difficult paradox many of us try to keep secret: We want everyone to have access to health care, but we don’t want our incomes capped by those rates. Not everything our patients come to see us for is medically necessary treatment. Some of it is quality of life and personal insight, and maybe our patients should pay for that themselves. This may sound like a two-tiered system, and that’s because it is, and in my opinion you will see this two-tiered system get acted out as soon as we switch to a medical home, global payment model.

For me a good living is not having a home and enough to support my family. I want an XBox, and an iPad, and someone to help me clean my house, and vacations and my Starbucks as well as some other things that even I am reluctant to admit. I want things that exceed a comfortable lifestyle. Maybe you want these things as well, or a yoga retreat, a summer home or a pony, I dunno. Take a look at cable TV sometime, and ask yourself why there is such a proliferation of reality TV surrounding making/winning/wheeling/dealing so much money. Our voyeurism betrays our fantasies. But Priscilla or Myles, our inner Pilgrim, still trips us up, and we are afraid to admit exactly what we want as a good life.

In case you think that I have exorcised Myles from my psyche, let me assure you I still struggle with wanting, having and making money. In a way, my evangelizing on this could be a reaction formation. But it is a feeling, and I can’t let a feeling get in the way of understanding myself and being ethical.

You see, I’m with Plato and Socrates on this one. Socrates defined the good life. The good life is the examined one, the life lived in pursuit of knowledge and consciousness. Socrates doesn’t really talk about money when he talks about the good life, but he does make some interesting points about virtue and how knowledge leads our virtuous behavior. Not what you feel, but what you know.

Sounds simple, but it isn’t. In Meno Socrates describes how important perplexity is in the process of attaining knowledge, and hence ethics. Perplexity is struggling with the contradictions to try to make sense of them, like “I want to help people,” and “I want the iPad 3.”

Periodically I re-evaluate what I want in my life, because my wants, my needs and my financials change. My financial limits are clear to me, and not always in accordance with those of others. For example, my billing company thinks that I shouldn’t allow balances higher than $200 to be carried. I consider $400 to be my limit. It is up to me to struggle with and get clarity on these things if I want to own and run a business. And money runs through and beneath my business. If I want to take a day off, my boss is pretty stingy. I rarely take sick days. I have a 48 hour cancellation policy that is much more rigid than many colleagues, but not as rigid as the week cancellation policy of some. I can live with all of that, I’ve thought it through. I don’t hide behind the vague salve of “making a good living,” I struggle with the perplexity of my needs and wants, the moral implications of them, and how to live ethically in the context of that struggle.

In many ways, that’s what I call a good life.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, HMOs, insurance, managed care, marketing, mental health parity, private practice, psychodynamic, ROI, social justice

Optimism

April 21, 2012 by langloimsw 11 Comments

This week I had the opportunity to meet with a group of college students who are on academic probation. There were supposed to be over 20 in the class, and 10 showed up, 5 late. One of the the things I was struck by initially was how subdued they were, and I suppose I can’t blame them. The class they are in, on how to succeed in school, meets twice a week in different locations at the college, half the time in a basement computer lab even though they won’t be using the computers. If they don’t pass this class they are out of the school altogether. There was something discouraging about the whole setup.

When I asked them how many of them played video games, they all did. Most of them had played their favorite game as recently as this past week. And when I went through the room and asked each what they liked playing, I was taken by how for a moment their face would brighten and they’d smile, even make eye contact. Probably the most memorable moment for me came after I shared with them the statistic that 80% of the time we play a video game we are failing at it, and asked them to think with me about why we can tolerate failure so much in video games yet have so little tolerance of failure in other parts of our lives such as school. What was different with a video game?

One student, I’ll call him John, raised his hand and said, “I might win.”

What a sad commentary on what education can do to students who don’t fit a certain mold. Somewhere along the line, John and thousands like him have lost a sense of optimism, a sense that they even have a chance to win at life. And yet, throughout the one and a half hours I was with these students, every one of them participated, had really interesting comments, argued and engaged with me. The last holdout was a guy in the back row. I asked him what he had learned so far today about video games and our discussion.

He sunk a little into his seat, and said, “I’m drawing a blank.”

“Let’s take a minute,” I said, “and let’s assume optimism. Because you can add something to this discussion. I know you can. What have you learned in here today?”

Long pause.

And then he said, “self confidence.”

I should add, and did say to the class then, that we hadn’t even brought up that key concept to academic success yet. If he hadn’t have added it, we might not have ever gotten it into our discussion. Each of them had unique ideas, worthwhile ideas, not all of which we agreed with, but ideas nonetheless.

It takes optimism to risk answering a question in class, start a business, go to therapy, or play a video game. Without optimism we won’t risk trying and failing, and without trying and failing there can be no innovation.

Take a second and think about the world around us. Is it perfect in every way, or would you like some things to change? If you think it is perfect we’re done here.

But if you think that the world can be a better place, for people and all sentient beings, then you’re thinking something needs to change. Maybe you think racism needs to change. Maybe you think poverty and starvation needs to change. Maybe you need to be a better parent or partner, or learn more about something in school. Maybe you want a better job, or want to create a work of art. Maybe you want to better understand what it all means and how to fit in? Maybe you want your daughter to have a better life with more respect, maybe you want your son to have a better future. Maybe you want a war, all war, to stop.

Nothing gets better without change, and risk of failure. But to risk failure we need to think we can win. To fail and try again we need to think we could win this time. Optimism improves resilience and changes our body, according to dozens of studies done by Seligman and other positive psychologists. And optimism can create a more conducive learning environment.

Optimism, in my opinion is not simple delusion, or a brain defect, as some would say. Yes, we might fail, but let’s not let that get in the way of making an effort. Yes there is a lot of suffering and injustice in the world. We’d better get busy.

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.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, buddhism, building your business, children, education, failure, gamers, gaming, hope, optimism, positive psychology, psychodynamic, psychology, psychotherapy, resilience, seligman, social justice, stress, video games

Thinking, and Just Thinking

March 20, 2012 by langloimsw 5 Comments

Originally I was going to title this post, “How to Make A Million Dollars as a Therapist Without Ever Having to Talk About Money.” And if I was just concerned about driving traffic to my blog and business, that would be the title. Because there are a lot of our colleagues out there who want to have a very successful business without having to deal with the sordid matter of coin. I used to think this was the number one reason that psychotherapists have a hard time being successful as entrepreneurs. I used to read, and agree with, several psychodynamic articles that have been written by colleagues which talk about how we feel shame around money, project our devaluation of ourselves by refusing to spend money on coaching or supervision, and have difficulty set fees and enforcing missed appointment charges with our patients because we feel that we don’t deserve to make money for our work.

I still think those are big hangups a lot of us have, but recently I’ve started to suspect that an even bigger one is our fuzzy thinking about thinking.

Therapists as a whole love to think. We like thinking deeply about our patients. Many of us love working with emergent adults in a large part because their neurology has finally blossomed and they are starting to reflect on their thinking. We often enjoy studying and debating the thoughts of major theorists. We even see the value of self-reflection in our work with patients. We like to think about others, the thoughts of others, our thoughts about the thoughts of others, and what great thinkers have thought about the thoughts of others and our thoughts about them. Boy, do we like to think about thinking.

Now I am no exception to this. I see an immense value to thinking, in fact I schedule time during my daily work week where I walk around the Charles and think. During this time I don’t take calls, I don’t check email, I don’t make appointments. I think. I intentionally schedule it during the day to remind myself that thinking has a critical place in my work, and has as much if not more value than a billable hour. And I will often lament to colleagues in academic settings about the need for more critical thinking skills. I’ve had colleagues critique my wanting more theory classes at BC by saying, “these students want classes that give them practical tools that they can use,” to which I respond, “how about thinking? That seems like a pretty good tool to me, when did we stop considering it practical?”

So I am not intending to come across as anti-thinking here. But I have noticed over the past several years who succeeds in getting their private practices off the ground and thriving, and who doesn’t. And the ones who fail are usually the ones who come to consult with me, or then need to “think about it.” I’m very concrete when I talk with consultees, and if they are in job crisis I call it that. I’ve worked with people whose incomes have shrunk by halves over the past several years. I tell them what has worked for me, and offer suggestions, and the suggestions require things like calling people to network or EAPs or insurance providers every day or write a business plan, or any number of other things.

They listen and say they’ll think about it.

Some people will make a lot of money off of those folks. There are dozens of people out there who can tell you how to “visualize” your ideal client, “ideate” abundance, or give you a 5 point plan to success. I’m not one of those people, and so sooner rather than later the conversation peeters out. Because they have a hard time moving into doing something other than thinking and talking. Maybe they’ll write a blog post or tweet a few times, but they get discouraged, because I’m not going to waste their time. This isn’t therapy. I’ll tell you what I think you ought to do. You don’t have to do it, but I don’t have a second set of things I think you ought to succeed in your business. So if you don’t want to do them, we really don’t have a lot more to talk about.

A lot of therapists, myself included, like to try to think and talk our way out of everything. And many things can be significantly impacted by strategic thinking, and thoughtful process. But eventually you have to do some other form of work if you want to be in private practice. We have more autonomy as sole proprietors, but we also can’t just sit in an office hour after hour “just helping people.” This is actually the fantasy I often hear expressed by colleagues, “I just want to help people,” as if the nobility of that entitles one to not have to exert any other effort.

One of my friends has a mentor who frequently says, “don’t confuse worry with effort.” Much of the time I think we confuse worrying with deep thinking, and even more so with taking other forms of action. We think if we worry about a problem either alone or with another that somehow that “counts” as having done something. The idea of sustained effort truly alarms us. I’m talking about me too here. One of the reasons I have a set time in my week to think about things is so that I contain that urge to think fretfully and know that there is a time and a place for me to think about stuff. And then I go on to other activities that are required of me during the day.

Another reason the Charles river is such an important place for me around this is that it is where I run. During the week I walk along it and think, and on the weekends at least once I run along it. But, and this is key, I don’t go to the Charles and think about running.

I can really only tell you what works for me, and incessant and indiscriminate thinking does not work for me, or my business. If someone tells you that there is an easy, simple way to succeed in creating and growing your practice, I encourage you to be skeptical. Creating and growing your business involves taking risks, trial and error, and most importantly sustained effort that is not entirely cerebral. My experience has taught me that you won’t think your way into a successful practice, but you may succeed in thinking yourself into a bankrupt one.

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, business, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, therapy

Protect Your Online Privacy: Start Blogging!

February 9, 2012 by langloimsw 8 Comments

Many therapists have lamented about the lack of privacy the internet has created. More to the point in my view, the internet has taken away the veil of secrecy psychotherapy has frequently sought refuge behind. It used to be that the anonymity of large urban areas, or the possibility of a commute to the suburbs insulated therapists from their patients after the analytic hour came to a close. I friend of mine once went for years before discovering that Therapist A, who had referred him to Therapist B when treatment was stymied, was actually married to Therapist B. They did not share last names, but my friend in a moment of high curiosity and low impulse control drove over to Therapist A’s home address and discovered Therapist B’s name there as well. He terminated therapy thereafter.

For myself, I learned that privacy is to a large extent illusory, not from the internet, but from my first job. I worked in a community mental health center on a 13 mile long by 7 mile wide island which was 2 1/2 hours by boat from the mainland. You get used to a diminished sort of privacy on an island. I couldn’t avoid my patients if I wanted to, unless I wanted to avoid the library, most restaraunts, coffeeshops, the beach, or the one movie theater we had in the winter. Nor could I find privacy in limiting the type of work I did there. The Community Mental Health Center was the only one on the island. We were responsible for, and I did, school counseling, Psychiatric hospitalizations (which involved flying with often psychotic people in a Cesna six-seater airplane,) outpatient therapy, Alcohol counseling and DUI classes, drug testing, and court-ordered counseling for domestic violence perpetrators. I can still remember how when a colleague and I went out to dinner at a local pub one night one-third of the people at the bar left. It wasn’t just my privacy that was affected here.

You have a choice in situations like that. You can hide out in your house with a cat and television (which I did at first) or you can start living your life in the community and negotiate boundary crossings on a case by case basis (which I settled upon as my strategy.) I learned to cultivate a sense of never-too-uptight-never-too-relaxed when I was in public. It became second nature in many ways.

When I moved to Cambridge, MA, it felt very anonymous by comparison. But as many practitioners in “The most opinionated zipcode in the US” will tell you, Cambridge is really a village in many ways. I still ran into people, and by this time, technology was becoming more of a factor.

As Thomas Friedman has observed, “The World Is Flat” in the 21st century. Globalization and technology have removed many of the barriers to, and some would say protections from, knowing each other. Our patients can Google us, Yelp hangs up a business page of us whether we like it or not, and are often only one Facebook friend away from connecting with us.

Even if you want to make the poor business decision of staying off the internet in terms of a website, eventually your contributions to the Democratic Party, your address, and notes about you in your alumni magazine are still going to find their way out to the world. We’re all on an island today.

So what can you do? Well, my advice is to start blogging. I know sounds counterintuitive, but it makes sense on a number of levels:

1. Buddhism tells us to move into the places that scare you. We exert so much energy trying to avoid things, find a spot where we can stay safe and stop the awkward and uncomfortable learning process. And yet we ask our patients to do the exact opposite so often: to look underneath those rocks, descend into the depths of the psyche, face their fears. Our obsessive quest for privacy is perhaps not that different.

2. Make the internet work for you. One of the best ways to protect your privacy is to generate a lot of content that you consciously know is public-facing. Google “Mike Langlois, LICSW” for example. Go ahead, I’ll wait. What came up probably is pages of my website, professional picture, Youtube videos, and blog posts. Dig a little deeper and you’ll see me commenting on a few blogs. This is the practice of radical transparency. All of that content was written with all of you in mind, my patients, colleagues, friends, family members, potential coaching clients, high school classmates, potential employers, my future children and grandchildren and the FBI. The way Google and other search engines work, the more content I put out there that is public, the further back any unintentional pieces about me will be. By embracing that the world is flat I have learned to cultivate a style that I can negotiate in my work life while still feeling authentic. And it is great advertising, or fair warning, if you are considering working with me.

3. Radical transparency protects your patient’s privacy as well. Whether we like it or not, therapists are finding themselves on review sites like Yelp. Yes, anyone can post a review, and no, Yelp will not taking it down if you ask. More importantly, your patients might not understand the ramifications for their privacy or PHI if they post a review. Keeley Kolmes has great resources on this, and you are welcome to use my version of her version as well. Take a look:

Notice that half of my allotted space is not advertising, but a direct message to any potential commenters. Rather than hide out and try to get Yelp to take my name down, I have used it as a platform to market my business, model what I feel is ethical professional standards, and provide some information to patients in the spirit of informed consent. Do I want to get bad reviews? Of course not, who does? But that is not an excuse to hide my head in the cybersand.

4. Last, but not least, get over your bad self. Sometimes listening to our colleagues you would get the feeling that they are dealing with the paparazzi, not the public. Sure patients and others may be curious about your life, but really most people in the blogosphere just aren’t that interested. On a good day, my blog gets 200 views, on an amazing day last August I got 689 views. There are 7 billion people on the planet. Feel free to correct my math here but according to my calculations that means on a busy day 0.000009842857142857142% of the people on the planet are checking out my most visible presence on the internet.

Am I saying you should blog for the sake of blogging? No. I am saying that there is a Copernican revolution going on in the 21st century, and therapists need to join it. Rather than avoiding technology and the internet we need to start understanding it and harnessing it. You can be googled whether you like it or not. Yelp doesn’t care about contaminating your transference.

Being professional is about how we rise to the occasion of Web 2.0, not deciding to skip out on the party.

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.

Filed Under: Gamer Therapy Tagged With: behavior change, blogging, buddhism, building your business, HIPAA, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, Web 2.0

How To Get An Epic Supervisor

January 25, 2012 by langloimsw 6 Comments

Education shapes our expectations of life and work, and education as it stands currently always involves giving up some degree of personal power. When we’re in elementary school we need to ask permission to leave to use the bathroom. In high school we need to show up at times diametrically opposed to our circadian rhythms. At college we have required course to complete our degree. And in graduate programs for clinical psychotherapy we often have limited to no control over who our supervisor is going to be.

And then when we graduate, we take our cue from licensure boards to a large extent. Sadly, license requirements shape our expectations of supervision. We see it as something we have to have in order to get our license in X number of years. I have noticed that there is a sharp decline in people buying supervision after they get their independent licensure, which does not mean that there is a correlative decline in our people needing it.

So today I want to talk about how to pick a good supervisor for you to have ongoing clinical supervision. If you are still in pre-independent licensure this can be an especially daunting experience, but also an incredibly freeing one. To be clear, you don’t have to purchase private supervision from anyone you don’t want to work with! Read on for some tips:

1. You often get (or don’t get) what you pay for (or don’t pay for.)

If your agency offers you a good supervisory package for free that is great. One place I supervise at provides employees and interns with a free secondary supervisor. Secondary supervisors are the ones who can usually help you most with integrating theory and practice and discussing difficult cases. Most primary supervisors I know may have good skills and an interest in doing the same, but they don’t have the time. Their role has become reduced in the age of managed care to helping you learn the ropes about paperwork, facilitating your first emergency room or child protective referrals, and being held responsible for holding you responsible for productivity. So although these hours count towards your licensure they don’t necessarily deepen your practice for lack of time, not skill.

So now you have some choices. You can take a fellowship or position at an agency that provides secondary supervision, or you can buy it privately. Don’t get caught in thinking it is an entitlement, because those days are gone. Yes, we’re underpaid as a profession, but I suggest you think of good supervision as a benefit valued at between $7200-$9600. If Agency A offers that, but pays less $5,000 less than Agency B, which doesn’t, you are getting a better deal at Agency A.

2. You may already have met your supervisor, but don’t know it yet

If you are one of the many folks who decides to buy supervision privately, take some time to think about the people you’ve worked with already. Did you enjoyworking with your first year placement’s supervisor? Call and ask her if she offers private supervision. Did you love a certain course in grad school? Call and ask him if he does supervision. If they don’t, ask if there are any people they can suggest. Think back to guest lecturers, colleagues you enjoyed working with, that alum you met at an event.

3. Do your research

In this day and age, everyone should have a LinkedIn profile (more on that in a bit.) Mine includes several recommendations from past or present supervisees. Make sure you Google your potential supervisor prior to making an appointment. Yes, Ms. Jones may have her licensure, but if you are interested in providing LGBT-affirmative therapy and she works at the local conversion treatment center, wouldn’t you like to know that before wasting both of your time?

When you contact a potential supervisor, hopefully they will offer to provide you with a reference of another past or present supervisee. If they don’t, ask.

Some of the old guard psychodynamic folks may object, saying that that contaminates your supervisory experience. To which I say, there will be plenty of transference that comes up regardless, and that the focus of supervisors should be on practicing radical transparency, not generating a absolutely blank screen. Supervision often resonates with therapy, but it is NOT therapy. If a supervisor comes off as seeming like a Freudbot, this may indicate a difficulty shifting cognitive frame sets from supervisor to therapist.

4. Know what is important to you

You can learn something from everyone, I truly believe that. However, when I look for a supervisor, I look for someone who provides psychodynamic-oriented supervision. That’s what I do, what I like, and why I became a therapist. If you are a solution-focused or CBT practitioner, get someone who is expert and experienced in that.

If someone says they are “eclectic,” run away. Far far away. If they can’t describe some of the several areas of their interest or competence to you, chances are they are being either vague or seductive. Yes, I said seductive. Supervision is a business prospect, and many people focus on landing a new supervisee to the detriment of both of them.

5. Beware of freebies, private supervision starts with the fee

I’m going out on a limb here, but I strongly discourage freebies. My Contact page warns away the brainpickers. These are the people who want to get something for nothing, and say, can “I just pick your brain for a second?”

No, you may not.

There is a lot of free content I’ve put out there that people have access to, but this is also my work and I need to be paid for it. So if you have done your research, hopefully potential supervisors will have papers published, posts online, lectures, recommendations. If not, please see item 6.

I have strong opinions about this, because I think it shows potential supervisees how to have professional boundaries and value their work. If you are doing supervision to “give back” at a reduced fee, that’s fine, as long as you let the supervisee know that you are reducing your fee and let them know the full fee. But be honest with yourself about this, are you doing it to gratify your self-ideal of social justice, or because you secretly believe that you aren’t worth the full fee, or some other reason?

If you are a potential supervisee, consider this: Do you need someone to help you learn to be a more noble person, a better clinician, and/or a more savvy businessperson? Will having a reduced fee lower your expectations of yourself and the supervisor? And would you like to charge no higher than the reduced fee you are being offered?

If the answer to the last is no, be careful, because this may be a set-up for resentment on your supervisor’s part, and you may both suffer from unconscious false pretenses.

Speaking of fee, I walk this walk, and when I negotiated my fee with my supervisor I negotiated to pay more, because I knew that I would have a harder time later if I didn’t. We then had a great conversation about the limits of this, because obviously she gets to set her fee not I. But it caused her to re-evaluate and raise her fee somewhat, and modeled for me her integrity, flexibility, and willingness to listen and learn. And each time I raise my fee, I bring this up again, and each time the supervision is the richer for it.

6. If you want supervision around private practice, stay away from technophobes.

I strongly maintain that to have a practice in the 21st century you will need to have an online presence, some technological savvy and the willingness to learn about it to work with people from the 21st century. This is even more true in a private practice, where marketing is moving more online every day.

I once had a couple of sessions with a supervisor I was considering starting work with. This was a world reknowned clinician, whose work I respect immensely. In the time between our first and second appointment I included her on my newsletter. Our next appointment she expressed how “astonished” she was that I would contact her that way, and wondered if I was sabotaging the supervision. Fortunately I have been in many supervisions and have a strong ego. That was our last appointment.

I suppose I could have chosen to stay and explore this, but that seems more her issue than mine. I want to have a practice that focuses on Web 2.0 and psychodynamic therapy, i.e. integrating, not pathologizing them. And if those were her boundaries, fair enough. But I’m paying for a service, and I’ll take my business to my current supervisor, who is very professional, very grounded in psychodynamic theory, and subscribes to my newsletter, remarking on every issue.

7. Kick the tires

Having read this, you may be thinking, “I don’t agree,” or “that’s not what I want,” or “what a pill he is!” If so, that’s great! Because that means you have some idea what you are or aren’t looking for. Or you may be thinking, “right on!” One thing my supervisees can probably tell you is that what you read here and what you get in supervision with me are pretty much the same thing. And it seems to be working well for all concerned. You aren’t in grad school anymore, you get to pick and choose your supervisor.

It is okay to try out a few supervisors before deciding. Pay attention to those first few appointments, when you and your supervisor “relax” into the supervision a bit. Do you notice drastic changes from the first week(s)? Do you look forward to supervision, dread it, or find yourself not caring either way? Ask yourself, and your supervisor, how the supervision is starting off. If your supervisor does not bring up how to get the most value out of your supervision in the first few months, bring it up yourself.

If you are having mixed feelings about a supervisor, don’t be afraid to bring that up. But if you can’t bring it up, or choose not to, don’t feel obliged to stay. Supervision is a long, intense and valuable process. No less than your professional development is at stake. Choosing wisely begins with remembering that you have a choice.

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.

Filed Under: Gamer Therapy Tagged With: building your business, education, licensure, managed care, marketing, oliver twist, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, self-promotion, supervision, therapy, Web 2.0

A Tale of Two Conferences

January 21, 2012 by langloimsw 3 Comments

Many consultees ask me how to get speaking engagements, and certainly that’s an important question. But this is also not the most important question. It is akin in many ways to the conversations around the question, “How do I get a job?” The focus is often too much on how to make a good impression on the interviewer, how to present as a good fit for the workplace in question. If you are only asking those questions and wanting to be a successful entrepreneur, I suggest you are barking up the wrong tree.

Because the questions that are equally important, if not more important, are the on the surface the less humble and self-effacing ones: Do I want to work for this person interviewing me? Would I enjoy this work environment? Are these people making a good impression on me? These are the questions which come from the perspective that you are a valuable commodity, and that perspective to a large extent needs to come from within. And let me be clear, not all workplaces, even those who purport to be empowering, want you to approach them from that perspective, because it lowers their bargaining potential when money (there he goes again with the money!) questions arise.

So too with public speaking engagements. There needs to be at least a sense of mutual value, mutual ROI that has to come from the speaker and the speaking engagement. Let me give you an example:

I am doing in the next year an engagement with conference A and conference B. Conference A approached me with a request, because they had had a personal referral to me. I will be speaking to a group of several hundred people at an event where I am one of several presenters.

Conference B sent out a general call for presenters and ideas. Several years running I have been nudged by some of the folks in charge to apply to present, so this year I did. Again, the conference will have an attendance of several hundred people and I will be one of several presenters.

Neither conference A nor conference B have an honorarium, but that is acceptable to me for a couple of reasons at this point in my career. One reason is that I now allot one pro bono presentation per month. But the other reason is that there is some clear ROI in both conference A and B: I will get exposure which leads to more paid speaking engagements; I will have a venue to make my book available for sale; and I will get my pro-gaming, pro-tech message out.

So far, so good. I should add here how both Conference A and B frequently include language in their letters to me about how valuable my contribution is and how much they appreciate me. But over the past few months I have received communications from both conferences that show how different they are in their attitudinal stance towards speakers.

Conference A sends me a paper letter with the details of registration for the conference. I am given the name of a specific person who handles presenter registration, told I am welcome to attend the entire conference for free and invited to a special luncheon for presenters on the day.

Conference B sends me a registration form, offers me a discount, and lets me know that they can only “give” me free admission to my presentation.

What?

I am being given free admission to my presentation? I’m confused. Is the implication that normally I should be paying for the privilege of presenting my expertise, but as a special gift I get to work for free? And are they really asking me to pay to attend a conference that I am donating my time and expertise to?

Guess which conference I will continue to work with in upcoming years?

If you guessed Conference A, bingo! Because they have the right attitude in my opinion. Their behavior is as valuing as their words. It costs them virtually nothing to get the group of us presenters in a smaller room for lunch and call it a special lunch, and it costs them virtually nothing for them to give me free attendance to the larger conference. And by assigning a specific person to handle my registration, they have made things even easier for me. What’s more they have in a few gestures given me what Chris Brogan calls that VIP Feeling.

Conference B has done none of that for their presenters. And think of all the value they are losing! They could have all of us experts in the field adding to the conference beyond our sessions. Asking questions or making comments at other presentations, networking with others, and being a free resource to other attendees at lunch, breaks and other down times.

Here is where word and deed don’t connect. What message are you sending when you ask people to work for free and then charge them? The irony is that Conference B will probably have some organizers who don’t understand why they end up getting a bunch of “hit and run” presenters and resent our not signing up for the conference. It’s a lose-lose situation for everyone, and it comes from a poverty perspective, not an abundance one.

So if you want to be a presenter, please remember this: You’re an expert in your field, act like one. Your time is valuable and limited, and you need to set the tone for that. Finally, pay attention to how potential presenting clients treat you. After talking with them, do you feel like a VIP, or do you feel like Oliver Twist?

Some of the old guard have told me that this is the industry standard. To which I say two things:

1. If that is true, the standard is wrong and needs to be changed.

2. This is one big reason why our profession is consistently undervalued and under-appreciated: Other people take our cue.

Also, someone should tell Conference A that they aren’t keeping lockstep with the industry standard by giving speakers the VIP treatment.

Oh, never mind, I’ll tell Conference A myself: Because they’ve earned my loyalty and I hope to be a presenter and attendee for years to come.

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, chris brogan, education, marketing, mindfulness, psychotherapy, referrals, ROI, self-esteem, self-promotion

Money: The Post You Don’t Want To Read But Should

January 7, 2012 by langloimsw 8 Comments

First off, not only am I not a financial advisor, an economist or an accountant, I have never been the poster-boy for “financial whiz.” I say this out of neither pride or shame, but for two other reasons. First, as a caveat to the reader that all of this is based on personal learned experience and therefore as limited as it is true for me. And second, because if I can do this, I think you can too.

Money is the Achilles heel of many therapists. We are averse to think about or speak aloud about it, and we come by this aversion honestly. At least in the US, we are raised and educated without a single class or course in financial planning or money management. Ask yourself, what subject have I ever learned about in life that I avoided thinking or talking about? But in the case of finances, many of us emerge into adulthood with huge blind spots about how to function in a capitalist economy and society.

In my coaching and clinical supervision with therapists, and in my talk with colleagues, I have heard some amazing examples of these blind spots. I once heard a colleague justify not charging a patient for a missed appointment because if she has to miss an appointment the patient doesn’t charge her! These statements bely an ambivalent and confused statement about money. Patients are hiring us, we aren’t hiring them. As uncomfortable as this assymmetry is, the fact is that we don’t pay patients to help us and they do pay us to help them.

I have launched into general diatribes before, but today I want to be really specific and concrete. I want to share with you one pointer I share with all my coaching clients about how to make more money and how to manage it better. I’m even going to give you a specific vendor link.

The pointer is this, if you want to make more money, take a look at the bank you’re using. Making money isn’t just about your fee or caseload, but the fees you may be paying out. (I know, some of you who’ve made it this far are already getting ready to click away, hang in there.) One of the things large banks have is large overhead. They are, for reasons too numerous and obvious, in a lot of distress these days. For example, Consumer Reports estimates that the government legislature that required them to cap their fee each time you use your debit card at 24 cents a transaction is going to cost banks 6 billion dollars in revenue lost. So to recoup their losses, they are finding other fees to levy on you that are legal.

What banks are banking on is that we’re afraid of change. And let’s face it colleagues, most of us want to find a place to “park” when it comes to money management. We want to find the fee we can set and not look at again rather than adjust it over time. We want to program our billing into computers or contract it out to services so we can not deal with it. And we don’t want to compare interest rates and fees, but rather find a bank and stick with it.

And the larger banks don’t just gouge you with fees, they use you in another way. Maybe you’ve noticed that when you do use your ATM or the bank website advertisements come up that are eerily resonant with what you spend your money on. This is because banks value your patronage for data mining purposes as well. Many of them are selling this data to big business. I am often struck by the irony that a profession which values privacy and confidentiality for our patients turns a blind eye or accepts the violation of their own financial privacy. So if nothing else, do a little research about whether your bank sells your debit transaction or other data, and if they do, move.

Since 2009 I don’t think I have set foot in a bank to do actual banking. The last time I went in the building was to have something notarized. By the same token, my deposits have become much more quick and efficient in my business, and my fees have been minor. Why is this?

It is because I use an online credit union, Digital Federal Credit Union in fact. DCU is a completely full-service credit union with the emphasis on online banking. This is not surprising since it began in 1979 as a charted credit Union for Digital Equipment Corporation. The eligibility requirements are not at all onerous, in fact your interest in social justice can make you eligible. I say this because my eligibility came from being a disability rights ally. I joined the American Association of People with Disabilities. That was it: Fifteen bucks to a great cause and I was eligible to join DCU.

As an online credit union, DCU is actually more portable than my licensure! I can move to any state, bank from any state, online. Their technology and website are in my opinion excellent. I can transfer funds easily from my account to other family members’ accounts at DCU, and interbank exchanges are almost as easy.

They have a great bill-paying feature that allows me to schedule payments electronically, either one-time or recurring. The bill-pay feature has also been a lifesaver for me when I need to dispute something with a vendor or track how much I have spent on utilities for my practice or home in a given amount of time.

And at tax time, house closing, or any other time you need financial documentation quick, DCU allows me to download check images, statements, etc. into PC files. Or if I am trying to sort my expense deductions for the year I can import the entire tax year into an Excel or other software spreadsheet to sort, locate, and calculate expenses.

But the thing about DCU that makes me go absolutely blissful is their iPad and iPhone app, because it allows me to take photos of checks and deposit them from my office, living room, wherever there is, well, the internet. No more hoarding checks to make a trip to the bank, no more waiting in lines at the bank. In fact, I often do my deposits late at night or on weekends, because banking hours aren’t really an issue.

Think about all the time you are spending, which is money you’re spending, on your banking. Do you spend 30 minutes running to the bank each week? That’s time you could see a patient. Is your income stream stuttering because you avoid depositing check until you have to? And clinically, what message(s) may you be sending your patient that you haven’t cashed their check yet? If you want to be a better therapist, get better with your money. And if you want to get better with your money, use an online credit union.

Oh, I have lots of thoughts and opinions on how to use technology to improve your therapy practice clinically and financially, maybe you want to work with me online or in person?

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, DCU, marketing, money, private practice, psychology, psychotherapy, ROI, social justice, Web 2.0

Occam’s Oyster

December 7, 2011 by langloimsw 2 Comments

The oyster has an amazing evolutionary trick. When a microscopic particle of something or other gets into its soft tissue, it creates over time layer upon layer of nacre, a substance which creates a pearl. What began as an irritant can go on to become a very valuable object.

You are not an oyster.

If something irritates you, you don’t always need to be stuck with it. And although I am a big fan of the cognitive reframe, to use it all the time overlooks that you can often resolve whatever is irritating you by removing it.

Case in point, for the past several years I have used a billing service. They’re great, but there has been something about the process of my patient intakes that irritates me. I have patients fill out an intake form, which they bring in to me. At the same time the billing office has a face sheet they use as well, but they need some information that is not on the face sheet but is on my intake form.

So for the past several years the patient will download my form off the site, fill it out and bring it in to me. I then have to scan the form and fax it to my billing office. To make things more complicated I have several computers and a scanner at home as well as an iPad. You’d think this would make things easy, but I can not seem to get them all to talk to each other the right way to scan something and email it in under 30 minutes. One laptop doesn’t get recognized by the wireless network. The iPad can scan the form but not email it. This has been going on for years, and I had grown accustomed to the irritation as I tried putting on layer after layer of “solutions.” I’d put off scanning the forms until my office asked me for them, which made their work harder, and payments from insurance choppy.

Then it hit me that I am not an oyster. Whenever this irritation came up I had been so focused on trying to make things go more easily, that I had never really taken a few minutes to think about how to make this problem go away. The answer in this case was simple. Instead of having my patients email the form to me, my introductory email to them can instruct them to email or fax it to the office directly. They need regular access to it, and I don’t. They have all of my other administrative paperwork which they keep all safe and secure, so it is actually far easier to have them keep it since they are doing all the billing. I rarely use that initial paperwork, and I’ll always know where it is.

I offer this as a nuts and bolts example of how your therapy practice needs to be evaluated periodically. The whole craziness above is a vestige of when I was doing all of my billing, and something I now realize I was not ready to let go of. And so I just got used to the irritant, ignored it, and hoped it would go away or become less irritating.

We therapists take more irritation for granted than is necessary in our business. We each have a different version of layering on the nacre. One of mine is constantly adding new gadgets and trying to find ways to make work easier, rather than making it go away entirely. I used to spend hours learning the intricacies of a billing software and calling insurance companies, and then I realized I wanted to get rid of the irritation. I researched different services, and finally decided on one which cost a little more, but did a lot more for me. Now I give them 9% of my fee, and in return they keep me credentialed with the insurances I take, send out statements, answer questions from patients and submit all my claims electronically to insurances. Not only do they trap more of my revenue because they can focus on it with more expertise than I, they save me valuable time.

I didn’t value my time as much when I started out, and I am glad I changed that, because I know I wouldn’t have had the time or energy to write a regular blog, do speaking engagements, or write my book this year if I had been chewing on all that paperwork.

So why does it often take us so long to fix systemic problems like this in our practices, or our lives for that matter? I would suggest that the answer is that we don’t value thinking.

I know, sounds crazy on the surface, therapists don’t value thinking? Thinking and thinking about thinking is a big part of our profession. But when was the last time you allotted yourself time specifically to think on something. By that I mean dedicated time where you think through something single-mindedly, not answering emails, talking on the phone, watching television, etc. Most people I coach can’t remember the last time they did that, in fact our coaching appointments are often the closest they come to it.

You don’t have to schedule a specific “thinking time” in your day, although you can certainly do that if it works for you. But in the case above I didn’t do that. Instead I noticed I was getting irritated for the umpteenth time and said to myself, “Ok, stop EVERYTHING, how can I make this irritation go away?” Within a relatively short time of dedicated thinking I identified what the system was, what the problem was, and what the new system would need to be to make the form nightmare go away. Not get less irritating, not more tolerable, but gone.

Look, I’m not saying that everything in life that irritates you can be removed, or even that that would be a good thing. I’m just saying don’t settle for mitigating damage before you’ve tried making the problem disappear. Ask yourself, “am I layering nacre over and over? Is that the best I can strive for?”

Then ask yourself, “am I making time to think, and am I thinking about the things I want to think about when I do?” Sure there are lots of times when you run a business that you’ll need to think about stuff you’d rather not think about; but if that’s how you’re spending the majority of your time then maybe you’re running the wrong business.

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, insurance, managed care, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, stress

Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined

November 3, 2011 by langloimsw 7 Comments

Every once in a while I receive an email that reminds me that the work I am doing is making a difference. Today I received this from a new colleague to our field, and with her permission I share it in its entirety. I hope that you will comment on it and show her that she’s not alone:

Hello Mike,

I am a newbie therapist, having entered the licensed profession less than a year ago. Though despite my newbie status, despite the fact that I currently have no clients, no office, no firm job prospects, with a website and business plan that are both still in the initial stages, I still feel that I am an Epic Therapist. Or, at the very least, I am in training to be one!

Anyway, I just wanted to let you know how truly, truly, refreshing I found your blog. In the past, I have spent many, many, many hours skimming one random psychotherapist website after another. More often than not, I get so bored to tears reading the same drivel. I can’t understand how so many of them stay in business. From their websites, I feel that often there is no real spark or passion for their profession, and that they are all trying so hard to play it so safe, that so many psychotherapists end up sounding so cookie cutter. Not to mention the rather pretentious attitude that comes with, “I specialize, well, in the whole DSM-IV. What is your disorder? How may I help you in your disordered state?” Or my personal favorite, “Are you anxious? Depressed? Do you find yourself worrying a lot? Do you sometimes find yourself feeling lonely?” My thinking after reading that is always, “Yeah, I am depressed and anxious just from reading that!” After exhaustive online research, I felt rather alone in feeling like a therapist could dare to have their personality shine online. And then I found your site, and I was like, “Someone who dares to break the mold!” YAY! 🙂

So I have basically spent my free time the past couple of days reading as many of your blogs as possible. I know that you must get many, many e-mails. And I am trying my very best to have my e-mail be worth your time. I am hoping at the very least that what I have to say might spark a possible interest for a blog response.

When I am in my Secret Headquarters, well, ummm, Head(corner) more like it, I feel like anything is possible. I feel the passion and excitement and knowledge for my blossoming niche, Sandplay/Play Therapy. I feel my passion and excitement for my professional focus on the more non-verbal approaches to psychotherapy, for the times when individuals just can’t seem to find the right words to truly express everything that is going on inside of them. Even right now, I feel myself fumbling around for words, and wish I didn’t have to rely solely on words at this moment in time to captivate my Epic Therapist passion. So when I am in my Secret Head(corner) I feel rather invincible. I feel like I can make it. I feel like I have the ability to design the website I want, and set up shop the way that I want. Though the moment I step out of my Secret Head(corner) I am immediately flooded with all these scripts of why I can’t do this. I feel like there are so many “voices” telling me I can’t succeed on my own terms quite yet because I haven’t paid my dues to the system. The current system that exists between many CMH, Non-Profit establishments and insurance companies, make it near impossible for newbie therapists to get a traditional job. From my own experience, I didn’t even qualify to apply for the clinical position for which I interned. When this happened to me, I acknowledged to myself that the current system is way out of joint, and that deep down inside, I have no real desire to associate with that kind of business structure. Though still I feel so many professionals trying to taint my passion for a private practice with their venom of, “Well, you need to walk, crawl, climb your way through Mordor, in order to finally be able to sever your newbie status ring into the fiery pits.” Though I tend to see another option rather than the traditional route: http://www.youtube.com/watch?v=1yqVD0swvWU (I love this video, two minutes of LoTR epic-parody goodness.)

In their eyes, I am trying to take a short-cut. Though I am not trying to take a short-cut, merely a different path. I have checked the policies and procedures regarding private practice, and even with my Limited License Professional Counselor (LLPC) status, I am able to set up shop. I have a qualified supervisor and seek out as many mentors as possible; I am constantly researching to gain as much knowledge as possible; I spent much time and effort in receiving professional training in Sandplay/Play Therapy. I feel like I am a blossoming professional in my field. I am determined to have an ethically driven, professional private practice, with a strong niche, and a strong professional voice. Though, every time I think of my “Limited License” status, or I think of all the things I still need to learn, I sometimes feel myself retreat into this defeated status. So I guess my question is this, how does one continue to build up and defend their Epic Therapist status, when so many naysayers want to tear you down because you are forging your own path?

If this sparks a possible blog/e-mail response that would be awesome. If it doesn’t, that is okay too. I know your time is valuable. I am just grateful if you took the time to make it to the end of my letter. Best of luck in all your efforts!

Sincerely,

Esther Dale, MA, LLPC

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

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, marketing, newbie, private practice, psychodynamic, psychotherapy, ROI, self-promotion, Web 2.0

Why Ursula the Sea-Witch is My Guru

October 29, 2011 by langloimsw 8 Comments

Ok, so first, let’s be honest, there’s a lot to take issue with in terms of Ursula the Sea-Witch. She definitely carries on Disney’s longstanding history of portraying evil as black, single, independent women, adding to that list women who are considered “overweight” by Western standards of health and beauty. Oh, and she’s sexually aggressive, in that she flirts with King Triton and likes to move in a way that shows she enjoys her body. So yes, I get that Ursula embodies a lot of the negative stereotypes that women and people of color have had to put up with in media.

But if we can look beyond that, I think Ursula has a lot to say that will help you with your business plan as a private practice therapist, and maybe beyond.

I also must admit that Ariel annoys me, especially at the beginning of the movie, which is where one of my favorite scenes is when she makes a deal with Ursula in “Poor Unfortunate Souls:”

Ariel is reluctant to make a deal, because she’ll risk losing contact with her family forever. And Ursula acknowledges this, and says, “Life’s full of tough choices, innit?”

The number one thing I hear from people who want to have a full-time private practice is, “where do you find the self-pay patients?” There are dozens of posts titled that on the Psychology Today forums, and right next to them are the posts saying how much many therapists hate Managed Care and having to take health insurances, with all the rules and restrictions, and low fees.

Yet, when I talk about building your practice to people, I also hear from many people how much they hate promoting their work, and how critical they are of others when they catch a whiff of self-promotion about them. I can’t tell you how many times my blog posts and book blurbs have been pointed at and I have been “accused” of self-promotion. Accused, as if somehow promoting your work and your business is a bad thing.

It’s not.

Look Ariels of the therapy world, life is full of tough choices. You can have a private practice that relies on insurance only, and that isn’t a bad thing. You’ll get to see a range of people who have worked hard to earn health benefits that they want to use, and you’ll have instant diversity of economic status in your practice, the more plans you accept. And the insurance company will list you for free, and you’ll probably build up your practice more quickly. The downside? You’ll make less money, have more complicated paperwork, and time will be spent doing it. And your income will be capped.

Or you can have a private practice where you focus on self-pay, and that isn’t a bad thing either. You’ll have the ability to set and raise your rates, less paperwork and reviews, and have more time to do other things. You’ll still be able to have a diverse practice, using my PB+5 model, and more independence in many ways. The downside? You’ll need to promote your work. You’ll need to give potential patients and colleagues some good reasons why they should forgo their insurance benefits and pay you more money.

To do this you’ll need to spend time working on networking, generating content for your website, speaking, writing a book or making a DVD. And you’ll need to keep doing it. That’s right, you’ll need to consistently promote yourself and your work. The time I used to spend on billing and reviews I now spend on self-promotion, and I do some of it every single week. Sometimes I like it, sometimes I don’t, but nevertheless I do it. Even though I have a wait-list I still do it. And I have watched as several colleagues, who have been in the field for a long time, have stopped doing it. And their practices have begun to dry up, because the phone doesn’t ring as much any more.

You can also try mixing and matching the above a bit, taking some insurances, and doing less promo. Charging more for some patients, and doing more pro bono. All of that is up to you.

But I’m here to tell you you can’t have it all. That’s right, I’m not going to pitch to the starry-eyed that everything is possible. A lot is possible, but everything is not. That’s right, somebody finally said it, there are limits, and you have to make tough choices.

When people work with me, they end up making those choices, and I don’t judge whichever they choose, because I don’t think there is a right answer to this. But I also am pretty outspoken that they are going to have to fish or cut bait. If you don’t like the idea of tooting your own horn, I’m not going to push you to do it, but then don’t complain to me about having to take health insurance. But if you want a predominantly self-pay practice, don’t get self-righteous about self-promotion. First off, self-promotion takes many forms: blogs, advertisements, peer-reviewed journals, telling someone what you do at a party. Everyone in our field does some of that, at least everyone I have ever met. But you’ll need to get off whatever train trip you’re on about how self-promotion is wrong.

There is absolutely nothing wrong with working in an agency full-time. There is absolutely nothing wrong with having a self-pay practice. There is absolutely nothing wrong with taking or not taking health insurance. There are plenty of therapists who are going to take the options that you don’t. But you need to choose something or you can’t have a business plan. And if you don’t have a business plan, don’t try to be self-employed.

Finally, I’d encourage you to get a clock and keep track of how many hours you spend griping about managed care, criticizing your colleagues who market themselves, or asking how to find those self-pay patients online. Because all of that time is time you could be spending on billing, filling out paperwork, writing a book, promoting a talk, in other words building your practice. Complaining to peers is not networking. Worrying about your business is not the same as effort. Don’t confuse the two.

Life’s full of tough choices, go make one.

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

Filed Under: Gamer Therapy Tagged With: building your business, HMOs, insurance, managed care, marketing, private practice, psychotherapy, referrals, ROI, self-promotion, ursula sea witch, Web 2.0

Dings & Grats

October 15, 2011 by langloimsw 1 Comment

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!

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

Filed Under: Gamer Therapy Tagged With: achievement, adolescents, behavior change, building your business, children, coaching, ding, education, gamers, gaming, grats, level, private practice, psychodynamic, psychotherapy, video games, Web 2.0, World of Warcraft

Fun & Failure

September 24, 2011 by langloimsw 4 Comments

Early in the summer I had the opportunity to give a workshop at the University of Buffalo. The evening before I gave it I had the opportunity to sit down and have dinner with Nancy Smyth, the Dean of the School for Social Work. Although we’d never met before in person, the time sped by with good conversation and laughter. Fortunately I had finished my prep for the workshop, because I was quick to crash that night.

The next day I spoke in front of a group of clinicians, caseworkers, and administrators. The age ranged from 20s to 60s, and the discussion was so lively that the day sped by, and before I knew it, I was being ushered out of the classroom and into the car to the airport. The workshop participants did not agree with each other (or me) on all points, but everyone said that they were walking away with me having changed their thinking about technology, video games, social media and healthcare.

Sometimes I take for granted how much fun my work is. There is enough diversity in who I work with to keep me invigorated most days, and the balance of a portfolio career really suits me. Being my own boss suits me as well, and this year I mixed it up a little. I dropped one class I was teaching and took this semester off so I could focus on writing and promoting my new book.

Promoting Reset is not something I enjoy doing. Although I coach and blog about the importance of self-promotion and what hold us back from doing it, that doesn’t mean that I enjoy doing it all the time. But one thing I have been learning is that writing the book was the eas(ier) part. I need to keep getting the word out about it, and sometimes I feel like I am overtaxing the patience of my Twitter followers, Google+ circles and Facebookies. Some of these people are in multiple groups, and I can imagine that they get irritated with another post about the book. “Enough already!” I imagine them saying.

Speaking up is not easy, and many of us actually have a much easier time speaking up for others than for ourselves. We speak up for our clients, our kids at school, our pets when they depend on us for care. It’s ironic that we get so good at striking blows for freedom, blogging against oppression, picketing, and political advocacy; and yet we cringe at the idea of promoting ourselves. Perhaps that is because the former makes us feel righteous, and the latter makes us feel guilty. I definitely enjoy advocating for technology and the people who use it with my colleagues, but I wonder if I would have promoted my book at Buffalo if it had been published then.

I’d better get used to it, because now there are more speaking engagements coming up, and having an eBook means I can’t just lug a pile of them to the the hotel and have them sit on a table. I need to be speaking up about Reset, because no one else will. And one thing I have also learned to do at talks is to let people in them know I enjoy speaking engagements and am available to do more. And each time I have done that, I have gotten a lead. Hopefully out of all of you reading this I’ll get hired to do another few.

This is such a contrast to my clinical work, where I am required to be more quiet, reflective, and other-focussed. I am not alone in this, psychotherapy tends to require us to listen more and talk less much of the time. It is also a safe place to “hide out” if we aren’t careful.

One of the most unfortunate lessons our current educational system teaches us is that we should hurry up and find out what we are good at, what comes easily for us, and then stick with that. In school settings, not-knowing is considered a bad thing rather than the predecessor to curiosity. By college we have learned to speed through any unpleasant “requirements,” and major in something that interests us. The problem with this is that by then we have learned to take an active disinterest in things that we struggle with. So we arrive in adulthood having learned to play to our strengths, and avoid the rest. And whereas children are fairly powerless to avoid what they struggle with in school, adults can often construct a life that cocoons them from learning unfamiliar things.

Therapists in particular, have pushed themselves through grad school and internships, licensing tests and boards, and by the time we get licensed to do private practice we feel entitled to close the office door on outside influences. Several times when I have been hired as a coach or consultant, I still find my clients reluctant to “come clean” about things they aren’t good at. Some haven’t billed insurers for months because they don’t know how to do the paperwork, or a claim has been denied and they are letting the appeal sit on their desk. Websites lie around half developed, brochures printed up but not mailed, and all of this is nothing compared to the disarray and avoidance of work/life balance. Office hours are whenever the patient can make it, their specialty is “anxiety and depression,” and they are running themselves ragged. And all the time, they suspect that they are really frauds awaiting discovery, and why? Because they learned that you aren’t supposed to admit you are confused or don’t know something, let alone ask for help.

Fortunately I play video games.

As Jesper Juul points out in Fear of Failing? The Many Meanings of Difficulty in Video Games failure is more than just about not winning. It forces gamers to readjust their perceptions. In fact, players prefer games where they feel responsible for failing. What’s more failure adds content to the game. Think about what a powerful paradigm shift that is. Failure adds content that wouldn’t be there. What might happen if we were able to see failure in our lives as adding content?

Actually, therapists often have a lead in understanding this. We know that empathic failures are often inevitable, and that when we successfully navigate them with our patients the relationship deepens. The failure adds content.

So think about your life, your practice, your business or your relationship. And look straight at where you are failing in it. I know, it’s tough, but try it for 5 minutes, and then ask yourself, “what content is this failure adding to it?”

This is much easier to do in hindsight, which is why we need to try to practice it in the now. Because if we don’t avoid seeing the failures, we can readjust our perceptions and progress farther. Maybe just a small progression, but anyone who works with kids knows the importance of proximal goals.

To go back to the Buffalo speaking engagement, this began as a failure and the setting of a proximal goal. The failure was this: I wasn’t getting enough paid speaking engagements. How did that add content to my life? Well, it added the mission, should I choose to accept it, of getting more paid speaking engagements. So I set the proximal goal of starting to let people know I was looking for them. One night on Twitter Nancy said something complimentary about a blog post, and I quipped that she’d better hire me as a speaker before my rates went up. A few months later I was invited to speak. And in addition I deepened a connection, met some really cool students, and saw Niagara Falls for the first time in my life: How’s that for added content?

So much is possible for you, your business and your life. None of what I have described above was achieved because I have some special gene. It took what Pema Chodron calls going to “the places that scare you.” We are all failures at something–come out of the closet! Over 6 billion people around you are failing and trying and failing and trying again every day. Those that aren’t are hiding inside an ever more rigid and constricted life. That doesn’t have to be you, and it sure as hell isn’t going to be me.

Oh, and I hope you buy my book, and I’m available for speaking engagements, so call me. 😉

Like this post? There’s more where that came from, for only $2.99 you can buy my book.

Filed Under: Gamer Therapy Tagged With: buddhism, building your business, failure, gamers, marketing, private practice, self-promotion, Web 2.0

Defeating the Boss: Overcoming Your “Big Bad”

September 18, 2011 by langloimsw 4 Comments

Like this post? There’s more where that came from, for only $2.99 you can buy my book.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, boss, building your business, coaching, consultant, gamers, gaming, private practice, psychotherapy, video games, Web 2.0, World of Warcraft

Why Therapist Directories Are A Waste Of Time

August 11, 2011 by langloimsw 56 Comments

This post is for all of you who have been considering or actively using listings in therapist directories. I frequently get asked from consultees which directories they should list in. I also frequently see colleagues debating on bulletin boards and listservs the merits and demerits of individual directories. So I figure it’s time to offer you my perspective. Please bear in mind that I am sharing my experience and opinions here, and if you’ve had a different one, hopefully you’ll mention it on the comments. If you own a directory service, I hope you’ll disclose that as well.

When I started building my practice, I had a lot of time to spend filling out various online directories. I literally spent hours filling out profiles that promised to make me visible to potential patients. To be fair it gave me the opportunity to hone my bio and elevator speech, but other than that I now think that I was wasting my time. But let’s talk a little about why directories may be a waste of your time, because I think it points to a larger misconception about marketing your practice online.

Billboard in a bottle.

Many therapists still approach the internet as if it was a giant Yellow Pages. We often create static content, the equivalent of a business card, cover letter and resume, and then slap it up on a website, or a directory. Then we sit back and wait for the phone to ring. It’s like we imagine that we created a giant billboard and threw it into the world wide web. But in reality, it’s more like a message in a bottle, thrown in a vast ocean. We imagine that that will get us recognized. It usually doesn’t, and here’s why.

If you google “find a therapist” you will literally find dozens of website directories guaranteed to help patients find the right provider. If you’re ambitious you could spend hours and days finding all of them and entering your information. Many of them are free, some charge money, and a few don’t let you know whether they will charge or not until you’ve entered all of your information. One of the main problems with directories is exactly that there are so many of them.

One thing I’ve learned from starting up social networks for other companies is that you always need a critical mass of members as quickly as possible. If you launch a site you have a few days to a week to achieve this in most cases. Otherwise potential members will log in to your site, look around and see little activity, and leave. So low enrollment of providers in a directory will drive little traffic to it.

On the other hand, if you take a directory like Psychology Today’s you will see that they did achieve a critical mass, and have more traffic. But the problem here is that this is because every therapist and her maiden aunt is now listed there. So the problem becomes how to set yourself apart from the rest. If you are determined to spend time on listing yourself in a directory, I’d suggest that you pay for the PT one and try to distinguish yourself as best you can. In fact, the Psychology Today site is the only directory I even try to keep current and pay for anymore.

Speaking of keeping current, here’s the other potential pitfall of directories: The more you participate in, the more you’ll need to update your content, remember more passwords, and check back in. Some directories require you to log in any time you get a message from a potential client (or spam) in an effort to drive up their traffic. It’s a lot of hassle for little ROI.

If you are determined to list yourself in directories, please consider the following:

If you are planning on practicing online, does the directory have global traffic?
If you are planning on practicing in a certain geographic location, does the directory get traffic from your part of the world?

One way to research this a little is to run the site’s address on Alexa, which will often tell you some information about traffic or rankings by country.

But while we’re talking about Alexa, let’s talk about how those numbers can be misleading. Alexa allows you to download the Alexa toolbar, which allows you to check a site’s alexa traffic rank, but it also allows Alexa to tabulate traffic to any site your browser visits, which is part of how they get those numbers. So it is very easy to drive traffic numbers up artificially. How? Easy, set your homepage to your website, and every time you open up your browser, it opens to your site, and adds to your number of visits. Not enough? No problem, have all of your family members do the same on their computers. Within days, your ranking will rise dramatically, without any real rise in potential referral visits. So keep that slight-of-hand in mind when you look at a therapist directory’s traffic. Maybe they do have 100s of visits a day, or maybe they have 10 people who have that site as their home page to drive up traffic.

So Now You Know.

When I review my practice referrals, I received probably %10 of them from a directory, usually Psychology Today. The majority of my referrals came from word of mouth, insurance company lists, and increasingly my blog and articles. By now, many of you will know where I am going with this: It is content and interaction that convert visits to your website into referrals. There is not a similar conversion rate from visits to your directory profile and calls to you, or even visits to your website.

Some may disagree with me, but my take on directories is that they are a waste of time, and that they capitalize on therapists’ reluctance to generate interactive and dynamic content. Put simply, people want to hang up their cybershingle and then go back to passively waiting for the phone to ring.

To spend a lot of time finding and listing yourself in a therapist directory is to confuse worry with effort. What you should be doing (Oh Nos! A therapist used the word “should” 😉 ) is generating content and creating opportunities for interaction with colleagues and potential patients. Examples of generating content include:

writing brief informative blog posts
tweeting links to articles that you find interesting to establish your “brand”
offering a free hangout on Google+ on your niche topic
creating a meditation podcast that people can download from your site
networking in Second Life or attending the Online Therapy Institute’s open office hours
doing a five-minute vblog on a CBT technique

I’ve done many of the above, and this blog post is another example. I guarantee you that this post will generate a new referral for me at some point soon, much sooner than my Psychology Today profile will.

So please take the time you could be playing it safe cutting and pasting your info into yet another directory, and instead take some risks, create some new content, or join in a conversation online. Web 2.0 is not about being a digital classified ad. Use your time marketing to do what therapists do best: Relate.

Filed Under: Business Tagged With: building your business, HMOs, insurance, marketing, private practice, psychology today, psychotherapy, ROI, self-promotion, social justice, social media, therapist directories, Web 2.0

Integrity Is Your Brand.

August 2, 2011 by langloimsw 7 Comments

Recently I had two experiences which took me a bit by surprise. The first was when a representative from an online gambling site contacted me and asked me to consider affiliating with their website. Apparently they had read several of my blogs and found my site and the posts to be in their words “respectable” and “well written.” They wondered how much I’d charge for them to be able to include a link to their site in my next blog.

As many of you can guess, I derive no direct monetary income from this blog. The revenue I do get comes in requests for consultation, workshops and speaking engagements from people find me through this site, and summer is slower in those areas. Needless to say the idea of making some money from the blog is always tempting. And I have nothing against online gambling per se. But I declined, and at this point I can’t imagine accepting advertising or affiliating. It might be more tempting if Blizzard or Nintendo were to call, but even then I would have to decline. Not because I think affiliate marketing is inherently wrong, but because in this case something more valuable is at stake.

The second experience didn’t involve money, but it was actually an even harder decision. Not long ago I had the privilege of being elected to the board of a professional organization. I’ve been on several boards, so I was expecting to commit a lot of time and work to this one. What I wasn’t expecting was to get a call from the chair about my blog. Seems that someone had forwarded a post where I criticized several organizations for their stance on technology, including this one. I was told that I’d have to retract the post, and refrain from making any future critical posts about the group.

This is an organization I think highly of, and I can tell that the members of this group are not just in it for the title. I’m sure I could have done a lot of good serving on it.

But again, I had to decline.

Neither money nor a titular position is more important than my integrity. In fact, I’d go so far as to say to you that integrity is your brand.

It’s important not to make the mistake of demonizing either of the two parties in the examples. There is nothing inherently wrong with marketing or in my opinion online gambling. But I have not built my reputation on being an expert on gambling, and I’m not one. So even though the website might derive benefit from having a respectable blog link to them, I wouldn’t. Sure money is great, but as I said, something more valuable, my integrity, might be lost. I have worked too hard and too long to risk losing that.

I can also understand the board’s point of view: As an ambassador of the organization, whatever I say about it, critical or otherwise could be problematic for them. I don’t agree with them entirely, but when I understood what was expected my choice was clear. This blog isn’t Mashable, but many of you have been reading it for as long as it has been up. And people expect me to tell it like it is, whether it be about technology, gamer-affirmative therapy, or growing your private practice. If you’ve read the comments you know that everyone doesn’t always agree with my point of view. But many people have come to find the blog, and me, consistent and honest. There are other people who can do board work, but without my integrity there is no blog.

At the risk of sounding self-righteous, I know that writing this has made a difference in the lives of therapists and the patients they treat. It has allowed me to gain access to publications and groups to spread the word that technology is not incompatible with therapy, and that gamers need therapists who are culturally competent in gaming rather than contemptuous prior to investigation. Seasoned clinicians have told me that they have begun to rethink some of the cherished ideas our field holds about addiction, and fledgling therapists have sought me out for supervision on how to grow and market a profitable and socially just practice. And of course writing for all of you has helped me feel “powered-up” to continue to do the work even when there’s pushback from colleagues and our field.

I’m not telling you this just for catharsis. And I don’t have that “Blog With Integrity” badge on the blog just for show. Here’s what I want to make sure you know:

One day, maybe very soon if it hasn’t already happened, you’re going to realize you’re a success. You’ll realize that you haven’t been worrying about your practice as much, or that your caseload is full, or that you’re being asked to teach on your expertise. One day, you’re going to be a success. And when that happens, you’re going to have opportunities that require you to make tough choices. Because people will notice you’ve become successful. Whether it be those word of mouth referrals or podcast interviews, you’re going to have become more influential. Some people will want to harness your influence to help them, others will want to harness it to control it. And the only person who can decide what choice to make is you.

If you don’t feel comfortable seeing yourself as successful or influential, that’s your problem. Ignorance is always a vulnerability. You matter. The work you do matters. Your thoughts and opinions matter. Its when we don’t think we have an impact that we hurt our patients, our families, our business, in fact our world.

Immanuel Kant once said, “Act only according to that maxim whereby you can at the same time will that it should become a universal law.” I take this to mean act as if anything you were about to do in your life would become a universal law for how to do it. That’s heavy stuff. It’s not easy to decide how to act in a way that you’d be willing to have be the way to act for the rest of your life. In this case, blog with integrity.

Integrity is your brand. Are you willing to do what keeps you whole and constant in your therapy, business and life? Do you stand up for the things you believe in even when they cost you money, comfort or being liked? And perhaps most difficult, are you willing to notice your success, admit that you matter, and live with the knowledge that you have an impact on the world?

Filed Under: Business Tagged With: branding, building your business, gamers, integrity, kant, marketing, private practice, ROI, self-promotion, social justice, social media, Web 2.0

How To Learn About Video Games & Why You Ought To

July 29, 2011 by langloimsw 1 Comment

http://www.youtube.com/watch?&v=JY8h-U7rE6Y

Filed Under: Gamer Therapy, Games Tagged With: adolescents, building your business, gamers, gaming, LGBT, play, psychodynamic, psychology, psychotherapy, ROI, social media, Web 2.0, Wizard 101, World of Warcraft, wow

What Google+ Could Mean For Therapy

July 25, 2011 by langloimsw 14 Comments

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.

Filed Under: Business Tagged With: addiction, adolescents, behavior change, building your business, Google+, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, stress, therapy, Web 2.0

Five Tips For Your Practice This Summer

July 15, 2011 by langloimsw 10 Comments

Filed Under: Business Tagged With: building your business, marketing, private practice, psychotherapy, ROI, social media, Web 2.0

Don’t Run Your Practice Like An HMO

June 18, 2011 by langloimsw 9 Comments

I was surprised today to get a letter from a local insurance company, authorizing payment to me for a session I’d done in September of last year. I wasn’t sure whether to be annoyed or laugh (I decided to laugh) and as I was grumbling about insurance companies I realized that they have taught me what to do and not do with my own billing.

Let’s face it, most therapists don’t like billing and most therapists don’t like insurance. (If you’re not a therapist, read on anyway, you might find it interesting.) Insurance companies are as a rule very difficult to deal with. They make us go through elaborate credentialing processes to join a network that pays us a fraction of our fee. And when we submit claims they often hold on to them for months, delaying our payment. Or they reject the claim because of some technicality, or request a half hour conversation with us to review the treatment so that they can find a reason to stop paying for it. Insurance companies are insulated by layers of administration and bureaucracy, and finding the person to answer the question or authorize treatment can take forever. In fact, the whole premise of insurance has been to have a large enough risk pool of paying clients that they can offset the damages they incur and still make a profit. In short, insurance companies are avoidant, outdated, and hostile to claims.

So why are we just like them?

Therapists groan about insurance companies, and yet we often act just like them when it comes to running our business. We avoid filing claims as long as we can, so that we’ll get reimbursement checks that are bigger and “worth the effort.” We avoid streamlining our billing processes. And we are extremely hostile when it comes to having to file claims to get paid.

Don’t run your practice like an insurance company. Instead, here are some suggestions for you:

1. Don’t delay your billing by unnecessary process. Take a few minutes to look at the way you process bills. Are you writing them down in a ledger, maybe more than one? Do you try to sort things by insurance company rotating different companies at different times of the month? Do you have elaborate formulas for payment plans for your patients’ co-pays? (That’s insurance fraud by the way.) Do you have a calendar that you transfer to your ledger? Or if you have a software program do you enter the same data in several different places? If you are doing any of these things, you’re wasting your time. Come up with one strategy and stick with it, and cut down the number of steps that any strategy you come up with has.

2. Don’t avoid by storing up your accounts receivable. You hate it when an insurance company sits on your claims, don’t do the same thing when it comes to your own accounts receivable. Don’t store up and hoard your accounts receivable to bill “later.” Your patients and you both deserve for you to bill promptly even if it is a $15 co-pay. Don’t drag out your co-pay billing for more than a month at most. Aside from sending a devaluing message to your patients, (“I don’t need that tiny amount of money”) it adds up and can become a source of anxiety to them. Bill out in smaller amounts on a regular basis, and if you don’t, ask yourself what your behavior is expressing about billing. Storing up your accounts receivable may present you with bigger checks later, but irregular ones. For people who know the value of consistent structure, we certainly drop the ball on this one, and then what happens? You see your bank account is low and you say, “I’ve got to do my billing.” And even if you send it out that day, you’ve just set yourself up for a few weeks of anxious trips to the mailbox to see if the money has finally arrived.

3. Don’t treat patient payments like a risk pool. When it comes to billing, don’t rely on a few consistently paying patients to help you avoid billing the rest. If you allow patients to carry a balance set a dollar figure that is consistent across all of them. Mine is $400, because I know that if a patient carries a higher balance than that I may start to get annoyed and that will create static in the treatment. My billing office thinks my limit is too high, but it is what has worked for me and allowed me to be consistent. By all means set your own limit, but don’t have 30 different billing schedules and expectations for 30 different patients! It isn’t fair to the ones who pay regularly, and it also isn’t fair to the ones who don’t. And it also isn’t fair to you. This may work for the insurance companies, but it definitely won’t work for your business.

4. Do your billing every 1-5 days. You heard me, every 1-5 days. None of this once a month or every few weeks or “when I have to” stuff. You’re in business and businesses bill their customers promptly and regularly. And here’s what’s really cool, if you bill every 1-5 days after a while you’ll begin to get paid every 5-7 days. That’s it for this one, 1-5 days, no excuses.

5. Do lose the paper. Not as in misplace it, but as in get rid of it! Many of you are probably saying to yourselves, “he’s crazy. I don’t have time to do all that paperwork every few days!” There’s the problem, you’re still using paper! Start billing electronically, most insurance companies have that capability, and there are plenty of software programs out there that can help. When I used software I would send out that days appointments at 5:30, took 15 minutes. The first few times you will need to spend more time on it by typing in things to the program’s database, but after that it goes pretty quickly. And if you can get in the habit of typing in the first part of the intake the day of the intake, that’s even better.

6. Do use a billing service. I saved the best for last. If you don’t want to do billing yourself, fess up to it. It’s a reasonable business expense to have. I haven’t missed the money I pay to my billing service CMS Billing one bit. The amount of money they have captured for me (including the check from last September) has probably offset what I pay them. In addition, they do all my billing intakes, insurance authorizations, credentialing and customer service for billing questions. The time they have freed up has allowed me to develop workshops, write this blog, and engage in other creative and lucrative aspects of my business. Remember that when it comes to owning a business you need to spend money to make money. Don’t be a tightwad, hire a billing service. Then you won’t have to worry as much about the technology part. But bear in mind that they can only bill as quickly as you report accounts receivable to them, so you still need to do that every few days.

As I write this, 97% of my accounts receivable are under 30 days. I get my money with regularity, and my patients know what to expect when they reach the $400 mark. This is possible for you as well! As this fiscal year draws to a close, take some time to take stock of your billing practices. If you’re acting more like a lending company or an HMO it may be time to change.

Filed Under: Business Tagged With: building your business, HMOs, insurance, managed care, marketing, money, private practice, psychology, psychotherapy, ROI

Being A Noob

June 11, 2011 by langloimsw 1 Comment

Over the past few months I have taken some time off from playing World of Warcraft to try a new MMO called Rift. Rift takes place in a different world from WoW, the world of Telara. It has a different storyline and although the user interface is pretty much a duplicate of WoW’s, there are many many other differences as well. I have been playing WoW for several years, and had progressed my character to level 85, the highest you can get as of now. In those several years I have been a member of three guilds, leveled 6 professions, and spent countless hours researching the internet on strategies, spell rotations, and boss strategies. I’ve traveled the length and breadth of Azeroth and Outland, and completed hundreds of quests and achievements.

And now I’m a noob again.

In Telara I’m just out of the training zone, and level 13. I have no idea where I am, and most of the map is still an undiscovered blank screen. I don’t have more then 20 points in any profession and I’m not in a guild. I’m reading new material and trying to figure out what sort of place Telara is, why the sky is constantly ripping apart as rifts from some other dimension open up and rain down monsters on me and any other players in the area at the time. I keep running the wrong way into mobs of villains many levels higher than me and dying. Lots and lots of dying. And lots and lots of running back from graveyards as a ghost trying to find my body.

Good times.

For those of you who don’t know this, being a “noob” is a term for being a newbie, a newcomer unfamiliar with game mechanics and the lay of the land. It can be a very frustrating experience. The first time I was a noob, in WoW, I had no idea how much I was learning as I was learning it. There was such a steady progression that I didn’t realize how much experience and skill I had amassed with the game until I switched over to a new game. Now it is like I have lost all of that experience and skill, and I can feel overwhelmed. I am nowhere near Rift’s “endgame,” and everything is new and weird. So why not just go back to playing WoW?

First off, I have a little faith. As I stumble through being a noob in Rift, I can remember feeling similarly clueless at the beginning of my time playing WoW. I know that I am learning a great deal, more than I can even tell, and that this sense of being overwhelmed will pass. Also, I am enjoying the heightened sense of discovery, stumbling into the city of Meridian for the first time, having chats with other noobs as we form public groups and down elites.

The last time I was on, my mage was teamed with a warlock and a warrior, and we took on an elite without a healer. We gave it all we got, and then the warrior was down and the warlock was getting attacked. As the warlock fell, and the boss approached me with only 5% of its health left I kept spamming shadow bolts at it until it got to me. Just as it killed me I set off one more bolt that killed it. We closed the Rift, resurrected ourselves, collected the loot, and I felt the same level of thrill and achievement as when I first started playing WoW.

Every gamer was once a noob. Every gamer you see in your therapy practice was once thrown into a strange unfamiliar world knowing no one, with only the clothes on her or his back and a few silver in their satchel. Those men and women in your office who have been deemed failures at school or work by parents or coworkers has tried and failed and tried again hundreds of times. They have wandered around lost in a dangerous world knowing no one, and struck up conversations with other wanderers. They’ve banded together with others to defeat powerful adversaries, worked diligently to perfect professions and skills, and you’ve known nothing about it, because you didn’t ask. Instead therapists often focus on how many hours a person plays, pathologizes gaming as an addiction, or dismisses it as a silly hobby with no clinical or real-life value.

(How many of us approach our patients’ dreams that way? How many of us ask, “how many hours a night do you dream?” or consider them to have a dreaming addiction? When was the last time you dismissed dreaming as a valueless, silly hobby.)

Being a noob takes courage, and stamina. We therapists know this deep down. Most of us gravitated to our profession because we wanted to help the vulnerable, the bewildered and the confused grow into the strong, wise and whole people our patients become. We help them map out their inner world, strengthen their coping skills through trial and error and retrial. We encourage them as they level their professions at work or school, build guilds of peers and loved ones to raid life with, and face whatever monsters they have to to heal from trauma. Let’s recognize the game mechanics in what we do, and learn from the game mechanics in what they do.

Last but not least, let’s talk business.

In the 21st century, many therapists are seeing a game change in our profession. The way we practice therapy and help our patients is changing in many ways. We can use Google to help them find the closest AA meeting, Skype with them when they are away on business in Hong Kong, email them DBT worksheets or set up mindfulness reminders for our groups on Twitter. Even if we avoid using these technologies with our patients, they are trying to talk to us about bullying via Facebook, sexting on their iPhones, or falling in love in Second Life or World of Warcraft. In the 21st century, technology is no longer negotiable, it is embedded in virtually all treatment issues one way or another. And so therapists are noobs once more. This doesn’t mean that we can’t still practice psychotherapy the way we always have. But do you think that that should be our prime goal, to do things the way we always have?

When I first advertised on Google, I paid .10 a click. Nowadays colleagues in my area are paying upwards of 6$ a click to be visible. Having a Google ad or website is now pretty common. Between changes in social media and healthcare, many of my colleagues and the therapists I consult with are finding that the game has changed again, and they feel frustrated and bewildered like they haven’t in years. They’ve become noobs again.

Being a noob isn’t bad, although it can be uncomfortable. But what I’ve learned from fellow gamers is that being a noob can be fun as well. The key is to keep your sense of humor, and not take having to learn new things as an insult. I sometimes hear colleagues express outrage at having to do things differently to grow their business, and heaven forbid they spend money on coaching or business planning or consulting with someone who has more expertise than they do! The subtext is “How dare I be treated this way?!”

Change isn’t meant to single out and insult you, lighten up. Of course you should be learning new things, and leveling up. Have a little faith that you are learning even though it feels clumsy. We keep trying to get to this “secure” place where we’ll never need to stretch or do something different, and it just doesn’t exist. We need to cultivate what my colleague Chris Willard refers to in his book of the same title as our “Child’s Mind.”

In other words, we need to embrace being a noob.

Filed Under: Gamer Therapy Tagged With: building your business, chris willard, gamers, gaming, marketing, noob, private practice, psychotherapy, rift, therapy, video games, Web 2.0, World of Warcraft, wow

Therapist Websites Are Not Enough

May 22, 2011 by langloimsw 25 Comments

Last March a friend and former graduate student I supervised was visiting me from out of town. He was telling me about a call he got that went something like this: “Hi Bob, great website! Would you like to do a workshop on creating a online presence for our chapter of NASW? You won’t be paid for this, but you’ll get exposure, what do you think?”

This sort of exchange contains every element you need to have to teach a lesson on how not to do things as a Web 2.0 therapist. Let’s break this down:

1. What you are doing is so valuable we’d rather not pay you for it. Anything that you would go to a workshop to learn is something you should be willing to pay for. Even if it was only $20, a small amount or honorarium is something you should offer when you recruit someone to help you. Offering a rationalization is not the same thing; if my former student needed exposure the last place to look for it would be from this cheapo crowd! I know we have had a longstanding tradition in the psychotherapy disciplines to expect that we will present papers or talks at big yearly conferences for free, and that kind of thing seems a little different in my mind, because they are national conferences or Symposia and have many presenters. But to recruit someone specific for a specific workshop and not pay them any honorarium seems both cheap and arrogant to me.

2. Online Presence=Having a web site. Wrong! A website is just one small (important, but small) part of having an online presence. Having a website is something you should have prior to trying to launch your online presence. Now opinions vary on how to get one. I have some colleagues who know this space who believe that Therapists need to hire someone to build a website for them, and I can see the merit of this. My own opinion is that WordPress and our current technology have made it possible to have a very professional website for a fraction of that price if you are willing to spend some time and a little extra money to get a framework like Genesis. That is the one I use, and this site is one that I was able to design and launch pretty quickly. I have an older site that is still out there, but doesn’t get anywhere near as many hits now. That being said, I do think that whether you build one or have a professional do that, you definitely ought to have a professional critique it. My colleague Juliet Austin has a expertise doing this, and having been in the market for a while, she has a great eye for dos and don’ts.

But having a website is not an online presence in 2011, it is a colorful classified ad. Yes it is necessary now that potential patients want to see and meet you before they see and meet you, but now that there are thousands of Therapists with websites it will not distinguish you much more than a Psychology Today profile. Having an online presence requires you have a vibrant combination of interactive dialogue, recommendations that establish your “brand” as a therapist, multiple forms of media to see, hear and read you, and some amount of change over time.

I’m not trying to discourage any of you from getting started online with a website, I just want to make sure you see it is only one component of having an successful online presence.

3. Professional Organizations need to become more professional when it comes to business and social media. Asking your constituents to take the lead without compensating them is just lame. But even more concerning are the attitudes I see many organization taking towards social media. One example recently was a workshop NASW was promoting on HIPAA and Social Media. The flyer began with the bold red words “Protect Yourself!” The workshop like many others I have seen approaches the Internet and Web 2.0 from the point of view of fear-mongering, if the advertisement is accurate. Be scared of social media. Don’t learn how to use it for marketing your business, let alone your clinical work. This is not the message we need from our leadership. Include a component on social media in a general ethics course, sure. But please stop fostering the association of technology with ethical risk, social media with liability.

Our professional organizations also need to put the same thought and care in finding expertise when it comes to Web 2.0 as they would other workshop topics. Would we ever email a colleague and say, “Hey, want to do a workshop for NASW on EMDR?” based on information as limited as a website? I doubt it. As leaders of our profession, our professional organizations need to treat the topic of social media and health care with the same care as other topics. Their endorsement gives an imprimatur. If they say, the only thing you need to know about social media is to avoid it or you’ll be sued, we learn nothing but fear. If they say, social media requires no expertise or experience, we underestimate the skills we all need to learn to use it.

Bob is a great guy and an excellent clinician, but his having a website doesn’t make one an expert. Being on Facebook or Twitter doesn’t make one an expert. Having 5-15 years of experience working in the space of Web 2.0 like Juliet, Susan Giurleo, or myself does. These are peer-vetted experts, experts vetted by peers in both the clinical and Internet fields. I used to be hesitant to say this, because even though I teach people how to self-promote as part of their business I still feel uncomfortable with it myself. But I feel it is important to make a distinction between people who have spent years and thousands of dollars learning how to integrate clinical practice and Web 2.0, and your colleague who has a nice website.

Look, we need to start taking social media seriously, 97% of our patients and other human beings use it. I applaud our professional organizations for trying to offer something. But the above approach reminds me of having your grandson hook up your DVD player when he comes home from college. It is shortsighted and underestimates the complexity of the matters at hand. At some point Therapists need to strike a balance between a healthy respect for the growing importance of social media and avoidant fear. And at some point we’re going to need to invest time, money, and serious thought into how, not if, we use it in our practice.

Filed Under: Business Tagged With: behavior change, building your business, marketing, private practice, psychotherapy, ROI, social justice, social media, twitter, Web 2.0

Epic Mickey and Frittering

May 13, 2011 by langloimsw 1 Comment

The last week I have had a blast playing Epic Mickey; two blasts actually. In the game you’re Mickey Mouse, and your primary tool is an enchanted paintbrush, which sprays two different substances with very different effects. The first is a magical blue paint, which can make invisible things real, and make an enemy in the game turn blue and become a friend. The second is a magical green paint thinner, which can make real things invisible, and thin an enemy into nothing.

There are good reasons to do both of these things, but the unnecessary obstacle in the game is that there is a limited amount of paint and thinner, and so if you use too much too quickly, you have to wait until a cooldown replenishes it, or until you find a power-up. Power-ups, in case you aren’t familiar, are items in the game you can come across that replenish your health, and in the case of Epic Mickey, your paint supply.

The game is a Wii game, and so the motion controller is how you aim the paintbrush to paint or thin. And when I started playing it quickly became apparent that I was going to have to get better at aiming if I wanted to accomplish anything before running out of paint/thinner.

Epic Mickey teaches therapists, gamers, and anyone else who wants to learn through video games some important lessons about living life and frittering away your resources. The game has very simple mechanics, but life often has more complicated ones. Fortunately, this video game can help serve as a meditation on mindfulness and achieving goals.

Lesson 1: Paint Vs. Thinner

When approaching a problem, relationship, or business, it isn’t always immediately apparent whether to add paint or thinner. Do we need to add more stuff or clear some off our plate? Will additional effort reveal opportunities that were invisible moments ago? Do we need to process more with our partner, or less? Perhaps we need to simplify, reduce or focus our practice niche? Maybe we need to remove an obstacle, rather than spray creativity all over the place. One of my favorite paint thinners in real life is Occam’s Razor, which has been often interpreted as “the simplest explanation is most likely the correct one.” Or to put it more like it was originally intended, we should try to avoid any unnecessary pluralities, and tend towards the simpler theories or applications. Sounds like thinner to me, who would have thought Mickey Mouse to be a Scholastic thinker?

And to make things more complicated, Epic Mickey shows us how if we can’t make up our minds we will go back and forth between paint and thinner, undoing anything we may have started and wasting time and effort. So whether we decide we need to add something or take something away, we need to commit to a course of action, or we’ll be confusing dithering with effort. In Epic Mickey so far, I have found that many problems can be solved in a variety of ways, some using paint, some using thinner. I suspect life is like that too.

Lesson 2: Keep an Eye on Your Power Reserves

In the game, you always have to keep an eye on your paint and thinner meters to make sure you pace yourself and don’t run out. They will replenish automatically over time, but slowly. In my business I can attest that this is also true. I usually have a couple of irons in the fire, but I have learned to pace myself. I remember a few years back I was seeing 25 patients a week, supervising three interns and therapists, teaching two classes, taking another, sitting on 2 commissions and trying to write. I had to learn the painful lesson that I was doing a subpar job of every one of these because I wasn’t prioritizing, and perhaps more importantly, I wasn’t allowing time for replenishing myself. Nowadays, I try to pace myself and make time to do fun stuff, like running at least once a week, playing some games, spending time with my family chilling or getting a massage, eat regularly and get enough sleep. Not only are these things rejuvenating, but if I can resist multitasking they block off time so I don’t get exhausted and put out subpar work.

Are you keeping an eye on your reserves? And more importantly, are you willing to give up a few things so that you can devote more time to living life and having fun so you have the energy to do others? I certainly didn’t want to give up any of the activities I was doing, I liked doing them all, just not all at once. Often I hear colleagues say “I just don’t have enough time to simplify and relax,” as if it is a luxury rather than a choice. Sure giving up a couple of things is going to discombobulate you, especially if you’ve learned to pride yourself on being busy. But you won’t run out of paint as often.

Lesson 3: Keep an Eye Out for Power-Ups

In Epic Mickey, time isn’t the only way to replenish, there are treasure chests with power-ups. When I recently defeated the Clock Tower Boss, the way I did it was to keep an eye out for power ups, and sometimes pass up what seemed a perfect shot to get a power-up. In the long run, keeping an eye out for the things that power you, your relationship or your work up will be worth foregoing the perfect shot. This is especially true in relationships: It can be very hard for us to resist zinging that perfect shot, but backing away and taking time to do something replenishing will usually make things turn out more harmoniously!

What are your Power-Ups? Is it a massage, a walk in a botanical garden, meditation, playing Super Mario or spending time with your kids? It’s your responsibility to figure out what these are, make a little time for them regularly, and do them even when you aren’t feeling totally depleted. Pay attention to what happens when you do certain things, eat a certain way, or take something else into your being. Do you double in size and power? Become able to hurl fireballs? Defeat previously impossible monsters? If so, chances are whatever you just took in is a power-up.

Lesson 4: Focus stops Frittering

Last, the more targeted you are in what you’re trying to do, the less wasted energy and resources you’ll have. In life, like in Epic Mickey, you often need to aim for something. Sure, sometimes random efforts yield surprising results. When it does, huzzah, but that’s no excuse for not trying to be focused. Mindfulness is in a large part about focusing your mind and body on something, letting distractions drift by. Use the Force Luke–if you don’t you will probably find yourself feeling depleted, frustrated, and confused as to why.

Yes, focusing means giving up on something else. Frittering means giving up on everything while deluding yourself you haven’t. Parents who become obsessed with quality time rather than choosing a game night are frittering. Saying you want a committed marriage while you’re out every night drinking beer with the buddies is frittering. Complaining about managed care and lower fees rather than marketing your business or helping a forward-thinking candidate is frittering. And there are a thousand other ways that all of us confuse dithering with effort. So pick something and try to focus on it single-mindedly. At least that’s what works for Epic Mickey, and can an 83 year-old mouse who can still defeat monsters and jump over chasms be all wrong? I think not.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, disney, epic mickey, game theory, gamers, gaming, managed care, mindfulness, nintendo, occam's razor, private practice, psychology, psychotherapy, stress, video games, Web 2.0, wii

Fear Is Where You Start From

May 9, 2011 by langloimsw 14 Comments

Recently I was having dinner with some colleagues, who were discussing the state of mental health and managed care. When these conversations start I sometimes begin to sit back, because I anticipate the worst. I expect that there will be some insurance bashing, and then discussion of how their salaries have shrunk, and how unfair the current system is, maybe a smattering of how better things used to be for our profession and concluding with uncertainty about how much longer they can stay in business. I expected this conversation to go the same way, and was preparing to decide whether to try to advocate for another, more empowering perspective.

I was pleasantly surprised.

The conversation did indeed start with the understandable concerns of therapists trying to grapple with the seismic shifts in our careers and businesses. But then one of them began to talk about how he was planning to change the way he did business. Others expressed curiosity about the things he was trying, and I finally offered a couple of ideas. When they found out that I provide consultation on building & maintaining your therapy practice, they were 100% enthusiastic and eager to hear some positive perspectives. They were able to hear my opinions of some tough truths, that we had bought into the managed care model because we were reluctant to market our businesses and have difficult conversations with patients about payment. No one was defensive at all, one even invited me to come talk with a local group of colleagues. At one point they made a joke about my “secrets” for success, and I told them I am not one of those people who holds back secrets to hook people into working with me, and that they could find a lot of free info on my site.

“I was kidding about having a secret,” one told me. “You don’t have a secret, what you have is a strategy.”

The Buddhist teacher Pema Chodron writes in her book of the same title, about going to “The Places That Scare You.” The goal of the Tibetan Buddhist practice of tonglen, or taking and sending, is to reverse the normal cycle of human existence. Rather than seeking out things we desire and avoiding suffering, the meditation practice of tonglen asks us to imagine inhaling and taking in the suffering for all sentient beings and exhaling happiness to send it to all sentient beings. Whether you believe in the mystical qualities of this, the principle is a useful one in that it teaches us to break the instinctual habit of trying to holding on to the things we like and get rid of the things we don’t. A version of this is going to the places that scare you, rather than running away from them.

The clinicians I have mentioned above are well on their way to maintaining and vastly improving their private practices, and its got nothing to do with me. They have realized that fear is real, and that it often is mistaken for the end of the line. They get that it is the opposite.

Fear is the place you start from.

People who deny that things are changing are in my opinion in for a rude awakening. They deny the way our profession is being challenged, the importance of emerging new technologies, and the evolving practice of psychotherapy. They deny the things that would evoke fear in them. This is not unique to therapists of course. Ironically, we often work trying to help patients see the devastating impact on their lives of repressing anxiety-provoking truths. Then we turn around and do the same things to ourselves, hoping that this change in economics or technology is “more of the same.” Folks in this group are in pre-contemplation of fear, they haven’t even gotten that far.

Then there are clinicians who have gotten that things are really changing, and they are terrified! They are paralyzed and miserable, commiserating with others and talking about the way things were in the past and how much better they were then. They see the point of fear and they think of it as the period on a life’s sentence of struggling. This is the end of our careers, we can’t learn to use technology, therapy is a dying art form. They give up, and go out of business in a lingering dwindling sort of way.

Fear is not the endpoint. Fear is where you begin. Fear is where you get going and hire a coach, research and write up a business plan, take a workshop on business development, marketing or integrating new technologies. Fear is the start of renovating your practice. Yes there is a lot of suffering in the world, let’s get going and reduce it.

Epic Therapists know all about fear. They aren’t fearless, there’s a lot to be worried about. Many businesses fail, money needs to be spent to make money later, there are long hours ahead and no structure but the one they give themselves. There is a lot they don’t know, a lot they’ve never learned to do to run a business, known expenses and surprises. But Epic is running toward that dragon, knowing this could be an epic failure, being afraid… and then doing it anyway.

Epic Therapists have learned the concept of “nevertheless.” I am scared that my business will fail, nevertheless I am starting it. I am afraid that I’ll rent an office full-time and not be able to find patients, nevertheless I am going to rent one. I am afraid I’ll sound inauthentic or greedy if I talk about my business to a colleague, nevertheless I am going to talk about my business. I am afraid no one will want to pay my fee, nevertheless I am going to set a firm “bottom line” fee for myself. I am afraid that I won’t be able to keep up with the changes in healthcare or technology, nevertheless I am going to make a strategy.

My last post about having a secret headquarters was fun to make, and it was also serious. We need to have a time and a place for strategizing. We can absolutely have fun doing it, but this is serious business. There really are things to fear in healthcare, building a private practice and starting a business. We need to think carefully and plan, and then we need to begin.

Filed Under: Business Tagged With: behavior change, buddhism, building your business, epic therapist, fear, insurance, managed care, marketing, pema chodron, private practice, psychotherapy, self-promotion, social media, Web 2.0

The Importance of Having a Secret Headquarters

May 4, 2011 by langloimsw 9 Comments

Filed Under: Business Tagged With: building your business, game theory, gamers, gamification, play, private practice, psychotherapy, secret headquarters, Web 2.0

The Lurker Below

April 20, 2011 by langloimsw 2 Comments

Both video and tabletop gamers know about Lurkers. There are two particularly famous ones. In Dungeons and Dragons, one of the earliest and most beloved monsters was the Lurker Above. Imagine a giant cave-dwelling manta-ray-like thing that clung to the ceiling until some unsuspecting party of adventurers wandered into its lair (lurkers and lairs go hand-in-hand in many cases.) Then it dropped on the adventurers and ate them if it was hungry. It was nearly always hungry.

A more recent favorite lurker is the Lurker Below in Serpentshire Cavern in WoW. This Lurker is the second boss in the instance, and perhaps even more importantly, the catalyst for the achievement “The Lurker Above,” where you fish up the Lurker from the bottom of Serpentshire Cavern.

A third and less famous lurker is my cat, Winnicott, pictured above. Winnie can lurk for hours. She is exceptionally good at it. Like the Lurker Above, she prefers high altitudes for the most part, but will opt for deep and semi-concealed places as well.

One of the important and distinguishing characteristics of lurkers is patience. They are always waiting for something, patiently, and still. Another characteristic is that they are observant, sensitive to the environment around them and the non-lurking entities going about their adventuring, fishing or laundry. The final characteristic I would mention is that lurkers don’t pounce until they are good and ready. That’s why we call them Lurkers and not Pouncers. Pouncing is only 2% of the entire lurking activity.

I wanted to talk about lurkers because I have been reading and thinking a lot about social media, Twitter in particular, and therapist’s aversion to it. And I agree with colleagues like Susan Giurleo that one should not use social media before one is ready. But I think a point that often gets overlooked is that you don’t have to actively participate in Twitter to engage with it. If you don’t have anything to say or aren’t ready to put yourself out there, by all means don’t. But don’t avoid social media. Lurk.

Lurking is a time-honored tradition on the internet, and there has been estimates that up to 90% of people on bulletin boards, online sites, Twitter and blogs could be lurking at any given time. That’s a lot of lurking going on, and it is not a bad thing.

One of the powerful ways social media can expand the way we interact is by allowing silent participation without social anxiety. Imagine you are an introvert at a party, only you could people-watch and stay on the perimeter for hours without some well-meaning host noticing you and urging you to mingle. You can relax and take it at your own pace, and in fact over time you might even engage more directly. Nick Yee and the Palo Alto Research Center refer to this as ambient sociability, which Jane McGonigal explores in her new book Reality is Broken. Ambient sociability in MMO games refers to the number of people who enjoy lower intensity and indirect social connection. These are the gamers who run around World of Warcraft by themselves pausing occasionally to help out another player, whisper that they like their character name, wave, or various other social activities that can occur when you are in a virtual world and enjoy being “around” people. Ambient sociability may also be the precursor for introverts to have positive interactions that promote deeper engagement.

Therapists are often introverts, in fact I’d suggest that often our choice to spend our days relating to others is often a counterphobic response! So it makes sense that social media can be intimidating for many of us, the conceptual framework of Twitter or Facebook can be hard to figure out, and we’d prefer to structure of the therapeutic framework. What we may need is to engage in a way that allows for social ambience without plunging us into public engagement at first.

Epic Therapists Lurk.

Epic therapists are not always in the know about all things internet, but they are willing to learn. And they are also willing to learn by lurking, rather than by jumping in with both feet, trying Twitter for a week by tweeting 20 things a day and then just giving up. Epic therapists are not petrified of HIPAA and confidentiality, but they are also willing to spend time learning about social media before subjecting themselves, their patients and their communities to its half-baked use. So let’s review the guiding principles of lurking, and how you can use them to become Epic in social media.

1. Lurking requires patience. Try following a few people or groups on Twitter that interest you. Use the search feature and look around. Pick Tweeters with large followings so you can feel even more anonymous. If it doesn’t make sense at first, just be patient and keep lurking. You can do that, you do it every day with patients. You don’t get up and leave the room 15 minutes into the session if you don’t understand what they are talking about. You pay attention patiently. Try the same with Twitter for 10 minutes here and there between your sessions, and allow yourself some time to feel the unfamiliarity of entering a new framework.

2. Lurking requires good observation. I know you all are experts in that, but we can forget to apply that principle to Web 2.0 You don’t have to respond to anything you’re reading or seeing, just notice things. Just be sensitive to the environment and what the denizens of the Twitterverse are doing. How are people interacting? What do their profiles say about themselves? What sorts of topics trend at certain times of day? Who is following who, and who else is connected to them? What kind of Tweets get the most responses? Who spams, and who sends out thoughtful links? And include yourself in the equation: What Tweets do you notice enjoying? What ones do you dislike? I personally don’t enjoy lots of famous quotations, but that’s just me? Other folks enjoy clicking links to photos, or clicking on the latest news from APA. So since you are giving yourself time to lurk, give yourself the opportunity to notice things and ask yourself questions.

3. Don’t pounce until you are good and ready! It is ok to lurk silently for as long as you want, and if you don’t feel sure about Tweeting, don’t tweet. My experience with social media both personally and as a consultant has been that when you’re ready, it will come organically. Maybe someone will post a link on Japan Earthquake Animal Rescue and you’ll want to retweet it (Note the clever insertion of a link that can take you to an amazing cause to donate to 🙂 ) Or maybe someone will ask a question that you can answer, and you’ll want to. Maybe there will be a conversation going on about healthcare social media and you’ll want to add your two cents worth. Don’t be afraid to open an account and begin lurking because you imagine you’ll be obligated to chime in at some point. Remember pouncing is only 2% of the game.

I forgot to mention one other thing about lurking: It can be fun! One of the keys to engaging with social media is enjoyment, and lurking can provide you with hours of quiet enjoyment with no responsibility to say anything. And if you like that, I know a good laundry basket you can hide in.

Filed Under: Gamer Therapy Tagged With: building your business, d & d, games, private practice, psychology, psychotherapy, social media, twitter, Web 2.0

Save and Continue

April 15, 2011 by langloimsw 6 Comments

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.

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, chris brogan, Freud, gamers, god of war 3, psychoanalysis, psychology, psychotherapy, referrals, susan giurleo, therapy, video games, Web 2.0

Do Your Dailies

March 28, 2011 by langloimsw 10 Comments

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

Filed Under: Gamer Therapy Tagged With: adolescents, buddhism, building your business, dailies, gamers, mindfulness, private practice, psychotherapy, video games, World of Warcraft

The Lessons of Zelda

March 22, 2011 by langloimsw 5 Comments

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?

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, building your business, gamers, gaming, mindfulness, psychotherapy, video games, zelda

What I Learned at Pax East.

March 12, 2011 by langloimsw 4 Comments

For those of you who aren’t in the know, Pax East is a 3 day event founded by Penny Arcade a great website for online comics and other fun stuff. Pax East takes place in Boston, and this is it’s 2nd year. It is a huge convention which had approximately 70,000 video, tabletop and PC gamers. Last year I went to Pax East because I had finally decided I needed to take gaming and gamer-affirmative therapy seriously as part of my growing practice. I had always thought video games were fun, but it was only over the past 10 years that I had come to see that they could be life-changing.

I had discovered firsthand how World of Warcraft, Mario, and Zelda had helped me recover from a terrible job loss and re-evaluate what I wanted my work and life to be like. I had met dozens of gamers in-game and out who were recovering from various life struggles through gaming. I met soldiers stationed in Iraq who were gaming to keep their morale up or stay in touch with their families. I met LGBT people who had come out and found community for the first time in a Warcraft guild. I met people who had fought off isolation in other countries by raiding with loved ones at home. Still more had survived a divorce, discovered a way to rebuild confidence when they’d lost the ability to walk, or taken the first steps to socializing when their autism had stigmatized them and all seemed lost.

I also began to meet a growing number of young men and women who were refusing to be labeled as addicted or abnormal by virtue of their gaming experience. And I began to wonder what it would be like if as a therapist I came out as a gamer and helped people begin to take video games seriously.

At the same time I began to realize that I needed to take my career more seriously, because I had decided to start a full-time private practice. I had had a part-time practice for over a decade, but it always felt like a hobby. And so when I began to float the idea to family and colleagues I was amazed by their response.

They took me seriously.

Anyone who has launched a business can probably identify to some extent. You spend a lot of time wishing, and then daring, and when you finally decide to tell others you find that they have a far easier time taking you seriously than you do yourself. It was as if the company I’d helped built, my education and my CV were all fluff in my head.

If I had a hard time imagining myself as a independent businessman and a full-time private practice therapist, you can imagine how hard it was to imagine being a successful therapist who specialized in video games, virtual worlds and social media. Sure I could justify playing video games with children I worked with, but a gamer-affirmative therapist? This was a harder row to hoe. I had people thinking I meant online gambling and referred gamblers to me. I had colleagues who pretended Facebook didn’t exist and glazed over when I told them about the social media company I had helped develop. And most often I had this response.

“Oh, I don’t know anything about video games.”

This from colleagues who were throwing out the term gaming addiction willy-nilly. So I knew that I had a couple of choices, keep quiet or begin working with gamers and educating psychotherapists about what video games actually are, and what they can do for us. And I decided that if I was to really try to educate people on video games and doing therapy with gamers, I’d have to take myself seriously. And that is where Pax East and Blizzcon came in.

Where better to meet gamers than in those places? And what better form of continuing education for me than to see what is happening in the gaming world? This was part of the work I wanted to do, and the only thing holding me back from engaging in it seriously was that I felt guilty for having fun. From graduate school and continuing education I had learned that education was serious and not necessarily fun. But when I took the plunge I found that the money I spent on travel and the conferences was totally worthwhile, and the people I met were really interested in my work. This is something my colleague Susan Giurleo wrote about recently regarding another such convention that she is going to, SXSW.

I’ve learned a lot in the past two years. Last year at Pax East I didn’t have nearly as much fun as I did this year, because I felt like I needed to be there every minute and take everything seriously. This year I went Friday and picked a few things I wanted to do, like attend Jane McGonigal‘s keynote speech. And I took fun more seriously and learned more. I got a sneak peek and play of the Nintendo 3DS. I got to watch the amazing new XBox Kinect game Child of Eden. I walked around all day with a Plants Vs. Zombies traffic cone on my head. I participated in the largest massively multiplayer thumb-wrestling match in world history! And all around me I saw happy and energized people playing and socializing with strangers.

I was reminded of the things I tell my supervisees all the time, that if you aren’t enjoying yourself in your work something is wrong. Because enjoying yourself helps you achieve a state of believing that success is possible. And that the people who settle for less in their work get less. Such optimism is crucial, because running your own business takes a lot of time and effort. I have never worked as hard at a job in my life, and I have never loved what I do as much as I do now.

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, marketing, Pax, private practice, psychology, psychotherapy, video games, Web 2.0, World of Warcraft

You Are Not A Non-Profit.

March 5, 2011 by langloimsw 16 Comments

Please do this for me; even if you never contact me and ask for a consultation or supervision, just do the following.

Print out this page.
Cut out the title to this blog post.
Find a picture of your child, partner, parent or other loved one.
Tape the title to the picture.
Place it on your office desk, where you can see it every day.

Huh?

This week in MA, we had further seismic tremors in the land of health care. Two tremors in fact. First, the news broke that our three biggest insurers Blue Cross, Harvard Pilgrim, and Tufts had reported financial gains this past year and strong investment income. In addition, the story reported that the CEOs of these companies made salaries ranging from 780K to 1.2 million dollars. News also revealed that BCBSMA’s board members collected an average of $68,000 last year to attend board meetings. That’s roughly $1,100 an hour.

The other big insurance news was that Tufts and Harvard Pilgrim decided to call off their merger. The reasons cited were that there wouldn’t be enough savings to offset the cost. Translation: They just wouldn’t make enough money to make it worthwhile.

What does this have to do with anything? Lots.

First, the salaries and board stipends underscore that Blue Cross Blue Shield is a non-profit business. That is why if you look at this list of BCBSMA’s Board of Directors, you will see top-ranking business-people and government officials. Put simply this means that it can dispense its surplus to reward board members and top management. They are a franchise, and in many cases, publicly-traded companies.

Second, and this is a reiteration of the first in a lot of ways, health-insurance companies are designed to make money, not just break even. They are a Non-Profit not because they don’t make money, but because of the way they disburse the money made, to their managers and board members (who incidentally are some of the people who have legislative power when it comes to healthcare reform.)

Back to your picture and my post title.

You are not a non-profit. You don’t even have to play the shell game with board members and management, because you are the management. It is understandable and easy to get distracted by the rage and yes, envy, that one feels at these “fat cats” making so much money. But let’s get real honest now. Here, I’ll go first:

1. I’d love to make 1.2 million dollars a year.

2. I live in a capitalist system, not a caste system, which means that just because I was born in a capitalist system I don’t have to live here, or, I can try to alter the system to be more in keeping with my socialist goals. But as long as I live in a capitalist system, money is an inevitable fact of my existence.

Now the hardest one, at least for me:

3. The minute I accept insurance reimbursement I become part of the medical establishment, and that means that the sickness and suffering of others is what creates a need for the commodity of psychotherapy. In other words, I need a steady stream of unwell or hurt people in order to make my living. If I do my job well enough, people won’t need me any more, and I’ll need to attract other hurt or unwell people. And even if I try to gussy it up in the form of “self-help,” I’ll still need people who need help.

Now I am not going to try to justify this to you, gentle reader, by saying I only make as much money as I need. I don’t believe greed is good, but I do want an iPad, and I don’t need an iPad. So I have to come clean and admit that I am not an non-profit.

I consult so often with therapists who take great pride in the amount of “slide” they have in their sliding scale. They are willing to give up that money without a lot of regret. Until they take out that picture of their family that I ask them (and now you) to put on the office desk. Look at it, at them. Those are the people you love, they are also being affected when you don’t charge full fee to someone who just got a new job, or when you don’t enforce your cancellation policy. They are the ones who are depending on you to help keep your family afloat. They are the ones who embody the best care you can give, and they will be with you and counting on you the rest of their lives in one way or another, often financially.

You are not a non-profit. You need to make a profit, and you need to stop pretending you don’t, and minimizing the profit so that you can pretend. I hate insurance companies and a lot of our healthcare system, and I am fighting for social justice when I am not working in my practice. But these companies get it, they get that they are in business.

We need to get that too.

Filed Under: Business Tagged With: building your business, HMOs, insurance, mental health parity, private practice, ROI, social justice, Web 2.0

(Un)Desperate Times, or Know Your Talent Trees

February 16, 2011 by langloimsw 12 Comments

Recently I was given a referral for an evaluation, and upon some reflection I declined it. This is not something I am often in the habit of doing, but in this case the evaluation would have involved a clinical situation that did not fit with my integrity. So it got me thinking about the relationship between building your business and professional integrity.

The referral would definitely have been lucrative, and within my scope of experience and skill. And most of us these days certainly cannot afford to turn away business.

Or can we?

If I had taken this evaluation on, I would have most likely have been called on to testify about something that I was not entirely behind. This would have compromised my ability to be an expert witness. As I weighed the pros and cons I was quickly aware of my feeling of “halfheartedness” about the whole thing. And that was what clinched it for me. No patient deserves anything less than a wholehearted therapist as far as I am concerned. And I believe that when we catch ourselves trying to make something “fit” with our practice, we should probably stop right there.

Most of us were trained in clinics or hospital settings where we did not choose our patients. We were there to help everyone, and the idea of a good clinical fit was something we were usually reluctant to give voice to. Social workers in particular are often encouraged to be little mental health Statues of Liberty, treating any of the huddled masses that get sent our way. But no one of us is supposed to treat everyone in my opinion. And believe it or not, there are therapists who want to work with every segment of the population. I have met therapists who love working with borderline personality disorder. Others feel invigorated by working with substance abusers. There are people who really enjoy working with schizophrenia, like me. So in the long run, I think it is important to notice who you like working with, especially if you want to be in private practice.

Being clear on this is hard enough when we are starting or growing our practice. Turning down a referral can be terrifying and guilt-inducing. Somebody needs our help, we need to earn money, and we’re going to decline a referral? Sometimes, yes. Sometimes we need to hold a space open in our practice for a bit. And always the patient deserves a therapist who is 100% committed to the therapeutic relationship. So if we are lucky and have a good coach or supervisor we brave our fears and hold open the space for a while.

But later on in the development of a private practice, you may encounter a slightly different issue, what can be called an “embarrassment of riches.” The phone starts ringing with calls from potential patients, requests for court or special education evaluations, or maybe your old employer wants you to come back and do a workshop for your old agency. It can be tempting to overextend yourself, but I would suggest the following when this happens: Don’t just do something, sit there. Give yourself time to evaluate whether this opportunity is the best opportunity for you after the initial shine or honor of being asked has worn off a little. Because only you know your business plan, and which of the opportunities presenting themselves to you is the best one for furthering your practice.

The picture at the beginning of the blog is what World of Warcraft veterans will recognize as a talent tree. Each character class has three talent trees they can choose from to put their talent points into. The more talents points you put into one tree, the more access you have to higher powers and abilities of a certain kind. At the same time, since you have a finite amount of talent points, putting talent points deep into one tree makes it impossible to put them deep into another. So for example, if I am a mage, I can choose to put my talents in Fire, Frost, or Arcane trees. If I put most of them in fire, I won’t be as powerful when I need to use frost spells.

Sometimes newbie gamers decide to spread their talents across all three trees. They divide up the points and suddenly notice that they are at a high level but aren’t doing that well in the game. At some point someone will notice their talent trees are a mess, and explain to them the importance of specifying their talents. Sometimes therapists do the same thing: We try to be everything to everyone and learn to do a little of this and a little of that. This is often where the diabolical word “eclectic” comes up. We’re not frost mages OR fire mages, instead we’re hurling bolts of lukewarm water, and who needs that really?

If you have been building your practice for a while, you have probably noticed that your phone is starting to ring more, or your website is getting more hits, and this can be so exciting and intoxicating you’ll lose sight of your business plan. This week I had a day like that, where I got 2 referrals for psychotherapy, an extended evaluation, and invited to teach 2 classes! You bet that feels good (and overwhelming!)

But I needed to spend my talent points wisely. If I load up on patients, I won’t have time to do my writing or workshops and ultimately develop passive revenue streams. What’s worse, the patients will get an overworked overtired therapist who is not wholehearted. If I teach two classes, I won’t have enough time to do something else, and if I take on an eval that has me interviewing, writing and expert witnessing, same thing. Time to refer back to my Tweaking 2011 plan. So everything went on hold for a day (remember, we’re running a private practice, not an ER: If something seems so emergent that it can’t wait a day, it may not be something to take on) and I ended up declining half of the embarrassment of riches, offered alternate referrals, and hopefully everyone will be the better for it.

Have you started to specify your talents yet? Have you chosen the talent tree you’ll put the majority of your points in? The secondary one that enhances the first? Does what type of work you accept clearly map to the business plan you’ve made for yourself? I’ve written before about being an Epic Therapist and this is one of the qualities that makes a therapist Epic: Epic therapists specify and hone their talents in one main area. And because they do that they can explain what kind of therapist they are at parties. And they can do solid work and reading in their area so the patient gets excellence. Excellence is what will keep your business afloat in the coming years, so spend your time and talents wisely!

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, private practice, psychotherapy, referrals, talent tree, therapy, Web 2.0, World of Warcraft

How to Have a 100% HIPAA Compliant Online Presence

January 17, 2011 by langloimsw 38 Comments

Fort Knox photo courtesy of Flickr

Many of you have asked me about protecting the privacy of patients in your practice online. Since this concern with privacy often feeds into the anxiety psychotherapists have about using social media, I wanted to offer you a way to build your online presence with an eye to best practices and a sense of confidence. So here is my instruction manual for having a practice that is 100% HIPAA compliant and respectful of patient confidentiality and therapist privacy. Do these things and you will never be in trouble.

1. Don’t talk about your patients online, ever.

People who work with me know that I am nonnegotiable on this one. Yes, in the 15 years I’ve been a therapist I’ve had plenty of poignant and instructive cases I could present and patients I could discuss. No, I am not going to tell you about them. Not on the internet anyway. The internet is not like a team meeting or case presentation, where you have a closed group of professionals discussing patients and asking for consultation. Anyone can read the posts, and patients can easily identify themselves (or imagine that they do) in your blog post. And if Facebook resets your privacy settings one day and I’m your 2:30 patient; and if I Google your Facebook as patients do at 3:25 and find you’ve just updated your status to say, “Just finished with the tough patient for the day, it’s all downhill from here;” then I will know, be offended, and if I’m savvy and litigious get ready to make some money to pay for the new therapist I’m about to hire.

And a special shout out to those of you who use forums such as LinkedIn and Psychology Today, even if you think your forum is open “only to professionals,” does it not occur to you that your patients are or one day could be in your profession? I look at some of the many forums I am on sometimes and I am horrified by the headings, which often resemble these:

“Wow, this patient is so self-centered!”

“What’s the funniest that thing your patient said in session today?”

“Potential clients wants to see me instead of my colleague they see now.” (Let’s hope the colleague doesn’t read the forums.)

and “I don’t want this borderline back! Help!” (Complete with a page long “brief” case presentation!)

Several of these have so much identifying information it’s not funny. And as for LinkedIn, most discussion groups are now open and searchable by web, so when you write in asking for advice about an adolescent smoking pot don’t be surprised if she ends up seeing it.

In closing on this one: I know we all need to vent and ask for help with patients from time to time. That’s what supervision is for, go buy some.

2. Life is temporary, the internet is forever.

Before you post anything, ask yourself how you would feel if it was printed on the front page of The New York Times or some similar print edition. Everything you post on the internet is housed on a server somewhere; backed up usually; then often trawled for and picked up by Google and made searchable. Once you put something on the web it stays there, even if you think you deleted it. So ask yourself, “Is it a good idea to have what I’m about to write floating around wherever it will forever?”

3. Don’t create an online identity that you aren’t prepared to have connected to you.

The nature of privacy is changing due to technology, and that means we can’t be assured that any identities we assume online will remain private now or in the future. Servers get hacked, laptops get stolen, and people, patients included, are very resourceful in satisfying their curiosity about us. So if you have specific groups or personas that you want to let loose on the world via WoW, alt.com or anywhere else, be prepared. If I can’t imagine myself being able to hold a conversation with a patient about their discovering a potential “secret identity,” I don’t create it. I know this may sound harsh, but this is one of the privileges we give up for the privilege of doing the work we do.

4. Don’t subscribe (or unsubscribe) to things you don’t want patients or colleagues to know about.

Subscribing to things is a choice, and you need to be prepared to have those choices made public. This ranges from sites which tell you how much a person donated to the Democratic Party to a blog or listserv. And in terms of collegial relationships, do not risk appearing deceitful by opting out of a Constant Contact list and then telling the colleague how much you enjoy their newsletters. Yes, this has been done to me, and I try very hard to resist telling the person that I can tell them the exact date day and time they unsubscribed on my CC account. Subscriptions and unsubscriptions are expressions of your agency online, express your agency with integrity.

5. Understand how email works.

Recently I agreed to provide coverage for a colleague, and when they offered to email a list of who I’d be covering I requested that they mail it. This surprised them, because they know what a technophile I am. When I explained it is because email is not secure they replied that the mail isn’t secure either, and that envelopes often arrive opened. That is an unfair comparison between email and mail in my opinion.

A more accurate comparison would be if you write a letter, make a copy for yourself and send me a copy; and then someone opens the letter at your post office, makes and keeps a photocopy of it and mails it to my post office, where a second worker opens it and makes and keeps a third copy of it before giving a fourth copy to me. That is how servers work, that is how hosted emails work. If you don’t want four or more entities having copies of your emails, don’t send them. If you want to send encrypted emails, which are definitely more in keeping with HIPAA and HITECH, I recommend Hushmail.

6.Keep current with the technology if you plan on using it.

You know I encourage you to try and use technology as much as possible, so the above may sound like an impossible and counterintuitive task, but there you are. If you are planning on taking pictures of your children with your iPhone and posting them on Facebook, make sure you know about geo-tags before you go about using Facebook or Craigslist. If you are considering using Dropbox or GoogleDocs for patient notes investigate whether these are verified as HIPAA compliant (I’ll save you time on this one: They are not. Don’t use them for patient notes.)

If you want to play around with some new technology, research it a little (Google “[whatever you’re playing around with] and privacy.” If you want to keep current with technology and best therapy practices, I recommend you check out the Online Therapy Institute’s “Ethical Framework for the Use of Technology in Mental Health.” They are on the cutting edge of this stuff, and they have great courses as well as free resources.

So these are my suggestions for having an online presence that is HIPAA compliant and protective of your patients’ and your privacy. I know they are a tall order, but the privacy of you and your patients is worth the effort. Please feel free to add: Did I miss anything?

Filed Under: Business Tagged With: building your business, confidentiality, HIPAA, managed care, patient privacy, private practice, psychotherapy, Web 2.0

Latest Newsletter is Out!

January 8, 2011 by langloimsw 1 Comment

Some of you have expressed interest in what my monthly newsletter for colleagues is like. So below is a link to the January one. The program I use is Constant Contact. I really enjoyed putting this one together, a combination of health reform, business and gaming stuff. Feel free to subscribe while you’re there. 🙂

January Newsletter

Filed Under: Gamer Therapy Tagged With: building your business, gamers, insurance, managed care, private practice, psychotherapy

Tweaking 2011

January 6, 2011 by langloimsw 5 Comments

This is my first blog entry on Evernote. I’m excited about that because learning and trying out Evernote is one of my 2011 goals. More about that in a sec.

One of the reasons I love supervising therapists is that it keeps me honest and focussed on innovation. The other night I was talking with a supervisee about scheduling our time for the upcoming year. Would an evening time on another day work better for me? (Quite a thoughtful supervisee, not an uncommon experience given our field.) I found myself answering that I wasn’t sure yet, because I needed to re-evaluate my evening time. I have been noticing a drop-off in my work with adolescents, and have been coming to the conclusion that if I want to keep working with adolescents I’ll need to give up some of my evening time.

This time of year is an excellent time of year to give your practice and your career the lookover. In the past several years I have gravitated to more traditional hours so I could pursue other projects. For example, my professional development and networking goals for the past year and a half have been fulfilled by my Fellowship appointment at the Massachusetts Institute for Psychoanalysis. In 2009 I identified the need for more collegial contacts and friendships as well as wanting to have CEs for my license. The Fellowship has provided me both in abundance. Like many of my actions to meet my goal, the MIP Fellowship was a “twofer.”

I always try to have as many twofers or threefers as possible, so that I don’t overwhelm myself with actions to meet the multiple goals. Twofers are important to me because I want to consolidate my actions, but not my goals. So I list my current goals and then put the actions under the goal(s) it fulfills. I also rate it hot or backburner. That way if I have a few actions I make myself evaluate the relative strength of my interest to do each. So follow me along for an example:

Professional Development Goal

MIP Fellowship- heading towards backburner. This is my last year of it, and I’m ready to move on to a different structure and get my Monday night back.
Program Exploration – hot. I need to begin planning on what I will do to replace the Fellowship, which means taking a look at workshop or mini-course offerings or webinars that happen during the day. Am I willing to give up my weekends yet? Traditionally I have balked at Saturday workshops, so I am revisiting this.
Continuing Ed on cultural competency working with transgender population- hot. My practice has been trending towards an increase working with this population, so I need to invest time in updating my skills in theory and best practices.

Clinical Therapy Goal

Adolescents- hot. I have noticed that I am trending downward in my work with adolescents, a population I love. Most adolescents require parental transportation and can’t miss school regularly, so I need to revisit my giving an evening up. Saturdays? No. (This is an excellent example by the way, of how there is no one right answer for this. My colleague Susan Giurleo regularly works an evening and Saturday, and there are lots of good reasons for doing this. I have consciously chosen the last 2 years to not have an evening because the evening time was more valuable to me than the money I was choosing not to make. Choosing not to make money is different than saying, “why can’t I fill my practice, whoa is me.” Money is one item of value, time is another, it is up to you to choose what you want to give up.
Gamers- hot. I want to continue to focus on working with more gamers. I need to revisit where and how to get referrals. This year I will try to offer more public speaking opportunities to colleagues to increase awareness of gamer-affirmative therapy. Also will use Twitter to remind my followers of my interest in working with this population.
Couples work- backburner. Even on my best day, this is not my preferred modality. I will maintain my “no more than 3” couple limit, but am tweaking it to focus on private pay, gamer couples or online therapy.

Technology Goal

Twitter-hot. I continue to find Twitter useful, but am tweaking it a lot. I will use it to Tweet blog articles or RTs and hold to my goal of 2RTs and 2 salient tweets (i.e., tweeting something I think is relevant professionally rather than for the sake of Tweeting. Recently I have fallen short of this goal because of the magnitude of tweets that come my way. Will add this to my Epic Win program and scale back on how much time I spend reviewing. Will keep an eye out for Tweet-management software to see if I find any I like more than TwInbox.
Evernote- hot. I have heard about how great Evernote is for too long from too many people I respect to ignore it. I will familiarize myself with this program and try using it for blogging, as well as exploring which other goals it might further.
Game exploration-hot. I have been focussing on WoW and Second Life.
Rockmelt-backburner. Still in beta and having some bugs. Still limiting access so limited as social media. Shut down and I lost a whole blog post! I am continuing to play with it a little but relying on Firefox until it gets a little more stable.

Social Justice Goal

Give an Hour-hot. I still find this a meaningful way of donating clinical time to fulfill the gap for returning vets. There is an increasing number of vets and active duty gaming, and this is a potential twofer with the Clinical goal.
Diversity Class- hot. I continue to find teaching this worth the “pay cut” I take by giving up those clinical hours. This is a twofer a teaching goal and writing goal on rethinking how we teach Diversity.
Masshealth-backburner. I am opting out of taking Masshealth due to the high cancel rate I’ve experienced in the past. This is a twofer with my business Goal below of decreasing my involvement with insurance and diversifying revenue.

Business Goal

Reduce dependence on insurance-hot. The writing is on the wall for decreased revenue and increased hassle as Health Care Reform takes effect. Leave Masshealth and UBH networks.
Increase online therapy-hot. I need to focus on increasing marketing for this modality, it is all private pay and more flexible in time to meet patients and my needs.
Increase consultation and supervision-hot. Supervision and consultation was the biggest growing area of my practice last year. Need to poll current consultees about what they find most valuable so I can emphasize that. Be willing to slide down to my bottom line to attract supervisees in early stage of their career. Make and post more video on supervision and consultancy.
Advertising-backburner. Google Ads not yielding much ROI, decrease ad bids. Stay on Psychology Today for next year but focus marketing/advertising through speaking engagements.

Teaching Goal

Additional psychodynamic class-hot. New syllabus written and course approved. Hopefully this will be offered this summer, will apply to teach it.
One class per semester-hot. This tweak from two classes one semester and one the next was a big improvement. Evaluations better, enjoyed work more. Will consider whether to make up third class by committing to summer course regularly.
Offer visiting lecture or workshops to universities-hot. This year I want to get out to more college health centers and schools for social work to present on gaming. Tufts very successful, will look for opportunities to present at other universities. Put the word out, twofer with business and professional development goals.

Writing and Research Goal

Newsletter-hot. The readership response has been positive and begun to generate revenue. Need to stay focussed on keeping newsletter relevant and yet distinct to my niche. Review of clicks indicates that the psychoanalytic topics are more popular than the gaming ones. How can I increase traffic to those stories?
Blog-hot. Now have over 100 readers subscribed, and growing. Need to continue to make this a focus. 2-3 posts weekly remains doable and will maintain 2 minimum. Again, the practice/business posts are more popular than the gaming ones, need to consider how to increase interest in those articles. This is a threefer with business and clinical goals.
Journal article-backburner. The style and tone of blogging is much more satisfying currently, will revisit later in the year to see if this changes.

So that’s my beginning of 2011 review and tweak. It took me 40 minutes to think and write about this. Don’t you think it would be worth 40 minutes of your time to do the same? What are your goals for this year, feel free to use the blog comment to get started!

Filed Under: Business Tagged With: building your business, gamers, Give An Hour, marketing, mental health parity, private practice, psychotherapy, Web 2.0

How Invested Are You?

January 4, 2011 by langloimsw 6 Comments

photo courtesy of Flickr

When you decided to become a therapist, how much time and money did you spend? Most therapists spend between three and six years (longer if they are MDs) enrolled in graduate programs that cost thousands of dollars. That’s a lot of money! But we do this because we value the profession, the work we do, and the people we help. We also do it because it’s reality. You don’t show up, knock on the door of a graduate program, and say, “hey, can I sit in on a few classes for free?” You want the education and you pay for it, by loan, scholarship or somehow.

It astounds me how this logic seems to go out the window when it comes to growing a therapy practice in a Web 2.0 world. This is probably because technology has become so easy to acquire. You want a blog? WordPress will let you get registered and started in 15 minutes. Twitter, takes 10 minutes and a valid email to enroll. So I see a lot of colleagues decide to “take the plunge,” start a blog, and then..

Nothing.

Nothing happens, or they don’t get traffic. Or they run out of ideas. Maybe they ask me for some advice, offer to buy me a coffee if I can help them with their blog. “Can we just chat?” they’ll say.

Then there are people like my colleague Carolyn, who hire me. That’s right, hire. She wanted some help with her blog, both in terms of the technology and setting it up, as well as market consultation on audience, focus, and sustainability. So she spent the time and money to do this, and even though we’ve just started working together she’s already seeing more of a focus in what she’s doing. We’re backing up and unraveling a few stitches, so that we can get her and her practice ready for the 2011 business year. Carolyn is going to thrive, and not because she hired me: She’s going to thrive because she is investing in her practice and taking technology seriously.

Taking technology seriously means at least two things:

1. Taking technology seriously means you accept that the point in history when using technology was optional is over. You can no longer ignore or opt out of using technology to have a successful practice. Whether you use email, social media, file claims electronically, request authorizations, etc., if you do not start utilizing the resources that technology affords you you will fail. I know that sounds brutal, but your colleagues will pass you buy. Web sites will trump the yellow pages every time.

2. Taking technology seriously means investing time and money in learning about it and how to use it. Just enrolling in a blog service is the equivalent to signing up for a psychology course, and then going out and hanging up your shingle. You’d be insulted if somebody implied that they could duplicate your expertise and services after taking one class or workshop.

Yet, I can’t tell you how many people approach the Web 2.0 practice that way. They’ll email me a question or two, ask for a free consult (which I no longer do) and I think on some level they are expecting that what they will get will be commiseration or something. A friendly “chat.” They really don’t take technology seriously, so they decide they’ll just do it themselves.

Where does he get off saying this?!

Let me give you a breakdown of the work I have done and the expertise that I have:

I have been a psychotherapist for over 15 years.
I co-founded a social media software company; meaning I participated in a startup business in many capacities to grow it. I pitched ideas to clients at meetings, helped orchestrate launches, analyzed client needs, kept an eye on marketing trends; wrote press releases, managed budgets and negotiated CEO contracts. Oh, and I also helped develop the product that several versions and six years later is one of the social media companies to be included in the latest Gartner Group report.
I have spent countless hours researching the changes and developments in the social media industry, and compared to my company’s employees I am behind the curve. This is because I am not involved in the company’s day to day ops, and because I am focusing on doing the other projects you read about. But I know social media, from a user experience and business perspective, and it isn’t from downloading Twitter and playing around with it or making an Excel spreadsheet.
I invested in my own supervision and consulting from top clinicians and coaches.
I have started up and grown a private practice from zero patients to a full practice in 30 weeks. I can tell you it was 30 weeks because that is the amount of unemployment benefits I received to survive on while I built it.

So I know what it is like to take the plunge and how to make it work.

I am saying this to you because you need to take technology and growing your business seriously. Sure if some people read this and want to consult with me, I’ll be very happy. But if not me, please, hire somebody. Susan Giurleo does great work, so do Casey Truffo and Juliet Austin. And Lynn Grodzki is amazing. Heck, check out a couple of people; we all have different styles, experience and foci. But accept that taking your business seriously means asking for help and hiring experts.

So, yes, of course I am marketing for your business, but I am also trying to convey something more: If you do not invest in the time and expertise to build your practice in the 21st century you will fail.

P.S. If you want to get help on generating blog ideas, a great source is Chris Brogan’s service, and yes, you’ll have to pay for it.

Filed Under: Business Tagged With: building your business, casey truffo, chris brogan, consulting, juliet austin, lynn grodzki, marketing, private practice, psychotherapy, susan giurleo, Web 2.0

2010 in review: Some Statistics and Most-Read Posts

January 2, 2011 by langloimsw 2 Comments

The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:

Healthy blog!

The Blog-Health-o-Meter™ reads Wow.

Crunchy numbers

A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 6,600 times in 2010. That’s about 16 full 747s.

In 2010, there were 35 new posts, growing the total archive of this blog to 47 posts. There were 69 pictures uploaded, taking up a total of 470mb. That’s about 1 pictures per week.

The busiest day of the year was November 5th with 216 views. The most popular post that day was Showing Up for No Shows.

Where did they come from?

The top referring sites in 2010 were linkedin.com, twitter.com, facebook.com, mail.yahoo.com, and mail.live.com.

Some visitors came searching, mostly for venn diagram 2 circles, venn diagrams, venn diagram circles, venn diagrams for kids, and blank venn diagram 2 circles.

Attractions in 2010

These are the posts and pages that got the most views in 2010.

Showing Up for No Shows November 2010
14 comments

Want a Private Practice in the 21st Century? Get a Thick Skin. November 2010
12 comments

The Truth? You Can Handle The Truth. October 2010
10 comments

Referrals, or, Flossing the Gift Horse October 2010
13 comments

About Me July 2010

Filed Under: Gamer Therapy Tagged With: building your business, gamers, marketing, private practice, psychotherapy, Web 2.0

The Readiness Is All

December 20, 2010 by langloimsw 2 Comments

Engraving by R. Brandard

There ’s a special providence in the fall of a sparrow. If it be now, ’t is not to come; if it be not to come, it will be now; if it be not now, yet it will come: the readiness is all.

Shakespeare, Hamlet. Act v. Sc. 2.

This time of year is for many of us quiet and busy and full of expectations. Many of us our preparing to celebrate a holiday, and all that entails. Some are getting ready to do last minute shopping; some are getting ready to cook and buying the necessary ingredients. Some therapists are getting ready to take a vacation; some patients are getting ready to face the holidays alone or with family they find challenging. And after the Christmas day, and Boxing Day if you want to push it, much of the world slides into a week or so of winding down until the New Year hits.

I enjoy Christmas, but I have always found Advent much more interesting. Advent as you may know if the Western Christian season that marks both the coming of Christ and the end of the liturgical year. It is the season of quiet expectancy. There is silence, there is waiting. A candle is lit each week until Christmas, and there are these great advent calendars, with doors for each day that you open one at a time to reveal the picture or treat underneath. And for the techies and gamers amongst us, the best example of this sort of advent calendar is the one from Angry Birds.

This is NOT going to be a post about the Christian Advent or religion, but it IS a post about business, and the spiritual concepts that can (and I think should) be applied to your business.

I am looking forward to celebrating the holiday season, and yes I plan to rest and reflect. But unlike Congress I am not sliding into a lame duck session. I am using these last two weeks to get ready. I’m getting ready to teach a course on psychodynamic theory, getting ready to right a series of blogs on ludology and tweaking the business plan for 2011. My friend and colleague Susan Giurleo is getting ready to do her latest teleseminar with Juliet Austin on Social Media Marketing. My friend and colleague Carolyn Stack is getting ready to ramp up her new website with a blog. My clients are busy doing their interim homework for me on building their therapy practices, and MIP is rolling out a whole bunch of workshops.

Ok, so what are you getting ready for?

You knew it was coming if you’ve ready any of my blogs before. Mike gives examples and then pounces, asks me what I’m going to do. Yep, what are you getting ready for? Do you have a workshop in the works? A satellite office day? Twitter script for a CBT adolescent group? Are you teaching a course at a local university, or doing a public forum for colleagues on something you are expert in? Writing a chapter, article or blog? Joining a political activist group? Adding a new skill or modality to your repertoire? Learning about Skype? Getting on Twitter to check it out? Or if you want to be a gamer-affirmative therapist, picking a free trial of a game, downloading it and playing around in-world?

Now some of you naysayers in the back are probably saying: forget it. This has been a hard year, health care reform has sucked, my patients have tired me out. My work is demanding, I deserve a break. I’m going to rest up and plan this stuff next year. Of course you deserve a break, I hope you scheduled yourself some vacation time. But let’s not kid ourselves here. The next two weeks has lots of room in it for both work and play. I’ve been winding down work the past week and managed to grade my papers, read a book, and still level a character in WoW to 85 (and yes I am proud of it!)

Please please please don’t end the year on a down note! Because I guarantee you you will start the new one off with a defeatist attitude. The boundary between 12/31 and 1/1 is in many ways an arbitrary social construct. Now is when you should be getting ready for new projects, when you have some flexibility in your schedule. Because then you’ll be out of the gate running when the first work week of January starts, when many of our colleagues are just sitting down to their desks to brainstorm. I want us all to be ahead of the pack.

And a note to those of our colleagues, who probably don’t read this, who have already decided they “know themselves” and that they are going to stick with what they have been doing, you’re setting yourself up. Health Care is changing the way you will be getting paid. If you don’t know what an ACO means and how global payment model could put your private practice out of business, get your head out of the sand and start surfing for info. Please don’t be like my colleagues who chatted with outrage about the health care changes in MA as if they were political discussions all summer and fall, or even worse ignored the issue, and then FREAKED OUT when they opened the first payment from BCBS that had slashed their fees drastically.

Strong words I know, but I want us all to have strong businesses. Change is coming, advent is here.

Get ready.

Filed Under: Business Tagged With: advent, building your business, managed care, private practice, psychodynamic, psychotherapy

Is your Practice Busy or Hectic?

December 10, 2010 by langloimsw 5 Comments

This time of year the reply I often get from colleagues when I ask how their business is going is “Busy!” This is often said with shortness of breath, decreased blinking, and other physiological signs of anxiety. At the college I teach at, I often see my fellow faculty members commiserating with each other about how busy they are there. I think lots of us are busy, but I think it is time to re-evaluate if we are really busy, or hectic.

The way I differentiate between busy and hectic is simple: ROI and organization. When I am busy, I have most of my clinical hours filled, am up to date on my billing, know which week I am teaching on the syllabus, and returning phone calls or emails within 24 hours. I am also eating and sleeping well. That’s “busy.” When I am “hectic” I am thinking “oh my god I have too many patients to see;” forget to do my billing (or avoid it;) unfocussed when I get ready to teach; and start “saving” (read sitting on/avoiding) voicemails and emails. I also feel more of a pull to commiserate, to tell people how “busy” I am. For me, talking about how busy I am when I could be doing something more productive is usually a sign that I am hectic, not busy.

Once you have started to feel more stress in your practice, pause immediately and ask yourself if this is a prod from your psyche to take care of yourself. Have you done that? Good, if the answer is you haven’t, and that you don’t have time to because you are too busy, you’re being hectic.

Now knock it off.

Really, I am suggesting it is that simple. Other than an opportunity to review for self-care there is NO ROI on being hectic. You won’t get more patients, you’ll get less. You won’t have more time by worrying or commiserating, you’ll have less. You may derive a sense of self-importance from how crazy things are, but you aren’t really impressing anyone, including if you are honest, yourself. So put down the cross, we need the wood.

Here’s a suggested checklist if you are still unsure whether you are being “busy” or “hectic:”

I miss appointments or double-book
I haven’t eaten today
I am avoiding the phone and email
I have complained to 2 or more people that I am busy
I feel like I am working too much, and making less than I usually do
I am behind on billing patients
I have open times for patients but can’t find the time to schedule intakes
I hate my office
I’m feeling cranky and dissatisfied with my clinical work
I can’t remember the last time I had a non-therapy conversation with a friend, or if I can it was over 24 hours ago
I feel a sense of dread when I think about work

You may notice that some of these can also be signs of burnout: This is not a coincidence. I firmly believe that if you don’t learn to distinguish between being hectic and busy, your business will fail. It will fail because you burn out, and or because you sabotage your income streams to the point where you have to close up shop and go work for someone else. And if you do that, you can guarantee they’ll help you learn the difference between busy and hectic the hard way.

So this weekend, take 15 minutes to sit and reflect, is my practice busy or just hectic? And if you don’t think you have 15 minutes to do that this weekend, you already have your answer. 🙂

Filed Under: Business Tagged With: building your business, mindfulness, private practice, ROI, stress

What Do You Do Wholeheartedly?

November 27, 2010 by langloimsw 4 Comments

Photo Courtesy of Jamie R.

Being city dogs, Emerson (left) and Boo (right) rarely get to run off-leash. Recently I was able to take them to an open field that was enclosed, and the above picture shows the result. Boo especially pours her heart and soul into running. When she has the space to open up, she amazes us all with her energy, focus and concentration. At eight years old, she is just as fast as she was 5 years ago.

My dogs are great therapists and coaches. They are great therapists because they remind me of the power of mindfulness. When they run, they aren’t worrying about dinner or money or what they need to do next. They run. They are great coaches because they do what they love without fear. They don’t hold “just a little bit” of their energy back, “just in case.”

Obviously I would be a horrible pet companion if I let those two off-leash just anywhere. They could get hurt if the space was not enclosed. The same goes for my business, I can’t just go dashing off willy-nilly most of the time. I can’t go off every insurance panel at once, or double my fee; there is a place for care and caution. But there are spaces I put into place where I have the safety to just barrel forward, I need those. Those moments when I am fully focussed and engaged with something, to hell with caution. Those moments when I feel wholeheartedly how powerful I can be, how alive I am.

Do you have those moments in your practice? When you are in “the zone?” I am sure many of you do. And I am referring specifically to your business and psychotherapy. Too often we think that “real life” is lived outside of our work, clinical or entrepeneurial. We view those things as the ends to the means of having time to do what we really want. Bad idea.

Say you work 40 hours a week, which has 168 hours in it. That is a quarter of your life. Have you really made the decision to give up on finding meaning and energy and purpose for a quarter of your life? Assuming you sleep that probably leaves you only half your lifeweek left. I’m not giving up that much time without a fight. And that’s what we do when we say things like, “They pay me to do this, that’s why they call it work.” It’s just like when a patient says, “that’s just the way I am.” We’re really saying in both cases, “I give up.”

So if you are going to work each day at some agency feeling numb, or opening your office door much of the time with a sense of dread, maybe it is time to invite your lifeforce in. Even if it is only a few fenced-in hours or a day, give yourself the space to take something and run with it. I can honestly say that most of the time, every day, I enjoy my work. I never, I repeat, never think about retirement, other than some financial planning for it.

You probably saw where I was going with this a while back: When was the last time you opened up and went full throttle in your practice? When was the last time you gave your single-pointed mindfulness and drive to your business? Why do you hold yourself back?

Filed Under: Business, Gamer Therapy Tagged With: building your business, mindfulness, pet therapy, private practice, psychotherapy

Want a Private Practice in the 21st Century? Get a Thick Skin.

November 23, 2010 by langloimsw 13 Comments

Photo courtesy of http://www.rhinos-irf.org/

Many therapists go into the psychotherapy field because we are sensitive to the feelings and behaviors of others. In the clinical session, this is very important. Even if you aren’t a Self Psychology-oriented treater, empathic attunement is crucial to understanding your patient and meeting them “where they’re at.” People often come to therapy hoping for and expecting a corrective emotional experience, and usually that is an unspoken part of the therapy contract. Patients desire to be understood and heard; therapists strive to understand and listen. In this, sensitivity to what the other is communicating is key.

This is not always recognized by those outside our profession: Many times when we are asked what we do, and when we reply that we are therapists, we hear, “Oh I could never do your job, I’m too sensitive.” Yeah, I can do this job because I’m a really callous asshole. I don’t ever say that in reply, usually I don’t mention I’m a therapist (if someone asks me what I do I usually leave it at, “I do interiors.”)

However, there is a place for insensitivity in owning a private practice, and that is what I want to talk about today. Many of you are excited to begin practicing in a Web 2.0 environment. You have your Twitter account, your professional Facebook presence, etc. But are you psychologically ready for what comes next?

Recently I did a blog on Gamer-Affirmative therapy. It got many positive responses that I don’t remember clearly, but one negative one of course stuck with me. The colleague wrote on a bulletin board, “…it’s just a PR stunt. “Gay affirmative-Transgender affirmative- bla bla bla” Don’t use it…sounds stupid.”

Ouch.

I could get huffy, refer the person to my earlier blog on managing your online presence, but I’m not going to do that.

What’s more, if I have a thick skin, I can look at the comments more objectively, see if they are pointing out something of value to me, something about an idea or plan I hadn’t anticipated. If they do, good deal! If they don’t, can I let it bounce off and move on to the next one without ruminating about it too much?

If you are planning on venturing out here with your practice, are you prepared? Can you take the good with the bad? Can you shake off the hurtful comments? Better yet, can you learn from them? Sure we’d like everyone to communicate on the web in a respectful, polite way. They don’t. Can you deal with this and move on? If you find yourself scrolling down to that comment or email and reading it for the umpteenth time and you haven’t learned anything from it or calmed down, you are not dealing with it and moving on.

Last word, don’t rush this: If you aren’t sure that your idea or practice focus is “ready for prime time,” who can you share it with that you trust will be more compassionate?

Oh, and if you want to donate to the International Rhino Foundation, click on the photo! 🙂

Filed Under: Business Tagged With: building your business, empathy, marketing, private practice, psychotherapy, rhino, self psychology, Web 2.0

Content is King, Quality is Queen

November 13, 2010 by langloimsw Leave a Comment

photo courtesy of Flickr

Colleagues who are connected to me via LinkedIn, Facebook, or this blog have probably noticed by now that you get a lot of communications from me, sometimes daily. I Tweet at you, send you newsletters, advertise upcoming workshops and webinars, and post blog updates. I do this for a couple of reasons; the first and probably obvious one is that I want to stay on your radar. I want you to be talking to someone about their patient who does some gaming thing and be able to say, “Hey, there’s this therapist, Mike Langlois, who does workshops and consults on gaming, let me give you his email.”

The second reason I do all the communication is that it helps keep me honest. Here’s how: I truly don’t believe in putting things in your email or website that is worthless. I really do stand behind everything I send you with the conviction of its value. Because that in my opinion is the major thing that separates the professional from the spammer. Web 2.0 has given us dozens of new ways to throw messages at each other instantly, frequently and from anywhere. What has not kept pace with that is content. So that is why I say content is king, and I am convinced that the next shift we will see in the Web 2.0 world is when people get tired of the bells and whistles and even more discerning about the content. This goes hand in hand with why privacy will never go out of style even on the internet, but that’s a blog for another time. Now I certainly get the occasional “unsubscribe,” and I confess that enthusiasm sometimes has me err on the side of risk, and get a note saying my material is not appropriate for the discussion group in question. But I have never gotten feedback to date that there is no value in the material, that it lacks content. That day may come, but it hasn’t yet.

But if content is King, then the other member of the Royal Family, Quality, is queen. Sure, sending you any article published on the APA website is content, but that isn’t what makes it quality. What makes it quality is that it has been filtered to you through the lens of my discernment. If you look at my blogs and newsletter you will notice some general trends and areas of interest in what I call to your attention. Hopefully my Tweets have that as well. Quality is the flavor of my discernment that filters the content I send you.

This is not to say that other articles are not high-quality, follow Psych Central on Twitter and you’ll see hundreds of quality articles, essays and posts each week. But I don’t want you emailing me to consult with you on couple’s treatment, not my area of expertise. I want you to keep me in mind for a few specific things: Web 2.0 psychotherapy, gamer-affirmative therapy, psychodynamic theory, GLBT, diversity and social justice. Even that is too much for a niche, but those are what I am good at and innovative about, those are my best qualities as a consultant and therapist. What quality do you bring to your patients, your practice, and your business? What will make you stick in our minds, for when we really need you and no one else?

Filed Under: Business Tagged With: blog, building your business, content, marketing, psychotherapy, self-promotion

How Do You Want to Be Remembered?

November 9, 2010 by langloimsw 5 Comments

photo courtesy of leelofland.com

Recently, a bulletin board I participate on had a thread that really made me think. A colleague posted a copy of an email she’d received from a third colleague. The email was basically an introduction, a brief explanation of the therapist’s practice, and concluded with an invitation to visit her website and hoping to receive referrals. The string of comments that ensued were mostly, although not completely, negative. But I was struck by how openly critical many of the folks who replied were. And what was even more striking than people referring to the email as unprofessional was how quickly several of these professionals began to say hurtful and insulting things to each other. Personally I always applaud emails like the one in question, as I think it takes guts to self-promote, but I accept that other people have variations in opinion. What I had a harder time accepting is the negative quality of the discussion.

A related incident occurred over the past few weeks with my blog. A colleague began emailing me after each blog pointing out typos or grammatical errors. I was a bit surprised, but at least she was taking the time to read it. The last email was a bit more frustrating, in that she started the email criticizing my latest post and then asked for free consultation! Still, I replied with a brief and polite answer to her question. I wasn’t expecting a thank you or anything, but I was really surprised at what happened next. When I posted a note to a listserv I am on with a link to my next blog post, which said, “You may find this blog post of interest,” she posted to the listserv saying simply, “No Mike.”

I tell you these two incidents to remind you that every time you post anything with colleagues you are also building your online presence. Everything we read tells us something about you. If you post something sarcastic you let us know that you are sarcastic. If you post something clinically astute we know you are clinically astute. When you post an article link you tell us that you are keeping abreast of research, as well as your areas of interest. When you post online about a patient you tell us that you talk about your patients online. And when you don’t play well with others you tell us about how it might be to collaborate with you on a case.

If you are mindful of this and are doing things the way that is in keeping with your professional style and identity, great. There are lots of different ways to be in the world. My point is to make sure you are mindful about how you are presenting yourself, because your online presence is everything out here!

Sometimes I get the impression that the same sense of narcissistic invulnerability we acquire when we get behind the wheel of our car happens when we get online. We feel protected by a sense of anonymity and the asynchronous communication. We say things that we might never say to the colleague’s face if we were in the same room. We sacrifice sensitivity for the opportunity to seem witty or clever in front of our peers, even if it hurts someone. We forget there are people behind the screens, or we decide we don’t care. I am sure I have done it too, nobody is perfect. But please think about what you are doing, because it can be really detrimental to building your business.

Take a look at the last 5 posts you made out here in Web 2.0. What do they say about you? If they were the only things a potential colleague or patient knew about you what might they think? How do you want to be remembered?

Filed Under: Business Tagged With: building your business, mindfulness, narcissism, private practice, referrals

Showing Up for No Shows

November 4, 2010 by langloimsw 15 Comments

photo courtesy of Ihasahotdog.com

Every therapist I know has to deal with the inevitable missed appointment. This blog is not about how to set up your cancellation policy, explain it to patients, and most importantly adhere to it. If you are interested in my basic thoughts about that you can surf on over to my site for my cancellation policy and download the intake form which has it, as well as email me with questions.

No, today I want us to think about how you show up for your no shows. Most therapists I know use their no shows to play a game of “catch-up.” They catch up with notes, catch up with phone calls, catch up with emails, catch up on the news, catch a few ZZZzzzzs in the chair. Note the progressive nature of the catch-ups: It goes from things you really should have dedicated time in your week/day for and easily degenerates to self-care before you know it.

I never thought I’d use the phrase degenerates into self-care, but there you have it. And I say it because on a meta level it is actually not self-care in the long run. Ok, I have times during the week, a few 90 minute blocks that I have built in to have my “catch-ups.” And if I get all my work stuff finished in the first 30 minutes, which I usually do, I go on to some self-care extras, like a walk on the Charles River near my office, surfing the net, reading on my Kindle or a quick nap. But these are extras, I schedule self-care time in my week regularly, even color-coding it on my Outlook calendar so I have dedicated times for that. So if you have your self-care scheduled, and you have your “catch-ups,” scheduled, that leaves your no shows.

No shows are used for me as additional times to work on my ongoing projects to build my business beyond the office. They include:

Blog posts like this one
Research for my newsletter
Writing a syllabus to propose to teach at the colleges I teach
Writing a workshop application for CEUs
Videotaping a webinar or short web feature to post on my blog or site
Tweeting some of my required Tweeting (I try to Tweet 4 times a day, 2 original tweets, 2 retweets of quality content from others)
Surfing Technorati or Mashable to keep abreast of recent developments in the blogosphere
Designing some Freebies I give away to promote a webinar or workshop
Creating a workshop for helping therapists deal with managed care
Test-driving new (or new to me) online games like Everquest, Aion, or Civilization V
Checking out new apps for the iPhone or iPad

Those are all things I have done in the past month or so when I have a no-show. They allow me to continue to work on the overall business plan I have and get me started on projects that I used to complain I had no time for. I don’t waste time seething that I’m losing money or call a colleague to complain. From the business perspective, the only negative in a no show is the “no” at the beginning of that phrase. As Bettye LaVette would say, I’ve got my own Hell to raise.

How about you? How do you show up for your no shows?

Filed Under: Business Tagged With: building your business, marketing, negativity, no shows, private practice, psychotherapy

The Demon of Comparison

November 1, 2010 by langloimsw 9 Comments

"Saint Anthony" Tempted by Master of the Osservanza

Have you ever noticed how comparison and resentment go hand in hand? I was reminded of this again when a new bout of it erupted on a listserv I follow.

One therapist began speaking about how s/he was on the phone with an insurance company for a claim, and began to ask them about their salary, and whether they, like the therapist had not seen an increase in it since the 1990s. This prompted a bevy of emails back and forth to the tune of, “Yeah, we should find out how much they make, what they’re salary structure is” and of course the inevitable, “it is terrible that their executives make X amount of dollars.”

Really? Do you really want to be like the executives of a managed care company?

I know that I often blog here about how it is important to cultivate a business sense, so this may sound like a contradiction, but there is a vast difference between learning from businesspeople and emulating the ones we consider are doing unconscionable acts. Therapists often seem to want to have it both ways, we want to have the money and ease we imagine the “fat cats” at HMOs have, but we want to decry them as monsters. You can’t have it both ways, or either, if you want a profitable yet socially just practice.

What I think we often see here is good old fashioned projection, namely, projecting whatever part of ourselves we either find unacceptable or yearned for. Many of our colleagues have strong ambivalence about getting paid for helping, listening, and emotional labor. Sometimes we disown the parts of ourselves that see what we do as valuable, worth every penny, amazing. The way we disown this is to judge it as greed, and project our greediness onto someone else we can despise. The CEOs of insurance companies make great targets, when we look at the financial reports they deliver to their Board of Directors.

But when we project these things on the customer service rep, or care advocate, we miss the mark in many ways. Probably the most important way is that we act out our aggression with a worker who is not making anywhere near the money a CEO makes. And those customer service people aren’t uncaring, their doing a job for a company and often protecting themselves from the assaults they receive via irate therapists all day. Did it ever occur to you that the call the person on the other end of the phone just before you was someone haranguing them about how much they make and how greedy and unfeeling they are?

Look, I’m not trying to make excuses for the bureaucratic nature of managed care. The point I am making is that splitting is a primitive defense, even when the target has a big ol’ bulls-eye on it. More importantly, it doesn’t help your practice.

We have to befriend the part of us that wants to make money by listening to it, and using it to motivate our creativity. If the only way we can access that is by “pinging” off a projection of the “greedy” other, we are staying stagnant. If you are looking to an insurance company, customer service rep, or CEO to recognize you’re value you are wasting your time. Go look in the mirror, that’s who you’ve got to get to recognize you. Can you look that person in the eye and say, “I want to make a good living, and I am valuable?”

Remember, each of you IS a CEO, of your own business. If you aren’t happy with your salary, what are you doing to grow the business that has been entrusted to you by yourself?

Filed Under: Business Tagged With: building your business, managed care, private practice, projection, psychotherapy

Process Schmocess

October 12, 2010 by langloimsw 4 Comments

Photo courtesy of michaelagee.com

We therapists are often a very process-oriented group. We come by it honestly. Maybe we grew up in environments where nobody was heard enough. Maybe we gravitated to the field because we have seen how introspection and exploration have healed the lives of our patients and ourselves. Maybe we learned early on to channel our aggression into verbal aggression. Maybe we want to try to control and slow down the immediacy of our lived experience by putting a webbing of words, a safety net of speech around it. We track the process in our sessions, help the patient process their emotion, encourage them by respecting their process of self-discovery.

Process process process.

I used to work with a lot of elementary school teachers. They were very talented and caring educators for the most part. They’d work long days at school, go home, and sometimes catch themselves saying to their spouses things like, “I need you to get ready for dinner now,” or “Let’s remember to take out the garbage” before their partner reminded them that they weren’t a first grader. By contrast, many of these teachers had husbands who were contractors, plumbers, masons or electricians. They worked long days, but they never seemed to bring their wrenches to the dinner table, use cement to help their kids with their homework, or rewire the television instead of watching it.

They knew how to put their tools down, when they aren’t appropriate to the task at hand.

You probably see where I’m going with this. We use our “self” at work in therapy in very specialized ways. That is very important. But like my teaching friends, therapists tend to approach every task as a verbal processing task. And that just isn’t the way we’re going to fight managed care or build our business. We need to start doing things in addition to talking and listening, we need to use other tools, and we need to start committing to other forms of work.

When I do a workshop on managed care, the first thing I ask people to do is go around the table and whine about it. I want participants to express their feelings of anger, frustration, worry and sadness at how their practice is inhibited by managed care. I listen carefully to each concern, all of them are heartfelt and valid.

I give us 5 minutes.

Then it is time to move on. Let’s talk strategies. Let’s plan how you can use the time you have in the day to market yourself and your work rather than fighting over a check for $60 Let’s get that negative thinking out in the open so you can see how being realistic is really being fatalistic much of the time, and then we can do the opposite and see what happens. I love these workshops, because I watch and literally see the fallen facial expression fall right off their faces. Then there is energy, then there is laughter, then they start trading cards and strategies. We stop processing feelings and start feeling like professionals and business people. They leave feeling renewed and in some cases re-educated, and I get to strike a blow for freedom.

I hope I am always clear that I respect our profession, I respect your calling as a therapist. I do. And I do respect that you have an emotional life worth talking about. But let’s put that on the back burner for a few minutes, an hour, whatever we can start out with. Because I want you to succeed at building your business, and confusing worry with effort and emotion with diligence is not a formula for success. And honestly you don’t need my help worrying, I am sure you do that fine on your own. But enough chat, what are you going to DO this week to build your practice?

Filed Under: Business Tagged With: building your business, managed care, psychotherapy

Psychotherapy and Web 2.0

September 14, 2010 by langloimsw 10 Comments

Recently, I had two referrals to offer to colleagues. Although I like to make personal referrals, these patients had already had problems finding in-network providers. So I mailed a general query to a listserv I am in. Within an hour I received 5 emails back from therapists saying they had availability and providing phone numbers and their emails. Only one had a website however. I cut and pasted all five into a note to my patients, and I can guarantee you they will only call the therapist with the website initially. This event provides us with a perfect example of the difference between Web 1.0 and Web 2.0

Web 1.0 refers to websites and internet technologies that were historically non-interactive, sites that we can read but not actually actively interact with. Remember those? Nowadays it is hard to find any examples of them. Email and listservs, while still VERY valuable, and not at all disposable, would probably be considered Web 0.5.0 . They are not going anywhere soon according to the recent tech experts I’ve read, but they are more limited in their nimbleness. They also tend to give people burnout more quickly, as many experience them as intrusive emails from strangers who lob their opinions into the group, then someone lobs back an equally long rebuttal, and so on. The majority of folks on listservs quickly become passive and resentful, and soon create that sort rule which sends all of the information into the infamous “folder” many of us have.

First let’s look at what all five therapists did that was marketable, in terms of 1.0 They are on listservs, they respond rapidly and include email as a way to be in touch with them. These are great things, they position these 5 therapists ahead of the pack. They are responsive and accessible in the manner needed for growing or maintaining a practice. Anyone who responds after two hours is too late. When I told my patients I would gladly forward other names if they came in, they basically said, don’t bother. So that is the power of Web 1.0, that is what these clinicians are doing right, and that is the barest minimum, the barely bare minimum of where you should be with technology if you want to have a private practice in the next 2 years.

If you are reading this, you are at least at Web 1.0, so now let’s look at the therapist above who has begun to make the jump to Web 2.0. But first, what is Web 2.0?

Web 2.0 basically refers to web-based social media and social networking websites, like Facebook, and LinkedIn. What makes it 2.0 is the interaction. We don’t just read what someone somewhere put up on a site, we participate. We respond to information; comment on videos; share links with friends and colleagues; post blogs; make podcasts for websites or continuing education that others can download; host webinars; IM with friends while we share news or music. In particular to LinkedIn, which is designed for our work world, we can sign up for discussion groups (and there are hundreds) but also create an online profile which can be as specific or vague as one likes. The profile can include publications, and links to them, and a professional version of Twitter called your status. Mine sometimes says “Michael Langlois is accepting new patients.” Folks looking at my profile can see that I have experience in gamer-affirmative therapy and learning disabilities, which makes it easier for people to refer to me or ask me different questions.

The therapist above has much of that. He has a website, it has an interactive copy of his book, a picture of him, links to other sites and information. He even has links for professionals and I joined a email list as a result of his site. If I were providing consultation to this guy, we would be able to devote a lot of time right from the start on webinars and podcasts, because he has a lot of Web 2.0 down pat! He gets that the rules of engagement for therapist and patients have changed significantly. Patients want to see your face, hear your voice, think about what you have written, read recommendations from colleagues about you. And they want to do all that before they meet you. Remember the saying that therapy begins when you say “hello” to a potential patient on the phone? Well, in a Web 2.0 world therapy begins before you even get the phone call.

So you need to become familiar with Web 2.0 ASAP. And not knowing how yet is not an excuse, because as one of my colleagues said “people don’t go around nowadays saying, ‘the telephone, I don’t know how to use that.’” The telephone has become much more a part of our daily world and Web 2.0 has become much more part of our patients’ world. Technology is constantly evolving, in some ways like psychoanalytic theory. Even 100 years ago we might have heard ourselves saying, “free association, what’s that? I don’t know how to use that.”

So please, because I really do want you to succeed, please start gearing up for Web 2.0 and beyond.

Filed Under: Business Tagged With: building your business, psychotherapy, referrals, Web 2.0

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