You are here: Home / Archives for building your business

What To Do When Your Therapist Turns Into A Kitten

May 1, 2013 by 10 Comments

kitten

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.

 

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: , , , , , , , , , , , , , , , , ,

Epic Supervision Fail

April 2, 2013 by 7 Comments

arts-graphics-2008_1186344a

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:

indexAC

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.

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: , , , , , , , , , , , , , , , , ,

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by 29 Comments

apps

 

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: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

What It Means To Make A Referral

January 7, 2013 by 4 Comments

referral cartoon

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: , , , , , , , , , , , , ,

Happy New Year!

January 1, 2013 by 1 Comment

brave_-_h_2012.jpg_rgb

 

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: , , , , , , , , , , , , , , , , , ,

‘Tis The Season For Power Ups

December 3, 2012 by 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: , , , , , , , , , , , , , , , , , , ,

Avatars & The Curated Self

November 25, 2012 by 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

 

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: , , , , , , , , , , , , , , , , , , , , , , , , , ,

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

November 16, 2012 by 2 Comments

 

http://youtu.be/pWQIbIkOVtY

 

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: , , , , , , , , , , , , , , , , , , ,

Taking An Interest

October 14, 2012 by 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.

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: , , , , , , , , , , , , , , , , , , ,

Contributing

September 27, 2012 by Leave a Comment

 
You can sign up for Extra-Life 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.  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , ,
« Previous Page
Next Page »