An Open Letter to Parents, Teachers & Administrators Now That School Is Officially Closed
So Now What? : Education During a Pandemic
Parents, Educators and School Administrators are beginning to realize that this isn’t a break or a blizzard. Many of them are hitting the ground running, some are laying as low as possible this week and hoping things will settle, a few are immobilized. And every teacher I know or talk to is trying to figure out a strategies. Teachers, you know it is true: You LOVE strategies. And I love you for it. But these are strange times, and if your strategies or lack of them are making you feel stuck, maybe some of this will help. I have my two cents and then a list of resources for you.
First, my two cents, based on working in special education, public education, higher education and clinically over the past 25 years. The most important thing right now for kids right now is to stay calm, connected and establish new flexible routines at home. No homework packets, no busy work to keep them “occupied.” As tempting as this may be to administrators, educators and parents, that does not really lend to good learning, in fact it is this adherence to the status quo that partly got us into this problem to begin with.
- Play is OK. There is a wealth of research out there on the benefits of physical and digital play on cognition, visuospatiomotor skills, social emotional learning, and more. Allowing kids to engage in stress-relieving fun will make them better learners, keep them in contact with their peers, & feel mastery at a time when all of us are feeling little.
- Look for the embedded learning in the activity. This is different than trying to structure learning too much. When you are able to focus on your child between other things you are doing as a parent or online educator, try to identify what learning is happening with the play activity and maybe share it when the child is done. I say maybe because first and foremost this is for you to reassure you and calm your anxiety that your child or student is falling behind and will end up living in a cardboard box on the highway because they are playing Portal 2 rather than doing math sheets. Instead, watch the game a bit, and ask yourselves, are there things about physics embedded in the game? Does Plants Vs. Zombies have an opportunity to discuss task planning, sequencing, or math skills (hint, it does: all of the above.) Try to see the things that kids are always learning in play. Now don’t interrupt and ruin it.
Ok, I know that’s not enough for many of you. So here’s a list of some things educational innovators are offering for parents, kids and schools as resources for online learning:
From Continuity with Care to Zoom Memes for Self Quaranteens–My Internet Responds to COVID-19
Parenting (in RL) during a pandemic
Resources For Teaching and Learning During This Period of Social Distancing
THE COLLECTION :Explore thousands of artworks in the museum’s wide-ranging collection—from our world-renowned icons to lesser-known gems from every corner of the globe—as well as our books, writings, reference materials, and other resources.
Coping With COVID19: Advice for Parents & Educators
Brown Center Chalkboard (Ed policy thinking)
Invitation: Continuity with Care During COVID-19: Curation & Conversation (Curated and Crowdsourced Teaching Tips)
Kind Words: Lo fi chill beats to write to
Creating Educational Experiences through Narrative in Minecraft with Stephen Reid
Educators can also join one of my free Zoom groups (download free software at (http://zoom.us )
Thursdays 3-4 EST
COVID19 Educator Support: Not tech support. This meeting is to provide psychoeducation and collegial support for educators adjusting their teaching to COVID19
Meeting ID: 906-040-691
Password: 02554
Coping With COVID19: Advice for Parents & Educators
As anticipated, I’ve begun to receive a few communications from therapists, parents and educators about the social distancing impact on them and their children. The first question I get usually is something like “I’m worried about my kid playing too much video games, should I be setting limits on this with them?” I’m going to give you an answer that you may not want to here, but may actually improve mental health.
First, as I mentioned earlier this week, we are all going through an adjustment reaction to a rapidly emerging situation that is impacting everyone you know at the same time. This alone is rare in that usually some of us are not dealing with psychological upheaval when some others are. But this time, whether you are denying, minimizing, remaining guardedly calm, scared, or overreacting, you too are on the same continuum that we all are. So welcome. 😊
Local governments and schools, comprised of similarly recalibrating individuals are doing what they can to get ready for the wave of shut-downs, and this includes for many teachers and kids a break for 2 or more weeks and then perhaps online learning. Many workplaces are closing and reducing hours, which means that families are about to spend more time together in closer quarters with less emotional and financial resources than usual.
So, what can you do?
Here are my suggestions which are based on my work, research and thinking about psychology and technology over the past 25 years:
- Focus on social distancing (skip ahead if you already have embraced this idea.) This is the most important way we have to #FlattentheCurve and mitigate against higher more rapid infectivity. As has been written at https://staythefuckhome.com/sfw/ the concept of self-quarantine works to mitigate the spread of infectious diseases. We have known this since the 1400s. This is hard on social creatures, and can start to evoke guilt in caregivers. Compassionate ideas like visiting elderly shut-ins in person; babysitting groups and play-dates; local support gatherings are all bad ideas when it comes to a pandemic.
- Anticipate but don’t panic. It is very likely that more disturbing information and misinformation will happen in the next several days. If you note the way COVID19 is trending things are going to worse and scarier pretty quickly. Remember this is happening at a pace that is quicker than you may be used to and be prepared to change your mind and recalibrate family rules and limits much more rapidly and often. Be prepared to say, “I know I said X but now that I have more information it is Y, and I’m sorry that we keep changing the rules on you. Building that understanding with your child that things are moving quickly is part of the overarching message “I love you, I’m listening and I’m going to keep you safe.”
- Let kids play their games. I have mentioned elsewhere and will include below several posts debunking the common misconceptions that demonize video games. But here let me put it a different way: 2 or more weeks is a long time to be in your home nonstop with your children in a state of embattlement. Video games are a great way to practice social distancing: Kids can talk with their friends online, escape the heightened stress at home or in our communities, and feel a sense of being in control of something. It also provides you with the respite you know you are going to need after a couple of days. Lift restrictions if your authoritative parenting style can handle it. One exception here is helping kids build in 5 minute movement breaks every 45 minutes or so.
- Try to see it from their point of view. No matter how much your child or teen loves you, they are used to having several hours a day away from you too. Like you, they find being distracted from family life by work and friends reinvigorating, so please don’t frame this as an opportunity for more quality time. It’s disingenuous and sets everyone up to feel like a failure when the reality of quarantine sets in. Of course if they are open to spend time with you, accept the invitation as they deliver it: Now may be the perfect time for you to finally learn how to play Fortnite with them.
- No, YOU go outside and play. Often parents find themselves exhorting kids to go outside when they are secretly yearning for escape themselves. If your child can be left alone safely for a bit, go outside and take a walk, get some fresh air and calm down. You already believe that exercise will do you good, so focus on the one you can control, you! Of course, if your family walks/hikes/runs together and you are not looking for alone time, definitely invite them along with you.
- Get in the habit of zooming, calling, texting with others regularly. Your kids may be experts at this, but older family members may need help with the habit or technology. Or you might. Learn how to use Zoom, which is being offered for free for most kids. Call and help other folks learn how to set it up and test drive it. This week is the week to get practice before things get more hectic.
- Practice mindfulness games and meditation when possible. My colleague Chris Willard has some excellent suggestions on this here. Don’t force kids to do this though, as it will turn them off. If anything, trust that if they are intently playing a video game they may be engaging in a form of concentration meditation which isn’t bad either.
- Confront and redirect the inadvertent demonization of touch. This one is huge. This past week many have become acutely aware of how often they touch their face, or others without asking permission. To control the spread of infection this is crucial, and yet we need to also resist the urge to begin to perceive touch as unnecessary or lethal. Touch and reaching is a part of healthy infant development (Beebee, 2016.) It plays a significant role in focusing attention and attachment security in adolescence (Ito-Jager, 2017.) Children need to touch themselves as part of learning motor imagery (Conson, 2011) body ownership (Hara, 2015) and the assembly of “self” (Salomon, 2017.) Research has shown that adolescents in America already touch each other less and are more aggressive to peers than in another country sampled (Field, 1999); and for all of us touch quite probably helps us with emotional self-regulation (Grunwald, 2014.) Self-touch is a cornerstone of mindfulness and compassion meditation practices. Practice everyday precautions while at the same time but remember that touch is necessary for basic neurological and psychological well-being. Find adaptive ways to continue giving yourselves touch so we do not become a planetwide Harlow monkey experiment.
- Special note to educators: Relax your curriculum and pedagogy. Please push back on your administrators on this one. You are all home because there is a global pandemic with all its increased stress and uncertainty; this is not a snow day or break. Kids should be focused on social connection, play and reduced stress. You aren’t going to hit your benchmarks this semester. There, someone finally said it. You can encourage your parents to read to kids, spend more time together, offer fun reading lists or math sites, but please let go of your own overarching expectations and resist any arbitrary ones placed on you as much as possible. If someone starts talking about lesson plans, say “this is a pandemic.” If someone starts talking about kids’ grades, say, “this is a pandemic.” Part of your job as an educator is to educate kids and their families about adjusting in reaction to events, I’m sorry you got stuck with this event, but there you have it.
- Pick one or two trusted sources to keep yourself and your kids informed. Two much information overloads kids and adults alike. Most of us don’t need to know what JCPenney or Walmart have to say about COVID19. On the other hand, I have found the info from Harvard very helpful. The Joan Ganz Cooney Center has some great thinking and writing for education and child development. Your Teen Magazine is very accessible to parents. Dr. Kristin Moffitt from Boston Children’s has a short but useful interview on how to talk to your kids about COVID19
If after all that you are STILL focused on screen time, please check out these items for your consideration:
- Yeah? Tell That to Squirtle: The Fallacy of “Screen Time”
- Dopey About Dopamine: Video Games, Drugs, & Addiction
- Improving Our Aim: A Psychotherapist’s Take On Video Games & Violence
- The Internet & Real Relationships
- 10 Nonviolent Video Games
- Innovation is Dangerous & Gaming Causes Asperger’s
- Finally! A Mindfulness Approach to Video Games for Play-Based Social-Emotional Learning, Just in Time for the Holidays
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Can’t We All Just Game Along?
I had a powerful reminder about the prosocial nature of video games this week, and it was nowhere near a console screen. I was on my way home and ran into a Dunkin’ Donuts, in a town I’d never been to before and was unfamiliar with. I ended up waiting in a rather lengthy line and was a bit grumpy. I happened to be wearing a T-Shirt which said this:
I hadn’t worn it for ages, and had forgotten in fact I was wearing it until the cashier called out to me, “I love your shirt.” Cue the endorphins.
“Thank you,” I said, and smiled (which thanks to state bound learning probably cued my body to produce even more endorphins.) Waiting in the line seemed much more pleasant by this point. I ordered my coffee and sandwich and while waiting for them received another compliment from a customer walking by.
The third person to compliment me was a man in his 40s, scruffy and in jeans and t-shirt. “I love that game,” he said. “I haven’t played it in a while though.”
By now I was in a mood that allowed me to initiate conversations, so I asked “What are you playing nowadays.”
He proceeded to tell me that his 14 year-old daughter had gotten him into Fortnite. She had enjoyed it initially for the crafting, he said, because she really enjoyed Minecraft; but now that they were playing together she was enjoying the combat as well. His face lit up as he recounted how much fun they were having together. I told him about a study that had been done by Brigham Young that indicated increased levels of protective factors against depression. He smiled at that, and we both went on our way.
We spend so much time debating the neurological impact of playing video games that we often lose sight of another dimension; that of talking about playing video games. Talking about arts and culture is a powerful social adhesive. It identifies commonalities, allows for compliments and increased levels of engagement with others, allows us to recall exciting moments and share them. All of these activities in turn facilitate attachment, and increase a sense of well-being on the neurological level. That was the best line I’ve waited in a ages!
We need to find a way to get that message to Salty Sally the Social Worker and Morose Martin the Mental Health Counselor, whose eyes grow dull at the mention of gaming when their patients bring it up. “How much time are you playing Candy Crush?” they say, in uninviting tones, and eye such T-shirts as a clear sign of video game addiction. The next patient, who comes in with a T-Shirt of Monet’s “Water Lilies,” will get a compliment on it and no such screening for an Impressionist Art Addiction. In fact, the WHO didn’t include Art Disorder this go round at all, unless you include the art form of the video game.
In this current political climate, where we are so polarized, I wonder how many bridges (Minecraft or other) might be built if we paused to ask strangers in line if they play any games? I imagine Republicans, Democrats and Independents alike play something.
If Teams Valor, Instinct, and Mystic can all get along together raiding in Pokemon Go, perhaps we can too..
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Taking Leaps: Fortnite, HIPAA & Psychotherapy
“You keep dying,” Sam* said. The annoyance in the 9 year old’s voice was palpable. I looked at my avatar lying face down on the screen. Another of the 100 players in the game, appearing as a brunette woman in sweats sporting a ponytail, was doing a victory dance with her rifle over me. Sam was nowhere to be seen on the screen, but I knew he was hiding somewhere in the game, and seething.
“You’re disappointed in me,” I said calmly. A moment of quiet.
“Yeah.”
“You were hoping I’d be better at this, as good as you or maybe better, and it’s frustrating.”
“Yeah… Can we try again?”
And so we tried again and again, and while we did I talked with Sam about the other adults who were disappointments to him, who kept leaving or letting him down. And I guessed that we were also talking about his frustration and disappointment in himself. And at the end of our appointment I promised I would practice Fortnite, the game we had been playing. We had turned on our webcams again so we could see each other to finish the session, so I could see that he brightened at this idea.
“Nice to see you again,” I said. He smiled faintly.
“You too.” His screen went dark.
As I reflect on the work I do with patients, meeting them where they are at, I am struck by the same issues, opportunities, and conversations that can happen in an online play therapy session. I only wish more of my colleagues would try it. What gets in the way? For some it is a dismissal of emerging technologies which masquerades a fear of trying something new. For others it is a worry about running afoul of HIPAA and being sued. If you are one of those people who wonders about how to integrate video games online into your therapy practice, read on.
* * * * *
Quick, without Googling it; what does the “P” in HIPAA stand for?
If you are a psychotherapist or other health provider, you probably guessed “privacy.” At least that’s often the consensus when I ask this question at my talks. It would be understandable if this was your guess. You’d be wrong.
The correct answer is “portability,” the basic premise that individuals have the right to healthcare treatment that moves with them as they go through the vicissitudes of life and work. That is also where technology comes in– electronic health records, telemedicine, etc., are ways that technology increases portability by collapsing time and space so that the patient and the healthcare professional can get to work.
In therapy, that work traditional has happened in an office setting. And in the case of children and youth especially, that meant play therapy which was bounded by the space and time of a physical office. From Uno to Sandtrays to the infamous “Talking Feeling Doing Game,” we have often assumed that play therapy needs to be the games of our own childhoods. But 21st century play can, and I maintain should, include 21st century play. That’s where video games come in.
In the days of the Atari 2600, there was no worry about patient privacy, because the system was hooked up directly to a television that didn’t even need to be connected to cable. But nowadays with SmartTVs, PCs and PS4s, video games are often played online with many other people and seamlessly connected to voice chat. This can be a concern for the psychotherapist who is unfamiliar with newer technology, especially with games like Fortnite, which boast Battle Royales having as many as 100 players at a time in the same game instance.
Videoconferencing programs and online therapy using video/audio chat have been around long enough to have specifications that adapt to HIPAA’s privacy requirements, largely because there is market force behind developing products that can be sold to the healthcare industry. Video games and their platforms, on the other hand, do not have a similar demand to give them an incentive to supply. Games like World of Warcraft, Platforms like STEAM, and streaming services like Twitch were designed for gamers, not therapists, and it is unlikely they will go through the technical and legal procedures to become HIPAA compliant anytime soon.
Some therapists have begun developing their own video games, which, like most therapy games are dismally boring. They are thinly veiled therapy interventions that are disguised as play, but lack any of the true qualities of play. True, they are more likely private; but they are also boring, and easily recognizable as “not playful” by patients. Mainstream games have broader appeal, critical user mass, and better graphics and gameplay in many cases, and are more immediately relevant to the patient’s life. But they are definitely not HIPAA-compliant. So what to do?
* * * * *
My solution, which I’m sharing as an example that has not been reviewed by policy experts, lawyers or the like, has two parts:
- Due Diligence– Research the existing privacy settings and technologies to maximize benefit and minimize risk to patient privacy. So for example, I structure the “talk” part of therapy to happen over HIPAA-compliant software like Zoom or GoToMeeting. We start on that platform with video camera on, until we begin playing. Then we, turn off the camera to save on bandwidth and talk over this software, not the game. Previously, I will have sent the patient or their parent a snapshot of the settings of the game we are using with the voicechat disabled if possible. We also want to lower or turn off the game sound so we can hear each other. So in the case of Fortnite, the settings would look like this:
2. Limited HIPAA Waiver- This is the part most therapists overlook as even being a possibility. You can ask patients to sign a release waiving in a limited capacity their HIPAA rights in order to use noncompliant technology. It is entirely voluntary and I’ve yet to have a patient decline. I use a informed consent form that I developed that looks like this:
These are examples of how to engage with online technologies in a clinical way that is thoughtful yet forward-moving.
* * * * *
Whether you love Freud or hate him, most experts agree that he was one of the fathers of modern psychiatry. He was also an early adopter. He based his hydraulic model of the drives on steam technology of his era. His concept of the “mental apparatus” was likewise integrated from the advances in mechanics and his formulation of ego defenses such as projection occurred simultaneously with the Lumiere brothers’ creation and screenings of motion pictures. Regulatory concerns aside, therapists can be early adopters. Doing so would probably help our patients no end, and definitely cut down on my waitlist.
* “Sam” is based on several patients whose identifying information has been disguised to protect patient privacy.
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Mindfulness, Minecraft & The I Ching
Video Games can be a form of mindfulness meditation, both playing and watching them. The Grokcraft Staff take you on a meditative creative session as we begin to build our I Ching Sculpture Park. Watch, listen, and enjoy..
For more info on joining the Grokcraft project, go to http://grokcraft.com . We are launching Grokcraft with an introductory subscription of $9.99 a month, & subscribers who join now will be locked in at that rate for as long as they are subscribed. If any of this appeals to you, please check out our new site at http://grokcraft.com & please spread the word to anyone you think might find this resource useful!
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Bio Breaks
If you’re a therapist looking to join a group of innovative colleagues for supervision, you may want to take advantage of this. Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info. Subscribe to the Epic Newsletter!
Tower Defense & Executive Functioning
Some of the most important tasks the human brain performs are known as the executive functions. According to the National Center for Learning Disabilities, executive function is “a set of mental processes that helps connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space.” As such, the executive functions are crucial to the learning process over the life cycle.
Like many phenomenon in mental health, executive functions were focused on initially in regards to populations that had some deficits in them. With the advent and prevalence of the diagnosis of ADHD, as well as the study of learning and learning disabilities, educators and therapists began to become familiar with a concept that had previously been of most interest to neuroscientists. We still tend to think of executive functioning from a pathology-based approach, only paying attention to how they work when they don’t work.
The truth is everyone has executive functions, which are a combination of nature and nurture, and can develop well into adulthood. They can also deteriorate for a variety of reasons, from traumatic brain injury to Alzheimer’s disease. And there is a body of research which suggests that mental and physical exercise can help maintain, if not improve our executive functions as we age. Not surprisingly, as the Baby Boomers age, interest and research grows in this area. At both ends of the life cycle, our focus on the executive functions are widening beyond pathology to the optimal environments for human learning. How might we get better at planning, attending, strategizing, and managing time and space?
My suggestion: Start playing more tower defense games.
Tower defense is a particular genre of video games, one which in general focuses on on preventing the progress of an enemy army across a map. This is done by the use of towers which have varying abilities, costs to build, and points earned from downing enemies. You don’t necessarily need to have towers in the game: Plants Vs. Zombies for example is an example of a tower defense game where the plants are the equivalent of towers, with special abilities used to defend against the march of those pesky undead across the lawn.
More recently I have been fascinated with one of the latest iterations of tower defense games on the iPad, Kingdom Rush. You start out with a variety of maps and coins for building. You can use one of 4 basic tower types. There are barracks which have soldiers who can fight and slow down the invaders. There are artillery towers which drop bobs for an area wide (AOE) damage. There are marksman towers which target individuals and fire arrows or guns. Finally, there are magician towers with wizards firing spells of various types.
Each invading monster has different strengths and vulnerabilities, which are discovered by trying out different towers and noting their effects. As the invading army is always moving forward in waves, the time element requires you to plan which towers to build first, where to place them, and what upgrades to focus on. To do this requires a tremendous amount of strategy, organization and time management. You also need to make decisions, including how long to delay gratification. The more powerful towers require you to save up many more coins to buy them. Upgrades that you can select from a talent tree add another layer of choice and complexity.
In short, to succeed in Kingdom Rush you need to have good executive functions. It isn’t enough to have good hand/eye coordination or reaction time. You need to be able to learn from your past experiences, and often switch strategies midway through the game. You need to recall which towers are best for different situations and monsters. There is a map to be managed in space and a marching army and builders to manage in time. You need to recognize both immediate feedback and notice trends. And there are multiple towers and units to keep track of.
The more I play Kingdom Rush, the more struck I am by how many if not all of my executive functions are required to succeed. I can see where using this game could be both a useful assessment tool and intervention for deficits in EF. It also has reminded me how necessary executive functions are in terms of managing money as well. The ability to recall prices, to budget and pace spending, and set up investments that accrue value over time–all these economic experiences are embodied in the game.
Speaking of economy, you can try this game for free if you have a computer in your office or classroom here. And you can buy it for a whopping $2.99 for your iPad. Check it out, and see if you agree that it might be a fun, feedback rich way to challenge your executive functions.
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Unplanned Obsolescence: Rethinking Play Therapy
Recently I ordered a copy of Call Of Duty: Modern Warfare 3, which I plan to try this week. As I have mentioned in a previous post, I am not easily interested by first-person shooters, but as a gamer-affirmative therapist I can’t let my low interest get in the way of educating myself.
I once calculated that by a conservative estimate I had played approximately 27,000 games of Uno in my decade working in a public school as a clinical social worker. I drove around with a ton of board games and a sand tray as well. I had learned the value of play therapy at the first placement I ever had as an intern, from Winnicott’s squiggle game to the infamous Talking, Feeling, Doing Game. This is all a roundabout way of establishing my “street cred” for valuing play therapy.
Back then, I would go home from work, and many times play Legend of Zelda: Majora’s Mask on the Nintendo 64. My roommate at the time liked to hang out with me while I played and we chatted about life, education (he was a teacher) and politics. He also liked to imitate the fairy guide in the game, and would often cry out, “Listen!” and offer a couple of tips.
In all those years, it never occurred to me that I could have played those games at school if I’d had an office (and some years I did) or that there was a disconnect between what I was doing with the students (card playing) and what they were talking about (Nintendo, XBox, Playstation.) I could hold a conversation with them about these things because I played them in my spare time, but the idea of playing them with my students didn’t register as, well, therapeutic.
I am not alone in this. Many if not most play therapists are not inclined to play video games with their patients, and it is time to rethink this. When 97% of the boys and 94% of the girls we work with play video games, it is no longer an outlier. But there are a few fallacies which I think get in the way of play therapists integrating play therapy into the 21st century.
One I hear frequently is that video games don’t require imagination, or offer projections to explore. But I think this is contempt prior to investigation for the most part. The proliferation of video games is itself the best evidence that there is imagination going into each generation of games, which are produced by imaginative people who must have been able to develop their imagination in part through video games. And we don’t start each session making our children build their own dolls and dollhouse from scratch. We use available tools that do to an extent always structure and limit the imagination. For example, why does the dollhouse have a pointy roof and two floors? This is limiting, and in fact didn’t represent 90% of the urban population I worked with at all. And few play therapists would avoid using Elmo puppets on the grounds that it limits the imagination of the child, even though Elmo is clearly an icon of popular culture.
In fact, play has often had its inception in the popular culture of the time. We may take chess for granted now, but when it came into being it was a reflection of a medieval monarchy, with kings, queens, and bishops. Yet play therapists often fall prey to nostalgia, if not luddism, and maintain that there are certain games and play that are relational and therapeutic, and others, usually the modern ones, are not.
This brings me to what I suspect is another reason we resist using video games in play therapy, which is the therapist’s fear of being incompetent or failing at the unfamiliar. Years of training in a traditional educational model have taught us to silo down in our area of “expertise” as soon as we can. We “major” in psychology or social work, go to graduate school for advanced specialization, and basically get to a point where we can work in a routine and structured environment. For years we get in the habit of certain forms of play therapy: Candy Land, Chutes and Ladders, cards, chess, dollhouses and telephones. These are easy and portable, but more importantly perhaps, we know how to play them, so we can not be “distracted” by the game, or lose by design if we want to build the kids self-esteem, and otherwise feel in control of the play situation.
It’s time we work through this resistance. People can and do have conversations while they play video games, and video games are in themselves social media. There are plenty of metaphors to explore in and after video gameplay. Angry Birds is rife with themes of anger, different abilities, and protecting the innocent and defenseless. Call of Duty can give rise to expression of competition, drives, and the hunger for destruction or cooperation. And a recent (to me) favorite, Demon Souls, is a tone poem on isolation, yearning to connect, and persistence in the face of despair.
I’m sure I’ll get comments arguing that video games are inherently violent as well. To which I would respond, just like Battleship and the card game War are inherently violent. We have become insulated to the violence in them, and it may not have the graphic sophistication of video games. But the next time you play Battleship ask yourself what you think happened to all the people on the battleships that sunk? The game doesn’t come with little lifeboats, you’re drowning people. Play therapy does not avoid violence in its expression.
Virginia Axline, one of the founders of modern play therapy, had 8 guiding principles for play therapists:
- The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
- The therapist accepts the child exactly as he is.
- The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
- The therapist is alert to recognise the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behaviour.
- The therapist maintains a deep respect for the child’s ability to resolve his own problems if given an opportunity to do so. The responsibility to make choices and to institute changes is the child’s.
- The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.
- The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognised as such by the therapist.
- The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship.
Nowhere in there does it say, the therapist sticks with the tried and true games s/he grew up with. To my colleagues who are ready to decry the death of the imagination and lesser play of video games, I think Axline said it best: “The child leads the way: the therapist follows.”
Following in the 21st century means having Gameboys and Playstations in our repertoire. If we don’t keep learning and using technology in our play therapy, we may find ourselves in a state of unplanned obsolesence. Am I saying we should stop playing Jenga and Uno? No. But if our patients are looking for video games amongst the chess sets and dollhouses, perhaps they are telling us something we need to pay attention to. Just because we don’t know how to play a game doesn’t exempt us from learning it. And what a gift it can be for an adolescent to experience themselves as more competent and talented by an adult! So many of them come to us having been labeled as “failed learners,” and we have the potential to help them experience themselves as successful teachers, of us.
Those of us working in agencies and schools need to resist the temptation whenever possible to use the excuse of needing to be mobile or budgetary constraints. Video games are now as portable as a Nintendo DS PSVita or Smartphone. And the price of a video game system is not so prohibitive as to be a given. The real reason we often don’t advocate for video games at the agency or school is our own bias that they are somehow less valuable as therapeutic play media.
I anticipate that this will meet with resounding criticisms from the “play-is-going-to-hell-in-a-hand-basket” crowd, but I’m really interested in hearing from colleagues who have managed to successfully integrate video games into their play therapy. What are your success stories? What have been some challenges you’ve had to overcome? Do you schedule online play sessions? How do you manage the noise in an office suite? I’m really interested in your experiences.
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Harriet At Forty-Eight
If you never read the novel Harriet the Spy, I hope you will ASAP. My hope is that most children, parents and therapists have had a chance to read it already, because it has a lot to teach us about digital citizenship. You can get it on Amazon here.
Harriet spends a lot of time writing down things in her notebook. Truthful things. Unflattering things. And one day the notebook falls into the hands of her classmates, who read these things, and respond to her with anger. What I find interesting is the way Harriet’s friends, teachers, and parents respond. Their initial response is to take, or try to take, Harriet’s notebook. Of course Harriet gets another one. That’s not the problem.
Harriet the Spy was published in 1964. According to Wikipedia, at least one variation of the technology of the notebook had been around since 1888, and there are examples of its common usage in the early 1900s. This technology was prevalent long before the 1960s. No one says to Harriet that she has a “notebook addiction,” although her usage of it becomes problematic. In fact, her redemption in the book also comes from the same technology of the written word.
One of my favorite moments in Harriet the Spy comes in Chapter 14, when Harriet has her initial appointment with a psychiatrist. As they settle down to play a game, the psychiatrist takes out his analytic pad:
Harriet stared at the notebook. “What’s that?”
“A notebook.”
“I KNOW that,” she shouted.
I just take a few notes now and then. You don’t mind, do you?”
“Depends on what they are.”
“What do you mean?”
“Are they mean, nasty notes, or just ordinary notes?”
“Why?”
“Well, I just thought I’d warn you. Nasty ones are pretty hard to get by these days.”
“Oh I see what you mean. Thank you for the advice. No, they’re quite ordinary notes.”
“Nobody ever takes it away from you, I bet, do they?”
This vignette illustrates how the clinician is not above or apart from technology. Harriet’s psychiatrist uses it himself. And his response to her struggle and worry about using technology is an approach I’ve come to see as key: He doesn’t try to restrict her from using the technology, he engages her around its use and thinking about its use. He actually gives her a notebook, and then respects her usage of it when he lets her leave the office without taking it back or asking to see it.
He then recommends that her parents talk to the school about allowing her to use technology to amplify her thoughts and expression there, via the school newspaper. He also suggests that they use technology in the form of a letter written by Harriet’s old nanny to give her some advice and connection. Many will say that Ole Golly’s letter is the pivot point for Harriet in the story, but I’d suggest that the pivotal moment comes when the mental health practitioner doesn’t demonize technology (the notebook) or pathologize its usage, but rather leans on technology as an avenue into the patient’s forward edge transference.
Technology, as Howard Rheingold reminds us, is a mind amplifier. It can be used to amplify our memory in the form of notes, for example. It can also be a voice amplifier, for better or for worse.
If Harriet was around today, I imagine she would be on LiveJournal, perhaps with her settings on private, but on LiveJournal nevertheless. In fact, her LiveJournal notebook would probably be more secure than a notebook carried around on her person without encryption. But maybe she’d also be on Facebook, Twitter, and Tumblr. And unless she had parents or teachers who talked to her about digital literacy, she might not know or care about privacy settings or mindful use of technology.
Every day, on Facebook or Twitter or other social media, people young and old post, and “drop their notebook” to be read by hundreds or thousands of people, who can amplify the notebook even further by liking, pasting, sharing or tweeting it. By comparison, Harriet’s class of 10-15 students seems paltry. When an adolescent complains about her ADHD medication on her status, or when a parent tweets how proud he is of his Asperger’s child, these nuggets of information, of expression, of identity formation are sent out into the world and amplified. Our work as therapists needs to be to help our patients understand the significance of what they are about to do to themselves and others when that happens. And to do that we need to understand the technology ourselves.
Few of us would consider giving Harriet a notebook as “feeding her addiction,” or giving her a hair of the dog that bit her. Yet, we level such technophobic claims on the social media and technology of our time, trying to focus on technology as an addictive substance rather than as a tool, and pathologizing its use far too quickly and easily. And we often join technophobia with adultism, when we try to intrude or control the use of technology by children and adolescents (note that I said “often,” not “always”)
When you look at some of the stories Harriet prints in the school newspaper, you have to marvel at the bravery of the educators in that school! How many of school administrators would allow entries like “JACK PETERS (LAURA PETER’S FATHER) WAS STONED OUT OF HIS MIND AT THE PETERS’ PARTY LAST SATURDAY NIGHT. MILLY ANDREWS (CARRIE ANDREWS’ MOTHER) JUST SMILED AT HIM LIKE AN IDIOT.” Can you imagine the parental phone calls, even though the parents were both the behavioral and quoted source for this story? Can you imagine kids being allowed to experience communication and learning with this minimal form of adult curation? But also, can you imagine parents saying that the problem is allowing access to the technology of writing a newspaper, and that the idea of a school paper should be abolished?
When you think about it, we live in an amazing era of the amplification of human thought and expression. Our children will need to learn how to manage that amplification in a way we still struggle to understand ourselves. I remember one notebook I dropped, when I was managing a staff of guidance counselors. I was very frustrated with the response of one of them to something, and wanted to share that with my supervisor. I thought it would be important to share my emotional response to this with someone I understood to have the role of helping me sort this stuff out, and I was being impulsive and cranky. I ended up sending the email to the staff instead. Boy, did that torpedo those relationships. But I did learn a lot about how to pay more attention to the power of technology, and that part of being a good digital citizen requires thoughtful use of ampliying your words and ideas!
Most of us probably have a notebook-we-dropped story we’d rather forget, but we need to remember them and share those stories with the up and coming generations as cautionary tales, and examples of good and poor digital citizenship. Ole Golly tells us, “Remember that writing is to put love in the world, not to use against your friends.” Writing, a technology we have come to understand a bit better since Gutenberg, can be used for good or ill; but we don’t ban it. Now we are all learning, albeit uncomfortably at times, how to handle the newer technologies of social media, digital communication, and video games. It may be a bit utopian to suggest that texting/tweeting/gaming/Facebook/blogging is to put love in the world. But the alternative seems to be that while some of us ignore, avoid or fear it, other people, governments and corporations will learn how to use it against our friends.
Embedded in Harriet the Spy is a quote from Lewis Carroll, which aptly describes where we find ourselves in the 21st century of social media: “‘The time has come,’ the Walrus said,/’To talk of many things:” Indeed, the chatter can be deafening, impulsive, hurtful and confusing. But the solution is to choose our words carefully, not to stop talking altogether.
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Attention, Distraction & Creepers, Oh My!
The Uses of Disenchantment
Magic fulfills the wish that we could have powers to be beyond who we sadly suspect we are. As children, magic explains the inexplicable nature of external forces (i.e. parents, teachers, death) and internal ones (unconscious drives, nameless attachments, inconsolable sorrows and consuming rages.)
Anyone who plays WoW, Elder Scrolls, or Dungeons & Dragons, knows that enchanted weapons and armor are valuable items to be gotten. They raise our stats, make us stronger, more intelligent agile, or resistant to harm. They fulfill the wish that we could be more than we are.
That being the case, the profession of Enchanting is a very valuable one to master. To do so is to be able to craft our own items for use or to sell. And to master the skill requires not only enchanting practice, but also the act of disenchantment.
Disenchantment is the breaking down of an enchanted item into its component reagents. In Skyrim this consists of taking the enchanted item and destroying it, which allows you to discover the enchantment. So, for example, if you come across an Iron Battleaxe of Scorching, you have a choice. You can enjoy your new battleaxe which will add fire damage to the physical damage you do using it. Or you can disenchant it, and learn how to imbue any weapon with the ability to do fire damage.
In World of Warcraft disenchanting items is necessary to provide you with the reagents, or raw materials, to do other enchantments. Learning the enchantment is done separately, by training or reading a recipe, but disenchantment is still necessary to break down enchanted items into components you can use for other enchantments. Enchantment operates in the domain of creation and destruction, attachment and loss. I can remember feeling many the hesitation as I was about to take an Epic staff I’d used for months and dissolve into Abyss Crystals. Even though I knew that I was going to get a new weapon with a strong enchantment out of it, disenchantment required sacrafice.
Many patients labor under the illusion that the purpose of therapy is to make you feel good. I have always maintained that that is not true. Therapy is not about making you feel good, but rather about learning how to not to feel good. It’s about learning how to experience and tolerate those unpleasant feelings in a different way than we’ve learned to previously. People abuse substances, food, sex, and yes, occasionally video games because they cannot tolerate feelings that don’t feel “good.” Who wants to feel inconsolable sorrow, thwarted passion, grief, terror, or hopelessness?
And so people come to us wanting symptom reduction, not character building; relief, not the raising of unmentionable wishes and fears to consciousness. At first, we often provide those other things to be sure. A compassionate ear to listen, a calming influence, a holding environment. But in the end, therapists are alchemists and enchanters: Nothing new can be created by our patients without something being destroyed. Something must be given up to create something else.
Consider this: Neurosis is like an enchanted armor that we can no longer use. Maybe we have outgrown it. Maybe it never really fit well but it was the best compromise we could come up with. Maybe it buffed up our strength stats when we really needed more intelligence to play our class effectively. For whatever reason, it is no longer helping us, in fact it has created distress.
Symptom reduction alone won’t solve this problem. It may alleviate our distress for the moment, relieve pain enough to create the “space” between feeling and behavior so that we can begin to do the longer-term work.
That’s where disenchantment comes in. We need to take the item, the neurotic conflict, and break it down into the components that create it. What is the wish and the worry? What causes the guilt? Just what are we so afraid of that we can’t look at it directly?
This doesn’t always have to be painful, and therapists shouldn’t use this as a justification for brutality. But to think that the process of therapy is not going to be uncomfortable and difficult; is not going to take some time and hard work is pretty much delusional. If our enchantments could have gotten us any farther we wouldn’t have given them up. Most addicts and alcoholics would have used longer if they could have. If they could have enjoyed one more binge, party or high, they would have.
Insurance companies love to focus on symptom reduction, and a narrow view of what evidence-based treatment really is. Symptoms are problems to be solved, rather than signposts pointing towards underlying issues. And although this is short-sighted, it is understandable: 10 sessions costs a lot less than weekly sessions. And yet, the most recent research I’ve read indicates that psychodynamic therapy is as effective as CBT and other therapies, and in fact more effective in sustaining longterm change.
Bruno Bettelheim, a psychoanalytic thinker, is perhaps best known for his book The Uses of Enchantment. In it he discusses how the themes of fairy tales often symbolize the real emotional and psychological struggles that children go through. Through the projections of stories, children are able to work through their fears in remote and tolerable ways. In a similar way, Klein speaks of the paranoid-schizoid position where the parent is split into good and bad objects, the fairy godmothers and evil witches of fairy tales.
Disenchantment, from a Kleinian lens, leads to the depressive position. It is where we hopefully get to, despite the depressing name, that point when we realize that people are not either all-good, or all-bad, but both good and bad, nurturing and depriving, gratifying and frustrating. In other words, human. The world seems less magical in some ways, and that is experienced as a loss. Sounds depressing, eh? So what is gained?
There is a practice in Tibetan Buddhism called tonglen. In this form of meditation, you begin by touching the tender spot of whatever is sorrowing or distressing to you. Say you’ve lost your loved one. Allow yourself to feel that grief for a moment, really feel it. What an awful wrenching feeling that is. You may reflect that nobody should have to feel what you’re feeling right now. And yet, all over the world, there are those who have felt that, may be feeling it even as you are right now. So you breathe in, and imagine breathing in all of that grief as if for that moment you could take it into your heart so that nobody else would have to feel it. And then you imagine yourself breathing out comfort and security and everything that is the opposite of grief and suffering to the world and to all those in it who need it. You reverse the cycle of trying to avoid pain and grasp pleasure, and in doing so generate compassion.
That is the use of disenchantment; breaking down our fantasies that we can avoid pain and transmuting it into compassion for others. Imagine if you were to really accept that everyone is human and fallible and mortal. If you were able to walk around tomorrow and remain conscious that everyone you meet is dying, would you treat them in the same way as you did today?
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How To Have An Epic Holiday With Your Child Or Teen & Video Games
As I write this, those of us in the US have 4 shopping days until Christmas. So I wanted to share a few tips on both games to consider but also how to connect with the gamer in your life during this time of year:
1. Play with your child. If it is a multiplayer game, join in. If it is a single-player, ask to take a turn.
2. Sit and watch your child play, and ask them to teach you how to play a game.
3. For adolescents, don’t take no for an answer. If they don’t want to show you how to play at that time, make an “appointment” with them for later.
4. Encourage boys and girls equally. A recent study showed that girls who play video games with their fathers endorse fewer symptoms of depression. Ask your children if there are different games they like.
5. Remember that multiplayer games are forms of social media and community. Your child may be having a chat while they are playing without you even knowing it. Be patient with them and ask if you are interrupting something. This is good training for when they are interrupting you. Remember social skills are a two-way street, and just because you don’t think something is important doesn’t mean they feel the same way.
6. Pay attention to ESRB ratings. They aren’t perfect, but they can give you a good idea of what ages and levels of maturity are the best fit for your child.
7. Vet the online community. If they want to join a server for Minecraft, search together for one that requires children apply and requires parental approval. Ask the adult moderators questions about what kind of activities and conversations happen in-world. Discuss how privacy is handled.
8. Sit with your child as they sign up for a game. Discuss whether they should answer questions about where they live and their age. If these are required, email the moderator if you don’t feel comfortable with that. Your child’s digital footprint starts here, and will last for decades to come, so be careful and thoughtful about it.
9. That said, don’t evoke a sense of anxiety and paranoia with your children. There are plenty of normal or healthy people online, and they may be making lifelong friends. If they want to chat or Skype with peers, don’t forbid it, but ask to have a brief introductory call with their parent, and have a week probationary period where all chat is audible before the headphones go on.
10. Have fun! Video games can improve your mood, sharpen your wits and fine motor skills, and even give you exercise. But the most benefit for you and your child will occur if you take an interest and try to play yourself.
Ok, so now for some suggestions. This is by no means exhaustive, and if you want to recommend others please comment below!
Multiplayer Games
These can often have a subscription, but sometimes they are free. A good family game for younger children is Wizard101, which takes place in a world of wizard schools and magic duels. Combat is turn-based card game style. If your children like Magic: The Gathering, chances are they’ll love this.
Another great one is Minecraft, which costs a one-time price of $26.99. The game allows no end of possibilities, from mining to building to exploring to killing monsters. If you join a multiplayer, the whole family can play together.
World of Warcraft is a perennial favorite of mine. In addition to buying the software, this game has a monthly subscription, and there are lots of servers to choose from. Try searching for child-friendly servers and guilds, there are plenty of them out there.
Eve Online is a MMO that takes place in outer space. If your family is more interested in building and flying spaceships than fighting dragons this may be the game for them. Like WoW there is a monthly subscription in addition to the software purchase.
Console Games
For your older gamers I recommend Dark Souls. This is a very challenging game, which players can expect to last for hours. There will be lots of dying and starting over, and lots of fun failure. This game also has a strong RPG element and a dark mood.
Not quite as dark, but very challenging, is the new Elder Scrolls: Skyrim. This game puts you in a Nordic-type environment as a “Dragonborn,” and the main quest has you fighting dragons and absorbing their powers. But the fun thing about this game is that you don’t have to do any one quest if you don’t want to. Players can focus on exploring, crafting, learning marriage or picking locks! The graphics are beautiful, and the music is fun too.
If you are more interested in a game with a puzzle-solving element, check out Portal 2. You wake up in an abandoned lab with only a wormhole gun to your name. In order to escape players will need to strategize and learn a lot about physics on the way. There’s a lot of fun humor in the game as well.
All of the above games are available for Xbox, PS3 and the PC.
For Xbox, you can also bring a bit of meditation to the family with Deepak Chopra’s Leela. This game uses the Kinnect, and you’ll your whole body playing games to both actively exercise and stimulate the chakras or energy centers in the body; or meditate and keep an eye on your posture. The game is easy to learn and very colorful, and you can even design your own mandala.
Also for the Kinnect and PS3 is Child of Eden. This full body game has you trying to same the AI Lumi from a computer virus. It’s a fast-moving game with some rocking music from the virtual band Genki Rockets.
As far as the Wii goes, there’s only one I want to recommend at the moment, and that’s Legend of Zelda: Skyward Sword. This latest addition to the classic Zelda series will take you back to history before the Ocarina of Time, and up into the clouds of Skyloft, as you help Link take wing to save his kidnapped friend Zelda.
iPad
Last but not least I want to direct your attention to a couple of games on the iPad. Infinity Blade II. This game is not for the faint of heart, there is a lot of melee combat, and a lot of dying. If you like swordplay and battling monsters this is the game for you. The world is 3D and dynamic, and there are lots of different weapons and armors to try. Be warned, there is an option to “buy” more gold, so have a talk with your child about whether and how to do that.
A more playful game for all ages is Windosill from Vectorpark. This is a short game, but the dreamlike quality and graphics make it feel more like having fallen into a picture book than playing a video game. Get your whimsy on with this one.
These are only some suggestions, and are based on games I have test-driven. For example, I haven’t recommended any Nintendo DS games because I haven’t played any lately. I’m not affiliated with any of the above companies. Have some other game suggestions? Let us know below. Have a great holiday!
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Dings & Grats
I am convinced that if more people played video games, in particular massively-multiplayer online games, the human race would become kinder and self-confident. Here’s one reason why:
In MMOs like Warcraft, you have a social chat text window that is in the lower corner of your screen, constantly streaming messages. These messages are color coated so you can identify those you want to be reading, and screen out or hide those you don’t. For example, I usually have my guild chat “on” so I can talk and listen to guildies, but I rarely have the world “Trade” chat on, because I’m not a big shopper.
As you progress through the game, you level up. And when you level up, that’s an accomplishment. So you type into guild chat: “Ding!”
Ding, reminscent of the bell on a game show, is a way of calling attention to the fact that you have accomplished something. It’s tooting your own horn. But in gaming, dinging is socially acceptable! So when you announce over chat, “Ding!” You usually get a stream of “Grats!”
Grats, you may have guessed, is short for “Congratulations!” It is the public acknowledgement in gamer culture of your achievements. And if you are in a big guild and there are a lot of people online, you will sometimes get a stream of 50 or more “Grats.” This also means that if you are logging on or only half-paying attention you will catch on that somebody just achieved something.
Since everyone goes through the same levels, everyone recalls what a sense of accomplishment they often had when they dinged, and they pay it back or forward because they know how great it felt to get those grats. What emerges is a culture where achievements are announced and mirrored, which makes for a heightened sense of community and self-esteem.
When gamer patients announce they’ve hit level 85, or downed a major boss, or rolled and won on a piece of Epic loot, I am often quick to Grats them. I also encourage some coaching clients to get better at dinging when they have hit an achievement. “I finally rented my own office, Ding!” “I have 10 new patients, Ding!” Each of these is worthy of a quick energetic announcement of accomplishment.
By now some of the naysayers are probably thinking, “How corny.” And who has time to congratulate someone for every little achievement? We’ll just end up raising a generation of narcisists who overstate every accomplishment.
Obviously I disagree. First off, you don’t have to Ding on world chat, so to speak. Who is your guild? What group of people form your supportive circle that want to know when you’ve accomplished something. Second, there is always some self-regulation when Dinging. I don’t ding every time I mine some ore or pick an herb in WoW, but when I hit level 85 you bet I Dinged.
Third, when did we get so miserly with compliments? Is it some sort of holdover from the Pilgrims and the dour work ethic? It takes a second to Ding and the same to Grats. What is lost in that second pales in comparison to the affective shift in our psyche and the change in our neurochemistry. Think about any day you went into a job you hated, and the number of decision moves you made to do it even though you didn’t want to. If that didn’t deserve a Ding as you passed a co-worker’s cubicle, I don’t know what does.
Lately I have been trying to increase my Grats as well. Whenever a colleague posts on Twitter that they published a book, or finished a course, or got their license, I try to retweet with a big “Grats!” I try to amplify their achievement, not ignore it or dismiss it. One of the great powers of social media is how it can amplify things. And one thing many of us need practice with is unlearning a depressive stance, where we only see the negative. Now I am not a positive thinker, in fact positive thinkers make me feel uncomfortable, because I think they’re a bit deluded. But that doesn’t mean that I can’t get better at noticing and acknowledging the achievements and positive contributions others make.
I’m sure you can begin to see how this is applicable to therapy. Help your couples patients practice dinging and gratsing. Work with school staff to set up a Ding and Grats system in their classroom. Can you imagine how amazing it would have felt in middle school to finish your presentation with a “Ding!” instead of “The End,” and hearing 25 voices say “Grats!”
Dinging and Gratsing are expressions of enthusiasm, and sometimes it seems to me that there is some silent war being waged on enthusiasm. We’re supposed to play it cool, be “laid back,” and never indicate we care that strongly about anything. Is that really the apathetic and guarded culture we want to pass on? Let’s get off Plymouth Rock for goodness sake, and start calling out with some enthusiasm!
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Some Beginning Games for Therapists to Try
This Video Blog was inspired by friend Carolyn Stack, who asked that I recommend a iPhone game to ease her into the world of iPhone gaming. Here are a few of my favorites and why you might want to try them:
Spring Fever, Etc.
Recently the Archives of Pediatric and Adolescent Medicine published an article finding that children whose parents and families are experiencing stress tend to have more fevers and illness than other children. The article, summed up in Medical News Today goes on to state that stress increases children’s immune functioning. You may want to share this with your colleagues, as this time of year is particularly stressful for children and adolescents. Between academic demands, increased testing, and gearing up for the “last stretch” of school, some children may be physically and metaphorically overheating!
Support for Bipolar Adults
In case you are not aware of this local resource, you and your patients may benefit from the services of the Manic-Depressive and Depressive Association of Boston. While not a replacement for treatment, MDDA offers support and information for people with affective disorders, including support groups that meet at McLean. These groups are a useful part of partial hospitalization discharge planning, especially with the increasingly shortened lengths of stay allowed by many insurances.
Insurance Update
I am happy to report that I have added Tufts Navigator and HMO Blue/Managed Care Behavioral Health to the insurances I accept. I currently have availability most weekday mornings and afternoons, with a waiting list for evenings. Please feel free to forward this information to whomever you’d like. If you or your clients have any questions about the practice, the answers can be found on my site, www.mikelanglois.com . Thanks to those of you who have made referrals, they are always appreciated.