Using Gaming & Gamification in Clinical Practice

What does “gamification” mean, and what is its relevance to mental health practice?  In this video of a conversation I had at University at Buffalo with Charles Syms, I take a stab at answering those questions.  This is just a start, and hopefully by the end of the video you can begin to see how applying principles of game design could be therapeutic for people dealing with issues ranging from trauma to executive functioning challenges to substance abuse and beyond.



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Gamer-Affirmative Practice: Today’s Play Therapy


The importance of play is universal, and in many ways the nature of play is timeless.  That said, there is a lot to learn about video games as 21st-century play, especially if you are a play therapist.  Adding 21st-century forms of play to your repertoire can be daunting.  With so many naysayers in the mental health profession, avoidance of learning the new takes the form of contempt prior to investigation.  With video games being low-hanging fruit for political arguments ranging from gun control to teen bullying, many social workers, psychologists and counselors give in to the media hype and spend far more time demonizing or ignoring this form of play than they do understanding it.

Recently my colleagues at the University at Buffalo made it a point to take a gamer-affirmative stance and offer a beginning piece of continuing education on integrating video games as play therapy in the form of a podcast.  In it my friend, colleague, and yes, fellow video game player Anthony Guzman and I have a beginning conversation about just that.  Have a listen:

inSocialWork® Episode 144 – Michael Langlois: Gamer-Affirmative Practice: Today’s Play Therapy


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Innovation is Dangerous & Gaming Causes Asperger’s

GamerTherapist blog is on vacation and will return with new posts after Labor Day.  In the meantime, here is a reader favorite:

At its heart, diagnosis is about exerting control.  Clinicians want to get some sense of control in understanding a problem.  We link diagnosis to prognosis to control our expectations of how likely and how much we will see a change in the patient’s condition.  Insurance companies want to get a handle on how much to spend on who.  Schools want to control access to resources and organize their student body.  And with the current healthcare situation, the government is sure to use diagnosis as a major part of the criteria in determining who gets what kind of care.

Therapists and Educators do not like to think of ourselves as controlling people.  But we often inadvertently attempt to exert control over our patients and entire segments of the population, by defining something as a problem and then locating it squarely in the individual we are “helping.”

This week has been one of those weeks where I have heard from several different colleagues about workshops they are attending where the presenters are linking Asperger’s with Gaming Addiction:  Not in the sense of “Many people on the Autism Spectrum find success and motivation through the use of video games,” but rather in the sense of “excessive gaming is prevalent in the autistic spectrum community.”

This has always frustrated me, for several reasons, and I decided its time to elaborate on them again:

1. Correlation does not imply Causation.  Although this is basic statistics 101 stuff, therapists and educators continue to make this mistake over and over.  Lots of people with Asperger’s play video games, this is true.  This should not surprise us, because lots of people play video games!  97% of all adolescent boys and 94% of adolescent girls, according to the Pew Research Center.  But we love to make connections, and we love the idea that we are “in the know.”  I can’t tell you how many times when I worked in education and clinics I heard talk of people were “suspected” of having Asperger’s because they liked computers and did not make eye contact.  Really.  If a kiddo didn’t look at the teacher, and liked to spend time on the computer, a suggested diagnosis of Autism couldn’t be far behind.  We like to see patterns in life, even oversimplified ones.

2. Causation often DOES imply bias.  Have you ever stopped to wonder what causes “neurotypical” behavior?  Or what causes heterosexuality for that matter.  Probably not.  We usually try to look for the causation of things we are busily pathologizing in people.  We want everyone to fit within the realm of what the unspoken majority has determined as normal.  Our education system is still prone to be designed like a little factory.  We want to have our desks in rows, our seats assigned, and our tests standardized.  So if your sensory input is a little different, or your neurology atypical, you get “helped.”  Your behavior is labeled as inappropriate if it diverges, and you are taught that you do not have and need to learn social skills.

Educators, parents, therapists and partners of folks on the Austism Spectrum, please repeat this mantra 3 times:

It is not good social skills to tell someone they do not have good social skills.

By the same token, technology, and video games, are not bad or abnormal either.  Don’t you see that it is this consensual attitude that there is something “off” about kids with differences or gamers or geeks that silently telegraphs to school bullies that certain kids are targets?  Yet, when an adolescent has no friends and is bullied it is often considered understandable because they have “poor social skills and spend too much time on the computer.”  Of course, many of the same kids are successfully socializing online through these games, and are active members of guilds where the stuff they hear daily in school is not tolerated on guild chat.

Let’s do a little experiment:  How about I forbid you to go to your book discussion group, poker night, or psychoanalytic institute.  Instead, you need to spend all of your time with the people at work who annoy you, gossip about you and make your life miserable.  Sorry, but it is for your own good.  You need to learn to get along with them, because they are a part of your real life.  You can’t hide in rooms with other weirdos who like talking about things that never happened or happened a long time ago; or hide in rooms with other people that like to spend hours holding little colored pieces of cardboard, sort them, and exchange them with each other for money; or hide in rooms where people interpret dreams and talk about “the family romance.”

I’m sure you get my point.  We have forgotten how little personal power human beings have before they turn 18.  So even if playing video games was a sign of Asperger’s, we need to reconsider our idea that there is something “wrong” with neuro-atypical behaviors.  There isn’t.

A lot of the work I have done with adults on the spectrum has been to help them debrief the trauma of the first 20 years of their lives.  I’ve had several conversations where we’ve realized that they are afraid to ask me or anyone questions about how to do things, because they worried that asking the question was inappropriate or showed poor social skills.  Is that really what you want our children to learn in school and in treatment?  That it is not ok to ask questions?  What a recipe for a life of loneliness and fear!

If you aren’t convinced, please check out this list of famous people with ASD.  They include Actors (Daryl Hannah,) bankers, composers, rock stars, a royal prince and the creator of Pokemon.  Not really surprising when you think about innovation.

3.  Innovation is Dangerous.  Innovation, like art, requires you to want things to be different than the way they are.  Those are the kids that don’t like to do math “that way,” or are seen as weird.  These are the “oversensitive” ones.  These are the ones who spend a lot of time in fantasy, imagining a world that is different.  These are the people I want to have over for hot chocolate and talk to, frankly.

But in our world, innovation is dangerous.  There are unspoken social contracts that support normalcy and bureaucracy (have you been following Congress lately?)  And there are hundreds of our colleagues who are “experts” in trying to get us all marching in lockstep, even if that means killing a different drummer.  When people try to innovate, they are mocked, fired from their jobs, beaten up, put down and ignored.  It takes a great deal of courage to innovate.  The status quo is not neutral, it actively tries to grind those who are different down.

People who are fans of technology, nowadays that means internet and computing, have always been suspect, and treated as different or out of touch with reality.  They spend “too much time on the computer,” we think, until they discover the next cool thing, or crack a code that will help fight HIV.  Only after society sees the value of what they did do they get any slack.

Stop counting the hours your kid is playing video games and start asking them what they are playing and what they like about it.  Stop focusing exclusively on the “poor social skills” of the vulnerable kids and start paying attention to bullies, whether they be playground bullies or experts.  Stop worrying about what causes autism and start worrying about how to make the world a better place for people with it.

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Dopey About Dopamine: Video Games, Drugs, & Addiction

Last week I was speaking to a colleague whose partner is a gamer. She was telling me about their visit to his mother. During the visit my colleague was speaking to his mother about how much he still enjoys playing video games. His mother expressed how concerned she had been about his playing when he was young. “It could have been worse though,” she’d said, “at least he wasn’t into drugs.”

This comparison is reminiscent of the homophobic one where the tolerant person says, “I don’t mind if you’re gay, as long as you don’t come home with a goat.” The “distinction” made actually implies that the two things are comparable. But in fact they are not.

Our culture uses the word addiction pretty frequently and casually. And gamers and opponents of gaming alike use it in reference to playing video games. Frequently we hear the comments “gaming is like a drug,” or “video games are addictive,” or “I’m addicted to Halo 3.” What muddies the waters further are the dozens of articles that talk about “proof” that video games are addictive, that they cause real changes in the brain, changes just like drugs.

We live in a positivistic age, where something is “real” if it can be shown to be biological in nature. I could argue that biology is only one way of looking at the world, but for a change I thought I’d encourage us to take a look at the idea of gaming as addictive from the point of view of biology, specifically dopamine levels in the brain.

Dopamine levels are associated with the reward center of the brain, and the heightened sense of pleasure that characterizes rewarding experiences. When we experience something pleasurable, our dopamine levels increase. It’s nature’s way of reinforcing behaviors that are often necessary for survival.

One of the frequent pieces of evidence to support video game addiction is studies like this one by Koepp et al, which was done in 1998. It monitored changes in dopamine levels from subjects who were playing a video game. The study noted that dopamine levels increased during game play “at least twofold.” Since then literature reviews and articles with an anti-gaming bias frequently and rightly state that video games can cause dopamine levels to “double” or significantly increase.

They’re absolutely right, video games have been shown to increase dopamine levels by 100% (aka doubling.)

Just like studies have shown that food and sex increase dopamine levels:

This graph shows that eating food often doubles the level of dopamine in the brain, ranging from a spike of 50% to a spike of 100% an hour after eating. Sex is even more noticeable, in that it increases dopamine levels in the brain by 200%.

So, yes, playing video games increases dopamine levels in your brain, just like eating and having sex do, albeit less. But just because something changes your dopamine levels doesn’t mean it is addictive. In fact, we’d be in big trouble if we never had increases in our dopamine levels. Why eat or reproduce when it is just as pleasurable to lie on the rock and bask in the sun?

But here’s the other thing that gets lost in the spin. Not all dopamine level increases are created equal. Let’s take a look at another chart, from the Meth Inside-Out Public Media Service Kit:

This is a case where a picture is worth a thousand words. When we read that something “doubles” it certainly sounds intense, or severe. But an increase of 100% seems rather paltry compare to 350% (cocaine) or 1200% (Meth)!

One last chart for you, again from the NIDA. This one shows the dopamine increases (the pink line) in amphetamine, cocaine, nicotine and morphine:

Of all of these, the drug morphine comes closest to a relatively “low” increase of 100%.

So my point here is twofold:

1. Lots of things, not all or most of them drugs, increase the levels of dopamine.

2. Drugs have a much more marked, sudden, and intense increase in dopamine level increase compared to video games.

Does this mean that people can’t have problem usage of video games? No. But what it does mean, in my opinion, is that we have to stop treating behaviors as if they were controlled substances. Playing video games, watching television, eating, and having sex are behaviors that can all be problematic in certain times and certain contexts. But they are not the same as ingesting drugs, they don’t cause the same level of chemical change in the brain.

And we need to acknowledge that there is a confusion of tongues where the word addiction is involved. Using it in a clinical sense is different than in a lay sense– saying “I’m hooked on meth” is not the same as saying “I’m hooked on phonics.” Therapists and gamers alike need to be more mindful of what they are saying and meaning when they say they are addicted to video games. Do they mean it is a psychological illness, a medical phenomenon? Do they mean they can’t get enough of them, or that they like them a whole lot? Do they mean it is a problem in their life, or are they parroting what someone else has said to them?

I don’t want to oversimplify addiction by reducing it to dopamine level increase. Even in the above discussion I have oversimplified these pieces of “data.” There are several factors, such as time after drug, that we didn’t compare. And there are several other changes in brain chemistry that contribute to rewarding behavior and where it goes awry. I just want to show an example of how research can be cited and misused to distort things. The study we started out with simply found that we can measure changes in brain chemistry which occur when we do certain activities. It was not designed or intended to be proof that video games are dangerous or addictive.

Saying that something changes your brain chemistry shouldn’t become the new morality. Lots of things change your brain chemistry. But as Loretta Laroche says, “a wet towel on the bed is not the same as a mugging.” We need to keep it complicated and not throw words around like “addiction” and “drug” because we want people to take us seriously or agree with us. That isn’t scientific inquiry. That’s hysteria.

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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:

  1. The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
  2. The therapist accepts the child exactly as he is.
  3. The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
  4. 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.
  5. 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.
  6. The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.
  7. The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognised as such by the therapist.
  8. 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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Failing Better


Play is a vital part of being a person, and failure is a vital part of play. One of the things I’ve been thinking about lately is the connection between autonomy and failure. When children, adolescents and adults for that matter play video games, they fail a lot. In fact, according to Nicole Lazzaro, 80% of the time we are playing video games we are failing. What other activities in our daily lives can we say that about?

Education, on the other hand, at least the traditional model, grades us on a 100% model very differently. If you get 70% of a test or a class material “correct” you get to pass it. If you get 69% it needs to be done over again, or you don’t get any credit at all. This system actually flies in the face of what educators and therapists know about learning, that it is a matter of trial, error, course correction, trial, error, course correction… and so on.

This in some ways answers a question I have often wondered about: Why are we willing to be failing 80% of the time in video games, and so reluctant to risk failure in “real life” even a fraction of the time? One answer the percentages above point to is that education often stacks the deck against us, effectively rendering any mastery of content below 70% as a failure. This failure has attached to it, shame, sense of time wasted, futility, and hopelessness.

But there is another aspect of failing in video games that I think we need to pay attention to, and that is the role of autonomy. In a 2009 study, Jesper Juul found that people prefer to play games where they feel responsible for failing. The majority of those surveyed didn’t want to attribute it to bad luck, but something the did or didn’t do. They wanted a sense of autonomy in their game play, not luck. Conversely, they didn’t want to feel victimhood either, but rather optimism.

I have been playing a game on the iPad called Incoboto which has given me pause to reflect on fun failure. (An aside for gamers who have also played this and Dark Souls, have you considered Incoboto as a cutified version of Dark Souls, trying to link the fire and bring light to a darkened solitary world? Just saying..) The game has a series of puzzles which one needs to solve in order to collect star pieces to feed to the kawaii sun Helios following your character around. There have been a few places where I got “stuck,” and spent in my opinion too much time having to throw something exactly the right way. This highlighted for me the subjective experience I had for the majority of gameplay, that I was being challenged but would eventually be able to overcome the unneccessary obstacle. On those occasions I called getting stuck, I began to experience feelings of victimization and externalize responsibility. The game was not “being fair,” it was too hard, there was a “bug” in it making the ball not land “right.”

What helped me persevere was both compelling graphics and gameplay, but also a sense of faith in the game. Ok, sometimes I cheated too, by looking up spoilers on the game forum. In those moments, you could say that I was giving up the voluntary attempt to overcome an unnecessary obstacle of the game. But, and this is what’s important, I was also ceding my sense of autonomy. It’s a weird balancing act, in one case I didn’t look at the cheat to find the solution as much as to get reassurance that what I was trying was the solution. But even though I was exercising my digital literacy here, I was also giving up for the moment my sense of autonomy, and agency.

Failure, and tolerance of failure is a subject thing, which is why Lazzaro’s presentations illustrate zones, not points, of fiero, frustration, relief, and bored. Everyone has variations in how they experience emotions, and failure in video games. And if I didn’t keep that in mind, I might feel very disheartened when I read this review of Incoboto:

“Great mix of platformer and puzzle game, very smooth learning/difficulty curve, and quite a nice gameplay experience too”

Now I am not going to get into a discussion on norms and trends and the importance of betas, because my point here is to compare and contrast the experiences of failure in video games and education.

Education in our country is trying to overcome some serious design flaws of its own. Children and adolescents are given tremendous responsibility for their performance without a commensurate amount of autonomy. This creates a culture of victimhood. Rather than noticing they got more than half of something right, we flunk them. Rather than setting meaningful individual goals, we create industrialized curriculum. And if we do give someone an individualized set of goals in the form of an IEP, we label them as learning disabled first to justify it!

We need to improve the quality and experience of failure in schools. Because video games don’t occur in a separate reality from the point of view of our minds. That mind/body split of Descartes has been debunked for ages, and yet we’re still talking about “real” life. The reality is that mastering challenges and fun failure creates a feeling of optimism, which neurologically and emotionally improves our ability to learn in the future. If we think we are capable of solving a problem, we will keep at it. Therefore, we need to foster a sense of autonomy in learning. The minute we start talking about “my special needs child,” we are taking away their autonomy.

Am I saying we should expect everyone to perform the same at school or other work? Not at all, I am saying we should be better curators of children in learning environments, and let them have less stigma around failure. In a real sense, every child should have an individualized education plan, because we are moving (hopefully) out of an industrial model of education.

As a therapist and educator who has worked in and with school systems and parents for nearly two decades, I have struggled with this frequently, both within myself and with my patients. The language of diagnoses and learning disabilities is a language I speak all too well, and I have unintentionally colluded at times with parents and systems who use it as shorthand for, “my kid can’t ___.” Maybe if failure was more tolerable and fun in school we wouldn’t be so quick to adopt these identities, and maybe if we curated environments that allowed for more autonomy we would notice different varieties of success as well.

The other night I was on a Minecraft server I participate in, founded by educators and edutechs for their children. Several of the kids were on and chatting when I logged in, and shortly thereafter this huge flame war erupted. Capital sentences of “I HATE YOU” flew across the screen. Kids stormed out of the chat room, returned, then logged off again. Some of the young moderators were instigating further conflict, while others were earnestly trying to figure out why people’s feelings had been hurt in the first place. From the therapeutic point of view, they were failing miserably, exhibiting poor social skills, dysregulated affect, and poor impulse control. It took a herculean act of will not to jump in and actively curate this group and allow them to exercise their autonomy.

They kept at the chatting, and over the next several minutes they began to collaborate on understanding what had happened. This did not have the grown up version of a happy ending where the aggrieved parties apologized and made up, so much as the group told one party that they appreciated the apology and weren’t ready to accept it then (my translation) told a second party to stop instigating in the guise of defending someone, and encouraged the third to come and build something to take his/her mind off of it.

In my mind, the fact that this took place in a game environment where failure is destigmatized and autonomy is presumed made it easier for people to keep at the challenge until it had been resolved “enough.” There was no adult who was forcing them to stay on and work at this, they were voluntarily engaged. There were several halting starts and stops of chat. But social emotional learning was occurring.

This in my opinion is an example of “failing better,” and I think this is a skill that not only can be translated from video game experience, but desperately needs to. The more we except failure as an essential part of learning and work, the less stigmatizing it will be. The less we stigmatize failure, the more we encourage autonomy and optimism. Autonomy and optimism make you a better learner, a better collaborator, and a better worker. Personally I think the world could use a lot more of that.

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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.


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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Not All Failure Is Epic

In gaming there is a concept known as the “Epic Fail.”  Roughly translated this means, a failure so colossal, so unbelievable in its nature, that it will go down in history as epic.  Epic failure can be extremely frustrating in the moment, but is almost always funny in retrospect.

Recently I was playing Dark Souls, and I was trying to down two bosses known as the Belltower Gargoyles.  Just as you get one down to half health, the other, who likes to breathe fire on you, shows up.  Oy.  I kept getting killed, which sent me back to a save point, running back up the belltower, and trying again.  What kept me going up there was that each time I was surviving a few seconds longer, and each time I was getting the gargoyle’s health down a little more.  At one point I started to consistently kill the first gargoyle before the second one finished me off.  Finally, through an unbelievable feat of mashing all the buttons, luck, and strategy, I beat them both.

The failure that kept happening was not what I would call Epic Failure.  It was certainly what Jane McGonigal et al call fun failure though.  It was failure with just enough progress mixed in that I’d say, “Oooh, you’re going to get it,” to the gargoyles and try again.  And again.  Fun failures in video games are designed to work that way.  The game can’t be so hard that the person gives up, but can’t be so easy that you don’t feel challenged.  Because if you don’t feel challenged then there is little or no sense of accomplishment.

Heinz Kohut, one of my favorite psychoanalytic thinkers, would probably have a lot to say about video games if he were alive today.  Kohut knew that failure was a part of life and human development.  In fact, he thought that therapy was full of failure.  He talked about empathic failure, when the therapist fails to respond empathically to the patient in some way.  Maybe we don’t pay attention enough to a story, or don’t remember something, or start 5 minutes late.  These are all parts of the therapist being human, and therefore being unable to stay absolutely in empathic attunement with the patient.  This kind of failure is inevitable.

Kohut goes on to say that it is not necessary to deliberately make mistakes and empathically fail our patients, because we are going to do so naturally in the course of our work with them.  In fact, to deliberately fail our patients is rather sadistic.  But usually we aren’t being sadistic when we forget something, or run late a few minutes, even though the patient may experience it that way.

So first a note to therapists here.  In the course of your work with patients you are going to fail a lot.  But not all failures are epic.  That is not to say that your patients won’t experience it that way.  That vacation you’re going on may be an epic failure on your part, as far as they are concerned.  Does that mean you cancel your flight plans?  Of course not.  Our job is initially to help the patient by understanding by empathy the epic nature of our failure from their point of view.  We try to imagine ourselves into that moment they are having.

But that doesn’t mean that we stay there.  We need to maintain some perspective, have some sense of fun failure, to keep doing our work.  By that I don’t mean have fun at our patient’s expense, but rather be able to be lighthearted enough in our introspection to say “Oops, I missed that one,” or “there I go again.”  If we can do that we are able to then refocus on the patient.  If we instead get sucked into the idea that this is an Epic Fail we will lose all perspective, and actually start focussing on ourselves rather than the patient.

Do you ever say to yourself, “I’m such a bad therapist?”  I don’t.  Of course, I also don’t say, “I’m such a perfect therapist” either.  I do frequently think, “I was not at my best today,” or, “oooh, how come I keep missing that with patients!”  This helps me keep perspective so that I can get back in the game as soon as possible.

Whether you are a therapist, a gamer or someone else who is still breathing, chances are that you are failing sometimes.  In fact, this time of year with all its’ hype and expectations about being joyful and loving families can make you feel even more like a failure.  Some examples of Epic Fail statements that we think consciously or unconsciously include:

  • I’m a terrible parent.
  • I’m a terrible daughter/son.
  • I’m a terrible sex partner.
  • I’m a terrible worker.
  • I’m a terrible cook.
  • I’m a terrible student.

and the list could go on.

If any of those sounds like you, take a moment to reflect.  Is this really an Epic Fail?  Or are you distorting things?  Chances are you are not a perfect parent, child, worker, sex partner, student or anything else.  But if you really identify this as an Epic Fail, chances are you are solidifying a form of self-identity rather than accurately appraising yourself.

Why would we do that?  Well, one reason is that we learned those messages of Epic Failure as a child.  You probably still remember a few failures that can make your stomach churn if you think of them.  But as often, I think we grasp on to solid identities, even negative ones, so we can stop working on ourselves.  I’m just X, I’m the kind of person who can’t Y, Nobody ever thinks Z about me:  These all kill our curiousity about ourselves and help us stay stuck.

Mindfulness is about fun failure.  It is about being able to look at ourselves and reflect on ourselves without going to extremes.  Mindfulness is about being able to be curious rather than judgmental, having roominess in our minds and souls rather than rigidity.  This perspective leads to “Ooooh, I’m going to get that boss down this time.”  The other leads to hopelessness.

So try to remember this as the days are getting shorter and tensions may be rising:  Not all Failure is Epic.  And if we can be right-sized about our failures we can learn from them.  We can take an interest in our thoughts, feelings and behaviors rather than judge ourselves.  If we catch ourselves saying “what kind of monster I must be to hate Aunt Myrtle,” we can perhaps think, “oops, there I go again. Isn’t it odd/interesting that I feel hatred towards Aunt Myrtle, what’s THAT about?”

Eighty-five percent of the time gamers are failing.  And yes some of those are Epic, but the gamer attitude is to view those Epic Failures as moments of camaraderie and learning.  In life outside the game, do you treat the Epic Fail that way?  Do you seek out others and try to learn from the experience, or do you isolate?  There is always some observing ego in the game Epic Fail that is often lacking in our non-game life.  And in some ways that is understandable, you can’t always reset in life outside video games.

But consider this:  Where there is life there is hope.  If this was a true Epic Fail in your life you can still learn from it in time.  Failures are inevitable, but with time and perspective they can be instructive as well.  In the end I’d say that whether you think you’ve had an Epic Failure or not what matters most is how you move on from it.  Who knows, maybe the only real Epic Fail is the one where you give up..

Note:  No real Aunt Myrtles were hated in the writing of this post.

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A Moment of Light in Dark Souls

For centuries the general thinking was that the world was flat, but by late antiquity the world was commonly accepted as being spherical.  Although it is a myth that Christopher Columbus proved that the world was round, it was much easier for seafaring cultures to conceptualize the earth as round, because they were able to measure and base their perceptions on additional observational evidence.  And so it was for the next 1800 years or so we labored under this second delusion.

Two weeks ago the English version of the video game Dark Souls came out.  I was one of the nearly 280,000 people who bought it the first week, and it has been growing in popularity ever since.  The game is in many ways a traditional “dungeon crawl,” with the emphasis on the “crawl.”  Your character dies in Dark Souls, a lot!  The game is billed as “Probably the Second-Hardest Game You’ve Ever Played,” by Matt Peckham of PC World.  I can attest to that.

The world of Dark Souls is one where the Flame that lights the world has almost vanished, and the player awakens to find themself as Hollow, or undead, in an asylum for the undead in the north of the world.  Over the course of the game’s beginning, you fight your way through other groups of other undead, dragons, and demons in a quest that presumably has something to do with restoring the light and warmth to the world.  I say presumably because the game offers few instructions, and emphasizes the experience of “throwness” in the game world.

You can save your progress at bonfires, and use the soul and humanity fragments you win from killing creatures to level up and restore yourself to a human being.  However, each time you do that, the dungeon resets, and every single creature you killed returns to life, and I swear they learn from their experience of fighting with you.  The game is not an MMO in a traditional sense, but you are connected to other players in some interesting ways.  You can see their last moments of a fatal battle as their specters dance through your game, and if you are human, you can summon the spirit form of another random player into your world to help you fight.

This is a story about that. (Although all identities and locations are heavily disguised to protect privacy.)

I had been trapped in the Undead Burg for about a week.  My pyromancer had been slowly leveling up but was very weak.  I had a wooden shield and battered axe that I had scavenged off of one of the fallen undead.  I had lit a second bonfire and managed to learn how to dodge the firebombs thrown by zombies as I tried to make my way to the Taurus Demon.  But usually I ran out of life and health flasks before I got to him, and when I did he one-shotted me, and seemed little more than irritated by my chops or fireballs.  What’s worse, there was this horrible Black Knight that kept ganking (slaughtering) me halfway there.  I knew the Knight was guarding some nice treasure, but I could only get him down to half-health before I would be sent back to my bonfire, stripped of all the soul points I had accrued.  My axe was getting battered, and was probably going to break at at any time.

I looted a scrap of humanity from a undead, and ran back to my bonfire.  I offered it up to restore my human form, and when I did I noticed for the first time some glowing white runes written on the floor.  I later discovered that these are summoning runes, which can only be seen when you are fully human.  I clicked on the runes, and a few seconds later a warrior bathed in golden light appeared.  Chibi was his name, and he was one of those transparent spirits summoned from another game somewhere to help me.  We couldn’t speak or chat with each other, but he signaled his friendly intentions by hopping up and down and I by running around in circles.

Chibi was level 53, and I was level 8, so I followed him as he tore through groups of undead that had taken me hours to get a handle on.  I was excited and emboldened by his prowess, but I still felt uneasy when I saw that he was actually making towards the Taurus Demon.  As we ran by the tunnel that the Black Knight hides in, I had an idea.  I stopped, and after a few minutes Chibi turned around and came back.  I ran to the tunnel mouth and began hopping up and down vigorously.  Chibi ran down the tunnel past me, and began attacking the Black Knight, while I hung back and hurled fireballs.  Within a minute the Knight was down, and I looted a magic ring, and then with surprise the Black Knight’s Sword!  Compared to my axe which did 40 points of damage, the magic sword did 200!

We continued on to the Taurus Demon, but since I wasn’t skilled enough yet to equip the new sword, the demon took a lot of damage from Chibi and then at about 25% health killed me again.  This sent me back to my bonfire, and Chibi back to his own game.  But I had a new sword to inspire me, and I was about to set out to level myself up to use it when my PS3 blinked that I had a message from Chibi.  I hadn’t realized people could send each messages, and when I clicked on it I read, “Sorry.  I killed it right after you died.”  I wrote a message back saying, “No worries, killing that Black Knight was a great help.”  I added Chibi as a friend on the network, and then realized I could open a chat window with him.  We spent the next half hour chatting.

Chibi’s real name was Taylor, and he was an iron worker in Montana.  Taylor was 36, and had just got a promotion at his factory which he was very proud of.  He worked 12 hour shifts and came home and gamed.  He did not tend to go out of the house other than that.  Taylor lived by himself, and had moved from to Montana from Pittsburgh 4 years ago, when his girlfriend and their unborn child had been killed in a car crash.  He had not talked for three of those years.

Taylor credited therapy with helping him recover from a depression that nearly took his life, and a grief I could not imagine.  Although he did not credit playing video games as helping him, I asked him if he thought they might have.  He said he didn’t know, he really couldn’t remember those years of his life.  Rather he remembered them the way trauma survivors often remember things, as memories of facts with shards of feelings sticking out of them.  He didn’t want to burden me with doing “work” and I told him not to worry about it.  He asked me about my life and family, and was very open and accepting of my story which was very different than his.

By now it was midnight in Massachusetts, and although it was earlier in Montana, he had a morning shift at his factory.  We logged off and I went to bed.

In the days that have followed I have leveled up my pyromancer to 25.  I can handle the Black Knight’s Sword and sliced through that Taurus Demon and a Red Dragon to boot.  I have moved from the Undead Burg to the Undead Parish, discovered bonfires and short-cuts, and somewhere along the line I have learned how to play Dark Souls.  I occasional see the anonymous flickers of other players flash through my game, nameless imprints of their last battle in some game somewhere in the U.S., Japan, or the world.  I have seen Taylor come online from time to time, and although I haven’t sent him a message I have no doubt that I will at some point.

As I talked with Taylor I imagined how my colleagues often thought about gamers.  I wondered if they would have focussed on how many hours he played video games and his isolation rather than his resilience, helpfulness and initiative in Dark Souls.  Would they focus on our focus on violent games or sword size?  Or would they note the themes of repetition compulsion, our attempts at mastery, our playing out the endless cycles of life, death and rebirth?

The world is not round, it is hollow and full.  It is not the one world we think we perceive, but hundred of overlapping worlds, layer upon layer of human struggles and stories, connected by time and feeling and, yes, technology.  There is a world where therapists from New England live, where iron workers go to work in Montana every day and look forward, not back.  There is a world where pyromancers run through abandoned cities and struggle to release a fire that will warm the world, where warriors grow stronger over time and adversity.  And every once in a while, if you have an open mind and heart, light from one of these worlds bursts through, and warms the other.

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