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
Streaming, Path of Exile & The Repetition Compulsion
As many of you know I have begun streaming. My goal in doing this is to both have some fun, and reach a wider audience when talking about psychodynamic concepts. This is my latest attempt, in which I talk about the Repetition Compulsion in terms of farming for a unique sword in the game Path of Exile. Keep in mind that the conversation about the repetition compulsion during the stream if for a general audience, and should not be substituted for seeking out medical advice or a mental health professional. My hope is that you’ll share it with the gamers in your life, therapy practice, class, etc. And of course if you sign up to follow my Twitch channel I’d be delighted!
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Can’t We All Just Game Along?
I had a powerful reminder about the prosocial nature of video games this week, and it was nowhere near a console screen. I was on my way home and ran into a Dunkin’ Donuts, in a town I’d never been to before and was unfamiliar with. I ended up waiting in a rather lengthy line and was a bit grumpy. I happened to be wearing a T-Shirt which said this:
I hadn’t worn it for ages, and had forgotten in fact I was wearing it until the cashier called out to me, “I love your shirt.” Cue the endorphins.
“Thank you,” I said, and smiled (which thanks to state bound learning probably cued my body to produce even more endorphins.) Waiting in the line seemed much more pleasant by this point. I ordered my coffee and sandwich and while waiting for them received another compliment from a customer walking by.
The third person to compliment me was a man in his 40s, scruffy and in jeans and t-shirt. “I love that game,” he said. “I haven’t played it in a while though.”
By now I was in a mood that allowed me to initiate conversations, so I asked “What are you playing nowadays.”
He proceeded to tell me that his 14 year-old daughter had gotten him into Fortnite. She had enjoyed it initially for the crafting, he said, because she really enjoyed Minecraft; but now that they were playing together she was enjoying the combat as well. His face lit up as he recounted how much fun they were having together. I told him about a study that had been done by Brigham Young that indicated increased levels of protective factors against depression. He smiled at that, and we both went on our way.
We spend so much time debating the neurological impact of playing video games that we often lose sight of another dimension; that of talking about playing video games. Talking about arts and culture is a powerful social adhesive. It identifies commonalities, allows for compliments and increased levels of engagement with others, allows us to recall exciting moments and share them. All of these activities in turn facilitate attachment, and increase a sense of well-being on the neurological level. That was the best line I’ve waited in a ages!
We need to find a way to get that message to Salty Sally the Social Worker and Morose Martin the Mental Health Counselor, whose eyes grow dull at the mention of gaming when their patients bring it up. “How much time are you playing Candy Crush?” they say, in uninviting tones, and eye such T-shirts as a clear sign of video game addiction. The next patient, who comes in with a T-Shirt of Monet’s “Water Lilies,” will get a compliment on it and no such screening for an Impressionist Art Addiction. In fact, the WHO didn’t include Art Disorder this go round at all, unless you include the art form of the video game.
In this current political climate, where we are so polarized, I wonder how many bridges (Minecraft or other) might be built if we paused to ask strangers in line if they play any games? I imagine Republicans, Democrats and Independents alike play something.
If Teams Valor, Instinct, and Mystic can all get along together raiding in Pokemon Go, perhaps we can too..
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Taking Leaps: Fortnite, HIPAA & Psychotherapy
“You keep dying,” Sam* said. The annoyance in the 9 year old’s voice was palpable. I looked at my avatar lying face down on the screen. Another of the 100 players in the game, appearing as a brunette woman in sweats sporting a ponytail, was doing a victory dance with her rifle over me. Sam was nowhere to be seen on the screen, but I knew he was hiding somewhere in the game, and seething.
“You’re disappointed in me,” I said calmly. A moment of quiet.
“Yeah.”
“You were hoping I’d be better at this, as good as you or maybe better, and it’s frustrating.”
“Yeah… Can we try again?”
And so we tried again and again, and while we did I talked with Sam about the other adults who were disappointments to him, who kept leaving or letting him down. And I guessed that we were also talking about his frustration and disappointment in himself. And at the end of our appointment I promised I would practice Fortnite, the game we had been playing. We had turned on our webcams again so we could see each other to finish the session, so I could see that he brightened at this idea.
“Nice to see you again,” I said. He smiled faintly.
“You too.” His screen went dark.
As I reflect on the work I do with patients, meeting them where they are at, I am struck by the same issues, opportunities, and conversations that can happen in an online play therapy session. I only wish more of my colleagues would try it. What gets in the way? For some it is a dismissal of emerging technologies which masquerades a fear of trying something new. For others it is a worry about running afoul of HIPAA and being sued. If you are one of those people who wonders about how to integrate video games online into your therapy practice, read on.
* * * * *
Quick, without Googling it; what does the “P” in HIPAA stand for?
If you are a psychotherapist or other health provider, you probably guessed “privacy.” At least that’s often the consensus when I ask this question at my talks. It would be understandable if this was your guess. You’d be wrong.
The correct answer is “portability,” the basic premise that individuals have the right to healthcare treatment that moves with them as they go through the vicissitudes of life and work. That is also where technology comes in– electronic health records, telemedicine, etc., are ways that technology increases portability by collapsing time and space so that the patient and the healthcare professional can get to work.
In therapy, that work traditional has happened in an office setting. And in the case of children and youth especially, that meant play therapy which was bounded by the space and time of a physical office. From Uno to Sandtrays to the infamous “Talking Feeling Doing Game,” we have often assumed that play therapy needs to be the games of our own childhoods. But 21st century play can, and I maintain should, include 21st century play. That’s where video games come in.
In the days of the Atari 2600, there was no worry about patient privacy, because the system was hooked up directly to a television that didn’t even need to be connected to cable. But nowadays with SmartTVs, PCs and PS4s, video games are often played online with many other people and seamlessly connected to voice chat. This can be a concern for the psychotherapist who is unfamiliar with newer technology, especially with games like Fortnite, which boast Battle Royales having as many as 100 players at a time in the same game instance.
Videoconferencing programs and online therapy using video/audio chat have been around long enough to have specifications that adapt to HIPAA’s privacy requirements, largely because there is market force behind developing products that can be sold to the healthcare industry. Video games and their platforms, on the other hand, do not have a similar demand to give them an incentive to supply. Games like World of Warcraft, Platforms like STEAM, and streaming services like Twitch were designed for gamers, not therapists, and it is unlikely they will go through the technical and legal procedures to become HIPAA compliant anytime soon.
Some therapists have begun developing their own video games, which, like most therapy games are dismally boring. They are thinly veiled therapy interventions that are disguised as play, but lack any of the true qualities of play. True, they are more likely private; but they are also boring, and easily recognizable as “not playful” by patients. Mainstream games have broader appeal, critical user mass, and better graphics and gameplay in many cases, and are more immediately relevant to the patient’s life. But they are definitely not HIPAA-compliant. So what to do?
* * * * *
My solution, which I’m sharing as an example that has not been reviewed by policy experts, lawyers or the like, has two parts:
- Due Diligence– Research the existing privacy settings and technologies to maximize benefit and minimize risk to patient privacy. So for example, I structure the “talk” part of therapy to happen over HIPAA-compliant software like Zoom or GoToMeeting. We start on that platform with video camera on, until we begin playing. Then we, turn off the camera to save on bandwidth and talk over this software, not the game. Previously, I will have sent the patient or their parent a snapshot of the settings of the game we are using with the voicechat disabled if possible. We also want to lower or turn off the game sound so we can hear each other. So in the case of Fortnite, the settings would look like this:
2. Limited HIPAA Waiver- This is the part most therapists overlook as even being a possibility. You can ask patients to sign a release waiving in a limited capacity their HIPAA rights in order to use noncompliant technology. It is entirely voluntary and I’ve yet to have a patient decline. I use a informed consent form that I developed that looks like this:
These are examples of how to engage with online technologies in a clinical way that is thoughtful yet forward-moving.
* * * * *
Whether you love Freud or hate him, most experts agree that he was one of the fathers of modern psychiatry. He was also an early adopter. He based his hydraulic model of the drives on steam technology of his era. His concept of the “mental apparatus” was likewise integrated from the advances in mechanics and his formulation of ego defenses such as projection occurred simultaneously with the Lumiere brothers’ creation and screenings of motion pictures. Regulatory concerns aside, therapists can be early adopters. Doing so would probably help our patients no end, and definitely cut down on my waitlist.
* “Sam” is based on several patients whose identifying information has been disguised to protect patient privacy.
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The Crisis Behind Crises
So far in 2018 alone, I have worked nationwide with the aftermath of one homicide/suicide in a video game server community; one threat issued over another; and 3 new requests for consultations from clinicians on how to improve their work with families and individuals related to online technology. Schools are now fielding multiple incidents of threatening language in chat rooms that get brought to their attention, and not necessarily handling them well. Multiple arraignments in district courts are pending because someone expressed violent language on gaming servers that was deemed threatening. Youth are ending up on probation for this.
I know, you’re probably thinking that I’m about to blame the technology, the erosion of family values, the rise of violence or some other social ill. I’m not. As I reflect over several of these cases, the common symptom I see is not mental illness or family dysfunction, but a crisis in digital literacy.
What all of these cases have in common is that before they got to the emergent stage, there were several opportunities for kids to solve their own problems; for educators to teach; for parents to engage or for therapists to help; if they’d seen the opportunities and had some education in digital literacy. Too often we see the end result of our dismissing or demonizing tech use. “Just leave the server, or Facebook,” we say, unintentionally further isolating kids. “You need to stop playing so many video games,” we opine, citing sketchy research to take away the one thing a person may experience some competency doing.
As a therapist and educator who has worked for the past twenty-five years with emerging technologies in mental health, I have been helping schools, clinics and workplaces identify vulnerabilities before, during and after crises. I assure you that before is the most useful and least utilized. I’m hoping you and your administrators will consider doing this differently. I have started offering custom educational offerings on Healthy Boundaries in the Digital Age, and you can find out more about it here. I’m still doing my other presentations as well.
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Mindfulness, Minecraft & The I Ching
Video Games can be a form of mindfulness meditation, both playing and watching them. The Grokcraft Staff take you on a meditative creative session as we begin to build our I Ching Sculpture Park. Watch, listen, and enjoy..
For more info on joining the Grokcraft project, go to http://grokcraft.com . We are launching Grokcraft with an introductory subscription of $9.99 a month, & subscribers who join now will be locked in at that rate for as long as they are subscribed. If any of this appeals to you, please check out our new site at http://grokcraft.com & please spread the word to anyone you think might find this resource useful!
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Evocation and Mindfulness: Or, How to Think Better
Like other art forms, video games can be both a mirror and a candle held up to our culture, at times reflecting it and at times revealing things about it. Normally I direct my posts primarily at people: therapists, gamers, educators, parents. But today I want to include the company that produces World of Warcraft as well. We have a crisis regarding thinking, and although I don’t think WoW created it at all, it has reflected it in a recent game mechanic change.
I am referring to a change mages that happened recently, where the spell Evocation was replaced by Rune of Power. For people not familiar with the game, here’s a simple explanation. Mages cast spells, but spells require an energy called mana, which gets used up gradually as you cast spells. How much mana you start with depends on your character’s intellect, and once you have used up your mana, you can’t cast any more spells until it is replenished. To replenish it you can either wait and it will gradually return (not the greatest idea in combat,) or eat and drink (not possible while you are in combat.) Or you could in the older days cast Evocation, which meant you stood in place as the spell was going, gain 15% of your total mana instantly and another 45% of your total mana over 6 sec. Move or get attacked, and the spell broke.
This recently was replaced with Rune of Power, which places a rune on the ground, which lasts for 1 min. While standing within 5 yds of it, your mana regeneration is increased by 75% and your spell damage is increased by 15%. You have to keep remembering to replace it every minute, but that’s not the problem. It may even be an easier game mechanic, but that’s not the problem either. My problem with it is how it reflects our dysfunctional attitude about thinking, and specifically our tendency to think of thinking as separate from doing something.
We live in a culture where people frequently worry about things, and in fact have ruminations that are intrusive. Many people report feeling hijacked by their minds with worrying or intrusive thoughts. And yet at the same time, few of us seem to mark our time and set it aside specifically for thinking. We schedule appointments to do things, but thinking isn’t one of them. We treat thinking, which is intangible, as if it can occur in the same space as doing other activities that are more observable and tangible. And then we are surprised when our minds rebel and hijack our thinking with thoughts and feelings that come unbidden, when all along we have been failing to cultivate the practice of intentional, mindful thinking about things.
This is where I think Blizzard and Wow initially had it right with Evocation. It was acknowledging an important truth, that Thinking IS doing something, and when done intentionally it occupies time and has benefits. Sure you weren’t able to do other things while casting Evocation, but isn’t that the point? In the real world, when you want to think deeply and seriously about something, you really do need to be intentional about it, and make a space in your day to do it. Rune of power definitely embraces the multitasking model, which encourages you to set up a rune and then go about your other business while keeping half an eye on it to know when to refresh. Multitasking is not inherently a bad thing, but there are times and places that intentional thinking may be more appropriate and less anxiety-provoking.
Part of helping patients learn to manage worrying is often to help them set up a specific time for worrying about things. This “worry time” can be a placeholder in the day or week which the patient uses when an intrusive worry enters into their thinking: They can dismiss it by deciding to put that on the agenda for the scheduled worry time. This is a way of training your mind to be intentional about what you choose to think about and when. But implicit in this is the idea that training your mind to think about things intentionally is a learned skill.
You can apply this to many different aspects of your life and work. If you are growing your private practice, when was the last time you set aside an hour to think deeply about your business plan or clinical focus. I’m not talking about daydreaming here, I’m talking about sustained intentional thought. Clinically, do you set aside supervision time to think deeply about patients? As students do you take 15 minutes after each article to think specifically about the reading? As parents, when was the last time you said to your co-parent, let’s make a time to think together about how our child is doing in life at home and school. Classroom teachers, when was the last time you asked students to take 5 minutes and think quietly about the classroom topic?
Another challenge here is the confusion of tongues around the concept of thinking. Self-help gurus often exhort us to stop thinking about things and JUST DO IT. But I don’t think they are talking about intentional thinking, I think they are talking about reactive or intrusive thinking. Procrastination is reactive thinking, worrying can be intrusive thinking. Those are often roadblocks to success, but the form of thinking I have been referring to is perhaps better described as a form of concentration meditation. Concentration meditation has come to be seen by many of us as concentrating on an image, or a candle, or chanting, or a revered object, but that is not necessarily the case, and in fact it is limiting.
What if your idea is the revered object? What if your thought process about your work, child, patient, class is worthy of your undivided attention? What if you were to schedule a specific time to think about a certain project?
If you are one of those detractors who say, “I just don’t have time to think,” I don’t buy it. Thinking time is not a luxury item, although it may be a learned discipline to set aside a few minutes at a time to do it. So please take a second and schedule a time on your calendar to think about an idea that is important to you. Schedule a time to hold your random worries and thoughts and show up at that appointed time to seriously consider them. I suspect this will free up more mental space and time than you may imagine.
And please Blizzard, bring back Evocation. I miss it, and the important life lesson in mindfulness it has to teach us.
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Avatars & The Curated Self
If I ever meet James Cameron, I hope I will remember to ask him if it was a coincidence that he chose to the make the aliens blue. His movie, Avatar, garnered 3 Academy Awards for it’s epic tale of humanity’s encounter with the Na’Vi, largely through the creation of avatars, body forms that humans beam their consciousness into so they can mingle and fraternize with the locals.
The concept of the avatar comes originally from Hinduism, and refers to the concept of a God or Supreme Being deliberately descending to earth in a manifest form. One of the most popular gods for doing this is Vishnu, also blue. The concept of avatar in Hinduism is more complicated than this, but the piece of it that pertains to this post is the general concept of the attempt of a supreme being to incarnate part of itself to enter the world. There is an inherent diminution or derivative quality to it.
If you are more familiar with video games than Hinduism, you are probably more familiar with the concept of an avatar meaning the graphical representation of the player’s character in the game. When we play Pac-Man, our avatar manifests in the video game as a little yellow circle with a mouth that races around gobbling dots. Over the decades games and graphics have become capable of more sophisticated avatars ranging from the Viking-like Nords of Skyrim to the soldiers of Call Of Duty. As these video game worlds proliferate, players descend into them with avatars of many shapes, sizes and species. Some games, like Eve Online, allow you to customize the features of your avatar extensively; others allow you to pick from a limited number. We are always diminished by the process of taking on an avatar. Even if the powers an avatar has in the video game world are immense, it is derivative of the complexity of being human.
What is interesting is that most of us use avatars every day online, we just never realize it. Video games are just one form of social media, and avatars abound in all of them. The graphic may be as simple as our picture next to a blog post or comment, or a video on Youtube. But in the 21st century most of us are digital citizens and use one form of avatar or another. Some people in the world will only ever know us through our avatar in a video game or Second Life. And yet we know something of each other.
I think more and more of us are becoming aware of the connection between the avatar and the curated self, the aspects of our psychological self we choose to represent online. The curated self is the part of ourselves we have some ability to shape, by what we disclose, what graphics we choose, and how we respond to others. Like an avatar, the curated self at its best is deliberate. I say at its best, because although the curated self is in our care, we can also be careless with it.
Recently I posted a video of myself on my YouTube channel entitled “Should Therapists & Social Workers Post Videos Of Themselves On YouTube?” In making the video I chose to wear a bike helmet, and by the end of the post was using the bike helmet as an example of the risks we take when we opt to attempt innovation of our curated self. The video was designed to inspire critical discussion and thinking, and it did just that. In some groups where it appeared people described the video and points it was illustrating as “brilliant.” Other groups interpreted it as an instructional video on how to advertise your therapy practice and lambasted it. There was a myriad of responses, and I’m sure even more from people who opted not to comment on it. I received a number of likes of it, and a number of dislikes.
What I think is important and instructional here was how people began to comment through their avatars as if they were addressing the whole person I am rather than an avatar. And they made incorrect assumptions ranging from my age to my motives. The bike helmet and my posture on the video became the target for some incredible nastiness disguised as constructive criticism. From the safety of their own avatars they hurled some invectives at who they thought I was and what they thought I was doing in front of an audience of other avatars who alternately joined in, were silent, emailed me privately to offer words of support, or publicly commented on what they saw. The irony to me was that people began to demonstrate all of the roles we encounter in “cyberbullying,” which was part of what the video also touched on. In a perhaps not surpising parallel process, we got to see and play out the sorts of dynamics that our patients and children experience all the time.
We need to remember that every avatar is a derivative of the person. It is connected enough that we have attachments and responses to it. We can feel proud or ashamed, hurt or healed through our avatars. In fact, research from Nick Yee on “The Proteus Effect” has shown that playing a game with a powerful avatar for 90 seconds can give the player increased self-confidence that persists for up to 6 hours. It stands to reason that if someone experiences their avatar as weak or socially unacceptable for a brief time there may be lasting effects as well. Behind the guy in a bike helmet is someone else. He may be a faculty member at Harvard, a sensitive fellow, a father, a student, a man who just lost his partner, a person with a criminal record, or any, all or none of these. But he is always more than the derivative of his avatar. We need to practice being mindful of this and model it as we train others to be digital citizens. It is counterproductive to sound off on cyberbullying to our children or grandchildren, when they can Google us online and see us doing it ourselves.
We also need to help our patients, their families, and colleagues understand the active role we need to take in curating ourselves online. We need to understand what may happen when we put certain things out there. For therapists this includes the dilemma of putting out a curated self that resembles what kind of work you would do, while not disclosing or conveying more than you want the world to know. The example I always use with students and consultees is how I talk about my family but never who they are in particular. This is deliberate, because it is no big disclosure that I have a family, everyone on the planet has one of sorts with the possible exception of Dolly the cloned sheep. But beyond that I curate a private self, and let folks project what they may. If we put out comments describing patients or coleagues as “screwed up,” we are also curating ourself, I suggest poorly. We need to be mindful that most groups we participate online in are open and searchable. Many of my colleagues became therapists at least in part because they didn’t want to be known and thought the best defense was a good offense (“We’re here to talk about you, not me.”) They’re used to sharing the gallows humor with the team, and think the same applies to online. I’m with Rilke on this one: “for here there is no place/that does not see you. You must change your life.”
To paraphrase Wittgenstein, “our self is everything that is the case,” not just one avatar, blog, string of emails or video; not even the composite of all of them. Nor is our curated self everything that is the case. We’re more than our Facebook likes or our Twitter following. Human beings are so much more, much more wondrous and tragic than the curated self. We descend into the Internet and are diminished, but do bring some deliberate part of ourselves along. We will only ever know hints and glimmers of ourselves and each other online. As for the rest:
“Whereof one cannot speak, thereof one must be silent.” –Wittgenstein
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Bio Breaks
If you’re a therapist looking to join a group of innovative colleagues for supervision, you may want to take advantage of this. Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info. Subscribe to the Epic Newsletter!
Minecraft & The Uncanny, Part 2
This is the second of a two part series on Minecraft. Up until now you could only read it if you bought my book, but I am posting it here to give you a sense of what the book is like. You can buy it here. More importantly, I’m hoping you will find the topic interesting enough to vote for my presentation proposal on Minecraft & Mindfulness for SXSW this year. You can do that here.
In Minecraft, nothing is present-at-hand, at least initially, until you realize that the ground you are running on or the mountain you are climbing aren’t just that, they are materials. You can dig up stone to make a furnace, then bake bricks out of clay, build a house and so on. The world gradually becomes ready-to-hand.
There is no avoiding the sense of throwness when you begin playing Minecraft. It comes with very few directions, although there is plenty of info on the web to be had. The downloadable beta allows you to play single and multi-player, with the single being a good way to practice the basic mechanics. The multiplayer version opens up a whole new vista.
The multiplayer game is hosted on individual servers all over the world, some of which you can log into for free, others for a small fee. Once logged in, the virtual world is a huge massively multiplayer sandbox, which can be a very social experience. The cooperative building in some of these worlds is incredible. My first journey to a server in France threw me into a world which included a vast underground city beneath a dome of molten lava. Players are allowed to explore the world, and at a certain distance from their neighbors mine, farm and build. Like Second Life, you can port to various places on the server, and encounter anything ranging from a Waterslide Park to a model of Hyrule, all built out of the game materials by the players.
Once in the multiplayer world, the social element of the game can become compelling. People on chat are offering to sell gold ingots, suits of armor they crafted, or tracts of land they have developed, for both in-game and out of game monies. You can have as much or as little to do with that as you like, and you can teleport to far-off corners of the map if you want to build and play in undeveloped lands.
In its simple mechanics, Minecraft allows us to glimpse the uncanny experience that I would suggest all video games have. Video games are a unique art form in that they are both interactive and aesthetic by nature. In fact they are far more stimulating and less anergic than watching television, and stimulate more regions of the brain.
Video games allow us to experience our throwness in a new world, and the animistic state of being inherent in the uncanny. We are never completely at home in the world of the game, although the game may become more familiar over time (or not, in the case of the indie game Limbo.) We are always just visiting, strangers in a strange land. But within the game world, mana and magic are also real, and our thoughts and strategies can quickly and permanently change the world.
Psychotherapy is in many ways, another sandbox game. There really is no way to win in it. The office becomes a setting for a potential space that can be shaped and altered by the patient and something new created. Psychotherapy is also an uncanny space, one that resembles the world outside the office and yet does not. It is a place for “everything that ought to have remained … secret and hidden but has come to light.” Within that space, the patient experiences hauntings by ghostly relationships from the past, encounters the internal monsters of the drives, and explores the wishes behind their secret injurious powers. Unexplored and avoided, these have calcified into symptoms, and the anxious, exciting, process of therapy helps the patient break down that calcification for a more flexible psyche.
Any child or gamer knows that play is a serious and dangerous business. There is always the risk of annihilation, and no place worth going to doesn’t have its hazards. But there are great treasures to be found in the game. Further, the emotional and intellectual changes encountered within the game can then be taken out of it into the daily life of the gamer. This is one of the reasons that video games are so compelling. Why else would people spend hours making houses out of pixel bricks?
Both psychotherapy and video games create very real thought and feeling states in people, and that is part of their curative power. In this book I hope I have shown that they can restore a sense of purpose and achievement that our patients have lost. I have discussed how they can help people stay connected with others over great distances in times of duress, help us feel the sense of achievement necessary to learn and change behaviors, and explore aspects of their personalities that may be less easily seen or developed in their daily lives. I have also explored how we can use the experience and metaphors from video games with patients to help them understand ego defenses, communication patterns and strategies that impact their relationships, and apply game mechanics to their lives to change them. I have tried to discuss the stigmatization of gamers and technology in terms of diversity, in particular social class. Finally, I hope I have shown how therapists can apply the principles from video games and gamification to impact both their clinical work and business skills.
All of this pales in comparison to doing the actual work, and by this I mean two things. The first and most obvious one is the practice of psychotherapy. Theory is a necessary but insufficient precursor to clinical practice and healing. The second piece of actual work will be for the therapist to begin playing some video games. Reading is not the same as doing, and it is only by entering the uncanny and enriching world of the video game that therapists can hope to truly understand them. Never has play been more important in our work, and never has understanding video games been more urgent in healing the world. To do so we need to rethink our attitudes and reconsider our biases towards gaming and technology.
It’s time to reset.
Gamer Therapist is on vacation, so we’ll see you in two weeks! In the meantime, please vote for our minecraft panel at SXSW!
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Minecraft & The Uncanny, Part 1
This is the first of a two part series on Minecraft. Up until now you could only read it if you bought my book, but I am posting it here to give you a sense of what the book is like. You can buy it here. More importantly, I’m hoping you will find the topic interesting enough to vote for my presentation proposal on Minecraft & Mindfulness for SXSW this year. You can do that here.
In 1919 Freud wrote and published an article on “The Uncanny.” In it he described the concept of the uncanny as a specific type of fear something both strange and familiar. It is worth noting that the article begins with an investigation into aesthetics, something that was not usually done in the medical literature of Freud’s time. But Freud realized that there was something particularly aesthetic about the uncanny. It is an anxiety that both draws on the aesthetic, and from a distance also acquires an aesthetic quality itself. In fact, it could be argued that a whole genre of fiction, such as Lovecraft, embodies the aesthetic of the uncanny.
In German, the uncanny is unheimlich, which translates literally to the “unhomely” or “unhomelike.” Here homely has a double meaning. First homely is the quality of domesticity, the warm hearth of the house, down comforters, a cheery cottage coziness, etc. Second, heimlich refers to concealment, contained within the house’s domestic sphere, hidden from the public eyes of outside society.
Seen in this light, the uncanny or unheimlich is both alien and a revelation or an exposure. Freud quotes Schelling as saying that ‘“Unheimlich” is the name for everything that ought to have remained … secret and hidden but has come to light..’” Is it any wonder that Freud took up exploration of this concept, with all of its allusions to the unconscious, anxiety, and societal repression?
Freud also talks about the element of repetition in the uncanny, such as arriving at certain places we’ve been to before, or noticing the number 62 appearing throughout the day in a variety of places. This element of repetition gives rise to the sense that there is a pattern that we may not be aware of, which in turn makes the world suddenly seem both stranger and more imbued with meaning.
Freud goes on to discuss something gamers will be very familiar with, mana, although he discusses it from outside the framework of fantasy as a form of magical thinking that attributes powers to the neurotic overvaluation of their thought processes and their impact on reality. But the game world is within the realm of fantasy. Within that world, what Freud refers to as “the Apparent death and the re-animation of the dead” are fairly commonplace. The game world returns us in many ways to the animistic state of being, characterized by “the prompt fulfilment of wishes, with secret injurious powers and with the return of the dead.”
The uncanny also figures largely in the philosophy of Martin Heidegger, and is connected to the idea of man’s “throwness” into the world. Human beings want to feel at home in the world, but when they encounter the uncanny they experience themselves as thrown into it and apart from it. For Heidegger the unheimlich eradicates our sense of Being-at-home-in-the-World, but as it does so it reveals something about the World to us.
For Heidegger the World is also revealed to us (and we are revealed as well) by that which is ready-to-hand, something that has a meaning that connects us to the world. An example is a hammer, which we experience as imbued with meaning and value and inextricably linked to human being. We don’t think about the hammer, in fact the only time we are really conscious of it is when it isn’t working. A similar example is your car, if you reflect on it you will probably notice that you only really pay attention to your car as a concept when it isn’t working.
As opposed to ready-to-hand, present-at-hand refers to an uninvested, detached way of looking at something, one that takes us out of any sort of meaningful relationship. Its meaning may be unclear and unconnected with human being at all. If I ask you what you’d like to do with that round green and red thing, you’ll be confused. But if you see it as an apple, things will become much clearer. It probably isn’t a coincidence, by the way, that most depictions of Adam and Eve in the Garden of Eden show the fruit as an apple. Before the Fall, everything is ready-to-hand and imbued with meaning. Afterwards, in our thrown state, things become less clear, and more uncanny. Paradise has been lost.
Ninety years after Freud wrote “The Uncanny,” Markus “Notch” Persson created the game Minecraft. Minecraft is a sandbox type of video game, meaning that the world generated can be permanently changed by the player. Creativity and survival is the goal, and there is no way to “win” the game. The premise of the game is that your character is thrown into a vast world designed with 8-bit graphics (think early Nintendo) with only your bare hands. The game has a day and night cycle, and at night zombies, skeletons, and other monsters come out and will attack you if you are exposed.
Everything in the game world can be destroyed and broken down into elements that can be crafted if you have the right ingredients. At first you have fewer options, because destroying a tree with your hands takes more time than if you had an axe. But slowly you gather materials so that you can build things that in turn allow you to build more things, so that you can hopefully build a shelter before night falls.
The landscape of the world is randomly generated by the game, and remains saved if you are killed. Dig a hole in the ground and it will be there when you return from the dead and to the game. The graphics are not realistic, with the blocky edges of 8-bit design, which underscores the uncanny element of the world. The world is vast, and looks like the real world, and also doesn’t. Minecraft is not trying to trick you into thinking it looks like real life, in fact that is one of the things that makes it so immersive.
Part 2, next week.
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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!
Why Therapy Is Like A Game
Game-playing often has negative connotations in the field of psychiatry. We have all sorts of erudite ways of describing what laypeople call “mind games.” A great example is in the language of Axis II personality disorders. People are borderline, dependent, avoidant, narcissistic, antisocial, and the most FABULOUS of them all, histrionic. These words attempt to describe the psychological conditions which motivate problematic behaviors. Serious business indeed.
But come right out and say that therapy is like a game, even a kind of game, and that gets a lot of hackles up. Therapy is serious business, and games are anything but serious, right? Wrong.
To describe something as a game is not to minimize it or take it less seriously, but I suggest to describe what Bernard Suits calls the “lusory attitude.” This is the state of mind, the psychological attitude, required of any player when they play a game. The most succinct way Suits describes the lusory attitude is to say that it allows the “voluntary attempt to overcome unnecessary obstacles”
An example of this, not mine originally, is that of golf. The activity is directed at achieving the goal of getting a ball into a hole. But instead of just creating an activity where we find a ball and drop it into a big hole, we take the hole, make it small, say you can’t use your hands to drop the ball in but must use a metal club, and start you off hundreds of feet away from the hole. That’s golf, and it is so full of unnecessary obstacles! There is no reason to make it so challenging, EXCEPT that that challenge is what makes it fun, and frustrating, and more fun. And nobody drags you into the wilderness, gives you a golf club and points a gun at your head to golf. It is a voluntary act. People love to, choose to, spend hours with sticks hitting balls from great distances with the hope of getting them into little holes. Why choose to do something so weird and difficult? Because they are playing. They have voluntarily attempted to overcome unnecessary obstacles. They have adopted a lusory attitude.
Life is hard. And for many of therapy patients, life has been extremely hard, and cruel. And yet, how often do we notice that they are making life even harder on themselves in some ways? Perhaps unconsciously, perhaps subtly, but more difficult nevertheless. That neurosis, the reenactment of the past, is what I would suggest is the unnecessary obstacle.
For example let us take PTSD-precipitated by child abuse. The abuse was serious, hurtful, sadistic, real. It happened. But in the case of the adult patient, the abuser is no longer there. The introjects, the learned stuff, the unconscious stuff, that is all there, but the perpetrator has fled the seen of the crime long ago. They were real obstacles, but trauma recreates them as unnecessary obstacles in the here and now.
Another example would be a phobia. Why not be fearful of everything? Spiders aren’t the only thing that we could fear: There’s death, and hurricanes, and black cats, and dirt, and blindness, and the next presidential election. But we don’t fear everything in the world that is or is perceived as harmful to us. Phobias are very specific, that is why there are so many clever names for them. They are again, unnecessarily specific obstacles.
Again, I want to stress that by calling these unnecessary obstacles that I am not at all saying that phobias or PTSD or not serious, painful, debilitating, conditions. What I am saying is that they are unnecessary to the life of the patient. Even as compromise solutions they have outlived their usefulness if the patient is in the here and now experiencing distress as a result of trying to defend against or cope with the past encroaching on their present. The repetition compulsion is a game of both danger and optimism. We do the same things over and over, often with disastrous results, true; but we keep doing it because on some level there is an urge to get it right. And like a video game, the repetition compulsion doesn’t just get defeated one day; rather we get progressively further in the game, acquire new levels and skills.
When our patients arrive at our office, they are in a state of lusory attitude, they are really trying to resolve the problems the best they can, and they have sought out our help to that end. If they are mandated to treatment, this is less likely to happen. But for a majority of patients, they choose to show up. And from a psychological point of view, showing up must be voluntary for therapy to work.
In order to do therapy, we also have to adopt together a lusory attitude. Both therapist and patient volunteer to work together to overcome the unnecessary obstacles. The therapy time and space are in some ways unnecessary obstacles: we choose to limit the session to the 45-50 mins, in a specific office, with only two “players” if it is individual therapy. These may be the warp and woof of therapy but they are also arbitrary distinctions that create unnecessary obstacles. We could rotate different therapists in, or meet for varying times whenever we both want, and hang out at Dunkins, but that would be therapy in the sense we are talking about would it? No, therapy, like games, must have agreed-upon rules.
Although I’m speaking in clearly psychodynamic terms here, doesn’t it seem that more behavioral approaches would find the concept of lusory attitude applicable as well? Surely we don’t try to extinguish behaviors we think are necessary. The behavioral approach also implies that the obstacle (behavior) is unnecessary and tries to over come it.
Having a lusory attitude is not always about being lighthearted, although it can be, but it is about taking play very seriously, engaging in it and often having an immersive experience. Psychotherapists who engage in play therapy with children often have an easier time understanding this than those who do adult psychotherapy. There is a general tone from our profession of, “we need to be taken seriously,” which I think has lots of its roots in the tendency of the medical profession in the past to have considered it less important. And somehow being taken seriously becomes equated with being important or being valuable.
I often supervise interns who repress any sense of enjoyment that comes from making an interpretation that moves a patient forward, or seeing theoretical elements manifest in the treatment, and try to help them see that enjoying the process of learning psychotherapy and learning about the patient is not the same as having fun at her/his expense. As Sutton-Smith says, “The opposite of play isn’t work. It’s depression.” In this regard I agree with him: When engaging in a lusory attitude with patients we are working with them. Removing those obstacles is very hard, dangerous work, and it is deeply and seriously playful.
To add gamers and video games into the mix, I would suggest that approaching video games as an addiction is a step in the wrong direction. This is not to say that I don’t think that some people play video games to the detriment of their lives and relationships. I do think that happens, just like I think people engage in a number of activities at times to the detriment of their lives and relationships. But to label them as pathological is to miss the point. Even if we rule out the cultural incompetency of the clinician around video games which often masquerades as dismissal or villainization, we need to understand that we are in essence asking the patient to adopt the same lusory attitude with us that is often there already for them with video games. We are saying, “don’t play that game, play this game of therapy instead.”
(Unless you have this view of psychotherapy:
Psychotherapy needs to stop taking the lusory attitude for granted. What if we became more mindful of our lusory attitude? We all have them, over coffee with a colleague when we look at each other and say, “this is such a weird profession!” It’s like golf in that respect, it seems; so intricate and complicated with rules we take for granted that make a particular human relationship much more complicated than it has to be. Try that on the next time you are trying to discuss your fee with someone: “I charge you $150 an hour because this is a weird relationship that has intricate rules and is much more complicated than human relationships have to be.”
I think that there are strong parallels between therapy, neurosis, and games, and that the thread that links them together may be the lusory attitude. In games, the design always boils down to a voluntary attempt to overcome and unnecessary obstacle. In neurosis, the attempt to repress intolerable conflicts and feelings creates an unnecessary obstacle even as the patient tries to remove the unnecessary obstacle of those same conflicts and feelings. (Game designers may recognize an interesting resemblance to the concept of iterative design here.) Finally, in therapy, the neurosis or symptom becomes the unnecessary obstacle that the therapist and patient voluntarily attempt to overcome.
What do you think? Does this jibe with your experience as a therapist, patient, gamer or game designer?
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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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If Freud Had Played Video Games
This post is dedicated to my supervisee, Alex Kamin, who inspired me to make the connections. I learn so much from my supervisees!
Last night I spent a great deal of time mining for diamonds. They are fairly rare, and can only be mined if you have an iron pickaxe (or a diamond one). This meant that I needed to mine iron ore first with a stone pickaxe, but I should start at the beginning.
Minecraft is a game which now rivals WoW in popularity. It has been around in beta for a while, but now has been released to the general public. The game takes place in what is known as a sandbox world. What that means is that the game world can be effected permanently by the player. Dig a hole and it stays dug, chop a tree down and it stays chopped, plant new ones and in time they grow. As opposed to having a beginning, middle and end, Minecraft can be played for as long as you like. You can play it in single-player mode or log on to a minecraft server and participate in a multiplayer world.
Starting with nothing but her or his bare hands, your character takes materials from the environment and fashions tools, houses, works of art out of these raw materials. That is the crafting part. Once you have fashioned the most basic pickaxe, out of wood, you start to do the mining part. Which brings me back to diamonds.
Diamonds are very rare blocks in Minecraft, and are mostly found at the bottom layer of the world. You have to tunnel through loads of dirt blocks, stone blocks, and gravel blocks. Sometimes you tunnel straight into lava and get burned up. Sometimes the ground beneath you turns out to be a giant chasm and you plummet. Sometimes there is water that floods your tunnel, or monsters if you are looking in one of the world’s many caves.
A lot of time is spent underground, but a big part of the game is to bring the materials back up to the surface. There you make your crafting table, house, and forge. Days and nights pass. At night the monsters from the caves come out and roam the surface, and you’d better be in your house with the doors shut!
This is a very brief synopsis of an amazing virtual world that is already being used in classrooms and by families to provide cooperative and fun learning. You can find one such example, The Massively Minecraft Network, here.
One group who could benefit from understanding and playing Minecraft is psychodynamic psychotherapists, especially psychoanalytically-oriented ones.
For decades, psychology textbooks have used the iceberg to explain Freud’s early topographical model of the mind. It’s the one I grew up as a therapist with, and you probably did too. One version is this one:
The topographical model introduces the concepts of the conscious, the preconscious, and the unconscious. Freud was ultimately dissatisfied with this model, and moved on to his structural theoretical model of Id, Ego and Superego. I wonder if he would have done so if he’d been able to play Minecraft.
Two of the deficits of the topographical model as pictured by an iceberg are its static nature and its failure to locate where and how psychotherapy works. The second deficit derives from the first. Psychodynamic therapy is as the name suggests, a moving process. Now imagine playing the game I described above, and you have a dynamic model. There is the conscious surface that changes over time, is constantly changing and growing, where things are visible. There are the caverns and depths which are the unconscious. And there is the preconscious twilight and night, when the monsters and creatures from the unconscious slip up to the surface and terrify us.
In terms of describing psychodynamic therapy, Minecraft makes that easy too. I have often had a difficult time explaining to a patient what the unconscious is and why I think it is important. But any gamer who has played Minecraft will understand the process of therapy and their work in it in the metaphors of mining. During the week, our patients roam the surface of their psychosocial world. Then one, two, or three times a week, they come into therapy and begin tunneling. Week after week they mine dirt, stone, and occasionally strike a vein of insight. Like iron ore, insight is a necessary but insufficient requirement for change. Without smelting and crafting, iron ore can never become a tool we can use. Likewise, without reflecting on our behaviors and changing them we can never improve our ego functions.
You can explain ego functioning via Minecraft as well, by discussing those above tools. Tools in Minecraft include shovels, pickaxes, hatchets, swords, wool shears and hoes. A hoe is excellent to use in gardening, whereas a sword will not function in the game that way. You can chop down a tree with a pickaxe but it takes longer and wears down the pickaxe more quickly than if you were to use a hatchet. Different ego functions do different things, and the ego defenses are only one subset of the ego functions. Only one of the tools is explicitly made to be a weapon.
And if you lead with your ego defenses all the time you will be disappointed. Take sheep for example. If you kill a sheep with a sword you get one block of wool. But if you shear it with the iron shears you get three wools, and the sheep lives to grow more wool. By the way, if you craft a hoe you can grow wheat, which allows you to domesticate and breed sheep for even more wool. Just so our ego functions, which provide a holistic and dynamic system that allows us to mediate the world and our wishes.
When you start mining you have a wooden pickaxe. You mine stone so you can get a stone pickaxe. You mine iron ore with the stone one. Only iron pickaxes can mine diamonds.
Psychotherapy takes time and effort, lots of time and effort, if you are aiming for more than symptom reduction. Patients begin with the raw tools they started out with, and build on each developmental gain. Often our patients will feel very raw and discouraged, state that they despair of ever getting better, whatever better means to them. When that happens we can remind them that therapy is minecraft. It takes delving and work back on the surface in the real world outside the office. It takes time and patience. Sometimes they will feel consumed by feelings as hot as lava, or flooded by memories like water in a mineshaft. Sometimes it will feel like they’ve lost everything they’ve been carrying and have to start over. But with each set of tools they acquire they’ll find it easier to make their way in the world.
And sometimes they will find diamonds.
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Skyrim, Stealing & Sadism
If you have been a therapist for at least, oh, say three months, you’ve probably had a conversation with a patient who steals. Sometimes it is mandated counseling as a result of a criminal charge or EAP referral; sometimes it is the confession of shoplifting. But if you haven’t talked about stealing yet, chances are you haven’t asked.
Stealing is always a metaphor and enactment. It may be other things as well, a means of survival, an indication of impulse control: But for the patient it always means something consciously, preconsciously or unconsciously. (If you don’t believe in the existence of the unconscious, why are you reading my blog?? No good can come of it.. 🙂 ) Sometimes the stealing is a symbolic expression of the desire to possess something that one feels was stolen from one: for example, a survivor of sexual abuse who steals toys to express the experience that her childhood was stolen. Sometimes it is to express the fear of being deprived; for example someone who steals and hoards food or clothing. I’m sure you could come up with plenty of examples, but let’s move on and discuss it in terms of narcissistic rage.
The difference between anger and narcissistic rage, according to some psychoanalytic thinkers like Kohut, is time and revenge. If a situation makes one angry, it usually has a short time span, and little to no accompanying desire for revenge. If a narcissistic injury occurs, the accompanying rage can last for a lifetime, as can the accompanying desire to have vengeance upon the person responsible. We experience both forms of feeling in our lives, and I’d say they’re different rather than better or worse for someone. And both are very useful sources of information about a patient’s inner world.
Skyrim is the latest video game in the Elder Scrolls series. This much-anticipated game has shipped 7 million copies worldwide its first week garnering $450M. Within the first 24 hours 280,000 PC players were downloading it, and within 48 hours Bethesda reported 3.5 million copies sold. It is looking to be one of the most popular video games this holiday season, if not Game of the Year.
Skyrim is a single-player game, not an MMO, but one of the things that makes it impressive is its scope, which is closer to MMO games than traditional single-player games. It has an immense game world, the province of Skyrim, and has an open-ended quality to it, in that you can play the game to your heart’s content without ever completing the main quest line. There is a main story, but you can choose to ignore it, and focus on doing other things. There are side-quests to train at Mage or Bard College, there are achievements to unlock and crafts like mining and smithing to learn.
And then there is stealing.
In Skyrim, there are lots of things lying around for you to take. If they are in a cavern or the world at large they are usually loot. But go inside someone’s shop or inn and you’ll see in red the option to steal them. If you do steal something, you may get caught or not. You may get caught and persuade the guard to let you go. You may get thrown in jail and forced to pay bail. Or you may get killed. The same applies to any lockpicking you do to break and enter someone’s real estate.
The more you steal, the higher the bounty on your head in each city gets. And each city has its own record of your crimes, meaning you can have a different reputation in each city. In fact, if your do enough criminal activity, the Thieves Guild, an invite-only thieves guild, may recruit you.
Not every video game allows for stealing, and by now some of you may be asking, “Why would anyone want to play a video game where they steal things?” Good question, let’s not dismiss this phenomenon: This game is 5th in a popular series which has consistently allowed theft in the game world, and developers don’t create and keep dynamics that nobody wants or plays. But to return to my earlier assertion that stealing is always a metaphor and enactment, we can begin to see the importance of asking our gamer patients about it in the particular, i.e., “What makes you steal in Skyrim?”
One of the advantages to taking a gamer-affirmative approach with patients who play video games is that you look at the video game as meaningful, rather than as merely a symptom or pathology. Once you do that the questioning loses it’s dismissive tone, and can become a useful part of the treatment. Why does the patient or gamer steal in Skyrim? Are they acting out a loss? Are they trying on a new way of being in the world? Or are they allowing some part of themselves to be expressed in the game that they try to hide from themselves in real life?
For example, did one of Skyrim’s NPCs with their Schwarzenegger accent say something insulting to you when you went in their shop? Maybe the fact that they sound like Schwarzenneger means something to you, and you like the idea of taking some tough bodybuilder down a peg. If you feel slighted, and steal from the innkeeper to “teach them a lesson,” this is an example of narcissistic rage. Having seen this in the game, can you begin to see any connections with people in your world outside the game whom you’ve felt insulted by, whom you wish you could teach a lesson?
It is often easier to look at our sadism and our narcissistic rage in the symbolism and displacement of a dream or art. Video games, which are social media and art forms with elements of dreams, are rife with opportunities to do this. The gamer-affirmative therapist can ask if your stealing to become noticed and recruited by the Dark Brotherhood might have any connection to the rage you feel that the girls/women/boys/men in your life only seem attracted to “jerks,” not “nice guys” like you. Or do other interesting (to a therapist) patterns emerge? Do you only steal from male NPCs? Do you ever regret stealing? Does whether you steal during gameplay depend on your mood that day? Do you think it is wrong to steal from the NPC? Why or why not?
Therapists: Don’t take the excuse, “it is only a game,” because any gamer knows, in fact we all know on some level, that play is not meaningless. You don’t accidentally steal, ok wait, scratch that–you can inadvertently click on something and steal it in Skyrim, and then all hell breaks loose. But if it was an accident, did you feel anything after it happened? Do you do it again? What does this say about your learning style, or repetition compulsion?
And sometimes, people steal in Skyrim to experience a conscious, guiltless pleasure and awareness of their own sadism. In video games, like in all fantasy, we get to do things we’d never do in real life, and enjoy them. If you’re recoiling at the idea of taking a loaf of bread from a little girl in a video game, stop and reflect: Might you have an overactive superego? Might you be splitting off and disowning some sadism here? Or was Oscar Wilde wrong when he said, “One must have a heart of stone to read the death of little Nell without laughing.”
There is a reason why the Germans have the word Schadenfreude in their vocabulary: There is something archetypal about taking joy in the suffering of others. In real life it can be more problematic than satisfying for us, or it can be an ethical dilemma. But in fantasy and in psychotherapy, exploration of sadism is often meaningful and important.
Gamers might worry that talking about the joy they experience stealing from or even killing characters in Skyrim will have adverse effects on them. In one direction, you may worry that exploring these fantasies and the satisfaction you feel might demystify and ruin the game for you. I doubt that will happen, understanding the meaning of an unconscious fantasy doesn’t have to spoil the fantasy, in fact it might enrich it. Or you may worry that talking about these fantasies will be trivialized or pathologized by your psychotherapist. To that I say, if they do, perhaps it is time for you to get a new one.
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Blogging for Therapists
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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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Epic Guest Post: Newbie Therapist Esther Dale on Staying Determined
Every once in a while I receive an email that reminds me that the work I am doing is making a difference. Today I received this from a new colleague to our field, and with her permission I share it in its entirety. I hope that you will comment on it and show her that she’s not alone:
Hello Mike,
I am a newbie therapist, having entered the licensed profession less than a year ago. Though despite my newbie status, despite the fact that I currently have no clients, no office, no firm job prospects, with a website and business plan that are both still in the initial stages, I still feel that I am an Epic Therapist. Or, at the very least, I am in training to be one!
Anyway, I just wanted to let you know how truly, truly, refreshing I found your blog. In the past, I have spent many, many, many hours skimming one random psychotherapist website after another. More often than not, I get so bored to tears reading the same drivel. I can’t understand how so many of them stay in business. From their websites, I feel that often there is no real spark or passion for their profession, and that they are all trying so hard to play it so safe, that so many psychotherapists end up sounding so cookie cutter. Not to mention the rather pretentious attitude that comes with, “I specialize, well, in the whole DSM-IV. What is your disorder? How may I help you in your disordered state?” Or my personal favorite, “Are you anxious? Depressed? Do you find yourself worrying a lot? Do you sometimes find yourself feeling lonely?” My thinking after reading that is always, “Yeah, I am depressed and anxious just from reading that!” After exhaustive online research, I felt rather alone in feeling like a therapist could dare to have their personality shine online. And then I found your site, and I was like, “Someone who dares to break the mold!” YAY! 🙂
So I have basically spent my free time the past couple of days reading as many of your blogs as possible. I know that you must get many, many e-mails. And I am trying my very best to have my e-mail be worth your time. I am hoping at the very least that what I have to say might spark a possible interest for a blog response.
When I am in my Secret Headquarters, well, ummm, Head(corner) more like it, I feel like anything is possible. I feel the passion and excitement and knowledge for my blossoming niche, Sandplay/Play Therapy. I feel my passion and excitement for my professional focus on the more non-verbal approaches to psychotherapy, for the times when individuals just can’t seem to find the right words to truly express everything that is going on inside of them. Even right now, I feel myself fumbling around for words, and wish I didn’t have to rely solely on words at this moment in time to captivate my Epic Therapist passion. So when I am in my Secret Head(corner) I feel rather invincible. I feel like I can make it. I feel like I have the ability to design the website I want, and set up shop the way that I want. Though the moment I step out of my Secret Head(corner) I am immediately flooded with all these scripts of why I can’t do this. I feel like there are so many “voices” telling me I can’t succeed on my own terms quite yet because I haven’t paid my dues to the system. The current system that exists between many CMH, Non-Profit establishments and insurance companies, make it near impossible for newbie therapists to get a traditional job. From my own experience, I didn’t even qualify to apply for the clinical position for which I interned. When this happened to me, I acknowledged to myself that the current system is way out of joint, and that deep down inside, I have no real desire to associate with that kind of business structure. Though still I feel so many professionals trying to taint my passion for a private practice with their venom of, “Well, you need to walk, crawl, climb your way through Mordor, in order to finally be able to sever your newbie status ring into the fiery pits.” Though I tend to see another option rather than the traditional route: http://www.youtube.com/watch?v=1yqVD0swvWU (I love this video, two minutes of LoTR epic-parody goodness.)
In their eyes, I am trying to take a short-cut. Though I am not trying to take a short-cut, merely a different path. I have checked the policies and procedures regarding private practice, and even with my Limited License Professional Counselor (LLPC) status, I am able to set up shop. I have a qualified supervisor and seek out as many mentors as possible; I am constantly researching to gain as much knowledge as possible; I spent much time and effort in receiving professional training in Sandplay/Play Therapy. I feel like I am a blossoming professional in my field. I am determined to have an ethically driven, professional private practice, with a strong niche, and a strong professional voice. Though, every time I think of my “Limited License” status, or I think of all the things I still need to learn, I sometimes feel myself retreat into this defeated status. So I guess my question is this, how does one continue to build up and defend their Epic Therapist status, when so many naysayers want to tear you down because you are forging your own path?
If this sparks a possible blog/e-mail response that would be awesome. If it doesn’t, that is okay too. I know your time is valuable. I am just grateful if you took the time to make it to the end of my letter. Best of luck in all your efforts!
Sincerely,
Esther Dale, MA, LLPC
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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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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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Fun & Failure
Early in the summer I had the opportunity to give a workshop at the University of Buffalo. The evening before I gave it I had the opportunity to sit down and have dinner with Nancy Smyth, the Dean of the School for Social Work. Although we’d never met before in person, the time sped by with good conversation and laughter. Fortunately I had finished my prep for the workshop, because I was quick to crash that night.
The next day I spoke in front of a group of clinicians, caseworkers, and administrators. The age ranged from 20s to 60s, and the discussion was so lively that the day sped by, and before I knew it, I was being ushered out of the classroom and into the car to the airport. The workshop participants did not agree with each other (or me) on all points, but everyone said that they were walking away with me having changed their thinking about technology, video games, social media and healthcare.
Sometimes I take for granted how much fun my work is. There is enough diversity in who I work with to keep me invigorated most days, and the balance of a portfolio career really suits me. Being my own boss suits me as well, and this year I mixed it up a little. I dropped one class I was teaching and took this semester off so I could focus on writing and promoting my new book.
Promoting Reset is not something I enjoy doing. Although I coach and blog about the importance of self-promotion and what hold us back from doing it, that doesn’t mean that I enjoy doing it all the time. But one thing I have been learning is that writing the book was the eas(ier) part. I need to keep getting the word out about it, and sometimes I feel like I am overtaxing the patience of my Twitter followers, Google+ circles and Facebookies. Some of these people are in multiple groups, and I can imagine that they get irritated with another post about the book. “Enough already!” I imagine them saying.
Speaking up is not easy, and many of us actually have a much easier time speaking up for others than for ourselves. We speak up for our clients, our kids at school, our pets when they depend on us for care. It’s ironic that we get so good at striking blows for freedom, blogging against oppression, picketing, and political advocacy; and yet we cringe at the idea of promoting ourselves. Perhaps that is because the former makes us feel righteous, and the latter makes us feel guilty. I definitely enjoy advocating for technology and the people who use it with my colleagues, but I wonder if I would have promoted my book at Buffalo if it had been published then.
I’d better get used to it, because now there are more speaking engagements coming up, and having an eBook means I can’t just lug a pile of them to the the hotel and have them sit on a table. I need to be speaking up about Reset, because no one else will. And one thing I have also learned to do at talks is to let people in them know I enjoy speaking engagements and am available to do more. And each time I have done that, I have gotten a lead. Hopefully out of all of you reading this I’ll get hired to do another few.
This is such a contrast to my clinical work, where I am required to be more quiet, reflective, and other-focussed. I am not alone in this, psychotherapy tends to require us to listen more and talk less much of the time. It is also a safe place to “hide out” if we aren’t careful.
One of the most unfortunate lessons our current educational system teaches us is that we should hurry up and find out what we are good at, what comes easily for us, and then stick with that. In school settings, not-knowing is considered a bad thing rather than the predecessor to curiosity. By college we have learned to speed through any unpleasant “requirements,” and major in something that interests us. The problem with this is that by then we have learned to take an active disinterest in things that we struggle with. So we arrive in adulthood having learned to play to our strengths, and avoid the rest. And whereas children are fairly powerless to avoid what they struggle with in school, adults can often construct a life that cocoons them from learning unfamiliar things.
Therapists in particular, have pushed themselves through grad school and internships, licensing tests and boards, and by the time we get licensed to do private practice we feel entitled to close the office door on outside influences. Several times when I have been hired as a coach or consultant, I still find my clients reluctant to “come clean” about things they aren’t good at. Some haven’t billed insurers for months because they don’t know how to do the paperwork, or a claim has been denied and they are letting the appeal sit on their desk. Websites lie around half developed, brochures printed up but not mailed, and all of this is nothing compared to the disarray and avoidance of work/life balance. Office hours are whenever the patient can make it, their specialty is “anxiety and depression,” and they are running themselves ragged. And all the time, they suspect that they are really frauds awaiting discovery, and why? Because they learned that you aren’t supposed to admit you are confused or don’t know something, let alone ask for help.
Fortunately I play video games.
As Jesper Juul points out in Fear of Failing? The Many Meanings of Difficulty in Video Games failure is more than just about not winning. It forces gamers to readjust their perceptions. In fact, players prefer games where they feel responsible for failing. What’s more failure adds content to the game. Think about what a powerful paradigm shift that is. Failure adds content that wouldn’t be there. What might happen if we were able to see failure in our lives as adding content?
Actually, therapists often have a lead in understanding this. We know that empathic failures are often inevitable, and that when we successfully navigate them with our patients the relationship deepens. The failure adds content.
So think about your life, your practice, your business or your relationship. And look straight at where you are failing in it. I know, it’s tough, but try it for 5 minutes, and then ask yourself, “what content is this failure adding to it?”
This is much easier to do in hindsight, which is why we need to try to practice it in the now. Because if we don’t avoid seeing the failures, we can readjust our perceptions and progress farther. Maybe just a small progression, but anyone who works with kids knows the importance of proximal goals.
To go back to the Buffalo speaking engagement, this began as a failure and the setting of a proximal goal. The failure was this: I wasn’t getting enough paid speaking engagements. How did that add content to my life? Well, it added the mission, should I choose to accept it, of getting more paid speaking engagements. So I set the proximal goal of starting to let people know I was looking for them. One night on Twitter Nancy said something complimentary about a blog post, and I quipped that she’d better hire me as a speaker before my rates went up. A few months later I was invited to speak. And in addition I deepened a connection, met some really cool students, and saw Niagara Falls for the first time in my life: How’s that for added content?
So much is possible for you, your business and your life. None of what I have described above was achieved because I have some special gene. It took what Pema Chodron calls going to “the places that scare you.” We are all failures at something–come out of the closet! Over 6 billion people around you are failing and trying and failing and trying again every day. Those that aren’t are hiding inside an ever more rigid and constricted life. That doesn’t have to be you, and it sure as hell isn’t going to be me.
Oh, and I hope you buy my book, and I’m available for speaking engagements, so call me. 😉
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Defeating the Boss: Overcoming Your “Big Bad”
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Being A Noob
Over the past few months I have taken some time off from playing World of Warcraft to try a new MMO called Rift. Rift takes place in a different world from WoW, the world of Telara. It has a different storyline and although the user interface is pretty much a duplicate of WoW’s, there are many many other differences as well. I have been playing WoW for several years, and had progressed my character to level 85, the highest you can get as of now. In those several years I have been a member of three guilds, leveled 6 professions, and spent countless hours researching the internet on strategies, spell rotations, and boss strategies. I’ve traveled the length and breadth of Azeroth and Outland, and completed hundreds of quests and achievements.
And now I’m a noob again.
In Telara I’m just out of the training zone, and level 13. I have no idea where I am, and most of the map is still an undiscovered blank screen. I don’t have more then 20 points in any profession and I’m not in a guild. I’m reading new material and trying to figure out what sort of place Telara is, why the sky is constantly ripping apart as rifts from some other dimension open up and rain down monsters on me and any other players in the area at the time. I keep running the wrong way into mobs of villains many levels higher than me and dying. Lots and lots of dying. And lots and lots of running back from graveyards as a ghost trying to find my body.
Good times.
For those of you who don’t know this, being a “noob” is a term for being a newbie, a newcomer unfamiliar with game mechanics and the lay of the land. It can be a very frustrating experience. The first time I was a noob, in WoW, I had no idea how much I was learning as I was learning it. There was such a steady progression that I didn’t realize how much experience and skill I had amassed with the game until I switched over to a new game. Now it is like I have lost all of that experience and skill, and I can feel overwhelmed. I am nowhere near Rift’s “endgame,” and everything is new and weird. So why not just go back to playing WoW?
First off, I have a little faith. As I stumble through being a noob in Rift, I can remember feeling similarly clueless at the beginning of my time playing WoW. I know that I am learning a great deal, more than I can even tell, and that this sense of being overwhelmed will pass. Also, I am enjoying the heightened sense of discovery, stumbling into the city of Meridian for the first time, having chats with other noobs as we form public groups and down elites.
The last time I was on, my mage was teamed with a warlock and a warrior, and we took on an elite without a healer. We gave it all we got, and then the warrior was down and the warlock was getting attacked. As the warlock fell, and the boss approached me with only 5% of its health left I kept spamming shadow bolts at it until it got to me. Just as it killed me I set off one more bolt that killed it. We closed the Rift, resurrected ourselves, collected the loot, and I felt the same level of thrill and achievement as when I first started playing WoW.
Every gamer was once a noob. Every gamer you see in your therapy practice was once thrown into a strange unfamiliar world knowing no one, with only the clothes on her or his back and a few silver in their satchel. Those men and women in your office who have been deemed failures at school or work by parents or coworkers has tried and failed and tried again hundreds of times. They have wandered around lost in a dangerous world knowing no one, and struck up conversations with other wanderers. They’ve banded together with others to defeat powerful adversaries, worked diligently to perfect professions and skills, and you’ve known nothing about it, because you didn’t ask. Instead therapists often focus on how many hours a person plays, pathologizes gaming as an addiction, or dismisses it as a silly hobby with no clinical or real-life value.
(How many of us approach our patients’ dreams that way? How many of us ask, “how many hours a night do you dream?” or consider them to have a dreaming addiction? When was the last time you dismissed dreaming as a valueless, silly hobby.)
Being a noob takes courage, and stamina. We therapists know this deep down. Most of us gravitated to our profession because we wanted to help the vulnerable, the bewildered and the confused grow into the strong, wise and whole people our patients become. We help them map out their inner world, strengthen their coping skills through trial and error and retrial. We encourage them as they level their professions at work or school, build guilds of peers and loved ones to raid life with, and face whatever monsters they have to to heal from trauma. Let’s recognize the game mechanics in what we do, and learn from the game mechanics in what they do.
Last but not least, let’s talk business.
In the 21st century, many therapists are seeing a game change in our profession. The way we practice therapy and help our patients is changing in many ways. We can use Google to help them find the closest AA meeting, Skype with them when they are away on business in Hong Kong, email them DBT worksheets or set up mindfulness reminders for our groups on Twitter. Even if we avoid using these technologies with our patients, they are trying to talk to us about bullying via Facebook, sexting on their iPhones, or falling in love in Second Life or World of Warcraft. In the 21st century, technology is no longer negotiable, it is embedded in virtually all treatment issues one way or another. And so therapists are noobs once more. This doesn’t mean that we can’t still practice psychotherapy the way we always have. But do you think that that should be our prime goal, to do things the way we always have?
When I first advertised on Google, I paid .10 a click. Nowadays colleagues in my area are paying upwards of 6$ a click to be visible. Having a Google ad or website is now pretty common. Between changes in social media and healthcare, many of my colleagues and the therapists I consult with are finding that the game has changed again, and they feel frustrated and bewildered like they haven’t in years. They’ve become noobs again.
Being a noob isn’t bad, although it can be uncomfortable. But what I’ve learned from fellow gamers is that being a noob can be fun as well. The key is to keep your sense of humor, and not take having to learn new things as an insult. I sometimes hear colleagues express outrage at having to do things differently to grow their business, and heaven forbid they spend money on coaching or business planning or consulting with someone who has more expertise than they do! The subtext is “How dare I be treated this way?!”
Change isn’t meant to single out and insult you, lighten up. Of course you should be learning new things, and leveling up. Have a little faith that you are learning even though it feels clumsy. We keep trying to get to this “secure” place where we’ll never need to stretch or do something different, and it just doesn’t exist. We need to cultivate what my colleague Chris Willard refers to in his book of the same title as our “Child’s Mind.”
In other words, we need to embrace being a noob.
Epic Mickey and Frittering
The last week I have had a blast playing Epic Mickey; two blasts actually. In the game you’re Mickey Mouse, and your primary tool is an enchanted paintbrush, which sprays two different substances with very different effects. The first is a magical blue paint, which can make invisible things real, and make an enemy in the game turn blue and become a friend. The second is a magical green paint thinner, which can make real things invisible, and thin an enemy into nothing.
There are good reasons to do both of these things, but the unnecessary obstacle in the game is that there is a limited amount of paint and thinner, and so if you use too much too quickly, you have to wait until a cooldown replenishes it, or until you find a power-up. Power-ups, in case you aren’t familiar, are items in the game you can come across that replenish your health, and in the case of Epic Mickey, your paint supply.
The game is a Wii game, and so the motion controller is how you aim the paintbrush to paint or thin. And when I started playing it quickly became apparent that I was going to have to get better at aiming if I wanted to accomplish anything before running out of paint/thinner.
Epic Mickey teaches therapists, gamers, and anyone else who wants to learn through video games some important lessons about living life and frittering away your resources. The game has very simple mechanics, but life often has more complicated ones. Fortunately, this video game can help serve as a meditation on mindfulness and achieving goals.
Lesson 1: Paint Vs. Thinner
When approaching a problem, relationship, or business, it isn’t always immediately apparent whether to add paint or thinner. Do we need to add more stuff or clear some off our plate? Will additional effort reveal opportunities that were invisible moments ago? Do we need to process more with our partner, or less? Perhaps we need to simplify, reduce or focus our practice niche? Maybe we need to remove an obstacle, rather than spray creativity all over the place. One of my favorite paint thinners in real life is Occam’s Razor, which has been often interpreted as “the simplest explanation is most likely the correct one.” Or to put it more like it was originally intended, we should try to avoid any unnecessary pluralities, and tend towards the simpler theories or applications. Sounds like thinner to me, who would have thought Mickey Mouse to be a Scholastic thinker?
And to make things more complicated, Epic Mickey shows us how if we can’t make up our minds we will go back and forth between paint and thinner, undoing anything we may have started and wasting time and effort. So whether we decide we need to add something or take something away, we need to commit to a course of action, or we’ll be confusing dithering with effort. In Epic Mickey so far, I have found that many problems can be solved in a variety of ways, some using paint, some using thinner. I suspect life is like that too.
Lesson 2: Keep an Eye on Your Power Reserves
In the game, you always have to keep an eye on your paint and thinner meters to make sure you pace yourself and don’t run out. They will replenish automatically over time, but slowly. In my business I can attest that this is also true. I usually have a couple of irons in the fire, but I have learned to pace myself. I remember a few years back I was seeing 25 patients a week, supervising three interns and therapists, teaching two classes, taking another, sitting on 2 commissions and trying to write. I had to learn the painful lesson that I was doing a subpar job of every one of these because I wasn’t prioritizing, and perhaps more importantly, I wasn’t allowing time for replenishing myself. Nowadays, I try to pace myself and make time to do fun stuff, like running at least once a week, playing some games, spending time with my family chilling or getting a massage, eat regularly and get enough sleep. Not only are these things rejuvenating, but if I can resist multitasking they block off time so I don’t get exhausted and put out subpar work.
Are you keeping an eye on your reserves? And more importantly, are you willing to give up a few things so that you can devote more time to living life and having fun so you have the energy to do others? I certainly didn’t want to give up any of the activities I was doing, I liked doing them all, just not all at once. Often I hear colleagues say “I just don’t have enough time to simplify and relax,” as if it is a luxury rather than a choice. Sure giving up a couple of things is going to discombobulate you, especially if you’ve learned to pride yourself on being busy. But you won’t run out of paint as often.
Lesson 3: Keep an Eye Out for Power-Ups
In Epic Mickey, time isn’t the only way to replenish, there are treasure chests with power-ups. When I recently defeated the Clock Tower Boss, the way I did it was to keep an eye out for power ups, and sometimes pass up what seemed a perfect shot to get a power-up. In the long run, keeping an eye out for the things that power you, your relationship or your work up will be worth foregoing the perfect shot. This is especially true in relationships: It can be very hard for us to resist zinging that perfect shot, but backing away and taking time to do something replenishing will usually make things turn out more harmoniously!
What are your Power-Ups? Is it a massage, a walk in a botanical garden, meditation, playing Super Mario or spending time with your kids? It’s your responsibility to figure out what these are, make a little time for them regularly, and do them even when you aren’t feeling totally depleted. Pay attention to what happens when you do certain things, eat a certain way, or take something else into your being. Do you double in size and power? Become able to hurl fireballs? Defeat previously impossible monsters? If so, chances are whatever you just took in is a power-up.
Lesson 4: Focus stops Frittering
Last, the more targeted you are in what you’re trying to do, the less wasted energy and resources you’ll have. In life, like in Epic Mickey, you often need to aim for something. Sure, sometimes random efforts yield surprising results. When it does, huzzah, but that’s no excuse for not trying to be focused. Mindfulness is in a large part about focusing your mind and body on something, letting distractions drift by. Use the Force Luke–if you don’t you will probably find yourself feeling depleted, frustrated, and confused as to why.
Yes, focusing means giving up on something else. Frittering means giving up on everything while deluding yourself you haven’t. Parents who become obsessed with quality time rather than choosing a game night are frittering. Saying you want a committed marriage while you’re out every night drinking beer with the buddies is frittering. Complaining about managed care and lower fees rather than marketing your business or helping a forward-thinking candidate is frittering. And there are a thousand other ways that all of us confuse dithering with effort. So pick something and try to focus on it single-mindedly. At least that’s what works for Epic Mickey, and can an 83 year-old mouse who can still defeat monsters and jump over chasms be all wrong? I think not.
Save and Continue
Recently I was playing God of War III, and noticing something I take for granted much of the time, the savepoint. This is something that has become so integrated into video games that gamers hardly notice it after we discover what the particular “savepoint” looks like in the game we are playing. The saved game has been around for decades, and has become increasingly important as games have grown in length and complexity. I was reminded recently by Nancy Rappaport, a colleague and attending psychiatrist at Cambridge Health Alliance about how the concept of the saved game may not be taken for granted. I was trying to explain to Nancy during a workshop certain gaming concepts, and she was explaining that her point of reference in playing video games was Pac-Man, and in a general sense video games from an arcade setting that early on didn’t always have savepoints, where the player was asked if they wanted to “Save and Continue.”
This may be useful to remember when you are becoming frustrated with a gamer who is not as concerned with the quantitative time (bedtime, for example) as they are with the qualitative time of getting to the savepoint. But that actually isn’t what this post is going to be about. Instead I want to return to the concept of what makes an Epic Therapist here:
Epic Therapists remember the importance of saving and continuing.
To start with, therapy is in many ways a savepoint. At certain times in their lives or week our patients arrive at our office, pause, and take stock of things. In his 1914 paper “Remembering, Repeating and Working-Through” Freud alludes to this when he remarks that “In these processes it particularly often happens that something is ‘remembered’ which could never have been forgotten because it was never at any time noticed–was never conscious.” Like the savepoint in a game, the patient arrives at the place for the first time, understands how important it is to hold on to that progress, and remembers or saves it from repression. But part of what makes therapy therapy is the therapeutic frame, and at some point the session ends, and the patient goes back out into the rest of their life. They can’t just stay at the savepoint, they have to continue.
Readers have probably noticed by now that I draw frequent parallels to psychoanalytic theory and video games, and this is no exception. Our profession has a rich theoretical history that has grown from individual therapists learning from each other, disagreeing with each other, building on the prior work of each other and diverging from each other. Psychology as a field to flourish has had to frequently “save and continue” by writing these theories down in journals and now blogs, to take stock of what we have learned, but we’ve also had to move forward and continue to challenge pre-existing models. It can never be just save or just continue: To just save would stagnate our thinking and practice, and to just continue would mean we never consider thoughtfully the work we are doing.
In many ways, the problem with healthcare has been few if any savepoints, discouraging providers from taking time between patients to reflect before continuing on to the next patient. Interns in mental health agencies have many no-shows, and with no infrastructure to hold patients responsible to keep their appointments, these interns “continue” through the years where they should be receiving the most training with a fluctuating and diminishing number of patients to practice their craft under supervision.
Ask yourself this: If you were about to have open heart surgery and the doctor told you that he had only had the opportunity in medical school to practice the procedure 3 times because most of his patients cancelled or no-showed, would you feel confident in their ability? And yet we crank our interns through graduate programs based on the number of years rather than skills acquired, because the healthcare system is flawed and and patients are not held accountable for missing/cancelling appointments. This isn’t the interns’ fault, they are trying to get through to their knowledge and experience “savepoint,” but graduate schools and placements inadvertently become the parent shutting off the light because its “bedtime,” and we are producing generation after generation of clinicians who have had inconsistent or insufficient practice. This is continue without the save.
On the other hand, let’s take a look at the radical save mentality that permeates our profession. There are certain parts of the way many of my colleagues practice psychotherapy which have become extremely fixed, and I too fall prey to this at times. The 45-50 hour, a certain therapeutic stance, and my favorite, shunning technology. They bar their adolescent patient’s cellphones at the door rather than exploring who is texting them, refuse to consider Skype as an option let alone suggest it to their patients.
I frequently get referrals emails from several listservs, looking for therapists in Seattle, London, or Singapore. I enjoy practicing in-person therapy immensely, but does it ever occur to these colleagues to consider beginning to practice online as well? Why refer a patient to someone in Taiwan based on location when you could have one of your colleagues whom you know and respect take the patient on? On occasion I reply to these referral requests asking if the patient would be interested in Skype, but for the most part I’ve become reluctant to do that because I am pretty sure it doesn’t go anywhere. In terms of technology these psychotherapists are often in a lock-down save mode, and I foresee that they will resist change as the world continues without them.
My friend and colleague Susan Giurleo and I often find these things frustrating, and I realized today one reason why we may have this in common. We both went to Connecticut College in the late 80s early 90s, between the college presidency of Oakes Ames and Claire Gaudiani. In fact our graduating class became known as “the folks who knew Oakes.” And during this time our college had a motto that was drilled into all of us: Tradition and Innovation. Everywhere we looked, in all the college information and stationary were those words, tradition and innovation. Save and continue.
I have definitely tried to live that in my profession and my life of the mind. I’m a psychodynamically oriented therapist who uses Twitter and plays video games. I teach my students about Freud and Facebook. And I think that perhaps the affinity I find in the fin de siecle of the 19th century is how its denizens struggled to save and continue, to embrace the advances of technology then as we do now in the 21st century. In a recent article at boston.com Chris Brogan alluded to this when he said, ““The excitement for me about [social media] is, it’s gone from ‘Gee whiz!’ to ‘Now what?’ ”
Technology is here to stay and embedded in our lives, and today, like after the Industrial Revolution, we must learn the “now what?” To do this we can’t just rush forward and forget everything we ever knew, but we can’t stay stuck in a mindset from the pre-IBM world. Web 2.0 has arrived, and we need both tradition and innovation if we want to progress.
We must save and continue.
Do Your Dailies
UVN4UFFHFPND
Epic Therapists do their dailies. And if you’re not a therapist, but a gamer or someone else who wants to have a better life, this post may be useful to you also.
At a recent workshop, I began by showing a slide with our “Epic Agenda.” And the first question I got from a therapist was a great one, one that staggered me:
“What does Epic mean?”
Gamers among you may be chuckling now, but try to answer that question, and try to remember back to a time when you didn’t know the difference between green and purple gear. Back then you didn’t know what Epic meant either. So let me offer us a working definition of Epic:
Epic means “the most super amazing over the top of all time.” An Epic Win would be the most super amazing over the top win of all time. An Epic Fail would be the most super amazing over the top fail of all time. Epic is big, Epic is superlative, the most super dooper in history.
We don’t talk about ourselves in epic language much. We tend to think of it as arrogant, unrealistic, and asking to be taken down a peg. The idea of being Epic anything makes us self-conscious, with a lower-case s. And yet, I think it is time we change that.
All over the world you people are being Epic. Right now in Japan, every one of those people is Epic. The people surviving a disaster of multiple phases and historic proportions are Epic. I doubt that any of my readers would argue that. Every person helping those survivors is Epic. Even as we speak the people of Japan are pulling off what will be seen in years to come as one of the biggest Epic Wins in their history. (By the way, if you want to support their Epic Win, go to the Red Cross and take 5 mins to donate. There’s also a great definition of psychosocial support there for you therapist types.)
But you don’t have to be at the epicenter of a disaster to be Epic. Gamers know that there are several ways to get that Epic gear. Sure, one of the ways to do that is to down that boss on heroic mode. But there is another way to get that gear and become Epic: Do your dailies.
Dailies, in WoW, are daily quests that you do to gain XP, gold, or points towards buying Epic gear. And it takes a long time to earn those points. But each day, the game server resets, and you get to run these daily quests again. One of the first things an experienced gamer will tell a “noob” who wants to get better gear is, “Do your dailies.”
Back to you therapists: Epic therapists do their dailies. The most successful therapists I know show up for those mundane tasks every day. They return phone calls every day, respond to emails every day, step back to consider the state of their practice every day. Epic therapists read about their craft regularly. Epic therapists learn about what their patients are talking about regularly. Epic therapists reach out and connect with their colleagues regularly, and Epic therapists take risks to make their business visible regularly.
Last Friday I met a dozen Epic therapists who came to my workshop. They spent time and money to learn about online gaming and gamers. I can’t tell you how moved I was to see these colleagues spend 3.5 hours with me learning how to better understand gamers. They were willing to step beyond the model of addiction and see gaming as a culture they needed to become more competent with. They decided not to dismiss video games as trivial or uninteresting and as a result will be able to meet their patients “where they’re at” more than ever. Less than 50 therapists across the world have ever spent 3.5 hours on a workshop to understand gaming, so these folks are truly Epic!
Am I suggesting you all enroll in my workshop to become Epic? Hardly. But I am suggesting that you do your dailies and when you’re feeling down about your practice, keep doing them. I have noticed that the people who tend to be naysayers in our profession tend to be people who don’t want to take risks or invest extra time on a daily basis. They are hoping for a quick fix or solution, one book or secret that will tell them how to succeed. I think there are a lot of books out there that may help, but I think the secret to becoming an Epic Therapist may just be to do your dailies.
And if you’re one of my gamer readers, this applies to you too. You can be Epic out of the game as well as in it. That same stamina it takes to do your Baradin Hold dailies can be applied to your life outside of Azeroth. Getting up a half hour earlier so that you can get to work without feeling anxious is doing your dailies. Doing every bit of your homework is doing your dailies. Listening to your parents and doing your chores are doing your dailies. Telling your partner that you love them is doing your dailies. Spending an hour in meditation, in therapy or at an AA meeting are examples of doing your dailies. Sometimes these dailies will seem easy and quick. Sometimes they will seem a grind. No matter.
Do your dailies.
UVN4UFFHFPND
The Lessons of Zelda
One of the most popular and longstanding game series in the Nintendo franchise is the Legend of Zelda series. The first game came out in 1986, and there have been 15 games to date. The games almost always revolve around the Hero Link and his attempts to rescue Princess Zelda and/or defeat the evil wizard Ganon. They are a combination of puzzle-solving, exploration and action fighting.
Nearly all of the games make use of the mechanic of transforming oneself or the world in order to win. Link must learn to use an Ocarina to change time in order to access all part of one game. He needs to transform himself into a wolf to complete another. One of the earliest games, and also my favorite, The Legenda of Zelda: A Link to The Past, established the concept of a parallel world that Link needs to shuttle back and forth between in order to ultimately defeat Ganon.
Another key to navigating the game is that the player needs to complete dungeons to get the reward of another item, which are necessary to move further into the game. Until you get the grappling hook, for example, you can’t swing across certain chasms to move on. Or if you don’t have the flaming arrows you can’t melt the ice block obstructing the passage to another dungeon.
Zelda is also famous for its concept of the Triforce, represented by three triangles connected to form a larger one. This force needs to be assembled from smaller parts in order to grant Link or Zelda extra super powers.
All of these elements are challenging yet soothingly familiar each iteration of the game. And all of these elements are useful examples of how therapists and gamers can communicate about strategies for handling real life challenges as well.
Lesson 1. You need to be able to shift between worlds to win in any of them.
People may take my posts, which are clearly pro-gamer, to indicate that I think that life in-game is more important or a replacement for the world outside of it. Nothing could be further from the truth. In fact, the recent research indicates that if you spend more than 3-4 hours a day playing video games, the positive effects of them begin to decline quickly. So this lesson is a good example to use with your gamer patients or friends about the necessity of not getting stuck in the gaming world to the detriment of the outside world. Ultimately that will ruin both worlds for you. If you stay home and don’t go to work you’ll lose your job and money and therefore access to playing.
On the other hand, if we can’t take a break from the outside world we will find that our functioning in it deteriorates as well. We need to be able to take a break on the most visceral level, its one of the reasons our eyes blink. In Ego Psychology this is referred to ARISE, or adaptive regression in service of the ego. Often when people are feeling stuck around a real life problem, playing video games can distract their conscious mind while their unconscious mind continues to work on it. AND the cognitive and emotional boost we get from gaming can actually refuel our brain’s ability to return to the world with renewed vigor. So with video games and real life, it is always both/and that brings success, not either or. With games though that axiom only works for sure for a limited, 3-4 hour period. More than that and all bets are off!
2. We need multiple tools to solve the problem.
Whether in Hyrule or Hoboken, there is no one instrument or approach that solves every problem. You can’t rely on your sword to swing across chasms, and you can’t rely on your intellect to lose 10 lbs. We need to encourage our patients to have as many tools in their toolbox as they can find and not rely on just one. And it is an interesting phenomenon that the acquisition of a tool or skill often brings access to new challenges for every problem it solves. And that’s a good thing! At SXSW this year Seth Priebatsch helped us wonder what education would look like if we unlocked achievements at varied paces rather than moved up grades homogenously (Answer: it would look a lot more fun, interesting and engaging than public education looks today.)
So whether you find yourself using your verbal sword to hack through relationships or your grappling hook to swing from person to person, take a look at all the items in your knapsack. Maybe a soothing ocarina might be a better choice than a flaming arrow when it comes to communicating with your employee. Maybe the opposite is necessary to melt through some rigid thinking. Isn’t it great that you can do both?
Lesson 3: It takes time, patience, and effort to assemble all the parts to succeed.
People often come to therapy looking for a quick fix. Insurance companies bank on this being a continuing trend with short-term therapy or medications. Those are often useful parts of the solution, but just that, parts. Whether you are trying to improve your life, build your practice, or heal a relationship, it is going to take a lot of time, patience and effort. And yes, it will often be redundant! In WoW we often talk about downing a boss using “rinse and repeat,” meaning that we learn the strategies we need, and then have to use them over and over and over to ultimately down the boss.
Rome wasn’t built in a day unless you’re playing Civilization III. It takes time to assemble the pieces of the most powerful parts of our lives. Therapists can remind gamers that they are good at this!! I can’t tell you how many times I have run the same dungeon in a Zelda to get the map to find the compass to find the boss to get the key to unlock the item to cross the obstacle to get the key to down the big boss. Gamers are no stranger to persistence when we’re engaged, and we’re not dissuaded from effort when we have some optimism, that’s how we roll. 🙂
So these are just some of the Lessons of Zelda, lessons that therapists and gamers alike can use to improve their coping and lives. Are there other lessons I’ve missed?
What I Learned at Pax East.
For those of you who aren’t in the know, Pax East is a 3 day event founded by Penny Arcade a great website for online comics and other fun stuff. Pax East takes place in Boston, and this is it’s 2nd year. It is a huge convention which had approximately 70,000 video, tabletop and PC gamers. Last year I went to Pax East because I had finally decided I needed to take gaming and gamer-affirmative therapy seriously as part of my growing practice. I had always thought video games were fun, but it was only over the past 10 years that I had come to see that they could be life-changing.
I had discovered firsthand how World of Warcraft, Mario, and Zelda had helped me recover from a terrible job loss and re-evaluate what I wanted my work and life to be like. I had met dozens of gamers in-game and out who were recovering from various life struggles through gaming. I met soldiers stationed in Iraq who were gaming to keep their morale up or stay in touch with their families. I met LGBT people who had come out and found community for the first time in a Warcraft guild. I met people who had fought off isolation in other countries by raiding with loved ones at home. Still more had survived a divorce, discovered a way to rebuild confidence when they’d lost the ability to walk, or taken the first steps to socializing when their autism had stigmatized them and all seemed lost.
I also began to meet a growing number of young men and women who were refusing to be labeled as addicted or abnormal by virtue of their gaming experience. And I began to wonder what it would be like if as a therapist I came out as a gamer and helped people begin to take video games seriously.
At the same time I began to realize that I needed to take my career more seriously, because I had decided to start a full-time private practice. I had had a part-time practice for over a decade, but it always felt like a hobby. And so when I began to float the idea to family and colleagues I was amazed by their response.
They took me seriously.
Anyone who has launched a business can probably identify to some extent. You spend a lot of time wishing, and then daring, and when you finally decide to tell others you find that they have a far easier time taking you seriously than you do yourself. It was as if the company I’d helped built, my education and my CV were all fluff in my head.
If I had a hard time imagining myself as a independent businessman and a full-time private practice therapist, you can imagine how hard it was to imagine being a successful therapist who specialized in video games, virtual worlds and social media. Sure I could justify playing video games with children I worked with, but a gamer-affirmative therapist? This was a harder row to hoe. I had people thinking I meant online gambling and referred gamblers to me. I had colleagues who pretended Facebook didn’t exist and glazed over when I told them about the social media company I had helped develop. And most often I had this response.
“Oh, I don’t know anything about video games.”
This from colleagues who were throwing out the term gaming addiction willy-nilly. So I knew that I had a couple of choices, keep quiet or begin working with gamers and educating psychotherapists about what video games actually are, and what they can do for us. And I decided that if I was to really try to educate people on video games and doing therapy with gamers, I’d have to take myself seriously. And that is where Pax East and Blizzcon came in.
Where better to meet gamers than in those places? And what better form of continuing education for me than to see what is happening in the gaming world? This was part of the work I wanted to do, and the only thing holding me back from engaging in it seriously was that I felt guilty for having fun. From graduate school and continuing education I had learned that education was serious and not necessarily fun. But when I took the plunge I found that the money I spent on travel and the conferences was totally worthwhile, and the people I met were really interested in my work. This is something my colleague Susan Giurleo wrote about recently regarding another such convention that she is going to, SXSW.
I’ve learned a lot in the past two years. Last year at Pax East I didn’t have nearly as much fun as I did this year, because I felt like I needed to be there every minute and take everything seriously. This year I went Friday and picked a few things I wanted to do, like attend Jane McGonigal‘s keynote speech. And I took fun more seriously and learned more. I got a sneak peek and play of the Nintendo 3DS. I got to watch the amazing new XBox Kinect game Child of Eden. I walked around all day with a Plants Vs. Zombies traffic cone on my head. I participated in the largest massively multiplayer thumb-wrestling match in world history! And all around me I saw happy and energized people playing and socializing with strangers.
I was reminded of the things I tell my supervisees all the time, that if you aren’t enjoying yourself in your work something is wrong. Because enjoying yourself helps you achieve a state of believing that success is possible. And that the people who settle for less in their work get less. Such optimism is crucial, because running your own business takes a lot of time and effort. I have never worked as hard at a job in my life, and I have never loved what I do as much as I do now.
The Gamification of Psychotherapy
In the 19th century Sigmund Freud revolutionized the fields of neurology and psychiatry. Whether you agree or disagree with the particulars, psychoanalytic theory, and the psychodynamic theories that sprang from it changed the way we understand the human mind. Freud pioneered our understanding of the psychosomatic illness, conflicts, drives and the unconscious, to name but a few of the ideas that still influence theory and practice of psychotherapy today.
The way Freud came to understand and then attempt to help us understand these ideas was by applying other theoretical models to our psychology. The industrial revolution, with its steam-powered hydraulics and locomotives powered by internal pressure, heavily influenced his beginning work of trauma affect and drive theories. His famous topographic model of the psyche, with its strata of conscious, preconscious and Unconscious, was inspired by the advances in geology and archaeology of his day. In short, the technological advances of his time informed and shaped the way he thought about and worked with people.
Now we are in the 21st century, which is new enough that saying it still fills us with amazement. The revolutions in technology continue, and I want to begin applying some of these technological advances to my theory and practice. I have blogged a lot about games, and today I want to discuss the application of game theory in understanding the human psychology.
Gamification is the act of using the elements of game design and applying it to other parts of human existence. We have seen gamification begin to be used in businesses like IBM and written about in the Harvard Business Review. MacDonald’s has been using gamification with its’ Monopoly game for years. The Army has been using viedo game technology to gamify our defenses. Socially Serious Games like Against All Odds are being used to educate people about human rights and global conflict. So can gamification be applied to psychotherapy?
I think so.
In her new (and excellent!) book Reality Is Broken, Jane MacGonigal reminds us of the concise yet brilliant description of what a game is according to Bernard Suits. Suits states that “playing a game is the voluntary attempt to overcome unnecessary obstacles” in his book The Grasshopper. An example of would be chess where we agree to use the playing pieces on the board, the unnecessary obstacle is that each type of piece can only move a certain prescribed way, and we attempt to overcome this in order to capture the king of our opponent.
One example of gamifying psychotherapy is if we posit something similar: Psychotherapy is the voluntary attempt to overcome unnecessary obstacles.
Psychotherapy must be voluntary to be successful. If the patient refuses to engage in the process either by physically or mentally absenting himself, therapy will not happen. Yet even people mandated to treatment can benefit from it if they agree subconsciously to engage with us. Adolescents who are dragged to treatment will sit with us in stony silence week after week because they are not there voluntarily. Sometimes we can get a part of them to come out and “play,” i.e. engage with us. And if we don’t want to work with the patient for some reason, it makes treatment next to impossible.
Patients come to us because they are attempting to overcome something. They don’t just drop in because they wanted to read the magazines in the waiting room. Something in their life has caused them pain, sadness, anger, discomfort and they want that to stop. They may have noticed a pattern of bad relationships, they may be having traumatic flashbacks, they may be encopretic. But something in their life outside the therapy office has seemed insurmountable, and they want our help in overcoming it.
Which brings us to the unneccessary obstacle. I would suggest that in many cases the symptom is the unnecessary obstacle. Whatever the behavior might have been in the past it is no longer necessary now. As a child, hiding their body or mind may have been necessary to keep themselves safe from an abusive parent or sibling. As an adult, their tendency to dissociate in meetings and avoid success at work is an unnecessary obstacle. As a teen a patient may try to control an out of control environment in order to feel a sense of self. As an adult they may seek to control their bodies through disordered eating or self-injury for much the same reason. The challenge here is that the patient continues to go through life unconscious of this and acting as if the obstacle was necessary. In a sense they are playing out (albeit very seriously and sometimes fatally) something outside of the playground.
Huizinga referred to the “magic circle” of play, within which the game unfolds. Therapy, with its 45-50 minute hour, office setting and professional boundaries, is such a magic circle. If you don’t take the idea of play seriously, you will probably find this analogy offensive. But in my opinion play is very serious. In psychotherapy, patient and therapist become earnestly engaged in the immediacy of what happens. People become ghosts of other people, monsters appear, and ancient kingdoms rise up from beneath the waves for a day. I believe that most people who have been in treatment will be able to recall the immersive and powerful experiences they have had there, experiences which have felt tragic and heroic. Hopefully the patient leaves the magic circle having changed, the unnecessary obstacle is overcome, and life gets better.
We live, as Freud did, at the threshold between two centuries. We live, as Freud did, in a world story frequently punctuated by war. I imagine that back then things felt as difficult, healing seemed as urgent as it does today. People came to Freud then, and us now, to help them overcome unnecessary obstacles that were ruining their lives. Freud benefited from applying the diverse technologies of hydraulics, geology and archaeology to understand the human condition; and I believe that we can benefit from applying ludology and game theory to the serious business of therapy. Gamification will not be used to “lighten up” treatment but rather deepen it. Patients who play video games may respond better to leveling up than treatment planning, power-ups as opposed to coping strategies. Virtual worlds may serve as practice for real ones, just as therapy has served as practice for other relationships.
Freud was an Epic Therapist. He researched and synthesized what was going on in the art and science of his day in order to do better treatment. Today’s Epic Therapists will need to do the same, and that means having the courage to play with technology, games and ideas. Our resistance to doing so is an unnecessary obstacle we need to overcome, and our success in achieving this will be an Epic Win for our patients and our profession.
(Un)Desperate Times, or Know Your Talent Trees
Recently I was given a referral for an evaluation, and upon some reflection I declined it. This is not something I am often in the habit of doing, but in this case the evaluation would have involved a clinical situation that did not fit with my integrity. So it got me thinking about the relationship between building your business and professional integrity.
The referral would definitely have been lucrative, and within my scope of experience and skill. And most of us these days certainly cannot afford to turn away business.
Or can we?
If I had taken this evaluation on, I would have most likely have been called on to testify about something that I was not entirely behind. This would have compromised my ability to be an expert witness. As I weighed the pros and cons I was quickly aware of my feeling of “halfheartedness” about the whole thing. And that was what clinched it for me. No patient deserves anything less than a wholehearted therapist as far as I am concerned. And I believe that when we catch ourselves trying to make something “fit” with our practice, we should probably stop right there.
Most of us were trained in clinics or hospital settings where we did not choose our patients. We were there to help everyone, and the idea of a good clinical fit was something we were usually reluctant to give voice to. Social workers in particular are often encouraged to be little mental health Statues of Liberty, treating any of the huddled masses that get sent our way. But no one of us is supposed to treat everyone in my opinion. And believe it or not, there are therapists who want to work with every segment of the population. I have met therapists who love working with borderline personality disorder. Others feel invigorated by working with substance abusers. There are people who really enjoy working with schizophrenia, like me. So in the long run, I think it is important to notice who you like working with, especially if you want to be in private practice.
Being clear on this is hard enough when we are starting or growing our practice. Turning down a referral can be terrifying and guilt-inducing. Somebody needs our help, we need to earn money, and we’re going to decline a referral? Sometimes, yes. Sometimes we need to hold a space open in our practice for a bit. And always the patient deserves a therapist who is 100% committed to the therapeutic relationship. So if we are lucky and have a good coach or supervisor we brave our fears and hold open the space for a while.
But later on in the development of a private practice, you may encounter a slightly different issue, what can be called an “embarrassment of riches.” The phone starts ringing with calls from potential patients, requests for court or special education evaluations, or maybe your old employer wants you to come back and do a workshop for your old agency. It can be tempting to overextend yourself, but I would suggest the following when this happens: Don’t just do something, sit there. Give yourself time to evaluate whether this opportunity is the best opportunity for you after the initial shine or honor of being asked has worn off a little. Because only you know your business plan, and which of the opportunities presenting themselves to you is the best one for furthering your practice.
The picture at the beginning of the blog is what World of Warcraft veterans will recognize as a talent tree. Each character class has three talent trees they can choose from to put their talent points into. The more talents points you put into one tree, the more access you have to higher powers and abilities of a certain kind. At the same time, since you have a finite amount of talent points, putting talent points deep into one tree makes it impossible to put them deep into another. So for example, if I am a mage, I can choose to put my talents in Fire, Frost, or Arcane trees. If I put most of them in fire, I won’t be as powerful when I need to use frost spells.
Sometimes newbie gamers decide to spread their talents across all three trees. They divide up the points and suddenly notice that they are at a high level but aren’t doing that well in the game. At some point someone will notice their talent trees are a mess, and explain to them the importance of specifying their talents. Sometimes therapists do the same thing: We try to be everything to everyone and learn to do a little of this and a little of that. This is often where the diabolical word “eclectic” comes up. We’re not frost mages OR fire mages, instead we’re hurling bolts of lukewarm water, and who needs that really?
If you have been building your practice for a while, you have probably noticed that your phone is starting to ring more, or your website is getting more hits, and this can be so exciting and intoxicating you’ll lose sight of your business plan. This week I had a day like that, where I got 2 referrals for psychotherapy, an extended evaluation, and invited to teach 2 classes! You bet that feels good (and overwhelming!)
But I needed to spend my talent points wisely. If I load up on patients, I won’t have time to do my writing or workshops and ultimately develop passive revenue streams. What’s worse, the patients will get an overworked overtired therapist who is not wholehearted. If I teach two classes, I won’t have enough time to do something else, and if I take on an eval that has me interviewing, writing and expert witnessing, same thing. Time to refer back to my Tweaking 2011 plan. So everything went on hold for a day (remember, we’re running a private practice, not an ER: If something seems so emergent that it can’t wait a day, it may not be something to take on) and I ended up declining half of the embarrassment of riches, offered alternate referrals, and hopefully everyone will be the better for it.
Have you started to specify your talents yet? Have you chosen the talent tree you’ll put the majority of your points in? The secondary one that enhances the first? Does what type of work you accept clearly map to the business plan you’ve made for yourself? I’ve written before about being an Epic Therapist and this is one of the qualities that makes a therapist Epic: Epic therapists specify and hone their talents in one main area. And because they do that they can explain what kind of therapist they are at parties. And they can do solid work and reading in their area so the patient gets excellence. Excellence is what will keep your business afloat in the coming years, so spend your time and talents wisely!
Real Life, Ego Defenses & You
Anna Freud, Sigmund Freud’s daughter, greatly expanded on her father’s theories of psychoanalysis. Perhaps one of the most memorable ways she did this was in her exploration and cataloging of the ego’s defenses. In her work “The Ego and the Mechanisms of Defense” in 1937, Anna laid the groundwork for understanding the ways we cope with internal conflicts between the way things are and the way we wish they could be. She initially came up with nine general categories, which I reproduce here from a great resource on www.changingminds.org :
- Denial: claiming/believing that what is true to be actually false.
- Displacement: redirecting emotions to a substitute target.
- Intellectualization: taking an objective viewpoint.
- Projection: attributing uncomfortable feelings to others.
- Rationalization: creating false but credible justifications.
- Reaction Formation: overacting in the opposite way to the fear.
- Regression: going back to acting as a child.
- Repression: pushing uncomfortable thoughts into the subconscious.
- Sublimation: redirecting ‘wrong’ urges into socially acceptable actions.
Ego defenses are numerous, and range from the most primitive (repression) to the most evolved (sublimation.) When I say primitive, I want to convey that they are the earliest we acquire developmentally, not the least useful or most pathological. And it is important to remember that all defenses are useful, and that the ego is using the best resources it has to cope with any given problem. Later thinkers would begin to specify and amend this list, but it was the first attempt to explain how the ego helps the human mind make the unbearable bearable.
When I assess patients who play video games, I am always very interested in which spells or actions they employ when they game. The reason I am so interested is because many of these spells and actions are directly parallel to certain ego defenses. If a warlock uses Fear a lot, I may wonder if they are inclined toward projecting their anxiety onto others, as a result of a world view that sees others as more powerful and scary than they are.
I also like to explain to patients the way they seem to be using their ego defenses in terms of these spells or abilities. For example, if someone always wants another member of the therapy group to go first in checking in, I may explain this displacement in terms of the Hunter’s ability Misdirection. Often gamers can understand the ego depenses exceptionally well, because these defenses are clearly illustrated in the way they play the game. Therapists working with gamers would do well to ask their patients what their class is (Warlock, Hunter) and then the spells or abilities they enjoy or use the most. Likewise, shifts in using different spell rotations or changing class can often indicate large shifts in the ego and character development of the patient.
And now a word about real life.
Real Life, is a concept used by both gamers and therapists. Gamers talk about how they can’t raid because they have a “RL obligation.” Therapists talk about a patient’s reality testing, and their ability to participate in real life. Real life is a useful concept, and like many useful concepts it is often misused.
I often hear therapists describe gamers as people who are trying to avoid “real life” by using games. The implicit judgement in this statement is that games are not a part of reality, and therefore are less than. But this seems like a false dichotomy to me, in many ways similar to the way therapists often talk about how therapy is not real life. Of course it is! Therapy has distinct rules and boundaries, and it is a rarified form of relationship, but it is not of a different substance than that of “real life.” If it were truly a different thing, it is unlikely that patients would gain anything useful from it.
By the same token, games are part of real life. World of Warcraft is inherently social, there are over 12 million real people playing it all over the world. Gamers deploy real skills to solve real problems and their neurological responses to an “Epic Win” or “Fail” are real physiological responses. This is not to say that the gaming part of a patient’s real life can’t get out of balance with other parts. But it is not a given, and it is not different from the way others use their ego defenses. We all use repression and sublimation to cope with the conflicts and anxiety that occur in daily life. I recall a clinical professor of mine who sublimated her murderous impulses by reading murder mysteries. Hurling fireballs in WoW is an excellent way to prevent oneself from hurling objects or insults in real life. The defenses are there for a reason, and they are not inherently bad.
If you are a therapist and you are seeing your patient who games as someone who is not paying attention to their “real life,” ask yourself if you are not perhaps projecting. Many therapists have a great deal of difficulty finding balance in their own lives. They may find it easier to say that a gamer needs to “get a life,” than to realize that they are projecting their own feelings of disregard for themselves onto gamers. By this I mean that therapists often overvalue the work they do in proportion to their family, friends, and other areas of their lives. For example therapists often will see too many patients at a sliding scale fee while their children are impacted by their lower income: They overvalue their therapist role and their parental role suffers. Other therapists may have a difficult time making time for friends or having conversations that go beyond 45 minutes, they may listen but not share of themselves. And still other therapists may neglect exercise and meditation because they don’t have the time, but overbook their work schedules.
Before we can help gamers appreciate the need for balance in their lives, we need to empathize with what they are doing. They are relying on the areas of strength they have in themselves when they game, and are reluctant to go to the areas that need development. We therapists do that too, if you don’t believe me just ask your spouse or child if they ever feel like you are using your therapeutic abilities on them!
Let’s be careful if we have to use the idea of “real life” at all. It is often a veiled judgment, and veiled judgments are often projections. Let’s go with Wittgenstein here, who began his Tractatus Philosophicus by stating “The world is everything that is the case.” Privileging some aspects of life over others is often the first step towards the oppression of others, be it race, gender, orientation, class, or I would suggest, gaming. It certainly won’t help our patients get any better.
And it may just make our own lives worse.
Some Beginning Games for Therapists to Try
This Video Blog was inspired by friend Carolyn Stack, who asked that I recommend a iPhone game to ease her into the world of iPhone gaming. Here are a few of my favorites and why you might want to try them:
Virtual Worlds, Real Feelings
When psychotherapists begin working with gamers and exploring their in-world experience, it can be a bit overwhelming. So much new language, trying to imagine virtual worlds that you’ve never seen. What’s a raid? Why would someone go on quests? And aren’t guilds something that artisans used in the Middle Ages to control the market? I’ve often encouraged therapists to take the time to use the free trial membership on WoW or other games in order to immerse yourself in the virtual world (and hopefully have fun!) for a little while.
But one thing that can get overlooked in the exploration of the technology is the exploration of feelings, and one reason that this gets overlooked is because therapists inadvertently trivialize the experience of feelings experienced in-game or in social media.
Let me give you a real-life, non-game example to start. I went to Connecticut College with my friend and colleague Susan Giurleo (she’d never say this, but Susan was definitely the more organized one in college 🙂 ) and we went on to live the next two decades with no real contact. And then Twitter stepped in, and we resumed contact. When I read her blogs and posts I was happy to discover that we had a lot of similar and overlapping interests. We made a time to meet for coffee via email, and I was excited and nervous to see her for the first time in a long while. Those feelings, of happiness, discovery, excitement and nervousness were all real feelings happening in real time to a real person via a virtual world. We’d reunited virtually and this has had a real and positive emotional impact on me.
You may still be inclined to dismiss the emotional impact of virtual worlds. “Sure, Mike, you had real feelings, but Susan was a real person that you have had real face-to-face contact with in the past.” So let me give you another example. I recently had the opportunity to email Chris Brogan, and in the course of that mentioned my knowing Susan. Shortly after that I “heard” them talking about me on Twitter:
from @susangiurleo @chrisbrogan So glad you met my friend, @MikeLICSW ! RT Gamers meet therapy – http://ow.ly/3DT0A
@ chrisbrogan @susangiurleo – yep, loved what he shared. That @MikeLICSW is a nice fellow.
Two lines of Twitter, and as I read them I noticed myself smiling, well actually beaming. That’s real pleasure I was feeling, from feeling recognized and introduced. And I’ve never laid eyes on Chris in the virtual world.
So virtual worlds create real feelings, and we need to remember that when working with gamers.
I’ve written before about the face behind the screen but it bears repeating. Gamers are people, and they have feelings. Even if the stereotypes were true (and they’re not) that gamers are autistic, people on the spectrum have feelings too. Gamers get excited when they down a boss, upset when someone says something racist in guild chat, and happy when someone whispers them that they did a good job or tells them a joke. There is a world of real feelings in those virtual worlds, and we need to pay attention to them.
So do you ask adolescents about their facebook friends as well as their classmates? Do you ask gamers about how they get along with their guildmates as well as their roomates or partners? Do you explore their relationship to their raid leaders as well as their parents and other authority figures? If not, you are missing a whole lot of significant information, and it is only an ask away. Gamers may be reluctant to talk about their in-world feelings and relationships because of past disinterested receptions, but don’t imagine they don’t have them.
The next time you are checking out Facebook and see an old friend, or read a political post, notice if you are feeling happiness, excitement or anger.
The ask yourself, can I tell the difference between this and a “real” feeling.
Latest Newsletter is Out!
Some of you have expressed interest in what my monthly newsletter for colleagues is like. So below is a link to the January one. The program I use is Constant Contact. I really enjoyed putting this one together, a combination of health reform, business and gaming stuff. Feel free to subscribe while you’re there. 🙂
Tweaking 2011
This is my first blog entry on Evernote. I’m excited about that because learning and trying out Evernote is one of my 2011 goals. More about that in a sec.
One of the reasons I love supervising therapists is that it keeps me honest and focussed on innovation. The other night I was talking with a supervisee about scheduling our time for the upcoming year. Would an evening time on another day work better for me? (Quite a thoughtful supervisee, not an uncommon experience given our field.) I found myself answering that I wasn’t sure yet, because I needed to re-evaluate my evening time. I have been noticing a drop-off in my work with adolescents, and have been coming to the conclusion that if I want to keep working with adolescents I’ll need to give up some of my evening time.
This time of year is an excellent time of year to give your practice and your career the lookover. In the past several years I have gravitated to more traditional hours so I could pursue other projects. For example, my professional development and networking goals for the past year and a half have been fulfilled by my Fellowship appointment at the Massachusetts Institute for Psychoanalysis. In 2009 I identified the need for more collegial contacts and friendships as well as wanting to have CEs for my license. The Fellowship has provided me both in abundance. Like many of my actions to meet my goal, the MIP Fellowship was a “twofer.”
I always try to have as many twofers or threefers as possible, so that I don’t overwhelm myself with actions to meet the multiple goals. Twofers are important to me because I want to consolidate my actions, but not my goals. So I list my current goals and then put the actions under the goal(s) it fulfills. I also rate it hot or backburner. That way if I have a few actions I make myself evaluate the relative strength of my interest to do each. So follow me along for an example:
Professional Development Goal
- MIP Fellowship- heading towards backburner. This is my last year of it, and I’m ready to move on to a different structure and get my Monday night back.
- Program Exploration – hot. I need to begin planning on what I will do to replace the Fellowship, which means taking a look at workshop or mini-course offerings or webinars that happen during the day. Am I willing to give up my weekends yet? Traditionally I have balked at Saturday workshops, so I am revisiting this.
- Continuing Ed on cultural competency working with transgender population- hot. My practice has been trending towards an increase working with this population, so I need to invest time in updating my skills in theory and best practices.
Clinical Therapy Goal
- Adolescents- hot. I have noticed that I am trending downward in my work with adolescents, a population I love. Most adolescents require parental transportation and can’t miss school regularly, so I need to revisit my giving an evening up. Saturdays? No. (This is an excellent example by the way, of how there is no one right answer for this. My colleague Susan Giurleo regularly works an evening and Saturday, and there are lots of good reasons for doing this. I have consciously chosen the last 2 years to not have an evening because the evening time was more valuable to me than the money I was choosing not to make. Choosing not to make money is different than saying, “why can’t I fill my practice, whoa is me.” Money is one item of value, time is another, it is up to you to choose what you want to give up.
- Gamers- hot. I want to continue to focus on working with more gamers. I need to revisit where and how to get referrals. This year I will try to offer more public speaking opportunities to colleagues to increase awareness of gamer-affirmative therapy. Also will use Twitter to remind my followers of my interest in working with this population.
- Couples work- backburner. Even on my best day, this is not my preferred modality. I will maintain my “no more than 3” couple limit, but am tweaking it to focus on private pay, gamer couples or online therapy.
Technology Goal
- Twitter-hot. I continue to find Twitter useful, but am tweaking it a lot. I will use it to Tweet blog articles or RTs and hold to my goal of 2RTs and 2 salient tweets (i.e., tweeting something I think is relevant professionally rather than for the sake of Tweeting. Recently I have fallen short of this goal because of the magnitude of tweets that come my way. Will add this to my Epic Win program and scale back on how much time I spend reviewing. Will keep an eye out for Tweet-management software to see if I find any I like more than TwInbox.
- Evernote- hot. I have heard about how great Evernote is for too long from too many people I respect to ignore it. I will familiarize myself with this program and try using it for blogging, as well as exploring which other goals it might further.
- Game exploration-hot. I have been focussing on WoW and Second Life.
- Rockmelt-backburner. Still in beta and having some bugs. Still limiting access so limited as social media. Shut down and I lost a whole blog post! I am continuing to play with it a little but relying on Firefox until it gets a little more stable.
Social Justice Goal
- Give an Hour-hot. I still find this a meaningful way of donating clinical time to fulfill the gap for returning vets. There is an increasing number of vets and active duty gaming, and this is a potential twofer with the Clinical goal.
- Diversity Class- hot. I continue to find teaching this worth the “pay cut” I take by giving up those clinical hours. This is a twofer a teaching goal and writing goal on rethinking how we teach Diversity.
- Masshealth-backburner. I am opting out of taking Masshealth due to the high cancel rate I’ve experienced in the past. This is a twofer with my business Goal below of decreasing my involvement with insurance and diversifying revenue.
Business Goal
- Reduce dependence on insurance-hot. The writing is on the wall for decreased revenue and increased hassle as Health Care Reform takes effect. Leave Masshealth and UBH networks.
- Increase online therapy-hot. I need to focus on increasing marketing for this modality, it is all private pay and more flexible in time to meet patients and my needs.
- Increase consultation and supervision-hot. Supervision and consultation was the biggest growing area of my practice last year. Need to poll current consultees about what they find most valuable so I can emphasize that. Be willing to slide down to my bottom line to attract supervisees in early stage of their career. Make and post more video on supervision and consultancy.
- Advertising-backburner. Google Ads not yielding much ROI, decrease ad bids. Stay on Psychology Today for next year but focus marketing/advertising through speaking engagements.
Teaching Goal
- Additional psychodynamic class-hot. New syllabus written and course approved. Hopefully this will be offered this summer, will apply to teach it.
- One class per semester-hot. This tweak from two classes one semester and one the next was a big improvement. Evaluations better, enjoyed work more. Will consider whether to make up third class by committing to summer course regularly.
- Offer visiting lecture or workshops to universities-hot. This year I want to get out to more college health centers and schools for social work to present on gaming. Tufts very successful, will look for opportunities to present at other universities. Put the word out, twofer with business and professional development goals.
Writing and Research Goal
- Newsletter-hot. The readership response has been positive and begun to generate revenue. Need to stay focussed on keeping newsletter relevant and yet distinct to my niche. Review of clicks indicates that the psychoanalytic topics are more popular than the gaming ones. How can I increase traffic to those stories?
- Blog-hot. Now have over 100 readers subscribed, and growing. Need to continue to make this a focus. 2-3 posts weekly remains doable and will maintain 2 minimum. Again, the practice/business posts are more popular than the gaming ones, need to consider how to increase interest in those articles. This is a threefer with business and clinical goals.
- Journal article-backburner. The style and tone of blogging is much more satisfying currently, will revisit later in the year to see if this changes.
So that’s my beginning of 2011 review and tweak. It took me 40 minutes to think and write about this. Don’t you think it would be worth 40 minutes of your time to do the same? What are your goals for this year, feel free to use the blog comment to get started!
2010 in review: Some Statistics and Most-Read Posts
The stats helper monkeys at WordPress.com mulled over how this blog did in 2010, and here’s a high level summary of its overall blog health:
The Blog-Health-o-Meter™ reads Wow.
Crunchy numbers
A Boeing 747-400 passenger jet can hold 416 passengers. This blog was viewed about 6,600 times in 2010. That’s about 16 full 747s.
In 2010, there were 35 new posts, growing the total archive of this blog to 47 posts. There were 69 pictures uploaded, taking up a total of 470mb. That’s about 1 pictures per week.
The busiest day of the year was November 5th with 216 views. The most popular post that day was Showing Up for No Shows.
Where did they come from?
The top referring sites in 2010 were linkedin.com, twitter.com, facebook.com, mail.yahoo.com, and mail.live.com.
Some visitors came searching, mostly for venn diagram 2 circles, venn diagrams, venn diagram circles, venn diagrams for kids, and blank venn diagram 2 circles.
Attractions in 2010
These are the posts and pages that got the most views in 2010.
Showing Up for No Shows November 2010
14 comments
Want a Private Practice in the 21st Century? Get a Thick Skin. November 2010
12 comments
The Truth? You Can Handle The Truth. October 2010
10 comments
Referrals, or, Flossing the Gift Horse October 2010
13 comments
About Me July 2010
Understanding Clients’ Involvement with Role-Playing Games
Today’s blog is a twofer, in a couple of ways. I wanted to be able to discuss what playing online games like World of Warcraft might mean to patients, and how to approach them clinically. And I wanted to take the day off.
So I am attaching a two-part article that appeared in the MA NASW Focus Newsletter this September and October. It is co-written by my colleague Bet MacArthur and myself. Bet is a very interesting and dynamic clinician, and you can find out more about her here. Special Thanks to Carol Trust and MA NASW for allowing the reprint and making it available to clinicians outside of the Massachusetts area! Check out the NASW MA website, even if you can’t go in the Members Only Section there is a lot of good stuff to peruse.
I hope you find these articles helpful, and let me know if you have any questions or thoughts on them.
The Face Behind the Screen
This past weekend at Blizzcon I met several interesting people. And I was reminded yet again how every gamer has a story, a very human story.
The first person I met while socializing in the ½ mile line of people waiting to get in was Luke (all names have been disguised.) Luke was a gay man who had begun playing World of Warcraft with his then partner and friends about 2 years ago. In the course of the past two years, Luke and his partner had tried unsuccessfully to adopt a child, which he believes was thwarted by a judge who did not think gay couples should marry. He and his partner saw the legalization of gay marriage and its overturn in his state, CA. His partner had lost his job, and their relationship subsequently deteriorated, ending in divorce. Throughout all of this Luke was able to stay connected and supported by his friends and other members of his guild. He attributes his ability to move on and be ready for the next phase of his life through the enjoyment of WoW and his guildies.
A second man credited WoW with saving his life. Sam was working abroad in Qatar in the Middle East. He told me how he had fallen into a profound loneliness and depression shortly after moving out of the country. His work began to suffer, and he had a hard time dealing with the isolation. All his friends were back in the US, and he had a hard time being in touch with them. He had seriously begun contemplating suicide. Then he remembered that his friends had been pestering him to try this game, World of Warcraft. He had nothing to lose, so he loaded the game onto his computer. He found the game very compelling, and was even happier to discover that he could log on to the same server as his friends at home. They were able to raid and talk together for the next 9 months he was living in the Middle East, and isolation and suicidality became a thing of the past.
I also met Matt, a young man in the elevator, wearing his gaming regalia. “How are you enjoying the convention?” I asked him. He looked glumly at me and pointed to his badge which said “TEAM 127” on it. “I came in 5th,” he said. “Congratulations,” I said, adding, 5th place isn’t bad.
“5th place you only win $1000,” he said, “1st is $25000.” Turns out that he had been flown across the country to participate in the WoW tournament. So much for gamers as slackers who have no ambition or work ethic.
I wish my colleagues could meet the thousands of people like Luke and Sam who made the trip to Anaheim for Blizzcon. They would see some very resilient people who were dealing with some pretty big life problems. These weren’t people who checked out of reality, instead they leaned on the virtual world and the human relatedness they found through it. I was struck by how affable and engaging everyone I met was. They were so happy to be in a place where they could engage with others around the games they enjoyed. The stereotypical lack of social skills people associate with gamers was not what I saw. I saw people willing to strike up a conversation with me as we waited in line. I saw fathers and their adolescent sons and daughters spending quality together. I saw couples of every configuration and entire families, all spending time together, not avoiding human contact.
I hope you’ll keep these stories in mind the next time you hear someone making fun of a gamer, or criticizing online gaming. Each gamer has a story, just like each of our patients do. And each story deserves our respect.