“Can I Kill You Again Today?”: The Psychoanalysis of Player Modes


In 1947, Virginia Axline published the first edition of what  was to become a seminal work in the field it was named for, Play Therapy.  In her book she championed the concept of non-directive play, the form of play therapy where the therapist takes in some ways a very Rogerian approach of reflecting rather than directing the play either overtly or subtly.

This is easier said than done, as I learned when I started using it as an intern.  I recall watching a youngster play and describe a family in a horrible car accident.  My first comment was, “are they all right?” covertly signalling to the child that I was anxious in the presence of such violence and the possibility of death.  The child reassured me that the family was okay, and I am convinced that I had essentially ruined that session’s treatment.  Fortunately I was lucky to have an amazing supervisor, Linda Storey (great name for a therapist too!) who helped me to learn how to truly be non-directive.  Over the next year and since I have greeted tornadoes, murder, floods, monster attacks, plane crashes, burning buildings and other disasters with “what happens next?”

Non-directive play therapy is still at it’s heart a two-part invention between the therapist and the patient.  However, unlike some other forms of treatment, it requires the therapist to be able to tolerate a lot of violence and anxiety.  Trying to direct children away from their aggressive fantasies and desires is often rooted in the therapist’s own anxiety about them.  Let’s face it, for many of us death and destruction are scary things.  It isn’t just a rookie mistake to ask the child to make the story turn out “okay,” and yet I think it has never been more urgent for therapists to be able to tolerate violent fantasy and encourage it to unfold in the play.

21st Century Play

Virginia Axline never had to contend with Call of Duty Special Ops, Modern Warfare or Battlefield 3.  What was different about 20th Century play therapy was that the games in the consulting room usually resembled the ones from the child’s everyday life at home or school.  The therapists therefore knew how to play them, and didn’t necessarily need to learn them as they went.  But now we are in the 21st century, where the therapy office often has games from our childhoods rather than those of our patients, and they are very different.

If you are a therapist and never intend to learn to play video games and play them with your patients, you should probably stop reading here; the post won’t be useful to you and I’ll probably annoy you.  But if you don’t plan on using video games with your young patients I hope you’ll consider stopping doing play therapy with children as well.  Certainly stop calling yourself a non-directive play therapist, because you’ve already directed the child’s play away from their familiar games and away from this century.  I actually hope, though, that you will lean into the places that scare you and try to meet your patients where they are at in their play, and for 97% of boys and 94% of girls that means video games.

Video games like Call of Duty and Minecraft are both very useful in both diagnosis and treatment of patients, as I hope to demonstrate by focusing just on one aspect here, that of player modes.  Most video games have a range of player modes, and what the patient chooses can say a lot about their attachment styles, selfobject needs, and object relations.

Solo Play is OK

Like other forms of play, sometimes patients want to play alone, and have me bear witness to their exploits.  They may do so out of initial mistrust, or a yearning for mirroring.  Solo play is looked down on by some therapists, who often think kids using “the computer” are austitic and/or “stuck” in parallel play.  I’d refer you to Winnicott, who taught us that it is a developmental achievement to be alone in the presence of another.  (I’d also refer you to my colleague and therapist Brian R. King who has a lot to say about a strengths-based approach to people on the autistic spectrum, on which he includes himself.)

The Many Reasons to Collaborate.

Some patients want to play with me on the same team in first person shooter games.  The reasons for this can vary.  Some patients want to protect me from their aggression because they are afraid I’ll be scared of it like parents, teachers and other adults may have been.  Other patients want to be on the same team because they want  to have a merger with an idealized parent imago to feel more powerful and able to take on the game.  Still other patients, seen in their daily lives as oppositional or violent, want to play on the same team so they can revive me and have me experience them as nurturing and a force for good in the world.

Some patients  want to have their competition framed by overall collaboration, meaning that they want to get the most or final “kills” but remain on the same team.  Some patients secretly yearn to play on a different team, and may need to “accidentally” change the settings to put us on opposing teams and passively want the game to continue.

Let’s Bring On A World of Hurt.

On the other hand, there are a lot of reasons patients want to compete.  They may want to see if I can stand their aggression and/or desire to win without being annihilated.  They may want to express their sadism by tormenting me for my lack of skill, or alternately project their yearnings for recognition by praising me when I kill them.  They may want to see how I manage my frustration when playing, and interpret that frustration as investment in the game and therefore my relationship with them.  They may be watching very carefully to see how I act when I win or lose.  Do I gloat when I win?  Do I make excuses when I lose?  How might these behaviors be understood by children and adolescents who often feel like they are chronically losing and behind their peers in the game of education?

More questions arise:  Does the patient ask me what mode I want to play or simply decide on one?  Do they modulate their anxiety by playing a combat mode but expressing the desire to stay away from the zombie mode?  By allowing them to do that am I helping them to learn that sometimes life is about choosing the lesser of two anxieties rather than avoiding anxiety altogether?

Multiplayer and Uninvited Guests

In terms of settings, there is some direction on my part, which is part of maintaining the therapeutic frame.  I make it a requirement that we play either locally or in a private game.  And of course this sometimes go wrong, with a random player joining us.

What to do then?  What if we are on an extremely high level and just terminating the game will do more harm than good?  In that case I make sure we are on mute and the our conversation can’t be heard by the added player, and then things get even more interesting in the therapeutic conversation:  Does the patient have any feelings about the new player’s arrival?  What do they imagine the usertag “NavySeal69” means anyway?  Do we help them when they are down or try to ignore them?  How do we feel if they are ignoring us?  Do we team up against them?

Minecraft and the Repetition Compulsion.

I could probably write a whole post or paper on this, but for know let’s talk about creative mode and griefing.  In Minecraft you and other players can build things alone or together.  Other players can also “grief” you, meaning cause you grief by destroying your structures and setting you back after a lot of hard work.   What does it mean when a patient griefs my building, apologizing and promising not to grief it if I rebuild, then griefs it over and over again?  What may be being reenacted here?  Are there adults in the patient’s life who tear her/him down again and again?  When does one give up on any hope for honesty or compassion from the other?  What sort of object are they inviting me to become to them; angry, patient, gullible, limit-setting, mistrustful?

I have used the term child or adolescent here, but exploring the gameplay of adults when they describe it to me is often useful as well.  I often encourage my adult students or gamer readers to do a little self-analysis on their play-style?  What does your preferred mode of moving through video games say about you?  What questions does it invite you to explore?

The goal here is not to give you an explicit case presentation or analysis of one hypothetical patient or game.  Rather, it is to provide you with a Whitman’s Sampler of practice and theory nuggets to give you a taste of the richness you are missing if you don’t play video games with your patients, especially if you are a psychodynamic therapist.  There is a lot that “happens next” if you engage with your patients in 21st century play that has themes you may find familiar:  How do I live in a world that can be hostile to me?  Why should I trust you to be any different?  Will my badness destroy or repulse you?  Will you hurt me if I am vulnerable?  These and dozens of other fascinating and relevant themes emerge in a way that never did for me when I forced kids to endure 45 minutes of the Talking, Feeling, Doing Game.  And what’s more you don’t have to remember to take the “What Do You Think About a Girl Who Sometimes Plays with or Rubs Her Vagina When She’s Alone?” card out of the deck.

I’m not THAT non-directive.  🙂


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New Lease on Second Life

So let me introduce you to Sigmund Steampunk, my avatar on Second Life.  I have already learned that there is more to Second Life and avatars than learning how to “walk” in the virtual world.  One of the lessons came from my supervisor, whom I value and idealize immensely, and who has only begun to learn about avatars and SL through our work together.  So the other day I emailed her and included the above photo of Sigmund, mentioning that since we’d been discussing it I thought she’d find it interesting to see what I was talking about.  She did, and then she lightheartedly mentioned that Sigmund looked like a slightly anorexic version of Ellen DeGeneres…

Lesson #1   Avatar Cathexis

People who experience avatars from the “outside in” don’t always understand immediately how cathected the user can be to them.  When I say cathexis, I am referring to the psychoanalytic concept of emotional and or libidinal investment in the object.  In most MMORPGs and virtual worlds the user has some to a lot of input into how to design their avatar.  The result?  The more time one spends shaping one’s avatar, the more emotionally invested in it one can become.  I was reminded of this when I read the less than flattering description of Sigmund:  I was taken aback by the fact that the description actually had an emotional impact.  Namely, ouch!

And when I noticed the ouch, I noticed that there was a stronger cathexis than I had bargained for.  So when you are given the opportunity to meet one of your patient’s avatars, tread carefully.  You don’t know how emotionally invested they are in their avatar.  They may not know how emotionally invested they are in it.  I know that we will have a rewarding supervision session next time, and I know that my supervisor will “get it.”  But I will think twice before introducing her to my level 80 draeni mage from World of Warcraft.  Sigmund has only been around for a few months, the mage has been around for 4 years!  Another example of avatar cathexis is said mage.  I recently wrote a two-part article for my local NASW paper on online gaming.  My co-author asked me what licensure or work qualifications I wanted included in my byline.  I wanted to include that I was an assistant faculty at Harvard Medical School and a level 80 draeni mage.  She informed me that NASW wouldn’t consider the mage qualification professional enough.  Again, ouch!  Do you know how many hours it took to level that guy?  We’ve been through thick and thin, and I consider him as source of pride on par as my Harvard appointment.  Looking at that from the “outside in” you may think that is bizarre.  But in terms of avatar cathexis it makes perfect sense.

Lesson #2  Avatar’s are fraught with meaning, conscious and unconscious meaning.

Now that I look at Sigmund, I can clearly see what my supervisor was describing.  I could make excuses, in truth I wanted his hair to be more dirty blonde like mine but couldn’t figure out how to do that.  But the reality is, I hadn’t been entirely conscious of my wish to be a few pounds thinner.  But there is my wish fulfillment, standing there waving at us.  Luckily I can tolerate seeing it.  Some of our patients may have a harder time.  Some may want to have more powerful bodies, others may want bodies assigned a different gender, still others want to give their avatar a chance at childlike innocence they never had, as the latest issue of TILT describes in “Alice in VirtualLand.”

So when exploring your patient’s avatar, tread carefully.  But definitely explore it, the avatar is a gift to the treatment.  It is wish fulfillment, idealized self, object relation, projection and IFS part all rolled up in one!  If you are a psychodynamically oriented psychotherapist, you’ll be amazed at what comes up for your patient when you start to express interest in getting to know their avatars.  And if you express disinterest, you have made a great empathic failure, and like all such empathic failures, you need to correct it ASAP.

In Second Life, there is a lot of joking about the bumping into things that first happens “inworld” when a user starts to try to move her or his avatar around.  I see this as also a metaphor for integrating avatar therapy into your treatment repertoire.  I have no intention of beginning to start having sessions with patients virtually in SL any time soon.  But I can see that a day may be coming when that will be part of meeting them where they are at.  I don’t want to be bumping around into walls or ego defenses, so I am practicing a little now, on my own time.  Many of the people I supervise around technology want to jump right in, and I applaud their enthusiasm.  I also caution them that we didn’t start meeting with patients before we had had at least some education in how to practice therapy, and that the same applies for learning to navigate Web 2.0.

What technology are you willing to play with and learn about before you are asked to by a patient?  Where will you go this week?