You are here: Home / Archives for private practice

One Bostonian’s Thoughts On Social Media

April 20, 2013 by 12 Comments

 MA Cambridge Charles River view of Boston

 

How does one begin to carry on with one’s life and work when the tide of history overwhelms a society?  This week I have had numerous conversations with colleagues about the myriad and often conflicting ideas and feelings we have been asked to hold alongside each other.  Initially I had been asked by one supervisee if I was going to write about the bombings in Boston, and my immediate response to him was, “No.”  I have seen too many colleagues either consciously or unconsciously use their social media to self-promote during times of tragedy.  Although I am a believer in the importance of self-promotion in building one’s business, this is not the time.

Hundreds of people in my Twitter feed and online seem to agree.  From therapist to marketing types, people noticed when your automatic Tweets continued unabated as the events of this week were unfolding.  And whether they were individual or enterprise level businesses, the response was pretty much the same, “turn it off.”

And I agree, now is not the time to self-promote one’s business or market, which ironically leaves those of us with social media back at where Web 2.0 all began.  Not for marketing, but for community.

So what I did want to discuss today I sincerely hope will be heard as sharing thoughts and feelings across the range of you all, who reading this are to some extent part of my community.  And why I want to discuss the topic of social media today is to offer some ideas to keep in mind as we go through the next piece of our history together.

Social media collapses time and space.  As I listened from my locked down house simultaneously to Twitter, the police scanner via Broadcastify, Facebook and other platforms, I heard firsthand how information and misinformation could spread far more quickly than it could have on 9/11.  Social media use and technology in general played a huge part in the ability to share, identify and ultimately capture one suspect.  It also hindered investigation at times by creating chatter that looped back to law enforcement in ways that were more confusing than helpful.

As someone who lives 2 miles from the explosions, a mile from where Patrol Officer Collier was killed, and far too close to the 7-11 and site of the carjacking, the week and especially last 48 hours were horrifying, confusing and anxiety-provoking for me.  But social media allowed me to reach out to friends, family, and colleagues, collapsing space in a way that brought a lot of comfort and support.  I can’t say enough about the gratitude I felt that the ping of Facebook and Twitter were heard consistently amidst the constant sirens and other sudden noises that hypervigilance brings.

Social media helped me express more pride as a Bostonian and New Englander could have ever imagined, as memes like this one popped up on and were shared by me on Facebook:

keep-wicked-calm-and-carry-the-hell-on

 

For those of you who aren’t locals, this pretty much summarizes how we people in the Hub of the Universe are, and how we dealt with things this week.

Unfortunately, social media also collapsed the space between MA and Arkansas, when we were subjected to this Tweet:

nate-bell-tweet

As enraging as this post was, social media allowed many of us in Boston to respond to this, including yours truly, with our Bostonian blunt arguments and a dash of humor thrown in:

nate comment

Social Media allowed thousands of people to respond alongside me, causing Bell to say to the Associated Press, “I really didn’t think about it going to Boston and was generally expressing my personal view of how I would have felt in that situation myself.”

This is one thing I hope we all can keep in mind over the next days and weeks, that we can remember the power of social media to collapse space and time and reach and impact a global and thus diverse audience.  Such a collapse can help bring comfort or quicken the pace of misinformation; bring a city together or divide a nation.

Social media amplifies feelings and emotions.  I hope colleagues can keep this in mind as we continue forward through the next days and weeks.  Social media can amplify love and community, and it can amplify hatred and racism.  It can amplify hysteria or reasonable thinking.  Social media can amplify comfort and applause, and it can amplify grief and vicarious trauma.

Please think before you tweet, post or share.  Ask yourself what you are shouting into the village square, what you are bringing to the conversation.  If you think you have something important to say, say it.  When in doubt, refrain.  Turn off your autobots advertising your wares or workshops for a bit.  And above all please remember that you are speaking to people you may not even imagine, whose experience of what has been happening ranges from the loss of an intellectual argument to the loss of a limb to the loss of a loved one.

How does one begin to carry on with one’s life and work when the tide of history overwhelms a society?  I’d like to suggest the answer is, carefully, thoughtfully, humbly and compassionately.

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , ,

Epic Supervision Fail

April 2, 2013 by 7 Comments

arts-graphics-2008_1186344a

This past week social work colleagues Ericka Kimball and JaeRan Kim had an article published in Social Work entitled: “Virtual Boundaries:  Ethical Considerations for Use of Social Media in Social Work.”  It’s a good article, and more importantly it’s a nice start.  The article discusses if, when and how to use social media ethically.  The authors don’t purport to have a solution to every potential problem that social media poses clinicians, but they have some good suggestions.

I have mixed feelings about the constant yoking of “technology” to “ethics” in our profession.  (In general, not specifically the article above.) It always seems to imply that social media and ethical problems go hand-in-hand.  No other ethics issue, even patient abuse by psychotherapists, gets as much play in our current professional development course offerings, and the irony is that there is evidence to support the much higher prevalence of the latter than the former.  It seems the only way the majority of psychotherapists can get curious about social media is if somebody scares them with the idea of ethical or legal violations.

Is there an ethical dimension to integrating technology into psychotherapy?  Absolutely.  It’s just not the only dimension.  And the problem with always focusing on ethics is it often encourages fear-mongering and contempt prior to investigation.  Part of the problem is that most of the people talking about ethics and technology in clinical practice have little to no experience with the technology side of things.  And as a result, they can’t engage us with ideas and brainstorming, but instead often adopt the fall-back of “you need to be careful.”

The result is that many clinicians get understandably scared:  You told me something is dangerous, and that the only solution is to be careful.  So seasoned clinicians often adopt what I call the “just say no” attitude.  Firewalls go up.  Patients can’t be emailed.  Agencies adopt no-Facebook policies, and in general evoke an air of monasticism.  I have even heard cases where clinicians are told they need to renounce having personal social media.  Though Shalt Not Tweet.

Into this  “just say no” milieu come our trainees.  Many of them are digital natives, and have been wired for technology in a way we digital immigrants may never be.  In many cases they are more digitally literate than we are.  They come into their supervision sessions with questions about cell phones in the office, suicide posts on Facebook, and being followed by patients on Twitter.

And they get “just say no.”

So let’s get real a sec here.

The Pew Internet Research Group states that roughly two-thirds of North Americans are on Facebook.  It, along with other social media, has become a primary source of communication and shaper of culture for our society.  This means that a majority of our trainees and their patients are probably using it.  We can’t just say no.  We can’t just say, “be careful out there.”  Our trainees look to us for supervision, and understanding social media and technology is part of 21st century clinical work.

I can’t tell you how many times I have heard horror stories in my classes about how supervisors fail their students this way.  And I get emails detailing, for example,  how a young clinician tried to bring up the positive impact of social media to a supervisor: “I thought her head was going to implode.”

Psychotherapy has a past history of using innovations in technologies to enhance our work, and our theoretical models.  Freud used the newer technologies of hydraulics to explain drive theory.  Similarly, advances in thermodynamic technology helped pave the way for family systems theory.  By now, many of the principles and parallels of those technologies have become so commonplace in our lives and understanding that we don’t even connect them with being familiar with technology.

Historically technology creates a period of suspicion and confusion before integration into culture.  A favorite example of mine is this:

indexAC

Prior to the Gutenberg printing press, books were a much rarer technology.  In the 8th Century, approximately 12,000 books were published in all of Western Europe; by the 18th century that number had risen to 1 billion.  As this technology became cheaper and more easily accessible, literacy rose.  But this was also a time when things got overwhelming.  When you had a handful of books read by a handful of people, the knowledge in them was much easier to locate.  But when the number of books and readers increased, there was an overwhelming amount of information to remember and locate.  The book index was the technology we came up with to solve that problem, but we needed to experience the technology as problematic before a solution was necessary.

Today we take indices, books and literacy largely for granted.  We know how they work, we aren’t afraid of them.  If anyone wanted to hold a workshop on the “Ethical Considerations of Printing” they’d be hard-pressed (heh) to get anyone to attend.

So now we find ourselves faced with a new technology, one as revolutionary in many ways as the printing press.  Only this time we are the generations that need to get used to it and confused by it.  And it’s risky and scary, because we don’t fully understand its implications yet.  But just as we wouldn’t have wanted our ancestors to forbid us to read and write, we need to let our trainees learn how to use the newer technology of social media in our lives and work.  And to do that, we need to learn it too.

This takes time, and it takes someone with expertise to teach you.  So before you hire a consultant, keynote speaker, or workshop presenter to talk about social media or technology in general, ask yourself, and them, these questions:

1. What do you plan to teach me beyond ethics about technology?

2.What strategies can you help me and my agency deploy besides be careful or “Just say no.”

3.What if any experience do you have with technology? Do you use social media? Professionally? Personally?

Just asking potential consultants those 3 questions could save you or your professional organization a lot of money down the line, as well as make the difference between helping you embrace innovation or stagnation.

Like this post?  I can speak in person too, check out the Press Kit for Public Speaking info.  And, for only $4.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , ,

Continuing Education From Pax East

March 24, 2013 by Leave a Comment

paxeast-pictures-epl-322

For those of you who may not know, Pax East is a yearly convention here in Boston celebrating all things video game. This year I was so fortunate to have the opportunity to present there on “Rethinking Gaming Addiction.” If you are interested in seeing what the presentation was about, you can view the Prezi here:

 

 

For those with the stamina, you can find a video of the presentation here:

 

 

And if you want to just listen to it in MP3 form, you can do so here:

 

Like this post?  I can speak in person too, check out the Press Kit for Public Speaking info.  And, for only $4.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

 

 

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , ,

Nice Everything You Have There: Mindful Minecraft

March 13, 2013 by 4 Comments

2013-03-08_22.06.42

Did you know that Minecraft has a lot to teach us about how we pay attention to, get distracted from, and cope with things? Embedded in the design and the lore of the game are nuggets of philosophy, neuroscience, and psychology. From work/life balance to physical and mental health to the meaning of life Minecraft has something to teach us.

That’s why I decided to present on mindfulness and Minecraft this year at SXSW.  If you were there, thanks for coming, but if you weren’t fret not, for David Smith of Austin, TX was kind enough to videotape the event on his iPhone.  David, thanks for your stamina!  The video is broken into 5 parts, and I’ll include the prezi for you to play with as well:

 

 

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by 29 Comments

apps

 

Mobile applications have a lot to offer therapists.  Whether you are looking for games to play with patients, productivity or billing tools, or something to help you research, there’s an app for that.  Many supervisees, students and consultees have asked me lately what apps I recommend, so I thought it was about time I gave you a list sampling those I find most helpful and fun.  Many are cheap or free, and available for the iPad, iPhone and Android:

1. GoToMeeting

Planning on doing online therapy?  Gotomeeting has desktop and app versions of videoconferencing software, which is HIPAA-compliant.  The app version allows you to attend meetings, but the meeting needs to be initiated from the desktop version.  I use this program for the majority of my online sessions with patients and supervisees.

2. IbisMail

If you are juggling multiple roles or a portfolio career, or simply want better therapeutic boundaries, this is the email program for you.  Installed on your iPad or iPhone, this program allows you to set up automatic filters, so you can sort through junk mail.  But it also allows you to set up folders for patient emails, so that you can have them all in one place.  Then it is up to you to decide when you review your patient communications, rather than have everything coming through one inbox.  Supports multiple email accounts.

3. Flipboard

If you are wanting to add value to your twitter followers or consultees, this is a great app.  It provides a slick intuitive interface on your mobile device that pulls in stories from feeds you set, from you Facebook account to the Harvard Business Review blog.  When you find something you want to share, the app allows seamless sharing on a variety of social media platforms.  In a few minutes you can browse and share selected readings and keep up to date on current interests.

4. Bamboo Paper

This app allows you to write notes on your iPad.  It is great for note-taking during evaluations, and allows you to send these notes to Evernote as a .pdf or email yourself a copy.  NOTE: Doing this is not HIPAA-compliant if you have distinguishing identifying information in the note, so I recommend you refrain from using the cloud-based features if you have any concerns about patient privacy.  If you are using it for workshops or other personal uses, however, no worries.  And if you keep the notes local to your password-protected device, it can be a great tool.

5. Evernote

I was hesitant to add Evernote due to the recent hack they experienced, but their quick and effective response to this have actually made me more confident that this cloud-based note-taking device is still useful.  It is NOT HIPAA-compliant, so I don’t use it for patient notes ever.  That said, it is great for dictating notes about workshops, blog ideas, snapping pictures of things for study aids, and a myriad of other useful tasks.  The notes synch up between every device you have them on, so you’re always up to date.

6. iAnnotate

One of my favorites.  iAnnotate allows you to mark up .pdf files on your mobile device.  If you need to sign off on a document someone emails or faxes you, no more scanning, printing, scanning again stuff.  And if you are a student or researcher this is a must-have, as it supports highlighting and annotating research articles.  Synchs with Mendeley and Dropbox so you can store your research library with notes online.

7. 1Password

How can you make your mobile device more secure and use your web-browser more safely?  This may be the answer for you.  1Password installs on your mobile or desktop, and allows you to save and generate extremely long and secure passwords.  The level of encryption can be adjusted for the most cautious of password protectors.  This program also synchs over the cloud so that you always have the up-to-date passwords on all of your devices.  Even more convenient, it can bookmark your sign-in pages.  All of this is secured by double-password protection on your iPhone.  Stop using the same lame password for everything and start generating unique hard-to-crack ones for true HIPAA-compliance.

8. Mendeley

One part social network, one part research library,  Mendeley allows you to store research articles and annotations online and on your device.  It allows you to network with other colleagues to see what they are researching, share articles, and store all of your articles in one place.  Often it can even pull up the bibliographic entry from the web just by reading the .pdf metatag.  Geeky research goodness!

9. PayPal

This is one option for billing patients and paying vendors that is good to have.  You can invoice by email, transfer money to your bank account, and keep track of online payments on the website.  The app works well in a pinch if you aren’t ready to swipe cradit cards in your office.  NOTE, each transaction has a small fee.

10. Prezi

I’d love to see more therapists using this one.  This presentation software allows you to create dynamic visual presentations on your computer or mobile device.  You could use it to convert boring DBT worksheets to a dynamic online presentation.  Prezi supports importation from powerpoint, and provides free online hosting of your prezis as well as tons of templates and tutorials.  If you do public speaking, upload some of your prezis on your LinkedIn profile to give potential clients a vivid sense of your work.  You can see a sample here, but bear in mind that it would make more sense if I was there giving the talk.  🙂

11. DCU

I haven’t been to a bank in over 2 years, and this app is the reason why.  Digital Credit Union’s Mobile Branch PC, allows me to deposit checks from patients via my iphone.  Just login, scan the checks, and in 10 minutes you’ve done your deposits for the week.  Meanwhile, the online interface allows you to keep track of your spending easily and export to Excel or accounting software if you need to.  Great for tax season!

12. Dropbox

Dropbox is a great and free way to store non-private information on the cloud.  The app allows you to email items easily, so I use it to email intake instructions to patients, press kits to people inquiring about keynotes, and a number of other items.  I also keep all my DBT worksheets on it so that they can be sent quickly and easily to patients should they be feeling in need of extra support between sessions but not acute enough to warrant hospitalization.

13. TED

This app allows you to stay inspired and experience innovation daily, by beaming TED talks to your mobile device from the offical TED site.  You can favorite, search, and share your favorite ones, or hit “Inspire me” for random ideas.  As I wrote this, I was listening to Amanda Palmer speak on “The art of asking.”  This app can allow you access to ideas outside of the filtered professional bubble with therapists often get ourselves stuck in.

14. Line2

Want a second phone line on your iPhone?  This app allows you to have one.  You can port your practice number to it, and stop carrying two cell phones.  At $9.95 a month you can have unlimited US/Canada calling, at $14.95 a month you get a toll-free number and virtual fax.

15. CardMunch

Tired of keeping all those business cards from a shoebox?  CardMunch allows you to snap photos of a colleague’s business card and convert it to a digital one which it stores in your contacts.  Synchs with LinkedIn.

16. Micromedex

Keeping up-to-date on medications is pretty daunting, but this app, with frequent updates, helps you keep track od a medication, its Black Box warnings, contraindications, drug interactions, adverse effects, alternate names, standard dosages and more.

And now for some games!

17. Plants Vs. Zombies

This game is great for helping patients who want to learn about strategy and pacing.  Choose a certain number of plant types to plant in order to stop the zombies from overrunning your backyard.

18. Zombies, Run!

Continuing my zombie kick, this game is better than any pedometer I’ve ever used.  The more you walk or run, the further you progress in this game of fleeing zombies.  Go on multiple missions, play with friends, and even train for a 5K.

19. Kingdom Rush

This game is a classic tower defense game, which helps patients learn to make choices, control impulse spending as part of a winning strategy, and work on pacing, problem-solving and a host of other cognitive abilities.

20. Minecraft Pocket Edition

This mobile app version of Minecraft is a great way to connect with a patient’s gaming, and the app allows you to play together on a wireless LAN, so you can fight for survival or create an amazing construction right from your office together.

21. Flower Chain

This is a completely nonviolent game that focuses on setting up a chain reaction of flower blooms in order to complete each level.  Great eye candy, and a fun game for clearing the mind after a difficult session.

22. Trainyard

This puzzle game requires you to plan out and design multiple railroad tracks.  The trick is to set them up and pace them so that they all meet their goals without running into each other.  Great prompt for talking with adolescents about how they can learn to negotiate peer relationships in the same way, or learn to compromise with adults in order to get along with them.

23. Lavalanche

This puzzle game is reminiscent of Jenga, in that you have to dismantle a tower without letting the Tiki Idol fall into lava.  Another great one for executive function capacity-building around sequencing, planning and problem-solving.

So there you go, give some of these a try and let me know what you think.  Have a favorite app that you want to share?  Please feel free to comment and include the link.

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Live At The Cooney Center: “Improving Our Aim: A Psychotherapist’s Take On Video Games & Violence”

February 20, 2013 by Leave a Comment

passetti_400-150x150

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , ,

Learn More About Rethinking Video Games & Addiction Here!

February 17, 2013 by 1 Comment

 

In the midst of several projects, including the upcoming 2013 SXSW presentation, but wanted to give you a post in the meantime.  Here is the presentation on rethinking gaming addiction I did there last year.

[gigya ]

This can give you an idea of:

  1. The power of Prezi, even in its’ most stripped down version
  2. The visuals that accompanied the presentation you can listen to if you go here
  3. What my approach to technology and psychology is
  4. What my style is as a public speaker

Enjoy, and I will be posting again with bigger news soon!

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

 

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , , ,

4 Tips For Dealing With Video Game Violence For Parents

February 2, 2013 by 2 Comments

See-no-evil-Hear-no-evil-Speak-no-evil-Star-Wars-Stormtroopers3

 

Whenever there is an upsurge in moral panic around violence in the media, the focus becomes more polarizing than pragmatic.  Despite the overwhelming research (such as these articles) that shows weak if any links between video games and violence, media pundits whip up mental health providers and the parents they work with into a frenzy.  Feelings such as a passionate urge to protect children and adolescents are often to intense to be suspended to look at data.  In the midst of all this, moderate and practical ways to address the graphic content of some video games are overlooked in favor of heated philosophical debates.  So for those of you who are parents and/or work with them, here are a few tips and links on how to handle violence in video games:

1. Set console parental controls.  You can set your game consoles to only play games of a certain rating.  If you haven’t done so and are complaining about violence in video games, take some action here.  Here are the how-tos:

XBox Parental Controls

Playstation Parental Controls (Video from CNET

Wii Parental Controls

These are password-protected, and will allow you to set the ratings limits, which brings us to:

2. Know your ratings.  Although I have mixed feelings about the Entertainment Software Rating Board, it’s what we’ve got.  But the ESRB is only as useful if you familiarize yourself with it.  This means not only looking at what each rating means, but using the other resources they have, including mobile tools, setting controls, family discussion guides and other tips for safety.  The message here is that there is more to understanding and moderating access to your child’s gameplay than a rating system, including discussion of in-game content.

3. Make use of graphical content filters.  Many parents, educators and therapists don’t know that a growing number of games have options that can be set to filter out violent graphics, profanity, and alter the experience of game content to a more family-friendly level.  If your child wants a video game, have searching online to see if the game has a GCF be part of the process.  Not only will you be teaching them about consumer choice, but digital literacy as well.  Here are some popular games that have GCFs:

Call of Duty Black Ops 2

Gears of War 3

World of Warcraft

4. MOST IMPORTANT TIP: Parenting has no “settings.”  Parents and educators often want some expert to rely on–don’t try to “park it” that way.  Most games can be rented before you buy them from services like GameFly so you can test drive them.  That’s right, I’m suggesting you play the games yourself so you can make a personally informed decision.  At the very least you should be watching your child play them some of the time, not to be nosy, but because part of your role as a parent is to take an interest in their world.  If you can spend 2 hours going to their Little League game, you can spend an hour watching (if not playing) Borderlands 2.

If you’re an educator or therapist, you’re not off the hook either.  🙂 If you are going to offer opinions on video games and their content, make sure you are playing them.  Chances are you don’t say things like “reading Dickens is dangerous for young minds” if you have never read any of his work.  If you did, you’d probably be out at a book burning rather than reading this blog.  By the same token, don’t presume to opine about video games if you have done nothing to educate yourselves about them.  And please note that asking children about them is a place to start, but by no means sufficient for educating yourself.  If you are a play therapist, please start including 21st century play materials like video games in your repertoire.  And be sure to provide parents with the resources they need to help them make sense of this stuff, such as the resources this post gives you.

Look anyone can have an opinion on video games and violence, but we need practical processes to help people be informed consumers.  This is one parenting issue that has practical, doable options, and is rated “O” for “Ongoing…”

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Epic Every Day: What Video Games and the Millenials Can Teach Us If We Let Them

January 23, 2013 by 4 Comments

millenials_splash

The term millennial refers to the generation following mine, Generation X, who were born between the early 80s and 2001.  There certainly may be some differences in the millennial cohort in terms of race and social class, but in my experience working in both urban and suburban settings, technology use is not one of them.  In fact, technology has probably exacerbated some of the traits millennials are known and often criticized for.  Social media has made expression more democratic and amplified, and millennials cite self-expression as extremely important.  Growing up with the internet has also placed them in the same social and informational spheres as their parents more than previous generations, making them more civic-minded than rebellious, and having different, some would say overly dependent, attachments to their parents.

Common complaints about millennials include that they are entitled, tethered to their parents, unable to tolerate longterm goals, averse to sustained effort and require a constant stream of praise for the most minimal pieces of work.  The other side of this coin is worth noting, too:  Higher sense of self-expression has led to millennials’ higher acceptance of diversity in others; they are more comfortable with switching jobs or organizations they work with and working outside the box in general.  Yes, they may also have a higher tendency to blame external rather than internal things for their problems, but having come to self-awareness post-9/11, can we really blame them?

In my work, I often encounter children, adolescents and young adults who are failing in school for a variety of reasons.  These “millennials” avoid attending, and often the blame is placed on excessive video game use.  They are seen to be escaping from reality, and although I can understand this perspective, it also puzzles me in some ways.  Video games would in many ways seem to me to be going from the frying pan into the fire:  They are rife with failure; in fact the statistic Jane McGonigal gives us is that people are failing 85% of the time in playing video games.  MMOs often require even more collaboration, sharing and critical thinking between individuals than classrooms in any given 30 minute period.

Millennials are often criticized as post-academic workers as well, for having less job loyalty, a need for constant feedback, and expecting that feedback to be praise.  In more affluent school districts I often heard their parents described as helicopter parents, who would email school minutes after receiving the report card to begin to debate the grades and exert pressure on educators to change them.  This has led to such grade inflation in my experience that my graduate school students are hurt and insulted when they get a B+ on a paper, sometimes to the point of tears.  I can’t remember a class I had in college where I wasn’t listening to a lecture, millennials are constantly asking for more small group work.  I’ve even had a call on occasion from a parent about their child’s performance.  Did I mention that I taught in graduate school?

From the above criticisms you’d think I was down on millennials, and you’d be dead wrong.  Because I think for the most part the millennials are happy, tolerant, and more likely to help others voluntarily than other generations, and the Pew Research on them bears this out.  And I think that a major reason for this is that they play video games.

The video games of today and the past decade have morphed from Pong and Space Invaders to Halo and World of Warcraft.  They have set up myriad game worlds where survival and thriving requires critical thinking, social collaboration, and lots of trial and error for mastery.  These games have also been played by over 90% of the millennial population, and I would suggest that the result is that millennials have been conditioned to be more collaborative, expect feedback to be quick and positive, and be more connected to others through technology.

Then we send them to school,  and it is frustrating for a majority of them, a majority of teachers, and a majority of parents.  Rather than encourage them to be “lifelong learners,” education as it is currently structured aims to produce a very narrow form of educated person, one that Sir Ken Robinson describes in his TED talk as an “academic professor.”  In addition, we all start to become impatient with millennials to adopt our own often individualistic notions of what adulthood is.  They need to stand on their own two feet, work without constant reassurance, and memorize things that they could just as easily Google.  All to get into the right college, and all to get a good job.

We criticize the millennials’ work ethic for many of the same reasons:  They won’t take individual responsibility for projects, they have trouble working independently, and they expect an award merely for being present.  They need to take things more seriously and get their nose to the grindstone, no one has time to hold their hand anymore.  These are all complaints I have heard levied against adolescents and young adults in my work, and the implicit message is that it is time to grow up.

One of the greatest things we can learn from millennials is something that I think they learned from video games, and that is how to destigmatize, and even enjoy, failure.  The epitome of this for me is the ‘Heron’ The Greatest Spelling Bee Fail/Epic Win of All Time’—which was posted on YouTube originally by the millennial who flubbed it.  This ability to have a sense of observing ego and humor about oneself is something many of us in psychotherapy work with our patients for years to achieve, and yet as a generation millennials seem to have grasped it more easily.

Part of my work with gamers is often to explore this paradox:  Why is it fun or okay to fail in video games so much, and so intolerable in work or school?  Sure, part of it is that play is a magic circle according to Huizinga, which is marked apart from real life.  But games impact the same brain, the same emotions that exists inside and out of that circle.  And if that is the case, there must be some transferable skills.  We work on how to destigmatize failure

Innovation requires lots of trial and error, and lots of failures.  As educator Lucas Gillispie said at a recent education conference in Second Life, it makes little sense to penalize so harshly when students get 69%.  Rather than see it as having acquired more than half the knowledge assessed, we make it a source of embarrassment and usually require they repeat the entire exercise, class, or grade.  Millennials have grown up with a split view of failure.  On the one hand, video games have helped them understand that failure can be fun, even if you’re failing 85% of the time.  On the other, they are put in educational environments where the A is everything, and the goal of learning is to get high marks rather than enjoy the creativity and critical thinking.   In fact, A’s are so limiting!  Why not focus on a high score which can always be improved upon in school?  If the best you can do is an A, then you have to resort to accumulating the most A’s possible, which is less intrinsically rewarding and dynamic.

Many detractors will say that millennials need to get with the existing program, that what I am suggesting is dumbing down a curriculum, or that I am being too Pollyanna and that some jobs just aren’t capable of being fun.  But for over a decade companies like IBM have found success modeling work environments on MMOs, and schools which institute dance classes notice higher math scores. And the solution to our economic and occupational troubles may not be the return of a “work ethic” or more job, but the creation of new types of schools and jobs, work we can’t even imagine yet because it hasn’t been innovated or invented.  Can you imagine some 14th century youth telling his farmer dad, “I don’t want to work on the farm.  I’d like to create and use something that applies pressure and ink to paper to make reading and writing something we can all do.”

It probably isn’t a coincidence that the word “epic” has become ubiquitous over the past several years, with so many millennials and others playing video games like World of Warcraft.  And it has come under fire by many of my colleagues, who maintain that in a culture where everything is Epic, nothing truly is.  I’m not saying that everything is Epic, but I am saying that there can be some Epic every day.  It’s what they call teachable moments, flow, success, even the Epic fail that we can laugh off with colleagues before redoubling our efforts to nail it next time.  What we’re really learning here is how to tolerate frustration.

Millennials know that “epic” is a superlative, they’re not devaluing the currency of that word.  If anything, I think that this is a sign that Buddhist thinking is becoming more integrated into the 21st century:  It is Epic that we are here alive in this moment, that we want and fear so much, and the struggles that ensure from those things. There are a lot of levels left to unlock and problems to be vanquished in the world, and we need to cultivate optimism and positive psychology at school and in the workplace, not stomp on it.

Millennials often have that sense that there can be some Epic every day.  Video games offer worlds where there can be some Epic every day, too.  Let’s start noticing it.

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: , , , , , , , , , , , , , , , , , , , , ,

What It Means To Make A Referral

January 7, 2013 by 4 Comments

referral cartoon

To speak with a relative stranger about the most intimate details of one’s life is an incredibly daunting prospect for many psychotherapy patients.  No matter how guarded a patient may be, she or he is daring to be incredibly vulnerable as well.  Often the only thing that can make this beginning possible is an appropriate therapy referral.  And yet never before has it been so easy for us to make a horrible or thoughtless referral to these brave souls.

It was hard enough when managed care began to shape the behavior of therapists to focus on insurance as being the number one or only criteria to make a referral.  But now technology has made it even worse.  Readers of this blog know that I am a great fan of technology in general and social networking in particular, so it may come as a surprise to hear me say this; an explanation is in order.

Recently I began to get emails from various therapists with the subject heading “Are you accepting new referrals?” or “Referral for you.”  In the past I have found those questions a nice compliment.  But these emails were actually invitations to join something called Referral Key, a small business referral network.  The message went like this:

If you’re taking on new clients, I’d like to include you in my private referral network to send you business leads.

Please accept my invitation below. Thanks!

Here’s the problem, none of the people who sent me these emails knew me in a professional capacity as far as I can tell.  We had never shared a patient, attended a fellowship together, worked at the same agency or supervised trainees at the same place.  The only qualification these people would know I had if I accepted their invite was that I wanted more business.

That’s not how you make a good referral.

Look, referring a patient to someone is risky enough when you do know the therapist or the patient.  Risky because we have never experienced what it is like to sit with the colleague as a patient.  But at least we have some other information to go on.  The nature of therapy requires that we be as thoughtful about referrals as possible.

In my experience with trainees and consulting to therapists I have come across a lot of marketing information on how to get referrals, but not a lot of clinical info on how to make them.  So here are my suggestions on when and how to make a good referral.  Keep in mind that these tips are a combination of my experience, opinions and pet peeves.  Between emails, listservs, social networks, etc., I see a lot of different ways therapists do it.

1. Don’t treat a referral as a consolation prize.  If you get a call from a patient who says they were referred to you by their insurance, and you are not accepting new patients, don’t feel pressured to offer them another name.  Ideally, if you have time to offer them an initial consult you may get enough information to make a suitable referral.  If they can come in, you can discuss their presenting problems, therapist preferences in terms of gender, experience, etc.  If you offer free phone consultations (which I discourage in general,) you can speak with them over the phone at enough length to get a sense of the patient’s needs.  For a thoughtful referral, my experience is that this takes 30-45 minutes.  looking online and saying, “Jane Doe appears to be in your network and I’ve heard good things about her” may be sufficient to assuage your conscience but is not sufficient to be a solid referral.  Jane may be a whiz at adult ADHD, but if the patient was referred to you for your expertise in PSTD you may have no idea whether Jane has interest or expertise in both.

2. Avoid referring to therapists who “do it all.”  I never refer to a therapist who treats ages 3-80 for issues ranging the breadth of the DSM-V.  The USDA deals with chunks of meat on a conveyor belt, we don’t.

3. Disclose the extent or limitation of your knowledge of the referral to the patient.  If you trained with the person and think highly of them from the way they discussed their work, say that.  If they are someone who responded to a listserv request you made and you know nothing about them or their work, say that.  Patients trust us to give them expert opinions, and if your expertise is limited the burden of disclosing that is on you.

4. When soliciting a referral, keep it brief and salient.  Don’t pepper the listserv or discussion boards with identifying information or your subjective impressions.  Age, presenting problem and therapist preferences (gender, takes X insurance, CBT) are enough.  So often I see referrals for someone seeking a therapist for a patient who is “a lovely, very insightful young man who would be a delight to work with.”  This is more of a sales pitch than salient data.  None of your colleagues are probably hoping to work with horrid, clueless people who are a misery to work with, now are they?  Nor do we really need to know that the referral is for the daughter of a good friend of yours.  If this is a referral that will involve collaboration (such as one member of a couple you are seeing) by all means offer to share more information if the referral works out.  But in the meantime, just the facts.

5. When possible, get feedback and use it to inform your future referrals.  If you referred to a colleague to treat one of your individual patients for couples therapy, ask them how it is going or went.  Please take this information seriously and do not dismiss it as transference.  It may be transference, but remember your alliance is with the patient and erring on the side of caution.  In my time I have had folks give me feedback that the people I referred to didn’t listen, feel asleep during a session, took their spouse’s side, smelled of alcohol, and a myriad of other concerning statements.  Do I know for a fact that any of these stories were true? No.  Do I plan on risking referring a patient to one of those people again, absolutely not.  If the person you refer to is difficult to reach or collaborate with, bear that in mind for future referrals.

6. Talk to your colleagues.  Ask them whether they are taking referrals, or what kind of patients they see.  Ask them what their expertise is if you are unsure.  Send them an email with brief and salient information asking if this sounds like someone they’d enjoy working with.  And absolutely send them a note if you give their name as a possible referral.

7. If you don’t have or want to take the time to make a solid referral, then don’t make one at all.  Too often our colleagues try to come up with a name rather than say, “I’m sorry I can’t help you.”  Our graduate programs rarely train us to say that.  But better you say that than misunderstand what a referral truly is.  A referral is a thoughtful recommendation to a patient for a clinical treatment of serious concerns.  If you don’t have time to give it sustained thought, understand the concerns or help needed, don’t give a referral.

Above all, please keep in mind that social networks are great for many things, and referring patients is not one of them.  If the only thing you know about a therapist and their work is that they are in your “network,” what kind of qualification is that?  Don’t confuse networking, marketing, or chatting with referring someone to therapy.  If you were looking for a therapist and someone said, “I got an email the other day from someone saying they are taking on new patients,” would that be sufficient for you to make an appointment?  Just because I’m in your Contacts or LinkedIn group doesn’t mean I am any good at therapy in general or for a patient in particular.  I could be a complete wingnut.

Do you really want to take that chance with someone’s mental health care?

Like this post?  I can rant in person too, check out the Press Kit for Public Speaking info?  And, for only $2.99 you can buy my book.  You can also  Subscribe to the Epic Newsletter!

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