psychology

An Open Letter to Parents, Teachers & Administrators Now That School Is Officially Closed

April 23, 2020 by langloimsw Leave a Comment

The following is a letter I wrote in response to Massachusetts’ School Closures Due to COVID19. It may or may not be applicable to your school system.

Hello all,

I decided to jot down a few thoughts, which you can take or leave with a grain of salt, as someone who has been a teacher, special educator, school social worker, psychotherapist, special needs foster parent and researcher over the past quarter of a century. I have been a Gen Xer since birth. I have heard how stressed parents have been getting trying to deal with online learning and although I can’t dispense clinical advice online, I have some informed opinions. This may not be what you want to hear, but here goes nothing:

For parents:

1) Please stop trying to be so productive. Our country is obsessed with productivity, it is part of what makes so many kids and adults so anxious. Let your kids eat untoasted pop tarts, sit and watch their iphones, hum to themselves, whatever.

2) Do not cook for your children all the time. Color code microwave speed buttons and have the oldest learn to “cook” for the youngest when possible. Leave out bread and some plastic knives and forks and materials for PBJs. They will be fine if they only drink milk for a day or three. They are in home quarantine not on a cruise ship, and you are not “the help.” If you refuse to let them fend for themselves and become resentful it is ON YOU.

3) Stop worrying about online learning, schools are going to need to assess kids’ academic baseline when school commences in September and reteach anyway. I give you permission to ignore the constant emails from school. They are anxious too. Consider sending your teacher a courteous email saying that your family has determined that your family’s emotional health and domestic harmony takes precedence over math and science facts, but that you may have your kiddo record a brief Youtube explaining a principle in Physics they learned playing Portal 2, or the concept of sequencing as evidenced in Plants Vs. Zombies. Assure their history teacher they will do the same for someone in Assassin’s creed. What are they going to do, suspend your child? THERE’S. NO. SCHOOL. Please don’t worry about this. If your child is an overachiever and feels more secure or relevant doing all assignments disregard the above. If your child had frequent suspensions or school phobia because education WAS their primary stressor please do not try to recreate the stress at home, but instead embrace this divine gift for the next few months.

4) Try to throw money at problems if at all possible. If everyone is online at home invest in the highest speed internet plan available. Get an extra iPad or PC or if possible get one for everyone. For every article about too much screen time I can send you two that discuss the benefits of screen time. If you all can Netflix/game/chat simultaneously without lag you will get along much much better.

5) Please don’t worry about screen time. Please don’t worry about video games causing violence. That is a moral panic and poorly correlated research concept. In fact, more of us have been on screens/gaming this year than ever, and it is the first March in 18 years we haven’t had a school shooting in the U.S. There are lots of articles which can show you how to use video games for educational purposes I can share with you: This is only to calm you down—play is inherently beneficial to cognitive development, so ideally you would just let kids play the games they like.

6) That said, if your family wants to sleep in the traditional fashion, i.e., at night, please switch from visual things (screens, reading, staring contests) to auditory ones (Audible stories, music, campfire songs) 90 minutes or so before your target bedtimes. When our eyes are working they tell our brains to stay awake. Listening to talking puts them to sleep—you probably know this already if you still attempt talking to your teenager.

Teachers:

1) Be subversive. Please try to avoid passing on institutional expectations if you think they are performance-based. If you are still a fan of performance-based expectations at this time please seek out therapy. The rest of you make silly videos of yourselves that showcase the creativity that got you into education in the first place. Dig deep I know it is there, I have worked with many of you and know that most of you don’t hold to the old adage “never let them see you smile before Christmas Break.”

2) Take care of yourselves. Meet colleagues online for coffee via Zoom and complain about the children or your families or whatever just like you used to during your 5 minutes of unscheduled time. Revel in the new freedom that comes from being able to use the bathroom whenever you want without worrying about 25 people waiting for you in your classroom. Do not assign any homework that you are not looking forward to reviewing 30 times while your spouse is playing the television too loudly. Remember those headaches, they haven’t been there for several weeks have they? Take the hint, don’t assign any homework at all.

3) Focus on your student’s parents more than the students. They don’t know how to be you, most of them weren’t trained to be you. Try not to point out that this demonstrates how you do more than childcare and deserve the summers off. Don’t go there. Please just reassure them that they are doing enough to keep their children safe and psychologically sound, and that their children will not be unemployed and living in a cardboard box at the airport, or worse still at home, when they are 30 because school stopped early this year.

4) Create a filter for email from your school admins. Do not look at it more than once a day. They are so overwhelmed they will not notice. They may have children at home they are feeding pop tarts to. They are probably dealing with budgets now. They are definitely giggling inappropriately sometimes.

School Administrators:

1) Please don’t be defensive. I know, nobody understands what you do, and they never call you unless there is a problem. It is lonely at the top, and now the top has multiple abandoned buildings that still are falling apart. It is also true that the Bureau of Special Education Appeals is forging ahead with zoom like the rest of us, so no respite there. And even though you all look (and are) tough I know you feel responsible for every single adult, adolescent and child in your district for everything. You aren’t but I know you feel that way. Try to remember that every one of the 200 emails/calls you got today doesn’t know about the other 199. Only you do, and it is exhausting. So breathe—getting defensive will only make it worse.

2) Model Self-Care. Mention loudly to your teachers and principals and assistant principals that you are in therapy, have a zoom peer group, whatever you are doing to keep yourself from going off the deep end. Limit your exciting emails about resources to one digest a day at the end of the day. (They won’t be reading them until the next morning anyway, see Teachers, 4, above.)

3) Encourage silliness wherever possible. Anticipate filling out state waivers for EVERYTHING this summer. Kick every can that has “MCAS,” “Curriculum Frameworks” or other bureaucratic jargon down the road you can. Be aware that you are demonstrating unprecedented leadership in our recent history. Did Churchill talk about “standards-based assessment” during the Blitz? I think not.

4) Plan to pivot. There are many reasons to believe that there will be another round of this in the Fall/Winter. Use the current closure to plan intentionally with your colleagues. Develop a district-wide pandemic plan if you don’t have one. But only do work “work” a few hours a day. The rest of the time have fun or be outrageous. Stream you and a few students playing Call of Duty on Twitch for the District. Pioneer using Tik Tok for Social Emotional Learning (SEL in 20 second increments? How can that NOT fit somewhere in the middle school schedule?)

There, I know that none of you may have wanted to hear that, and you may not agree, but I thought I’d give it a shot. I’ve been hearing too many of you being way too hard on yourselves during this pandemic, confusing “need for structure” with “maintaining standards.” This is not Lord of the Flies: Society will not fall into chaos if we relax our educational and parenting goals for a few months, but we might be able to lower the incidences of domestic violence and substance abuse if we can reorder our priorities a wee bit. Thanks for reading.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, covid19, education, gamers, games, psychology, technology

Streaming, Path of Exile & The Repetition Compulsion

June 11, 2019 by langloimsw Leave a Comment

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!

Find this post interesting? I can speak in person too: Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book. 🙂

Filed Under: Gamer Therapy Tagged With: addiction, adolescents, behavior change, education, Freud, game theory, gamers, games, gaming, path of exile, psychoanalysis, psychodynamic, psychology, psychotherapy, repetition compulsion, stress, technology, therapy, twitch, video games, Web 2.0

Yeah? Tell That to Squirtle: The Fallacy of “Screen Time”

August 11, 2018 by langloimsw Leave a Comment

Recently, the American Heart Association release an “statement” decrying the dangers of screen time. The report, according to USA Today, said screen time can lead to sedentary behavior increasing the odds that kids can grow up obese. The statement says among other things,

Although the mechanisms linking screen time to obesity are not entirely clear, there are real concerns that screens influence eating behaviors, possibly because children ‘tune out’ and don’t notice when they are full when eating in front of a screen.. (USA News & World Today, August 8, 2018)

Most people won’t dive deeper than the article and it’s quote, which is problematic in itself. “Although the mechanisms linking screen time to obesity are not entirely clear,” is really a way of saying what “this is a correlative statement, which is very different than causality.” If you are unfamiliar with the vast difference between the two, this is a great video to explain it. Come back when you’re done.

The problem with these studies, once they get amplified, is that they fuel the ongoing panic we have with emerging technologies. Once again, here’s my reminder list:

1. Doing any activity for more than several hours in a row is unhealthy, with the exceptions of sleep and meditation.

2. Not all “screens” are equal, have identical lighting and spectrums, and therefore identical impact on sleep.

3. Research shows that using your eyes at night stimulates the areas of your brain that arouse you. So reading, looking at your aquarium, crosswords, and even knitting will also hinder the onset of sleep if you use your vision.

4. Whether in a scientific journal or Trump’s “400 lb guy in a basement,” can we please stop fat-shaming people? Not every heavy body type is the same, nor is obesity a moral issue. Why not focus on teaching your children to be kind, critically thinking and funny humans than focusing on their bodies so much?

In fact, I can make a very different correlation, based on my experience with PokemonGo. This summer I increased my gameplay of this screen-based smartphone app quite a bit. To date I have walked over 150 miles catching Pokemon. I also have lost 5 lbs. My experience would predispose me to conclude that increasing this screen time has actually decreased the sedentary nature of my lifestyle, and lowered my weight. Of course, the fact that I spend half of my time in a rural community with friends who like to hike in the summer doesn’t hurt either, but that’s correlation for you.

While I’m at it, since folks are so concerned with the public health of our children here are some pro-active suggestions based on other possible correlations:

Stop fat-shaming kids so they seek escaping reality so much.
Fund schools better and test them less so things like recess are longer than 15 minutes.
Institute better gun control so children and their families aren’t afraid to go outside and get shot.
Decrease stigma of trans youth so they can safely explore gender in ways other than just an avatar of a different gender.
Make playgrounds and athletic teams universally accessible so that kids can play and engage regardless of physical differences.

You want to connect some dots, there, I got you started. Now stop going for the low hanging fruit and blame something other than Nintendo.

Find this post interesting? I can speak in person too: Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book. 🙂

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, digital literacy, education, gamers, gaming, LGBT, play, pokemongo, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0

Taking Leaps: Fortnite, HIPAA & Psychotherapy

May 31, 2018 by langloimsw Leave a Comment

“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.

Find this post interesting? I can speak in person too: Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book. 🙂

Filed Under: Gamer Therapy Tagged With: adolescents, avatar, children, digital literacy, Fortnite, Freud, gamers, games, gaming, HIPAA, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, technology, therapy, video games

The Crisis Behind Crises

April 10, 2018 by langloimsw Leave a Comment

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.

Find this post interesting? I can speak in person too: Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book.

Filed Under: Gamer Therapy Tagged With: adolescents, digital literacy, education, gamers, gaming, psych, psychology, therapy, video games

Boundaries and Health in the Digital Age

January 10, 2018 by langloimsw Leave a Comment

2017 saw an historic rise in women and men coming forward to speak out against sexual assault and harassment. Whether it was the #MeToo movement, news outlets, or Time’s naming the “Silence Breakers” Person of the Year, our society has felt a seismic shift in how we understand sexual misconduct.

A common misperception is that sexual harassment occurs in person between two people. In fact, boundary transgressions of this kind happen frequently between adolescents and adults who exclusively work with them “virtually.” Technologies such as social media, texting, video games and geosocial apps have allowed for greater connection and amplification in our lives. At the same time, with greater connection come new personal boundaries for both educators and the adolescents in their care.

Educators and counselors now find themselves inundated with daily examples and dilemmas: What do I do when a student brings me a nude text they received? When I overhear a YouTube video that is sexist or homophobic, how do I respond? Meanwhile, youth are trying to sort out unwanted attention on Facebook, demeaning chat while gaming, and humiliation on Snapchat resulting in school avoidance.

The possibility of turning technology off is no longer an option. Now we need to begin to recalibrate our thinking and teaching in light of it. Part of digital literacy and social emotional learning is the ways that we create and maintain respectful boundaries in learning communities. “Boundaries and Health in the Digital Age” is a project I’ve started to do just that.

I have worked with youth and their families for 25 years, and gained an understanding of them and the technologies they use. Through a combination of presentation and discussion tailored to your needs, I can provide education and support around a topic which is both charged and urgently needed. Far from being anti-technology, I’m helping agencies and learning communities appreciate and understand the power of the digital world to amplify harm AND healing. Talking, and more importantly, listening to youth, we CAN help them create and maintain healthy boundaries both online and in person.

As a Teaching Associate in Psychiatry at Harvard Medical School, I consult and educate on the topics of adolescence, technology and mental health. If you are interested in having me come work with you, email mike@mikelanglois.com for more information. If you want more information before you do that, check out my Public Speaking page for videos and reviews.

Filed Under: Gamer Therapy Tagged With: activism, adolescents, digital literacy, education, psychology, psychotherapy, social media, stress, technology, Web 2.0

What Disruption Is, and Isn’t

January 2, 2018 by langloimsw Leave a Comment

As I sat down to start the new year, I was thinking about an interesting Vanity Fair article I’d just read by Emily Chang, detailing the sexually predatory parties of Silicon Valley. In it, she describes a group of tech industry “hotshots [who]… proudly about how they’re overturning traditions and paradigms in their private lives, just as they do in the technology world they rule.”

I juxtapose this with conversations I’ve had recently with Trump supporters, one of whom said to me, “Yes, I know he’s a sociopath, he’s a fool, but he has tapped into the spirit of our time for many of us.” I try assiduously to avoid betting political on these posts, but the two quotes I just shared crystallized for me something that has been concerning me for sometime; namely, what “disruption” is and what it isn’t.

As a therapist and social worker who focuses on the impact of emerging technologies on our human condition, I am extremely interested in the concept of disruption. I do think we are seeing the disruption of our economies by Bitcoin, our news media by Twitter, and our politics by Facebook. I do think technological advances are disrupting the Post-Industrial concept of work, and Khan Academy and gamification are disrupting the relevance and primacy of traditional education. And from the Arab Spring to live streaming police brutality and organizing activists by the thousands by using a hashtag, I think social media has begun to disrupt systems of power that have been in place for centuries. I do think these forms of disruption have some things in common: They are often unforeseen by most if not all of us; and they call to society for a response.

There is nothing unforeseen to me about what is detailed in the Vanity Fair article, except the idea that the participants in her “Brotopia” are disrupting anything. There is nothing disruptive, nothing innovative about the use of gender inequality for power plays and gratification. And although we may feel called to respond to the article itself, that is what is disruptive. (In fact Vanity Fair, has been disrupting in an amazing way recently.) Nor is the current administration unforeseen, backlashes never are, really.

In my workshops I talk about how technology always amplifies things. Whether it be hate (books like Mein Kampf), information (Google,) misinformation (Russian bots,) attachment (Skype,) connection (pencils to write letters, LinkedIn,) reach (telegraph) or impact (hammers,) technology always amplifies. There is a big difference between disrupting existing systems of oppression and amplifying existing ones.

I am deeply concerned that people have begun using the concept of disruption to cover up or justify the actual attempts to amplify hatred. It is hard to notice what we are NOT seeing. We are not seeing parties of Silicon Valley women preying on aspiring young men, or in fact non-gender binary elites preying on cis gender people. When people talk about making America great again, that is not the language of disruption. The use of social media to “cyberbully” is not disruptive either, but an amplification of bullying that research has shown is often present in the physical environment of victim and perpetrator.

Technology often disrupts with no regard to the humans using it, because a hammer doesn’t tell you whether you “ought” to use it. But technology itself does not have an agenda. Technology does, however, as Martin Heidegger said, reveal us. Technology uncovers who we are, and sometimes that is not pleasant. Other times technology reveals human phenomenon like attachment.

As we enter a new year, I invite all of you to think carefully about what disruption is and is not. What and how are we using technologies? Are people claiming to be “disrupters” actually innovating and changing existing systems; or are they in fact a backlash from the existing systems against innovation and change? Does it feel surprising or unforeseen, or does it feel tedious? Do you feel called to respond or avoid? And as 2018 begins I’ll ask you what I often ask my audience: What do you want to amplify?

Find this post interesting? I can speak in person too: Click here for Public Speaking info & Press Kit. And, for only $4.99 you can buy my book.

Filed Under: Gamer Therapy Tagged With: behavior change, digital literacy, mindfulness, psychology, social justice, technology, Web 2.0

Mindfulness, Minecraft & The I Ching

March 5, 2016 by langloimsw Leave a Comment

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!

Find this post interesting? 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: adolescents, behavior change, children, Confucianism, digital literacy, education, gamers, games, gaming, I Ching, meditation, mindfulness, minecraft, play, private practice, psychodynamic, psychology, psychotherapy, technology, therapy, video games

A New Startup Focusing on Minecraft & Social Emotional Learning

January 4, 2016 by langloimsw 4 Comments

Happy New Year, Gentle Reader!

I wanted to let you know about a new startup project that launches this month that you may find of interest called Grokcraft.

Grokcraft is a Minecraft server, learning lab, & community where parents, kids & professionals engage in playful collaborative social-emotional learning (SEL.) All our members are vetted & for youth require parent permission to participate. Our counselors are available to mentor youth in SEL. Our youth group, Grok Corps, will be open to those who want to be trained in conflict resolution & online moderation. Our vision is that kids will not avoid conflicts as much as learn to resolve them when they arise. We believe that in free play, children & adults can learn mindfulness, empathy & other social skills in a playful environment. You can read more about this in our Manifesto. With both adult and youth groups approaching with complementary educational needs & abilities in SEL & tech skills, there are constant opportunities for collaboration embedded in (most importantly!) fun.

Grokcraft is an educational rather than therapeutic milieu. Based on the educateur model, professionals are encouraged to refer clients who would benefit from play-based social emotional learning. Some examples of people who might refer:

A psychotherapist who has a patient needing to improve mindfulness, relational skills or empathy training beyond the clinical hour
A speech & language therapist who wants to provide a student with more opportunities for social pragmatic skills acquisition
A special educator who with students who need more opportunities to learn & practice SEL
A parent or professional who wants a child in their care to have a Minecraft community that is safe & supportive & vets each member personally

At the same time, Grokcraft provides a high-touch learning environment for adult educators & clinicians to learn how to use Minecraft in their work. Monthly seminars for educators, in-game coaching & instruction are available to give professionals a fun way to learn & practice 21st-century game play & add it to their professional repertoire. Some examples of professionals who may benefit:

A psychotherapist who wants clinical training in online play therapy techniques from experts
A speech & language therapist who wants a place to provide social pragmatics groups
A special educator who wants a secure place to have virtual field trips/project-based learning
A parent who wants parent guidance around digital literacy & SEL
All of the above who want a peer community where they can exchange ideas & develop community that is not technophobic

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!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, building your business, children, digital literacy, education, game theory, gamers, games, gaming, grokcraft, mindfulness, minecraft, psychodynamic, psychology, social justice, social media, technology, video games, Web 2.0

Heroes

November 1, 2015 by langloimsw Leave a Comment

This post is more personal than some, but then at some time in many of our lives cancer gets personal. As many of you know, I have a companion and co-therapist named Boo. For the past 12 years Miss Boo has worked with me to help in therapy. We have worked with hundreds of children, adolescents and adults in settings ranging from special needs classrooms, alternative schools and outpatient settings. And for the past decade we have been working together in my private practice.

This past Spring Boo developed a form of cancer known as osteosarcoma, which is a form of cancer where the tumor grows in the bone. In her case, Boo began limping and we discovered that she had it in her front right leg. What followed was a series of scary tests and decisions. The recommended treatment for this in dogs is amputation of the limb and a course of chemo. I was worried about this on so many levels: I didn’t want to lose my friend, I didn’t want her to be in pain, and how was I doing to explain this to my patients? You can’t just have a dog show up one week with one less leg and be all blank screen about it. Some people suggested I retire her, but so many people come to me with ruptures in attachment, people who just walked out on them or were taken from them, that that didn’t make sense either. Nope, we were going to do this honestly and mindfully. If Boo could show up for such a challenging treatment, I could show up for her and we could show up for our patients.

Over the next few weeks I let people know what was going on if they wanted to know, to the extent they wanted to know. While she was recovering from surgery I let people know that as well. And when Boo came back to work, well that was a powerful week. Cancer changes your body, but the self persists. Boo had a visible change, there was a scar. Some people approached petting her, some didn’t. Boo accepted all of them. Some people were reluctant to talk at first, imagining their problems were nothing compared to cancer or losing a leg, but we explored and put those concerns in perspective. We all had work to do, and we did it.

Time passed, and chemo ended. This is the result:

Each year, I take part in Extra Life, a worldwide celebration of the social impact of gamers of all kinds from video games to board games and tabletop RPG’s! Since 2010, Extra Life has raised more than $14 million to help children’s hospitals provide critical treatments and healthcare services, pediatric medical equipment, research and charitible care. Your donation is tax-deductible and ALL PROCEEDS go to help kids nationwide and locally at my awesome colleagues at Boston Children’s Hospital.

This year, on November 7th, I’ll be playing World of Warcraft with a special avatar in honor of Boo. (Of course I’ll be taking breaks every 45 minutes to keep my health ans stamina in good shape.) If you want to join our team, Miss Boo’s Battalion, you can do that too!* You don’t have to play WoW, you can play Minecraft, Dark Souls, Candy Crush, my colleague Jane McGonigal’s Superbetter, Zombies Run!, anything. You can play Tabletop games like D&D or Pathfinder. You don’t have to go 24 hours straight, any amount of time, anything you raise, helps. Sharing the post helps too–you never know who might decide to donate or get their game on.

Miss Boo is my hero, and if you are living with cancer in your life you are my hero too. Whether you are battling it yourself, defeating it, thriving after it, supporting someone who is, celebrating a win or grieving a loss, you are a hero. On Saturday, November 7th, why not be a hero too?

*Past and present patients are asked to refrain to protect their privacy, but can always get involved with Extra Life on their own here.

Filed Under: Gamer Therapy Tagged With: activism, adolescents, behavior change, cancer, digital literacy, education, extra-life, gaming, mindfulness, private practice, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft

Better Living Through Minecraft

April 22, 2015 by langloimsw 2 Comments

Last month I had the opportunity to talk at SXSW 2015 about how the video game Minecraft has a lot to teach us about mindfulness. Video games often get a bad rap with mental health folks, but I try to change that thinking by pointing out that playing video games can actually be a form of concentration meditation, albeit one that does not jibe with many people’s traditional concepts of such (focus on your breathing, focus on the candle, focus on..erm, Mario?) If you want to hear more, the Audio is here:

https://soundcloud.com/michael-langlois-6/better-living-through-minecraft-audio-version

If you want to see the visuals from the Prezi, feel free to do so here:

If you enjoy it, please feel free to share, and if you want me to come talk to you and your colleagues drop me a note.

Filed Under: Gamer Therapy Tagged With: activism, adolescents, behavior change, buddhism, children, digital literacy, education, game theory, gamers, games, gaming, mindfulness, minecraft, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, sxsw, technology, therapy, video games, Web 2.0

The Internet & Real Relationships

January 11, 2015 by langloimsw 7 Comments

Today I was slicing some lemons for shish kabobs and so not surprisingly I began to think about social media, attachment and what constitutes an authentic relationship.

Authenticity was a key term when I was becoming a therapist in the mid nineties, and society in general. Today, most people I have spoken to in the mental health profession would say our happiness in part depends on having authentic relationships with others. Setting aside for a moment that we often talk about “authenticity” as if there is one monolithic thing that “everyone knows” it is, this belief in the connection between authentic relationships and happiness often gives psychotherapists, social workers and educators their moral imperative to discourage use of technology. That’s where the lemons come in.

Ten years ago, I met my friend Jackie Dotson on the bulletin boards of Psychology Today. These bulletin boards were designed for clinicians to have an online forum where they could discuss a range of issues, make referrals, and share ideas. They were also a place where early-adopting clinicians stumbled and experimented, behaved badly, gossiped and misspoke, as we tried to make sense of emerging technologies. I remember heated online conversations about whether the forums were private and “safe,” where people were startled to consider that anyone could cut and paste your confidential posts anywhere on the web. People were emboldened or perhaps I should say “emoboldened” by the relative anonymity on the forum to say things that could be breathtaking in both their vulnerability and/or sadism. It was the Wild West of mental health on the web.

My interactions with Jackie were few and far between when she and I were both active there. It wasn’t until I moved on from the forums to spending more time on Facebook that I think we really began socializing more. Perhaps it was because FB allowed for a flow of text and images, more seamless interaction, and chat. Whatever the reason, over the past few years my life has intersected with Jackie more and more. We have several mutual acquaintances from the PT forums, and a mutual friend with whom I went to college with. I’m glad I friended her.

From 3,000 miles away, Jackie has crept into my online and emotional life with the secret code of affinity that could only be shared via social media. We share a love of bone marrow as evidenced by our food pics, and she has forced me to rethink my stance in social media workshops I do where I used to announce to my audience, “Nobody wants to see your food.” Our dark wit and banter is present more days than not in my FB feeds, I’ve even taken more of an interest in my local sports teams so I can insult hers. In return she pretends to be a bigot on LGBT issues to bait me. Although I’ve never told her explicitly, she has reassured me when I worried about how my picture looks online, and comforted me when my city suffered a terrorist attack.

And then last year she started sending me lemons. Real lemons.

Jackie lives in CA, and has at least one prolific lemon tree. Last year she offered to mail a box of them to anyone of her friends on Facebook for the price of shipping. I jumped at the chance. They arrived within days and were enjoyed by my family immensely. So immensely, that when Jackie began posting pictures of budding trees this year, I grew quite impatient for them. They arrived two weeks ago, and for the past two Sundays I have used them for cooking. As I write this, there are chicken kabobs marinating in lemon and thyme for tonight.

Jackie and I have never sat down together for a heart to heart or face to face conversation, but we carry our connection to each other throughout our day with our smartphones. In the decade that we have been in each others’ orbits, I suspect we have each known deep sadnesses that we haven’t spoken of to each other. Yet I am convinced that if I ever chose to reach out to her that way it would be okay and vice verse. Not all intimacy needs to be acted on.

That said, for two Sundays, as I have chopped and squeezed fresh lemons, I have thought of Jackie and smiled. I have imagined her and our conversations as I move through my kitchen, while my brain alters levels of different neurochemicals and changes my affective state in ways that are real and comforting to me.

The stubborn adherence to imagining that technological use inherently diminishes our authenticity has been eroding the mental health field’s relationship with the people we work with for decades now. Friends and colleagues of mine in the tech industry are consistently amazed that I still need to educate and advocate with my peers about this. Our profession continues to act as if relationship mediated by emerging technologies is one step removed from other relationships, less authentic because we use our bodies in different ways to achieve connection with each other. I wonder if our dogs feel that we are less authentic because we have replaced smelling butts with eye contact and uttering sounds all the time?

I jest, in part because I doubt our companion animals feels as fearful of becoming irrelevant as many of my colleagues do. I think this fear is only justified to the extent that we are dogmatic about what constitute authenticity for everyone. Pierre Teilhard de Chardin once said:

Love is the only force which can make things one without destroying them. … Some day, after mastering the winds, the waves, the tides and gravity, we shall harness.. the energies of love, and then, for the second time in the history of the world, man will have discovered fire.

I do not think it is the role of the therapist to be the arbiter of truth in what makes intimacy or authentic relationships. Our role is to help our patients explore their capacity and harness their energies for love in ways that may go beyond the imagination our own experience affords us. It is not for us to give them fire as gods would, but to help them make themselves whole without destroying them.

Filed Under: Gamer Therapy Tagged With: attachment, behavior change, de chardin, digital literacy, education, facebook, lemons, LGBT, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, stress, technology, therapy, Web 2.0

The Lava Expert

January 2, 2015 by langloimsw 2 Comments

“Sometimes it is the people no one imagines anything of who do the things that no one can imagine.” –The Imitation Game

Shortly before I fell into the lava I began a conversation with an eleven year old girl, we’ll call her Sal. This was a while back, on a Minecraft server I play on from time to time. My name when I play Minecraft has the word “therapist” in it, and Sal had noticed this.

“Hey, are you really a therapist?” Sal asked via our server text chat.

“Yes I am.” I typed back. I had been mining obsidian and using a river to cool the lava so I could chip away at it with my diamond pickaxe. In the time it took to type my reply, I managed to fall into the river and get washed into the lava. I watched myself go up in flames, and with me most of my loot. There is always a chance though, when one falls into lava this way, that some of one’s loot can be thrown clear. So upon respawning I quickly made my way back to the scene of my demise as we continued our conversation.

“Oops, burned up,” Sal said, as the server had announced just that when I fell in the lava. “Are you the kind of therapist that talks to kids about their problems?”

“Kids and adults both, yes.”

“My mother wants me to see a therapist,” Sal said.

“Why?” asked another one of the kids on the server.

“She says I have problems with friends,” Sal said. By this point I had returned to the lava pool. There was no loot that had survived.

“Sal,” I said. “Everyone needs help with their problems from time to time. That’s why there are 7 billion people on the planet, to help each other out.”

For some reason that made quite an impact with the other players. “Wow, you must be an expert!!” one typed. I’m not sure how he’d come to that conclusion.

“I’m certainly not an expert on lava,” I replied, and fortunately the conversation went back to the business of mining after some sympathetic emoticons.

I have no problem talking with kids about therapy, or being a psychotherapist. If I did, I certainly wouldn’t have the word in my userid. And it wasn’t even that I was “off duty.” I’ve had many conversations in chats over the years and heard a range of problems. In part I was a little protective of Sal’s right to privacy, although experience has again shown me that kids are often less hung up on therapy than adults, and in many ways are often more trusting of psychotherapy than adults are. Mostly the reason I wanted us all to get back to playing was that I had caught myself sounding “educational.”

* * * * *

In play if there is any such thing as an expert it is certainly not the therapist, or adults in general. Virginia Axline, knew this. In her book Play Therapy she writes, “Non-directive therapy is based upon the assumption that the individual has within himself… the ability to solve his own problems satisfactorily.” (Axline, 1947) My trainees are often as surprised to find that I am friend to both psychodynamic and solution-focused theories as I am to find that they have been taught the two have irreconcilable differences.

As I see it, my job is often to be a unique experience in the lives of patients. “It is a unique experience,” Axline writes, “for a child to find adult suggestions, mandates, rebukes, restraints, criticisms, disapprovals, support, intrusions gone.” (Axline, 1947) And by the time people come to us as adolescents or adults, those suggestions, mandates, rebukes, restraints, criticisms, disapprovals, etc. have become internalized. By adulthood, many of us feel as if we lack expertise in anything, except perhaps screwing our lives up.

Education has increasingly played a hand in this. We do not teach so that our students learn to think independently and feel resourcefully. Instead we teach them to think like someone else. Critical thinking and exploration become supplanted by the sense that education has to give us something tangible in a materialistic sense: A good grade; a profitable job; published ideas or maybe if we really drink the Koolaid admiration from other academics.

One thing that is so enjoyable about Minecraft for many is its’ open sandbox environment. There is an endgame you can play if you want, but there are also myriad variations of play you can do instead. Sal and millions of other children and adults can range freely through such open and creative spaces without “experts.” Education certainly can happen there, but often in a lightly curated if not autodidactive way. People have created versions of Westeros, Middle-Earth, Panem or their own creations. There are PvP versions where conflict and combat, stealth and griefing hold sway; fantasy realms where people can role-play. It is a topsy-turvy world where children can have the most wisdom, and we adult experts can trip and fall into lava.

* * * * *

In a world obsessed with measuring outcomes, psychotherapy can have a rough time of it. If Sal ever goes to therapy, she will have to be labeled as ill somehow if her mother wants insurance to help pay for it. Notes will have to be written, treatment plans planned, goals and objectives filed away so bean-counters can determine that Sal should get 14 beans-worth of help. It’s hard for me to get too angry at the bean-counters though, over the past 25 years I’ve met a few of them and they don’t seem too happy either.

Education fares little better, with things like the Common Core which tells us what should be taught; standardized testing which masquerades as achievement; and trigger warnings which are supposed to warn students of upsetting content as if they somehow were entitled to get through the mind-altering experience of learning without ever being upset.

It takes bravery to stand up to this. To let the individual chart their own course, make their own mistakes, draw on their own core. For the therapist and educator it takes bravery to get out of the way, to radically reflect the developing self. I do believe that each one of us needs help throughout our lives; but that help needs to be asked for lest we run the risk of telling others what to do and implying they aren’t up to the task of living their own lives.

* * * * *

Many therapists, social workers, and teachers I have met chose to become members of those professions at least in part as an expression of admiration for their own therapists, social workers and teachers. They had no interest in falling into the lava ever again, so they started focusing on helping other people out. It’s a thankless job if you are going to go through it secretly hoping to be thanked. I’m not sure I’ve ever had someone I work with refer to me as an “expert” unless they were being facetious about some blunder I’d just made. And I’ve made many. As an apotheosis, being a psychotherapist or academic is rather anticlimactic, not because the work is devoid of meaning or value, but rather because if we truly place such people on a divine pedestal it needs a steady stream of troubled people to hold it steady.

Perhaps an alternative for therapists, social workers, educators and our ilk is to think of ourselves as “lava experts.” We have some acquaintance with falling into pits, being consumed by intense feelings, losing all our, erm, loot. These are human experiences. This is not a secret to anyone, and I doubt most people would put their trust in someone who knows nothing of failure, obsession, overwhelm or grief.

What’s more is we’ve fallen into lava, often the same pit again and again! We know something of the repetition compulsion. We have let our yearning for whatever we think we need lead us to risky or self-defeating behaviors. We can talk to people about their problems, because we are people who have problems ourselves. We’ve been burned. Minecraft miners know mining deep is risky: We know what we’re doing even up to that moment our bones ignite.

Rather than being an expert on a pedestal, accept that you will tumble into fire, again and again, looking outside of yourself for what is precious. Straight A’s, that book you published, six or seven figures–There’s a little Gollum in all of us. It’s what makes us forget mindfulness, build empires, win arguments or wars. No one was ever oppressed by play, only the lack of imagination that comes from the absence of it.

Filed Under: Gamer Therapy Tagged With: activism, addiction, adolescents, behavior change, buddhism, children, digital literacy, education, game theory, gamers, games, gaming, HMOs, managed care, mindfulness, minecraft, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, virginia axline, Web 2.0

Using Gaming & Gamification in Clinical Practice

June 25, 2014 by langloimsw 4 Comments

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

Find this video interesting? 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: activism, addiction, adolescents, behavior change, call of duty, children, dark souls, education, game theory, gamers, games, gamification, gaming, mindfulness, minecraft, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft, wow

Gamer-Affirmative Practice: Today’s Play Therapy

June 13, 2014 by langloimsw 1 Comment

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

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

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

Find this podcast interesting? 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: addiction, adolescents, behavior change, call of duty, children, dark souls, digital literacy, education, game theory, gamers, games, gaming, mindfulness, minecraft, play, play therapy, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, video games, Web 2.0, World of Warcraft, wow

Bringing Emerging Technology into the Clinical Process: Implications for Engagement and Treatment

June 2, 2014 by langloimsw 1 Comment

If you have ever wondered how to begin attending to, listening for, and asking questions about a patient’s use of technology, this video might give you some ideas. In it my colleague Lesa Fichte, LMSW, University at Buffalo School of Social Work, and I, discuss the role of technology, people’s relationship with technology, and how to integrate it into the treatment process by listening, inquiring, and learning.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, digital literacy, education, facebook, gamers, games, gaming, LGBT, mental health parity, mindfulness, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, twitter, video games, Web 2.0, World of Warcraft

The Relationship Between Emerging Technology & Psychodynamic Theory

May 23, 2014 by langloimsw Leave a Comment

Often when I present, people are surprised that I teach on both emerging technologies such as social media and video games, and classic psychodynamic theories. Although it may initially seem counterintuitive, especially to classically trained psychotherapists and social workers, I see a strong connection between the two. Here is the first in a series of posts featuring work I am doing with the University at Buffalo, in which Charles Syms and I discuss the relationship between the two.

Filed Under: Gamer Therapy Tagged With: activism, building your business, digital literacy, education, emerging technology, Freud, game theory, gamers, games, gaming, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, video gmaes, Web 2.0

Works, Life and Marshmallows: Iterative Design

February 13, 2014 by langloimsw 2 Comments

They say the journey of a thousand miles begins with a single marshmallow. Ok, I say that, and more specifically I am talking about your life, job or relationship rather than a journey. I am coming back to my practice from a brief sabbatical, and have been noticing that while many things are going to stay the same, a few are changing as well. I’ll get back to the marshmallow in a minute.

One thing I learned on my sabbatical is that I definitely want to continue my therapy practice. As I said to some friends on Facebook this week, “You know, I’m kind of grateful that I get to challenge the self-hatred of others for a living.” As a clinical social worker and psychotherapist I get paid to do that. One thing I also decided on my leave was to withdraw from the last managed care insurance panel I was on. It made no sense to continue to decrease the time I could be seeing people due to paperwork and bureaucratic hassles, and it made no financial sense to have a waiting list of people who are willing to pay my full fee and also deserve treatment just so I could work at half my rate. I have always built pro bono or sliding scale slots into my practice because I have a commitment to serving a diverse population, so why was I doing that and letting an insurance company slide the remaining hours of my week?

Part of the answer to this and most “why-have-I-been-doing-this-this-way-when-it-doesn’t-work-in-my-favor?” questions is fear. Most of us are afraid of change. Whether we are staying in an abusive relationship, having difficulty getting sober, flunking out of college or missing days at work, most of us have moments when we see what we are doing to ourselves and ask the above question. And then we often resume whatever the pattern is, leaving an interesting question unanswered and instead turning it into self-recrimination, which is really just evasion. Another part of the answer is that we often act is if we only get one shot at answering the question of life satisfaction. Here comes the marshmallow.

Invented by Peter Skillman of Palm, Inc. and popularized by Tom Wujec of Autodesk, the Marshmallow Challenge may be familiar to some of you: “It involves the task of constructing the highest possible free-standing structure with a marshmallow on top. The structure must be completed within 18-minutes using only 20 sticks of spaghetti, one yard of tape, and one yard of string.” (per Wikipedia) You can call it an exercise, or play, but in either event the creators of the challenge have observed something very interesting about how different groups tend to approach it. Children tend to make a first structure, stick the marshmallow on top, and then repeat the process over and over, refining it as they go. Adults tend to engage in group discussions, arguments, power plays and plans to produce one structure built once to which the marshmallow is added. In other words they tend to approach it derivatively rather than iteratively.

Iterative design is a method of creating a thing or addressing a problem by making a prototype (first attempt,) testing it, analyzing the prototype, and then refining it. Rinse and repeat. Iterative design isn’t good for everything: As parents know, often there is not time in the world for everything to get done in 18 minutes or before the school bus gets here. But a life built on derivative design alone is destined for stagnation and rigidity.

Derivative design, as the name suggests, takes something from a pre-existing something-else, whether it be a rule, materials, social construction or interpretation of the something-else. When you psychoanalyze a patient’s dream and interpret it as a manifestation of their Oedipus Complex, you are deriving your interpretation and their dream from the something-else of Freud, who in turn derived his Oedipal Conflict theory from the something-else of Greek mythology. Derivative design can save time and effort in many important ways, by collapsing cultural memes and thinking and transmitting them forward through time from Sophocles to your office. But as feminist thinkers and cultural critics have shown us, we might have arrived at a different “complex” if Audre Lord et al had been in on the prototyping of it.

Derivative thinking left unchecked can get you in a rut. One of my most recent examples of this comes from The Little Prince, where he encounters the drunkard:
“- Why are you drinking? – the little prince asked.
– In order to forget – replied the drunkard.
– To forget what? – enquired the little prince, who was already feeling sorry for him.
– To forget that I am ashamed – the drunkard confessed, hanging his head.
– Ashamed of what? – asked the little prince who wanted to help him.
– Ashamed of drinking! – concluded the drunkard, withdrawing into total silence.
And the little prince went away, puzzled.
‘Grown-ups really are very, very odd’, he said to himself as he continued his journey.”

Everything derives from the previous thing, but in the end it sometimes gets us nowhere.

We all get in these difficult spirals. A good therapist or supervisor can point them out to us and then encourage us to become iterative in our design:

So what are you going to do this time?
How did that work out?
So what are you going to do differently?

Therapists starting their private practices also come to see me, often stuck in derivative thinking:

-I need my NPI number.
-Ok, why?
-To get on Medicare.
-Ok, because?
-So I can get on insurance panels.
-Ok, why?
-So I can get patients who will pay me so I can rent an office so I can have an address to register for my NPI.

If you are one of my consultees reading this rest assured I am NOT talking about you in particular: I have had this conversation a hundred times with people. We get indoctrinated into the world of managed care and get, well, managed. In this case, I usually recommend the consultee start by imagining what kind of office space they want. Answers have varied and included: Sunny, exposed beams, plants, yellow paint, toys, music system, waiting room with receptionist, friendly colleagues in suite, accessible to public transportation, elevator, warm colors, cool colors, and all sorts of other iterations.

Once you have a mental prototype you can either build or design your office, or find and rent it. Again I tell folks to walk around the areas they want to work in, find buildings that look interesting to them, then walk inside and ask to speak with someone about seeing a unit. Testing involves going to see several spaces. Then they can analyze the results: Does the space look like it would become what they imagine it to be furnished? Are there things about their ideal that need to be discarded? Do they now realize that they could be even more wild in their expectations?

This is just one example of the ways that iterative design can open up possibilities. But be warned, iterative design can be daunting for many of us raised in our current education system. We have been trained to create one product presented in final form with the expectation that we will be graded on that product alone. Everything becomes about that one paper or exam, which is often more about regurgitation rather than innovation.

I have colleagues who take my breath away with the number of projects and ideas they are consistently throwing out there to see what happens: It takes guts to do that. I myself often am afraid that the Project Police are going to pop out and say, “What happened to your idea of a Minecraft group? Shame on you for proposing it and not completing that project! You are not allowed any more ideas until you show us you can carry that one out.”

Sound ridiculous? Of course it is, but does it sound familiar to you as well? If it does, go out and buy yourself some spaghetti, tape and marshmallows: The quality of your job, relationship and life may depend on it.

Interested in setting up a consult for your practice? I have some openings come March. 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: addiction, behavior change, buddhism, building your business, children, education, gamers, games, gaming, marshmallows, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, social justice, technology, therapy, video games, Web 2.0

No Matter How You Feel, You Still Failed

January 14, 2014 by langloimsw 4 Comments

Psychotherapists are often people who prefer to deal with feelings in their workings with people. Feelings are important, and being empathically attuned to how patients are feeling is equally important. We are taught to explore the patient’s feelings, imagine ourselves into their lived experience, and validate that experience.

This is often where we become disconnected from other professionals we collaborate with, such as educators. Be it Pre-K or graduate school, educators are charged with working with students to learn and grow as a whole person. It’s not that they aren’t concerned with feelings, they just can’t get hung up on them to the exclusion of everything else.

To be fair, psychotherapy has a long history of taking a broader view on the individual as well. A famous psychoanalyst, Winnicott, once responded to a patient of his who was expressing feelings of hopelessness by saying something to the effect of “sometimes when I am sitting with you I feel hopeless too, but I’m not going to let that get in the way of continuing to work with you.”

But often in the past decade or two, feelings have held sway over everything. Students don’t complete their assignments because they felt overwhelmed and still expect to pass the course. Adults feel emotionally exhausted and miss work or are late to it. Children feel angry at the injustice of chores and don’t do them but still want their allowance.

A criticism I often hear toward video games is that they encourage people to believe that they can always just reset, do over and have another shot. But implicit in this criticism is the fact of something I feel video games actually do better than many of us sometimes: They acknowledge the reality of failure.

When we play video games, we are failing 80% of the time. Failing in the sense of Merriam Webster’s definitions including:

to not succeed : to end without success
to not do (something that you should do or are expected to do)
to fall short <failed in his duty>
to be or become absent or inadequate
to be unsuccessful

In video games the reality of this is driven home to us by a screenshot:

You can feel any way you’d like about it, angry, sad, annoyed, blase, frustrated with a touch of determination. But no matter how you feel you still failed.

In life outside games, many of us have a hard time accepting the reality principle when it comes to failing at something. We think we can talk, think, or feel our way out of failing to meet expectations. My own predilection is that of a thinker, which is probably why I became a psychodynamic psychotherapist and educator. I often waste a lot of time trying to think (or argue) myself into a new reality, which just boils down to not accepting the reality principle. I notice the same with patients, colleagues and students, who miss deadlines, avoid work, come late to class and then try their best to think or feel their way out of it.

The first class each semester I tell my students, who are studying to be social workers and psychotherapists, that the most frequent complaint I get as an instructor is “I feel put on the spot by him.” I assure them that this is a valid feeling and actually reflects the reality that I will put each and every one of them on the spot. I will ask them tough questions, I will point out that they are coming late to class, I will disagree with ideas that seem erroneous to me. Because if they think it is ok to be late or avoid thinking through a problem or confrontation in class, how in the world will they ever be a decent psychotherapist or social worker? If the single mother you are working with wants to know how to apply for WIC, and you say you feel put on the spot by her question, that is a valid feeling AND you are useless to her. If your therapist was 15 minutes late every week I hope you’d fire him. And when you are conducting a family session and someone discloses abuse it is unprofessional to say “I’m feeling overwhelmed and sad right now, can you ask somebody else to go next?”

These sort of disconnects doesn’t happen overnight. It comes from years of being enabled by well-intentioned parents and yes, mental health providers who focus on feelings to the exclusion of cognition and behavior, and worse, try to ensure that their children grow to adulthood feeling a constant sense of success. When I hear self psychology-oriented folks talk it is almost always about mirroring and idealizing, and never about optimal frustration. And I suspect that this is because we have become so focused on feelings and success that we are preventing people from experiencing optimal frustration at all.

The novelist John Hersey has said “Learning starts with failure; the first failure is the beginning of education.” We commence to learn because reality has shown us that we lack knowledge or understanding. That’s the good news. We’ve woken up! In this light I regard video games as one of the most consistent learning tools available to us. When that fail happens and that screen goes up you can try to persuade it to cut you some slack, flatter or bully it, weep pleadingly for it to change to a win, but no matter how you feel, you still failed. And because that reality is so starkly there, and because the XBox or PS3/4 doesn’t get engaged in your drama, that feeling will eventually dissipate and you will either try again, or give up.

Because that is in a lot of ways the conflict we’re trying to avoid isn’t it? We want to avoid looking reality square in the face and taking responsibility for what comes next. We want to keep the feelings flowing, the drama going, and we are willing to take entire groups of people and systems with us. If we are lucky they put their feet down, but more often then not they want to avoid conflict too, and the problem just continues.

So here’s a confession: I have failed at things. I have ended a task without success. I have not done things I was expected to do. I have fallen short, been inadequate and been unsuccessful at stuff. And nobody took away my birthday. I’m still around doing other things, often iterations of the previous failures, quite successfully.

If you are a parent or educator please take a lesson from video games. Start saying “Game Over” to those in your care sometimes. If they can try again great. If they want to read up on some strategy guides or videos to learn how to do it better, awesome. But please stop capitulating to their desire to escape reality on the illusory lifeboats of emotional expression, rationalization or verbal arguments. As Mrs. Smeal says in “Benny and Joon,” “when a boat runs ashore, the sea has spoken.” Reality testing is probably the most important ego function you can help someone develop, please don’t avoid opportunities to do so.

Nobody likes to experience failure, I know it feels awful. But to move through it to new realizations can be very liberating, and in time become more easily bearable. And I truly believe that success without past failures feels pretty hollow. When I play through a video game from start to finish without a fail I don’t feel like a winner. I feel cheated.

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: addiction, adolescents, behavior change, buddhism, building your business, children, digital literacy, education, ego psychology, failure, Freud, gamers, games, gaming, Kohut, mindfulness, minecraft, optimal frustration, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, reality testing, ROI, self psychology, social justice, social work, stress, technology, therapy, video games

Reality Testing & The 7 Billion Rule

December 20, 2013 by langloimsw 3 Comments

In this video, I discuss the ego function of reality testing, how it affects us, and ways to cope with distortions in it. This is also another example of how I use technology, in particular YouTube as a transitional object for patients, allowing them to continue to remember our work together without compromising any of their personal health information.

This will be the last post for 2013, have a good end of the year and I’ll see you sometime in late January!

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: adolescents, behavior change, children, cognitive distortions, distortions, education, ego, ego psychology, Freud, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, reality testing, social media, stress, technology, therapy, Web 2.0

Obama, Selfies, Projections & Death

December 11, 2013 by langloimsw 1 Comment

In this video Mike Langlois, LICSW gives an analysis of what the furor around President Obama’s selfie at Mandela’s funeral could say, not about him, but us.

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: activism, behavior change, digital literacy, education, facebook, mandela, mindfulness, obama, obamaselfie, psychoanalysis, psychodynamic, psychology, psychotherapy, selfie, social justice, social media, technology, therapy, Web 2.0

Selfie Esteem

December 2, 2013 by langloimsw 6 Comments

Nancy J. Smyth, PhD, Dean & Professor, University at Buffalo

“Photographs do not explain, they acknowledge.” –Susan Sontag

Last month, the Oxford Dictionary made the word “selfie” not only an official word, but their word of the year for 2013. Defining selfie as “a photograph that one has taken of oneself, typically one taken with a smartphone or webcam and uploaded to a social media website” the OD made explicit what has implicitly grown to be the norm of our world; a world of smartphones, self pics and social media.

Many psychotherapists and social workers have and will continue to decry this as another sign the the “narcissism” of our age. Selfies have become synonymous with the millenials, the dumbing down of the populace by the internet, and sometimes even stretching to how Google is making us stupid. My chosen profession has historically played fast and loose with calling people and cultures narcissistic. Karen Horney coined the term “the neurotic personality of our time” in the 1930s, initially in part as a critique to the Freudian critique of Victorian modesty. Kohut’s groundbreaking work on “tragic man,” and the healthy strands of narcissism in human life was co-opted within years by Lasch (1979) to describe the then-current “culture of narcissism.” In short, even though narcissism has been a part of human being at least since Narcissus gazed into the water in Greco-Roman times, we continue to see it as perennially on the uprise.

Joanna Pappas, Epic MSW Student

This dovetails with each generation’s lament that the subsequent one has become more self-absorbed. And yet, as Sontag points out, by making photography everyday, “everybody is a celebrity.” Yep, that’s what we hate about the millennials, right? They think everything is an accomplishment, their every act destined for greatness. But as Sontag goes on to say, making everybody a celebrity is also making another interesting affirmation: “no person is more interesting than any other person.”

Jonathan Singer, Assistant Professor, Temple University

Why do many of us (therapists in particular) have a problem then with selfies? Why do we see them as a “symptom” of the narcissism of the age? Our job is to find the interesting in anyone, after all. We understand boredom as a countertransference response in many cases, our attempt to defend against some projection of the patient’s. So why the hating on selfies?

I think Lewis Aron hits on the answer, or at least part of it, in his paper “The Patient’s Experience of the Analyst’s Subjectivity.” In it he states the following:

I believe that people who are drawn to analysis as a profession have particularly strong conflicts regarding their desire to be known by another; that is, they have conflicts concerning intimacy. In more traditional terms, these are narcissistic conflicts over voyeurism and exhibitionism. Why else would anyone choose a profession in which one spends one’s life listening and looking into the lives of others while one remains relatively silent and hidden?

(Aron, A Meeting of Minds, 1996, p. 88)

In other words, I believe that many of my colleagues have such disdain for selfies because they secretly yearn to take and post them. If you shuddered with revulsion just now, check yourself. I certainly resemble that remark at times: I struggled long with whether to post my own selfie here. What might my analytically-minded colleagues think? My patients, students, supervisees? I concluded that the answers will vary, but in general the truth that I’m a human being is already out there.

Mike Langlois, PvZ Afficianado

Therapists like to give themselves airs, including an air of privacy in many instances. We get hung up on issues of self-disclosure, when what the patient is often really looking for is a revelation that we have a subjectivity rather than disclosure of personal facts. And as Aron points out, our patients often pick up on our feelings of resistance or discomfort, and tow the line. One big problem with this though is that we don’t know what they aren’t telling us about because they didn’t tell us. In the 60s and 70s there were very few LGBT issues voiced in therapy, and the naive conclusion was that this was because LGBT people and experiences were a minority, in society in general and one’s practice in specific. Of course, nobody was asking patient’s if they were LGBT, and by not asking communicating their discomfort.

What has this got to do with selfies? Well for one thing, I think that therapists are often similarly dismissive of technology, and convey this by not asking about it in general. Over and over I hear the same thing when I present on video games–“none of my patients talk about them.” When I suggest that they begin asking about them, many therapists have come back to me describing something akin to a dam bursting in the conversation of therapy. But since we can’t prove a null hypothesis, let me offer another approach to selfies.

All photographs, selfie or otherwise, do not explain anything. For example:

People who take a selfie are not explaining themselves, they are acknowledging that they are worth being visible. Unless you have never experienced any form of oppression this should be self-evident, but in case you grew up absolutely mirrored by a world who thought you were the right size, shape, color, gender, orientation and class I’ll explain: Many of our patients have at least a sneaking suspicion that they are not people. They look around the world and see others with the power and prestige and they compare that to the sense of emptiness and invisibility they feel. Other people can go to parties, get married, work in the sciences, have children, buy houses, etc. But they don’t see people like themselves prevailing in these areas. As far as they knew, they were the only biracial kid in elementary school, adoptee in middle school, bisexual in high school, trans person in college, rape survivor at their workplace.

So if they feel that they’re worth a selfie, I join with them in celebrating themselves.

As their therapist I’d even have some questions:

What were you thinking and feeling that day you took this?
What do you hope this says about you?
What do you hope this hides about you?
Who have you shared this with?
What was their response?
What might this selfie tell us about who you are?
What might this selfie tell us about who you wish to be?
Where does that spark of belief that you are worth seeing reside?

In addition to exploring, patients may find it a useful intervention to keep links to certain selfies which evoke certain self-concept and affect states. That way, if they need a shift in perspective or affect regulation they can access immediately a powerful visual reminder which says “This is possible for you.”

Human beings choose to represent themselves in a variety of ways, consciously and unconsciously. They can be whimsical, professional, casual, friendly, provocative, erotic, aggressive, acerbic, delightful. Are they projections of our idealized self? Absolutely. Are they revelatory of our actual self? Probably. They explain nothing, acknowledge the person who takes them, and celebrate a great deal. If there is a way you can communicate a willingness see your patient’s selfies you might be surprised at what opens up in the therapy for you both.

Melanie Sage, Assistant Professor, University of North Dakota

In other posts I have written about Huizinga’s concept of play. Rather than as seeing selfies as the latest sign that we are going to hell in a narcissistic handbasket, what if we looked at the selfie as a form of play? Selfies invite us in to the play element in the other’s life, they are not “real” life but free and unbounded. They allow each of us to transcend the ordinary for a moment in time, to celebrate the self, and share with a larger community as a form of infinite game.

It may beyond any of us to live up to the ideal that no one is less interesting than anyone else in our everyday, but seen in this light the selfie is a renunciation of the cynicism I sometimes see by the mental health professionals I meet. We sometimes seem to privilege despair as somehow more meaningful and true than joy and celebration, but aren’t both essential parts of the human condition? So if you are a psychotherapist or psychoeducator, heed my words: The Depth Police aren’t going to come and take your license away, so go out and snap a selfie while everyone is looking.

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: adolescents, avatar, behavior change, children, digital literacy, education, game theory, gamers, games, gaming, LGBT, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, selfies, social justice, social media, video games, Web 2.0

The Changing Landscape of Social Work

November 17, 2013 by langloimsw Leave a Comment

Recently I had the great opportunity to be a scholar-in-residence at The University at Buffalo’s School of Social Work. For three days I met with students, faculty and staff to speak about emerging technologies ranging from Twitter to video games. During one morning, Dean Nancy Smyth and I sat down for a series of informal discussions around various topics, and the University was kind enough to let me share these videos with you. If you want to learn more about how I can come to your institution to do the same thing, please contact me.

How to Use Social Media and Technology to Develop a Personal Learning Network:

http://www.youtube.com/watch?v=zb74jYN0k5Y&feature=share&list=UUQG8usDJjq8OjMgtNDQC6fg

If I Don’t Use Social Media and Technology in Social Work Practice What Am I Missing?

Social Work is Changing: Integrating Social Media and Technology Into Social Work Practice

http://youtu.be/FQWUMTxXVus

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: adolescents, behavior change, buddhism, building your business, digital literacy, education, facebook, gamers, marketing, mental health parity, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, twitter, video games, Web 2.0

Evocation and Mindfulness: Or, How to Think Better

October 16, 2013 by langloimsw 2 Comments

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.

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: behavior change, building your business, digital literacy, education, game theory, gamers, games, gaming, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, stress, video games, World of Warcraft, wow

Mental Health: Yes, There’s an App for That..

October 6, 2013 by langloimsw 2 Comments

Nobody wants to be irrelevant, and many mental health practitioners want to try out new technologies like Apps, but how to choose? Currently the App Store in iTunes makes available 835,440 different Apps, of which approximately 100,000 are categorized as lifestyle, medical or healthcare & fitness. And Android users have just about as many to choose from according to AppBrain, which says there are a whopping 858870 as of today. With so many to look at, how can a clinician keep current? Hopefully we can help each other.

Instead of writing the occasional “Top 10 Post,” I’m setting up a site for you to visit and review different Apps. I’ll review some too, and hopefully by crowd sourcing we can get a sense of what are some of the best. I’ll need Android users to weigh in heavy, as I will be test-driving Apple products alone.

Why have I decided to do this? Several reasons, the complicated one first:

1. Web 2.0 is interactive. We forget that, even those of us who are trying to stay innovative. We keep thinking we need to get on the podium and deliver lectures, information, content. And to a degree that is true, but we can easily slide back to the old model of doing things. That’s what you see in a lot of our well-intentioned “Top 10 App” posts and articles. Recently I found myself trying to explain on several occasions why doing a lecture or post on the best Apps for Mental Health didn’t sit right with me. Part of it was because Apps are put out there so fast, and then surpassed by other apps, that it becomes a bit like Project Runway: “One day you’re in, the next day you’re out.”

I was getting trapped behind that podium again, until I realized that we don’t need another post about the top 10 mental health apps, we need an interactive platform. I need to stop acting as if I’m the only one responsible for delivering content, and you need to break out of the mold of passive recipient of information. I’m sure that many of my colleagues have some suggestions for apps that are great for their practice, and I’m hoping that you all share. Go to the new site, check out some of the ones I mentioned, and then add your own reviews. Email me some apps and I’ll try ’em and add them to the site. Let’s create something much better than a top 10 post with an expiration date, let’s collaborate on a review site together. Which brings me to:

2. I want to change the world. That is the reason I became a social worker, a therapist, and a public speaker. I think ideas motivate actions, and actions can change the world. The more access people have to products that can improve their mental health, the better. By creating a site dedicated solely to reviewing mental health applications, we can raise awareness about using emerging technologies for mental health, and help other people improve their lives. Technology can help us, which brings me to:

3. Technology can improve our mental health. Yes, you heard it here. Not, “we need to be concerned about the ethical problems with technology X,Y or Z.” “Not, the internet is making us stupid,” or “video games are making people violent,” but rather an alternate vision: Namely, that emerging technologies can allow more people more access to better mental health. Let’s start sharing examples of the way technology does that. There are Apps and other emerging technologies that can help people with Autism, Bipolar, Eating Disorders, Social Phobias, Anxiety, PTSD and many more mental health issues. I can’t possibly catalog all those alone, so I’m hoping you’ll weigh in and let me know which Apps or tech have helped you with your own struggles.

Is this the new site, Mental Health App Reviews, a finished product? Absolutely not. What it will be depends largely on all of us. This is how crowd sourcing can work. This is how Web 2.0 can work.

If you want to contribute, just email me at mike@mikelanglois.com with the following:

App name
Screenshot if possible
Price
Link to App

and I’ll take it from there. Please let me know if you are a mental health provider and or the product owner in the email as well.

You can also contribute by reviewing the Apps below that you use. Be as detailed as possible, we’re counting on you! And while you’re at it, follow us on Twitter @MHAppReviews

Filed Under: Gamer Therapy Tagged With: activism, Apps, behavior change, digital literacy, education, gamers, gaming, iPhone App, marketing, mental health, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social justice, social media, technology, video games, Web 2.0

The Internet Is Not A Meritocracy, That’s Why You Hate It

September 21, 2013 by langloimsw 4 Comments

Recently, I had a discussion with a student about social media, and the fact that I usually start off a comment on a blog with “great post!” She noted two things: First, that it rang false to her initially, making her wonder if I even read the posts people write; and second, that despite this initial impression she found herself commenting anyway. So let me define what a great post is.

A great post is one that captures your interest and keeps the thoughtful discourse going.

Now many of my academic readers are going to vehemently disagree. They may disagree with this blog post entirely, and you know what? If they comment on it, I’ll publish the comment. Because the comment keeps the discourse going.

Also recently, I was explaining my pedagogy to colleagues who were questioning my choice to assign a whole-class group assignment for 25% of the student grade. The concern was that by giving the class a grade as a whole I would run the risk of grade inflation. This is a real concern for many of my peers in academia and I respect that, and as someone who believes in collaboration I intend to balance advocating for my pedagogical view with integrating the group’s discerning comments and suggestions. In my blog however, let me share my unbridled opinion on this.

I don’t care about grade inflation.

Really, I don’t. I went to a graduate school which didn’t have grades, but had plenty of intellectual rigor. I am more concerned with everyone having a chance to think and discuss than ranking everyone in order. That is my bias, and that is one reason I like the internet so much.

The old model of education is a meritocracy, which according to OED is:

Government or the holding of power by people chosen on the basis of merit (as opposed to wealth, social class, etc.); a society governed by such people or in which such people hold power; a ruling, powerful, or influential class of educated or able people.

I think that Education 2.0 has many of us rethinking this. Many of our students were indoctrinated into that view of education that is decidedly meritocratic. I suspect this was part of what was behind my student’s skepticism about “great post!” My role as an educator in a meritocracy is to evaluate the merit of these comments and ideas, rank them and award high praise only to those which truly deserve it. By great posting everything I demean student endeavors.

One of my colleagues Katie McKinnis-Dietrich frequently talks about “finding the A in the student.” This interests me more than the finite game of grading. Don’t get me wrong, I do offer students choices about how to earn highest marks in our work together, I do require things of them; but I try hard to focus more on the content and discourse rather than grades.

I frequently hear from internet curmudgeons that the internet is dumbing down the conversation. The internet isn’t dumbing down the conversation: The internet is widening it. Just as post-Gutenberg society allowed literacy to become part of the general population, Web 2.0 has allowed more and more human beings to have access to the marketplace of ideas. We are at an historic point in the marketplace of ideas, where more intellectual wares are being bought and sold. More discernment is certainly required, but the democratization of the internet has also revealed the internalized academic privilege we often take for granted. Every ivory tower now has WiFi, and so we can experience more incidents of our sneering at someone’s grammar and picking apart their spelling. What is revealed is not just the poor grammar and spelling of the other, but our own meritocratic tendencies.

Detractors will pointedly ask me if I would undergo surgery performed by someone who had never been to medical school, and I will readily admit that I will not. But how can we reconcile that with the story of Jack Andraka, a 15 year-old who with no formal training in medicine created a test for pancreatic cancer that is 100 Times More Sensitive & 26,000 Times Cheaper than Current Tests. In fact, if you listen to his TED talk, Jack implicitly tells the story of how only one of the many universities he contacted took him seriously enough to help him take this discovery to the next level. Meritocracy in this case slowed down the process of early intervention with pancreatic cancer. One side of this story is that this test will save countless lives; the darker side is how many lives were lost because the meritocracy refused to believe that someone who hadn’t been educated in the Scholastic tradition could have a real good idea.

I am urgently concerned with moving education further in the direction of democracy and innovation. Any post that gets me thinking and interacting thoughtfully with others is a great post. On a good day I remember this.

But like many academics and therapists and educators and human beings brought up in a meritocracy, I have my bad days. Like many of you, I fear becoming irrelevant. I resist change, whether it be the latest iOS or social mores. Last night I caught myself reprimanding (internally) the guy wearing a baseball cap to dinner in the restaurant I was in.

We still live in a world where only students with “special needs” have individualized education plans– quite frankly, I think that everyone should have an individualized education plan. I think our days of A’s being important are numbered. There are too many “A students” unemployed or underemployed, too many untenured professors per slot to give the same level of privilege in our educational meritocracy. Digital literacy is the new frontier, and I hope our goal is going to be maximizing the human potential of everyone for everyone’s sake. Yes this is a populist vision, I think the educational “shining city on the hill” needs to be a TARDIS, with room for the inclusion of all. I also think that those of us who have benefited from scholastic privilege will not give this privilege up easily. We desperately want to remain relevant.

I know it is risky business putting this out in the world where my colleagues could see it. I know this will diminish my academic standing in the eyes of many. I know my students may read it and co-opt my argument to try to persuade me to give the highest grade. But if I believe in discourse and collaboration I’ll have to endure that and walk the walk.

I’m not saying that every idea is a good one. What I am saying, what I believe that has changed my life for the better is something I find more humbling and amazing about the human being: Not every idea is a good one, but anyone, anyone at all, can have a good idea.

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: adolescents, behavior change, children, digital literacy, education, game theory, ideas, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0

Innovation is Dangerous & Gaming Causes Asperger’s

August 31, 2013 by langloimsw Leave a Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: activism, adolescents, behavior change, call of duty, children, dark souls, digital literacy, education, gamers, gaming, mindfulness, minecraft, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft

Dopey About Dopamine: Video Games, Drugs, & Addiction

August 25, 2013 by langloimsw 4 Comments

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.

Filed Under: Gamer Therapy Tagged With: addiction, adolescents, behavior change, call of duty, children, dark souls, dopamine, education, Freud, game theory, games, gaming, mindfulness, minecraft, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft

Breaking Eggs and Holding Your Fire: Some Thoughts on Skills Acquisition

August 14, 2013 by langloimsw Leave a Comment

Not too long ago, I was learning how to fire a sniper rifle in Call of Duty. It wasn’t going very well. I kept firing (which you do by holding down the right-hand trigger) and missing. Or I would use the scope, which you do by holding down the left-hand trigger; and then try to find my target so slowly that I’d get shot long before seeing it. To make thing more complicated, my patient Gordon** was trying to teach me the difference between “hardscoping” which meant to press and hold down the left trigger, and “quickscoping” which was more like a quick tap and release of the scope.

The key to success, I was told, was to locate the target, quickscope it for a second to take aim, and then fire. The source of my failure was that I’d see the target and not bother to scope at all, and just fire. At first I didn’t even know I was doing that. I thought the scope was going up, and it was, but it was going up a split second after I was firing and not before. After several fumbled attempts Gordon said, “you have to not fire and learn to push the scope first instead.” I suddenly realized that he was teaching me about impulse control.

Because many parents and therapists are reluctant to play video games, in particular first-person-shooters, they only tend to see them from outside the experience. What they learn from seeing that way is that FPS are full of violence, mayhem, blood and noise. Is it any wonder then that they grow concerned about aggression and the graphic nature of the game? It’s all that is really available to them unless there is a strong plot line and they stick around for that.

But as someone who has been playing video games for years I can tell you things are different from within the experience. And one of the most counterintuitive things I can tell you from my experience is this: First Person Shooters can help you learn impulse control. It takes a lot more impulse control to not fire at a target the second you see it. It takes a lot more impulse control to wait and scope. And because all of these microdecisions and actions take place within the player’s mind and the game experience, outside observers see violence and aggression alone and overlook the small acts of impulse control the player has to exert over and over again.

Any therapist who has worked with adolescents, people with ADHD, personality disorders and a host of other patient types understands the importance of learning impulse control. That act of mindfulness, that ability to create a moment’s space between the situation and the patient’s reaction to it is necessary to help people do everything from their homework to suicide prevention. In addition, there is always a body-based aspect to impulse control, however brief or small, and so to create that space is to forge a new and wider relationship between mind and body.

All of this was going on as we were playing Xbox. Over and over again, I was developing, practicing impulse control from behind that virtual sniper rifle. Again and again I was trying to recalibrate my bodily reflexes and sensations to a new mental model. Don’t fire. When my kill score began to rise, it wasn’t because my aim had gotten better, it was because my impulse control had.

Meanwhile, for the past two weeks I have been practicing making omeletes.

In particular, I have been learning how to make an omelette roulée of the kind Julia Childs makes below (you can skip to 3:30 if you want to go right to the pan.)

This type of omelette requires the ability to quickly (in 20-30 seconds) tilt and jerk the pan towards you multiple times, and then tilting the pan even more to flip it. Doing this over the highest heat the movement needs to be quick and reflexive or you end up tossing a scrambled eggy mess onto the burner. I can’t tell you how tense that moment is when the butter is ready and you know that once you pour in the egg mixture there is no going back. To jerk the pan sharply towards you at a tilt seems so counterintuitive, and this is an act of dexterity, meaning that your body is very involved.

In a way an omelette roulée requires impulse control just like Call of Duty in order to learn how to not push the pan but pull it toward you first. But just as importantly, making this omelette requires the ability to take risks. It can be scary to make a mess, what happens if the eggs fly into the gas flame?!

Let me tell you, because I now know what happens: You turn off the flame, wait a minute and wipe off the messy burner. And then you try again.

Adolescents, all people really, need to master both of these skills of impulse control and risk-taking. To do so means widening the space in your mind between situation and action, but not let that space become a gaping chasm impossible to cross. Learning impulse control also happens within experience, not in a special pocket universe somewhere apart from it. Learning risk-taking requires the same. And at their core they are bodily experiences, which may be what Freud meant when he said that the ego was first and foremost a body ego.

When I worked in special education settings, I was often called on to restrain children in crisis. Afterwards we would usually do a postvention: “What was happening?” “How could you do things differently next time?” We were looking at their experience from the outside, constructing a little pocket universe with words, as if we understood what had been going on in the experience, in the body and psyche of the child. I doubt these post-mortems taught impulse control.

I wonder what might have happened if we had risked throwing some eggs on the fire and encouraged the kids to play first person shooters or other video games. If my theory is right, then we would have been cooking.

**Not his real name. Name, age, gender and other identifying information have been altered to preserve confidentiality.

Mike is on vacation until September, which means that he has started talking in the third person at the end of blog posts. It also means that the next new post will be next month. He’ll repost an old fave or book excerpt to tide you over in the meantime.

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: adolescents, avatar, behavior change, call of duty, children, digital literacy, education, Freud, game theory, gamers, games, gaming, mindfulness, omelette, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, video games

Guild Wars: The Conservative Attack on Online Therapy

August 4, 2013 by langloimsw 11 Comments

“European commerce during the Dark Ages was limited and stifled by the existence of a multitude of small kingdoms that were independently regulated and who suppressed the movement of goods across their borders through a confusing and inconsistent morass of taxation, tariff, and regulation. This forced merchants to find another solution to move their goods, one that would avoid the strangulation that resulted from this cumbersome regulatory model. These merchants chose to move their goods by sea without being subject to the problems that were created by this feudal and archaic design, a move that changed the world. The little kingdoms took hundreds of years to catch up.”

–Harris, E., & Younggren, J. N. Risk management in the digital world.

Keeping up with policy is not my favorite thing: But if I am to continue to be a consultant to therapists building their business and an educator on integrating technology into social work practice, it is part of the prep work. So when a recent client asked me a question about licensure and online therapy in our Commonwealth of Massachusetts I surfed on over to our Division of Professional Licensure to take a look. Good thing I did, and a lesson for all of you thought leaders and innovators out there, regardless of what state you live in.

There wasn’t much about technology, except for the interesting fact that the past several Board Meeting minutes made mention of a Committee discussion open to the public on “E-practice policy.” I assumed (correctly it turns out) that this meant that the Social Work Board was formulating a policy, so I reached out to the Division and asked some general questions about what it was going to look like. The answer was prompt and pretty scary.

The representative stated in her email to me that the “Board feels as if the use of electronic means should be employed as a last resort out of absolute necessity and it is not encouraged. The social worker would have the burden of proof that electronic means were employed as a last resort out of absolute necessity.”

I have several concerns about this.

Before elaborating on them, I want to explain that my concerns are informed by my experience as a clinical social worker who has used online therapy successfully for several years, as well as an educator nationwide on the thoughtful use of technology and social work practice. I have had the opportunity to present on this topic at a number of institutions including Harvard Medical School and have created the first graduate course on this topic for social workers at Boston College. In short, this issue is probably the most defining interest and area of study in my career as a social work clinician, educator and public speaker.

I also am a believer in regulation, which is why I have been licensed by the Board of Licensure in Oregon, and am in process of similar applications in several states, including CA, and NY, so that I may practice legitimately in those jurisdictions. I am a very concerned stakeholder in telemedicine and here are only a few of my concerns about a policy of “extenuating-circumstances-only-and-be-ready-to-prove-it:”

E-Therapy is an evidence-based practice. It has been found to be extremely efficacious in a number of peer-reviewed studies, over 100 of which can be found at http://construct.haifa.ac.il/~azy/refthrp.htm . In fact, telemedicine has been found to have comparable efficacy to in-office treatment of eating disorders (Mitchell et al, 2008,) childhood depression (Nelson et al, 2006,) and psychosocial case management of diabetes (Trief et al, 2007) among others. To limit an efficacious modality of treatment by saying it needs to be used only in an “extenuating” circumstance or as a last resort which is discouraged would be a breathtaking reach and troublesome precedent on the part of the Board, which has not been done with any other treatment modality to the best of my knowledge. Telemedicine was also endorsed by the World Health Organization 3 years ago. And as I wrote this post, the University of Zurich released research showing online therapy is as good as traditional face-to-face therapy, and possibly better in some cases (Birgit, 2013.)
To place and require a burden on the individual social worker to account for why this treatment modality is justified by necessity of extenuating circumstances also raises the issues of parity and access. Providers familiar with the issue of mental health parity will hopefully see the parallels here. Clinical social workers for example may become more reluctant to work with patients requiring adaptive technology if they realize that they could be held to a higher level of scrutiny and documentation than their counterparts who do not use online technology. Even though the Board would possibly deem those circumstances “extenuating” it would require an extra layer of process and bureaucracy that could have the side effect of discouraging providers from taking on such patients.
Insurers such as Tricare and the providers in the military are increasingly allowing for reimbursement for telemedicine; and videoconferencing software is becoming more encrypted and in line with HIPAA. While these should not be the reasons that drive telemedicine in social work, we should consider that a growing segment of the population finds it a reputable form of service delivery.
Such policies require input from people with expertise in clinical practice, the law, technology, and the integration of the three. When I asked about whether any members of the Board had experience with the use of different newer technologies in clinical practice or how to integrate them, I was informed that “the Board is comprised of members with diverse backgrounds. They have reviewed the policies and procedures for electronic means for many other jurisdictions as well as the NASW and ASWB Standards for Technology and Social Work Practice in addition to the policies set forth for Psychologists, LMHC’s and LMFT’s in MA.”

The NASW policy which I believe she is referring to was drafted 8 years ago in 2005. For context, it was drafted 5 years before the iPad in 2010, 2 years before the iPhone in 2007, and 4 years before the HITECH act in 2009. In fact, the policy I reference says nothing about limiting technology such as online therapy to “last resort;” rather it encourages more social workers and their clients to have access to and education about it. That professional organizations may be lagging behind the meaningful use and understanding of technology is not the Board’s fault. But to rely on those policies in the face of recent and evidence-based research is concerning. If the Board does wish to be more conservative than innovative in this case, I’d actually encourage it to consider the policy adopted by the Commonwealth’s Board of Allied Mental Health Professionals at http://www.mass.gov/ocabr/licensee/dpl-boards/mh/regulations/board-policies/policy-on-distance-online-and-other.html which in fact does not make any mention of setting a criteria of extenuating circumstances or potentially intimidate providers with the requirement of justification.

I hope the Board listens to my concerns and input of research and experience in the respectful spirit that it is intended. I am aware that I am commenting on a policy that I have not even seen, and I am sure that the discussions have been deep and thoughtful, but I know we can do better. As a lifetime resident of Massachusetts, I know we take pride in being forward thinkers in public policy. Usually we set the standard that other states adopt rather than follow them. I invited the Board to call upon me at any time to assist in helping further the development of this policy, and reached out to state and national NASW as well. I hope they take me up on it, but I am not too hopeful. I had to step down from my last elected NASW position because I refused to remove or change past or future blog posts.

If you practice clinical social work or psychotherapy online, it’s 3:00 AM: Do you know what your licensing boards and professional organizations are doing? Are they crafting policies which are evidence-based and value-neutral about technology, or are they drafting policies based on the feelings and opinions of a few who may not even use technology professionally?

This is a big deal, and you need to be involved, especially if you are pro-technology. The research from Pew Internet Research shows that people age 50-64 use the internet 83% of the time, about 10% less than younger people; and only 56% of people 65 or older do. These older people and digital immigrants are often also the decision-makers who are involved in policy-making and committees.

If you don’t want to practice online, you may bristle at this post. Am I saying that older people are irrelevant? No. Am I saying that traditional psychotherapy in an office is obsolete? Absolutely not. But I am saying that there is a backlash against technology from people who are defensive and scared of becoming irrelevant, and fear does not shape the best policy. Those of us with experience in social justice activism know that sometimes we need to invite ourselves to the party if we want a place at the table.

And with government the table is often concealed behind bureaucracy and pre-digital “we posted notice of this public hearing in the lobby of the State House” protocols. My local government is relatively ahead of the curve by posting minutes online, but I look forward to the day when things are disseminated more digitally, and open to the public means more than showing up at 9:30 AM on a work day. If they allow videoconferencing or teleconferencing I will gladly retract that.

At its heart, divisions of professional licensure are largely about guildcraft: They regulate quality for the good of the whole guild and the consumers who purchase services from guild members. They establish policies and sanction members of the guild as part of establishing and maintaining the imprimatur of “professional” for the entire guild. They develop criteria both to assure quality of services and to regulate the number of providers allowed in the guild with a certain level of privileges at any time: LSWs, LCSWs, and LICSWs are the modern-day versions of Apprenctice, Journeyman and Master Craftsman. This is not to say guilds are bad, but it is to say that we need more of the senior members of the guild to advocate for technology if they are using it.

Too often the terms “technology” and “online therapy” get attached to term “ethics” in a way that implies that using technology is dangerous if not inherently unethical. That’s what I see behind the idea that online therapy should only be used as a “last resort.” We thought something similar about fire once: It was mysterious to us, powerful and scary. So were books, reading and writing at one point: If you knew how to use them you were a monk or a witch.

Technology has always been daunting to the keepers of the status quo, which is why you need to start talking to your policymakers. Find out what your licensing boards are up to, advocate, give them a copy of this post. Just please do something, or you may find your practice shaped in a way that is detrimental to your patients and yourself.

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!

References

Birgit, W., Horn, A. B., & Andreas, M. (2013). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal Of Affective Disorders, doi:10.1016/j.jad.2013.06.032

Funderburk, B. W., Ware, L. M., Altshuler, E., & Chaffin, M. (2008). Use and feasibility of telemedicine technology in the dissemination of parent-child interaction therapy. Child Maltreatment, 13(4), 377-382.

Harris, E., & Younggren, J. N. (2011). Risk management in the digital world. Professional Psychology: Research And Practice, 42(6), 412-418. doi:10.1037/a0025139

Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., et al. (2008). A randomized trial comparing the efficacy of cognitive–behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour Research & Therapy, 46(5), 581-592.

Nelson, E., Barnard, M., & Cain, S. (2006). Feasibility of telemedicine intervention for childhood depression Routledge.

Trief, P. M., Teresi, J. A., Izquierdo, R., Morin, P. C., Goland, R., Field, L., et al. (2007). Psychosocial outcomes of telemedicine case management for elderly patients with diabetes. Diabetes Care, 30(5), 1266-1268.

Filed Under: Gamer Therapy Tagged With: activism, aswb, behavior change, boards, building your business, digital literacy, e-therapy, education, guilds, HMOs, insurance, licensure, managed care, massachusetts, mental health parity, middle ages, NASW, policy, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, social justice, social media, technology, telemedicine, therapy, Web 2.0

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

July 28, 2013 by langloimsw 2 Comments

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. 🙂

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: adolescents, axline, battlefield, behavior change, call of duty, children, digital literacy, FPS, Freud, gamers, games, gaming, mindfulness, minecraft, object relations, play, private practice, psychoanalysis, psychology, psychotherapy, rogers, self psychology, shooters, social media, special ops, technology, therapy, video games

Automation

July 20, 2013 by langloimsw 2 Comments

Recently I was washing my hands in a public restroom. The paper towel dispenser was one of those that automatically dispense. There was a towel ready to be pulled off; you took it, and the dispenser automatically pushed another towel out for the next user.

I was in the middle of taking my fourth towel when I realized that my hands were long-since dry and that I was taking the towels continuously because the dispenser was offering them to me.

Technology offers itself to us, but technology doesn’t decide whether or not we should use it. That is and always has been a human decision. We can forget that, or ignore it, but we do so at our peril.

If the towel dispenser was one of the motion detected sort, the above story would never have happened to me, because I would have always had to exercise my agency to get it going. Ironically that was what the Greeks meant when they first used the term automatos or αὐτόματος: It came from , autos (self) and méntis (thought) and meant “self-moving, moving of oneself, self-acting, spontaneous” according to Wiktionary. It wasn’t until the late 1940s when the term automation became more widely used, by General Motors in reference to their new Automation Department.

Although my towel story might be funny to some (it was to me,) it has some serious implications when we think about social media and digital literacy, in particular for our children. Let’s take this example:

One of things that has created a confusion of tongues in social media is the fact that we are bombarded with opportunities to share regardless of what the implication might be if we do. The Facebook status update box is a great example: As someone I know once said, “they gave us the box, but they didn’t tell us what to with it.”

What is your status update? Is it how you are feeling? What you are eating? What you are doing/thinking/talking about? If the box tells you to write something in it, do you have to? If you are not feeling happy, sad or tired, do you leave it blank. And what if you aren’t grateful for something right now? The status update can be seen as akin to the towel dispenser: pushing out prompts for you to think or communicate a certain way, but not telling you how or even that you have the choice to refrain from doing so as well.

In the 21st century, to educate our children and adolescents about personal responsibility and agency is to educate them in digital literacy. This is the responsibility of adults who themselves were raised in a culture that never trained them how to deal with the increasing automation of society or the way social media has changed our brain, sense of self and the social milieu.

It may not come as a surprise that I have strong opinions about this, and they come in a large part from my training as a clinical social worker. I believe that social workers have a responsibility to help their clients achieve and improve their digital literacy. In general if you are a mental health provider I think it is your job to do this. We are tasked with helping the human being in the social environment, and technology is part of the social environment for the majority of the population we serve. If you do not know how to use Facebook then you are insufficiently educated to work with families and children in the 21st century. If you are unaware of geotagging and the risk it poses to domestic violence victims seeking safety from their perpetrators you are putting your clients in jeopardy. If you are an LGBT-affirmative therapist and you don’t know about Grindr you won’t be effective. If you are a psychotherapist and you don’t ask about your patients’ use of social media you are missing out on a significant part of their daily interactions, behaviors, thoughts and feelings.

Chances are that if you are reading this blog you are not one of my colleagues who is completely averse to technology, so I hope that you’ll pass on some of this info to your colleagues who are. To the best of my knowledge there are only two graduate courses that teach social workers about the impact of technology on our clients, and I’m teaching them. This will have to change if we are to remain relevant to the populations we serve.

Technology is offering itself to our clients every day in hundred of ways. It is up to us to remind them to pause and remember that they have agency. If we don’t, then we are the ones who have become the machine.

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: activism, adolescents, agency, automation, behavior change, children, digital literacy, education, facebook, LGBT, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self, social justice, social media, technology, therapy, towel dispenser, Web 2.0

Saving Ideas

July 9, 2013 by langloimsw 2 Comments

Sometime, over 40,000 years ago, someone decided to put images of human hands on the cave pictured above. It turned out to be a good idea. This painting has given scientists information on life in the Upper Paleolithic, raised questions about the capacity of Neandrathal man to create art, and sparked debate about which species in the homo genus created it. Other later cave paintings depict other ideas: Bulls, horses, rhinoceros, people.

I wasn’t there in the Paleotlithic but I doubt that the images we are seeing in caves were the first ones ever drawn. I imagine that drawing images in sand and other less permanent media happened. I suspect that the only reason we have cave paintings is because at some point somebody decided they wanted to be able to save their idea, to keep it longer or perhaps forever.

Every day, 7 billion of us have untold numbers of ideas. So what makes a person decide that an idea is worth saving? What makes us pause and make a note in our Evernote App or Moleskine journal? What inspires us to make a video of our idea on YouTube or write a book? We can’t always be sure that an idea is a “good” one or even what the criteria for a good idea is. It usually comes down to belief.

In the past several centuries, the ability to save ideas was relegated to the few who were deemed skillful or divinely inspired. Books were written in monasteries, then disseminated by printing presses, and as ideas became easier to save, more people saved them. But, and this is very important, saving an idea doesn’t make it a good idea, just a saved one. Somewhere along the line we began to get the notion that only a few select people were capable of having a good idea, because only a few select people were capable of saving them. Even in the 21st century, many mental health professionals and educators cling to the notion that peer-reviewed work published in journals is the apex of quality. If it is written, if it was saved by a select few it must be a good idea. If you have any doubt of what I’m talking about just Google “DSM V.”

With each leap in human technology comes the power to save more ideas and then spread them. People who talk about things going viral often forget that an idea has to be saved first, and that in essence something going viral is really a form of society saving an idea. If anything, technology has improved the democratization of education and ideas.

This makes many of us who grew up in an earlier era nervous and frustrated. We call the younger generation self-absorbed rather than democratizing. We grumble, “what makes you think you should blog about your day, take photos of your food, post links to cute kitten videos?” We may even take smug self-satisfaction that we aren’t contributing to the static. I think that’s a bad idea, although it clearly has been saved from earlier times.

40,000 years from now, our ideas may take on meanings we never anticipated, like cave drawings. Why were kittens so important to them? In the long view I think we remember that people have to believe they have an good idea before they take the leap of faith to save it. The citizens of the future may debate who saved kitten videos and why, but it will be taken as given that they must have been important to many of us.

What if everyone had the confidence to believe that they had an idea worth saving? What if everyone had the willingness to believe that it just might be possible that their idea was brilliant? Each semester I ask the students in my class to raise their hand if they think they can get an A- or higher in the class, and most do. Then I ask them to raise their hand if they think they can come up with in an idea in this class that could change the world. I’ve never had more than 3 hands go up. That’s sad.

This is why I admire the millennials and older groups who take advantage of social media and put their ideas out there. I doubt that they are all good ideas, but I celebrate the implicit faith it takes to save them. Anyone, absolutely anyone at all, can have a good idea. It may not get recognized or appreciated, but now more than ever it can get saved. Saving an idea is an act of agency. It is a political act. Saving an idea is choosing to become just a bit more visible. On the most basic level saving an idea is a celebration and affirmation of the self. Think about that, and dare to jot down, draw, record or otherwise save one of your ideas today. I just did and it feels great. Then maybe you can even share it with someone else.

What makes a person decide an idea is worth saving?

You do.

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: activism, adolescents, behavior change, buddhism, building your business, cave paintings, children, digital literacy, education, facebook, gamers, gaming, ideas, LGBT, marketing, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, saving, self-promotion, social justice, social media, technology, twitter, video games, Web 2.0

Bad Object Rising: How We Learn to Hate Our Educated Selves

June 30, 2013 by langloimsw 1 Comment

Recently I had the opportunity to work with a great set of educators in a daylong seminar. One of the things I do with teachers when I present is have them play Minecraft. In this case I started off by giving a general presentation that ended with a story of auto-didactism in an Ethiopian village, where 20 children who had never seen the printed word were given tablets and taught themselves to read. I did this in part to frame the pedagogy for what came next: I had them turn on Minecraft and spend 30 minutes exploring the game without any instruction other than getting them networked.

The responses were as varied as the instructors, but one response fascinated me in particular. Midway into the 30 minutes, one teacher stopped playing the game and started checking her email. Later, when we returned to our group to have a discussion about the thoughts and feelings that came up around game play, this same teacher spoke up. We were discussing the idea of playfulness in learning when she said , “you know, I hear a lot about games and learning, and making learning fun; but sometimes learning isn’t fun and you have to do it anyway. Sometimes you just have to suck it up and do the work.”

“I’m not saying that I disagree with you entirely,” I said. “But then how do we account for your giving up on Minecraft and starting to check your email?”

She looked a little surprised, and after a moment’s reflection said, “fair enough.”

I use this example because these are educators who are extremely dedicated to teaching their students, and very academically educated themselves. Academia has this way, though, of seeping into your mind and convincing you that academics and education are one and the same. They’re not.

I worked in the field of Special Education for more than a decade from the inside of it, and one of the things I came to believe is that there are no unteachable students. That is the good news and the bad news. Bad news because if a student was truly unteachable, they wouldn’t learn from us that they are dumb or bad if they don’t demonstrate the academic achievement we expect. I remember the youth I worked with calling each other “SPED monkeys” as an insult; clearly they learned that from somewhere and someone. They had learned to hate themselves as a bad object, in object relations terms, or to project that badness onto other students. They learned this from the adults around them, from the microaggressions of hatred they experienced every day: By hate I’ll go with Merriam as close enough, “intense hostility and aversion usually deriving from fear, anger, or sense of injury.”

We tend to mistakenly equate hatred with rage and physical violence, but I suggest that this is because we want to set hatred itself up as hated by and other from ourselves; surely we never behave that way. But hatred is not always garbed in extremis. Hatred appears every day to students who don’t fit the academic mold. Hatred yells “speak English!” to the 6 year olds getting off the bus chatting in Spanish. Hatred shakes its head barely (but nevertheless) perceptibly before moving on to the next student when the first has fallen silent in their struggle. Hatred identifies the problem student in the class and bears down on her, saying proudly, “I don’t coddle my students.” And Hatred shrugs his shoulders when the student has been absent for 3 weeks, and waits for them to be dropped from the rolls.

I’m not sure how I came to see this, because I was one of the privileged academically. I got straight A’s, achieved academic awards and scholarships that lifted me into an upperclass world and peer group. I wrote papers seemingly without effort, read for pleasure, and was excited to get 3 more years of graduate school. And I have had the opportunity to become an educator and an academic myself, having taught college and graduate students. I could have stayed quiet and siloed in my area of expertise, but work with differently-abled learners taught me something different. It taught me that people learn to dislike education, shortly after academia learns to dislike them.

Perhaps one of the best literary portrayals of adult hatred of divergent thinkers comes from the movie Matilda:

“Listen, you little wise acre. I’m smart, you’re dumb; I’m big, you’re little; I’m right, you’re wrong. And there’s nothing you can do about it.”

Nowadays I teach in a much different way than I did early on, before I flipped my classrooms and facilitated guided learning experiences rather than encourage people to memorize me and ideas that I had memorized from others. And I struggle with this new approach, because I enjoy it so much I feel guilty. You see, I have internalized the bad object too. Even with my good grades I internalized it. And any time I start to depart from the traditional mold of the educated self, I experience a moment of blindness, then a stony silence that seems to say, “you’re being lazy, you should make them a powerpoint and prepare a lecture.” Yet, if my evaluations on the whole and student and colleague testimonies have truth to them, I am a “good” educator. So let’s say I am a “good” educator, and if I as a good educator struggle with this, we shouldn’t assume that people that struggle with these issues are “bad” educators.

In fact, when it comes to emerging technologies like social media and video games, educators often try to avoid them, if not because they are fun and suspect, then because educators risk experiencing themselves as the bad object: Who wants to experience themselves as hopelessly dumb, clumsy or lazy when they can experience themselves as the bountiful and perfectly cited fount of all wisdom? Truth is, both are distorted images of the educated self.

Don’t forget that educators themselves experience tons of societal hatred. For them it often comes in the guise of curriculum requirements or linking their performance to outcomes on standardized testing. Hatred comes in the low salaries and the perception that people doing intellectual or emotional labor aren’t really working. All of this helps educators to internalize a bad object which feels shaming and awful; is it any wonder that we sometimes unconsciously try to get that bad object away from ourselves and locate it in the student?

The good news as I said before is that we are all teachable. We can learn to make conscious and make sense of the internalized bad object representations. We can see that thinking of people in terms of smart or dumb is a form of splitting.

And yes, there’s a lot we can do about it.

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: ADHD, adolescents, Asperger's, behavior change, children, digital literacy, education, gamers, games, gaming, minecraft, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, special education, stress, technology, therapy, video games, Web 2.0, World of Warcraft

Empathy (Re)Training

June 8, 2013 by langloimsw 2 Comments

Last night I was mining Gold Omber in the asteroid belt near Erindur VI, and I can’t begin to tell you what an accomplishment that was. (This post is not just about spaceships, but about pacifists, Ethiopia and education, so non-gaming educators and therapists keep reading.) OK, let me tell you why it was an accomplishment. I am talking about playing the MMO EVE Online, which involves piloting spaceships across vast amounts of space in order to mine, trade, build or pirate among other things. In essence, your spaceship is your character, with the ship’s parts being the equivalent of your armor and weapons in games like World of Warcraft. But you can only build or use these parts as your pilot acquires skills, ranging from engineering to planetology to cybernetics, so in that way the player’s pilot is the character in the game. But at the start of the game you’re told that the pilot is actually a clone (this becomes important later on) and as someone was explaining to me last night the whole cloning thing has its own complications once you start using implants to modify individual clones, which you can only do after you’ve trained the skill of Cybernetics. And why all that is important is because once you use implants you can learn skills more quickly.

If you think that is confusing, try learning how to use the sprawling user interface or UI, which one of my friends says “was made by demons who hate people, hate their hopes and dreams. Know that you are playing with toys made by demons for their amusement and tread lightly.” Another way of putting it is that you have keep trying to remember what window you opened in the game to do what, and often have multiple windows open simultaneously in order to figure out what you’re doing or buying or training. There is a robot tutorial program in the game that helps somewhat, but the whole thing is very frustrating and intriguing for the first several hours of game play. During this time I was ganked repeatedly, lost lots of loot and ore I had mined, as well as a nice spaceship or two. So to get to the point where I had learned enough skills to be able to warp halfway across the galaxy, lock onto an asteroid, orbit and mine it while defending myself from marauders was extremely exciting. I was only able to do this because my above-mentioned friend had given me a much bigger and safer ship than I had started out with, as well as lots of instructions on how to do things; and because I was chatting with people in the game who offered great tips. Of course one of those people then clicked on my profile in chat to then locate me and gank me again (bye-bye nice ship,) but the knowledge is mine to keep.

By now you may be asking “what has any of this got to do with psychotherapy, social work or education?” so I’ll explain. I had tried EVE months ago, and given up after about a week of on and off attempts, but this past month I have begun teaching an online course for college educators and MSWs about integrating technology into psychotherapy and education. One of the required exercises in the course is for the students to get a trial account of World of Warcraft and level a character to 20. There has been a lot of good-natured reluctance and resistance to doing this, in this class and others: I have been asked to justify this course material in a way I have never had to justify other learning materials to students. This included several objecting to playing the game because of violent content prior to playing it much or at all. It’s as if people were not initially able to perceive the course material of World of Warcraft as being in the same oeuvre as required readings or videos. It is one thing to bring up in your English literature class that you found the violence in “Ivanhoe” or the sex in “The Monk” objectionable after reading it, but I’ve not heard of cases where students have refused to read these books for class based on those objections. So I was curious, what made video games so different in people’s minds?

Things became easier for several folks after I set up times to meet them in the game world, and help them learn and play through the first few quests. As I chatted with them and tried to explain the basic game mechanics I realized that I had learned to take for granted certain knowledge and skills, such as running, jumping, and clicking on characters to speak with them. I started to suspect that the resistance to playing these games was perhaps connected to the tremendous amount of learning that was having to go on in order to even begin to play the game. In literacy education circles we would call this learning pre-readiness skills. Being thrown into a learning environment in front of peers and your instructor was unsettling, immediate, and potentially embarrassing. And I think being educators may have actually made this even harder. Education in the dominant paradigm of the 20th and 21st century seeks to create literary critics and professors as the ultimate outcome of education, according to Ken Robinson. So here are a group of people who have excelled at reading and writing suddenly being asked to learn and develop an entirely new and different skill set within the framework of a college course: Of course they were frustrated.

So I started playing EVE again not just to have fun, but to have a little refresher course in empathy. I have leveled to 90 in WoW, so I know how to do things there, and had begun to forget how frustrating and bewildering learning new games can be. In EVE I have been clueless and failing repeatedly, and getting in touch with how frustrating that learning curve can be. I have also been re-experiencing how thrilling it is the first time I make a connection between too concepts or actions in the game: When I realized that there was a difference between my “Assets” and my “Inventory” I wanted to shout it from the rooftops. I have begun to see and help my students reflect on similar “learning rushes” when they get them as well. They are now , in short, rocking the house in Azeroth.

We forget how thrilling and confusing it can be to learn sometimes, especially to the large population on the planet that doesn’t necessarily want to be a college professor or psychotherapist. We forget that our patients and students are asked to master these frustrations and resistances every day with little notice or credit.

There is a village in Ethiopia, where 20 children were given Xoom tablet computers last year. The researchers/founders of One Laptop Per Child dropped them off in boxes to these children, who had never learned to read or write. They were offered no instruction and the only restriction placed on the tablet was to disable the camera. Within minutes the children had opened the box and learned how to turn the computers on; within weeks they were learning their ABCs and writing; and within months they had learned how to hack into the tablet and turn the camera back on, all without teachers. This story inspires and terrifies many. It is inspiring in that it tells the story of what children can learn if they are allowed to be experimental and playful. It is terrifying because if all this was done without a teacher to lecture or a therapist to raise self-esteem, it raises the question “do we still need them?”

Having played EVE, and taught academics in World of Warcraft, let me assure you that the world still needs teachers and therapists. But the world needs us to begin to learn how to teach and help in a different way. If EVE had nothing but online tutorials I would have probably struggled more and given up. I needed to remain social and related to ask for help, listen to tips, and get the occasional leg up. We need to retrain ourselves in empathic attunement by going to the places that scare or frustrate us, even if those places are video games. The relationship is still important; to inspire, encourage and enjoy when learning happens in its myriad forms. But we need to remember that there are many literacies and that not all human beings aspire to teach an infinitely recurring scholasticism to others. We need to remember how embarrassing it can be to “not get it,” and how the people we work with every day are heroic that they can continue to show up to live and be educated in a system that humiliates them.

What’s exciting and promising, though, is this simple fact: Learning is happening everywhere, all the time! Whether it’s a village in Ethiopia, Elwynn Forest in Azeroth, or in orbit around Erindur VI; learning is happening. Across worlds real and imagined, rich and poor, learning IS happening.

And we get to keep all the knowledge we find.

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: adolescents, avatar, behavior change, children, digital literacy, education, EVE, game theory, gamers, games, gaming, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft, wow

You’re The Reason Building Your Business Is So Hard

May 31, 2013 by langloimsw 22 Comments

Recently I was asked by a student to take some time and talk with her about her career options. She was trying to plan for her career post-graduate school, and struggling some with the vicissitudes of a graduate program in mental health. Such vicissitudes, once you commit to studying in the field of your choice, are out of your control. Students are often told what to learn, how to learn it, where to intern, and what kind of internship they can have. Want to learn psychodynamic theory? Sorry, school X doesn’t believe in it, so if you go there there may be one or no mention of it in your foundation work. Want to work at a leading hospital? Sure, you and 100 other students from the schools in your area; so apply, but don’t count on it. So, in graduate school, students like my student often have to like it or leave it.

This disempowers the budding therapist in many ways, not the least of which is that it conditions her to take her cues from others even beyond graduate school. It is hard to learn that you have the power to build your career and business after having been taught that the schools, placements and agencies are the ones who make the rules.

If you are out of school, you have more power than you think, and therefore more responsibility than you may want.

Many therapists want to avoid taking responsibility for their businesses. No sooner do we get out of a school or agency then we start to recreate an agency of our own devising. We create our own set of disempowering expectations, and there are usually plenty of people around to collude with us in this. I call them disempowermentors.

Disempowermentors in the mental health field are the ones that tell you all sorts of rules about how things work. They’ll tell you you can’t build a practice without being on insurance panels. They’ll tell you you need to work in our field for 10 years to build up a reputation before you can open a practice. They’ll tell you you should sublet a few hours and not jump in to a full-time practice. None of these things are true, but most of them are usually fear-based. They are usually the way the disempowermentors did things, either because they recreated their own inner agency and/or because they listened to disempowermentors themselves. If my student isn’t careful, she’ll end up listening to one of these folks, and set herself and her future business back a few years. She’ll have a structure, but it will be one that restricts her choices rather than increases them.

Take a look at who you are listening to: Are they disempowermentors? (One sure clue is that disempowermentors almost always look more tired than happy, more miserable than inspirational.)

One example of someone whom the disempowermentors would say is doing everything wrong is my consultee Lindsey Walker. Lindsey is going right into private practice after finishing graduate school. Lindsey is working on building a full-time practice. Lindsey isn’t in any insurance networks. And things are starting to happen for her. This is largely because Lindsey is very creative and responsible. She has started a blog, Waking The Image, which combines photography and essays on psychodynamic theory. She also just finished writing her first e-book Love Over Trauma: Healing With Your Partner on helping couples recover when one or both of them has trauma in their past.

None of these projects occur in a separate pocket universe: Lindsey works daily on these projects and other tasks that we come up with in the course of our work together. I send her a list of things she’s committed to, and within the next several days she does them. That is why her work is slowly but surely getting noticed and her practice growing. She isn’t waiting passively in her office sublet for the phone to ring. She isn’t waiting passively for insurance panels to accept her, or accepting the fee they want to pay her. Lindsey knows that she is responsible for the success of her business. She is investing time and money into building it, not subletting 2 hours somewhere cheap and hoping she’ll get a client or two after her “day job.” Lindsey made the decision to make building her business her day job. I should also mention that she is not independently wealthy, and that this venture has been a risky and courageous one.

So take a look at your career. Are you happy with it? Is being safe worth it? Are you investing time and money into building your business? Are you taking risks?

If you answered no to those questions, then you are the reason building your business is so hard. You aren’t in grad school any more. You choose to apply for a job, accept it, or strike out on your own. You choose whether to make building your business your day job and make whatever sacrifices you need to make to do that. You decide whether or not to invest in an office, a consultant, or other business expenses. You decide to wait passively for someone to pay you a fraction of your fee, or actively market and network for hours and days and weeks. You decide whether to contribute a blog, book, talk or idea to the world like Lindsey; or not to contribute anything without permission from somebody else. You decide whether to confuse worry with effort and wishing with doing.

Lots of things are possible for you. Owning your own business is neither easy or safe, but it is possible. It takes lots of effort and doing. It’s risky, but no one is making you do it or holding you back. It’s up to you to decide.

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!
<a

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, digital literacy, disempowermentors, education, HMOs, insurance, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, therapy

Want To Help Stop Youth Cyberbullying? Let Your Kids Raid More.

May 23, 2013 by langloimsw 7 Comments

The above title is misleading. In fact it is as misleading as the term cyberbullying, which is an umbrella term used from experiences which range drastically. “Cyberbullying” has been used to describe the humiliation of LGBT youth via video; the racial hatred of Sikhs on Reddit, the systematic harassment and suicide of a teenage girl by a neighboring peer’s mother; a hoax wherein a Facebooker pretended to be a woman’s missing (for 31 years); and the bad Yelp reviews of a restauranteur in AZ.

Wait, huh?

My point, exactly: All of the things described above are different in scope, intentionality, form of media used, duration, and impact. We need to keep this complicated. This is not to take away from the horrific acts that people have perpetuated with social media, or excuse them. Rather I think we need to help kids and their parents find more nuanced ways to make sense of the way newer technologies are impacting us.

Social media amplifies ideas, feelings, and conflicts. It often dysregulates family systems. Growing up, many family members didn’t need to learn the level of digital literacy that today’s world requires. Parents may be tempted to put their children in a lengthy or permanent internet lockdown. I hear the threats, or read them, all the time: No screens. You’re unplugged. She’s grounded from Facebook.

Please don’t do that.

I’ve worked with a number of young adults who have had the experiences of being on the receiving end of hatred, stalking, harassment and intrusion delivered via the internet. And thank goodness that their parents didn’t unplug them as kids. Because they stayed online they got to:

learn how to ignore haters
see/hear others stand up for them in a social media setting
come to the defense of a peer themselves
increase their ability to meet verbal aggression with cognition
make the hundreds of microdecisions about whether to “fight this battle”
seek out support from other peers
form strong online communities and followings that helped them cope with and marginalize the aggressors

More and more, online technologies are becoming a prevalent form of communication, and to take away access is to remove the hearing and voice of youth. To do this is disempowerment, not protection.

I’ve said before that parents need to take an engaged approach with kids in order to be there to help kids understand and process the conflicts that are communicated through and amplified by social media. But this time I want to go further, and suggest that one way to help kids achieve digital literacy in terms of social skills is to let them play more multiplayer video games.

Many of you probably saw that coming, but for those of you who didn’t, let me explain. 21st century video games are themselves a powerful form of social media. Multiplayer games allow individuals to band together as guilds, raids, platoons and other groups to achieve higher endgame goals. Collaboration is built into them as part of the fun and as necessary to meet the challenges.

There are exceptions to this, but it has been my experience that people don’t begin systematic personal attacks on each other when they are in the middle of downing Onyxia. They are too busy joining forces to win. I am convinced that much hatred we see in the developed world is there in large part because of boredom and apathy. Games provide an alternative form of engagement to hatin’

Look, I’m not saying that people playing games never say sexist things, swear, or utter homophobic comments. But I can say that I have heard more people, adults and children, stand up to hatred in World of Warcraft than I ever have in the 2 decades I worked in public school settings. I’ve seen racism confronted numerous times in guild chat, seen rules for civility created and enforced over and over, always citing a variation of the same reason: “We’re all here to have fun, so please keep the climate conducive to that.”

Video games provide powerful interactive arenas for diverse groups of people to collaborate or compete strategically. They capture our interest with a different sort of drama than the sort that we see our youth struggle with in other settings. In fact, for many individuals video games provide a welcome respite from the drama that occurs in those other settings.

Social media does indeed amplify nastiness, harassment and hatred. It also amplifies kindness, hope, generosity and cooperation. If we don’t lean into social media with our kids, they’ll never know how to use it to amplify goodness in the world. Worse yet, if we cut them off from connecting with the world online we’ll deprive them of the necessary opportunities to recognize and choose between good and evil.

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: adolescents, behavior change, buddhism, children, cyberbullying, digital literacy, education, facebook, game theory, gamers, games, gaming, LGBT, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, twitter, video games, Web 2.0, World of Warcraft

Alphabet Soup: The Perils & Promise of E-Learning

May 19, 2013 by langloimsw 1 Comment

CMS stands for Content Management System, which Wikipedia defines as “a computer program that allows publishing, editing and modifying content as well as maintenance from a central interface.” Several of the universities I have taught or teach at use a CMS called Blackboard. It has several iterations; Blackboard Vista, Blackboard 9, etc. Faculty are encouraged to use Blackboard by many college administrators, but I have yet to talk to a faculty member who has enjoyed using them.

Blackboard is the latest skirmish in a struggle between faculty and administration that I have seen go on for 2 decades in educational settings from Pre-K to PhD. It usually goes like this:

Technology A is developed in the private sector. Some enterprising developer of Technology A decides to take it to Educational Setting B. This takes a while, as it is often hard to find the decision maker in Educational Setting B. An administrator or administrators finally see the potential of Technology A, and Educational Setting B buys a very expensive version of Tech A.

Tech A is presented to the faculty of Setting B. “This is a great resource,” they are told. They are encouraged to use it. Some enterprising faculty try it, but become confused or bored with it and stop. The rest of the faculty never try it. Administrators of Setting B get frustrated, and often mandate the use of Tech A. They invest more money in consultants to come in and offer training. This often consists of scripted powerpoints, or nowadays video tutorials. Sometimes an in-house Tech A supporter is hired. The supporter is avoided, because s/he is associated with a top-down administrative initiative. Slowly the faculty begins to use Tech A as little as possible as rarely as possible. Administrators get frustrated, and begin to answer every Faculty complaint with a thinly veiled, “if you only used the expensive solution we bought you you’d have more time to do X,Y or Z and there would be no more problems.”

Meanwhile, in the outside world, Technology A is now obsolete, because in the time it takes educators to change we have developed, beta-tested, and marketed better stuff. We’re now on Technology Q, but when Educational Setting B is approached by the salespeople for Technology Q, they are rebuffed by administrators, who say, “Look, our faculty never used Technology A, so we’re not going to waste money on Technology Q.” Technology Q folks stop trying to design a product that would work really well for educators, because if no one buys it, well, what’s the point.

OK, back to the particular brand of technology called CMS, content management software. In this case, people have begun to confuse the software, which allows you to upload content into a course shell, with E-Learning. At its worst, this stifles creativity, because it misses the point that education is not about content but about facilitating learning. In a recent TED Talk, Sir Ken Robinson put it this way: “Teaching properly conceived is not a delivery system.”

By now, many educators and learners, will have heard of MOOCs, Massively Open Online Courses. The Pros of MOOCs for E-Learning are several, most notably the provision of access to educational resources to people who may be disenfranchised in some way. People can enroll in MOOCs for little or no money, take them after their workday or on weekends, and view and review material at their own pace.

But their are costs, literally and figuratively. Many MOOCs require entire production teams to create “professional” looking media. (The Khan Academy does a great job with less polish, but it often produces less formal media which some may consider less professional.) And ultimately, MOOCs are not going to be free, and seed money will need to be replaced. In my hometown for example, EdX is beginning to look at ways to generate revenue from future courses.

Not all E-Learning should or does take the shape of a MOOC. Not all E-Learning is scalable, at least not at first. Perhaps most importantly, not all E-Learning needs the same kinds of technology to make it good education.

There is a lot more to creating a good online educational experience than converting a syllabus into learning modules. The content management software can be used to powerfully enhance E-Learning, but in many cases it lends itself to being used as “pedagogy management software” instead.

I was reminded of this recently as I have been developing an online course. And the ironic part was that I was being stifled not by the administration but by myself. I had been given free rein to produce a course by the university administration. They were and are extremely supportive, encouraging and confident that I can teach something well. But I let myself get sucked into Blackboard. I started thinking that I had to produce a certain size and shape widget. The fact that I could create class modules became an internal mandate to fill them with material. I began to feel oppressed.

It wasn’t until I noticed that the only one expecting me to do that was me, and maybe the software, that I realized I could get off the treadmill. And I had to, because for me education is about facilitating learning, not putting content into student’s heads. In this case, a large part of the course is about social media and gaming, so a large part of my work will be about using social media with the students, playing games with them, and then discussing those experiences. I’ll certainly use Blackboard when it makes sense, but I’m not going to be assimilated by it.

I’m one of the lucky ones. Many educational settings wouldn’t be so encouraging of faculty creativity and thinking outside the box. Many of my colleagues instead find themselves scolded and asked, “why aren’t you using the box?” I have several colleagues who are engaging educators who have been avoiding E-Learning because they like the interaction with students, as if E-Learning has to be inherently non-interactive.

Fortunately a lot of administrators in higher education are also instructors, so hopefully we can begin to bridge this divide. These technologies are all relatively new to us, so there really shouldn’t be any hard and fast rules on how to educate students online. We’re pioneers, and we’re going to make lots of mistakes, but if we can remember to think of education as a laboratory for innovation rather than a delivery service, we may have some epic wins as well.

Filed Under: Gamer Therapy Tagged With: behavior change, blackboard, CMS, digital literacy, e-learning, education, edx, khan academy, MOOC, online learning, psychology, social media, special education, technology, twitter, Web 2.0

What To Do When Your Therapist Turns Into A Kitten

May 1, 2013 by langloimsw 10 Comments

I have been working with patients online for about 6 years, and even now I have some interesting surprises in the work. Recently I was meeting online with one of my long-term patients for their regular session. I use my laptop but have a better web camera and monitor hooked up to it. The bigger monitor allows me to see the patient’s image, but also keep an eye on my image so I can see what the patient is seeing. The laptop monitor stays dark, and the laptop’s built-in webcam goes unused, at least most of the time. But this particular day the laptop webcam decided to switch on 15 minutes into the appointment, and hijacked the webcam I was using. So from what my patient could see, one minute I was there listening empathically, and the next minute I had disappeared.

Those of you who enjoy object relations theory should be enjoying this story by now. Wait, it gets better.

As I was explaining to my patient why I’d disappeared, I was trying to turn off the laptop’s built-in webcam. Instead I turned on a special program the laptop has that replaces the screen with the image of a kitten, the one seen above in fact. Suddenly I was not invisible, but a kitten. Better yet, the kitten was lip synching and moving its mouth when I spoke. Fortunately this wasn’t happening at a particularly delicate moment in the therapy, and we both had a good laugh at it. I apologized to my patient and said, “you know, I studied a lot of things at grad school, but they never taught me what I’m supposed to do if I turn into a kitten when I’m with a patient.”

Many psychotherapists have the sort of relationship with technology that resembles the folks they treat with Borderline Personality Disorder: They alternately overidealize and devalue tech, often in the same breath. “Skype” will be the way we salvage our dwindling practices, we’ll be able to reach people all over the planet, make our own hours and go completely self-pay because most insurance doesn’t cover it. It will be wonderful. That’s the overidealizing part, the devaluing part is more subtle.

Because I do a growing amount of therapy and supervision online, I often get requests for a consultation session to help therapists who want to do online therapy and “need my help getting on Skype.” At this point I try to explain that Skype is not HIPAA-compliant, and that there is more to it that getting a webcam, but here’s where the devaluing of technology comes in. It’s as if some folks think that the only thing one needs to know in order to be an online therapist is how to download a program and turn on the camera.

Most therapists who decide to get Basic EMDR training wouldn’t bat an eye at needing to go through two weekend trainings and a minimum of 20 didactic and 20 hours of supervised practice in order to be certified. And yet many therapists don’t consider that working online and with emerging technologies requires more than learning how to flick a switch. It’s sort of the way people often treat the IT guy at the workplace: With one breath we describe ourselves to him as “clueless” about technology; and yet we really want him to stay in that basement office until we need him to come up and fix our email.

Graduate programs teach us next to nothing about how to use technology in our practice, except perhaps to warn us to avoid it at all costs. Think about it. Do you know what to do if you disappear in the middle of talking with a patient? Do you know what to do if you turn into a talking kitten? More importantly do you know how to prevent yourself from turning into a talking kitten, or turn yourself back from one if you do? And perhaps most importantly, do you know how to help patients anticipate the glitches with virtual therapy, process the unique empathic failures that can arise, and create a good-enough holding environment online?

People like my colleagues DeeAnna Merz-Nagel and Kate Anthony founded the Online Therapy Institute for just this reason. They offer dozens of different 5 hour courses on various technologies, from video conferencing to text chat to conducting therapy in virtual realities like Second Life. The takeaway here is that there is a lot more to learn about online therapy than downloading Skype.

Look, I am not trying to discourage people from doing online therapy, in fact the opposite. I know that it can be a very effective treatment modality, and easily accessed by a growing global population. I’m not even trying to get you to sign up for consultation with OTI or me or anyone in particular. The point I am trying to make is that it is an additional skill set that needs to be learned and integrated into your clinical repertoire.

Psychotherapists don’t just buy chairs and a couch and start talking. EMDR isn’t just wiggling your fingers in traumatized people’s eyes. Both take time, case supervision and specialized training.

Online therapy, and integrating social technologies into your therapy practice is no different.

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: avatar, building your business, digital literacy, education, facebook, kitten, mindfulness, online therapy, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, skype, social media, therapy, Web 2.0

One Bostonian’s Thoughts On Social Media

April 20, 2013 by langloimsw 12 Comments

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:

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:

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:

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: activism, behavior change, boston, digital literacy, education, facebook, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, social networking, technology, twitter, Web 2.0

Skyrim Family Values

April 13, 2013 by langloimsw Leave a Comment

In psychotherapy we have grown to have a narrow definition of what it means to prescribe something. Most of us think of prescription in terms of medication, however if we take this definition, you’ll see why I often prescribe video games:

pre·scribe

/priˈskrīb/

Verb

(of a medical practitioner) Advise and authorize the use of (a medicine or treatment) for someone, esp. in writing.
Recommend (a substance or action) as something beneficial.

(Google, Transmitted from http://bit.ly/XyztcE, 2013)

I have mentioned before my assertion that video games are among other things models of the world, that must both resemble and be distinct from the world to be effective. Sometimes they are models that present dystopian worlds, and other times they model how things could be if we set aside some of our differences.

The game The Elder Scrolls V: Skyrim is such a game, and one I recommend that therapists who work with a diverse range of families familiarize themselves with. Like other prescriptions it does have some effects that need to be considered carefully before recommending it to patients. It is rated M by the ERSB, which is characterized as “MATURE: Content is generally suitable for ages 17 and up. May contain intense violence, blood and gore, sexual content and/or strong language.” For parents who are very concerned with violence in video games, this one has a range of it: Set in a quasi-Nordic society, it contains the brutality one would expect there, including a decapitation in the first 10 minutes of the game’s opening.

So what on earth am I thinking in recommending it?

Last week the U.S. and the Supreme Court engaged in public deliberation on Proposition 8 in CA, the repeal of DOMA, and the question of what makes a marriage, and by extension, a family. As the debate unfolded, the statistics reported indicated that the court of public opinion had already reached a majority about the subject. The Washington Post reported that 58% of Americans favored gay marriage, the highest percentage of our citizens yet. And in the Supreme Court, Justice Kennedy raised this:

He was alluding to children of parents in same-sex relationships, some of whom are biological offspring, but a substantial number of others who are adopted. Adopted children often experience marginalization by virtue of their adoptive status, which can in itself be stigmatizing in a world which often give genetics primacy over nurturance. But the child who is adopted by same-sex parents often faces a double whammy in a world where their family system goes unrecognized if not persecuted.

I’d like to think that at least part of the change in public opinion on gay marriage and families is due to Skyrim. The video game from its inception has allowed for quest lines that culminate in your proposal, wedding, and marriage to a partner who can either be the same or different sex. If your character is female and you ask another female character to get married, your experience is one of acceptance. Later you get married in a ceremony celebrated and witnessed by several people in your community. Still later you set up house together, and have the experience so many of us have craved, coming home to someone who loves you after a hard days work (or dragon-slaying as the case may be.) As of last July, 10 million copies of the game had been sold worldwide, so it is not unreasonable to imagine that a large number of these found their way into the homes and minds of U.S. gamers. So let’s not give Will and Grace all the credit.

When working with patients from adoptive and/or same-sex families, Skyrim can be a valuable resource in providing a model of a world where adoption and gay marriage are accepted and treated with little fanfare as part of life. Families can use the game as a launch pad for discussion about what makes a family. Perhaps more importantly, kids, adolescents and adults can enjoy hours of gameplay in a world that celebrates marriage diversity and the family of adoption. It’s by no means a perfect world, but the benefits of such a video game may outweigh the concerns about gore. I can tell you that what I hear discussed eagerly by players is not how cool the gore is, but rather how neat it is to be able to be adopted or marry who you want.

Think about how often parents wish their children could understand them better. Now your child has the opportunity to imagine themselves choosing a child as they were chosen. Imagine a LGBTQ adolescent being able to experience choosing to marry who they want regardless of sex. And imagine a straight person seeing that they aren’t always what “normal” has to look like. Not medication, but a powerful prescription for what often ails our patients, and our nation.

And then, as I was preparing to write this post, I was bitten by a vampire.

Another common occurrence in the world of Skyrim is encountering a vampire. In my case, without choosing to, I had been bitten, and within a few days of game play, people in Skyrim began to notice. At first the shopkeepers would tell me I looked pale. A day or so later I was told by the guards that I had a hungry look in my eye. Finally, when my vampirism was no longer concealable everyone turned hostile. I couldn’t enter any city, including my hometown without being attacked, both verbally and physically. No matter that I hadn’t hurt anyone yet, I was forced to sneak around everywhere. I felt frustrated and victimized. It was a powerful lesson in ostracism.

I wish I could assign Skyrim to every one of my social work students studying diversity and racism. The game provides a model of a world which provides you with the experience of tremendous acceptance and empowerment, as well as hatred and stigma. It also shows us models of love and families which we have yet to embrace sufficiently in the United States of America.

There are 38 children in Skyrim who could be parented by a same-sex couple, in CA there are some 40,000 who have been. In our nation as a whole an estimated 65,000 adopted children are being raised by same-sex parents. We risk raising a portion of these, our future population, to feel ashamed, marginalized and flawed.

We can do better.

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: activism, adolescents, adoption, behavior change, children, doma, education, gamers, games, gaming, LGBT, LGBTQ, psychoanalysis, psychodynamic, psychology, psychotherapy, Skyrim, social justice, social media, therapy, video games, Web 2.0

Epic Supervision Fail

April 2, 2013 by langloimsw 7 Comments

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:

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: activism, building your business, digital literacy, education, facebook, Freud, gaming, gutenberg, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, Web 2.0

Continuing Education From Pax East

March 24, 2013 by langloimsw Leave a Comment

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: addiction, adolescents, behavior change, children, digital literacy, education, game theory, gamers, games, gaming, LGBT, mindfulness, minecraft, Pax east, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, public speaking, social media, therapy, twitter, video games, Web 2.0, World of Warcraft, youtube

Nice Everything You Have There: Mindful Minecraft

March 13, 2013 by langloimsw 4 Comments

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: adolescents, avatar, behavior change, buddhism, children, creeper, digital literacy, education, game theory, gamers, games, gaming, mindfulness, minecraft, Minecraft Pocket Edition, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, stress, sxsw, technology, therapy, video games, Web 2.0, Xbox

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by langloimsw 29 Comments

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: #sworcery, 1Password, adolescents, Apps, Bamboo Paper, behavior change, building your business, CardMunch, children, DCU, Dropbox, education, evernote, Flipboard, Flower Chain, gamers, games, gaming, GoToMeeting, iAnnotate, IbisMail, kingdom rush, Lavalanche, Line2, marketing, Mendeley, Micromedex, Minecraft Pocket Edition, PayPal, plants vs. zombies, prezi, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, TED, therapy, Trainyard, twitter, video games, Web 2.0

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

February 20, 2013 by langloimsw Leave a Comment

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: addiction, adolescents, behavior change, children, cooney center, digital literacy, education, game theory, gamers, games, gaming, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, sesame, social media, technology, video games, violence, Web 2.0, World of Warcraft

Learn More About Rethinking Video Games & Addiction Here!

February 17, 2013 by langloimsw 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:

The power of Prezi, even in its’ most stripped down version
The visuals that accompanied the presentation you can listen to if you go here
What my approach to technology and psychology is
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: adolescents, behavior change, children, digital literacy, education, game theory, gamers, games, gaming, mindfulness, play, prezi, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, sxsw, technology, therapy, video games, Web 2.0, World of Warcraft, wow

4 Tips For Dealing With Video Game Violence For Parents

February 2, 2013 by langloimsw 2 Comments

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: adolescents, call of duty, children, digital literacy, education, ESRB, gamers, games, gaming, Gears of War, parenting, play, Playstation, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, violence, wii, World of Warcraft, wow, Xbox

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

January 23, 2013 by langloimsw 4 Comments

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 14^th 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 21^st 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: adolescents, behavior change, digital literacy, education, facebook, gamers, games, gaming, generation y, millennials, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, twitter, video games, Web 2.0

What It Means To Make A Referral

January 7, 2013 by langloimsw 4 Comments

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: building your business, digital literacy, insurance, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, social media, technology, therapy

Happy New Year!

January 1, 2013 by langloimsw 1 Comment

As we start the New Year I wanted to share a quote I think applies to you:

“Talent hits a target no one else can hit; Genius hits a target no one else can see.”

— Arthur Schopenhauer

Going into the New Year, entertain the possibility that you are a genius. Whether you are a gamer playing first-person shooters, a therapist trying to build your private practice, an educator trying to reach students, or someone trying to live a good life, ask yourself: What are the targets you can see that other people can’t?

Don’t expect praise, people will think you are crazy for shooting into thin air. You may be bullied, insulted or ignored, but remember you are not alone. Find that person or group who believes in you even though they can’t see your target. Those are true people of faith in your life.

Does this mean you’ll be coasting? Nope. It takes practice allowing yourself to look for things invisible to most. It takes constant effort to hone your talent.

If you play Minecraft, think of 2013 as your new sandbox. 2013 is loaded with things you’ve not discovered yet. Any rock could conceal diamonds or ore. You will encounter creepers when you least expect them, lose things and have setbacks. But you can opt for multiplayer, and build in community. All of the materials are there for you. You may think you are starting with nothing, but you always have the tools to build tools.

If you keep at it you can change the world.

Whether you are a regular visitor or a loyal follower of this blog, thank you. In case you missed them, below are the 5 most popular posts from this year:

Dopey About Dopamine: Video Games, Drugs, & Addiction

Epic Mickey and Frittering

Gamer Therapy

How to Get Taken Seriously as a Mental Health Professional

Skyrim, Stealing & Sadism

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: behavior change, building your business, education, gamers, games, gaming, marketing, mindfulness, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social media, technology, video games, Web 2.0

Angry Birds, Advent, & the 12 Links of Christmas

December 13, 2012 by langloimsw 5 Comments

You may be familiar with Angry Birds, one of the most popular smartphone games in the world. But did you know that they have a holiday season edition? They cover several world holidays, but by far my favorite is the Christmas version, which comes out early each December.

The reason I like it so much is that it is basically an Advent calendar. For those of you who aren’t familiar with them, advent calendars are holiday calendars used to help celebrate the anticipation of Christmas. There are usually 24 little doors or windows in the calendar, and each night you open one of the doors as you get closer to the 25th. Behind the door may be a picture, small piece of chocolate, part of a story, or something else.

Angry Birds Seasons allows you to play one game level per day leading up until Christmas. Whether you whiz through it or play for 2 hours, the next day’s level is locked until midnight. You’ll see a countdown page if you try to move forward, but that’s it.

Many spiritual traditions emphasize the celebration of small patient acts. Hanukkah uses the nightly lighting of the menorah and exchange of small gifts for 8 nights. Diwali has 6 nights of celebration in its festival of lights, and there are many more. And now we have the more secular tradition of Angry Birds.

I want to celebrate with you the idea of waiting and enjoying small things. I think we can enjoy anticipation, see the value in the smallest of gifts. And that those gifts can be as powerful as they are small.

So whatever your particular holiday tradition is, or isn’t, I hope you’ll accept this gift from me to you. I call them the Twelve Links of Christmas, but you can call them whatever you want. They’re hyperlinks (sorry Zelda fans) to 12 different activities and ideas. Some of them are video games you can try, others are gift ideas, some are videos of change. All of them engage you in some activity involving social justice.

Don’t open them all at once! Each day from now until the 25th, click on one link and try it out.

The Twelve Links

1. Darfur is Dying: Refugee Game for Change Play this game to learn more about the genocide in the Darfur region. One of my students played the game for 45 minutes before realizing that she had now spent more time learning about Darfur in one sitting than the totality of her life before.
2. Eli Pariser TED Talk: Beware online “filter bubbles” In this TED Talk, Eli Pariser helps us see how we are in danger of having our experiences and information filtered by emerging technologies, and warns us of the potential consequence of such searches mediating and filtering our understanding of the world.
3. True Colors It’s been two years since this performance was belted out by the LA Gay Men’s Chorus, but it is as moving as ever. Sung to the world, but also to every LGBT youth feeling isolated and hopeless, this resounding cry of comfort and encouragement is perhaps best summed up in the powerful vocals at 3:50: “So don’t be afraid..”
4. Foldit: Science Game for Health Learn about and play the game that contributed to HIV research in 10 days of gaming in ways that computer models had been trying to do for years. Foldit uses a video game to fold proteins, which aids in the search for cures of health issues such as Cancer and AIDS. Within minutes, anyone can begin playing the game and help!
5. Tropes Vs. Women #3: The Smurfette Principal This is one video from Anita Sarkeesian’s series, which offers a feminist perspective on the limited and limiting ways women are portrayed in popular culture. Anita’s more recent exploration of sexism and these tropes in video games sparked a hateful backlash from some, and may just have ushered in a new era of discussion and self-critique as gamers and game developers supported Sarkeesian and have begun working to make the days of such hate numbered.
6. Papo and Yo If you still have any doubt that video games can be both art and social commentary, this powerful trailer may convince you otherwise. This PS3 game offers a powerful exploration of childhood abuse, ethnicity, poverty and the power of the imagination to solve the puzzle trauma inflicts on the oppressed.
7. Ken Robinson Says Schools Kill Creativity Check out this TED talk, not just for its commentary on education in general, but as a meditation on how we could rethink learning disabilities, autism, and other differences in the human learning process.
8. Ethos and Seniors Flash Mob for Elder Abuse Awareness Day This year, senior citizens in my very own Massachusetts dropped into the local supermarket for a flash mob to raise awareness on elder abuse. Their choice of song was apt, and even a bit chilling. Check out the video and see if you can notice how many stereotypes of elders it helps debunk.
9. Heifer.org : Rethinking Gift-giving A perennial favorite of mine, the mission of Heifer is simple: “To work with communities to end hunger and poverty and care for the Earth.” This website will show you the way you can change the world this holiday season by giving a gift of sustainable food and agriculture to indigenous peoples all over the world. Much nicer than another soap on a rope.
10. I Am: Trans People Speak A brave and bold use of social media, this project is affiliated with the Massachusetts Transgender Political Coalition in partnership with the Gay & Lesbian Alliance Against Defamation. It seeks to raise awareness about diversity within transgender communities, as well as empower individuals to create positive change in the media representations of trans people.
11. Food Force 2 Look, you’re on Facebook anyway, why not spend some time learning a bit about sustainability, community organizing and world hunger? This game, sponsored by the United Nations World Food Program, seeks to raise both awareness and money to solve real world food shortages. Since it is a video game on a social media platform, perhaps you can invite your friends to play too!
12. Give An Hour: Psychotherapists Supporting Veterans Got a spare 50 hours? Of course not. Okay, how about 10 minutes to check this video out. In it my colleague Barbara Van Dahlen discusses how she founded Give An Hour, an organization that connects returning veterans with psychotherapists who have volunteered to donate an hour a week of free therapy. After you listen to some of the soldier’s stories, you may find yourself inspired to make room for that hour a week in your practice. I have since 2006, and I recommend it highly.

If you’ve checked out the link before, maybe there is someone important to you you could send it to? Maybe you haven’t shared it with your child? Maybe someone else who you know will be alone for the holidays, or someone you’ve been meaning to reconnect with and can’t quite figure out how to do it?

I hope you find these links as rewarding and enriching as I have. Please accept them as my thank you for reading the blog this year. Please take them as an invitation to change the world. Because that is what social justice is, isn’t it?

;

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!

Filed Under: Gamer Therapy Tagged With: activism, angry birds, behavior change, children, education, gamers, games, gaming, LGBT, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0

‘Tis The Season For Power Ups

December 3, 2012 by langloimsw 2 Comments

This time of year is for many of us a time of stress and reflection. The days get shorter and much of the time it seems as if we are wandering around in darkness waiting for things to change. We may be pursued by haunting images of past relationships and mistakes we have made. We may feel like we are doing things over and over the same way expecting different results. We may become painfully aware of our repetition compulsion even as we charge around trying to get something to fill us up. We may dread the end and fear death.

You all know I’m talking about Pac-Man, right?

No, seriously, by now everyone on the planet, gamer or not, must know that Pac-Man is not just a fun video game but a compelling spiritual meditation. First off, Pac-Man is walking a labyrinth over and over, focusing on his path, how mindful is that? And then there are the ghosts, don’t even get me started on them. They pursue him constantly, like the specter of death or the ruminating thought that can’t be shaken. They are constantly somewhere on the board with him, yet Pac-Man is essentially alone in the world.

This would all be pretty depressing if it weren’t for the power-ups. Traditionally there are four of them, in the form of larger blinking white dots in the corners of the maze. You probably recall the drill: Pac-Man runs away from the ghosts until he finally eats one of those power-ups. And then everything changes. The ghosts turn blue and run away from him, and he can eat them for more points. Yep, turns out Pac-Man applies good old Buddhist principles to the whole situation: He faces his fears, and moves toward them. As Pema Chodron would say, Pac-Man goes to the places that scare him and leans into the sharp points.

Ok, so back to you and your life, or your business or your family or your health, whatever situation or ghostly thoughts are running around the maze in your head. Let’s do some Pac-meditation on them:

1. Who’s chasing you? Take a moment to stop rushing around and ask yourself what are you worrying about? Are you legitimately busy or being hectic? Remind yourself that in this present moment, the people, places or things you may be avoiding are probably not really there in front of you. If you aren’t physically moving, then remind yourself of that with a breath or two. If you feel like you are moving and you really aren’t, gently remind your mind of that. And if you are moving, try moving like you are walking a labyrinth not running around a maze: purposefully, single mindedly. Mindfulness is the difference between a maze and a labyrinth.

2. Don’t let the bouncing fruit distract you. This time of year especially it is easy to get thrown off course because you can become fixated on one goal: The perfect gift, the perfect holiday dinner, the New Year’s resolution to change X,Y, or Z. Much of it is hype or a collective hysteria. Look again, there isn’t one special dazzling fruit (or pretzel) that you have to have to win. Nope, it’s just ordinary time, the present moment stretching out before you like a string of yummy pellets. Enjoy those quiet unassuming moments where everything is calm and sufficient.

3. Know your ghosts. Take a few minutes now to get to know your four ghosts. This doesn’t need to be all psychoanalytic. Just try to list off 1-4 things that are most pressing to worry about. The ghosts often have less scary identities than you may suspect:

Those are the traditional names, but now let’s have you take your ghosts and put your names on them. For example they could be:

Try to limit the ghosts to four–Remember, this isn’t Space Invaders. What are the most pressing urgent concerns? The goal is to get them down and begin to do what Michael White referred to as “externalizing the problem.”

Now you’re ready for…

4. Identify your power-ups. What are those things that help you feel more powerful, more effective? Some people identify a song that powers them up to go to the gym. A favorite quote can be your power-up. In my office I have one of those Staples Easy Buttons which some people find useful. My own personal power-up is an Iced Venti Americano at Starbucks. Sometimes power-ups are specific to the particular ghost you are dealing with, sometimes one power-up works for many different ones. This is not a new concept, people have been using talismans for years. Object relations folks would probably call power-ups “transitional objects.”

Last, but not least:

5. Use your power-ups. This is not as easy as it sounds. People often forget they have power-ups even after they have identified them. You need to make sure your power-up is ready at hand. If yours is an Easy button, you need to keep it at your workspace in plain view. If it is fresh orange juice you need to make sure there is some in the fridge. If it is a song it needs to be downloaded on all your gadgets. If prayer or meditation is your power-up put the cushion on the floor in front of your bedroom doorway. Enlist your partner or family members to remind you that you have these power-ups. Then use them no matter how silly it feels, no matter how hopeless you feel. Just. Use. Them.

This isn’t the only time of year you can use power-ups, but it is definitely a good time to start. Not because it is the holiday season, but because it is the present. Right now you are awake, so you can reflect and take action. The only person stopping you from logging off and figuring out your ghosts and power-ups is you: Game on!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, building your business, cbt, game theory, gamers, games, gaming, mindfulness, pac-man, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, stress, video games, Web 2.0, winter

Avatars & The Curated Self

November 25, 2012 by langloimsw 2 Comments

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

Filed Under: Gamer Therapy Tagged With: adolescents, avatar, behavior change, building your business, call of duty, curated self, digital citizenship, digital literacy, education, Eve Online, gamers, gaming, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, rilke, second life, self-promotion, Skyrim, video games, Web 2.0, wittgenstein, World of Warcraft

Should Therapists & Social Workers Post Videos of Themselves on YouTube?

November 16, 2012 by langloimsw 2 Comments

http://youtu.be/pWQIbIkOVtY

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, children, education, Liz lasky, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, self-promotion, social justice, social work, social workers, technology, therapy, video, Web 2.0, youtube

On The Importance Of Feeling Useless

November 7, 2012 by langloimsw 1 Comment

Recently I was being trounced in a game of Call Of Duty 3: Modern Warfare 3. Not only was I having a difficult time understanding the lingo and mechanics of the game, the controls for this first person shooter were bewildering to me. I found myself staring down at the controller more than at the screen. Why couldn’t I remember what the A button did? Over the course of the week, I was also informed that Halo 4, Assassin’s Creed, and Paper Mario: Sticker Star are also here or on the horizon.

I wasn’t sure when I was going to find the time to try all of these. I was already behind. Skyrim had new DLC, Minecraft had different updates for both PC and the XBox 360 versions, and the Secret World and Guild Wars 2 had both been preempted by the latest World of Warcraft : Mists of Pandaria expansion. And what about Salem? I had gotten a beta key for that, didn’t that make me obligated to try a little more? And I won’t even go into the iPad and iPhone games, but Baldur’s Gate was just 3 weeks away…

I write all this because I have found that readers and colleagues often assume that because gaming is an area of clinical practice and focus of mine, that I am up on all of the latest games. If you have been imagining that I always know what every MMO gamer is talking about, or can jive with adolescents about the finer points of COD: MW3 (Call of Duty: Modern Warfare 3) and how it differs from Max Payne, you are in for a rude awakening.

I can relate to every therapist who has sat with a patient and said no repeatedly to “Do you know about” questions involving video games. I can relate to every colleague with thumbs of lead who plays with (against) their patients on XBox. I too struggle against the countertransference urge to display my “hipness.” And boy am I tempted sometimes to throw up my hands and say I am so over the latest thing.

But I don’t throw up my hands because I recognize that it is a defense against feeling useless. Who wants to feel slow, clumsy, behind the times? Feeling useless coincides with feeling powerless, devoid of meaning or hope, and isolation. For me, that feeling of uselessness is touching the water’s bottom: It’s where I kick off. Uselessness is almost always the feeling that precedes determination for me and the moment when I am closest to getting going again. Here are just a few reasons why feeling useless can be important:

1. Feeling useless reminds me of how my patients often feel. Regardless of age, gender or walk of life, I have sat with people who experience feelings of utter uselessness. Most kids feel useless in school at one point or another. Adults tend to embrace amnesia when it comes to remembering how dumb education can make you feel before you feel smart. They have forgotten what it was like to be called last for the kickball team, or draw and erase and draw until your paper ripped. And the population of Baby Boomers can feel useless as they sense the impatiences of their younger colleagues in the workplace: You talk too slow, drive too slow, and why don’t you just retire? Meanwhile, younger adults send out resume after resume and spend more hours in sweatpants as they feel that they and their education are both useless. Parents send their children off to college and experience the empty nest, or send them off to war and experience a more terrifying version of uselessness. We need to remember how it feels to be useless if we are going to stay empathically attuned to our patients.

2. To recognize that you are feeling useless is to begin to wake up. At least it can be, because the sense of being useless is completely irrational. There is nobody, not one person on the planet who has nothing to give of themselves. There is no such thing as a useless person, it is a cognitive distortion. And the minute we recognize that distortion we can begin to use our observing ego to ask ourselves “who is this who is telling me I am useless?” Whoever it is, the media, a parent, an old tape running in our head, or all of the above, it is just wrong. And that’s ok, because we’ve been wrong before, and now that we know it we can begin to gently guide our thinking back to a more rational place. If this sounds like meditation, that’s probably because it is.

3. To feel useless is only a feeling. Sure feelings are important, and a powerful part of human experience. But they are only one part of human experience. Thinking and behavior are two other parts. We can use feeling useless to motivate ourselves. We can use it as a barometer for our overall mental health. We can also use it as a defense to stay stuck, or to attempt to elicit pity from others. There are all sorts of ways we can use a feeling, and they aren’t all necessarily, well, useful. Or we can just sit still for a bit, because being just a feeling, feeling useless will float by and be replaced by another feeling, and another and another…

So if you are a therapist, and you notice yourself feeling useless, you are one step closer to coming to your senses. You can become more mindful of how unpleasant the feeling is, and mindful of how your patient may feel when they experience it. You can remember it is only a feeling, and become curious about it and why it is coming up. And you can consciously decide how to use it or cope with it, rather than unconsciously act out in response to it.

To return to my video game example, here’s how I used it. I noticed the feeling and said to myself, “That’s how my patients experience themselves sometimes.” From there I went on to think, “That’s how the therapists I consult with about technology experience themselves sometimes.” Interesting information, and it helped me pause a moment more. And when I sat with it more it occurred to me that there was some symbolic content that had come up in a session recently that I’d overlooked. And then it occurred to me to write this blog, and as I wrote the first paragraph I remembered how video games are a form of social media, and how my friend Susan Giurleo often reminds me that we don’t need to be on every single platform of it to be technically savvy. From that stream of consciousness, and more importantly, from my feeling of uselessness, came this post. And I have no doubt that at least a few of my colleagues will find it useful, which totally debunks the useless Mike theory.

What about you? What has elicited a feeling of uselessness for you lately? What is that feeling about, and what are you going to do with it?

Filed Under: Gamer Therapy Tagged With: adolescents, Assassin's Creed, behavior change, buddhism, call of duty, children, education, gamers, games, gaming, Halo, mindfulness, minecraft, Pandaria, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, video games, World of Warcraft

Taking An Interest

October 14, 2012 by langloimsw 2 Comments

This week I was at the dentist, and the appointment probably took twice as long as it was supposed to. This was because as I was waiting in the dentist chair, I was playing Denki Blocks on my iPhone when the assstant came in. She found the game interesting, and confessed to me that she didn’t know how to download games on her new iPhone. And as I was explaining how to do that, the dentist came in and he talked about how his children weren’t allowed to play games on the iPhone because they discouraged socializing. So then of course I explained that there was research that suggested very differently. He listened quietly and I said, “maybe I shouldn’t be arguing with someone who is about to put a drill in my mouth.”

“No, no,” he said. “It’s just that I’m thinking about what you said, and I haven’t thought about it that way before.” All three of us had an ongoing conversation between all the stages of filling a cavitiy, about smartphones, digital literacy, gaming. And at the end of it I

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Government or the holding of power by people chosen on the basis of merit (as opposed to wealth, social class, etc.); a society governed by such people or in which such people hold power; a ruling, powerful, or influential class of educated or able people.

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

pre·scribe

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this: