Tetris Beats Nazis: Video Games & Worry

This week I have two stories about video games, one that causes worry and one that effects it.

The first, worrisome, one concerns white nationalism, video games and propaganda. For as long as we have had Nazis, Aryanism, or White Nationalism, we have had its propaganda. Art is one of the most powerful medium that propaganda gets disseminated: Paintings by Erler and Feuerbach; film by Leni Riefenstahl; and music curated by Axis Sally were all examples of how the art form was used to convey Nazism. It should surprise no one that 21st century art mediums such as video games have their own share of deplorables.

One example, which I won’t link to, from the early 21st century was “Ethnic Cleansing” which came out in 2002. Since then there have been games like “Muslim Massacre” and “Zog’s Nightmare.” The games primarily target, Jews, Blacks, and Latinos, and are often on or linked to Nazi sites. Meanwhile, young people may find themselves being solicited online, where low-to-no moderation servers and bulletin boards like Discord and 4Chan provide a safe place to foster white supremacy.

Today, NPR came out with a story worth your attention, on the rise of recruitment efforts by white hate groups in online gaming environments. Now please don’t blame Fortnite. Most video games, even the violent ones, do not blatantly pedal nazi propaganda. The few that do are pretty explicit about it. What we need to worry about is how disillusioned and disenfranchised young men are vulnerable to being recruited by domestic terror groups, and of course they will be doing recruitment where youth are, including video games. My recommendation? When hate crimes or white supremacy comes up in your family discussions please ask your kids if they ever here things online that sound like hate speech or stereotypes. Assure them that you are more interested in hearing about what they may be experiencing than pulling the plug on Call of Duty, and that this is just one thing that people need to keep an eye on in online communities.

If anything shows up in their chat, consider taking screenshots and sending it to Discord or the chat platform you are using to let them know about the hate speech or recruitment. Both things are violation of TOS, and if your child doesn’t send it and someone else does they be banned themselves. Above all, keep an eye on gameplay, the content and the chat happening while it is happening. You don’t have to be Big Brother all the time, but let family members know that occasionally the games and chat need to be without headphones so you get a sense of who their “friends” are, just like you would if the friends were visiting your home in body.

Now that I have you worried about something new, go play some Tetris. That’s right, a recent study published in Emotion, a psychology journal, found that Tetris helped distract people from worrying by helping them achieve flow experiences. I have discussed before how distraction gets a bad rap and is actually evolutionarily adaptive. Here is some more research to support that theory!

So, now that I’ve made you worry, go play a little Tetris. You can do that here. Then, tomorrow, go vote.

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

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.

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Boundaries and Health in the Digital Age

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.

A New Startup Focusing on Minecraft & Social Emotional Learning

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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!

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Heroes

 

Extra Life Boo & Wow

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.

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Better Living Through Minecraft

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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.

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The Internet & Real Relationships


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.

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The Lava Expert

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“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.

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Using Gaming & Gamification in Clinical Practice

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

 

 

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Gamer-Affirmative Practice: Today’s Play Therapy

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

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

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

 

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

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.

 

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The Relationship Between Emerging Technology & Psychodynamic Theory

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.

 

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Social Justice & Technology Revisited

mccormick_reaper

I have written before about how technology often makes life easier for a large number of the population while simultaneously disenfranchising others.  The good news is that this does not have to be the case.

The example I used in the past was the Starbucks App which allows customers to use, gain rewards for, and reload their account on their smartphone, while making it more cumbersome and difficult to tip baristas.  This again does not have to be an inevitability, but requires Starbucks to enhance the functionality of its App.

So I was pleased to discover (special thanks to my student Marissa for bringing this to my attention) this week that come Wednesday March 19th, Starbucks will be rolling out an update to their smartphone App which allows just that.  You can read more about it at Forbes here.  You will be able to download the update from places like iTunes, and include your tip easily.

While some may dismiss this as a first-world problem, I cannot emphasize how powerful a shift I consider this to be in terms of workers’ rights in the service sector.  I am convinced it comes in part as a result of advocacy by and for workers, and sets the bar higher and yet attainable for corporations to maximize their value to customers while not disenfranchising their employees.

How can you help advocate for social justice in the technology you use?  First, simply by mindful usage.  Take a few minutes today to open your smartphone and make note of the Apps you use most frequently.  Next, ask yourself, who, if anyone is disadvantaged by my using this App?  Just thinking about the connections can be a powerful mental exercise.  Notice how complicated it can get fairly quickly:  If I use Evernote frequently, I am less likely to write things down on paper, which may be good for the environment but may also disenfranchise industrial workers in paper mills.  Hold on, did I say that you had to stop using Evernote or lobby for paper mills?  No, I’m asking us to sit with the complexity of a problem here for a minute to see the larger systems at play.  Technology has always resulted in job loss for some even as it may provide workplace improvements or quality of life for others.  It’s when we don’t think about these things in a more complex way that we stop innovating social justice itself.

Part of what I’m trying to encourage us to see is that social justice, workers’ rights, unions, and any person or group committed to social justice needs to keep pace with innovation and in fact keep innovating themselves.  Technology always runs the risk of disenfranchising people, especially workers.  If the McCormick reaper in a few hours does the day’s job of three workers, what happens to those three workers?  We are still living in a capitalist society in the US, and it is unlikely that as technology improves and reduces the need for human workers that all of these people will be able to afford to turn their minds and lives to the pursuit of art and culture.  Everything isn’t always getting better for everyone in the current system, and we are seeing overcrowding in occupations ranging from factory to legal work.

If social justice advocates, and social workers are to continue to help the disenfranchised, they are going to need to keep pace with technological developments and continue to think innovatively about 21st century equity in complex and sustained ways.  And by the way, thinking, “the gap is just going to get wider, the social fabric is unraveling,” is not an example of innovative thinking, but defeatism that exempts us from the work of innovation.

This brings me back to my social work colleagues, and my continued urging for them to keep pace with emerging technologies, especially if you are touting the concept of social innovation.  Social innovation without leveraging emerging technology will ultimately lead to future disenfranchisement.  If you have a social innovation department in your social work program that doesn’t leverage technology you are not being socially innovative.  I certainly don’t have all the answers, but I know that the answer to social injustice will inevitably need to integrate emerging technology into it.

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Reality Testing & The 7 Billion Rule

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!

 

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Obama, Selfies, Projections & Death

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.

 

 

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Selfie Esteem

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

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

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

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

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:

 

looting

 

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

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.

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The Changing Landscape of Social Work

TrekWorld_Nicholas-Roerich_Kanchendzonga-1944

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

 

 

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

apps2

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

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

lightbulb

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.

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Innovation is Dangerous & Gaming Causes Asperger’s

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Dopey About Dopamine: Video Games, Drugs, & Addiction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So my point here is twofold:

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

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

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

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

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

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

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

cod-sniper

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.

 

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Guild Wars: The Conservative Attack on Online Therapy

Commercial-routes

“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:”

 

  1. 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.)
  2. 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.
  3. 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.
  4. 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.

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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 Practice42(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.

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

2057142-shepards

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

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

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

21st Century Play

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

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

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

Solo Play is OK

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

The Many Reasons to Collaborate.

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

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

Let’s Bring On A World of Hurt.

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

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

Multiplayer and Uninvited Guests

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

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

Minecraft and the Repetition Compulsion.

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

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

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

I’m not THAT non-directive.  🙂

 

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Automation

papertowel-dispenser

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:

status updates

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.

 

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Saving Ideas

cave painting

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.

 

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

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.

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10 Nonviolent Video Games

Sometimes mental health providers, parents and educators get so caught up in the debate about video games and violence that we imagine all video games have violent content.  They don’t.

So when I am feeling proactive (like now) I point out that there are dozens of nonviolent video games.  In this case, I’ll give you a rundown of some of my favorites available on smartphones and/or tablets.  You may ask, “Mike, how do you find all of these games?”  I find them for free in several places, and you can too!  One place in the real world is a certain coffee chain we all know and love which often has App of the Day cards to try for free.  Another good source of freebies is App Gratis.  App Gratis has 1-2 daily deals on free apps for iPhone, iPad, and Android.  The app itself is free, so download it as soon as you are ready to go bargain hunting.

Without further ado, here are some games I’m enjoying lately:

 

1. Puzzlejuice

 puzzlejuice

Ok, so the tag line is violent:  Puzzlejuice is billed as a game “that will punch your brain in the face.”  But there’s no punching or violence beyond that blurb.  Puzzlejuice combines the spatial skills of Tetris with the wordplay of Scrabble.  You rotate blocks to line up 3 or more blocks of one color, which turns them into letters.  Spell words with the letters by dragging your finger across them and the blocks disappear.  Sound simple?  Please come back and comment on this post once you’ve tried it, heh.

 

2. Circadia

circadia2

Circadia is all about timing and pace.  The graphics are simple enough, where you try to tap expanding rings in order to time their intersection with a dot and other rings.  But this game is all about impulse control, patience and learning from your mistakes.  Different colors and musical tones indicate different speeds of ring expansion, and once you are through the tutorial you find yourself timing 3 or more rings, dots that move, and increasingly complicated sequences.

 

3. Denki Blocks!

 denki

This is a perennial favorite of mine.  Move blocks with the swipe of your finger to connect all of the same color, avoiding obstacles that will get you stuck.  Add to that timer challenges, special shapes and bonus mystery rounds and you have a simple, playful puzzle game that will challenge you for hours.

 

4. Ticket To Ride

Ticket_to_ride

Based on the German-style board/card game, you can now play TTR on your smartphone or tablet.   TTR combines strategy, planning and blocking other players as they race to build train routes connecting different cities in the US, Europe or “Legendary Asia.”  Play against the computer or online with other players, and if you’re feeling social, the built in chat feature allows you to chat with other players between turns.

 

5. Hundreds

hundreds

Who would have thought a black and white (ok, and gray and red) game could be so beautiful and elegant?  The website explains the basic premise of the game, but just dive right into the tutorial like I did and see what it’s like to learn a game from within it.  Did I mention how beautiful it is?  🙂  Minimalists take note..

 

6. Tilt World

tilt world

Playful, but with a strong ecological message, this offering from game designer and thought leader Nicole Lazzaro makes use of the smartphone or tablet’s accelerometer to make Flip the tadpole help fight the Blight that has affected Shady Glen by eating carbon and planting seeds.  The game is tied to a real world impact:  For each milestone of player points in the world, more trees get planted in Madagascar.  More than 10,000 trees have been planted to date, and players can see a real-world impact calculator here.

 

7. Carcassonne

carcasonne3

Based on the classic tile game, Carcassonne is a game of building medieval towns, castles and monasteries.  Build your cities, place your Meeples, and try to get the most points by the end of the game.  Best part, you can share points with other players, so the game is about strategic alliances as well as blocking another player’s move.  Play by yourself or on networked multiplayer.  Note to therapists:  The basic game can usually be played in the 10 minutes between sessions, just sayin’..

 

8. Osmos

osmos

If you like your games with ambience and an organic dreamlike quality, try this one out.  In Osmos you play a single cell Mote who jets around and absorbs smaller motes to become the biggest cell on the block.  But be careful, because the jet propelling you is made by expelling your own matter, so the farther you go the smaller you get!  This game emphasizes patience and planning over speedy acquisition.  Accompanied by some great electronic music.

 

9. Flower Chain

flower chain

I disagree with the developer Joybean describing this as  “a beautiful game for girls,” and exhort you to play this game regardless of gender!  Tap on one of the small floating buds to cause a flower to burst open, touch a nearby bud and start a chain reaction.  Easy when the early levels only require you to hit 2-3 flowers, but when you have to get a chain reaction of 50, choose where and when you tap carefully!

 

10. Nintai 2

nintaii2

The Japanese term “nintaii” means “patience, perseverance, or endurance,” and you’ll need it to get through all 100 levels of this puzzle.  Flip a rectangular block through a 3-D platform landscape to get to the end of the maze.  Each level is accompanied by trippy music and seemingly random titles like “Joy,” “Bravery,” and “Wealth.”  This game has a high “Huh?” factor, but is a compelling experience and best of all, non-violent.

Versions of these games range from free to $9.99 for most smartphones and tablets, and nothing is shot or slashed, not even watermelon (sorry, Fruit Ninja.)  Many of these games emphasize one or more social and cognitive skills, from cooperation to word-building to problem solving and impulse control.  But don’t let that discourage you–have fun!

Have a favorite non-violent game?  Let us know below!

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Empathy (Re)Training

 

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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.

 

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You’re The Reason Building Your Business Is So Hard

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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.

 

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

OnyxiaBreath.12.8.06

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.

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Alphabet Soup: The Perils & Promise of E-Learning

locutus

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.

What To Do When Your Therapist Turns Into A Kitten

kitten

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.

 

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One Bostonian’s Thoughts On Social Media

 MA Cambridge Charles River view of Boston

 

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

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

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

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

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

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

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

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

 

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

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

nate-bell-tweet

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

nate comment

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

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

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

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

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

Skyrim Family Values

hearthfire-adoption

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
  1. (of a medical practitioner) Advise and authorize the use of (a medicine or treatment) for someone, esp. in writing.
  2. 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.

 

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Epic Supervision Fail

arts-graphics-2008_1186344a

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

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

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

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

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

And they get “just say no.”

So let’s get real a sec here.

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

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

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

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

indexAC

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

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

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

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

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

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

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

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

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Continuing Education From Pax East

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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:

 

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Nice Everything You Have There: Mindful Minecraft

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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:

 

 

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Twenty-Three Apps for the 21st Century Therapist

apps

 

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

1. GoToMeeting

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

2. IbisMail

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

3. Flipboard

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

4. Bamboo Paper

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

5. Evernote

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

6. iAnnotate

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

7. 1Password

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

8. Mendeley

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

9. PayPal

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

10. Prezi

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

11. DCU

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

12. Dropbox

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

13. TED

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

14. Line2

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

15. CardMunch

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

16. Micromedex

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

And now for some games!

17. Plants Vs. Zombies

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

18. Zombies, Run!

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

19. Kingdom Rush

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

20. Minecraft Pocket Edition

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

21. Flower Chain

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

22. Trainyard

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

23. Lavalanche

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

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

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

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Learn More About Rethinking Video Games & Addiction Here!

 

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

[gigya ]

This can give you an idea of:

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

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

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

 

4 Tips For Dealing With Video Game Violence For Parents

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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…”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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What It Means To Make A Referral

referral cartoon

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

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

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

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

Please accept my invitation below. Thanks!

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

That’s not how you make a good referral.

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

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

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

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

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

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

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

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

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

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

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

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Happy New Year!

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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!

Angry Birds, Advent, & the 12 Links of Christmas

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?

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‘Tis The Season For Power Ups

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!

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On The Importance Of Feeling Useless

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?

 

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Taking An Interest

 

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 noted how clearly this is a topic for our times if all of us can be talking and listening intently about it for such a long period of time.

In college, one of my creative writing teachers once said, “What interests you is interesting.”  I think there is a lot of truth in this in general, and specifically when it comes to psychotherapy and running a business.  I feel extremely fortunate to be in a portfolio career that allows me to pursue my interests and take an interest in the psyche and society.  Not everybody has an easy or clear path to this in our society.  Some self-help gurus make it sound like all you need is a burning interest to become the happy and successful, which is absolutely not true.  There are millions of talented people out there that start off with less privilege and opportunity, and more stressors due to race, gender, poverty, or living in an ableist culture.  But what I do think my professor was on to was the idea that often what interests you can be a strong motivator to yourself and exciting to others.

A supervisee and I recently were discussing the possible meanings and messages that could be conveyed in leaving a voicemail for a patient.  After discussing this for 30 minutes, I interjected by saying, “Can I just take a step back and point out what a weird profession we’re in that we can spend so much time talking about this?”  We both laughed at this, and it was true, but the time had gone by so fast because we were mutually interested in the subject.

Enthusiasm, in its original meaning, was taken from the Greek enthousiasmos, which came from enthousiazein, to be possessed from within by a spirit or god.  That sense of a powerful force from within that can fill one with energy and ideas and lose track of time is at work in all of the stories above.  It is not the only ingredient to having a successful business, but I believe it is an essential one.  We need to be able to geek out about what we do, to go on at length about it.  Hopefully we can do so in an engaging way, but we need to be able to lose a bit of self-consciousness to be able to focus properly on our patients, our work, and our business.

Frequently I consult with therapists who come to me because they want to grow their practice.  A few of them say that, but what they really mean is that they want to make more money and work less.  That is not in itself a bad thing, but for some it is an attempt at compromise.  For they have grown tired or disinterested in what they are doing.  They feel trapped in their work, not interested in it.  They are afraid that they are too old to change, or don’t have anything else they can do.  Some dream about a time they’ll retire and write a novel.  But for now they are consigned to sit silently and voicelessly in their office.  They grow bored and resentful of their patients, who if they are lucky, escape.  This vicious cycle can go on for years.

The same holds for supervision.  I have heard from a lot of supervisees about supervisions where it’s all about the paperwork, or the liability, or the billable hours.  I’ve heard supervisors lament how they don’t have time to focus on talking about the dynamics of therapies, as if that was “extra” stuff!  My experience is that these comments are voiced midway or at the end of a progression towards burnout.  First the supervisor feels overwhelmed by the “musts” of paperwork and filing 51As, and then the supervision shifts to only being about those.  Next, the supervision gets defined as merely being about that, so that the supervisee sees the supervisor rushing down the hall or on the phone, pausing to ask, “Anything we need to talk about?”  If there is no crisis the student feels pressured and becomes trained to say no, there isn’t.  And now that supervision is only about crises and paperwork, it becomes something everyone wants to avoid because it is boring, lifeless.  There is no enthusiasm.

I would suggest this is ultimately a setup for malpractice.  Supervisees trust supervisors who seem interested in them.  Over and over I have heard that supervisees have a hard time connecting or trusting supervisors who are “just business,” or cheerleaders.  Yes, supervisees don’t want a supervisor who lets them talk for an hour and then says, “sounds like you handled that well.”  This bears saying, because sometimes we unconsciously or consciously try to substitute affirmation for engagement and interest.  If you’re a supervisor, don’t do it, because your supervisees can smell it a mile away.  If you’re vacant, they know it.  If you are filled with the spirit of interest, they know that as well.

I’ve had colleagues tell me how clever I am to have found the niche I have, which drives me crazy frankly.  I didn’t choose to focus on technology, gaming and social media in therapy because I saw a vacuum.  I was just lucky that there was one.  I chose these areas of specialty because I am a total geek about them.  I could play or talk about video games for hours.  I can’t talk about Twitter or Google+ without getting animated.  I see their influence everywhere, read vociferously about them on my “free” time.  I wrote a book about it which I charge $2.99 for.  When asked to teach a class on clinical practice I declined, and said, “No, but I’ll write a syllabus and teach a class for social work and technology.”  Any of you who have taught at the graduate level know that teaching from a pre-existing syllabus is easier and less time-consuming than writing and proposing a pilot course.  But I was enthusiastic about the topic, which fueled my work ethic.  And this has set up a virtuous cycle, where I get more recommendations for reading or TED Talks than I can handle, and referrals to work with those patients.

I’d be lying if I said I didn’t hope someday to become famous or rich, but it is more likely that I will make a decent living and have a modest reputation.  Because as I said there are thousands, no millions of people out there who have talents and interests to share with the world.  I’m just grateful I got lucky enough to be one of the ones who got the chance to do it.

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The New Achievement Gap

 

Last night while watching the political debate, I was struck by how Mitt Romney tried to reassure the nation that his Medicare plan would not affect current retirees.  This is not an anti-Romney, or even political post, because I have heard other politicians, both Democratic and Republican, often use this reassurance when pitching a policy.  This won’t effect you, they say, only future generations.

Only future generations?  Is it possible that people really care that little about people outside our own little 80-year life span bubble?

Actually this post is going to be about education, how proud I am of my students, and how worried I am about the social work and mental health professions.

This year, Boston College made a step into the future of social work when they allowed me to propose and teach the first graduate social work class on Social Work Practice and Technology.  It was a leap of faith for the faculty and administration, and one not lost on me.  A few weeks into the class I bumped into a colleague who sat on the committee to approve the course.  She asked how the class is going, and when I updated her she said, “honestly, when we were reading your syllabus we didn’t understand half of what you were talking about, but I said ‘let Langlois teach it, if anyone can do it he can.'”

Very flattering, but more importantly an example of a social work program taking a leap of faith into educating 21st century social workers.  Are you paying attention, Deans of other social work schools?

But although I am proud of BC and myself for this, I’m even more proud of the students and how they are doing in our class!  They’re starting blogs and commenting on each others, researching and test driving smartphone Apps for possible clinical benefit, and venturing into a class which will be conducted today in World of Warcraft.  In our discussions they are raising thoughtful comments and challenging my technophilia as much as their technophobia.

At the same time, I am being reminded of the mistake older clinicians often make when we assume that all “young people” know how to use technology.  This is an impossibly blanket and uniform statement to make about the diverse group of social work students today.  Many grad students have avoided smartphones, dislike Twitter, and think of blogging as solo and literary rather than multimedia and interactive.  But the speed at which they are learning and innovating is impressive!

So here is the new Achievement Gap, or Achievement Gaps as I see them:

1. The Gap between current students and continuing education.

This class was filled up on its first run, which contrasts sharply with workshops I often try to do with colleagues for professional development. Too many older clinicians are thinking they can still “opt out” of learning about things like social media, video games, and internet technologies.  They’re the Romneys of the social work world, reassuring themselves that technology changes will not effect their business or the quality of the work they do.  And perhaps just as bad, they are leaving it to the younger generation to learn on their own.

This achievement gap is troubling for many reasons, which brings me to:

2. The Gap between knowing how to use technology technically and how to use it clinically and ethically.

Even if we were to overlook the ageism in the assumption that “young folks know all about the new technologies,” it simply is not true.  Young people, and technology itself, are too diverse for that.  Not all grad students have had the same access to technology, the same aptitude or interest, or time to keep up with the proliferation of new technologies.  And even if they did, there is a vast difference between knowing how to use Twitter mechanically and how (or if) to use it as a clinician.

For learning how to be a clinician our students have always looked to our faculty and supervisors for direction.  From what I have heard over the past several years, the response students get to technology-related questions is usually dismissal or fear.  This is reflected in our profession’s consistent focus on technology as an ethical issue rather than as a modality for treatment.  Technology workshops pay lip service to how technology can provide us with new and exciting innovations, but then skip over how to actually do that and focus on the ethical concerns.  Our profession has bought into the moral panic around the internet by making it into solely an ethical topic almost all the time.

In the search of graduate school curricula, I found only one course on the graduate level that addressed technology, perhaps not surprisingly at UT Austin.  The focus however was much more on IT for informatics and case management than clincial social work.

According to the Council for Social Work Education‘s latest report, there are over 213 MSW programs in the US.  Of those reporting information, the indication is that 85,290 full-time and 26,129 part-time social work students are enrolled currently.  That’s 111,419 students.  Of these students, 20 will graduate this year with advanced clinical training on utilizing online technologies and social media.

That’s an Achievement Gap.  That’s scary.

Look, no one is saying that grad schools and agencies, faculty and supervisors, are in an easy position.  We are being called on to teach future professionals knowledge that we often don’t have a sufficient grasp on ourselves.  But that’s a call to action, not a call to resigning that knowledge to be the responsibility of some future generation, or worse the students who pay us thousands of dollars to prepare them for social work in the 21st Century.  This is an epic fail, and one I hope graduate schools remedy quickly.

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What Back to School Could Mean

This past week, over 70 million students from Pre-K to PhD went back to school in the United States.  Of those, an estimated 1 million students are homeless, an all-time high.  And this past week, many of us went back to school ourselves to teach these folks.  Maybe you have a adjunct position, or maybe you are supervising an intern, or maybe you are a school counselor or work at a university health service.

It has never seemed more urgent to me then now that we help people get the educations they desire and work toward.  Our country has been struggling immensely over the past several years with fiscal crashes, growing gaps between the upper, middle and working classes, and the sense of hopelessness and pessimism that accompany them.  When 1 million children are homeless in one of the 10 richest countries in the world, there is a lot of change needed.

Education should be fueled by optimism even though it always begins in failure.  By that I mean that we start off by not knowing stuff, and hoping to change that.  If we all knew how to read, write and think critically innately, we’d never need to go to school.  We begin not-knowing, but, and this is what is amazing, hard-wired to learn things.  We are wired to attach to caregivers, acquire language, and make meaning of the world.  And we all have the ability to have ideas.

Recently there has been a lot of useful commentary on how we need to get better at failing, in order to be able to innovate.  That is true, and it is only half the story.  To be able to innovate, we need to be willing to risk and tolerate failure, true.  But just as importantly, we need to allow for the possibility that we could contribute something important and transformative to the world as well.

Recently I was talking with a group of my graduate students, and I asked them to be honest with me and raise their hand if they thought they could get an A in my class.  I was heartened to see that 3/4 of class raised their hands.  Then I said, “Now raise your hand if you believe that you could have an idea in this class that could change the world.”

One student raised their hand.  It was a poignant moment for me, and I suspect many of them.

What has happened to our educational system and values that we teach people to expect they can get an A, but not come up with an idea that can change the world?

I do not fault the students at ALL for this, because I think they have been taught this pessimism by our system.  SATs and standardized tests are the ways we grant access to more educational privilege in the U.S., but numbers don’t allow for the reality that everyone has the ability to ideate, to come up with a new thought that could change the world in small and large ways.  And students are given or not given financial support based on numbers, which at best only indicate potential, the potential in many ways to know what has already been known, rather than the ability to discover the unknown.  These numbers become a driving concern to parents and children, to teachers and students 0f all ages.

Many of the students you are working with are starting the year feeling defeated already.  I remember a talk I gave a while back to students on academic probation at a community college, in the last chance class they had to pass in order to continue.  Every one of them played and enjoyed some sort of video game, and I asked them why they were willing to try and fail repeatedly with video games when they were having such reluctance to try and fail at school?

One student raised his hand and answered, “because with a video game, I might win.”

What a damning indictment of the educational environment we are shaping people’s hearts and minds in.  And yet, by the end of that class every one of the students had spoken, had put forth an idea of their own which brought us as a group further.

Recently, I have been playing a new MMO called Guild Wars 2 and I am finding it very timely for the back to school season.  Although I have played WoW for years and have leveled characters up to 85 there, suddenly I find myself thrown into a new world.  There is a completely unexplored map, a new economy to master, the game mechanics and character classes just different enough to make my keyboard skills rusty.  I didn’t have a clue what was going on until I hit level 5 or 6, when suddenly I began to “get it.”  The big question I have for you is, what kept me going to level 5?

I suspect the answer is that video games like GW2 create an optimistic world, where the possibility of success and creating something new is a distinct one.  I kept trying in places where I got stuck because I knew both that failure was a possibility but so was success.  I also had the opportunity to play the beta version, where we were always being asked by the game designers for our impressions and ideas.  Many of these ideas have been incorporated into the later iterations of games like GW2, WoW, and Minecraft.  These ideas have literally changed the worlds of these games.

What if we looked at our classrooms and studies more like a beta test?  What if we allowed for the possibility that each of us, any of us, could have an idea that changes the world?  What kind of learning and character building would that environment produce?

I highly doubt that if aliens were to visit our planet thousands of years from now that they would be impressed with anyone’s GPA.  I doubt that they’d sift through the ashes of a civilization to see its test results.  They might note the high levels of anxiety and rhetoric in the 21st century speeches on education reform though.

If you are a student reading this I hope you will take this to heart:  I believe that you are capable of coming up with an idea that could change the world.  If you are a teacher I hope you’ll fight to keep your classroom a laboratory of innovation or a beta test rather than crank out widgets of standardized educational achievement.  If you are a therapist I hope you will help support your patients and their families to maintain a sense of their capability and optimism.  If you are a parent I hope you will remember that your children’s willingness to take risks and find interests in the world may not always match your own or the status quo and that that is a good thing.

Someone, many someones, somewhere, many somewheres out there, a world-changing idea is about to happen.  Let’s not miss it.

 

If you’re a therapist looking to join a group of innovative colleagues for supervision, you may want to take advantage of this.  Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.  Subscribe to the Epic Newsletter!

How to Get Taken Seriously as a Mental Health Professional

Many therapists looking to start or grow their private practice often wonder the same question when they are starting out:  How do I get referrals?  If you can tolerate a mild rant, I may have one answer for you.

Let’s look at this concern through a tried and true mental health paradigm.  First, we take a symptom, and then we look at the underlying conflict that the symptom represents.

So what’s the symptom?  That’s easy, head on over to LinkedIn and take a look at several profile pictures of colleagues.  Go ahead, I’ll wait.  What did you see?  When I looked I saw some professional headshots, but more of the following:

  • blank photos
  • top of head/ chin cut off
  • people in front of a car
  • waterfalls
  • tank tops
  • the “I’m holding my phone camera at arm’s length” shot
  • at a party
  • graduation gown
  • flower
  • too dark to see
  • wearing sunglasses
  • skiing

 

If you want to generate referrals, this may be a problem. Some colleagues may have a different opinion or be too diplomatic to say this, but let me not mince words.  If you don’t have a professional headshot it is doubtful I will refer to you.  I don’t send people to waterfalls for psychotherapy.  I suspect people wearing shades of paranoia or vampirism.  I envy people who can ski much too much to ever want to help them grow their business.  Cars in photos are either nicer than mine or too shabby, triggering too much judgment either way.  And party-goers scare me.  😉

My experience as a consultant has been that these headshots are symptomatic of one of two scenarios:

1.  You don’t take social media seriously.  In this day and age, our potential patients want to see us before they see us.  They often do their research by checking out our online presence.  If you go on LinkedIn for example, you may find that several people viewed your profile this week.  A picture is worth a thousand words.  I have seen great head shots in black and white, or even avatars for online therapists, so it doesn’t have to be a standard color shot.  But the way technology works now, whatever picture you choose will most likely attach to your emails, tweets, blog comments, posts, and feeds of all kinds. There are exceptions to this, like my colleague Social Jerk, who needs to maintain a tight hold on her anonymity to allow for her to create such creative and satiric posts about social work.  But if you are not trying to be a satirist, but rather grow a therapy practice, this will not work for you.  And if you’re on Twitter, please don’t be an egg.  When I need to jettison followers to follow additional people, the eggs are often the first to go.  Accept that social media is the point of professional first contact with your colleagues and customers.  Take it seriously.

2.  You don’t take yourself as a therapist and businessperson seriously.  Anyone that has read this blog or chatted with me at a workshop can probably tell you that I am neither dour nor constantly serious.  I certainly think there is a lot of room in our profession for humanity, play and creativity.

That said, we are in the business of providing treatment for serious concerns, working with people who have a range of predicaments.  We assess for suicidality, psychosis and trauma.  Your patients come to you with vulnerability and hope that you will help them create profound change, recovery and healing in their lives, maybe even help them stay alive.  If you think that therapy is just two people in a room chatting, then by all means keep the beach picture.

To get a professional head shot requires investment of your time and money.  It is a business expense.  If you are unwilling to invest in a professional image to represent your business concern I suspect you are not ready to own and run a business.  If you are unwilling to invest the time to look through your existing photographs and select one (if you have it) that presents a professional demeanor online then I suspect you are not ready to own and run a business.

Now I know that the term “professional” photo is vague and subjective.  I am not saying that you need to be in a suit and tie.  You can be a play therapist and have affect like my colleague Charlotte Reznik.  But slapping up a blurry photo of you near a palm tree sends the message that you can’t be bothered to represent yourself or your brand.  And in business we need to be concerned about our brands, even as therapists.

Look, I’m not saying these things to hurt your feelings.  I really want you to succeed, and I know that there are a lot of people out there who need your help.  That’s why I suggest that the photo is the symptom of an underlying issue, which is the difficulty to take either technology or your business seriously.  If you have taken time and consulted with trusted colleagues and have come to the conclusion that “I want potential patients to see me as someone blurry whom they could go skiing with” is your brand, and that the head shot is a conscious and intentional image to brand yourself online than you have my blessing.

If not, get thee to a photographer.

 

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall.  You can find out more about it here.

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Post to a Young Therapist

I’m a big believer in twofers.  When you run your own business, twofers are essential.  So when I get several emails about a topic I try to craft a post in response.  Recently I have been getting emails from many therapists or therapists in training who want advice on how to pursue a career as a gamer therapist.  Many of them grew up playing video games and have a lot more comfort and familiarity with them than their therapists who have been around for a bit.

Take Claire for example, who has graciously allowed me to share an excerpt from her email to me:

For most of my life, both video games and service to others have been passions of mine. I’ve recently been working at a game company in XYZ, and have been immersed in the gaming culture more than ever. The more I see it (and experience it first-hand) the more I see a need for therapists who can address the issues so many gamers face as a result of their passion.

Before today, I had no idea if anyone had pioneered this field of study, of if there was even a place for it. And then I found you. A quick perusal of your website tells me that you and I are very much aligned in our beliefs about how games affect us, and why they matter. Seeing that you have crafted this job for yourself inspires me to look further into the possibility of knitting together these passions of mine.

Note the use of the word “passion” here.  I hear from these younger folks how their interest and curiosity around video games and technology in general is met with skepticism and often hostility.  Supervisors turn into lawyers before their very eyes and begin every conversation about technology with the words “HIPAA” and “liability.”  The only question asked in the exploration of patient’s video game is “how many hours are they on the computer?”

Part of the problem with this disconnect is that many up and coming therapists become inadvertently ashamed of the fact that they are gamers themselves.  The implicit or explicit pathologizing of video games and tech use shapes the behavior and expectations about whether discussing gaming, or even using it as an intervention, stops before it begins.

Those of us who have been in the field for a while can often become set in our ways.  We can act as if education and the workplace haven’t changed much since we started our practice.  Insulated in our office and routine, we stick with the phone, maybe email, and play therapy games that have changed little since the 70s.  With this stance we are not prepared to work with patients in the 21st century, let alone supervise 21st century trainees.

If you are training to be a therapist, here’s what I recommend if you want to be a gamer therapist:

1. Start from Within

Repeat after me, “It is okay to experience excitement and enjoyment when I am working with patients.”  Somewhere along the line our graduate programs have begun to give you the message that you are supposed to be an evidence-based automaton with little emotional investment in treatment.  I have had students who have heard dozens of times in their training ideas like “emotional detachment,” and “inappropriate boundaries;” yet not once has anyone talked to them about feeling excited and enjoyment in their sessions.  Even trainees doing play therapy express guilt or fear about getting “caught up” in the play.  You’d think we were supposed to spend our entire careers with dull, depressing people!  Allowing for a range of emotional experience with patients means the whole range, including excitement and fun.  So if you are going to be a gamer therapist, start building your capacity to enjoy yourself in sessions.

2.  Create A Gamer-Affirmative Environment

Did you know that research has suggested that 1 out of 4 comic book readers are age 65 or older?  Yet how many offices have comic books for their adult patients alongside People and Time?  The same is true for video games.  Geeking up your office and waiting room sends the message that you don’t equate video games or technology with “toys.”  In my waiting room I don’t have comic books currently, but I do have Wired magazine and titles devoted to video games.  Many conversations have begun as a result.  I also have a Deathwing statue and other game-related memorabilia.  Recently someone saw a Post-It I had with the word Katamari on it.  I had made a note of the game to remind myself to check it out.  That Post-It was all it took to begin a very excited and meaningful conversation about the game (which has a free App, by the way.)  The smallest changes to your office can convey that you are interested.

3. Try (and I mean play) lots of different video games

This is the fun part, usually.  I have the major game platforms and am always trying one or two new games a week.  If a patient mentions a game in a session, I make a note to try it ASAP if I haven’t already.  Sometimes this requires discipline, because like most people I don’t like every sort of game.  But each game I test out helps me understand the patient better.

4. Have video games in your office

I have always had handheld video game consoles in my office, but in addition I have an XBox 360 as well.  I don’t think you can be doing contemporary play therapy well without it.

5. Disclose that you play video games

The fact that you have game consoles probably implies this a bit, but let’s be explicit. Regardless of age, 64% of Americans play video games, and the percentage is much higher under 40.  So if you have played video games, disclose that you have.  If you have a supervisor who sees that disclosure as more akin to “I smoked pot as a teen” than “Yes, I saw Star Wars” run away.  Video games are an art form not a controlled substance, and there is a big difference between those two conversations.

6. That said, be on the lookout for countertransference.

Whether you like or hate, play or avoid, video games, you need to be mindful of the reasons why and when you talk about aspects of it.  If your patient is telling you that they managed to fish up the giant sea turtle in WoW, it is an empathic failure to say, “Yeah I got that last week, isn’t it cool,” rather than to reflect to them what that says about their persistence and discipline.  Note any feelings of competition you have (or don’t have) and wonder about it.

7. Get good supervision, even if you have to pay for it privately.

One of the downsides of licensure having a (in MA) 2 year post-graduate supervision requirement before you get your independent license is that it inadvertently sends the message to fledgling clinicians that after two years you don’t need it any more.  That is not true.  I encourage new therapists to consider ongoing supervision of some sort to be a business expense to build right into your practice.  I had the opportunity to have weekly supervision for free at my workplace for 12 years.  That sort of job benefit has gone the way of the milkman in many places today.  This means you’ll need to buy some.

If you buy private supervision, remember that it is a different experience from your earlier or agency experiences with it.  This is not your boss, you are hiring them.  Hiring people means interviewing them, and screening them for fit.  If they are technophobic they are not going to be a good fit for a gamer therapist, so it is important to let them know your pro-technology and gaming stance from the beginning.

If you are interested in participating in a small group supervision experience, you may want to check out the Supervision Package I’ll be offering this fall.  You can find out more about it here.

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.
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When Wallflowers Attack

Back in graduate school, my group therapy professor once said to me, “early risk-takers are often scapegoated by the group.”  This comment came on the heels of yours truly taking a risk in the group, a group of psychotherapists in training.  I learned two things in that group class on that day.  The first was that early risk-takers are often scapegoated.  The second was that we therapists can be just as cruel with our comments as anyone else.

This is something that many of my supervisees encounter when they start to put themselves out there, especially on the interwebs.  They are stunned when the blog post they write elicits comments that are sometimes shocking in their nastiness.  They are confused as to why this happens, and what to do about it.  If you are beginning to use social media to build your psychotherapy practice, write newsletters, prepare a public speaking campaign or just write a blog, this post is for you.

The internet has made it easier to be both impulsive and anonymous, and emboldened some people to hurl invectives.  I call these people the wallflowers.  These are the people in any given group who are afraid to take risks or stand out, and resent those who are brave enough to do so.  They are quietly resentful, and more often than not envious of people who are not quiet.  I’m not talking about introverts here, but rather a particular group who stand on the sidelines seething.

These are the people who send you a nasty email at 2:00 AM criticizing your post for a spelling error, or the folks who text really ugly comments to you after you post something on a listserv they don’t like.  They’re the people who make personal attacks on your workshop evaluation in the guise of constructive criticism, or bait you in discussion groups by deliberately misconstruing your words.  Yes, I’m not making this stuff up, all of these things and worse have come at me by email, Twitter, Facebook, blog comment, and text message.  The majority of the time it will be behind the scenes of whatever arena you’re in, so that you can see it and the larger group can’t.  Consciously or unconsciously, wallflowers are counting on you not passing these barbs on to the larger group.  Nobody likes a tattletale.

So what do you do about them?

First, take a second and calm down, and note that the intensity of your response is probably an indicator that this is out of the ordinary.  Next, try to find a trusted friend or family member that you feel comfortable sharing it with, and ask them what they make of it.  Supervisors are often really helpful here.  Often they will react more strongly then you did, which gives you another clue its a wallflower attack.  Your inclination may be to try to learn something from the comment.  I’m going to say something that may go against the therapist grain here–Dismiss the comment and the wallflower.  Don’t bother trying to make this into a growth opportunity, there are plenty of other growth opportunities out there for you.  Don’t give this your energy.

In my experience this is very hard to do, because therapist wallflowers have a lot of skills to hook you.  They bring their therapeutic arsenal and try to come at you as a therapist, by analyzing or interpreting you.  Don’t fall for it.  Just because you both speak the same language doesn’t mean you have to have a conversation with them.  Therapy is a specialized and voluntary form of conversation, and anyone who tries to inflict this on you unasked is using their Jedi therapy powers for ill.

This is your reminder.

This is the price you will have to pay for being an innovator and a risk taker.  Early risk takers are often scapegoated.  You didn’t do anything wrong, you were just putting yourself out there.  And every time you do that, you will run the risk of a wallflower attack.  Don’t overprocess it, move on.  And definitely don’t let it stop you.  Remind yourself that the reason they had anything to attack you about is because you’re doing something they wish they could, creating.  Anyone can ping off a blog post, or fire off a Tweet in reaction, but it will only be a reaction, not a standalone.

Remind yourself that your ideas are precious.  I’m not trying to sound New Agey here.  What I mean is that the fact that you had something to put out there is not to be taken for granted or underestimated.  You could have not had the inspiration for that workshop or podcast, but you had it.  All over the world there are people who have not given awareness to ideas, throughout history millions of good ideas have never been expressed or seen the light of day.  Not you.  You did it!  And if you stop taking risks the wallflowers win, and the prize is one less idea in the world.  Yippee.

I know this can be hard to do, trust me.  And the technology we have today has made it even easier for wallflowers to attack.  It’s sort of like that sense of invincibility drivers get when they are encased in the protection of their cars.  Shake it off.  Share it with someone you trust for perspective.  Dismiss it.  Stay focused.  You can take time to smell the roses, but don’t get distracted by the wallflowers.

 

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21st Century (Psycho)education

Whether you’re a psychotherapist, an educator or a parent, sooner or later you will be involved in the facilitation of growth through learning.  The bad news is that most of us were educated in the 20th century, when education was largely modeled on the 19th century.  The view of literacy then was narrower, standardized and often monolithic.  The good news is that technology today can help us invigorate learning as never before, often by using the mechanics or design of video games and social media.

Before we press on, it is time to choose your own adventure!  I encourage you to ask yourself and answer this question: Is education inevitably like a daily spoonful of cod liver oil?  That is, do I believe that it is something that is routine, unavoidably unpleasant the people need to just suck it up and deal with?

If you answered yes, click here to stop reading this post and go to Mordor, where you can play a free MUD with other denizens of gloom and doom.

If you answered no, read on to find some examples of how simple game mechanics can revolutionize a curriculum.

1. Game Patches

Game patches are supplementary, downloadable game content that patches into existing games to either fix bugs or introduce new content into existing games.  One example was the famous Burning Crusade from World of Warcraft, which added another world of play, new races to create characters as, flying, and many new quests to challenge players.  More recently, Minecraft added patches to include jungles (1.2,) fixed multiple crashes (1.2.4,) and made cats more impatient and eager to sit on things (1.2.5.)  Much of the patch content comes from user experience comments, and players often know and eagerly await for patches for weeks in advance of their arrival.

Introducing content into classroom settings can benefit from this approach.  First off, polling students during subject matter about what aspects of what they are learning would they like to know more about?  What ways can learning or behavioral problems be debugged?  For example, elementary school teachers can hype up the class before rolling out Grade 3.5, at the halfway mark of the year, and include in this patch a total restructure of seating plans, allowing new class configurations and addressing problems in a way that starts to be both expected and exciting.

In terms of curriculum, from kindergarten to college, most educators have some lesson plan, and previewing content of upcoming lessons can generate interest and engagement.  This can range from creating a funny trailer on YouTube with teasers for the next lesson, to releasing hints about upcoming problems and subject matter.  This can include contests to name upcoming characters, for example the characters involved in mathematical word problems, or residents of new areas about to be unlocked and explored in geography.

In school-based and outpatient therapy groups, where is often a psychoeducation component, group leaders can initiate a countdown before patching new content or welcoming new group members into the group.  For process-oriented groups, members can be invited to debug and modify the design of the group to deal with challenges or conflicts in the group.  I remember a really interesting version of this that a colleague of mine went through in her internship.  We were at an outpatient mental health clinic, and although it was not languaged as a patch, her co-leader had her join the group for the first several weeks as a participant-observer.  She attended the first 4 groups without speaking, and as week five approached there was much discussion and projection from other members about what she would say when she finally spoke.  She was in essence the new content “patched” into the existing group, which introduced change, and new transference while maintaining some group stability and continuity.

2. Talent Trees

If we can just get beyond the tendency towards and linear thinking in curriculum, I am convinced that this intervention could be extremely effective.  First, for those of you who are unfamiliar with the idea of a talent tree, here’s an example:

 

In many games, players have some choices about how to specialize in the area of talents.  As they progress through levels, they acquire talent points to spend on unlocking different talents.  So if an educator can be flexible in the order of learning certain topics, students can choose to specialize in learning something first or second.  Let’s take Literature, would you like to be an Arcane Satirist, Epic Voyager, or specialize in Bloodmagic Murder.  If you want to progress through the first talent tree, you will need to read and complete assignments involving Gulliver’s Travels, the second, The Odyssey, and the third MacBeth.

If you are doing psychotherapy we already have a version of this, it’s called DBT.  In it people focus on unlocking talent points in the trees of mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.  Which does the patient feel that they would benefit from working on first?  Which do you recommend?  For adolescents especially, this can make the difference between engaging in treatment and just another boring worksheet.

Other ways to use talent trees effectively can include:  Helping gamer couples unlock skills to better communicate or improve their sex lives; helping parents focus on and prioritize specific behaviors to work on with their children; a template for an emergent adult’s first career search; and systematic desensitization of a phobia.

These are just two ways that we can use both the technology and concepts behind it effect change therapeutically and educationally.  Can you think of others?

 

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“On the Computer.”

You can often tell a lot about how people value (or don’t) something by a preposition.  It is very subtle, but I have come to find that “on” in particular is a problematic one.  People are on drugs, on parole, etc.

Often I hear parents or clinicians talk about how much time Janey spends “on” the computer, or on Xbox, Playstation, etc.  I also hear about how much time Eric is “on” Facebook, 4Chan, etc.  There is always a negative connotation to this.  I have never heard someone complain about how much time someone spends “on” the book, on the gym, on the dance, etc.

This may seem like a small detail, but why are the recent technologies, things that we are “on?”  Is it because the web and video games were seen as analagous to the phone and television in their early days?  I don’t think that is the whole story.  Maybe we view technology as still cold and alien so we don’t curl up “with” a video game like we would a good book.  I can’t quite put my finger on it, but there seems to be something perjorative about being on the computer or social media that just isn’t presented the same ways with the older more familiar literacies and arts in our culture.

But my biggest problem with this preposition is that it allows important clinical data to hide in plain site of the clinician: Our patient telling us that they are on the computer at night tells us next to nothing about what they are doing with it.  The same goes for Facebook or Tumblr.  When someone tells you in your office that they spent several hours on Facebook, do you ask them what they are doing on it?

These question matter, because as technology has become more advanced and mainstream the computer can be used to access many things: information, play, sexual excitement, art, all these and more are a mere mouse-click away.  And when we are told someone is on the computer, I’d suggest we are only one question away from a panoramic window into their conscious and unconscious life.

So to with Facebook.  In 2012 being on Facebook can mean any or all of these: reading, status updating, letter-writing, IMing, game-playing, listening to music, political activism, remembering a birthday, seeing photos of grandchildren, searching content, RSVPing to a party, planning a party, and yes, even having a party.  Many relational things are happening on social media, real connections are beginning, middling and ending on it as you read this.

One good check for you is to pause and ask yourself what you think they are doing on Facebook.  I am often amazed at how disinterested therapists appear to be about that.  I have heard things at workshops like, “I don’t want to have anything to do with Facebook.”  End of subject.  Well, the statistics are accurate, more than half of the people in the US are “on” Facebook.  And I personally think when  half the population is involved in something, we can’t afford to be disinterested in it.  At best this dismissal of a patient’s interest is an empathic failure, at worst it is dangerous.

I believe more and more that we have an ethical duty to educate ourselves about social media sufficiently so that we can help our patients and our society move towards universal digital literacy.  We need to be able to help parents understand privacy settings, as well as challenge them not to think parenting has a privacy setting they can “park” their responsibility on.  We need to help schools help kids learn how to communicate online even as we educate them that cyberbullying is different than traditional bullying, and in fact often more indicative of a moral panic about technology rather than an “epidemic.”  We need to help extend our support of the individual’s reality testing to the online world, or as Howard Rheingold says, help them develop their “crap detector.”

Additionally, we need to become more nuanced in our understanding of what can be done or experienced “on” the computer, in order to understand how to keep psychology and social work relevant.  We need to include video games in play therapy, use Pinterest for DBT skills building, YouTube to provide transitional objects or guided imagery.  These do not have to dilute traditional psychotherapy, but our reluctance to use them does.  As a psychodynamic practitioner I note how we are falling behind our more behaviorally-oriented colleagues in using technology.  Technology has always had its place in psychoanalytic theory, as metaphor, analogy, and the technology of literacy to help us make sense of human experience.  Technology aids and abets the ego defenses, creates another arena for object relations to play out, and provides selfobject functions.

We are not just “on” the computer or Facebook, our relationship with them and their’s with us is much more complicated than that.  If by on we are talking about position, we’ve got the position all wrong.  “On” implies perching on top of something, like a precipice.  We are within experiences of the computer and social media, the plunge has been taken and we are swimming in it.  Now we need to begin to figure out what that means.

 

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Technology and Time Management: Some Simple Tips

Sometimes people get the impression from my presentations, book, or this blog that I think that there is no such thing as too much use of video games, social media & technology, so let me set the record straight.  I do think that there is such a thing as problem usage.  One of the first questions I get when I speak to therapists, educators or parents usually is, “how much time spent playing video games, texting, or using Facebook is too much?”  The concern is real and understandable, but the problem is the way the question is framed.

Other than sleep, and maybe meditation, I can’t think of any activity that is good to do for 8 hours straight on a regular basis.  Nothing, not gaming, sitting on an airplane, playing hopscotch, calisthenics, drinking alcohol or water, studying, or mowing the lawn, will be without adverse effects if you do it constantly for 8 hours straight.  What makes most things problematic is not the quantity of time, but the quality of your life as a result of the usage.  If you were to play hopscotch for any length of time such that it lost you your job, ruined your school performance, jeopardized your relationships with loved ones, or made you feel more negatively about yourself, those qualitative concerns are what would make it problematic.  That said, another qualitative factor in determining whether using technology has become problematic for you can be its impact on your time management skills.

I strongly suspect that people have had time management challenges for as long as there have been sundials.  And we do know from history that each introduction of a new technology is followed by an exponential increase in its use, which in turn creates feelings of overwhelm.  And these feelings of being overwhelmed are what necessarily precede our developing the mental, physical and technological skills to manage the new use.  The earliest known book indexes showed up about 150 years after the printing press, and were preceded by 50 years of increasing overwhelm as Europe’s book collection grew from approximately 30,000 to over 20 million.  (And no doubt, even as knowledge and the arts grew so rapidly, there were members of the population who had little interest in learning to read, and would have criticized time wasted reading that could have been put to better use, like tilling the fields or baking bread.)

So here we are again, with a proliferation of technology and the demonization, confusion, and yes, real problems that come with it.  Two years ago the average amount of time adults in the U.S. spent online was 13 hours excluding email, and with the advent of the iPad it has undoubtedly increased from there.  Fortunately, people are starting to talk about ways to reflect on the way we use technology, such as Howard Rheingold in his new book, Net Smart.  Which is important, because we’ve passed the point where using technology is optional, at least if you want to live and work in the U.S.  So here are a few tips I thought I’d pass on that I and people I work with have found helpful in learning to how to manage your time and tech use:

 

  1. First, figure out what thing is the most time suck for you, because it varies.  For some people it is going on Facebook, for others it’s gaming.  Personally, I don’t think I spend more than 30 minutes a week on Facebook, because it isn’t my “thing.”  On the other hand, I need to do something about the 2,500 unread emails in my box.
  2. Next, drill down into that technology and figure out what particular elements are taking up the most time.  Saying “I spend hours on Facebook or Google+” is pretty meaningless, because these platforms have such varied functionality.  Are you on FB chatting?  Reading updates? Playing Farmville?  Take a few minutes to reflect on what you do and how much time it tends to consume.
  3. Consider Chunking.  Remember how I said my email was my biggest time suck?  When I really feel overwhelmed, I begin setting aside a couple of 30 minute blocks to read carefully and respond thoughtfully to emails.
  4. If you’re a therapist, I suggest you take a lesson from your voicemail, and begin using an auto-responder.  They are pretty universally available through either your webmail settings or your software.  I do think we have a responsibility to our patients to let them know that their message has been received, and told that if this is an emergency they should not wait for a reply, but go to the ER or call 911.
  5. Peter Bregman, a blogger for the Harvard Business Review, makes the excellent suggestion of having two lists for your day.  The first one lists the things you need to pay attention to that day.  The second one is lists the things you need NOT to pay attention to.  Many of us have a really hard time making priorities.  We think that everything needs to be attended to, and sure, if you put something on the NOT list, you will miss out on something.  It doesn’t feel good or easy to set priorities, because that is the nature of prioritizing.
  6. To the above lists, I suggest that you apply my own (non-patented) Postit Rule.  Quite simply, the Postit Rule is that any list needs to fit legibly on a regular sized Postit, or be shortened.  If I cannot print the items on my list legibly on one side of a postit, then more things need to go on the “NOT attending to” list.  Experience has proven that if I don’t do this I won’t get everything done anyway, because even though “dither and complain about how busy I am” never shows up on either list, it somehow seems to consume a lot of time.
  7. For gamers who are having a hard time logging off, I suggest a PostIt that is taped up to the edge of your monitor saying something like “Just win?  Maybe now’s a good time to log off.”
  8. For gamers who are interested in doing some self-reflection, I suggest you do this experiment:  Keep a pad and pen near the place you’re playing.  Tell yourself (and others if you’re grouped) that you are going to log off the next fail, not as a rage quit, but as an exercise.  Then, when you lose, log off and spend 10-15 minutes writing down the thoughts, feelings, and impressions that come up immediately after a fail.  Does it feel infuriating to lose?  Urgent? Funny? A relief?  What thoughts do you catch running through your mind?  After you’ve reflected a minute, put it away, but take it out and reread it an hour later and a day later.  What do you think of it now?
    You may have noticed that the above strategies don’t depend for the most part on advanced technology, but rather putting tangible reminders in your field of vision during the day.
    That said, there are several apps and sites that may help you get a handle on your time as well:
  1. If you surf a lot, consider using a news aggregator.  One Howard Rheingold recommends is NetVibes, which is very customizeable.  I find it a little too overwhelming, and I surf mostly on my iPad rather than a desktop, so I use  the App Flipboard.  It has a nice intuitive interface and allows me to read and share material very easily from within it.  Or you can try Google’s Feedburner or FeedDemon.
  2. If you haven’t tried Evernote yet, especially on the latest iPhone, you are missing out on another good time-saver for non-confidential sorts of info.  Evernote stores your notes, lists, pictures, and webpages so you can access them on any computer.  It makes what you save searchable, and best of all IMHO in the latest iPhone you can dictate notes.  If you’re a student or work with students, I recommend StudyBlue as well.

These are just some of the things out there that can help you achieve more mindfulness and organization.  Because in my opinion the hours counting and addiction labeling is dodging the real issue, how to increase our own mental abilities to become self-reflective and intentional in our use of technology.  Notice what you are attending to, increase the space between thinking and doing, and I’ll bet you find yourself a better gamer, blogger, worker, student, or other user of technology.

 

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Homework on Mars

In the 20 years that I have been working with children, adolescents and their families, I have seen no end of grief caused by homework.  In fact, I sometimes wonder what families would do with all the time they saved if they weren’t doing homework, fighting about doing homework, looking for lost homework, trying to understand homework, or reading notes from teachers about incomplete homework.

And having worked in several school systems across communities of varying socioeconomic status, I can tell you that bad and boring homework knows no barrier of class or poverty.  I’ve seen my fair share of photocopied worksheets and looked at “problems 1,2, 4-8 on pages 125-129″ enough to empathize with my patients over the years.  Sometimes I manage to answer the question, how is this going to help me in life?”  But more often I’m of the opinion that I’d glaze over looking at some of the homework assignments too if I were them.

If you are someone who believes in the idea that we’ve always had homework, and that kids and young adults have just got to shut up and do it, don’t waste anymore time reading this post.  Because I think in general that homework is more over-prescribed than any psychiatric medication, and that it reinforces some pretty distorted views about education and work.  Unfortunately, they are also pretty prevalent views of education and work, but they definitely aren’t the only ones.

I’m not alone in my critique of homework.  Educator John T. Spencer wrote a great blog post about it a year ago, which points out that among other things, homework has been shown to not improve academic achievement and may even decrease it.  This research came from Cooper’s metaanalysis of over 180 studies of homework conducted between 1987 and 2006, and you can find it here.  Nor is this a recent critique:  As Gill and Schlossman point out in their work many learned and progressive people spent the earlier part of the 20th century trying to abolish homework.  Most of us parenting today however, were taught in such a way that we think of homework as a fundamental and inevitable “given” when it comes to school.

From the point of view of social emotional development and creativity at least, kids have a lot more important things to do when they aren’t in school.  Homework takes time away from developing peer relationships, engaging in extracurricular activities, and, well, being a kid.  And most assignments come in the form of worksheets and packets, which encourage dry research rather than lived experience or creativity.

I have a colleague whose son was given a list of “historic places” to research, which did not include one location in our Metro Boston area.  No Old North Church, no African Meetinghouse, no Lexington Battle Green, nothing.  No one place that encouraged parent/child time to take a trip or have a fun experience.  This is one way that schools inadvertently teach kids to “phone it in.”  And that’s not the only problematic habit homework instills:  If a child comes home from a day of work and does more work, that is being a good student; if an adult comes home from a day of work and works more we call them a workaholic.

The other thing about homework is that it inherently demeans teachers.  Although we are seeing some exciting developments with MITx, Udacity, the Khan Academy and other attempts to make education more scalable, we are being reminded that direct instruction by teachers is in many ways irreplaceable.  Even if homework reinforces what is done during the day, which it may or may not, it doesn’t replace it.

Worksheets in particular become just another metric for grading, and a metric that doesn’t say much about how varied in support and context each of the homes it is occurring in can be.  It can be argued that truly egalitarian public education happens in the school setting, as that is the one place that is a level playing field in terms of race and class.

But I don’t doubt that homework is not going away, if for nothing else than because it is “the way we do things.”  But given the wonderful new technologies out there, I don’t see any reason why it has to be so rote and dismal as it often is.  Originally I was going to write about using Netvibes as a virtual “Trapper Keeper” for homework, but then I began exploring and gardening on Mars.

Waking Mars is a game from Tiger Style, which I recently sampled for the iPad (it also is available for iPhone.)  You play the game as Liang, an astronaut who finds himself exploring subterranean caverns on Mars.  There he discovers various species of creatures called Zoa, who may be plants, animals, or something else entirely.  In order to solve the mysteries of the cavern, Liang must experiment and learn how to interact with the different Zoa.  This includes planting seeds, changing the pH of ground, helping mobile Zoa reproduce or herding them into predatory Zoa to create compost.  As one progresses, the player must gather data on each Zoa in terms of their reproduction, vulnerabilities, ideal environment and interactions in order to help replenish the biomass of each cavern.

I could envision a range of educational uses for this game.  It could be used to illustrate the concept of phyla and Linnaean taxonomy in general.  It demonstrates both symbiotic and autonomous relationships in biology.  It requires one to observe behavior and learn to predict it.  It shows how and why understanding the environment and life cycles of a biosystem may have applied value.  It requires problem-solving and critical thinking to advance, and the ability to compare and contrast types as well.

Waking Mars is an example of what could be begun in a connected classroom, and then continued at home.  Achievements are recorded and available for later assessment.  There is also social media capabilities to help kids collaborate on learning by tweeting things they’ve learned, and help teachers assess where the class as a whole is in terms of content.  Best of all it is fun, and more intrinsically rewarding than a worksheet.  I suspect parents would find it enjoyable too, and engage with their kids in a much more fun and playful way than the traditional role of parent as homework monitor.

These games are out there, and gamification is already being used in many educational settings.  And if you think about it, it makes a lot of sense.  What would you rather do, fill out a form or complete a quest?  Both require literacy and other skills, but the added benefit of playing video games and using social media is that it begins to let kids integrate learning about digital literacy as well.  One example of digital literacy that Howard Rheingold discusses is “crap detection,” where the individual doesn’t just Google something, but also questions whether the source is reputable, and fact checks it.  So to return to Waking Mars, an instructor could pose the question, “should we consider the game and its’ website factual evidence to support the hypothesis that Mars has caves?”  Why or why not?  And if not, what or where might we search online to get more valid information?

Sometimes we need to allow for the possibility that youth might know better than us about something.  If they are demonstrating that they want to spend time on iPads or computers, let’s ditch the pencils.  If they enjoy video games and technology, let’s throw away the weekly worksheets.  Do we want them to have the same disempowering and puritanical experience of education that many of us had?  Or do we want them to enjoy learning and become lifelong learners? It would be great if we could get rid of homework entirely, but if we insist on having it let’s make it fun and engaging.  Enough with the worksheets and problems 1,2, 4-8 on pages 125-129.  Let’s jet-pack through caverns and garden on Mars.

 

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Social Justice & Technology

Every day technology makes life easier for millions of people, and in doing so makes life harder for others.

Adam Gopnik, in his New Yorker Article, “The Information: How the Internet Gets Inside Us,” breaks down the population into three groups:

call them the Never-Betters, the Better-Nevers, and the Ever-Wasers. The Never-Betters believe that we’re on the brink of a new utopia, where information will be free and democratic, news will be made from the bottom up, love will reign, and cookies will bake themselves. The Better-Nevers think that we would have been better off if the whole thing had never happened, that the world that is coming to an end is superior to the one that is taking its place, and that, at a minimum, books and magazines create private space for minds in ways that twenty-second bursts of information don’t. The Ever-Wasers insist that at any moment in modernity something like this is going on, and that a new way of organizing data and connecting users is always thrilling to some and chilling to others—that something like this is going on is exactly what makes it a modern moment.

Anyone who has read this blog or heard me speak would have me pegged as a Never-Better, and that is pretty close to the truth. I do think that we live in an era that rivals that of the printing press, with its subsequent explosion of literacy and education. In my lifetime I have already seen a startling collapse of time and space due to how the internet and other technologies have allowed us to traverse great geographical distances in seconds. From my home I can bank, buy, and sell. I provide therapy and consultation to people as close as my city and as far as Singapore with little to no noticeable difference. And when I want to relax I join colleagues and friends in a virtual world that has denizens from Australia, the UK, and Asia.

And yet, as much a Never-Better as I am, I have noticed how social justice continues to lag behind. Not in the technology, but in both the access to it and fit between human beings and the systems they are in. Technology, as always, has advanced beyond our ability to master it, think critically about it, and perhaps most importantly achieve equity with it.

Let me give you an example I have experienced fairly recently in how the technology that benefits me has put others in my own social sphere at a disadvantage. I have an iPhone App, courtesy of a nameless coffee vendor, that has allowed me to use my iPhone to pay for my daily coffee with the flash of a barcode. My local barista rings me up, scans my iPhone, and the transaction is finished. At first, as an early adopter, I was one of the few folks using this in the Cambridge area, but more and more people are taking advantage of this App, and it is now commonplace in Austin, TX and Silicon Valley.

The problem with this App is that is financially disadvantages the baristas. There is no functionality as of yet in the App to allow for adding a gratuity, and since technology has worked all too well in eliminating the need for paper currency, I rarely carry any money with me to add a gratuity. When I initially became aware of this, the temptation was to slink away from the register as quickly as possible, and if I didn’t have ongoing relationships with the baristas I might easily have done so. But instead I asked them if they had noticed a drop in gratuities since the App became prevalent, and they remarked that they had. So what has been a convenience for me has significantly reduced the regular income of others.

This may seem a privileged example, and a minor one, but that is in fact one reason that I am mentioning it. Every day, through these minute transactions, we are influencing the lives of others, often without thought. The trope of the machine replacing the worker is in fact an industrial one: Each day, a section of our population does basically the same work they did a decade ago, but technology has made it easier to overlook and underpay them. And for that to change, we need to notice the behavior, and then, I suggest, address the technology.

There is a shortfall between lived experience, social justice and technology occurring on a microscopic level in the US, and part of why we all need to become more digitally literate is so that we can advocate on behalf of under-served and marginalized populations for technology to improve their lives. Avoiding technology is not the answer. Slinking away from the register is not the answer. The answer, in part, is to contact the company in question and suggest adding features to the technology to bridge the gap. In this case, I’m contacting the nameless coffee company suggesting they add a feature in either the App-user interface or the register-barista interface to allow for the inclusion of a gratuity. Seems like a simple fix, but as someone who owns and works in a company that creates customizable features I can tell you that they are expensive, and therefore often not made until somebody requests them.

In terms of world equity and technology we have an even greater challenge, namely, access. More than 81% of people in the US have some form of broadband internet access, as compared to approximately 5% of the African continent. 1 out of 3 people in the US have internet speeds 10 Mbs, as opposed to 0 in Ghana, Venezuela, and Mongolia.

Recently I had the opportunity to participate in a game developed by Jane MacGonigal at SXSW, which she claims will have have boosted my resiliency and hence extended my life by 7-8 minutes after playing it just once. I believe her. Which makes me think it is all the more important that we find ways not only to create games where people in the developed world learn about developing countries; but help people in developing countries access and develop their own video games. With all of the great work being done in the US and Europe on socially serious games, and games for health, we are seeing how video games can increase resilience and learning skills. How can we use these technologies to bring about similar changes in less affluent countries and populations? Because if playing a video game could help us crack the eznymatic code of HIV, which 1.2 million people in the US live with, what about playing a video game to increase resilience in Subsaharan Africa, where 22.9 million people live with it?

I think it is also imperative that people in developing countries have access not only to playing video games, but creating them. If they don’t, then the same cultural colonialization that has happened in the past will repeat itself. We need to support social justice in such geeky and subtle ways as making sure that indigenous cultures all over the planet have the opportunity to design games that reflect their own cultures, not a globalized McVersion of it.

Between the whittling away of a worker’s salary in the US and Subsaharan HIV are a myriad other social justice concerns, but digital literacy and emerging technologies are the threads that bind them all together. The same internet that allowed LGBT people to find each other in a hostile 20th century can be used to out them against their will today. The same social media that allows a more participatory experience can give people new avenues and amplifications when they want to harass people. The problem is not technology, but our lack of digital literacy. And by “our” I mean the individual you and me. Because corporations and governments are making it their business to learn how to master technology and its power even while we debate whether it was Better-Never or Never-Better.

I’ve often said on this blog that if you want to run a private psychotherapy practice in the 21st century you cannot ignore technology. Now I’m upping the ante, and saying that if you want to be a socially just human being you cannot ignore it. We need to learn how emerging technologies work and how they don’t. We need to identify the slippages between human systems and the technologies that convenience some at the expense of others. We need to see the internet as an infrastructure necessary to make the developing world as viable as the developed. And we need to understand how digital literacy can empower us before someone takes that power away.

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Failing Better

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Worth a Thousand Words?: Infographics on Video Games

 For those of you who haven’t heard, Pinterest is a pinboard style of social media which emphasizes visuals.  Recently I was trying to learn more about it and how it might apply to the psychotherapy/psychology field.  So far I can see possibilities:

DBT- Using Pinterest to create worksheet boards, or better yet boards of images which provide self-soothing for distress tolerance.

Behavior Charts which are visual and available instantly from home instead of going home in a book bag and being forgotten.

Virtual Comic Books to help adolescents learn and practice sequencing and pragmatic speech.

Screenshots of video games that can be shared by gaming patients with gamer-affirmative therapists.

Psychoeducation Tools for a variety of issues, including the above example.  Click on the image to see my board on Infographics for video games and gaming.  They are not intended as professionally vetted research, and you’ll not the heading encourages viewers to check out the research.

There are obviously things to be concerned about, such as privacy and how best to bring Pinterest into the therapeutic session, office and process.  Pinterest is not HIPAA-compliant, for example, so would a link sent via hushmail be secure enough for some uses?  How might we make sure our patients could use this powerful visual tool in a way that did not disclose what health information described what they were using it for.

What do you think?  How might we use this powerful visual medium to enhance our treatment with patients in an best-practice way?

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.

But Not Your Thoughts: Social Media & Children

 

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.

 

When They Hate You.

Many therapists I work with dream of expanding their practice to being a consultant and presenter. In our initial appointments they ask me with a lot of excitement about my experience doing these things. And I am usually very positive and optimistic about it. But although I am “living the dream,” there are many rude awakenings along the way.

One such awakening came this week when I received my evaluations back from a recent talk. Out of the 760 people who attended, 566 of them did evaluations. It isn’t often that I have a chance to get feedback from 566 colleagues at once. What struck me is how I tended to react to them and how I had to fight the urge to focus on the negative. If 535 people rated me as good or excellent, my eye was drawn more often to the 2 “poor” ones. No matter that .35% is a really small percentage, that fraction of a percent that delivered a poor rating was hard to overlook.

The comments were even more challenging, as I noticed that my eyes flew over comment after comment describing me as interesting, great, edgy, fresh, thought-provoking, relevant, a gem, and passionate. But boy did they stop when I read this: “His bias towards media enraged me,” or this: “Seems like he has a chip on his shoulder, perhaps because he was told he had poor social skills.”

Ouch.

Would-be presenters please take heed. When you put yourself out there, people will take shots at you. This will hurt, even when it is a fraction of a percent. Part of what hurts is the asynchronous and anonymous nature of these comments, because you have little recourse to respond, correct an error you may have made, or just plain defend your point of view. But if you want to do public speaking, you’ll need to get a thick skin.

Part of why you need a thick skin is to allow for the accurate appraisal of your work. Here’s how I do it:

I divide the critical comments into one of three categories: Absolutely Useful, Fair Enough, and No ROI.

  1. Absolutely Useful: These comments are ones that don’t make me defensive, where I can imagine myself saying to the person, “absolutely.” An example of this kind is “it was somewhat difficult to follow along in the booklet because he seems to have changed the order of slides.” This comment was extremely useful, as I can put more emphasis in my prep to not change my slides at the last minute. This is an easy fix, and will benefit the audience.
  2. Fair Enough: These comments do make me a little defensive, but there is some benefit in spending time to acknowledge or address them. I can imagine myself saying “your point is well taken, however…” For example the comment “limited research” is fair enough. Your point is well taken, however I was only allowed 45 minutes to present, and needed to choose from my copious slides only 60. Another commentator expressed that they wished I had spoken more about the impact of violent video games and how they are a problem. This is fair enough, however there are plenty of places people can get that information or misinformation, and few places that they can get my take. What I can take from these comments are points to consider weaving in or addressing when there is more time.
  3. No ROI. These are the comments that are clearly ad hominem arguments. A good clue is if they hurt my feelings or make me feel extremely defensive. “Seems like he has a chip on his shoulder, perhaps because he was told he had poor social skills” is an example of this sort. There is little return on investment of time or energy I should expend on this. Who knows why a person would think that comment would help anyone, but more importantly, how would it help make a presentation’s argument more effective? These need to be set aside ASAP to focus on more helpful comments.

The irony is that the most useful comments are usually not the ones that are extremely validating or invalidating, but matter of fact, like the slide order comment. The job of a presenter is to become a better presenter. Whether you like the information and opinions I present is none of my business really, my job is to present it.

In my opinion, part of what makes a person an effective speaker is also bound to make them hated: namely, their passion and conviction. Of course I am biased, of course I think that my point of view is important. Would you really want me up there talking about things I don’t feel or think strongly about? At an old internship of mine a colleague once asked me, “have you ever been hated by somebody?” At the time I thought I hadn’t, and said so. “That’s too bad,” she replied, “It’s very defining.”

Since then I have come to realize that I, like most of us, have in fact been hated. Merriam Webster defines the noun hate as “intense hostility and aversion usually deriving from fear, anger, or sense of injury.” People are hated because they are black, or white; LGBT or straight; rich or poor; Nazi or Jew. In everyday affairs we like to pretend this is not true, and when we do so it is crazy-making. It is often a bittersweet relief to a patient when we say, “you weren’t crazy, you really were experiencing hatred.” Finally, someone told the truth.

When I present about technology and video games, I speak out explicitly or implicitly about adultism. This comes across when I challenge people around the concept of screen time. One very prescient member of my audience stated that my message seemed to be focused on changing adult behavior, not child behavior. Bingo.

When it comes to gaming, technology, and education, we need to take a good hard look at how adultism is implicit in many of our practices. We think we know better than our youth, and we think we know better than they how they should spend their time. Back in grade school, well-meaning adults decided that my time would be better spent memorizing multiplication tables, drilling them into my mind, giving me A’s for knowing them. Yet, now I live in a world where I am never more than few feet away from my phone, laptop, or dedicated calculator, and I have to question whether that time couldn’t have been spent better learning other things. What we are taught as important is bound by the history and culture of the adults in power at the time, and it isn’t always a good thing. In retrospect, I’d have been more prepared for life if I’d learned about the subjugation of indigenous people in school rather than drawing hand turkeys.

So if you are passionate about something, it will give you the passion to devote time and energy to it, go above and beyond the workaday life that we often lead. But it will put you out in front of people who don’t agree with you, see you as a threat to what they believe as good and true. You will be hated. You will get tired and hurt and frustrated. And when that happens I recommend that you take some solace from loved ones and friends, and then get back to work.

Some posts, like this one, are written for me as much as for my colleagues and consultees. We all get discouraged and need to be reminded that we are choosing to strike a blow for freedom in whatever path we choose. But I want to give the last word to one of my commentators, who said exactly what I need to hear when I have moments of flagging confidence and doubt: “Mike’s presentation changed my outlook on technology in my professional and parenting roles. Thank you so much, from a FORMER technophobe!!”

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.

 

I Come To Praise First-Person Shooters, Not To Bury Them

 

I should begin by saying that I don’t personally enjoy the type of video game known as a first-person shooter (FPS) very much.  They make me jittery when I play, and I am easily overwhelmed by them.  I’m still stuck in the tutorial room with Jacob in Mass Effect 2.  If there are settings to disable gore and swearing on a game I’ll click ’em.  But as I looked back on my past posts I realized that I have neglected to weigh in on FPS, and in doing so am guilty of the same kind of dismissal I critique in colleagues.  (Note to gamers: I know there are several important distinctions between FPS and TPS or third-person shooters, but that’s for another post.)

There’s a lot to like about FPS games, and here’s a few examples.

  1. Many FPS such as Halo 2 can be collaborative as well as violent.  Players join platoons and need to learn how to coordinate, communicate and problem-solve in a fast-paced environment.  Games like Halo also provide environments for players to learn how to assume leadership roles, follow directions from other players, and think critically about stressful in-world situations.
  2. FPS encourage impulse control as well as aggression.  Crucial to success in FPS games is the ability to time attacks and maneuvers.  This requires the ability to control the impulse to pull that trigger.  Although we tend to focus on the aggression in FPS, there’s often a lot of sneaking going on as well.  In Bioshock there are actual decision points in the game where refraining from killing characters changes the entire outcome of the game.  Even though the player is not learning teamwork in single-player games, they are often learning the same sorts of forms of decision-making and impulse control in good old-fashioned “Red Light, Green Light.”
  3. First-person shooters improve hand-eye coordination.  One important component of hand-eye coordination is visuospatial attention.  Research by Green et al. suggests that video games improve visuospatial attention, and further that FPS video games do it even better than games like Tetris.  Hand-eye coordination is a skill most of us would agree is a good thing to have.  It helps improve your readiness to learn, increases your ability to excel at sports, increases your confidence and makes juggling less stressful.
  4. First-Person Shooters may increase a sense of mastery and alertness.  So many parents and educators lament how children aren’t able to pay attention.  And yet, what makes FPS games so compelling is their immersive quality.  As Grimshaw et al. discuss, the literature describes immersion in varying ways, such as ‘the state of consciousness when an immersant’s awareness of physical self is diminished or lost by being surrounded in an engrossing total environment, often artificial’  Further, in order to be completely immersed in an environment, “players ‘must have a non-trivial impact on the environment.”  Wandering around the game world may not be sufficient to immerse players into a flow-like state, and shooting people, whatever else you may say about it, does not lend itself to feeling trivial in an environment.  Imagine if classrooms could harness the ability to create such immersive qualities in the classroom.  Much more effective than saying loudly, “Pay attention!” which usually has the exact opposite effect than the statement intended.

Given the above compelling reasons to think well of FPS, why are they so often singled out as the bad seed of video games?  The answer, I would suggest, is a sociopolitical one that gamers as a whole ignore at their peril.

Science is often, maybe always, political, and has an uneasy relationship with civil rights movements.  The example that springs to my mind is the LGBTQ civil rights movement.  Back when a preponderance of science was pathologizing of all LGBTQ people, there was a more predominant solidarity amongst the various thinkers, activists, and citizens of those subcultures.  From Stonewall up through the early AIDS crisis, there was less fragmentation and more coordination, with the understanding that civil rights benefited everyone.

But within the past two decades, many members of the LGBTQ community have begun to receive recognition and acceptance in society as a whole.  At this writing 7 states have legalized gay marriage (Welcome Washington!) and more accept domestic partnerships between same-sex couples.  Bullying based on sexual orientation and hate crimes have received more coverage from media with sympathetic stances towards LGBTQ youth.  And I can’t remember the last time I heard talk about the latest study locating the “gay gene.”

And yet, science and politics have turned their gaze towards specific subsets of the LGBTQ population.  Transgender rights (a notable recent gain in my home state) are still ignored or reduced to bathroom conversations and debates about the poor parenting of those who don’t make their children conform to Cisgender norms.  The status of LGBTQ youth of color as a priority population is met with grumbling.  Bisexuals are still considered in transition or confused, asexuals frigid or repressed.  Polyamory is confused with lack of commitment or neurotic ambivalence, and BDSM isn’t even recognized as worthy of any sort of advocacy.

And to a large extent, whenever one of these specific subcultures are targeted, the other factions of the LGBTQ community remain silent.  And in doing so, they become allied with the perpetrator.  As Judith Herman points out in her seminal work, Trauma And Recovery, “It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing.”  This is exactly what members of the LGBTQ community are doing when they cease to maintain the solidarity and mutual support that helped get homosexuality removed from the DSM-III.

And so the focus shifts from the general “gay people are bad/sick” to the more specific populations also under the LGBTQ umbrella, and rather than fighting for them we allow them to be omitted from civil rights.  A case in point was made by openly trans HRC member Donna Rose, when she resigned in protest to HRC supporting an Employment Non-Discrimination Act which included sexual orientation but didn’t include protections for transgender people.  A group may only be as strong as its weakest member, but solidarity often ends when the strongest members of an alliance get what they want.

The gaming community would do well to take a lesson here.  Recently video games have been getting increasing recognition as an art form, an educational tool, and possible solution to world problems ranging from poverty to AIDS.  As society moves to a more progressive stance on technology and video games, studies come under scrutiny for their sweeping and pathological generalizations of a complex and diverse group.

(The most pernicious example of this in my opinion is the concept of the “screen” and “screentime.”  Studies ask questions about how much time subjects spend in front of electronic devices, as if all activities were identical in experience and effect.  Watching television, playing video games, surfing on Facebook are all treated as similar neurological phenomenon, when they aren’t.  It’s much more complicated than that, and different physiological systems are affected in different ways.  Even the idea that all screen time dysregulates sleep the same way is being questioned recently, with televisions showing less repression of melatonin than iPads.  So what screen you’re doing things on makes a difference.  And then there’s what you are doing.

Watching television is a more passive and anergic activiy than playing video games in my experience.  No, I’m not going to cite a particular study here, because I want us to focus on thinking critically about the designs of studies not the data.  And as Paul Howard Jones points out in his video, learning itself activates different parts of the brain at different phases of the individual’s learning cycle of a particular activity.  So yes, video game users have different looking brains than those that aren’t using them, that doesn’t mean it is bad, but that they are using different parts of their brain function and learning different things.  Most people in the gaming community would have some solidarity here with other gamers, and balk at the idea that a screen is a screen is a screen.  And “screen time” is usually implying screens watching television, playing games or surfing the net, not screens compiling doctoral dissertation lit reviews, planning a vacation, doing your homework, or looking up a recipe.)

So gamers are solidly behind fighting these blanket generalizations.  That’s great.  But I find that where gamer solidarity is starting to fall apart is around the more specific attacks that are being levied in science and politics around FPS and violent games.  Studies says these desensitize children to violence, increase aggression and correlate to hostile personalities.  There are also studies that conflict these findings, but I want to ask a different, albeit more provocative question:

What’s wrong with being aggressive?

I think that child’s play has a long history of being aggressive:  Cops and Robbers, water pistols, football, wrestling, boxing, tag all encourage some element of aggression.  Most of us have played several of these in our lifetime with some regularity, have we become desensitized and aggressive as a result?  Am I sounding too hostile?  🙂

And we are sending children and adolescents a mixed message if we label aggression as all out bad.  Not everyone or every job requires the same amount of aggression.  Wanting to be #1 and competing, whether it be in a boxer or a president, requires some aggression.  Aggression is in fact a leadership quality.  It allows us to take risks, weigh the potential hazards, and go for something.  Feelings of aggression heighten our sense acumen, can speed up our assessment of a situation and help us stand up to bullies.  Whether we agree with this war or that, would we really want our soldiers to be in-country with no aggression to help them serve and defend?  Fortune, as the saying goes, favors the bold, not the timid.

FPS games have a place on the Gamestop shelf and a place in the gaming community.  They allow us to engage in virtual activities that have real-life benefits.  They are a focal point for millions of gamers, and I believe unlocking their DNA will go a long way to discovering how to improve work and learning environments.  Stop letting critics shoot them down, or don’t be surprised if you’re in the crossfires next.

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.

Protect Your Online Privacy: Start Blogging!

Many therapists have lamented about the lack of privacy the internet has created.  More to the point in my view, the internet has taken away the veil of secrecy psychotherapy has frequently sought refuge behind.  It used to be that the anonymity of large urban areas, or the possibility of a commute to the suburbs insulated therapists from their patients after the analytic hour came to a close.  I friend of mine once went for years before discovering that Therapist A, who had referred him to Therapist B when treatment was stymied, was actually married to Therapist B.  They did not share last names, but my friend in a moment of high curiosity and low impulse control drove over to Therapist A’s home address and discovered Therapist B’s name there as well.  He terminated therapy thereafter.

For myself, I learned that privacy is to a large extent illusory, not from the internet, but from my first job.  I worked in a community mental health center on a 13 mile long by 7 mile wide island which was 2 1/2 hours by boat from the mainland.  You get used to a diminished sort of privacy on an island.  I couldn’t avoid my patients if I wanted to, unless I wanted to avoid the library, most restaraunts, coffeeshops, the beach, or the one movie theater we had in the winter.  Nor could I find privacy in limiting the type of work I did there.  The Community Mental Health Center was the only one on the island.  We were responsible for, and I did, school counseling, Psychiatric hospitalizations (which involved flying with often psychotic people in a Cesna six-seater airplane,) outpatient therapy, Alcohol counseling and DUI classes, drug testing, and court-ordered counseling for domestic violence perpetrators.  I can still remember how when a colleague and I went out to dinner at a local pub one night one-third of the people at the bar left.  It wasn’t just my privacy that was affected here.

You have a choice in situations like that.  You can hide out in your house with a cat and television (which I did at first) or you can start living your life in the community and negotiate boundary crossings on a case by case basis (which I settled upon as my strategy.)  I learned to cultivate a sense of never-too-uptight-never-too-relaxed when I was in public.  It became second nature in many ways.

When I moved to Cambridge, MA, it felt very anonymous by comparison.  But as many practitioners in “The most opinionated zipcode in the US” will tell you, Cambridge is really a village in many ways.  I still ran into people, and by this time, technology was becoming more of a factor.

As Thomas Friedman has observed, “The World Is Flat” in the 21st century.  Globalization and technology have removed many of the barriers to, and some would say protections from, knowing each other.  Our patients can Google us, Yelp hangs up a business page of us whether we like it or not, and are often only one Facebook friend away from connecting with us.

Even if you want to make the poor business decision of staying off the internet in terms of a website, eventually your contributions to the Democratic Party, your address, and notes about you in your alumni magazine are still going to find their way out to the world.  We’re all on an island today.

So what can you do?  Well, my advice is to start blogging.  I know sounds counterintuitive, but it makes sense on a number of levels:

1.  Buddhism tells us to move into the places that scare you.  We exert so much energy trying to avoid things, find a spot where we can stay safe and stop the awkward and uncomfortable learning process.  And yet we ask our patients to do the exact opposite so often: to look underneath those rocks, descend into the depths of the psyche, face their fears.  Our obsessive quest for privacy is perhaps not that different.

2.  Make the internet work for you.  One of the best ways to protect your privacy is to generate a lot of content that you consciously know is public-facing.  Google “Mike Langlois, LICSW” for example.  Go ahead, I’ll wait.  What came up probably is pages of my website, professional picture, Youtube videos, and blog posts.  Dig a little deeper and you’ll see me commenting on a few blogs.  This is the practice of radical transparency.  All of that content was written with all of you in mind, my patients, colleagues, friends, family members, potential coaching clients, high school classmates, potential employers, my future children and grandchildren and the FBI.  The way Google and other search engines work, the more content I put out there that is public, the further back any unintentional pieces about me will be.  By embracing that the world is flat I have learned to cultivate a style that I can negotiate in my work life while still feeling authentic.  And it is great advertising, or fair warning, if you are considering working with me.

3.  Radical transparency protects your patient’s privacy as well.  Whether we like it or not, therapists are finding themselves on review sites like Yelp.  Yes, anyone can post a review, and no, Yelp will not taking it down if you ask.  More importantly, your patients might not understand the ramifications for their privacy or PHI if they post a review.  Keeley Kolmes has great resources on this, and you are welcome to use my version of her version as well.  Take a look:

Notice that half of my allotted space is not advertising, but a direct message to any potential commenters.  Rather than hide out and try to get Yelp to take my name down, I have used it as a platform to market my business, model what I feel is ethical professional standards, and provide some information to patients in the spirit of informed consent.  Do I want to get bad reviews?  Of course not, who does?  But that is not an excuse to hide my head in the cybersand.

4. Last, but not least, get over your bad self.  Sometimes listening to our colleagues you would get the feeling that they are dealing with the paparazzi, not the public.  Sure patients and others may be curious about your life, but really most people in the blogosphere just aren’t that interested.  On a good day, my blog gets 200 views, on an amazing day last August I got 689 views.  There are 7 billion people on the planet.  Feel free to correct my math here but according to my calculations that means on a busy day 0.000009842857142857142% of the people on the planet are checking out my most visible presence on the internet.

Am I saying you should blog for the sake of blogging? No.  I am saying that there is a Copernican revolution going on in the 21st century, and therapists need to join it.  Rather than avoiding technology and the internet we need to start understanding it and harnessing it.  You can be googled whether you like it or not.  Yelp doesn’t care about contaminating your transference.

Being professional is about how we rise to the occasion of Web 2.0, not deciding to skip out on the party.

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.

The Kids Are All Right

image courtesy of gamerfit.com

image courtesy of gamerfit.com

Last week some family friends came over to our house for dinner. The children, we’ll call them Larry, Curly and Moesha, were ages 12, 4, and 8 respectively. As you may imagine, children enjoy coming over to the Gamer Therapist house, which has 3 gaming consoles and a dedicated big-screen TV. After a quick tour of the gaming room, Larry and Moesha sorted through my games and located Portal 2, and within minutes had set themselves up to play cooperative mode. Curly was content to sit between them, and the adults retired to the first floor to hang out and prepare dinner.

Throughout the evening we could hear the sounds of the happy gamers and the game, while my friend Rebecca talked frankly about her ambivalence about their gameplay. The ambivalence sprang primarily from a well-meaning friend who had criticized her parenting style. Another set of parents had told them that their children wouldn’t be able to play with them anymore because they thought that the children were picking up bad messages from video games.

This conversation was interrupted by the children twice, both by Moesha. The first time she came down to inform us that Larry had succeeded in unlocking a very difficult achievement. The second time she came down to ask me if I could join them and help them solve a puzzle in the game they had been struggling with. I went up, and within a few minutes a fresh perspective and Larry having some patience as I familiarized myself with the controls had advanced them to the next level. A polite thank you let me know that I was no longer required, and I returned to our conversation.

A discussion about education and video games was in full swing, and a debate about how much screen time is too much. At this juncture I pointed out how hard it is for us to catch children when they are doing things right. I observed that for the past 2 hours children, siblings, spanning an age difference of 8 years had been engaged in cooperative learning. What’s more they had voluntarily engaged with the adults on two occasions. The first was for one child to express pride in the achievement of her sibling. The second was to request adult assistance with some problem solving. And all along our parental ears had heard not one whit of conflict or argument. Yet all of this would have been easy to miss, or worse, dismiss as “parking the children in front of a screen.”

Every day, parents like Rebecca are bombarded with much-hyped exposes on how dangerous video games are to children. Horror stories like the one my colleague at BC psychologist Peter Gray blogs about are touted, in which a South Korean young man plays for 50 hours straight and dies after going into cardiac arrest. Gray goes on to put this tragedy in perspective: There are 7 billion people on the planet, and this incident represents 0.000000014% of the population. It is by contrast far more difficult to catch the number of children and adult gamers doing things like learning physics, researching a vaccine for HIV, or gaming to raise money for hospitals.

And although studies linking the dangerous connection video games have to childhood obesity, the media somehow never manages to pickup ones like this that showed that children who had electronic devices in their room were more likely to engage in outdoor play. Perhaps the Obama administration did read this study though, as they are moving to a more gamer-friendly position with the appointment of Constance Steinkhueler to study the civic potential of playing games (Thanks to my colleague Uriah Gilford for calling my attention to this.) The video game danger is overhyped.

Parents are playing a game far more dangerous than any video game, and that is the “Who Is Parenting Best” game. Over and over I hear conversations about what the best school district is, how to set privacy settings and enrichment activities. This despite, as Rob Evans EdD. points out in his book Family Matters that by age 18 children and adolescents will have only spent about 10% of their total lives in school. Setting privacy settings is the first and most minimal step to helping children navigate the 21st century community that relies on the internet. And enrichment activities are unfortunately often activities that appeal to what a parent wants quality time to look like, rather than what a child enjoys.

In discussing school districts, privacy settings and quality time, parents are often missing the point. Worse, they are confusing worry with effort.

We need to stop “phoning it in” with our kids, finding the “right” school, program or setting to park them on so we don’t need to worry. It is human nature to want to get to a safe spot to relax and stop changing: We need to fight it.

Often when I speak with parents who complain about the amount of time their offspring are spending playing I ask them if they have ever played the game with their child. The answer is invariably that they haven’t, even though a recent study showed that girls who gamed with their fathers reported lower levels of depression. Quality time always has to be some Puritanical ideal: a bracing hike, the symphony, or a museum. I love doing all of those things, which is why I do them. That doesn’t mean that a child or adolescent will have them as a preferred activity.

I know, I’m criticizing your parenting, please bear with me. Because you can take it, and your children need you to stop playing the Who Is Parenting Best Game. They need you to try playing Portal 2 with them if that is what they’re into. If you fumble with the controller, all the better, because we adults have forgotten how clumsy and awkward learning makes children feel. Education has gone taught us to find a safe spot and stop learning about anything that is outside that comfort zone.

We have long known that one of the strongest protective factors for children is an involved parent, but somewhere along the line we have gotten the mistaken idea that that means control. To be clear, parental control does not equal parental involvement. At best it is one element of involvement, at worst it is phoning it in.

Does this mean schools have no responsibility? Absolutely not. But I would like to suggest we return to Larry, Curly, and Moesha for a different example, namely a curatorial model. That means setting up a place for them to explore and negotiate things on their own for the most part, while we are constantly available for engagement. Yes that is a tall order, and one that requires that we think beyond the nuclear family and school as factory models.

I am fortunate to belong to massivelyminecraft.org a server where children and adults from the UK, US, Australia and other places play the sandbox game Minecraft together. It is not segregated by age, but vetted by the server moderators, who require parental permission for children to join. Within the game world, you can see adults and children learning and playing together at any hour of the day or night. They are voluntarily learning about geometry, math, physics, animal husbandry, chemistry, geology, economy, social skills, communication and a host of other things, in a way that is curatorial rather than proscriptive. Adults are there and occasionally on chat or via Skype will step in to mediate a conflict between two children, or if help with a task is requested.

Why can’t 21st century education be like this? Imagine a virtual classroom where parents and teachers can privately chat while both observing unobtrusively a child’s progress. Imagine homework at the table replaced by building a virtual pyramid together. Imagine virtual trips to Paris in Second Life, where no one is too poor to come along. Imagine time on learning that is maximizing the child’s engagement and minimizing unnecessary supervision. Imagine adolescents finally having educational settings that run synchronously with their biological clocks. Imagine a collaborative effort that doesn’t segregate human beings by rigid grades, parent/teacher roles or socioeconomic status. Imagine recess that can happen year-round, sometimes in a field, sometimes on the Wii Fit or Kinnect.

I believe the research is showing more and more that these things are possible. And I believe that our children are counting on us taking a leadership role in technology and education rather than a fear-based ones.

I leave you with this image. As he was leaving my house, Larry looked at me and declared that I “wasn’t entirely horrible” for an adult. What parent wouldn’t love to hear such high praise from their tween?

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Ethics & Technology: A Mild Rant

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A Follow Up to Dings & Grats

My last post, “Dings & Grats,” generated quite a lot of commentary from both therapists and gamers alike.  I was surprised at many of the comments, which tended to fall into one of several groups.  I’ll summarize and paraphrase them below, following with my response.

1. “I haven’t seen any research that shows video games can increase self-confidence, but I have seen research that shows they cause violent behavior.”

Fair enough, not everyone keeps up to date on research in this area, and the media certainly hypes the research that indicates “dire” consequences.  So let me direct you to a study here which shows that using video games can increase your self-confidence.  And here is a study from which debunks the mythology of video games causing violence.

2. “I find gamers to be generally lacking in confidence, introverted, reactive and aggressive, lacking in social skills, etc.”

These responses amazed me.  Gamers are part of a culture, and I doubt that many of my colleagues would say such overarching generalizations about other groups, at least in public.  Would you post “I find women to be generally lacking in confidence,” or “I find obese people introverted,” or “I find African American people lacking in social skills?” And yet the open way many mental health professionals denigrated gamers without any sense of observing ego was stunning.  I was actually grateful that most of these comments were on therapist discussion groups, so that gamers didn’t have to read them.  This is cultural insensitivity and I hope that if my colleagues aren’t interested in becoming culturally competent around gaming they will refer those patients out.

3. “Real relationships with real people are more valuable than online relationships.”

This judgment confused me.  Who do we think is behind the screen playing video games online, Munchkins?  Those are real people, and they are having real relationships, which are just as varied as relationships which aren’t mediated by technology.  Sure some relationships online are superficial, and others are intense; just like in your life as a whole some of your relationships are superficial and others are intense and many between the two.  I’ve heard from gamers who met online playing and ended up married.  And if you don’t think relationships online are real, stop responding to your boss’s emails because you don’t consider them real, see what happens.

4. “Video Games prevent people from enjoying nature.”

I am not sure where the all or nothing thinking here comes from, but I was certainly not staying that people should play video games 24 hours a day instead of running, hiking, going to a petting zoo, or kayaking.  I know I certainly get outside on a daily basis.  But even supposing that people never came up for air when playing video games, I don’t think that would be worse than doing anything else for 24 hours a day.  I enjoy running, but if I did it 24/7 that would be as damaging as video games.  What I think these arguments were really saying is, “we know what is the best way to spend time, and it is not playing video games.”  I really don’t think it is our business as therapists to determine a hierarchy of leisure activities for our patients, and if they don’t want to go outside as much as we think they ought to, that’s our trip.

5. “I’m a gamer, and I can tell you I have seen horrible behavior online.”

Me too, and I have seen horrible behavior offline as well.  Yes, some people feel emboldened by anonymity, but we also tend to generalize a few rotten apples rather than the 12 million + people who play WoW for example.  Many are friendly or neutral in their behavior.  And there is actually research that shows although a large number of teens (63%) encounter aggressive behavior in online games, 73% of those reported that they have witnessed others step in to intervene and put a stop to it.  In an era where teachers turn a blind eye in”real” life to students who are bullied or harassed, I think video games are doing a better, not worse job on the whole addressing verbally abusive behavior.  Personally, I hate when people use the phrase “got raped by a dungeon boss,” and I hope that people stop using it.  But I have heard language like that at football games and even unprofessional comments at business meetings.  I don’t think we should hold gamers to a higher standard than anyone else.  Look, we’ve all seen jerks in WoW or Second Life, but we’ve seen jerks in First Life as well.  Bad behavior is everywhere.

6. “Based on my extensive observations of my 2 children and their 3 best friends, it seems clear to me that…”

Ok, this one does drive me nuts.  If you are basing your assertions on your own children, not only do you have a statistically insignificant N of 2 or so, but you are a biased observer.  I know it is human nature to generalize based on what we know, but to cite it as actually valid data is ludicrous.

7. “I think face to face contact is the gold standard of human contact.”

Ok, that’s your opinion, and I’m not going to argue with it.  But research shows that it is not either/or, and the majority of teens are playing games with people they also see in their offline life.  And let’s not confuse opinion with fact.  You can think that video game playing encourages people to be asocial, but that is not what the research I’ve seen shows.  In fact, I doubt it could ever show that, because as we know from Research 101 “correlation is not causation.”

By now, if you’re still with me, I have probably hit a nerve or too.  And I’ve probably blown any chance that you’ll get my book, which is much more elaborate and articulate at this post.  But I felt compelled to sound off a little, because it seemed that a lot of generalizations, unkind ones, were coming out and masquerading as clinical facts.  Twenty-First Century gaming is a form of social media, and gamers are social.  What’s more they are people, with unique and holisitic presences in the world.  I wasn’t around to speak up in the 50s, 60s and 70s when therapists were saying that research showed all gays had distant fathers and smothering mothers.  I wasn’t around when mothers were called schizophrenogenic and cited as the cause of schizophrenia.  And I wasn’t around when the Moynihan Report came out to provide “evidence” that the Black family was pathological.  But I am around to push back when digital natives in general and gamers in particular are derided in the guise of clinical language.

To those who would argue that technology today is causing the social fabric to unravel, I would cite a quote by my elder, Andy Rooney, who once said, “It’s just amazing how long this country has been going to hell without ever having got there.

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Radical Transparency

By now you may have read the story of the student in Manchester, NH who was arrested in his school cafeteria by a police officer who lifted him out of his seat, and forced him into a prone position on a table.  Another student captured the video, and you can see it and the story here.  Although the police handling of the situation was clearly disturbing, even more disturbing are the voices of the teachers caught trying to get the student recording to stop, and then attempted to take the phone away from him.  By his report they did make him delete a couple of pictures, but the video went undiscovered until it went viral.

It’s time we get real about transparency in the professional world.  My prediction is that the school administration will address this situation by trying to either enforce a no-cell phone policy or create a policy that prohibits the use of electronics on school grounds to record such incidents.  I hope they don’t, and use this as an opportunity to open some conversations between school staff, parents, students, and officers.  But I will be pleasantly surprised if that happens.

Professionals who work with people “in their care,” be it therapy, education or something else, often cite privacy concerns when it comes to transparency.  I’m convinced that the reality is often that they want to protect their privacy as much as if not more than that of their patients.  What happens behind closed doors is secret.

Remember that phrase “you’re only as sick as your secrets?”

Other professionals want to commute to work so they have a “private life.”  They are outraged with the amount of information available about them online, information that their patients, students, anyone, can access about them.  When I do public speaking about technology and therapy and education, I often find that privacy concerns boil down to this sort of fear and outrage.  Sure, HIPAA is brought up, but that is usually in the context of another fear, getting sued.

I practice and encourage my colleagues to practice what I call “radical transparency.”  I define Radical Transparency as engaging with technology as if it is always in the Public sphere visible to anyone.  To be clear, this does not mean either never using technology to communicate about one’s personal or professional life.  Nor does it mean telling everyone everything all the time.  Rather, radical transparency means that before you “utter” anything via technology, and before any choices you make with technology, you consider what would happen if it one day comes to light.

I’m not saying you have to like radical transparency, I’m just saying that it is time we get clear with our relationship to technology and others with it.  And I’m not saying I am perfect with it, but I try to comport myself with authenticity.  If you search online you will (hopefully) not find my public posts or comments cutting or snide.  If you somehow got hold of my emails over the past few years, what would emerge is an acerbic, funny, tart guy who is prone to arrogance and does not suffer fools gladly.  You’d find a good deal of kindness and wisdom as well, but certainly you’d find frustration, self-righteousness and negativity.  In short, you’d glimpse my human condition.  But there you have it, I am prepared to accept the revelation of any warts that may come along.

Radical transparency, I am suggesting, is not just about what you “put out there” on the internet.  It is not about gussying yourself up so you are acceptable to everyone.

Radical Transparency is about getting clear, clear with yourself.

I have found two spiritual traditions especially helpful with this idea.  The first is Buddhism, which talks about nonattachment and going to the places that scare you.  But in this post I want to focus more on the second tradition which has influenced me, and I think may have some good insights into technology and our place in the world.  That second tradition is Quakerism.

What I have learned from Quakers and my own connection to the Society of Friends, is the importance of gaining clearness, and discernment.  One quote that sums up what I am saying is from an article written by M.L. Morrison in the book Spirituality, religion and peace education.  In it she says:

“Key to a Quaker philosophy of education is the belief that each individual has the capacity for discerning the truth.  The truth does not solely come from the teacher or mentor… The process of getting clear about a particular discernment implies testing it out in a community of fellow seekers.  In this way individuals are accountable to the communities in which they live and learn and the community can support the strength and leadings of its members.” (Italics mine)

What if we started seeing the world, online and off as that sort of community?  Get clear with who you are and what you’re about.  Be authentic.  And after you have achieved a certain amount of clarity have a discerning attitude about what you put out there about yourself, and above all behave as we feel we ought.  Am I saying that we all need to adopt Buddhism or Quakerism?  Of course not.  But we need to start focussing first on who we are in the world, not who shouldn’t be videotaping us.

Technology is not going away folks.  And adolescents are rightly exploring and testing the limits of it, because they will be using it to maintain, more accurately repair, the world we have given them.  September 11th taught these kids that media can be used to bear witness to terrorism and injustice in real-time.  And since then, Youtube has proliferated with videos of the atrocities professionals have perpetrated.  I have seen a juvenile collapse walking around a courtyard of lockup, only to be kicked and ignored by the warden when he was in need of medical attention.  I have seen a college student tasered in a library.  We have seen an Iranian woman shot to death and die before our eyes.

And these images change us, and they go viral.  This is what globalization is, this is our whole planet struggling to get clear.  And there are lots of people, those in power, who want the status quo.  Keep the doors shut so people have to “go through the proper channels.”  But technology is trending towards dialogue and democracy.  You just can’t get away with being cruel unobserved and often unchallenged.  Make fun of a teen who may have Asperger’s and he’ll post a rebuttal on Youtube.

These are the same people as the teachers who try to take away the student’s cellphone, or the administrators that forced Matt Gomez to shut down his class Facebook page.  All the parents had signed off on it, but concerns about privacy were still cited.  And that again, I believe is often a professional rhetoric for “controlling access to information.”

I have worked on the inside of several school districts, and in all of them I saw stellar educators, people who were always taking risks and getting creative.  And I saw lots of lazy, verbally abusive educators there as well.  The way our education, and our mental health, systems are set up there are a lot of disempowered angry people working with even more disempowered angry people.  And many are in the middle, trying to just keep their head low and not make waves.  I know, because I have been all of these at one point or another.

This is not going to be as easy from now on.  If you swear at a student, someone’s going to record it on their phone and have it posted on Youtube before you can blink.  If you gripe about a patient on your Facebook page they’ll find it and call you on it.  And those of you who are trying to just keep out of it all, we’ll see you too.  And more importantly, you’ll see you, and when the kid you ignored being bullied because you didn’t want to deal with it that day kills himself, you’ll have to live with the guilt that thousands of people he never knew reach out to assure those like him that it gets better, while you, the person who saw him every day or week just sat there and did nothing.

Talking about patients online, getting rough with a student, shooting a woman–Yes, these are all very different events.  But they all connect around the idea of an ethics of radical transparency.  Or as Rainer Maria Rilke put it in “Archaic Torso of Apollo:”
for here there is no place
that does not see you. You must change your life.

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Why Therapist Directories Are A Waste Of Time

This post is for all of you who have been considering or actively using listings in therapist directories.  I frequently get asked from consultees which directories they should list in.  I also frequently see colleagues debating on bulletin boards and listservs the merits and demerits of individual directories.  So I figure it’s time to offer you my perspective.  Please bear in mind that I am sharing my experience and opinions here, and if you’ve had a different one, hopefully you’ll mention it on the comments.  If you own a directory service, I hope you’ll disclose that as well.

When I started building my practice, I had a lot of time to spend filling out various online directories.  I literally spent hours filling out profiles that promised to make me visible to potential patients.  To be fair it gave me the opportunity to hone my bio and elevator speech, but other than that I now think that I was wasting my time.  But let’s talk a little about why directories may be a waste of your time, because I think it points to a larger misconception about marketing your practice online.

Billboard in a bottle.

Many therapists still approach the internet as if it was a giant Yellow Pages.  We often create static content, the equivalent of a business card, cover letter and resume, and then slap it up on a website, or a directory.  Then we sit back and wait for the phone to ring.  It’s like we imagine that we created a giant billboard and threw it into the world wide web.  But in reality, it’s more like a message in a bottle, thrown in a vast ocean.  We imagine that that will get us recognized.  It usually doesn’t, and here’s why.

If you google “find a therapist” you will literally find dozens of website directories guaranteed to help patients find the right provider.  If you’re ambitious you could spend hours and days finding all of them and entering your information.  Many of them are free, some charge money, and a few don’t let you know whether they will charge or not until you’ve entered all of your information.  One of the main problems with directories is exactly that there are so many of them.

One thing I’ve learned from starting up social networks for other companies is that you always need a critical mass of members as quickly as possible.  If you launch a site you have a few days to a week to achieve this in most cases.  Otherwise potential members will log in to your site, look around and see little activity, and leave.  So low enrollment of providers in a directory will drive little traffic to it.

On the other hand, if you take a directory like Psychology Today’s you will see that they did achieve a critical mass, and have more traffic.  But the problem here is that this is because every therapist and her maiden aunt is now listed there.  So the problem becomes how to set yourself apart from the rest.  If you are determined to spend time on listing yourself in a directory, I’d suggest that you pay for the PT one and try to distinguish yourself as best you can.  In fact, the Psychology Today site is the only directory I even try to keep current and pay for anymore.

Speaking of keeping current, here’s the other potential pitfall of directories:  The more you participate in, the more you’ll need to update your content, remember more passwords, and check back in.  Some directories require you to log in any time you get a message from a potential client (or spam) in an effort to drive up their traffic.  It’s a lot of hassle for little ROI.

If you are determined to list yourself in directories, please consider the following:

  • If you are planning on practicing online, does the directory have global traffic?
  • If you are planning on practicing in a certain geographic location, does the directory get traffic from your part of the world?
One way to research this a little is to run the site’s address on Alexa, which will often tell you some information about traffic or rankings by country.
But while we’re talking about Alexa, let’s talk about how those numbers can be misleading.  Alexa allows you to download the Alexa toolbar, which allows you to check a site’s alexa traffic rank, but it also allows Alexa to tabulate traffic to any site your browser visits, which is part of how they get those numbers.  So it is very easy to drive traffic numbers up artificially.  How?  Easy, set your homepage to your website, and every time you open up your browser, it opens to your site, and adds to your number of visits.  Not enough?  No problem, have all of your family members do the same on their computers.  Within days, your ranking will rise dramatically, without any real rise in potential referral visits. So keep that slight-of-hand in mind when you look at a therapist directory’s traffic. Maybe they do have 100s of visits a day, or maybe they have 10 people who have that site as their home page to drive up traffic.
So Now You Know.

When I review my practice referrals, I received probably %10 of them from a directory, usually Psychology Today.  The majority of my referrals came from word of mouth, insurance company lists, and increasingly my blog and articles.  By now, many of you will know where I am going with this:  It is content and interaction that convert visits to your website into referrals.  There is not a similar conversion rate from visits to your directory profile and calls to you, or even visits to your website.

Some may disagree with me, but my take on directories is that they are a waste of time, and that they capitalize on therapists’ reluctance to generate interactive and dynamic content.  Put simply, people want to hang up their cybershingle and then go back to passively waiting for the phone to ring.

To spend a lot of time finding and listing yourself in a therapist directory is to confuse worry with effort.  What you should be doing (Oh Nos! A therapist used the word “should” 😉 ) is generating content and creating opportunities for interaction with colleagues and potential patients.  Examples of generating content include:

  • writing brief informative blog posts
  • tweeting links to articles that you find interesting to establish your “brand”
  • offering a free hangout on Google+ on your niche topic
  • creating a meditation podcast that people can download from your site
  • networking in Second Life or attending the Online Therapy Institute’s open office hours
  • doing a five-minute vblog on a CBT technique

I’ve done many of the above, and this blog post is another example.  I guarantee you that this post will generate a new referral for me at some point soon, much sooner than my Psychology Today profile will.

So please take the time you could be playing it safe cutting and pasting your info into yet another directory, and instead take some risks, create some new content, or join in a conversation online.  Web 2.0 is not about being a digital classified ad. Use your time marketing to do what therapists do best: Relate.

Technology, Video Games & Class

Some 500 years after the Greeks began using the alphabet they’d adopted from the Phoenicians, Socrates expressed his concern and disdain for the new technology of writing:

“for this discovery of yours will create forgetfulness in the learners’ souls, because they will not use their memories; they will trust to the external written characters and not remember of themselves… they will be hearers of many things and will have learned nothing; they will appear to be omniscient and will generally know nothing; they will be tiresome company, having the show of wisdom without the reality.” –Socrates in Phaedrus

Fortunately for us, Plato disagreed with Socrates, at least to the point where he wrote down the dialogues which have endured to the present.

Aristotle, who was probably a teenager when Phaedrus was written, describes in his Nicomachean Ethics several different concepts of thought including episteme, techne, and phronesis.  Episteme referred to knowledge that is rational, eternal and certain.  Phronesis is ethical thought.  And techne is usually translated as “craft” or “craftsmanship.”  Techne was considered the realm of the Mechanical Arts by the ancient Greeks, as opposed to the Liberal Arts.  As such it was the realm of the common worker of the lower classes, while episteme was the pursuit of the free man of the upper class.  This perhaps is why Socrates was so concerned about writing:  The common worker would not have the time to engage in dialogues with learned teachers, and his understanding of philosophy could go awry.  The Liberal Arts clearly involved having free time to talk and listen to teachers.

I elaborated on all this to help make the point that technology has always been about class.

Anything kinesthetic, or hands on, was associated with techne, and the lower class occupations of masonry, carpentry, and back in ancient Greece, medicine.  Working with ones hands was not then, or is it now, considered one of the characteristics of the upper class.  Gentleman don’t work with their hands.

This attitude persists, albeit more subtly to this day.  We see it in our educational system:  Students who don’t score high on IQ tests are often tracked to vocational tech schools.  Students are often discouraged from using the technology of calculators because they need to “learn” how to solve the problem.  What distinguishes us as adults in math is our ability to count in our heads, not with our hands.  We see it in work in the difference between blue and white collar jobs.  And we see it in our attitude of technology.

Therapists often view technology in general, and video games in particular with a thinly veiled disdain.  Technology has been accused of ruining relationships, causing addictions, destroying our neurology, and fostering escapism.  We pathologize people playing video games in a way that is reminiscent of the novel in the 19th century, when solitary reading was considered a dangerous pastime for women, leading to languishment and insanity.  The gamer has become the hysteric of the 21st century:  out of touch with reality, immature, lazy and troubled.

Anything that smacks of being technological and kinesthetic is also seen as at best a necessary evil in therapy.  Using the phone to call insurance companies, filling out paperwork are examples of the work we therapists often feel takes away from our time to do “what matters.”  Emails, Facebook and Twitter are unnecessary and probably a liability issue.  In fact the majority of our workshops on technology aren’t actually about techne but Phronesis, i.e., the “ethical” use of technology.  And when our patients try to talk with us about technology, they are often rebuffed or pathologized (“How many hours are you spending on the internet, anyway?”)

With our adolescent patients, the assumptions are even more dire:  It’s less than face to face contact.  It’s too complicated to understand.  It’s too boring to listen to teens about.  It gets in the way of “real” relationships.  It distracts teens from therapy, and listening to adults in general.  Its for kids with Aspergers Syndrome / who have poor social skills.  And heaven forbid they meet people they talk to online, they’ll be killed.

It is a dangerous assumption to leave unexamined, the linking of different forms of thought to class.  We have seen how it has played out in race, gender, and sexual orientation.  And it is being played out today in our disdain and suspicion of all things technical and the people who use those things.  Just listen at your local office or agency to the way people talk about the “IT guy” and you’ll hear it.

Although class issues remain in play, techne and technology inevitably become integrated into our society.  Imagine for example that you go to the local Apple store, only 600 years ago:

Skeptical customer: “I’ve begun seeing more and more of these “pencils” around, but they don’t seem very useful to me.”

Pencil salesman: “Oh not true, they are very useful indeed. Combined with this “paper” they become a powerful storage system.  You can write your ideas down on the paper, and it will store it for later use.  And you can expand your paper and store even more ideas.”

Skeptical:  “But isn’t that a privacy risk?  If I write something with this pencil, can’t it be lost and read by others?”

Pencil Salesman:  “Well, yes, but you can always store the paper securely..”

Skeptical:  “But even so, what if I write down something on paper and want to unwrite it later.”

Pencil Salesman:  “Our developers have anticipated that!  See down here, this part of the pencil is an “eraser.” Just swipe the eraser across the markings and they’ll disappear.”

Skeptical:  “I dunno, I don’t have a lot of writing to do.”

Pencil Salesman:  “Well, everyone has different needs, that’s why this pencil comes with several Applications.  You can use the pencil to draw pictures.  You can use it to do mathematics.  Or you can compose poetry.  Or you can play games with it alone or with your children.  Whatever you want to do, there’s an App for that.”

Nobody would seriously imagine that they need to be convinced of the usefulness of the technology of the pencil.  Nor would they suggest that if you write a threatening note to someone that it was because the pencil was bad.  But today we seem to be at an earlier phase of development with computers, smartphones and tablets.  And much of this fear and suspicion, I would suggest, involves class.

Technology has become more complex through time, but our attitudes about it are still generally simplistic.  And right in the middle of this terrain we have the video game.  It’s one thing to have to use technology for our work, but to actually enjoy using it?  That’s strange and suspect.  And so people talk about how much time others are “wasting” on Facebook, or playing World of Warcraft, downloading music to their iPod, or surfing the net.  I know people who are actually ashamed that they spend time trying to figure out a new technology like Google+, and we have a word for these people, geeks.  Although the term geek has begun to be reclaimed by many, it’s important to remember that the word comes from the English and German dialects to mean fool or freak.

We need to be open to learning about our patients, and with gamers especially, about their technology.  To do this we need to understand how gamers, and geeks, are part of a marginalized population.  To practice gamer-affirmative therapy one needs to be culturally competent, and I believe that part of this competence is understanding the stigmatizing connection between technology and class.

To be gamer-affirmative, I believe therapists need to get technical, that is, “hands on.”  Every time I do a consult or a workshop I tell therapists that there are dozens of free trials of the different games their patients play, and encourage them to spend some time playing them.  I consistently get resistance on this, usually a version of the comment “I don’t have time to play video games.”  Really?  Over half of all adults play video games, and 4 out of 5 young adults do.  If they can find the time to play while holding down a job and having meaningful relationships, so can you.When email first came out, many people decried it saying that it was going to be impossible to use it because there wasn’t enough time in the day.  And yet, we’ve managed somehow to make time.  “I don’t have time to play video games” is usually a gussied-up version of “I have better things to do with my time than play video games.”

But too often people have bought into the stereotype of gamers as unemployed, unmarried, and unfit.  This is the same form of projection and splitting that our society has used to “other” people in terms of race (lazy Mexicans,) gender (weaker sex,) sexual orientation (promiscuous bisexuals,) and class (poor white trash.)

Very often I hear therapists protest that they like technology, that it has “its place” in our lives.  This sense of having and knowing one’s place is inextricably bound to issues of class and status.  Technology doesn’t have its place, technology is everywhere.  It is a vital part of human being, ever evolving, responding to us, shaping and being shaped by us.  In therapy, we need to unlearn our privileging of one group over another if we are to truly understand our patients.  When we demure and say, “oh I don’t know anything about video games or Facebook,” we are being more haughty than contrite.  The fact that we act as though using or talking about technology is unnecessary is our class bias at work in our profession.

Integrity Is Your Brand.


Recently I had two experiences which took me a bit by surprise. The first was when a representative from an online gambling site contacted me and asked me to consider affiliating with their website.  Apparently they had read several of my blogs and found my site and the posts to be in their words “respectable” and “well written.” They wondered how much I’d charge for them to be able to include a link to their site in my next blog.

As many of you can guess, I derive no direct monetary income from this blog.  The revenue I do get comes in requests for consultation, workshops and speaking engagements from people find me through this site, and summer is slower in those areas.  Needless to say the idea of making some money from the blog is always tempting.  And I have nothing against online gambling per se.  But I declined, and at this point I can’t imagine accepting advertising or affiliating.  It might be more tempting if Blizzard or Nintendo were to call, but even then I would have to decline.  Not because I think affiliate marketing is inherently wrong, but because in this case something more valuable is at stake.

The second experience didn’t involve money, but it was actually an even harder decision.  Not long ago I had the privilege of being elected to the board of a professional organization.  I’ve been on several boards, so I was expecting to commit a lot of time and work to this one.  What I wasn’t expecting was to get a call from the chair about my blog.  Seems that someone had forwarded a post where I criticized several organizations for their stance on technology, including this one.  I was told that I’d have to retract the post, and refrain from making any future critical posts about the group.

This is an organization I think highly of, and I can tell that the members of this group are not just in it for the title.  I’m sure I could have done a lot of good serving on it.

But again, I had to decline.

Neither money nor a titular position is more important than my integrity.  In fact, I’d go so far as to say to you that integrity is your brand.

It’s important not to make the mistake of demonizing either of the two parties in the examples.  There is nothing inherently wrong with marketing or in my opinion online gambling.  But I have not built my reputation on being an expert on gambling, and I’m not one.  So even though the website might derive benefit from having a respectable blog link to them, I wouldn’t.  Sure money is great, but as I said, something more valuable, my integrity, might be lost.  I have worked too hard and too long to risk losing that.

I can also understand the board’s point of view: As an ambassador of the organization, whatever I say about it, critical or otherwise could be problematic for them.  I don’t agree with them entirely, but when I understood what was expected my choice was clear.  This blog isn’t Mashable, but many of you have been reading it for as long as it has been up.  And people expect me to tell it like it is, whether it be about technology, gamer-affirmative therapy, or growing your private practice.  If you’ve read the comments you know that everyone doesn’t always agree with my point of view.  But many people have come to find the blog, and me, consistent and honest.  There are other people who can do board work, but without my integrity there is no blog.

At the risk of sounding self-righteous, I know that writing this has made a difference in the lives of therapists and the patients they treat.  It has allowed me to gain access to publications and groups to spread the word that technology is not incompatible with therapy, and that gamers need therapists who are culturally competent in gaming rather than contemptuous prior to investigation.  Seasoned clinicians have told me that they have begun to rethink some of the cherished ideas our field holds about addiction, and fledgling therapists have sought me out for supervision on how to grow and market a profitable and socially just practice.  And of course writing for all of you has helped me feel “powered-up” to continue to do the work even when there’s pushback from colleagues and our field.

I’m not telling you this just for catharsis.  And I don’t have that “Blog With Integrity” badge on the blog just for show.  Here’s what I want to make sure you know:

One day, maybe very soon if it hasn’t already happened, you’re going to realize you’re a success.  You’ll realize that you haven’t been worrying about your practice as much, or that your caseload is full, or that you’re being asked to teach on your expertise.  One day, you’re going to be a success.  And when that happens, you’re going to have opportunities that require you to make tough choices.  Because people will notice you’ve become successful. Whether it be those word of mouth referrals or podcast interviews, you’re going to have become more influential.  Some people will want to harness your influence to help them, others will want to harness it to control it.  And the only person who can decide what choice to make is you.

If you don’t feel comfortable seeing yourself as successful or influential, that’s your problem.  Ignorance is always a vulnerability.  You matter.  The work you do matters.  Your thoughts and opinions matter.  Its when we don’t think we have an impact that we hurt our patients, our families, our business, in fact our world.

Immanuel Kant once said, “Act only according to that maxim whereby you can at the same time will that it should become a universal law.”  I take this to mean act as if anything you were about to do in your life would become a universal law for how to do it.  That’s heavy stuff.  It’s not easy to decide how to act in a way that you’d be willing to have be the way to act for the rest of your life. In this case, blog with integrity.

Integrity is your brand.  Are you willing to do what keeps you whole and constant in your therapy, business and life?  Do you stand up for the things you believe in even when they cost you money, comfort or being liked? And perhaps most difficult, are you willing to notice your success, admit that you matter, and live with the knowledge that you have an impact on the world?

How To Learn About Video Games & Why You Ought To

http://www.youtube.com/watch?&v=JY8h-U7rE6Y

Five Tips For Your Practice This Summer

Therapist Websites Are Not Enough

Last March a friend and former graduate student I supervised was visiting me from out of town. He was telling me about a call he got that went something like this: “Hi Bob, great website! Would you like to do a workshop on creating a online presence for our chapter of NASW? You won’t be paid for this, but you’ll get exposure, what do you think?”

This sort of exchange contains every element you need to have to teach a lesson on how not to do things as a Web 2.0 therapist. Let’s break this down:

1. What you are doing is so valuable we’d rather not pay you for it. Anything that you would go to a workshop to learn is something you should be willing to pay for. Even if it was only $20, a small amount or honorarium is something you should offer when you recruit someone to help you. Offering a rationalization is not the same thing; if my former student needed exposure the last place to look for it would be from this cheapo crowd! I know we have had a longstanding tradition in the psychotherapy disciplines to expect that we will present papers or talks at big yearly conferences for free, and that kind of thing seems a little different in my mind, because they are national conferences or Symposia and have many presenters. But to recruit someone specific for a specific workshop and not pay them any honorarium seems both cheap and arrogant to me.

2. Online Presence=Having a web site. Wrong! A website is just one small (important, but small) part of having an online presence. Having a website is something you should have prior to trying to launch your online presence. Now opinions vary on how to get one. I have some colleagues who know this space who believe that Therapists need to hire someone to build a website for them, and I can see the merit of this. My own opinion is that WordPress and our current technology have made it possible to have a very professional website for a fraction of that price if you are willing to spend some time and a little extra money to get a framework like Genesis. That is the one I use, and this site is one that I was able to design and launch pretty quickly. I have an older site that is still out there, but doesn’t get anywhere near as many hits now. That being said, I do think that whether you build one or have a professional do that, you definitely ought to have a professional critique it. My colleague Juliet Austin has a expertise doing this, and having been in the market for a while, she has a great eye for dos and don’ts.

But having a website is not an online presence in 2011, it is a colorful classified ad. Yes it is necessary now that potential patients want to see and meet you before they see and meet you, but now that there are thousands of Therapists with websites it will not distinguish you much more than a Psychology Today profile. Having an online presence requires you have a vibrant combination of interactive dialogue, recommendations that establish your “brand” as a therapist, multiple forms of media to see, hear and read you, and some amount of change over time.

I’m not trying to discourage any of you from getting started online with a website, I just want to make sure you see it is only one component of having an successful online presence.

3. Professional Organizations need to become more professional when it comes to business and social media. Asking your constituents to take the lead without compensating them is just lame. But even more concerning are the attitudes I see many organization taking towards social media. One example recently was a workshop NASW was promoting on HIPAA and Social Media. The flyer began with the bold red words “Protect Yourself!” The workshop like many others I have seen approaches the Internet and Web 2.0 from the point of view of fear-mongering, if the advertisement is accurate. Be scared of social media. Don’t learn how to use it for marketing your business, let alone your clinical work. This is not the message we need from our leadership. Include a component on social media in a general ethics course, sure. But please stop fostering the association of technology with ethical risk, social media with liability.

Our professional organizations also need to put the same thought and care in finding expertise when it comes to Web 2.0 as they would other workshop topics. Would we ever email a colleague and say, “Hey, want to do a workshop for NASW on EMDR?” based on information as limited as a website? I doubt it. As leaders of our profession, our professional organizations need to treat the topic of social media and health care with the same care as other topics. Their endorsement gives an imprimatur. If they say, the only thing you need to know about social media is to avoid it or you’ll be sued, we learn nothing but fear. If they say, social media requires no expertise or experience, we underestimate the skills we all need to learn to use it.

Bob is a great guy and an excellent clinician, but his having a website doesn’t make one an expert. Being on Facebook or Twitter doesn’t make one an expert. Having 5-15 years of experience working in the space of Web 2.0 like Juliet, Susan Giurleo, or myself does. These are peer-vetted experts, experts vetted by peers in both the clinical and Internet fields. I used to be hesitant to say this, because even though I teach people how to self-promote as part of their business I still feel uncomfortable with it myself. But I feel it is important to make a distinction between people who have spent years and thousands of dollars learning how to integrate clinical practice and Web 2.0, and your colleague who has a nice website.

Look, we need to start taking social media seriously, 97% of our patients and other human beings use it. I applaud our professional organizations for trying to offer something. But the above approach reminds me of having your grandson hook up your DVD player when he comes home from college. It is shortsighted and underestimates the complexity of the matters at hand. At some point Therapists need to strike a balance between a healthy respect for the growing importance of social media and avoidant fear. And at some point we’re going to need to invest time, money, and serious thought into how, not if, we use it in our practice.

Fear Is Where You Start From

Recently I was having dinner with some colleagues, who were discussing the state of mental health and managed care.  When these conversations start I sometimes begin to sit back, because I anticipate the worst.  I expect that there will be some insurance bashing, and then discussion of how their salaries have shrunk, and how unfair the current system is, maybe a smattering of how better things used to be for our profession and concluding with uncertainty about how much longer they can stay in business.  I expected this conversation to go the same way, and was preparing to decide whether to try to advocate for another, more empowering perspective.

I was pleasantly surprised.

The conversation did indeed start with the understandable concerns of therapists trying to grapple with the seismic shifts in our careers and businesses.  But then one of them began to talk about how he was planning to change the way he did business.  Others expressed curiosity about the things he was trying, and I finally offered a couple of ideas.  When they found out that I provide consultation on building & maintaining your therapy practice, they were 100% enthusiastic and eager to hear some positive perspectives.  They were able to hear my opinions of some tough truths, that we had bought into the managed care model because we were reluctant to market our businesses and have difficult conversations with patients about payment.  No one was defensive at all, one even invited me to come talk with a local group of colleagues.  At one point they made a joke about my “secrets” for success, and I told them I am not one of those people who holds back secrets to hook people into working with me, and that they could find a lot of free info on my site.

“I was kidding about having a secret,” one told me.  “You don’t have a secret, what you have is a strategy.”

The Buddhist teacher Pema Chodron writes in her book of the same title, about going to “The Places That Scare You.” The goal of the Tibetan Buddhist practice of tonglen, or taking and sending, is to reverse the normal cycle of human existence.  Rather than seeking out things we desire and avoiding suffering, the meditation practice of tonglen asks us to imagine inhaling and taking in the suffering for all sentient beings and exhaling happiness to send it to all sentient beings.  Whether you believe in the mystical qualities of this, the principle is a useful one in that it teaches us to break the instinctual habit of trying to holding on to the things we like and get rid of the things we don’t.  A version of this is going to the places that scare you, rather than running away from them.

The clinicians I have mentioned above are well on their way to maintaining and vastly improving their private practices, and its got nothing to do with me.  They have realized that fear is real, and that it often is mistaken for the end of the line.  They get that it is the opposite.

Fear is the place you start from.

People who deny that things are changing are in my opinion in for a rude awakening.  They deny the way our profession is being challenged, the importance of emerging new technologies, and the evolving practice of psychotherapy.  They deny the things that would evoke fear in them.  This is not unique to therapists of course.  Ironically, we often work trying to help patients see the devastating impact on their lives of repressing anxiety-provoking truths.  Then we turn around and do the same things to ourselves, hoping that this change in  economics or technology is “more of the same.”  Folks in this group are in pre-contemplation of fear, they haven’t even gotten that far.

Then there are clinicians who have gotten that things are really changing, and they are terrified!  They are paralyzed and miserable, commiserating with others and talking about the way things were in the past and how much better they were then.  They see the point of fear and they think of it as the period on a life’s sentence of struggling.  This is the end of our careers, we can’t learn to use technology, therapy is a dying art form.  They give up, and go out of business in a lingering dwindling sort of way.

Fear is not the endpoint.  Fear is where you begin. Fear is where you get going and hire a coach, research and write up a business plan, take a workshop on business development, marketing or integrating new technologies.  Fear is the start of renovating your practice.  Yes there is a lot of suffering in the world, let’s get going and reduce it.

Epic Therapists know all about fear. They aren’t fearless, there’s a lot to be worried about.  Many businesses fail, money needs to be spent to make money later, there are long hours ahead and no structure but the one they give themselves.  There is a lot they don’t know, a lot they’ve never learned to do to run a business, known expenses and surprises.  But Epic is running toward that dragon, knowing this could be an epic failure, being afraid… and then doing it anyway.

Epic Therapists have learned the concept of “nevertheless.”  I am scared that my business will fail, nevertheless I am starting it.  I am afraid that I’ll rent an office full-time and not be able to find patients, nevertheless I am going to rent one.  I am afraid I’ll sound inauthentic or greedy if I talk about my business to a colleague, nevertheless I am going to talk about my business.  I am afraid no one will want to pay my fee, nevertheless I am going to set a firm “bottom line” fee for myself.  I am afraid that I won’t be able to keep up with the changes in healthcare or technology, nevertheless I am going to make a strategy.

My last post about having a secret headquarters was fun to make, and it was also serious.  We need to have a time and a place for strategizing.  We can absolutely have fun doing it, but this is serious business.  There really are things to fear in healthcare, building a private practice and starting a business.  We need to think carefully and plan, and then we need to begin.

The Lurker Below

Both video and tabletop gamers know about Lurkers. There are two particularly famous ones. In Dungeons and Dragons, one of the earliest and most beloved monsters was the Lurker Above. Imagine a giant cave-dwelling manta-ray-like thing that clung to the ceiling until some unsuspecting party of adventurers wandered into its lair (lurkers and lairs go hand-in-hand in many cases.) Then it dropped on the adventurers and ate them if it was hungry. It was nearly always hungry.

A more recent favorite lurker is the Lurker Below in Serpentshire Cavern in WoW. This Lurker is the second boss in the instance, and perhaps even more importantly, the catalyst for the achievement “The Lurker Above,” where you fish up the Lurker from the bottom of Serpentshire Cavern.

A third and less famous lurker is my cat, Winnicott, pictured above. Winnie can lurk for hours. She is exceptionally good at it. Like the Lurker Above, she prefers high altitudes for the most part, but will opt for deep and semi-concealed places as well.

One of the important and distinguishing characteristics of lurkers is patience. They are always waiting for something, patiently, and still. Another characteristic is that they are observant, sensitive to the environment around them and the non-lurking entities going about their adventuring, fishing or laundry. The final characteristic I would mention is that lurkers don’t pounce until they are good and ready. That’s why we call them Lurkers and not Pouncers. Pouncing is only 2% of the entire lurking activity.

I wanted to talk about lurkers because I have been reading and thinking a lot about social media, Twitter in particular, and therapist’s aversion to it. And I agree with colleagues like Susan Giurleo that one should not use social media before one is ready. But I think a point that often gets overlooked is that you don’t have to actively participate in Twitter to engage with it. If you don’t have anything to say or aren’t ready to put yourself out there, by all means don’t. But don’t avoid social media. Lurk.

Lurking is a time-honored tradition on the internet, and there has been estimates that up to 90% of people on bulletin boards, online sites, Twitter and blogs could be lurking at any given time. That’s a lot of lurking going on, and it is not a bad thing.

One of the powerful ways social media can expand the way we interact is by allowing silent participation without social anxiety. Imagine you are an introvert at a party, only you could people-watch and stay on the perimeter for hours without some well-meaning host noticing you and urging you to mingle. You can relax and take it at your own pace, and in fact over time you might even engage more directly. Nick Yee and the Palo Alto Research Center refer to this as ambient sociability, which Jane McGonigal explores in her new book Reality is Broken. Ambient sociability in MMO games refers to the number of people who enjoy lower intensity and indirect social connection. These are the gamers who run around World of Warcraft by themselves pausing occasionally to help out another player, whisper that they like their character name, wave, or various other social activities that can occur when you are in a virtual world and enjoy being “around” people. Ambient sociability may also be the precursor for introverts to have positive interactions that promote deeper engagement.

Therapists are often introverts, in fact I’d suggest that often our choice to spend our days relating to others is often a counterphobic response! So it makes sense that social media can be intimidating for many of us, the conceptual framework of Twitter or Facebook can be hard to figure out, and we’d prefer to structure of the therapeutic framework. What we may need is to engage in a way that allows for social ambience without plunging us into public engagement at first.

Epic Therapists Lurk.

Epic therapists are not always in the know about all things internet, but they are willing to learn. And they are also willing to learn by lurking, rather than by jumping in with both feet, trying Twitter for a week by tweeting 20 things a day and then just giving up. Epic therapists are not petrified of HIPAA and confidentiality, but they are also willing to spend time learning about social media before subjecting themselves, their patients and their communities to its half-baked use. So let’s review the guiding principles of lurking, and how you can use them to become Epic in social media.

1. Lurking requires patience. Try following a few people or groups on Twitter that interest you. Use the search feature and look around. Pick Tweeters with large followings so you can feel even more anonymous. If it doesn’t make sense at first, just be patient and keep lurking. You can do that, you do it every day with patients. You don’t get up and leave the room 15 minutes into the session if you don’t understand what they are talking about. You pay attention patiently. Try the same with Twitter for 10 minutes here and there between your sessions, and allow yourself some time to feel the unfamiliarity of entering a new framework.

2. Lurking requires good observation. I know you all are experts in that, but we can forget to apply that principle to Web 2.0 You don’t have to respond to anything you’re reading or seeing, just notice things. Just be sensitive to the environment and what the denizens of the Twitterverse are doing. How are people interacting? What do their profiles say about themselves? What sorts of topics trend at certain times of day? Who is following who, and who else is connected to them? What kind of Tweets get the most responses? Who spams, and who sends out thoughtful links? And include yourself in the equation: What Tweets do you notice enjoying? What ones do you dislike? I personally don’t enjoy lots of famous quotations, but that’s just me? Other folks enjoy clicking links to photos, or clicking on the latest news from APA. So since you are giving yourself time to lurk, give yourself the opportunity to notice things and ask yourself questions.

3. Don’t pounce until you are good and ready! It is ok to lurk silently for as long as you want, and if you don’t feel sure about Tweeting, don’t tweet. My experience with social media both personally and as a consultant has been that when you’re ready, it will come organically. Maybe someone will post a link on Japan Earthquake Animal Rescue and you’ll want to retweet it (Note the clever insertion of a link that can take you to an amazing cause to donate to 🙂 ) Or maybe someone will ask a question that you can answer, and you’ll want to. Maybe there will be a conversation going on about healthcare social media and you’ll want to add your two cents worth. Don’t be afraid to open an account and begin lurking because you imagine you’ll be obligated to chime in at some point. Remember pouncing is only 2% of the game.

I forgot to mention one other thing about lurking: It can be fun! One of the keys to engaging with social media is enjoyment, and lurking can provide you with hours of quiet enjoyment with no responsibility to say anything. And if you like that, I know a good laundry basket you can hide in.

Video Games and Social Media