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

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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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