Save and Continue

Recently I was playing God of War III, and noticing something I take for granted much of the time, the savepoint. This is something that has become so integrated into video games that gamers hardly notice it after we discover what the particular “savepoint” looks like in the game we are playing. The saved game has been around for decades, and has become increasingly important as games have grown in length and complexity. I was reminded recently by Nancy Rappaport, a colleague and attending psychiatrist at Cambridge Health Alliance about how the concept of the saved game may not be taken for granted. I was trying to explain to Nancy during a workshop certain gaming concepts, and she was explaining that her point of reference in playing video games was Pac-Man, and in a general sense video games from an arcade setting that early on didn’t always have savepoints, where the player was asked if they wanted to “Save and Continue.”

This may be useful to remember when you are becoming frustrated with a gamer who is not as concerned with the quantitative time (bedtime, for example) as they are with the qualitative time of getting to the savepoint. But that actually isn’t what this post is going to be about. Instead I want to return to the concept of what makes an Epic Therapist here:

Epic Therapists remember the importance of saving and continuing.
To start with, therapy is in many ways a savepoint. At certain times in their lives or week our patients arrive at our office, pause, and take stock of things. In his 1914 paper “Remembering, Repeating and Working-Through” Freud alludes to this when he remarks that “In these processes it particularly often happens that something is ‘remembered’ which could never have been forgotten because it was never at any time noticed–was never conscious.” Like the savepoint in a game, the patient arrives at the place for the first time, understands how important it is to hold on to that progress, and remembers or saves it from repression. But part of what makes therapy therapy is the therapeutic frame, and at some point the session ends, and the patient goes back out into the rest of their life. They can’t just stay at the savepoint, they have to continue.

Readers have probably noticed by now that I draw frequent parallels to psychoanalytic theory and video games, and this is no exception. Our profession has a rich theoretical history that has grown from individual therapists learning from each other, disagreeing with each other, building on the prior work of each other and diverging from each other. Psychology as a field to flourish has had to frequently “save and continue” by writing these theories down in journals and now blogs, to take stock of what we have learned, but we’ve also had to move forward and continue to challenge pre-existing models. It can never be just save or just continue: To just save would stagnate our thinking and practice, and to just continue would mean we never consider thoughtfully the work we are doing.

In many ways, the problem with healthcare has been few if any savepoints, discouraging providers from taking time between patients to reflect before continuing on to the next patient. Interns in mental health agencies have many no-shows, and with no infrastructure to hold patients responsible to keep their appointments, these interns “continue” through the years where they should be receiving the most training with a fluctuating and diminishing number of patients to practice their craft under supervision.

Ask yourself this: If you were about to have open heart surgery and the doctor told you that he had only had the opportunity in medical school to practice the procedure 3 times because most of his patients cancelled or no-showed, would you feel confident in their ability? And yet we crank our interns through graduate programs based on the number of years rather than skills acquired, because the healthcare system is flawed and and patients are not held accountable for missing/cancelling appointments. This isn’t the interns’ fault, they are trying to get through to their knowledge and experience “savepoint,” but graduate schools and placements inadvertently become the parent shutting off the light because its “bedtime,” and we are producing generation after generation of clinicians who have had inconsistent or insufficient practice. This is continue without the save.

On the other hand, let’s take a look at the radical save mentality that permeates our profession. There are certain parts of the way many of my colleagues practice psychotherapy which have become extremely fixed, and I too fall prey to this at times. The 45-50 hour, a certain therapeutic stance, and my favorite, shunning technology. They bar their adolescent patient’s cellphones at the door rather than exploring who is texting them, refuse to consider Skype as an option let alone suggest it to their patients.

I frequently get referrals emails from several listservs, looking for therapists in Seattle, London, or Singapore. I enjoy practicing in-person therapy immensely, but does it ever occur to these colleagues to consider beginning to practice online as well? Why refer a patient to someone in Taiwan based on location when you could have one of your colleagues whom you know and respect take the patient on? On occasion I reply to these referral requests asking if the patient would be interested in Skype, but for the most part I’ve become reluctant to do that because I am pretty sure it doesn’t go anywhere. In terms of technology these psychotherapists are often in a lock-down save mode, and I foresee that they will resist change as the world continues without them.

My friend and colleague Susan Giurleo and I often find these things frustrating, and I realized today one reason why we may have this in common. We both went to Connecticut College in the late 80s early 90s, between the college presidency of Oakes Ames and Claire Gaudiani. In fact our graduating class became known as “the folks who knew Oakes.” And during this time our college had a motto that was drilled into all of us: Tradition and Innovation. Everywhere we looked, in all the college information and stationary were those words, tradition and innovation. Save and continue.

I have definitely tried to live that in my profession and my life of the mind. I’m a psychodynamically oriented therapist who uses Twitter and plays video games. I teach my students about Freud and Facebook. And I think that perhaps the affinity I find in the fin de siecle of the 19th century is how its denizens struggled to save and continue, to embrace the advances of technology then as we do now in the 21st century. In a recent article at Chris Brogan alluded to this when he said, ““The excitement for me about [social media] is, it’s gone from ‘Gee whiz!’ to ‘Now what?’ ”

Technology is here to stay and embedded in our lives, and today, like after the Industrial Revolution, we must learn the “now what?” To do this we can’t just rush forward and forget everything we ever knew, but we can’t stay stuck in a mindset from the pre-IBM world. Web 2.0 has arrived, and we need both tradition and innovation if we want to progress.

We must save and continue.

How Invested Are You?

photo courtesy of Flickr

When you decided to become a therapist, how much time and money did you spend?  Most therapists spend between three and six years (longer if they are MDs) enrolled in graduate programs that cost thousands of dollars.  That’s a lot of money!  But we do this because we value the profession, the work we do, and the people we help.  We also do it because it’s reality.  You don’t show up, knock on the door of a graduate program, and say, “hey, can I sit in on a few classes for free?”  You want the education and you pay for it, by loan, scholarship or somehow.

It astounds me how this logic seems to go out the window when it comes to growing a therapy practice in a Web 2.0 world.  This is probably because technology has become so easy to acquire.  You want a blog?  WordPress will let you get registered and started in 15 minutes.  Twitter, takes 10 minutes and a valid email to enroll.  So I see a lot of colleagues decide to “take the plunge,” start a blog, and then..


Nothing happens, or they don’t get traffic.  Or they run out of ideas.  Maybe they ask me for some advice, offer to buy me a coffee if I can help them with their blog.  “Can we just chat?” they’ll say.

Then there are people like my colleague Carolyn, who hire me.  That’s right, hire. She wanted some help with her blog, both in terms of the technology and setting it up, as well as market consultation on audience, focus, and sustainability.  So she spent the time and money to do this, and even though we’ve just started working together she’s already seeing more of a focus in what she’s doing.  We’re backing up and unraveling a few stitches, so that we can get her and her practice ready for the 2011 business year.  Carolyn is going to thrive, and not because she hired me:  She’s going to thrive because she is investing in her practice and taking technology seriously.

Taking technology seriously means at least two things:

1. Taking technology seriously means you accept that the point in history when using technology was optional is over.  You can no longer ignore or opt out of using technology to have a successful practice.  Whether you use email, social media, file claims electronically, request authorizations, etc., if you do not start utilizing the resources that technology affords you you will fail.  I know that sounds brutal, but your colleagues will pass you buy.  Web sites will trump the yellow pages every time.

2. Taking technology seriously means investing time and money in learning about it and how to use it. Just enrolling in a blog service is the equivalent to signing up for a psychology course, and then going out and hanging up your shingle.  You’d be insulted if somebody implied that they could duplicate your expertise and services after taking one class or workshop.

Yet, I can’t tell you how many people approach the Web 2.0 practice that way.  They’ll email me a question or two, ask for a free consult (which I no longer do) and I think on some level they are expecting that what they will get will be commiseration or something.  A friendly “chat.” They really don’t take technology seriously, so they decide they’ll just do it themselves.

Where does he get off saying this?!

Let me give you a breakdown of the work I have done and the expertise that I have:

  • I have been a psychotherapist for over 15 years.
  • I co-founded a social media software company; meaning I participated in a startup business in many capacities to grow it.  I pitched ideas to clients at meetings, helped orchestrate launches, analyzed client needs, kept an eye on marketing trends; wrote press releases, managed budgets and negotiated CEO contracts.  Oh, and I also helped develop the product that several versions and six years later is one of the social media companies to be included in the latest Gartner Group report.
  • I have spent countless hours researching the changes and developments in the social media industry, and compared to my company’s employees I am behind the curve.  This is because I am not involved in the company’s day to day ops, and because I am focusing on doing the other projects you read about.  But I know social media, from a user experience and business perspective, and it isn’t from downloading Twitter and playing around with it or making an Excel spreadsheet.
  • I invested in my own supervision and consulting from top clinicians and coaches.
  • I have started up and grown a private practice from zero patients to a full practice in 30 weeks.  I can tell you it was 30 weeks because that is the amount of unemployment benefits I received to survive on while I built it.

So I know what it is like to take the plunge and how to make it work.

I am saying this to you because you need to take technology and growing your business seriously.  Sure if some people read this and want to consult with me, I’ll be very happy.  But if not me, please, hire somebody.  Susan Giurleo does great work, so do Casey Truffo and Juliet Austin.  And Lynn Grodzki is amazing.  Heck, check out a couple of people; we all have different styles, experience and foci.  But accept that taking your business seriously means asking for help and hiring experts.

So, yes, of course I am marketing for your business, but I am also trying to convey something more:  If you do not invest in the time and expertise to build your practice in the 21st century you will fail.

P.S. If you want to get help on generating blog ideas, a great source is Chris Brogan’s service, and yes, you’ll have to pay for it.