therapy

Streaming, Path of Exile & The Repetition Compulsion

June 11, 2019 by langloimsw Leave a Comment

As many of you know I have begun streaming. My goal in doing this is to both have some fun, and reach a wider audience when talking about psychodynamic concepts. This is my latest attempt, in which I talk about the Repetition Compulsion in terms of farming for a unique sword in the game Path of Exile. Keep in mind that the conversation about the repetition compulsion during the stream if for a general audience, and should not be substituted for seeking out medical advice or a mental health professional. My hope is that you’ll share it with the gamers in your life, therapy practice, class, etc. And of course if you sign up to follow my Twitch channel I’d be delighted!

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

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

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

August 11, 2018 by langloimsw Leave a Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can’t We All Just Game Along?

July 16, 2018 by langloimsw Leave a Comment

I had a powerful reminder about the prosocial nature of video games this week, and it was nowhere near a console screen. I was on my way home and ran into a Dunkin’ Donuts, in a town I’d never been to before and was unfamiliar with. I ended up waiting in a rather lengthy line and was a bit grumpy. I happened to be wearing a T-Shirt which said this:

I hadn’t worn it for ages, and had forgotten in fact I was wearing it until the cashier called out to me, “I love your shirt.” Cue the endorphins.

“Thank you,” I said, and smiled (which thanks to state bound learning probably cued my body to produce even more endorphins.) Waiting in the line seemed much more pleasant by this point. I ordered my coffee and sandwich and while waiting for them received another compliment from a customer walking by.

The third person to compliment me was a man in his 40s, scruffy and in jeans and t-shirt. “I love that game,” he said. “I haven’t played it in a while though.”

By now I was in a mood that allowed me to initiate conversations, so I asked “What are you playing nowadays.”

He proceeded to tell me that his 14 year-old daughter had gotten him into Fortnite. She had enjoyed it initially for the crafting, he said, because she really enjoyed Minecraft; but now that they were playing together she was enjoying the combat as well. His face lit up as he recounted how much fun they were having together. I told him about a study that had been done by Brigham Young that indicated increased levels of protective factors against depression. He smiled at that, and we both went on our way.

We spend so much time debating the neurological impact of playing video games that we often lose sight of another dimension; that of talking about playing video games. Talking about arts and culture is a powerful social adhesive. It identifies commonalities, allows for compliments and increased levels of engagement with others, allows us to recall exciting moments and share them. All of these activities in turn facilitate attachment, and increase a sense of well-being on the neurological level. That was the best line I’ve waited in a ages!

We need to find a way to get that message to Salty Sally the Social Worker and Morose Martin the Mental Health Counselor, whose eyes grow dull at the mention of gaming when their patients bring it up. “How much time are you playing Candy Crush?” they say, in uninviting tones, and eye such T-shirts as a clear sign of video game addiction. The next patient, who comes in with a T-Shirt of Monet’s “Water Lilies,” will get a compliment on it and no such screening for an Impressionist Art Addiction. In fact, the WHO didn’t include Art Disorder this go round at all, unless you include the art form of the video game.

In this current political climate, where we are so polarized, I wonder how many bridges (Minecraft or other) might be built if we paused to ask strangers in line if they play any games? I imagine Republicans, Democrats and Independents alike play something.

If Teams Valor, Instinct, and Mystic can all get along together raiding in Pokemon Go, perhaps we can too..

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

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, buddhism, candy crush, children, education, gamers, games, gaming, minecraft, play, pokemon, psychodynamic, psychotherapy, stress, technology, therapy, video games

Taking Leaps: Fortnite, HIPAA & Psychotherapy

May 31, 2018 by langloimsw Leave a Comment

“You keep dying,” Sam* said. The annoyance in the 9 year old’s voice was palpable. I looked at my avatar lying face down on the screen. Another of the 100 players in the game, appearing as a brunette woman in sweats sporting a ponytail, was doing a victory dance with her rifle over me. Sam was nowhere to be seen on the screen, but I knew he was hiding somewhere in the game, and seething.

“You’re disappointed in me,” I said calmly. A moment of quiet.

“Yeah.”

“You were hoping I’d be better at this, as good as you or maybe better, and it’s frustrating.”

“Yeah… Can we try again?”

And so we tried again and again, and while we did I talked with Sam about the other adults who were disappointments to him, who kept leaving or letting him down. And I guessed that we were also talking about his frustration and disappointment in himself. And at the end of our appointment I promised I would practice Fortnite, the game we had been playing. We had turned on our webcams again so we could see each other to finish the session, so I could see that he brightened at this idea.

“Nice to see you again,” I said. He smiled faintly.

“You too.” His screen went dark.

As I reflect on the work I do with patients, meeting them where they are at, I am struck by the same issues, opportunities, and conversations that can happen in an online play therapy session. I only wish more of my colleagues would try it. What gets in the way? For some it is a dismissal of emerging technologies which masquerades a fear of trying something new. For others it is a worry about running afoul of HIPAA and being sued. If you are one of those people who wonders about how to integrate video games online into your therapy practice, read on.

* * * * *

Quick, without Googling it; what does the “P” in HIPAA stand for?

If you are a psychotherapist or other health provider, you probably guessed “privacy.” At least that’s often the consensus when I ask this question at my talks. It would be understandable if this was your guess. You’d be wrong.

The correct answer is “portability,” the basic premise that individuals have the right to healthcare treatment that moves with them as they go through the vicissitudes of life and work. That is also where technology comes in– electronic health records, telemedicine, etc., are ways that technology increases portability by collapsing time and space so that the patient and the healthcare professional can get to work.

In therapy, that work traditional has happened in an office setting. And in the case of children and youth especially, that meant play therapy which was bounded by the space and time of a physical office. From Uno to Sandtrays to the infamous “Talking Feeling Doing Game,” we have often assumed that play therapy needs to be the games of our own childhoods. But 21st century play can, and I maintain should, include 21st century play. That’s where video games come in.

In the days of the Atari 2600, there was no worry about patient privacy, because the system was hooked up directly to a television that didn’t even need to be connected to cable. But nowadays with SmartTVs, PCs and PS4s, video games are often played online with many other people and seamlessly connected to voice chat. This can be a concern for the psychotherapist who is unfamiliar with newer technology, especially with games like Fortnite, which boast Battle Royales having as many as 100 players at a time in the same game instance.

Videoconferencing programs and online therapy using video/audio chat have been around long enough to have specifications that adapt to HIPAA’s privacy requirements, largely because there is market force behind developing products that can be sold to the healthcare industry. Video games and their platforms, on the other hand, do not have a similar demand to give them an incentive to supply. Games like World of Warcraft, Platforms like STEAM, and streaming services like Twitch were designed for gamers, not therapists, and it is unlikely they will go through the technical and legal procedures to become HIPAA compliant anytime soon.

Some therapists have begun developing their own video games, which, like most therapy games are dismally boring. They are thinly veiled therapy interventions that are disguised as play, but lack any of the true qualities of play. True, they are more likely private; but they are also boring, and easily recognizable as “not playful” by patients. Mainstream games have broader appeal, critical user mass, and better graphics and gameplay in many cases, and are more immediately relevant to the patient’s life. But they are definitely not HIPAA-compliant. So what to do?

* * * * *

My solution, which I’m sharing as an example that has not been reviewed by policy experts, lawyers or the like, has two parts:

Due Diligence– Research the existing privacy settings and technologies to maximize benefit and minimize risk to patient privacy. So for example, I structure the “talk” part of therapy to happen over HIPAA-compliant software like Zoom or GoToMeeting. We start on that platform with video camera on, until we begin playing. Then we, turn off the camera to save on bandwidth and talk over this software, not the game. Previously, I will have sent the patient or their parent a snapshot of the settings of the game we are using with the voicechat disabled if possible. We also want to lower or turn off the game sound so we can hear each other. So in the case of Fortnite, the settings would look like this:

2. Limited HIPAA Waiver- This is the part most therapists overlook as even being a possibility. You can ask patients to sign a release waiving in a limited capacity their HIPAA rights in order to use noncompliant technology. It is entirely voluntary and I’ve yet to have a patient decline. I use a informed consent form that I developed that looks like this:

These are examples of how to engage with online technologies in a clinical way that is thoughtful yet forward-moving.

* * * * *

Whether you love Freud or hate him, most experts agree that he was one of the fathers of modern psychiatry. He was also an early adopter. He based his hydraulic model of the drives on steam technology of his era. His concept of the “mental apparatus” was likewise integrated from the advances in mechanics and his formulation of ego defenses such as projection occurred simultaneously with the Lumiere brothers’ creation and screenings of motion pictures. Regulatory concerns aside, therapists can be early adopters. Doing so would probably help our patients no end, and definitely cut down on my waitlist.

* “Sam” is based on several patients whose identifying information has been disguised to protect patient privacy.

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

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

The Crisis Behind Crises

April 10, 2018 by langloimsw Leave a Comment

So far in 2018 alone, I have worked nationwide with the aftermath of one homicide/suicide in a video game server community; one threat issued over another; and 3 new requests for consultations from clinicians on how to improve their work with families and individuals related to online technology. Schools are now fielding multiple incidents of threatening language in chat rooms that get brought to their attention, and not necessarily handling them well. Multiple arraignments in district courts are pending because someone expressed violent language on gaming servers that was deemed threatening. Youth are ending up on probation for this.

I know, you’re probably thinking that I’m about to blame the technology, the erosion of family values, the rise of violence or some other social ill. I’m not. As I reflect over several of these cases, the common symptom I see is not mental illness or family dysfunction, but a crisis in digital literacy.

What all of these cases have in common is that before they got to the emergent stage, there were several opportunities for kids to solve their own problems; for educators to teach; for parents to engage or for therapists to help; if they’d seen the opportunities and had some education in digital literacy. Too often we see the end result of our dismissing or demonizing tech use. “Just leave the server, or Facebook,” we say, unintentionally further isolating kids. “You need to stop playing so many video games,” we opine, citing sketchy research to take away the one thing a person may experience some competency doing.

As a therapist and educator who has worked for the past twenty-five years with emerging technologies in mental health, I have been helping schools, clinics and workplaces identify vulnerabilities before, during and after crises. I assure you that before is the most useful and least utilized. I’m hoping you and your administrators will consider doing this differently. I have started offering custom educational offerings on Healthy Boundaries in the Digital Age, and you can find out more about it here. I’m still doing my other presentations as well.

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

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

Mindfulness, Minecraft & The I Ching

March 5, 2016 by langloimsw Leave a Comment

Video Games can be a form of mindfulness meditation, both playing and watching them. The Grokcraft Staff take you on a meditative creative session as we begin to build our I Ching Sculpture Park. Watch, listen, and enjoy..

For more info on joining the Grokcraft project, go to http://grokcraft.com . We are launching Grokcraft with an introductory subscription of $9.99 a month, & subscribers who join now will be locked in at that rate for as long as they are subscribed. If any of this appeals to you, please check out our new site at http://grokcraft.com & please spread the word to anyone you think might find this resource useful!

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

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, Confucianism, digital literacy, education, gamers, games, gaming, I Ching, meditation, mindfulness, minecraft, play, private practice, psychodynamic, psychology, psychotherapy, technology, therapy, video games

Heroes

November 1, 2015 by langloimsw Leave a Comment

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

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

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

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

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

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

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

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

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

Better Living Through Minecraft

April 22, 2015 by langloimsw 2 Comments

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

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

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

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

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

The Internet & Real Relationships

January 11, 2015 by langloimsw 7 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Lava Expert

January 2, 2015 by langloimsw 2 Comments

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

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

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

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

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

“Kids and adults both, yes.”

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

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

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

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

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

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

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

* * * * *

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

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

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

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

* * * * *

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

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

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

* * * * *

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

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

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

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

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

Using Gaming & Gamification in Clinical Practice

June 25, 2014 by langloimsw 4 Comments

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

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

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

Gamer-Affirmative Practice: Today’s Play Therapy

June 13, 2014 by langloimsw 1 Comment

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

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

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

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

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

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

June 2, 2014 by langloimsw 1 Comment

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

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

The Relationship Between Emerging Technology & Psychodynamic Theory

May 23, 2014 by langloimsw Leave a Comment

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

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

Works, Life and Marshmallows: Iterative Design

February 13, 2014 by langloimsw 2 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interested in setting up a consult for your practice? I have some openings come March. Like this post? I can speak in person too, check out the Press Kit for Public Speaking info. And, for only $4.99 you can buy my book. You can also Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: addiction, behavior change, buddhism, building your business, children, education, gamers, games, gaming, marshmallows, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, social justice, technology, therapy, video games, Web 2.0

No Matter How You Feel, You Still Failed

January 14, 2014 by langloimsw 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reality Testing & The 7 Billion Rule

December 20, 2013 by langloimsw 3 Comments

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

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

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

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

Obama, Selfies, Projections & Death

December 11, 2013 by langloimsw 1 Comment

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

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

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

The Changing Landscape of Social Work

November 17, 2013 by langloimsw Leave a Comment

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

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

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

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

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

http://youtu.be/FQWUMTxXVus

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

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

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

September 21, 2013 by langloimsw 4 Comments

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

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

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

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

I don’t care about grade inflation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Innovation is Dangerous & Gaming Causes Asperger’s

August 31, 2013 by langloimsw Leave a Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dopey About Dopamine: Video Games, Drugs, & Addiction

August 25, 2013 by langloimsw 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So my point here is twofold:

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

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

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

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

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

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

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

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

August 14, 2013 by langloimsw Leave a Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Guild Wars: The Conservative Attack on Online Therapy

August 4, 2013 by langloimsw 11 Comments

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

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

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

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

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

I have several concerns about this.

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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

July 28, 2013 by langloimsw 2 Comments

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

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

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

21st Century Play

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

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

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

Solo Play is OK

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

The Many Reasons to Collaborate.

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

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

Let’s Bring On A World of Hurt.

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

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

Multiplayer and Uninvited Guests

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

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

Minecraft and the Repetition Compulsion.

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

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

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

I’m not THAT non-directive. 🙂

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

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

Automation

July 20, 2013 by langloimsw 2 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

June 30, 2013 by langloimsw 1 Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10 Nonviolent Video Games

June 17, 2013 by langloimsw 4 Comments

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

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

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!

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

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

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

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

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

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

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

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!

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

Filed Under: Gamer Therapy Tagged With: activism, adolescents, android, behavior change, buddhism, children, digital literacy, gamers, games, gaming, ipad, iphone, nonviolent games, pacifism, play, private practice, psychoanalysis, psychodynamic, psychotherapy, smartphone, social justice, social media, technology, therapy, video games

Empathy (Re)Training

June 8, 2013 by langloimsw 2 Comments

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

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

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

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

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

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

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

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

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

And we get to keep all the knowledge we find.

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

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

You’re The Reason Building Your Business Is So Hard

May 31, 2013 by langloimsw 22 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

May 23, 2013 by langloimsw 7 Comments

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

Wait, huh?

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

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

Please don’t do that.

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

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

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

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

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

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

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

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

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

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

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

What To Do When Your Therapist Turns Into A Kitten

May 1, 2013 by langloimsw 10 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

Skyrim Family Values

April 13, 2013 by langloimsw Leave a Comment

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

pre·scribe

/priˈskrīb/

Verb

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

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

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

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

So what on earth am I thinking in recommending it?

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

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

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

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

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

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

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

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

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

We can do better.

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

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

Epic Supervision Fail

April 2, 2013 by langloimsw 7 Comments

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

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

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

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

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

And they get “just say no.”

So let’s get real a sec here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Continuing Education From Pax East

March 24, 2013 by langloimsw Leave a Comment

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

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

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

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

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

Nice Everything You Have There: Mindful Minecraft

March 13, 2013 by langloimsw 4 Comments

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

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

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

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

Twenty-Three Apps for the 21st Century Therapist

March 3, 2013 by langloimsw 29 Comments

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

1. GoToMeeting

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

2. IbisMail

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

3. Flipboard

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

4. Bamboo Paper

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

5. Evernote

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

6. iAnnotate

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

7. 1Password

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

8. Mendeley

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

9. PayPal

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

10. Prezi

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

11. DCU

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

12. Dropbox

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

13. TED

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

14. Line2

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

15. CardMunch

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

16. Micromedex

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

And now for some games!

17. Plants Vs. Zombies

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

18. Zombies, Run!

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

19. Kingdom Rush

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

20. Minecraft Pocket Edition

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

21. Flower Chain

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

22. Trainyard

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

23. Lavalanche

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

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

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

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

Learn More About Rethinking Video Games & Addiction Here!

February 17, 2013 by langloimsw 1 Comment

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

[gigya ]

This can give you an idea of:

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

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

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

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, digital literacy, education, game theory, gamers, games, gaming, mindfulness, play, prezi, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, sxsw, technology, therapy, video games, Web 2.0, World of Warcraft, wow

4 Tips For Dealing With Video Game Violence For Parents

February 2, 2013 by langloimsw 2 Comments

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

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

XBox Parental Controls

Playstation Parental Controls (Video from CNET

Wii Parental Controls

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

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

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

Call of Duty Black Ops 2

Gears of War 3

World of Warcraft

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

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

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

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

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

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

January 23, 2013 by langloimsw 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, digital literacy, education, facebook, gamers, games, gaming, generation y, millennials, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, technology, therapy, twitter, video games, Web 2.0

What It Means To Make A Referral

January 7, 2013 by langloimsw 4 Comments

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

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

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

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

Please accept my invitation below. Thanks!

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

That’s not how you make a good referral.

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

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

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

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

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

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

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

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

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

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

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

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

Filed Under: Gamer Therapy Tagged With: building your business, digital literacy, insurance, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, social media, technology, therapy

Angry Birds, Advent, & the 12 Links of Christmas

December 13, 2012 by langloimsw 5 Comments

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

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

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

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

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

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

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

The Twelve Links

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

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

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

;

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info. Subscribe to the Epic Newsletter!

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

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

November 16, 2012 by langloimsw 2 Comments

http://youtu.be/pWQIbIkOVtY

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

Taking An Interest

October 14, 2012 by langloimsw 2 Comments

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

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

Filed Under: Gamer Therapy Tagged With: building your business, education, gamers, games, gaming, interest, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, supervision, technology, therapy, twitter, video games, Web 2.0, World of Warcraft

The New Achievement Gap

October 4, 2012 by langloimsw 3 Comments

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.

Filed Under: Gamer Therapy Tagged With: behavior change, Boston College, education, gamers, gaming, graduate school, psychodynamic, psychology, psychotherapy, social media, social work, technology, therapy, Web 2.0

Bio Breaks

September 17, 2012 by langloimsw 1 Comment

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!

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, bio break, children, education, gamers, games, gaming, mental health parity, private practice, psychodynamic, psychology, psychotherapy, stress, technology, therapy, video games, World of Warcraft, wow

What Back to School Could Mean

September 8, 2012 by langloimsw 2 Comments

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.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, education, gamers, games, gaming, guild wars 2, gw2, mindfulness, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social justice, social media, technology, therapy, video games, Web 2.0, World of Warcraft, wow

Minecraft & The Uncanny, Part 2

August 27, 2012 by langloimsw 1 Comment

This is the second of a two part series on Minecraft. Up until now you could only read it if you bought my book, but I am posting it here to give you a sense of what the book is like. You can buy it here. More importantly, I’m hoping you will find the topic interesting enough to vote for my presentation proposal on Minecraft & Mindfulness for SXSW this year. You can do that here.

In Minecraft, nothing is present-at-hand, at least initially, until you realize that the ground you are running on or the mountain you are climbing aren’t just that, they are materials. You can dig up stone to make a furnace, then bake bricks out of clay, build a house and so on. The world gradually becomes ready-to-hand.

There is no avoiding the sense of throwness when you begin playing Minecraft. It comes with very few directions, although there is plenty of info on the web to be had. The downloadable beta allows you to play single and multi-player, with the single being a good way to practice the basic mechanics. The multiplayer version opens up a whole new vista.

The multiplayer game is hosted on individual servers all over the world, some of which you can log into for free, others for a small fee. Once logged in, the virtual world is a huge massively multiplayer sandbox, which can be a very social experience. The cooperative building in some of these worlds is incredible. My first journey to a server in France threw me into a world which included a vast underground city beneath a dome of molten lava. Players are allowed to explore the world, and at a certain distance from their neighbors mine, farm and build. Like Second Life, you can port to various places on the server, and encounter anything ranging from a Waterslide Park to a model of Hyrule, all built out of the game materials by the players.

Once in the multiplayer world, the social element of the game can become compelling. People on chat are offering to sell gold ingots, suits of armor they crafted, or tracts of land they have developed, for both in-game and out of game monies. You can have as much or as little to do with that as you like, and you can teleport to far-off corners of the map if you want to build and play in undeveloped lands.

In its simple mechanics, Minecraft allows us to glimpse the uncanny experience that I would suggest all video games have. Video games are a unique art form in that they are both interactive and aesthetic by nature. In fact they are far more stimulating and less anergic than watching television, and stimulate more regions of the brain.

Video games allow us to experience our throwness in a new world, and the animistic state of being inherent in the uncanny. We are never completely at home in the world of the game, although the game may become more familiar over time (or not, in the case of the indie game Limbo.) We are always just visiting, strangers in a strange land. But within the game world, mana and magic are also real, and our thoughts and strategies can quickly and permanently change the world.

Psychotherapy is in many ways, another sandbox game. There really is no way to win in it. The office becomes a setting for a potential space that can be shaped and altered by the patient and something new created. Psychotherapy is also an uncanny space, one that resembles the world outside the office and yet does not. It is a place for “everything that ought to have remained … secret and hidden but has come to light.” Within that space, the patient experiences hauntings by ghostly relationships from the past, encounters the internal monsters of the drives, and explores the wishes behind their secret injurious powers. Unexplored and avoided, these have calcified into symptoms, and the anxious, exciting, process of therapy helps the patient break down that calcification for a more flexible psyche.

Any child or gamer knows that play is a serious and dangerous business. There is always the risk of annihilation, and no place worth going to doesn’t have its hazards. But there are great treasures to be found in the game. Further, the emotional and intellectual changes encountered within the game can then be taken out of it into the daily life of the gamer. This is one of the reasons that video games are so compelling. Why else would people spend hours making houses out of pixel bricks?

Both psychotherapy and video games create very real thought and feeling states in people, and that is part of their curative power. In this book I hope I have shown that they can restore a sense of purpose and achievement that our patients have lost. I have discussed how they can help people stay connected with others over great distances in times of duress, help us feel the sense of achievement necessary to learn and change behaviors, and explore aspects of their personalities that may be less easily seen or developed in their daily lives. I have also explored how we can use the experience and metaphors from video games with patients to help them understand ego defenses, communication patterns and strategies that impact their relationships, and apply game mechanics to their lives to change them. I have tried to discuss the stigmatization of gamers and technology in terms of diversity, in particular social class. Finally, I hope I have shown how therapists can apply the principles from video games and gamification to impact both their clinical work and business skills.

All of this pales in comparison to doing the actual work, and by this I mean two things. The first and most obvious one is the practice of psychotherapy. Theory is a necessary but insufficient precursor to clinical practice and healing. The second piece of actual work will be for the therapist to begin playing some video games. Reading is not the same as doing, and it is only by entering the uncanny and enriching world of the video game that therapists can hope to truly understand them. Never has play been more important in our work, and never has understanding video games been more urgent in healing the world. To do so we need to rethink our attitudes and reconsider our biases towards gaming and technology.

It’s time to reset.

Gamer Therapist is on vacation, so we’ll see you in two weeks! In the meantime, please vote for our minecraft panel at SXSW!

Filed Under: Gamer Therapy Tagged With: education, Freud, game theory, gamers, gaming, heidegger, mindfulness, minecraft, psychoanalysis, psychodynamic, psychology, psychotherapy, sxsw, technology, therapy, uncanny, video games, Web 2.0

Minecraft & The Uncanny, Part 1

August 15, 2012 by langloimsw Leave a Comment

This is the first of a two part series on Minecraft. Up until now you could only read it if you bought my book, but I am posting it here to give you a sense of what the book is like. You can buy it here. More importantly, I’m hoping you will find the topic interesting enough to vote for my presentation proposal on Minecraft & Mindfulness for SXSW this year. You can do that here.

In 1919 Freud wrote and published an article on “The Uncanny.” In it he described the concept of the uncanny as a specific type of fear something both strange and familiar. It is worth noting that the article begins with an investigation into aesthetics, something that was not usually done in the medical literature of Freud’s time. But Freud realized that there was something particularly aesthetic about the uncanny. It is an anxiety that both draws on the aesthetic, and from a distance also acquires an aesthetic quality itself. In fact, it could be argued that a whole genre of fiction, such as Lovecraft, embodies the aesthetic of the uncanny.

In German, the uncanny is unheimlich, which translates literally to the “unhomely” or “unhomelike.” Here homely has a double meaning. First homely is the quality of domesticity, the warm hearth of the house, down comforters, a cheery cottage coziness, etc. Second, heimlich refers to concealment, contained within the house’s domestic sphere, hidden from the public eyes of outside society.

Seen in this light, the uncanny or unheimlich is both alien and a revelation or an exposure. Freud quotes Schelling as saying that ‘“Unheimlich” is the name for everything that ought to have remained … secret and hidden but has come to light..’” Is it any wonder that Freud took up exploration of this concept, with all of its allusions to the unconscious, anxiety, and societal repression?

Freud also talks about the element of repetition in the uncanny, such as arriving at certain places we’ve been to before, or noticing the number 62 appearing throughout the day in a variety of places. This element of repetition gives rise to the sense that there is a pattern that we may not be aware of, which in turn makes the world suddenly seem both stranger and more imbued with meaning.

Freud goes on to discuss something gamers will be very familiar with, mana, although he discusses it from outside the framework of fantasy as a form of magical thinking that attributes powers to the neurotic overvaluation of their thought processes and their impact on reality. But the game world is within the realm of fantasy. Within that world, what Freud refers to as “the Apparent death and the re-animation of the dead” are fairly commonplace. The game world returns us in many ways to the animistic state of being, characterized by “the prompt fulfilment of wishes, with secret injurious powers and with the return of the dead.”

The uncanny also figures largely in the philosophy of Martin Heidegger, and is connected to the idea of man’s “throwness” into the world. Human beings want to feel at home in the world, but when they encounter the uncanny they experience themselves as thrown into it and apart from it. For Heidegger the unheimlich eradicates our sense of Being-at-home-in-the-World, but as it does so it reveals something about the World to us.

For Heidegger the World is also revealed to us (and we are revealed as well) by that which is ready-to-hand, something that has a meaning that connects us to the world. An example is a hammer, which we experience as imbued with meaning and value and inextricably linked to human being. We don’t think about the hammer, in fact the only time we are really conscious of it is when it isn’t working. A similar example is your car, if you reflect on it you will probably notice that you only really pay attention to your car as a concept when it isn’t working.

As opposed to ready-to-hand, present-at-hand refers to an uninvested, detached way of looking at something, one that takes us out of any sort of meaningful relationship. Its meaning may be unclear and unconnected with human being at all. If I ask you what you’d like to do with that round green and red thing, you’ll be confused. But if you see it as an apple, things will become much clearer. It probably isn’t a coincidence, by the way, that most depictions of Adam and Eve in the Garden of Eden show the fruit as an apple. Before the Fall, everything is ready-to-hand and imbued with meaning. Afterwards, in our thrown state, things become less clear, and more uncanny. Paradise has been lost.

Ninety years after Freud wrote “The Uncanny,” Markus “Notch” Persson created the game Minecraft. Minecraft is a sandbox type of video game, meaning that the world generated can be permanently changed by the player. Creativity and survival is the goal, and there is no way to “win” the game. The premise of the game is that your character is thrown into a vast world designed with 8-bit graphics (think early Nintendo) with only your bare hands. The game has a day and night cycle, and at night zombies, skeletons, and other monsters come out and will attack you if you are exposed.

Everything in the game world can be destroyed and broken down into elements that can be crafted if you have the right ingredients. At first you have fewer options, because destroying a tree with your hands takes more time than if you had an axe. But slowly you gather materials so that you can build things that in turn allow you to build more things, so that you can hopefully build a shelter before night falls.

The landscape of the world is randomly generated by the game, and remains saved if you are killed. Dig a hole in the ground and it will be there when you return from the dead and to the game. The graphics are not realistic, with the blocky edges of 8-bit design, which underscores the uncanny element of the world. The world is vast, and looks like the real world, and also doesn’t. Minecraft is not trying to trick you into thinking it looks like real life, in fact that is one of the things that makes it so immersive.

Part 2, next week.

Filed Under: Gamer Therapy Tagged With: Freud, game theory, gamers, games, heidegger, mindfulness, minecraft, play, psychoanalysis, psychodynamic, psychology, psychotherapy, sxsw, technology, therapy, video games, Web 2.0

How to Get Taken Seriously as a Mental Health Professional

August 8, 2012 by langloimsw 8 Comments

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.

Filed Under: Gamer Therapy Tagged With: building your business, education, linkedin, managed care, marketing, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, social media, technology, therapy, twitter, Web 2.0

Tower Defense & Executive Functioning

July 24, 2012 by langloimsw 2 Comments

Some of the most important tasks the human brain performs are known as the executive functions. According to the National Center for Learning Disabilities, executive function is “a set of mental processes that helps connect past experience with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details, and managing time and space.” As such, the executive functions are crucial to the learning process over the life cycle.

Like many phenomenon in mental health, executive functions were focused on initially in regards to populations that had some deficits in them. With the advent and prevalence of the diagnosis of ADHD, as well as the study of learning and learning disabilities, educators and therapists began to become familiar with a concept that had previously been of most interest to neuroscientists. We still tend to think of executive functioning from a pathology-based approach, only paying attention to how they work when they don’t work.

The truth is everyone has executive functions, which are a combination of nature and nurture, and can develop well into adulthood. They can also deteriorate for a variety of reasons, from traumatic brain injury to Alzheimer’s disease. And there is a body of research which suggests that mental and physical exercise can help maintain, if not improve our executive functions as we age. Not surprisingly, as the Baby Boomers age, interest and research grows in this area. At both ends of the life cycle, our focus on the executive functions are widening beyond pathology to the optimal environments for human learning. How might we get better at planning, attending, strategizing, and managing time and space?

My suggestion: Start playing more tower defense games.

Tower defense is a particular genre of video games, one which in general focuses on on preventing the progress of an enemy army across a map. This is done by the use of towers which have varying abilities, costs to build, and points earned from downing enemies. You don’t necessarily need to have towers in the game: Plants Vs. Zombies for example is an example of a tower defense game where the plants are the equivalent of towers, with special abilities used to defend against the march of those pesky undead across the lawn.

More recently I have been fascinated with one of the latest iterations of tower defense games on the iPad, Kingdom Rush. You start out with a variety of maps and coins for building. You can use one of 4 basic tower types. There are barracks which have soldiers who can fight and slow down the invaders. There are artillery towers which drop bobs for an area wide (AOE) damage. There are marksman towers which target individuals and fire arrows or guns. Finally, there are magician towers with wizards firing spells of various types.

Each invading monster has different strengths and vulnerabilities, which are discovered by trying out different towers and noting their effects. As the invading army is always moving forward in waves, the time element requires you to plan which towers to build first, where to place them, and what upgrades to focus on. To do this requires a tremendous amount of strategy, organization and time management. You also need to make decisions, including how long to delay gratification. The more powerful towers require you to save up many more coins to buy them. Upgrades that you can select from a talent tree add another layer of choice and complexity.

In short, to succeed in Kingdom Rush you need to have good executive functions. It isn’t enough to have good hand/eye coordination or reaction time. You need to be able to learn from your past experiences, and often switch strategies midway through the game. You need to recall which towers are best for different situations and monsters. There is a map to be managed in space and a marching army and builders to manage in time. You need to recognize both immediate feedback and notice trends. And there are multiple towers and units to keep track of.

The more I play Kingdom Rush, the more struck I am by how many if not all of my executive functions are required to succeed. I can see where using this game could be both a useful assessment tool and intervention for deficits in EF. It also has reminded me how necessary executive functions are in terms of managing money as well. The ability to recall prices, to budget and pace spending, and set up investments that accrue value over time–all these economic experiences are embodied in the game.

Speaking of economy, you can try this game for free if you have a computer in your office or classroom here. And you can buy it for a whopping $2.99 for your iPad. Check it out, and see if you agree that it might be a fun, feedback rich way to challenge your executive functions.

Like this post? There’s more where that came from, for only $2.99 you can buy my book. I can rant in person too, check out the Press Kit for Public Speaking info.
Subscribe to the Epic Newsletter!

Filed Under: Gamer Therapy Tagged With: ADHD, children, education, executive functions, gamers, games, gaming, kingdom rush, learning disabilities, plants vs. zombies, psychoanalysis, psychodynamic, psychology, psychotherapy, technology, therapy, tower defense, video games

21st Century (Psycho)education

July 8, 2012 by langloimsw 2 Comments

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?

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, dbt, education, gamers, gaming, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, stress, technology, therapy, video games, Web 2.0, World of Warcraft

Failing Better

April 7, 2012 by langloimsw 6 Comments

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.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, children, dark souls, education, game theory, gamers, gaming, incoboto, learning disabilities, minecraft, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, special education, therapy, video games, Web 2.0

Thinking, and Just Thinking

March 20, 2012 by langloimsw 5 Comments

Originally I was going to title this post, “How to Make A Million Dollars as a Therapist Without Ever Having to Talk About Money.” And if I was just concerned about driving traffic to my blog and business, that would be the title. Because there are a lot of our colleagues out there who want to have a very successful business without having to deal with the sordid matter of coin. I used to think this was the number one reason that psychotherapists have a hard time being successful as entrepreneurs. I used to read, and agree with, several psychodynamic articles that have been written by colleagues which talk about how we feel shame around money, project our devaluation of ourselves by refusing to spend money on coaching or supervision, and have difficulty set fees and enforcing missed appointment charges with our patients because we feel that we don’t deserve to make money for our work.

I still think those are big hangups a lot of us have, but recently I’ve started to suspect that an even bigger one is our fuzzy thinking about thinking.

Therapists as a whole love to think. We like thinking deeply about our patients. Many of us love working with emergent adults in a large part because their neurology has finally blossomed and they are starting to reflect on their thinking. We often enjoy studying and debating the thoughts of major theorists. We even see the value of self-reflection in our work with patients. We like to think about others, the thoughts of others, our thoughts about the thoughts of others, and what great thinkers have thought about the thoughts of others and our thoughts about them. Boy, do we like to think about thinking.

Now I am no exception to this. I see an immense value to thinking, in fact I schedule time during my daily work week where I walk around the Charles and think. During this time I don’t take calls, I don’t check email, I don’t make appointments. I think. I intentionally schedule it during the day to remind myself that thinking has a critical place in my work, and has as much if not more value than a billable hour. And I will often lament to colleagues in academic settings about the need for more critical thinking skills. I’ve had colleagues critique my wanting more theory classes at BC by saying, “these students want classes that give them practical tools that they can use,” to which I respond, “how about thinking? That seems like a pretty good tool to me, when did we stop considering it practical?”

So I am not intending to come across as anti-thinking here. But I have noticed over the past several years who succeeds in getting their private practices off the ground and thriving, and who doesn’t. And the ones who fail are usually the ones who come to consult with me, or then need to “think about it.” I’m very concrete when I talk with consultees, and if they are in job crisis I call it that. I’ve worked with people whose incomes have shrunk by halves over the past several years. I tell them what has worked for me, and offer suggestions, and the suggestions require things like calling people to network or EAPs or insurance providers every day or write a business plan, or any number of other things.

They listen and say they’ll think about it.

Some people will make a lot of money off of those folks. There are dozens of people out there who can tell you how to “visualize” your ideal client, “ideate” abundance, or give you a 5 point plan to success. I’m not one of those people, and so sooner rather than later the conversation peeters out. Because they have a hard time moving into doing something other than thinking and talking. Maybe they’ll write a blog post or tweet a few times, but they get discouraged, because I’m not going to waste their time. This isn’t therapy. I’ll tell you what I think you ought to do. You don’t have to do it, but I don’t have a second set of things I think you ought to succeed in your business. So if you don’t want to do them, we really don’t have a lot more to talk about.

A lot of therapists, myself included, like to try to think and talk our way out of everything. And many things can be significantly impacted by strategic thinking, and thoughtful process. But eventually you have to do some other form of work if you want to be in private practice. We have more autonomy as sole proprietors, but we also can’t just sit in an office hour after hour “just helping people.” This is actually the fantasy I often hear expressed by colleagues, “I just want to help people,” as if the nobility of that entitles one to not have to exert any other effort.

One of my friends has a mentor who frequently says, “don’t confuse worry with effort.” Much of the time I think we confuse worrying with deep thinking, and even more so with taking other forms of action. We think if we worry about a problem either alone or with another that somehow that “counts” as having done something. The idea of sustained effort truly alarms us. I’m talking about me too here. One of the reasons I have a set time in my week to think about things is so that I contain that urge to think fretfully and know that there is a time and a place for me to think about stuff. And then I go on to other activities that are required of me during the day.

Another reason the Charles river is such an important place for me around this is that it is where I run. During the week I walk along it and think, and on the weekends at least once I run along it. But, and this is key, I don’t go to the Charles and think about running.

I can really only tell you what works for me, and incessant and indiscriminate thinking does not work for me, or my business. If someone tells you that there is an easy, simple way to succeed in creating and growing your practice, I encourage you to be skeptical. Creating and growing your business involves taking risks, trial and error, and most importantly sustained effort that is not entirely cerebral. My experience has taught me that you won’t think your way into a successful practice, but you may succeed in thinking yourself into a bankrupt one.

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.

Filed Under: Gamer Therapy Tagged With: behavior change, building your business, business, managed care, marketing, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, referrals, ROI, self-promotion, therapy

Why Therapy Is Like A Game

February 25, 2012 by langloimsw 15 Comments

Game-playing often has negative connotations in the field of psychiatry. We have all sorts of erudite ways of describing what laypeople call “mind games.” A great example is in the language of Axis II personality disorders. People are borderline, dependent, avoidant, narcissistic, antisocial, and the most FABULOUS of them all, histrionic. These words attempt to describe the psychological conditions which motivate problematic behaviors. Serious business indeed.

But come right out and say that therapy is like a game, even a kind of game, and that gets a lot of hackles up. Therapy is serious business, and games are anything but serious, right? Wrong.

To describe something as a game is not to minimize it or take it less seriously, but I suggest to describe what Bernard Suits calls the “lusory attitude.” This is the state of mind, the psychological attitude, required of any player when they play a game. The most succinct way Suits describes the lusory attitude is to say that it allows the “voluntary attempt to overcome unnecessary obstacles”

An example of this, not mine originally, is that of golf. The activity is directed at achieving the goal of getting a ball into a hole. But instead of just creating an activity where we find a ball and drop it into a big hole, we take the hole, make it small, say you can’t use your hands to drop the ball in but must use a metal club, and start you off hundreds of feet away from the hole. That’s golf, and it is so full of unnecessary obstacles! There is no reason to make it so challenging, EXCEPT that that challenge is what makes it fun, and frustrating, and more fun. And nobody drags you into the wilderness, gives you a golf club and points a gun at your head to golf. It is a voluntary act. People love to, choose to, spend hours with sticks hitting balls from great distances with the hope of getting them into little holes. Why choose to do something so weird and difficult? Because they are playing. They have voluntarily attempted to overcome unnecessary obstacles. They have adopted a lusory attitude.

Life is hard. And for many of therapy patients, life has been extremely hard, and cruel. And yet, how often do we notice that they are making life even harder on themselves in some ways? Perhaps unconsciously, perhaps subtly, but more difficult nevertheless. That neurosis, the reenactment of the past, is what I would suggest is the unnecessary obstacle.

For example let us take PTSD-precipitated by child abuse. The abuse was serious, hurtful, sadistic, real. It happened. But in the case of the adult patient, the abuser is no longer there. The introjects, the learned stuff, the unconscious stuff, that is all there, but the perpetrator has fled the seen of the crime long ago. They were real obstacles, but trauma recreates them as unnecessary obstacles in the here and now.

Another example would be a phobia. Why not be fearful of everything? Spiders aren’t the only thing that we could fear: There’s death, and hurricanes, and black cats, and dirt, and blindness, and the next presidential election. But we don’t fear everything in the world that is or is perceived as harmful to us. Phobias are very specific, that is why there are so many clever names for them. They are again, unnecessarily specific obstacles.

Again, I want to stress that by calling these unnecessary obstacles that I am not at all saying that phobias or PTSD or not serious, painful, debilitating, conditions. What I am saying is that they are unnecessary to the life of the patient. Even as compromise solutions they have outlived their usefulness if the patient is in the here and now experiencing distress as a result of trying to defend against or cope with the past encroaching on their present. The repetition compulsion is a game of both danger and optimism. We do the same things over and over, often with disastrous results, true; but we keep doing it because on some level there is an urge to get it right. And like a video game, the repetition compulsion doesn’t just get defeated one day; rather we get progressively further in the game, acquire new levels and skills.

When our patients arrive at our office, they are in a state of lusory attitude, they are really trying to resolve the problems the best they can, and they have sought out our help to that end. If they are mandated to treatment, this is less likely to happen. But for a majority of patients, they choose to show up. And from a psychological point of view, showing up must be voluntary for therapy to work.

In order to do therapy, we also have to adopt together a lusory attitude. Both therapist and patient volunteer to work together to overcome the unnecessary obstacles. The therapy time and space are in some ways unnecessary obstacles: we choose to limit the session to the 45-50 mins, in a specific office, with only two “players” if it is individual therapy. These may be the warp and woof of therapy but they are also arbitrary distinctions that create unnecessary obstacles. We could rotate different therapists in, or meet for varying times whenever we both want, and hang out at Dunkins, but that would be therapy in the sense we are talking about would it? No, therapy, like games, must have agreed-upon rules.

Although I’m speaking in clearly psychodynamic terms here, doesn’t it seem that more behavioral approaches would find the concept of lusory attitude applicable as well? Surely we don’t try to extinguish behaviors we think are necessary. The behavioral approach also implies that the obstacle (behavior) is unnecessary and tries to over come it.

Having a lusory attitude is not always about being lighthearted, although it can be, but it is about taking play very seriously, engaging in it and often having an immersive experience. Psychotherapists who engage in play therapy with children often have an easier time understanding this than those who do adult psychotherapy. There is a general tone from our profession of, “we need to be taken seriously,” which I think has lots of its roots in the tendency of the medical profession in the past to have considered it less important. And somehow being taken seriously becomes equated with being important or being valuable.

I often supervise interns who repress any sense of enjoyment that comes from making an interpretation that moves a patient forward, or seeing theoretical elements manifest in the treatment, and try to help them see that enjoying the process of learning psychotherapy and learning about the patient is not the same as having fun at her/his expense. As Sutton-Smith says, “The opposite of play isn’t work. It’s depression.” In this regard I agree with him: When engaging in a lusory attitude with patients we are working with them. Removing those obstacles is very hard, dangerous work, and it is deeply and seriously playful.

To add gamers and video games into the mix, I would suggest that approaching video games as an addiction is a step in the wrong direction. This is not to say that I don’t think that some people play video games to the detriment of their lives and relationships. I do think that happens, just like I think people engage in a number of activities at times to the detriment of their lives and relationships. But to label them as pathological is to miss the point. Even if we rule out the cultural incompetency of the clinician around video games which often masquerades as dismissal or villainization, we need to understand that we are in essence asking the patient to adopt the same lusory attitude with us that is often there already for them with video games. We are saying, “don’t play that game, play this game of therapy instead.”

(Unless you have this view of psychotherapy:

Psychotherapy needs to stop taking the lusory attitude for granted. What if we became more mindful of our lusory attitude? We all have them, over coffee with a colleague when we look at each other and say, “this is such a weird profession!” It’s like golf in that respect, it seems; so intricate and complicated with rules we take for granted that make a particular human relationship much more complicated than it has to be. Try that on the next time you are trying to discuss your fee with someone: “I charge you $150 an hour because this is a weird relationship that has intricate rules and is much more complicated than human relationships have to be.”

I think that there are strong parallels between therapy, neurosis, and games, and that the thread that links them together may be the lusory attitude. In games, the design always boils down to a voluntary attempt to overcome and unnecessary obstacle. In neurosis, the attempt to repress intolerable conflicts and feelings creates an unnecessary obstacle even as the patient tries to remove the unnecessary obstacle of those same conflicts and feelings. (Game designers may recognize an interesting resemblance to the concept of iterative design here.) Finally, in therapy, the neurosis or symptom becomes the unnecessary obstacle that the therapist and patient voluntarily attempt to overcome.

What do you think? Does this jibe with your experience as a therapist, patient, gamer or game designer?

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.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, game theory, gamers, gaming, lusory attitude, play, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, therapy, video games

When They Hate You.

February 22, 2012 by langloimsw 5 Comments

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.

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.
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.
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.

Filed Under: Gamer Therapy Tagged With: adolescents, adultism, education, gamers, gaming, private practice, psychodynamic, psychology, psychotherapy, public speaking, ROI, self-promotion, social media, therapy, video games

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

February 14, 2012 by langloimsw 3 Comments

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.

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.
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.”
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.
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.

Filed Under: Gamer Therapy Tagged With: adolescents, behavior change, Bioshock, children, education, first-person shooter, FPS, game theory, gamers, gaming, Halo, LGBT, LGBTQ, mental health, psychoanalysis, psychodynamic, psychology, psychotherapy, social media, therapy, TPS, video games

How To Get An Epic Supervisor

January 25, 2012 by langloimsw 6 Comments

Education shapes our expectations of life and work, and education as it stands currently always involves giving up some degree of personal power. When we’re in elementary school we need to ask permission to leave to use the bathroom. In high school we need to show up at times diametrically opposed to our circadian rhythms. At college we have required course to complete our degree. And in graduate programs for clinical psychotherapy we often have limited to no control over who our supervisor is going to be.

And then when we graduate, we take our cue from licensure boards to a large extent. Sadly, license requirements shape our expectations of supervision. We see it as something we have to have in order to get our license in X number of years. I have noticed that there is a sharp decline in people buying supervision after they get their independent licensure, which does not mean that there is a correlative decline in our people needing it.

So today I want to talk about how to pick a good supervisor for you to have ongoing clinical supervision. If you are still in pre-independent licensure this can be an especially daunting experience, but also an incredibly freeing one. To be clear, you don’t have to purchase private supervision from anyone you don’t want to work with! Read on for some tips:

1. You often get (or don’t get) what you pay for (or don’t pay for.)

If your agency offers you a good supervisory package for free that is great. One place I supervise at provides employees and interns with a free secondary supervisor. Secondary supervisors are the ones who can usually help you most with integrating theory and practice and discussing difficult cases. Most primary supervisors I know may have good skills and an interest in doing the same, but they don’t have the time. Their role has become reduced in the age of managed care to helping you learn the ropes about paperwork, facilitating your first emergency room or child protective referrals, and being held responsible for holding you responsible for productivity. So although these hours count towards your licensure they don’t necessarily deepen your practice for lack of time, not skill.

So now you have some choices. You can take a fellowship or position at an agency that provides secondary supervision, or you can buy it privately. Don’t get caught in thinking it is an entitlement, because those days are gone. Yes, we’re underpaid as a profession, but I suggest you think of good supervision as a benefit valued at between $7200-$9600. If Agency A offers that, but pays less $5,000 less than Agency B, which doesn’t, you are getting a better deal at Agency A.

2. You may already have met your supervisor, but don’t know it yet

If you are one of the many folks who decides to buy supervision privately, take some time to think about the people you’ve worked with already. Did you enjoyworking with your first year placement’s supervisor? Call and ask her if she offers private supervision. Did you love a certain course in grad school? Call and ask him if he does supervision. If they don’t, ask if there are any people they can suggest. Think back to guest lecturers, colleagues you enjoyed working with, that alum you met at an event.

3. Do your research

In this day and age, everyone should have a LinkedIn profile (more on that in a bit.) Mine includes several recommendations from past or present supervisees. Make sure you Google your potential supervisor prior to making an appointment. Yes, Ms. Jones may have her licensure, but if you are interested in providing LGBT-affirmative therapy and she works at the local conversion treatment center, wouldn’t you like to know that before wasting both of your time?

When you contact a potential supervisor, hopefully they will offer to provide you with a reference of another past or present supervisee. If they don’t, ask.

Some of the old guard psychodynamic folks may object, saying that that contaminates your supervisory experience. To which I say, there will be plenty of transference that comes up regardless, and that the focus of supervisors should be on practicing radical transparency, not generating a absolutely blank screen. Supervision often resonates with therapy, but it is NOT therapy. If a supervisor comes off as seeming like a Freudbot, this may indicate a difficulty shifting cognitive frame sets from supervisor to therapist.

4. Know what is important to you

You can learn something from everyone, I truly believe that. However, when I look for a supervisor, I look for someone who provides psychodynamic-oriented supervision. That’s what I do, what I like, and why I became a therapist. If you are a solution-focused or CBT practitioner, get someone who is expert and experienced in that.

If someone says they are “eclectic,” run away. Far far away. If they can’t describe some of the several areas of their interest or competence to you, chances are they are being either vague or seductive. Yes, I said seductive. Supervision is a business prospect, and many people focus on landing a new supervisee to the detriment of both of them.

5. Beware of freebies, private supervision starts with the fee

I’m going out on a limb here, but I strongly discourage freebies. My Contact page warns away the brainpickers. These are the people who want to get something for nothing, and say, can “I just pick your brain for a second?”

No, you may not.

There is a lot of free content I’ve put out there that people have access to, but this is also my work and I need to be paid for it. So if you have done your research, hopefully potential supervisors will have papers published, posts online, lectures, recommendations. If not, please see item 6.

I have strong opinions about this, because I think it shows potential supervisees how to have professional boundaries and value their work. If you are doing supervision to “give back” at a reduced fee, that’s fine, as long as you let the supervisee know that you are reducing your fee and let them know the full fee. But be honest with yourself about this, are you doing it to gratify your self-ideal of social justice, or because you secretly believe that you aren’t worth the full fee, or some other reason?

If you are a potential supervisee, consider this: Do you need someone to help you learn to be a more noble person, a better clinician, and/or a more savvy businessperson? Will having a reduced fee lower your expectations of yourself and the supervisor? And would you like to charge no higher than the reduced fee you are being offered?

If the answer to the last is no, be careful, because this may be a set-up for resentment on your supervisor’s part, and you may both suffer from unconscious false pretenses.

Speaking of fee, I walk this walk, and when I negotiated my fee with my supervisor I negotiated to pay more, because I knew that I would have a harder time later if I didn’t. We then had a great conversation about the limits of this, because obviously she gets to set her fee not I. But it caused her to re-evaluate and raise her fee somewhat, and modeled for me her integrity, flexibility, and willingness to listen and learn. And each time I raise my fee, I bring this up again, and each time the supervision is the richer for it.

6. If you want supervision around private practice, stay away from technophobes.

I strongly maintain that to have a practice in the 21st century you will need to have an online presence, some technological savvy and the willingness to learn about it to work with people from the 21st century. This is even more true in a private practice, where marketing is moving more online every day.

I once had a couple of sessions with a supervisor I was considering starting work with. This was a world reknowned clinician, whose work I respect immensely. In the time between our first and second appointment I included her on my newsletter. Our next appointment she expressed how “astonished” she was that I would contact her that way, and wondered if I was sabotaging the supervision. Fortunately I have been in many supervisions and have a strong ego. That was our last appointment.

I suppose I could have chosen to stay and explore this, but that seems more her issue than mine. I want to have a practice that focuses on Web 2.0 and psychodynamic therapy, i.e. integrating, not pathologizing them. And if those were her boundaries, fair enough. But I’m paying for a service, and I’ll take my business to my current supervisor, who is very professional, very grounded in psychodynamic theory, and subscribes to my newsletter, remarking on every issue.

7. Kick the tires

Having read this, you may be thinking, “I don’t agree,” or “that’s not what I want,” or “what a pill he is!” If so, that’s great! Because that means you have some idea what you are or aren’t looking for. Or you may be thinking, “right on!” One thing my supervisees can probably tell you is that what you read here and what you get in supervision with me are pretty much the same thing. And it seems to be working well for all concerned. You aren’t in grad school anymore, you get to pick and choose your supervisor.

It is okay to try out a few supervisors before deciding. Pay attention to those first few appointments, when you and your supervisor “relax” into the supervision a bit. Do you notice drastic changes from the first week(s)? Do you look forward to supervision, dread it, or find yourself not caring either way? Ask yourself, and your supervisor, how the supervision is starting off. If your supervisor does not bring up how to get the most value out of your supervision in the first few months, bring it up yourself.

If you are having mixed feelings about a supervisor, don’t be afraid to bring that up. But if you can’t bring it up, or choose not to, don’t feel obliged to stay. Supervision is a long, intense and valuable process. No less than your professional development is at stake. Choosing wisely begins with remembering that you have a choice.

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.

Filed Under: Gamer Therapy Tagged With: building your business, education, licensure, managed care, marketing, oliver twist, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, ROI, self-promotion, supervision, therapy, Web 2.0

The Uses of Disenchantment

January 12, 2012 by langloimsw 6 Comments

Magic fulfills the wish that we could have powers to be beyond who we sadly suspect we are. As children, magic explains the inexplicable nature of external forces (i.e. parents, teachers, death) and internal ones (unconscious drives, nameless attachments, inconsolable sorrows and consuming rages.)

Anyone who plays WoW, Elder Scrolls, or Dungeons & Dragons, knows that enchanted weapons and armor are valuable items to be gotten. They raise our stats, make us stronger, more intelligent agile, or resistant to harm. They fulfill the wish that we could be more than we are.

That being the case, the profession of Enchanting is a very valuable one to master. To do so is to be able to craft our own items for use or to sell. And to master the skill requires not only enchanting practice, but also the act of disenchantment.

Disenchantment is the breaking down of an enchanted item into its component reagents. In Skyrim this consists of taking the enchanted item and destroying it, which allows you to discover the enchantment. So, for example, if you come across an Iron Battleaxe of Scorching, you have a choice. You can enjoy your new battleaxe which will add fire damage to the physical damage you do using it. Or you can disenchant it, and learn how to imbue any weapon with the ability to do fire damage.

In World of Warcraft disenchanting items is necessary to provide you with the reagents, or raw materials, to do other enchantments. Learning the enchantment is done separately, by training or reading a recipe, but disenchantment is still necessary to break down enchanted items into components you can use for other enchantments. Enchantment operates in the domain of creation and destruction, attachment and loss. I can remember feeling many the hesitation as I was about to take an Epic staff I’d used for months and dissolve into Abyss Crystals. Even though I knew that I was going to get a new weapon with a strong enchantment out of it, disenchantment required sacrafice.

Many patients labor under the illusion that the purpose of therapy is to make you feel good. I have always maintained that that is not true. Therapy is not about making you feel good, but rather about learning how to not to feel good. It’s about learning how to experience and tolerate those unpleasant feelings in a different way than we’ve learned to previously. People abuse substances, food, sex, and yes, occasionally video games because they cannot tolerate feelings that don’t feel “good.” Who wants to feel inconsolable sorrow, thwarted passion, grief, terror, or hopelessness?

And so people come to us wanting symptom reduction, not character building; relief, not the raising of unmentionable wishes and fears to consciousness. At first, we often provide those other things to be sure. A compassionate ear to listen, a calming influence, a holding environment. But in the end, therapists are alchemists and enchanters: Nothing new can be created by our patients without something being destroyed. Something must be given up to create something else.

Consider this: Neurosis is like an enchanted armor that we can no longer use. Maybe we have outgrown it. Maybe it never really fit well but it was the best compromise we could come up with. Maybe it buffed up our strength stats when we really needed more intelligence to play our class effectively. For whatever reason, it is no longer helping us, in fact it has created distress.

Symptom reduction alone won’t solve this problem. It may alleviate our distress for the moment, relieve pain enough to create the “space” between feeling and behavior so that we can begin to do the longer-term work.

That’s where disenchantment comes in. We need to take the item, the neurotic conflict, and break it down into the components that create it. What is the wish and the worry? What causes the guilt? Just what are we so afraid of that we can’t look at it directly?

This doesn’t always have to be painful, and therapists shouldn’t use this as a justification for brutality. But to think that the process of therapy is not going to be uncomfortable and difficult; is not going to take some time and hard work is pretty much delusional. If our enchantments could have gotten us any farther we wouldn’t have given them up. Most addicts and alcoholics would have used longer if they could have. If they could have enjoyed one more binge, party or high, they would have.

Insurance companies love to focus on symptom reduction, and a narrow view of what evidence-based treatment really is. Symptoms are problems to be solved, rather than signposts pointing towards underlying issues. And although this is short-sighted, it is understandable: 10 sessions costs a lot less than weekly sessions. And yet, the most recent research I’ve read indicates that psychodynamic therapy is as effective as CBT and other therapies, and in fact more effective in sustaining longterm change.

Bruno Bettelheim, a psychoanalytic thinker, is perhaps best known for his book The Uses of Enchantment. In it he discusses how the themes of fairy tales often symbolize the real emotional and psychological struggles that children go through. Through the projections of stories, children are able to work through their fears in remote and tolerable ways. In a similar way, Klein speaks of the paranoid-schizoid position where the parent is split into good and bad objects, the fairy godmothers and evil witches of fairy tales.

Disenchantment, from a Kleinian lens, leads to the depressive position. It is where we hopefully get to, despite the depressing name, that point when we realize that people are not either all-good, or all-bad, but both good and bad, nurturing and depriving, gratifying and frustrating. In other words, human. The world seems less magical in some ways, and that is experienced as a loss. Sounds depressing, eh? So what is gained?

There is a practice in Tibetan Buddhism called tonglen. In this form of meditation, you begin by touching the tender spot of whatever is sorrowing or distressing to you. Say you’ve lost your loved one. Allow yourself to feel that grief for a moment, really feel it. What an awful wrenching feeling that is. You may reflect that nobody should have to feel what you’re feeling right now. And yet, all over the world, there are those who have felt that, may be feeling it even as you are right now. So you breathe in, and imagine breathing in all of that grief as if for that moment you could take it into your heart so that nobody else would have to feel it. And then you imagine yourself breathing out comfort and security and everything that is the opposite of grief and suffering to the world and to all those in it who need it. You reverse the cycle of trying to avoid pain and grasp pleasure, and in doing so generate compassion.

That is the use of disenchantment; breaking down our fantasies that we can avoid pain and transmuting it into compassion for others. Imagine if you were to really accept that everyone is human and fallible and mortal. If you were able to walk around tomorrow and remain conscious that everyone you meet is dying, would you treat them in the same way as you did today?

Interested in working with me online or in person? Check out the Gamer Therapy and Work With Me Pages!

And if you want to learn more about gaming and psychotherapy, you can always buy my book…

Filed Under: Gamer Therapy Tagged With: addiction, bettelheim, buddhism, children, disenchantment, enchantment, gamers, gaming, klein, managed care, psychoanalysis, psychodynamic, psychology, psychotherapy, Skyrim, therapy, tonglen, World of Warcraft

If Freud Had Played Video Games

December 12, 2011 by langloimsw 20 Comments

This post is dedicated to my supervisee, Alex Kamin, who inspired me to make the connections. I learn so much from my supervisees!

Last night I spent a great deal of time mining for diamonds. They are fairly rare, and can only be mined if you have an iron pickaxe (or a diamond one). This meant that I needed to mine iron ore first with a stone pickaxe, but I should start at the beginning.

Minecraft is a game which now rivals WoW in popularity. It has been around in beta for a while, but now has been released to the general public. The game takes place in what is known as a sandbox world. What that means is that the game world can be effected permanently by the player. Dig a hole and it stays dug, chop a tree down and it stays chopped, plant new ones and in time they grow. As opposed to having a beginning, middle and end, Minecraft can be played for as long as you like. You can play it in single-player mode or log on to a minecraft server and participate in a multiplayer world.

Starting with nothing but her or his bare hands, your character takes materials from the environment and fashions tools, houses, works of art out of these raw materials. That is the crafting part. Once you have fashioned the most basic pickaxe, out of wood, you start to do the mining part. Which brings me back to diamonds.

Diamonds are very rare blocks in Minecraft, and are mostly found at the bottom layer of the world. You have to tunnel through loads of dirt blocks, stone blocks, and gravel blocks. Sometimes you tunnel straight into lava and get burned up. Sometimes the ground beneath you turns out to be a giant chasm and you plummet. Sometimes there is water that floods your tunnel, or monsters if you are looking in one of the world’s many caves.

A lot of time is spent underground, but a big part of the game is to bring the materials back up to the surface. There you make your crafting table, house, and forge. Days and nights pass. At night the monsters from the caves come out and roam the surface, and you’d better be in your house with the doors shut!

This is a very brief synopsis of an amazing virtual world that is already being used in classrooms and by families to provide cooperative and fun learning. You can find one such example, The Massively Minecraft Network, here.

One group who could benefit from understanding and playing Minecraft is psychodynamic psychotherapists, especially psychoanalytically-oriented ones.

For decades, psychology textbooks have used the iceberg to explain Freud’s early topographical model of the mind. It’s the one I grew up as a therapist with, and you probably did too. One version is this one:

Photo found on Allpsych.com

The topographical model introduces the concepts of the conscious, the preconscious, and the unconscious. Freud was ultimately dissatisfied with this model, and moved on to his structural theoretical model of Id, Ego and Superego. I wonder if he would have done so if he’d been able to play Minecraft.

Two of the deficits of the topographical model as pictured by an iceberg are its static nature and its failure to locate where and how psychotherapy works. The second deficit derives from the first. Psychodynamic therapy is as the name suggests, a moving process. Now imagine playing the game I described above, and you have a dynamic model. There is the conscious surface that changes over time, is constantly changing and growing, where things are visible. There are the caverns and depths which are the unconscious. And there is the preconscious twilight and night, when the monsters and creatures from the unconscious slip up to the surface and terrify us.

In terms of describing psychodynamic therapy, Minecraft makes that easy too. I have often had a difficult time explaining to a patient what the unconscious is and why I think it is important. But any gamer who has played Minecraft will understand the process of therapy and their work in it in the metaphors of mining. During the week, our patients roam the surface of their psychosocial world. Then one, two, or three times a week, they come into therapy and begin tunneling. Week after week they mine dirt, stone, and occasionally strike a vein of insight. Like iron ore, insight is a necessary but insufficient requirement for change. Without smelting and crafting, iron ore can never become a tool we can use. Likewise, without reflecting on our behaviors and changing them we can never improve our ego functions.

You can explain ego functioning via Minecraft as well, by discussing those above tools. Tools in Minecraft include shovels, pickaxes, hatchets, swords, wool shears and hoes. A hoe is excellent to use in gardening, whereas a sword will not function in the game that way. You can chop down a tree with a pickaxe but it takes longer and wears down the pickaxe more quickly than if you were to use a hatchet. Different ego functions do different things, and the ego defenses are only one subset of the ego functions. Only one of the tools is explicitly made to be a weapon.

And if you lead with your ego defenses all the time you will be disappointed. Take sheep for example. If you kill a sheep with a sword you get one block of wool. But if you shear it with the iron shears you get three wools, and the sheep lives to grow more wool. By the way, if you craft a hoe you can grow wheat, which allows you to domesticate and breed sheep for even more wool. Just so our ego functions, which provide a holistic and dynamic system that allows us to mediate the world and our wishes.

When you start mining you have a wooden pickaxe. You mine stone so you can get a stone pickaxe. You mine iron ore with the stone one. Only iron pickaxes can mine diamonds.

Psychotherapy takes time and effort, lots of time and effort, if you are aiming for more than symptom reduction. Patients begin with the raw tools they started out with, and build on each developmental gain. Often our patients will feel very raw and discouraged, state that they despair of ever getting better, whatever better means to them. When that happens we can remind them that therapy is minecraft. It takes delving and work back on the surface in the real world outside the office. It takes time and patience. Sometimes they will feel consumed by feelings as hot as lava, or flooded by memories like water in a mineshaft. Sometimes it will feel like they’ve lost everything they’ve been carrying and have to start over. But with each set of tools they acquire they’ll find it easier to make their way in the world.

And sometimes they will find diamonds.

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

Filed Under: Gamer Therapy Tagged With: ego psychology, Freud, gamers, gaming, minecraft, psychoanalysis, psychodynamic, psychology, psychotherapy, therapy, video games

Ethics & Technology: A Mild Rant

October 27, 2011 by langloimsw 7 Comments

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

Filed Under: Gamer Therapy Tagged With: CEU, education, ethics, HIPAA, private practice, psychodynamic, social media, therapy, video games, Web 2.0

A Moment of Light in Dark Souls

October 23, 2011 by langloimsw 3 Comments

For centuries the general thinking was that the world was flat, but by late antiquity the world was commonly accepted as being spherical. Although it is a myth that Christopher Columbus proved that the world was round, it was much easier for seafaring cultures to conceptualize the earth as round, because they were able to measure and base their perceptions on additional observational evidence. And so it was for the next 1800 years or so we labored under this second delusion.

Two weeks ago the English version of the video game Dark Souls came out. I was one of the nearly 280,000 people who bought it the first week, and it has been growing in popularity ever since. The game is in many ways a traditional “dungeon crawl,” with the emphasis on the “crawl.” Your character dies in Dark Souls, a lot! The game is billed as “Probably the Second-Hardest Game You’ve Ever Played,” by Matt Peckham of PC World. I can attest to that.

The world of Dark Souls is one where the Flame that lights the world has almost vanished, and the player awakens to find themself as Hollow, or undead, in an asylum for the undead in the north of the world. Over the course of the game’s beginning, you fight your way through other groups of other undead, dragons, and demons in a quest that presumably has something to do with restoring the light and warmth to the world. I say presumably because the game offers few instructions, and emphasizes the experience of “throwness” in the game world.

You can save your progress at bonfires, and use the soul and humanity fragments you win from killing creatures to level up and restore yourself to a human being. However, each time you do that, the dungeon resets, and every single creature you killed returns to life, and I swear they learn from their experience of fighting with you. The game is not an MMO in a traditional sense, but you are connected to other players in some interesting ways. You can see their last moments of a fatal battle as their specters dance through your game, and if you are human, you can summon the spirit form of another random player into your world to help you fight.

This is a story about that. (Although all identities and locations are heavily disguised to protect privacy.)

I had been trapped in the Undead Burg for about a week. My pyromancer had been slowly leveling up but was very weak. I had a wooden shield and battered axe that I had scavenged off of one of the fallen undead. I had lit a second bonfire and managed to learn how to dodge the firebombs thrown by zombies as I tried to make my way to the Taurus Demon. But usually I ran out of life and health flasks before I got to him, and when I did he one-shotted me, and seemed little more than irritated by my chops or fireballs. What’s worse, there was this horrible Black Knight that kept ganking (slaughtering) me halfway there. I knew the Knight was guarding some nice treasure, but I could only get him down to half-health before I would be sent back to my bonfire, stripped of all the soul points I had accrued. My axe was getting battered, and was probably going to break at at any time.

I looted a scrap of humanity from a undead, and ran back to my bonfire. I offered it up to restore my human form, and when I did I noticed for the first time some glowing white runes written on the floor. I later discovered that these are summoning runes, which can only be seen when you are fully human. I clicked on the runes, and a few seconds later a warrior bathed in golden light appeared. Chibi was his name, and he was one of those transparent spirits summoned from another game somewhere to help me. We couldn’t speak or chat with each other, but he signaled his friendly intentions by hopping up and down and I by running around in circles.

Chibi was level 53, and I was level 8, so I followed him as he tore through groups of undead that had taken me hours to get a handle on. I was excited and emboldened by his prowess, but I still felt uneasy when I saw that he was actually making towards the Taurus Demon. As we ran by the tunnel that the Black Knight hides in, I had an idea. I stopped, and after a few minutes Chibi turned around and came back. I ran to the tunnel mouth and began hopping up and down vigorously. Chibi ran down the tunnel past me, and began attacking the Black Knight, while I hung back and hurled fireballs. Within a minute the Knight was down, and I looted a magic ring, and then with surprise the Black Knight’s Sword! Compared to my axe which did 40 points of damage, the magic sword did 200!

We continued on to the Taurus Demon, but since I wasn’t skilled enough yet to equip the new sword, the demon took a lot of damage from Chibi and then at about 25% health killed me again. This sent me back to my bonfire, and Chibi back to his own game. But I had a new sword to inspire me, and I was about to set out to level myself up to use it when my PS3 blinked that I had a message from Chibi. I hadn’t realized people could send each messages, and when I clicked on it I read, “Sorry. I killed it right after you died.” I wrote a message back saying, “No worries, killing that Black Knight was a great help.” I added Chibi as a friend on the network, and then realized I could open a chat window with him. We spent the next half hour chatting.

Chibi’s real name was Taylor, and he was an iron worker in Montana. Taylor was 36, and had just got a promotion at his factory which he was very proud of. He worked 12 hour shifts and came home and gamed. He did not tend to go out of the house other than that. Taylor lived by himself, and had moved from to Montana from Pittsburgh 4 years ago, when his girlfriend and their unborn child had been killed in a car crash. He had not talked for three of those years.

Taylor credited therapy with helping him recover from a depression that nearly took his life, and a grief I could not imagine. Although he did not credit playing video games as helping him, I asked him if he thought they might have. He said he didn’t know, he really couldn’t remember those years of his life. Rather he remembered them the way trauma survivors often remember things, as memories of facts with shards of feelings sticking out of them. He didn’t want to burden me with doing “work” and I told him not to worry about it. He asked me about my life and family, and was very open and accepting of my story which was very different than his.

By now it was midnight in Massachusetts, and although it was earlier in Montana, he had a morning shift at his factory. We logged off and I went to bed.

In the days that have followed I have leveled up my pyromancer to 25. I can handle the Black Knight’s Sword and sliced through that Taurus Demon and a Red Dragon to boot. I have moved from the Undead Burg to the Undead Parish, discovered bonfires and short-cuts, and somewhere along the line I have learned how to play Dark Souls. I occasional see the anonymous flickers of other players flash through my game, nameless imprints of their last battle in some game somewhere in the U.S., Japan, or the world. I have seen Taylor come online from time to time, and although I haven’t sent him a message I have no doubt that I will at some point.

As I talked with Taylor I imagined how my colleagues often thought about gamers. I wondered if they would have focussed on how many hours he played video games and his isolation rather than his resilience, helpfulness and initiative in Dark Souls. Would they focus on our focus on violent games or sword size? Or would they note the themes of repetition compulsion, our attempts at mastery, our playing out the endless cycles of life, death and rebirth?

The world is not round, it is hollow and full. It is not the one world we think we perceive, but hundred of overlapping worlds, layer upon layer of human struggles and stories, connected by time and feeling and, yes, technology. There is a world where therapists from New England live, where iron workers go to work in Montana every day and look forward, not back. There is a world where pyromancers run through abandoned cities and struggle to release a fire that will warm the world, where warriors grow stronger over time and adversity. And every once in a while, if you have an open mind and heart, light from one of these worlds bursts through, and warms the other.

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

Filed Under: Gamer Therapy Tagged With: dark souls, gamers, gaming, play, psychoanalysis, psychodynamic, psychology, psychotherapy, therapy, video games, Web 2.0

A Follow Up to Dings & Grats

October 18, 2011 by langloimsw 12 Comments

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.”

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

Filed Under: Gamer Therapy Tagged With: activism, adolescents, gamers, gaming, LGBT, private practice, psychoanalysis, psychotherapy, social justice, social media, therapy, Web 2.0, World of Warcraft

Technology, Video Games & Class

August 6, 2011 by langloimsw 5 Comments

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.

Filed Under: Gamer Therapy Tagged With: adolescents, aristotle, class, gamer, gaming, philosophy, play, social justice, social media, socrates, technology, therapy, video games, Web 2.0, World of Warcraft

What Google+ Could Mean For Therapy

July 25, 2011 by langloimsw 14 Comments

Every technology reveals the hand that shaped it. The technology of the 21st Century is no exception: Social Media has proliferated because human beings are inherently social creatures, even when that sociability takes on different forms. And the explosion of access to information was detonated by our own curiosity.

For better or for worse (usually worse) our ability to engineer and zeal to use technology usually outstrips our ability to behave well with it, and in a large part I believe that this is what spurs on our refinement of it. Listservs are a great example: They allowed amazing access to online community through emails and postings, and they elevated the concept of “flame war” in comments to a new level. Eventually, email and bulletin boards were insufficient to allow us to be sociable, and Web 2.0, with its emphasis on interactivity and real-time community was born.

And then Facebook, MySpace, Friendster and other social network platforms quickly outstripped the listserv and bulletin board. The emphasis became on finding and connecting with old friends, acquiring new ones, and maintaining a steady if sometimes awkward flow of real-time announcements, status updates and feedback to them. The online world expanded exponentially, and in fact that interactivity and information became overwhleming.

Which brings us to Google+.

For those of you who have not had the pleasure, Google+ is a new social networking platform (and in many ways much more than that) which has brought a new level of functionality to online social media. Although it is still in beta, the number of people participating in the largest usability test in the history of the world is growing by leaps and bounds. If your patients have not mentioned it, it is only a matter of time before they do, and that alone should be a good reason to learn to use it. But in fact, Google+ has already begun to show me how valuable it may be in actual treatment.

So today I want to introduce you to two of the core concepts of Google+, Streams and Circles, and show you how each of these may present you and your patients with an arena to talk about psychological concerns and skills in therapy.

Circles

The Google+ system of circles is as powerful as it is flexible. Whereas on Facebook you really had only one big group of people called your Friends, Google allows you to create and label various circles, such as “Friends,” “Colleagues,” and “Family.”

The interface let’s you drag the name and image of different people located on the top to one or more of the circles below. When you mouse over the circle it expands to give you an idea of who you have put in it. And if you drag a person to the grey and white circle on the far left, you can create a new circle, one which you label yourself. For example, I have a circle for “Minions.” I’ve always wanted minions.

This graphic representation of the way we can and often do categorize people in our life may allow our patients to visualize the decisions and boundaries they struggle with in real life. This can be especially useful with patients on the autistic spectrum. We can begin by empathizing with them when we upload our 1000 email contacts, and discover that we now have an overwhelming 1,000 individuals to make sense of. Who goes where? Is everyone a friend? Can we put people in more than one circle? Decide to take them out of one and into another, like say out of “acquaintance” and into “friend”? What sort of circles might we want to create that Google+ didn’t give us?

People with Aspergers often have exceptional spatial reasoning, and can find mapping out relationships very helpful. Now they have a dynamic way to do this, and a visual representation of how unruly and confusing social relationships can be. Even though we can use this only as a powerful metaphor and coneptual tool, we could go even further. Inviting a patient to bring in their laptop and taking a look at Google+ could be a helpful intervention. We could help them explore and decide how to set up their own personal boundaries and affectional investment.

Or imagine for a second you are working on emotional regulation issues with a patient. You can encourage them to create circles like “love them,” “Push my buttons,” “scary,” “feel sad,” and help them take a snapshot of their life at any given time to see who they want to put in each circle. Do some people go in more than one circle of affect? Do they notice that they are taking people in and out of circles frequently, or never?

Or imagine working with social phobia, and trying to help the patient brainstorm what activities they might want to try to invite someone to. They can create circles like “Go to movies,” “Have dinner,” “Learn more about them,” and other options for various levels and types of engagement, and then they can sort people into those. And all of a sudden they also have a visual list of who they can call when they are trying to socialize.

Last example, working with trauma and/or substance abuse. Circles can be created for “Triggers me,” “Can call when I want a drink,” “My supports,” “self-care partners,” etc. Then populate each with the people in their life, so they have a ready-made resource for when they are in crisis. It also can be very illuminating to share and explore this in therapy, allowing you to make comments like, “what do you make of the fact that most of the people in your family circle are also in your triggers one, but not in the support one? What do you think you could do about that?”

So these are just a few quick examples of how you can use the Circle concept of Google+ to understand your patients better, help them understand themselves better, and use social media to intervene in a variety of situations.

Streams

In Google+ circles go hand in hand with your Stream or Streams. A stream is a stream of comments, updates, links to information, invitations, photos, video and other media, posted by people in your circles. It is probably important to note here that similar to Twitter, you can invite people into your circle without their permission, but that doesn’t mean they will invite you back. And you can set each circle to have different levels of access to your posts. In other words, circles and streams together allow you to learn and set boundaries. Here’s what a Stream can look like:

This is only the fraction of the incoming Stream, which gives you a sense of how multimedia, interactive, and possibly uninteresting some of it could be sometimes. Much like Twitter, or like life. If we had to pay attention to everyone all the time in the same way, we would become very fatigued. Like our patients with ADHD, we would be overwhelmed despite our best attempts to understand at times. Again, we can use this technology that our patients may be familiar with to begin to deepen our empathic attunement with them. But it gets even more interesting.

If you look at the upper left-hand corner under Stream, you will see a list of your circles, in this case family, friends, acquaintances, etc. Now if you click on any of those circles, the Stream changes. Specifically, it changes to list only the posts from the people in any given circle clicked. This synergy between circles and streams highlights not only the importance of privacy, but that focussing our attention is inherently a social as well as cognitive function.

Imagine working with an adolescent and reviewing their streams together. What sorts of media, comments, and concerns are streaming through their lives at any given moment? And what is the consequence of having 500 “friends” in their friend circle? Do they feel intimate or able to attend to all of these friends? Or are there some times that they may be more interested in attending to some friends than others? If so, why? Might it be time to start to rethink what it means to be a friend? Is it ok to select who they attend to at certain times? Do they really find the content they get from A interesting? And if it is consistently uninteresting, does that say anything about their relationship? Sorting through Streams to make sense of their world quickly becomes a talk about sorting through their values and their relationships.

For a second example, let’s return to the patient with ADHD. Perhaps they could create circles for “School,” “Fun,” “Work,” “Family,” and sort people that way. That way when they are doing work for school they can focus only on the Stream for the School Circle, which may contain links to papers, classmate comments, or lecture recordings from their professor. If that stream starts to have too many other types of posts, maybe that is an indicator that someone is in the wrong circle, or that they need to only be in the “Fun” one until that paper is done. Remember the circles are easily adjusted back and forth, so this is neither difficult or permanent to do. But these types of decisions and focussing techniques may be crucial to staying on task. (For those of you who might be ready to suggest that they not need to follow any Streams when they are studying, I encourage you to take a look with them at how much academic content and collaborative learning is done online before you rush to judgment. It’s not always just “playing on the computer” now.)

Other ways that you can use Streams to help your patients therapeutically may come to mind if you reflect on the names of their circles. Do they really want to follow the Stream of posts from their “Pushes My Buttons Circle?” Maybe they’d rather tune into a steady Stream from their “Supports” circle instead? And what might happen if they created a circle for “Intimates” that only contained people that touched them in deeply meaningful ways? Could they still enjoy their “Friends” Stream, but switch to a “Skeleton Crew” one when they are needing to simplify their social life?

We make these decisions all the time, we just aren’t always conscious or overt about it. And if we don’t make those decisions, we often suffer for it by overextending or stressing ourselves. We need to have boundaries and filters. We need to be able to focus and set limits and values. These needs have begun to be more clearly revealed by the technology of Google+. Knowing about that technology may improve our ability to treat our patients.

Filed Under: Business Tagged With: addiction, adolescents, behavior change, building your business, Google+, mindfulness, private practice, psychoanalysis, psychodynamic, psychology, psychotherapy, stress, therapy, Web 2.0

Being A Noob

June 11, 2011 by langloimsw 1 Comment

Over the past few months I have taken some time off from playing World of Warcraft to try a new MMO called Rift. Rift takes place in a different world from WoW, the world of Telara. It has a different storyline and although the user interface is pretty much a duplicate of WoW’s, there are many many other differences as well. I have been playing WoW for several years, and had progressed my character to level 85, the highest you can get as of now. In those several years I have been a member of three guilds, leveled 6 professions, and spent countless hours researching the internet on strategies, spell rotations, and boss strategies. I’ve traveled the length and breadth of Azeroth and Outland, and completed hundreds of quests and achievements.

And now I’m a noob again.

In Telara I’m just out of the training zone, and level 13. I have no idea where I am, and most of the map is still an undiscovered blank screen. I don’t have more then 20 points in any profession and I’m not in a guild. I’m reading new material and trying to figure out what sort of place Telara is, why the sky is constantly ripping apart as rifts from some other dimension open up and rain down monsters on me and any other players in the area at the time. I keep running the wrong way into mobs of villains many levels higher than me and dying. Lots and lots of dying. And lots and lots of running back from graveyards as a ghost trying to find my body.

Good times.

For those of you who don’t know this, being a “noob” is a term for being a newbie, a newcomer unfamiliar with game mechanics and the lay of the land. It can be a very frustrating experience. The first time I was a noob, in WoW, I had no idea how much I was learning as I was learning it. There was such a steady progression that I didn’t realize how much experience and skill I had amassed with the game until I switched over to a new game. Now it is like I have lost all of that experience and skill, and I can feel overwhelmed. I am nowhere near Rift’s “endgame,” and everything is new and weird. So why not just go back to playing WoW?

First off, I have a little faith. As I stumble through being a noob in Rift, I can remember feeling similarly clueless at the beginning of my time playing WoW. I know that I am learning a great deal, more than I can even tell, and that this sense of being overwhelmed will pass. Also, I am enjoying the heightened sense of discovery, stumbling into the city of Meridian for the first time, having chats with other noobs as we form public groups and down elites.

The last time I was on, my mage was teamed with a warlock and a warrior, and we took on an elite without a healer. We gave it all we got, and then the warrior was down and the warlock was getting attacked. As the warlock fell, and the boss approached me with only 5% of its health left I kept spamming shadow bolts at it until it got to me. Just as it killed me I set off one more bolt that killed it. We closed the Rift, resurrected ourselves, collected the loot, and I felt the same level of thrill and achievement as when I first started playing WoW.

Every gamer was once a noob. Every gamer you see in your therapy practice was once thrown into a strange unfamiliar world knowing no one, with only the clothes on her or his back and a few silver in their satchel. Those men and women in your office who have been deemed failures at school or work by parents or coworkers has tried and failed and tried again hundreds of times. They have wandered around lost in a dangerous world knowing no one, and struck up conversations with other wanderers. They’ve banded together with others to defeat powerful adversaries, worked diligently to perfect professions and skills, and you’ve known nothing about it, because you didn’t ask. Instead therapists often focus on how many hours a person plays, pathologizes gaming as an addiction, or dismisses it as a silly hobby with no clinical or real-life value.

(How many of us approach our patients’ dreams that way? How many of us ask, “how many hours a night do you dream?” or consider them to have a dreaming addiction? When was the last time you dismissed dreaming as a valueless, silly hobby.)

Being a noob takes courage, and stamina. We therapists know this deep down. Most of us gravitated to our profession because we wanted to help the vulnerable, the bewildered and the confused grow into the strong, wise and whole people our patients become. We help them map out their inner world, strengthen their coping skills through trial and error and retrial. We encourage them as they level their professions at work or school, build guilds of peers and loved ones to raid life with, and face whatever monsters they have to to heal from trauma. Let’s recognize the game mechanics in what we do, and learn from the game mechanics in what they do.

Last but not least, let’s talk business.

In the 21st century, many therapists are seeing a game change in our profession. The way we practice therapy and help our patients is changing in many ways. We can use Google to help them find the closest AA meeting, Skype with them when they are away on business in Hong Kong, email them DBT worksheets or set up mindfulness reminders for our groups on Twitter. Even if we avoid using these technologies with our patients, they are trying to talk to us about bullying via Facebook, sexting on their iPhones, or falling in love in Second Life or World of Warcraft. In the 21st century, technology is no longer negotiable, it is embedded in virtually all treatment issues one way or another. And so therapists are noobs once more. This doesn’t mean that we can’t still practice psychotherapy the way we always have. But do you think that that should be our prime goal, to do things the way we always have?

When I first advertised on Google, I paid .10 a click. Nowadays colleagues in my area are paying upwards of 6$ a click to be visible. Having a Google ad or website is now pretty common. Between changes in social media and healthcare, many of my colleagues and the therapists I consult with are finding that the game has changed again, and they feel frustrated and bewildered like they haven’t in years. They’ve become noobs again.

Being a noob isn’t bad, although it can be uncomfortable. But what I’ve learned from fellow gamers is that being a noob can be fun as well. The key is to keep your sense of humor, and not take having to learn new things as an insult. I sometimes hear colleagues express outrage at having to do things differently to grow their business, and heaven forbid they spend money on coaching or business planning or consulting with someone who has more expertise than they do! The subtext is “How dare I be treated this way?!”

Change isn’t meant to single out and insult you, lighten up. Of course you should be learning new things, and leveling up. Have a little faith that you are learning even though it feels clumsy. We keep trying to get to this “secure” place where we’ll never need to stretch or do something different, and it just doesn’t exist. We need to cultivate what my colleague Chris Willard refers to in his book of the same title as our “Child’s Mind.”

In other words, we need to embrace being a noob.

Filed Under: Gamer Therapy Tagged With: building your business, chris willard, gamers, gaming, marketing, noob, private practice, psychotherapy, rift, therapy, video games, Web 2.0, World of Warcraft, wow

Exploring the Mystery of Suicide: Video Book Review of “In Her Wake.”

June 4, 2011 by langloimsw Leave a Comment

Filed Under: Gamer Therapy Tagged With: adolescents, health, In Her Wake, Nancy rappaport, politics, psychology, psychotherapy, suicide, therapy

Save and Continue

April 15, 2011 by langloimsw 6 Comments

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 boston.com 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.

Filed Under: Gamer Therapy Tagged With: adolescents, building your business, chris brogan, Freud, gamers, god of war 3, psychoanalysis, psychology, psychotherapy, referrals, susan giurleo, therapy, video games, Web 2.0

(Un)Desperate Times, or Know Your Talent Trees

February 16, 2011 by langloimsw 12 Comments

Recently I was given a referral for an evaluation, and upon some reflection I declined it. This is not something I am often in the habit of doing, but in this case the evaluation would have involved a clinical situation that did not fit with my integrity. So it got me thinking about the relationship between building your business and professional integrity.

The referral would definitely have been lucrative, and within my scope of experience and skill. And most of us these days certainly cannot afford to turn away business.

Or can we?

If I had taken this evaluation on, I would have most likely have been called on to testify about something that I was not entirely behind. This would have compromised my ability to be an expert witness. As I weighed the pros and cons I was quickly aware of my feeling of “halfheartedness” about the whole thing. And that was what clinched it for me. No patient deserves anything less than a wholehearted therapist as far as I am concerned. And I believe that when we catch ourselves trying to make something “fit” with our practice, we should probably stop right there.

Most of us were trained in clinics or hospital settings where we did not choose our patients. We were there to help everyone, and the idea of a good clinical fit was something we were usually reluctant to give voice to. Social workers in particular are often encouraged to be little mental health Statues of Liberty, treating any of the huddled masses that get sent our way. But no one of us is supposed to treat everyone in my opinion. And believe it or not, there are therapists who want to work with every segment of the population. I have met therapists who love working with borderline personality disorder. Others feel invigorated by working with substance abusers. There are people who really enjoy working with schizophrenia, like me. So in the long run, I think it is important to notice who you like working with, especially if you want to be in private practice.

Being clear on this is hard enough when we are starting or growing our practice. Turning down a referral can be terrifying and guilt-inducing. Somebody needs our help, we need to earn money, and we’re going to decline a referral? Sometimes, yes. Sometimes we need to hold a space open in our practice for a bit. And always the patient deserves a therapist who is 100% committed to the therapeutic relationship. So if we are lucky and have a good coach or supervisor we brave our fears and hold open the space for a while.

But later on in the development of a private practice, you may encounter a slightly different issue, what can be called an “embarrassment of riches.” The phone starts ringing with calls from potential patients, requests for court or special education evaluations, or maybe your old employer wants you to come back and do a workshop for your old agency. It can be tempting to overextend yourself, but I would suggest the following when this happens: Don’t just do something, sit there. Give yourself time to evaluate whether this opportunity is the best opportunity for you after the initial shine or honor of being asked has worn off a little. Because only you know your business plan, and which of the opportunities presenting themselves to you is the best one for furthering your practice.

The picture at the beginning of the blog is what World of Warcraft veterans will recognize as a talent tree. Each character class has three talent trees they can choose from to put their talent points into. The more talents points you put into one tree, the more access you have to higher powers and abilities of a certain kind. At the same time, since you have a finite amount of talent points, putting talent points deep into one tree makes it impossible to put them deep into another. So for example, if I am a mage, I can choose to put my talents in Fire, Frost, or Arcane trees. If I put most of them in fire, I won’t be as powerful when I need to use frost spells.

Sometimes newbie gamers decide to spread their talents across all three trees. They divide up the points and suddenly notice that they are at a high level but aren’t doing that well in the game. At some point someone will notice their talent trees are a mess, and explain to them the importance of specifying their talents. Sometimes therapists do the same thing: We try to be everything to everyone and learn to do a little of this and a little of that. This is often where the diabolical word “eclectic” comes up. We’re not frost mages OR fire mages, instead we’re hurling bolts of lukewarm water, and who needs that really?

If you have been building your practice for a while, you have probably noticed that your phone is starting to ring more, or your website is getting more hits, and this can be so exciting and intoxicating you’ll lose sight of your business plan. This week I had a day like that, where I got 2 referrals for psychotherapy, an extended evaluation, and invited to teach 2 classes! You bet that feels good (and overwhelming!)

But I needed to spend my talent points wisely. If I load up on patients, I won’t have time to do my writing or workshops and ultimately develop passive revenue streams. What’s worse, the patients will get an overworked overtired therapist who is not wholehearted. If I teach two classes, I won’t have enough time to do something else, and if I take on an eval that has me interviewing, writing and expert witnessing, same thing. Time to refer back to my Tweaking 2011 plan. So everything went on hold for a day (remember, we’re running a private practice, not an ER: If something seems so emergent that it can’t wait a day, it may not be something to take on) and I ended up declining half of the embarrassment of riches, offered alternate referrals, and hopefully everyone will be the better for it.

Have you started to specify your talents yet? Have you chosen the talent tree you’ll put the majority of your points in? The secondary one that enhances the first? Does what type of work you accept clearly map to the business plan you’ve made for yourself? I’ve written before about being an Epic Therapist and this is one of the qualities that makes a therapist Epic: Epic therapists specify and hone their talents in one main area. And because they do that they can explain what kind of therapist they are at parties. And they can do solid work and reading in their area so the patient gets excellence. Excellence is what will keep your business afloat in the coming years, so spend your time and talents wisely!

Filed Under: Gamer Therapy Tagged With: building your business, gamers, gaming, private practice, psychotherapy, referrals, talent tree, therapy, Web 2.0, World of Warcraft

What Do Gamers & Social Workers Have In Common?

January 22, 2011 by langloimsw 16 Comments

The Dutch cultural theorist and early scholar of ludic studies Johan Huizinga took play very seriously. Gamers and Social Workers alike would have loved Johan–he spoke out against Nazism and German influence on Dutch Science in 1942 at a lecture he gave. This was not the first time he had done so. As early as 1935 he had grown alarmed at the rise of fascism and written, “We live in a demened world, and we know it.” By 1942, his speaking truth to power had finally gone too far in Nazi estimations, and he was imprisoned, then detained, by the Nazis in the village of De Steeg. He died there 3 years later.

It was during these final years of his life that he refined and wrote his book, Homo Ludens, which translates to “Man the Player.” In this book he explored the serious nature of play as a cultural phenomenon present in art, war, and politics.

Huizinga determined that play has 5 essential elements, to which I add examples as appropriate to gaming and/or social work:

Play is free, is in fact freedom. When we are playing, we are not doing it for any other reason than that we want to. Play to be play must be a voluntary activity that we initiate or accept the invitation to enter into ourselves. In that regard you could say that play is always an assertion of the self, and free will. We gamers choose to spend our time gaming, choose one game over the other. This is why gaming as play does not adhere to the slavish concept of addiction.
Play is not “ordinary” or “real” life. What makes play so much fun, and so important is specifically that is isn’t bounded by the realities of daily living. It is pretend, and extraordinary, and it allows us to escape real life. But this is exactly why gamers and other people who play aren’t psychotic. We may talk about the games we play to lengths that bore or disturb others, but we know that games are apart from real life. That’s what makes them fun! I may hurl arcane energy at a dragon in WoW, but I am aware (albeit sadly at times) that if I ever encounter a dragon in real life I will not be able to summon magic at my whim to destroy it. And that is why Second Life is not called First Life. For play to be play, we have to know we are taking ourselves out of the real world to participate in something else.
Play is distinct from “ordinary” life both as to locality and duration. When I get ready to play WoW, I sit down or stand at my computer; but when I play I am in Azeroth. Whether it is chess, poker or a video game, the play experience takes place in another time and space, and it has a beginning and an end. Even MMORPGs, which push the last quality in some ways, have an end for individual players, when we cease participating in the game world for the time being and resume the activities of daily living that await us in the real world.
Play creates order, is order. Play demands order absolute and supreme. By this Huizinga meant that for play to work it needs to have rules as well as time and space boundaries. We all know how to play Hide and Seek, the next time you play it try being the “Seeker” and go hide along with everyone else; or come out of hiding and start chasing the Seeker. Bizarre and funny, but the game won’t be Hide and Seek anymore–Tag, maybe, but then we’ll know that something has fundamentally changed. And in World of Warcraft everyone needs the same amount of experience points to get to level 80, and we expect the griffin flight paths to always stop in the same places. Wizards will never wear plate mail and hunters can’t teleport. That’s just the way things are, that’s the order of things.
Play is connected with no material interest, and no profit can be gained from it. Ask any gold farmer around the world, and they will tell you that there is a big difference between playing WoW and logging in to the game to make and then sell money. Gold selling can’t even happen entirely in-game, and Blizzard bans it for good reason. It’s cheating, not serious play. The loot items that I “get” in the game aren’t things I can profit from in the real world. I can’t take my Corp’rethar Ceremonial Crown with me when I leave the game, which is why I would be so useless if a dragon shows up in Harvard Square. And although Second Life has a different approach, allowing you to buy in-world “Lindens” for real-world monies, I’d suggest that the act of buying the Lindens occurs outside the play experience: Sigmund Steampunk isn’t buying Lindens, Mike is buying Lindens “out here” and sending them to Sigmund “in there.”

So what’s all this got to do with gamers and social workers? Lots! Both gamers and social workers value freedom a great deal for starters. And social workers (I am saying social workers, but this applies to all psychotherapists) understand that therapy, like gaming, is a form of play. We experience more freedom to explore and express our internal world in therapy. It happens at a given time and place, even as an online event. What happens inside the therapy, a la Winnicott’s “Transitional Phenomenon,” is both alike and different from the “real world.” And there is order in therapy, some firm rules and limits in terms of what can or should happen in it.

As for the money bit, I would suggest that if we lived in a culture where capitalism was not the norm, the same parts of therapy that are so powerful and rewarding, the play-elements, would still be as powerful. Another way of looking at this is to ask yourself if you conduct therapy any differently with patients who are on Medicaid than those who are private pay? I’m not talking about feeling annoyed that you aren’t getting paid well, but the game you play. Do you only think psychodynamically with your private patients? Do you change the boundaries when its Medicaid? Or do you try your best to do what’s best for each patient regardless of the payment?

And as social workers, don’t you advocate for others with the powers that be in ways that are not connected with your material interest? Take Civil Rights, for example. The years and years of advocating, protesting and legislating are not something that the social workers involved derived a profit from. In fact that is what makes our endurance in fighting for social justice so admirable.

This is why many gamers will make excellent social workers, by the way. Gamers are experts at endurance. That guy in your office that seems like a “slacker” actually has more in common with you than you think. He has spent hours trying to down the Lich King–trying and failing, and then trying again. He has spent hours researching strategies to work as part of a team and not given up. Jane McGonigal pointed out recently on NPR that majority of time gamers are online, they are failing to accomplish their tasks. That’s why it is so admirable that they keep at it. So yes the adolescent you’re sitting with may have grades that are plummeting in school, but don’t blame the games! Try instead to harness that discipline, focus and stamina by exploring how it shows up in-game, and then how it can be used to change his real life.

And the connection between gaming and social justice isn’t as far-fetched as you may think: A 2009 Pew presentation from Amanda Lenhart showed that 49% of teen gamers reported seeing people being “hateful, racist or sexist” while playing– which means that they can identify hate, sexism and racism. What’s more, three-quarters of these kids reported seeing other players regularly respond to such behavior to confront it. That’s a hell of a lot better than most high schools and college campuses are doing these days!

So gamers and social workers both understand the value and seriousness of play, as an imagined space in therapy or in Azeroth. Gamers and social workers both understand the value of psychic change and social activism. And gamers and social workers alike regularly demonstrate hard work and stamina in the face of dragons and fascism.

Johan Huizinga would be proud.

Filed Under: Gamer Therapy Tagged With: avatar, fascism, gamers, gaming, jane mcgonigal, johan huizinga, play, private practice, psychotherapy, social justice, therapy, Web 2.0, World of Warcraft

The Face Behind the Screen

October 26, 2010 by langloimsw 11 Comments

photo courtesy of Koku Gamer

This past weekend at Blizzcon I met several interesting people. And I was reminded yet again how every gamer has a story, a very human story.

The first person I met while socializing in the ½ mile line of people waiting to get in was Luke (all names have been disguised.) Luke was a gay man who had begun playing World of Warcraft with his then partner and friends about 2 years ago. In the course of the past two years, Luke and his partner had tried unsuccessfully to adopt a child, which he believes was thwarted by a judge who did not think gay couples should marry. He and his partner saw the legalization of gay marriage and its overturn in his state, CA. His partner had lost his job, and their relationship subsequently deteriorated, ending in divorce. Throughout all of this Luke was able to stay connected and supported by his friends and other members of his guild. He attributes his ability to move on and be ready for the next phase of his life through the enjoyment of WoW and his guildies.

A second man credited WoW with saving his life. Sam was working abroad in Qatar in the Middle East. He told me how he had fallen into a profound loneliness and depression shortly after moving out of the country. His work began to suffer, and he had a hard time dealing with the isolation. All his friends were back in the US, and he had a hard time being in touch with them. He had seriously begun contemplating suicide. Then he remembered that his friends had been pestering him to try this game, World of Warcraft. He had nothing to lose, so he loaded the game onto his computer. He found the game very compelling, and was even happier to discover that he could log on to the same server as his friends at home. They were able to raid and talk together for the next 9 months he was living in the Middle East, and isolation and suicidality became a thing of the past.

I also met Matt, a young man in the elevator, wearing his gaming regalia. “How are you enjoying the convention?” I asked him. He looked glumly at me and pointed to his badge which said “TEAM 127” on it. “I came in 5^th,” he said. “Congratulations,” I said, adding, 5^th place isn’t bad.

“5^th place you only win $1000,” he said, “1^st is $25000.” Turns out that he had been flown across the country to participate in the WoW tournament. So much for gamers as slackers who have no ambition or work ethic.

I wish my colleagues could meet the thousands of people like Luke and Sam who made the trip to Anaheim for Blizzcon. They would see some very resilient people who were dealing with some pretty big life problems. These weren’t people who checked out of reality, instead they leaned on the virtual world and the human relatedness they found through it. I was struck by how affable and engaging everyone I met was. They were so happy to be in a place where they could engage with others around the games they enjoyed. The stereotypical lack of social skills people associate with gamers was not what I saw. I saw people willing to strike up a conversation with me as we waited in line. I saw fathers and their adolescent sons and daughters spending quality together. I saw couples of every configuration and entire families, all spending time together, not avoiding human contact.

I hope you’ll keep these stories in mind the next time you hear someone making fun of a gamer, or criticizing online gaming. Each gamer has a story, just like each of our patients do. And each story deserves our respect.

Filed Under: Gamer Therapy Tagged With: blizzcon, gamers, gaming, suicide, therapy, warcraft

Talking the Talk… Or At least Understanding It

May 9, 2007 by langloimsw 1 Comment

Anyone who has worked with adolescents for part of their practice has experienced the sense of speaking a language from an alternate universe, similar to yet quite unlike our own. And anyone who has worked in the field of adolescence for a significant amount of time will from time to time experience a sense of being hopelessly “behind the curve.” Fortunately, there is a resource out there for those of you who want to translate what your clients, or children are saying to you: www.urbandictionary.com . This highly nonclinical dictionary can definitely help, although like anything concerned with youth it is unconventional and preoccupied with some of the traditional categories of teen interest—sex, drugs, and music. Nevertheless it contains just about every phrase, including text-messages, that you’ve ever heard about.

Peer Supervision

A peer supervision group is forming in Harvard Sq. The group welcomes clinicians of various disciplines and theoretical backgrounds. We’re looking for members with 5 or more years of clinical experience, an ongoing interest in learning, and a sense of humor. Current members use psychodynamic, CBT, DBT, and systems theory in their clinical work, and are open to broadening their scope. The group meets Mondays at 12:00 PM, please contact me for more details.

Filed Under: Gamer Therapy Tagged With: adolescents, therapy

An Hour of Service

February 9, 2006 by langloimsw Leave a Comment

For those of you who are considering ways of doing pro bono work, or working with PTSD and veterans, check out An Hour of Service. It is a nonprofit that allows clinicians to register as willing to provide an hour’s worth of mental health service to a veteran returning from active service in Iraq. The website has links to other timely articles, including a sobering one detailing how returnee’s suicide rates are approaching record levels.

Filed Under: Gamer Therapy Tagged With: Give An Hour, military, therapy

Streaming, Path of Exile & The Repetition Compulsion

Can’t We All Just Game Along?

Taking Leaps: Fortnite, HIPAA & Psychotherapy

The Crisis Behind Crises

Mindfulness, Minecraft & The I Ching

Bio Breaks

Minecraft & The Uncanny, Part 2

Minecraft & The Uncanny, Part 1

Tower Defense & Executive Functioning

Thinking, and Just Thinking

Why Therapy Is Like A Game

How To Get An Epic Supervisor

The Uses of Disenchantment

If Freud Had Played Video Games

A Moment of Light in Dark Souls

What Google+ Could Mean For Therapy

Being A Noob

Exploring the Mystery of Suicide: Video Book Review of “In Her Wake.”

Save and Continue

(Un)Desperate Times, or Know Your Talent Trees

The Face Behind the Screen

Talking the Talk… Or At least Understanding It

An Hour of Service

Mouse Over My Pic For A Secret Message..

Epic Tweets

Ye Olde Vault

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

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

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

pre·scribe

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Mouse Over My Pic For A Secret Message..

Epic Tweets