Working With Achievements

A comment on an earlier post expressed the hope that I would at some point talk about the practical ways therapists might use social media with their patients in treatment.  I realize that I had not made a connection explicit yet in this blog.

Video games are a form of social media.

When we say social media a lot of us think Facebook or Twitter.  But the Web 2.o world is a lot more social and interactive than that.  Whenever you play Scrabble with friends on Facebook, post your high score on a leaderboard, help a friend complete something on Farmville, or create a platoon for Call of Duty, you are engaging with social media.  Perhaps it is because we have begun to take social media more seriously more quickly than video games that we overlook this.  So although I will at some point discuss ways to use Facebook, Twitter, etc. therapeutically, let’s start with video games.

One of the most fun and pervasive parts of various games is “unlocking” an achievement.  That usually happens when you complete a task that is spectacular in its rarity, or epically mundane.  One example is the fishing achievement in WoW of “Turtles All The Way Down.”  This is the achievement of catching a Giant Sea Turtle mount while you are fishing.  The chances of doing that on each cast is pretty low, so this usually consists of fishing up hundreds of fish over a long period of time before it happens.  Then all of a sudden it there’s a burst of light on your screen, and a little achievement sign pops up with some music to tell you that you’ve accomplished Turtles All The Way Down.  You get the reward of a turtle mount, and the achievement goes on your achievement log for all to see.  Grats!

Therapists with a pathologizing stance will be inclined to think, “Wow, what a waste of this patient’s time.  No wonder they can’t lose that 40 pounds or clean up their laundry or make dinner for their spouse.”  At best they’ll hold this judgment in, and at worst they’ll say something like “Do you think that this is the best way to use your time given the problems you’ve mentioned in here.”

A gamer-affirmative therapist, on the other hand, can try this approach:

“Congratulations, that must have taken a lot of time to complete.  It also shows us that you have the capacity to stick with tasks that may be pretty boring, let’s see how we could use that to your advantage outside of the game as well.”

Okay, so just how can the therapist do that?

First, you need to acknowledge to yourself and to the patient the reality that real life is often a lot less stimulating than games when it comes to tasks.  We all do mundane tasks every day (or avoid them) and no lights or music comes up, and we don’t get a prize.  And we live in a very puritanical culture which steps up to the plate and says, “Just so.  Virtue is its own reward.  Work, for the night is coming.  Work, for the end draws nigh.”


I remember working in an urban school district and going into the lunch room, and borrowing a trick I learned from Loretta Laroche.  Several of my friends and colleagues were already sitting at the table eating, and I said, “Excuse me please, I have an announcement to make.”  (If you have never tried that part, do it!  You get to make announcements, you’re allowed.  It is SO cool.)  They looked up at me.

“I didn’t have to come in today.  I could have stayed home instead.  But I did, and I worked very hard this morning, and I would like a standing ovation.”

They burst into immediate applause.  And that was it, I got my standing ovation, felt great, we all laughed and the day got even better.

You can make real life look more fun and shiny in the mundane spots.  And bear in mind that this is for the rough spots.  I am NOT saying that I’d rather log on to Second Life and see a simulated version of the Himalayas if I was offered an all-expense paid trip to Tibet.  Remember that we’re talking about our patients’ challenges here.  Doing laundry IS boring.  Exercising or dieting is long and often tedious, and unless you love cooking and have plenty of time, making dinner isn’t always that fun either.

So what does this have to do with social media and using achievements therapeutically?

Well, there is great website to help you do this called the World of Warcraft Achievement Generator.  It lets you create your own achievement banners, and gives you the opportunity to send the link, or the actual picture.  So for example if you are working with a school-anxiety or absenteeism issue with a middle school child, you can plan out what they need to do for what kind of achievement.  Say they are having trouble getting to school on time.  You set the goal of getting to school on time once this week.  When they do, they or their parent emails you to turn in that quest, and they get an email back from you which says this:

For those of us that recall the gold star on the chart, the principal behind this shouldn’t be revolutionary.  But we hesitate to use the technology to gamify therapy.  And this is not just behavioral reinforcement, this is social.  The child or parent emails us, expressing pride in an accomplishment, and we email something back that hopefully conveys something about who we and they are, and mirrors their achievement.

Therapists who work with adults can use the concept of achievements as well.  Patients who are trying to lose weight can engage their partner or a supportive friend to generate the achievement banners that the patient plans out with you in treatment.  In the case of weight loss they might have achievements for eating smaller portions, adding veggies, or losing a certain amount of weight.  Once they do one they receive this:

Note that you can integrate this with Weight Watchers or other token economies.

Often patients need some help breaking down seemingly insurmountable tasks into manageable chunks.  So to win the Title Achievement of Master Launderer you may help them do this in session, and create smaller achievements as they work towards their title, like:

Detractors may think that this is too facile, that life doesn’t work that way.

But it can.

There is no harm in providing enriched stimulation to motivate a patient.  Let’s face it, you probably wouldn’t go to work for too long if you never got paid.  And you earn those achievement points we call “vacation days” too.  We need to get over this puritanical idea that we’re either supposed to love work with all its drudgery, or that having fun is not the point.  What if having fun is the point, or at least one of them?

So games are social media, and game concepts can be used therapeutically.  One example of using gaming and technology is the achievement generator.  Can you think of others?

P.S.  Yes, there is a way to gamify the goal of having your partner cook dinner.  The non-cooking partner takes a lesson from Iron Chef and picks 2-3 “secret ingredients.”  The cooking partner than has to come up with a meal based on those ingredients with what you have in the kitchen.  Good Luck!



  1. 1) Dude! Can it be that you don’t know about Chore Wars? Someone has already provided all the infrastructure to do what you describe, and far more socially — families and households can construct their own XP systems for the chores in their lives.

    2) While I fully acknowledge the social nature of games, the aspect of games you’re discussing isn’t particularly dependent on sociality. After all, the effectiveness of your “Turtles All The Way Down” example isn’t that you’ve got an achievement that everyone else can see, or stand alone games like Plants vs. Zombies wouldn’t have achievements and I wouldn’t have just spent a week getting to level 15 on Vasebreaker Endless, about which I didn’t even care until I downloaded the upgrade with the achievements feature. Achievements are straight-up behavioral modification.

    As such, there is (or so I was given to understand by my behaviorism professor back in grad school) a vast literature of how to use behavioral modification successfully in psychotherapy. The tricky thing is that, as simple as behaviorism looks, it’s actually much harder to get right in practice than most people — most clinicians — think. I like to compare behavioral modification to black magic as depicted in fantasy and horror: it’s and incredibly brittle and non-forgiving discipline, which is likely to do something, just if you don’t get every jot and tittle absolutely correct, it’s likely not what you wanted to happen at all. (Which also makes it sort of like coding in perl.)

    And, interestingly, psychotherapeutic behavioral mod here ties right into the craft of game design. I trust you’ve seen any of the psychological analyses of the behavioral modification properties of popular games that have floated around the internet (there was a famous one about Everquest, and recently this more casual discussion of Angry Birds

    So, an example. Let’s say a gamer presents with difficulty cleaning their home. The clinician proposes using a game-like reinforcement system. Sure, says the client, how do we do that? That’s a good question. If we were to say — to pick an obviously absurd example — “Clean your room and you’ll get a gold star” that wouldn’t work. And it’s worth pausing a moment to reflect on why it’s obvious that it wouldn’t work. We know intuitively from own experience with rewards that that is too little reward for too big a problem. That intuition is an excellent one. Game design and psychotherapeutic reward schedule design are crafts of figuring out (among other things) what and how much reward will be administered to which emitted behaviors and when.

    In this case, clearly, we need to break the big, complex behavior of “clear your room” into small, more manageable tasks. What should those tasks be?

    Suddenly, we have gotten down to brass tacks. “What are the subtasks involved in cleaning your room?” may be the very question the client can’t answer. One of the commonest reasons people have trouble with housekeeping is because they get emotionally overwhelmed by the scope of the whole of the project.

    And it’s not only that they have trouble keeping their attention on the subtask instead of the whole. It may be that the complexity of relation between subtask and whole resides in the nature of the problem. That is often the case when housekeeping has been let go for a while. “I can’t put my coats in the coat closet because the closet is full of stuff I was going to put in the basement, and, anyways, there’s a stack of boxes in front of it, so I can’t get to it to begin with, not without figuring out where to put those boxes.” Housekeeping is often a yak shave.

    So actually, the game the client is playing isn’t WoW or PvZ — it’s Tetris. It’s the very complicated and emotionally fraught riddle of “how to I figure out a something I can do to advance housekeeping that is one small manageable task?”

    Playing and winning that game is actually some of the core difficult psychotherapeutic work the client needs to do, and is a necessary precursor to doing any sort of behavioral modification through rewards schedules!

    Now, part of what makes yak shaves deadly to projects is that they delay reward, and effectively put what looked like a reasonable reward condition back in the previously described obviously wrong situation of a small reward for the completion of a huge, protracted project. This is true even when there isn’t an external formal reward system administrated: because what has been mentally defined as the goal by the person doing the project has been delayed by other tasks, they don’t get the intrinsic reward of succeeding at the goal they chose until after all the intervening tasks are completed. If you don’t get the satisfaction of seeing your kitchen sink shine like new until after you’ve also cleaned out the garage, maybe the twinkle of your clean sink isn’t sufficient motivation for the month of work on the garage.

    So where the therapist can help is by identifying yak shaves, and helping break them into a series of tasks each of which is redefined into it’s own project and getting their own rewards. This is a process of discovery and analysis, and also of reframing.

    And in doing this, all sorts of cognitive and affective issues can emerge. “Daddy beat me if I didn’t clean my room.” “Clutter is how I feel safe.” “What if I need it again some day because I’m poor.” “I don’t know how to categorize and classify things.” “Filing makes me feel incompetent and stupid.” Etc.

    I hope I’ve shown that there’s a huge richness that can be unearthed by attempting to “gamify” a therapeutic project, and that we are most likely to connect with it if we have good groundings in the theory and art of what makes good games and what makes a good behavioral modification programs.

    • Mike Langlois, LICSW says:

      LOL. I should have known my post would get me
      chided by a behaviorist! 🙂

      Thanks for such an engaged post and the great links. I had not heard of Chore Wars, there’s a lot to keep up on. But you gave some good examples of why therapy has an important role to play in behavioral change. Patients can set up XP systems and an achievement for losing a pound a day, but that doesn’t mean it’s a safe or healthy goal.

      Obviously I have a much more solid training in psychodynamic theory than behavioral theories. I love the analogy of black magic, no surprise there.

      I would argue however that all of the examples I gave of social elements were social, perhaps not in the sense of behavioral thinking, but definitely in more a ontological framework. The nature of a reward is inherently social. Someone somewhere sometime evaluates and gives something to someone else as a reward. Comparing scores in leaderboard requires me to on some level care about the Other to have really much meaning.

      Thanks for taking the time to write!

      • Heh, I’m not actually a behaviorist in my clinical practice, I guess I just play one on the internet. I’m actually a Rogerian by training and conviction, and apparently now a cognitive-behaviorist by payer mandate. It’s extremely rare that I use behavior mod in my clinical practice, precisely because how touchy and fussy and baroque it is, and also because it violates my prime directive, “Never work harder than the patient”. And your comment about client-chosen goals is an excellent one. Before I would cast so coercive a spell on someone, I’d want to establish to my satisfaction that the part of the mind we were overriding wasn’t the part keeping the patient safe, and that I wasn’t inadvertently allying with a punitive, self-harming part of the client.

        As to the sociality of rewards, I’ve got to disagree with you there. It’s absolutely not intrinsically social. It is simply not the case that rewards all are or need to be given by someone else, somewhere, sometime. It’s possible to set up a behavioral modification system for oneself without involving anyone else. Even more fascinatingly, people can become inadvertently conditioned by impersonal happenstance, for instance someone who become unconsciously averse to wearing red because of a natural disaster which happened on a day they wore red. It’s how someone can be “addicted” to farming in a MMPORG, a behavior which is not motivated by advancement in the game, through the completely automated semi-randomness of drops. A reward doesn’t need to be chosen or administered by an agency outside of oneself to motivate one, and it’s not the perceived regard of someone else evaluating and judging which gives some more concrete or abstracted reward its motive power.

        Which is not to say that the perceived regard of someone evaluating is not potentially itself motivating. But consider the smoker who was ashamed of their smoking and who felt the social pressure of negative evaluation from Others esteemed and loved, who nevertheless could not stop smoking merely for the sake of their good opinion, yet who could stop in a behavioral modification paradigm. The efficacy of the reward stimuli is clearly not that it somehow made the situation more social. What the reinforcement paradigm brought to the subject was clearly not additional desire or opportunity to earn positive evaluation, since the subject already had those in abundance and they were not sufficient, but but a hack involving the part of the mind one which attempts to optimize results from behavior.

        As to your example of comparing scores on a leaderboard, absolutely, that’s a very social behavior. Competing for status or esteem or dominance are socially motivated acts. Of course, many solo games keep score without a leaderboard. The leaderboard is what brings the social element to the rewards system of scorekeeping; the scorekeeping is motivational even without it.

  2. Thanks for sharing these examples of how one may use the achievement model/game “pieces” from social media to assist clients in reaching various goals or overcoming different obstacles in their lives.

    These illustrations really brought your points across of how helpful social media and gaming may be with one’s clinical work.

    I also happen to love Loretta Laroche; she’s a great comedian who tries to inspire in everyone a happy and positive outlook to life 🙂

  3. Love the post and the links you’ve provided, Mike, and thanks to @Minder for the Chore Wars link (not to mention a great post illustrating the some of the nuances of behavioral treatment, a commonly misunderstood and oversimplified therapeutic method).

    Social recognition is very powerful—many workplace surveys indicate how important it is as a motivational factor (more so than financial recognition). So when you think about it, it’s not surprising that social media would become so powerful. It’s platform for communicating not only with the people we’re talking directly with, but also to others who might be listening.

  4. Great post! I’m all for ideas that provide positive reinforcements, and I think in social work we can forget that while folks want an absence of pain they also want more fun and enjoyment from life. I’m with you on Team Have Fun!


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