Using Gaming & Gamification in Clinical Practice

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



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Gamer-Affirmative Practice: Today’s Play Therapy


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

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

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


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Evocation and Mindfulness: Or, How to Think Better


Like other art forms, video games can be both a mirror and a candle held up to our culture, at times reflecting it and at times revealing things about it.  Normally I direct my posts primarily at people: therapists, gamers, educators, parents.  But today I want to include the company that produces World of Warcraft as well.  We have a crisis regarding thinking, and although I don’t think WoW created it at all, it has reflected it in a recent game mechanic change.

I am referring to a change mages that happened recently, where the spell Evocation was replaced by Rune of Power.  For people not familiar with the game, here’s a simple explanation.  Mages cast spells, but spells require an energy called mana, which gets used up gradually as you cast spells.  How much mana you start with depends on your character’s intellect, and once you have used up your mana, you can’t cast any more spells until it is replenished.  To replenish it you can either wait and it will gradually return (not the greatest idea in combat,) or eat and drink (not possible while you are in combat.)  Or you could in the older days cast Evocation, which meant you stood in place as the spell was going, gain 15% of your total mana instantly and another 45% of your total mana over 6 sec.  Move or get attacked, and the spell broke.

This recently was replaced with Rune of Power, which places a rune on the ground, which lasts for 1 min. While standing within 5 yds of it, your mana regeneration is increased by 75% and your spell damage is increased by 15%.  You have to keep remembering to replace it every minute, but that’s not the problem.  It may even be an easier game mechanic, but that’s not the problem either.  My problem with it is how it reflects our dysfunctional attitude about thinking, and specifically our tendency to think of thinking as separate from doing something.

We live in a culture where people frequently worry about things, and in fact have ruminations that are intrusive.  Many people report feeling hijacked by their minds with worrying or intrusive thoughts.  And yet at the same time, few of us seem to mark our time and set it aside specifically for thinking.  We schedule appointments to do things, but thinking isn’t one of them.  We treat thinking, which is intangible, as if it can occur in the same space as doing other activities that are more observable and tangible.  And then we are surprised when our minds rebel and hijack our thinking with thoughts and feelings that come unbidden, when all along we have been failing to cultivate the practice of intentional, mindful thinking about things.

This is where I think Blizzard and Wow initially had it right with Evocation.  It was acknowledging an important truth, that Thinking IS doing something, and when done intentionally it occupies time and has benefits.  Sure you weren’t able to do other things while casting Evocation, but isn’t that the point?  In the real world, when you want to think deeply and seriously about something, you really do need to be intentional about it, and make a space in your day to do it.  Rune of power definitely embraces the multitasking model, which encourages you to set up a rune and then go about your other business while keeping half an eye on it to know when to refresh.  Multitasking is not inherently a bad thing, but there are times and places that intentional thinking may be more appropriate and less anxiety-provoking.

Part of helping patients learn to manage worrying is often to help them set up a specific time for worrying about things.  This “worry time” can be a placeholder in the day or week which the patient uses when an intrusive worry enters into their thinking: They can dismiss it by deciding to put that on the agenda for the scheduled worry time.  This is a way of training your mind to be intentional about what you choose to think about and when.  But implicit in this is the idea that training your mind to think about things intentionally is a learned skill.

You can apply this to many different aspects of your life and work.  If you are growing your private practice, when was the last time you set aside an hour to think deeply about your business plan or clinical focus.  I’m not talking about daydreaming here, I’m talking about sustained intentional thought.  Clinically, do you set aside supervision time to think deeply about patients?  As students do you take 15 minutes after each article to think specifically about the reading?  As parents, when was the last time you said to your co-parent, let’s make a time to think together about how our child is doing in life at home and school.  Classroom teachers, when was the last time you asked students to take 5 minutes and think quietly about the classroom topic?

Another challenge here is the confusion of tongues around the concept of thinking.  Self-help gurus often exhort us to stop thinking about things and JUST DO IT.  But I don’t think they are talking about intentional thinking, I think they are talking about reactive or intrusive thinking.  Procrastination is reactive thinking, worrying can be intrusive thinking.  Those are often roadblocks to success, but the form of thinking I have been referring to is perhaps better described as a form of concentration meditation.  Concentration meditation has come to be seen by many of us as concentrating on an image, or a candle, or chanting, or a revered object, but that is not necessarily the case, and in fact it is limiting.

What if your idea is the revered object?  What if your thought process about your work, child, patient, class is worthy of your undivided attention?  What if you were to schedule a specific time to think about a certain project?

If you are one of those detractors who say, “I just don’t have time to think,” I don’t buy it.  Thinking time is not a luxury item, although it may be a learned discipline to set aside a few minutes at a time to do it.  So please take a second and schedule a time on your calendar to think about an idea that is important to you.  Schedule a time to hold your random worries and thoughts and show up at that appointed time to seriously consider them.  I suspect this will free up more mental space and time than you may imagine.

And please Blizzard, bring back Evocation.  I miss it, and the important life lesson in mindfulness it has to teach us.


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Empathy (Re)Training



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

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

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

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

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

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

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

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

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

And we get to keep all the knowledge we find.


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Learn More About Rethinking Video Games & Addiction Here!


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

[gigya ]

This can give you an idea of:

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

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

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


4 Tips For Dealing With Video Game Violence For Parents



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

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

XBox Parental Controls

Playstation Parental Controls (Video from CNET

Wii Parental Controls

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

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

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

Call of Duty Black Ops 2

Gears of War 3

World of Warcraft

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

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

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

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Bio Breaks


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!

What Back to School Could Mean

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Worth a Thousand Words?: Infographics on Video Games

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

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

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

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

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

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

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

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

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How To Learn About Video Games & Why You Ought To