The Therapist Gamer

In February 2015 I was asked to participate in an interview about this website for the blog Social Work FTW.  This is the transcript:

 

 

Eve:  First off, tell me about your background as a clinician.

 

 

Mike: I got a couple of college degrees that helped me have a strong theoretical and practical foundation in mental health and therapy. I’ve worked in a variety of settings, including residential and outpatient services.

 

I worked at a school for adults with Autism Spectrum Disorders and other learning disabilities; an outpatient treatment center for mothers with substance dependence issues; another treatment center for people on probation who were required to attend substance abuse treatment; a traditional outpatient therapy office; and I currently work on a forensic unit at a psychiatric hospital.

 

As far as my therapeutic orientation goes, in general I agree with Carl Rogers in his approach that people are naturally inclined to growth when they feel a sense of unconditional positive regard, genuineness, and empathy. These principles are woven throughout everything I do as a clinician.

 

I also think that many people’s issues tend to arise as a way of avoiding emotions. Consequently, I tend to zero-in on those emotional issues and try to assist people in having a more peaceful, less scary relationship with their emotions. I don’t do formal Emotion Focused Therapy, but I like a lot of the principles.

 

I believe in starting where the client is at, and thus am willing to use a variety of theoretical perspectives and interventions if it would be helpful to the client, such as Cognitive-Behavioral Therapy, Solution Focused Therapy, etc.

 

 

Eve: So you have a diverse background in the mental health field to draw from. So, tell me about your background as a video game player.

 

 

Mike: I’m not sure how to answer this question without being boring. In short, I’ve been playing video games ever since I remember, starting at about age three when I played “Duck Hunt.” My brothers and sisters all played games as well, but it was probably obvious that I liked them the most. I think there are some reasons for this, but then we’d start to delve into my psyche and things will get weird.

In short, I think I liked the sense of fun, adventure, and challenge offered by games. I also liked playing them with others – playing video games was one of the primary things I did with my friends as a teenager and I honestly credit this as a significant reason why I never got into much trouble (like with gangs, drugs, etc.).

 

My family had pretty strict rules about when we could play – only on Friday and Saturday night after 7:00 P.M., and Saturday morning until 10:00 (which was a joke because we’d have to work in the morning). This probably only made me obsess about them more, and became irrelevant when I was older because I just went to my friends’ houses to play games with them.

 

Video games have created some problems for me throughout my life, but probably not in the way you’d expect. Simply put, I’ve always liked games, but those around me – including my family and apparently society in general – have repeatedly given me the message that there is something wrong with me for liking them.

 

My family would tease me for playing games and religious leaders would imply video games were not congruent with living a proper life. I really liked playing the game “Doom 2″ with my friends on their LAN-linked computers, but I definitely didn’t mention this after news outlets accused this exact game for causing the Columbine shooting.

 

I internalized these messages and honestly have struggled quite a bit with believing I am a normal, functioning person who happens to enjoy video games. Intellectually I know this, but emotionally there are still some barriers for me.

 

 

Eve: Video games have built up quite a stigma with claims that they can lead to aggression, violent behavior, and social skills issues. As a clinician, what do you think about these assertions?

 

 

Mike: Not a day goes by that I don’t fight the urge to gun down hundreds of innocent civilians. I see the images and just have to act them out! And it’s made all the worse since I am doing the actions in the game!

 

As you can see, I am not sure I can answer this question without some of my own emotional issues coming up. I’ve dealt with this stigma my whole life and have emotional reactions ranging from feeling incredibly depressed to wanting to tell the nay-sayers to go far, far away.

 

I think I’ve lived first-hand the issues that come with the stigma around this issue, and I would really, really like for the stigma to decrease so that others don’t have to go through it. It’s one of the reasons I started the website. It’s also healing for me to be able to talk about it in a public manner.

 

I have two main concerns about people playing video games: addiction and their content. As far as video game addiction goes, I think it’s the same as any other addiction that does not have a physiological component; that is, it serves some purpose for the individual.

People engage in addictions for a variety of reasons, which, in my opinion, ultimately boil down to avoiding unpleasant emotions and the situations associated with them. Pretty much anything can be an addiction and video games are just one more of them. A therapist getting distracted by the actual addiction might be missing the bigger picture.

 

As far as video games leading to aggression and violent behavior, I’m not as easily convinced as the authors of some scholarly articles. I’m not saying Albert Bandura was a bozo, but I think his assertions about social learning are easily overgeneralized by others.

With regard to video games, I think there are some issues that are often overlooked. For one thing, I think the ability to tell fantasy from reality is something possessed by most people, but this is not always the case with children. This is why movies and games have a rating system – because children probably can’t handle what is going on in them.

 

I’ve probably killed hundreds of thousands of virtual people, but I have never once engaged in an act of violence since I was about 13 (and I could very easily argue that that violence was much more closely linked to the violence I personally experienced as a child). I don’t want to hurt others. If I were to see a person shot in real life, then I think I would be significantly traumatized.

 

So how is it that I can play all sorts of games, including violent games, and be so peaceful? I would submit because I am a relatively normal person who is able to tell the difference between reality and fantasy. If adults couldn’t tell the difference, therapy offices would be flooded for years with people grieving after they’d seen an action movie.

 

With this in mind, I also consider it extremely irresponsible for adults to purchase “M” rated games for kids without knowing the content of the games. Five year-olds should not be playing “Call of Duty.”

 

Of all of the research I’ve read on the issue, the studies that I find most convincing, both as a gamer and as a social scientist, are ones that causally link playing competitive games to aggressive behavior. In other words, you are more likely to be aggressive immediately after playing a competitive game of “Mario Kart” than you are after playing a cooperative game where you shoot people. This appears to be because competitiveness is a real thing that people actually get worked up about, whereas this is not really the case with other types of games.

 

I will add that there are a huge variety of non-violent games in existence. In fact, some of the highest-selling games of all time have no violence whatsoever!

 

Final thoughts about this: If you are working with someone who plays video games, you will probably make huge strides if you see them as a normal person who engages in a hobby. When people feel understood and accepted, magical things can happen.

 

 

Eve: So would you say that violent video games themselves don’t lead to aggressive behavior, but that children who aren’t mature enough to discern the difference between fiction and fact and process what they see on the screen could have adverse effects?

 

 

Mike: I would say that I have yet to read convincing research which causally links violent video games to real-life violent behavior. I would agree that such games might have adverse effects on children (or adults, for that matter) who aren’t mature enough to process what is going on. I think Schindler’s List is an important film, but I wouldn’t show it to a six year-old simply because their mind can’t process what is happening. They don’t know how to make sense of what they are seeing.

 

 

Eve: Alright. So, what interested you in doing psychoanalysis of video game characters?

 

 

Mike: The website was initially just a place for me to store my screenshots and videos as a sort of scrapbook. This turned into writing down some of my experiences while playing the games, both for my own memory and to inform others who might be interested in playing them.

 

It wasn’t until a few months later that I thought of doing the diagnoses and treatment plans. In fact, I didn’t (and still kind of don’t!) anticipate that anyone other than myself would really ever look at what I was doing.

 

I’ve read humor articles where people diagnose video game characters with mental health issues. Usually these articles are glib, silly, and good for a silent laugh. There is so much content on the internet, but I realized I could actually do something that, to my knowledge, has not been done before – offer professional analysis of video game characters by a licensed therapist. This seemed to combine three things I like – mental health, video games, and humor.

 

Hopefully this comes through to the reader, but my tactic is to take a very serious approach to an obviously silly subject matter. If people actually visit my website and like it, then I’ll keep adding content and hopefully my writing and humor skills will improve.

The process of diagnosing these characters has also given me a chance to sharpen some clinical skills and improve my understanding of mental health generally.

 

 

Eve: Okay, so it was kind of a culmination of your interests. Tell me about your process when choosing, assessing, diagnosing, and writing a treatment plan for a video game character.

 

 

Mike: Choosing is probably the hardest part. I figure there are a few different types of people who might read my writing:

1. People who are both therapists and gamers: I think they will like the site the most, but they are a rare breed.

2. People who are therapists and not gamers: I think they probably won’t like the site because they will miss the joke. That is, it is not funny to read a diagnosis of Mario if you don’t know about him. You would just think he’s actually a dangerous, anti-social man with a hallucinogen problem.

3. People who actively play modern games, and not just on their phone: I think these people will probably like the site, but the degree of analysis may be a turn off to those looking for a quick laugh. They might like the screenshots and videos.

4.  People who played games as a kid but are not really into them as adults: These are people that will “get” the joke for Mario and Link, but a modern character like Kratos from the “God of War” series will be lost on them.

 

I’m personally drawn to the characters that strike me as interesting, such as Ethan Mars. In his game, Ethan has significant mental health issues and actually seeks therapy in the game. However, it’s hard to make this funny. Joking about a father with a kidnapped child just isn’t right. So characters like Mario tend to be more fertile ground for what I’m doing right now.

 

Assessing. This process is kind of automatic in my mind. I just write down any initial impressions about disorders the character might have, and briefly scour the web to see if anyone has written anything about them. I have a rough idea of all of the disorders in my head, but sometimes I’ll skim the DSM table of contents to see if I’m missing anything obvious.

 

Diagnosing. I start by typing up the diagnostic criteria and thinking about what applies. Then I’ll read the sections of the DSM that discuss the disorder category and the disorder itself. During this time I have lots of thoughts and I just try to mentally organize them and put them down in a way that I think will be funny.

 

Then, like in real life, I use some clinical judgment to decide if I believe a character warrants a particular diagnosis. So far I’ve only chosen characters that I know a lot about – I wouldn’t pick a character from a series with 10 games if I’ve never played them because that would be way to much information to review.

 

Treatment Plans. These are much less serious than the diagnoses. I try to think of what therapy would actually be like with this character and write accordingly.

 

 

Eve: So other than having the physical client in your office, do you feel that there are many similarities between diagnosing a video game character and a real person? Is it challenging not having a physical interview?

 

 

Mike: Hmm, interesting question. I suppose it actually is pretty similar diagnosing a real person and a fake one. It would definitely be ideal to be able to meet with the characters in person. There are certain things that are conveyed while speaking with someone that you just can’t get merely from observing their behavior. However, being able to observe how a person actually behaves in their environment is arguably more valuable than simply talking to someone in a therapy office.

 

Ironically enough, this is something I need to do regularly. At my current job, I help assess individuals’ cognitive abilities, mental state, understanding of legal proceedings, and even if they are faking a mental illness to avoid prison time. Sometimes these people will absolutely refuse to interact with treatment staff. Consequently, I am left with hours of observed behavior to analyze and little or no face-to-face time – just like with the characters I diagnose on my website.

 

 

Eve: Oh wow, so this isn’t that different than what you often have to do. On your website, you mention not liking to label patients with diagnoses. Why is that? Do you think differential diagnosis in the mental health field is necessary?

 

 

Mike: I knew a person who was diagnosed with Asperger’s in his twenties. When he was told about his diagnosis, he and his mother were very happy and relieved. Someone knew what was going on! There were people who knew how to help people like him!

In this case, I think diagnoses can be very helpful. However, I would argue that the label itself is not what was helpful. In these types of situations, people seem to appreciate that they’re understood, that they’re not alone, and that people know how to help them. So why bother differentiating these factors when they are all included with the label? Because labels can create other problems, too.

Someone might say “well, I have Asperger’s so I’m obviously not going to get along with others” or “I’m a drug addict and so I need drugs.” Labels can also create social stigma. I would submit there are ways of getting the benefits of labels without the limitations.

If a client wants to know their diagnosis, then I am happy to share my thoughts. I try to do this in a way that is empowering. For example, I might say, “Well, it seems like you get anxious mostly around this specific situation that is pretty new. So I put down a diagnosis of Adjustment Disorder with Anxiety. This means that you don’t have lots of anxiety around everything, but rather once you work through this issue things should get a lot better.” I think this helps them see my thinking and can give them a chance to correct anything that I’m misunderstanding.

 

I get annoyed at health insurance companies, but this is probably a different rant for a different time (in short, we have a pharmaceutical industry that is financially incentivised if people are sick, and an insurance industry that is financially incentivised by denying services – not a good combination). I’ll offer two examples of how diagnoses often work in this system.

 

I know a therapist who was working with a woman who obviously had PTSD. The therapist submitted this diagnosis to the insurance company, and the treatment was denied. Her supervisor instructed her to simply change the diagnosis to depression (which was also accurate), and voila! the sessions would now be covered.

 

The second example comes from my own therapy as a client. After a few sessions, my therapist (who knows I’m also a therapist) asked “So, I need to send in some stuff to your insurance company.  What diagnosis do you want me to put?” I told him just to put whatever would be covered because I technically met the criteria for about three different disorders. It’s examples like these that cause me not to get too worked up about diagnosing.

 

This isn’t to say that I don’t think differential diagnosis is necessary. However, I do think sometimes therapists are more interested in solving an intellectual puzzle than in helping an actual person. I knew a person who was diagnosed with schizophrenia due to the delusional belief that an entity was trying to harm him.

 

Does it really matter if he has Schizophrenia or simply a delusional disorder? I think so. In addition to positive symptoms, Schizophrenia is also characterized by negative symptoms like cognitive impairments and avolition. This man seemed completely functional in all areas of his life, with the exception that he had these non-bizarre beliefs that rose to the level of a delusion.

 

I think these distinctions are important because treatment will be different. In this case, medication wouldn’t be (and wasn’t) helpful, whereas anti-psychotic medication would likely help a person with Schizophrenia. Similarly, it would be nice to know if a person has Major Depressive Disorder or if the depression is due to a specific incident, as in Adjustment Disorders. In other words, is the person depressed and in prison, or depressed because he is in prison? Treatment would likely take different courses in each of these cases.

In general, I also think it is easy to look at labeled people in a different way and not purely as people. I find that labels get in the way of a person-centered approach.

 

 

Eve: It seems that sometimes therapists treat the diagnosis and not the person when the disorder may present very differently in different people.

 

 

Mike: Yes, I agree. I think this is another problem with insurance companies’ insistence that therapists use the Medical Model when helping people. “A broken bone is always fixed the same way, so you need to treat depression the same way with everybody, too” – says insurance companies. I believe they’ve influenced the way therapists think.

 

I think some therapists also get an ego boost when they are able to show themselves how smart they are by accurately diagnosing a disorder and successfully “treating it.” They are also missing the point of therapy, which is to help others.

 

 

Eve: And in order to help others, we have to take care of ourselves. In the mental health field self-care is always emphasized. Do you consider playing video games to be a healthy form of self-care?

 

 

Mike: Yes. Thanks for this softball-pitch question that reinforces my world-view, Eve! I honestly don’t think I could’ve gotten through college and graduate school without relaxing with video games. For me, they offer a sense of adventure, challenge, and fun that I just don’t get in other ways.

 

Some games have significantly shaped who I am today. For example, the Metal Gear Solid series significantly changed my perspective on war and nuclear weapons and spoke to me in a way that I just can’t forget.

 

Incidentally, I think that people’s gaming habits can actually provide a lot of clinical information and things to process. For example, a person who plays the same game over and over might be trying to get a psychological need met. Perhaps he’d like a sense of mastery, control, or familiarity because he needs such things in his life right now.

 

I’d advise mental health professionals to try to be open-minded about gaming and see how their acceptance of it can help their clients.

 

 

Eve: So if therapists are informed on what kinds of games their clients are playing, you think that they might be able to offer better interventions?

 

 

Mike: I think so. Even a basic understanding of certain game types might be helpful. However, it might be unrealistic for therapists who know nothing about games to learn many details. It would probably be most beneficial to simply ask clients why they like games and what they get out of playing them. They may lack insight, but just having a therapists ask such questions in a non-judgmental manner can go a long way in building a therapeutic relationship.

 

 

Eve: That’s excellent food for thought. Anything else you’d like to add?

 

 

Mike:  Nah. I think you’ll agree I’ve said more than enough for now!

 

 

Eve: Thank you so much, Mike, and I look forward to seeing more video game characters’ diagnoses on The Therapist Gamer!

 

 

Mike: Thanks Eve! I genuinely appreciate you taking the time to speak with me. I hope this interview is helpful to your readers!