Gaming Analogies In Group Therapy

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As a ther­a­pist, I’d like to say that every group ses­sion I’ve done with young peo­ple goes great. Unfortunately, the truth is that some ses­sions are marked less by epipha­nies and more by blank stares, fight­ing, and crayon-eating. The main dif­fer­ence? Whether the day’s topic actu­al­ly res­onates with the group.

Much of the stan­dard mate­r­i­al pro­vid­ed for men­tal health issues ranges from cheesy to opaque. The same think­ing that leads to painful mid­dle school assem­blies and per­plex­ing anti-drug ads has found itself in pro­fes­sion­al coun­sel­ing pro­grams. Therapists often have to sort through raps about self-esteem and baf­fling analo­gies to find rel­e­vant ways to dis­cuss mean­ing­ful issues. For exam­ple, how do you talk to a bunch of 3rd graders about the fact that their friends might not always want them to suc­ceed? You could start by men­tion­ing “neg­a­tive peer pres­sure” if you’d like to see a room full of eight-year-olds roll their eyes simul­ta­ne­ous­ly, or you could go to the com­mon­ly used “crabs in a pot” anal­o­gy, where boil­ing crabs will pull an escapee back into the pot. This is a fan­tas­tic exam­ple if the kids are already famil­iar with the con­cept or if you can show a video of the phe­nom­e­non, but for the kids whose intro­duc­tion to crus­taceans has pri­mar­i­ly been through The Little Mermaid, it’s less suc­cess­ful. When I used this exam­ple in one of my groups, to pre­dictably poor results, one kid had never even seen a crab before.

“No, it’s like…it’s got claws…” After fum­bling through an unclear anal­o­gy and then fail­ing to base a com­plex con­cept on these hazy descrip­tions, I final­ly thought, “screw it, I’m just going to talk about Mario Kart.” I asked every­one who had played Mario Kart to raise their hands. The response was uni­ver­sal. Okay, already we had a bet­ter recog­ni­tion rate. I asked about a time when they were doing great in the game, and if a friend had ever done some­thing that left them feel­ing betrayed and angry. Their imme­di­ate answer: the blue shell. And there it was. A sim­ple term we could use to parse the mire of child­hood friend­ships.

It’s blue… it has a shell… and claws. [Photo by Dan Dorothy, English Wikipedia]

This anal­o­gy did­n’t just work because it involved video games. If I’d walked in and said “Hey chil­dren, y’all feel­in’ Gucci? We gon’ to get in our Mario Karts of friend­ship, avoid the blue shells of jeal­ousy and get all the stars of stay­ing off drugs!” it would not have gone well. Shoehorned pop-culture analo­gies fail, not nec­es­sar­i­ly because of the con­tent, but because of the source. This bor­ders on tau­tol­ogy, but for some­thing to be mean­ing­ful to some­one, it has to be rel­e­vant to them. The prob­lem with most failed cookie-cutter pre­sen­ta­tions is that kids are told what mat­ters to them. For groups to real­ly work, they can be guid­ed by a ther­a­pist, but they have to be led by kids.

Instead of tear­ing up the floor­boards and replac­ing all of our cur­rent analo­gies with gam­ing ref­er­ences, I sug­gest that we recog­nise video games as a font for cases where kids have already encoun­tered (and often tri­umphed over) real-world issues. Mario Kart was­n’t just a thing that those kids knew — it was a place where they felt anger and betray­al. It con­front­ed them with the fact that their friends don’t always sup­port them. For those kids, a ref­er­ence to Mario Kart was an acknowl­edge­ment of these com­plex expe­ri­ences.

Games are an eas­i­er ref­er­ence point for ther­a­peu­tic pur­pos­es than other forms of media because — by design — they require input. Games can engage play­ers by tap­ping into and cap­i­tal­is­ing on real-world thoughts, feel­ings, and impuls­es. Puzzle games tap into the enjoy­ment and sat­is­fac­tion that comes from con­fronting and com­plet­ing a chal­lenge. Games can use a feel­ing a play­er already has (like frus­tra­tion), and cre­ate a new, more relat­able expe­ri­ence of the play­er feel­ing that way. In ther­a­py, those gam­ing expe­ri­ences can be used as touch­stones, when the kids are deal­ing with more com­plex issues or when those same feel­ings are more intense.

For some kids just their day-to-day exis­tence can feel over­whelm­ing. In hos­pi­tal set­tings there is often a stan­dard length-of-stay but it is not so for a sub­set of chil­dren in fos­ter care. When chil­dren have just been removed from a home or a fos­ter fam­i­ly says they can no longer take care of them, it’s up to the Child Protective Services (CPS) case­work­er to find them a place to live. Through an agree­ment between the hos­pi­tals, CPS, and insur­ance, these kids can end up stay­ing an addi­tion­al week or two, in order to give their case­work­er more time. This can lead these chil­dren to feel­ing stuck. Even when they are feel­ing and act­ing bet­ter, they stay, watch­ing peers who have worse depres­sion or get in more argu­ments come and go. Not know­ing when they’ll be leav­ing or where they’ll be going can be ter­ri­fy­ing. Some of these kids have lived in shel­ters or been placed in fos­ter homes more abu­sive than the ones from which they were removed. They can express their fears and pref­er­ences, but if there’s just not an open­ing then there’s not much they can do to affect where they’re placed.

In one hos­pi­tal place­ment I had a group of boys, between 15–17 years old, who were all in this sit­u­a­tion. There is often a notice­able U‑curve pat­tern in the atti­tude of kids who are on place­ment like this; their behav­iors improve, then wors­en once they real­ize that they’re not going home. This was one of the angry groups: a few of the boys had already picked up the atti­tude that noth­ing they did mat­tered any­way, so why should they both­er doing any­thing?

One group ses­sion start­ed with a boy greet­ing me with the announce­ment that he was going to put his fist through the wall. The other boys were sup­port­ive. It was a solid plan. They con­ced­ed that it might not work out too well for the boy’s hand, but punch­ing some­thing was def­i­nite­ly in order. CPS case­work­ers were unable to be reached. Siblings, placed in dif­fer­ent fos­ter homes, had not been seen in years. Birthdays, up against the CPS dead­line, risked being spent in the hos­pi­tal. A sin­gle issue under­pinned every­thing: the wait to go home felt unbear­able.

“How do you deal with wait­ing?” they want­ed to know. The first boy had gone with threat­en­ing the wall. Others thought that a human tar­get, per­haps their doc­tor or CPS case­work­er, would pro­duce bet­ter results. Another fac­tion believed that with­draw­ing was the way to go. They rea­soned that if they slept all day, they could avoid this pain. None of these answers seemed to be espe­cial­ly sat­is­fac­to­ry or con­vinc­ing. There was a long pause. Some looked at me, oth­ers shook their heads at the floor or ceil­ing.

“When you guys are play­ing a game, what kinds of stuff do you have to wait to do?” I asked. Now this was a much eas­i­er ques­tion. Some of them leaned for­ward imme­di­ate­ly. “This quest was hard” or “that game had long har­vest­ing times.” Others fol­lowed, not both­er­ing to wait for the first speak­ers to fin­ish. They raised their voic­es, agree­ing or dis­agree­ing, shar­ing their own expe­ri­ences and frus­tra­tions. The con­ver­sa­tion turned to Minecraft, then focused in on a spe­cif­ic item. “It took for­ev­er to fin­ish!” some said. “But it was total­ly worth it” came the response.

There it was. Not only had they all played the same game, but they worked togeth­er to pick a sin­gle exam­ple. Now it was time for me to rejoin the dis­cus­sion.

How did they deal with the wait? The answers came, again, all at once. “Tame hors­es!” “Fix up my house!” “Punch chick­ens in the face!” Good. Playing this game had given them an expe­ri­ence of spend­ing wait time doing some­thing pro­duc­tive — or at least fun.

Steampunk Minecraft house by Markecgrad [source: Deviantart, CC Attribution-Share Alike]

How did they know these choic­es were avail­able? “My friend told me!” “Minecraft Wiki!” “I just like punch­ing chick­ens!” Excellent. This was con­crete expe­ri­ence of these kids ask­ing for help, using resources, and focus­ing on activ­i­ties they enjoy.

They already had all the skills they need­ed. It was time to build on them. “You guys knew what to do because you could look up the Minecraft Wiki, but there’s no CPS Wiki.” Where could they find tips for their cur­rent chal­lenge? Did options even exist?

There was a pause as the boys mulled these ques­tions over. One boy dis­agreed. He start­ed to tell me how the sit­u­a­tions were noth­ing alike, when anoth­er boy leapt to his feet. “I’m stuck, and I don’t know what to do,” he pro­claimed. “But there could be some­thing, I just haven’t thought of it. There’s no CPS wiki. But there could be.”

That’s the power of gam­ing analo­gies. I did­n’t have to sell them on chang­ing their per­spec­tive or alter­ing their behav­iors. They found their own way in, using exam­ples that were rel­e­vant in a con­text that was mean­ing­ful to them. Minecraft pro­vid­ed real expe­ri­ences of being stuck and hav­ing to wait. Minecraft pro­vid­ed real alter­na­tives to “think of all the peo­ple you’d like to threat­en.” The boys had already encoun­tered their cur­rent prob­lem. What’s more, they’d already tri­umphed.