This article is part of our special series on Mental Health and Gaming, and was supported by community funding. If you want to help support future feature articles and special series, please consider donating to our Patreon.
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.
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.
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.