In 1947, Virginia Axline published the first edition of what was to become a seminal work in the field it was named for, Play Therapy. In her book she championed the concept of non-directive play, the form of play therapy where the therapist takes in some ways a very Rogerian approach of reflecting rather than directing the play either overtly or subtly.
This is easier said than done, as I learned when I started using it as an intern. I recall watching a youngster play and describe a family in a horrible car accident. My first comment was, "are they all right?" covertly signalling to the child that I was anxious in the presence of such violence and the possibility of death. The child reassured me that the family was okay, and I am convinced that I had essentially ruined that session's treatment. Fortunately I was lucky to have an amazing supervisor, Linda Storey (great name for a therapist too!) who helped me to learn how to truly be non-directive. Over the next year and since I have greeted tornadoes, murder, floods, monster attacks, plane crashes, burning buildings and other disasters with "what happens next?"
Non-directive play therapy is still at its heart a two-part invention between the therapist and the patient. However, unlike some other forms of treatment, it requires the therapist to be able to tolerate a lot of violence and anxiety. Trying to direct children away from their aggressive fantasies and desires is often rooted in the therapist's own anxiety about them. Let's face it, for many of us death and destruction are scary things. It isn't just a rookie mistake to ask the child to make the story turn out "okay," and yet I think it has never been more urgent for therapists to be able to tolerate violent fantasy and encourage it to unfold in the play.
21st Century Play
Virginia Axline never had to contend with Call of Duty Special Ops, Modern Warfare or Battlefield 3. What was different about 20th Century play therapy was that the games in the consulting room usually resembled the ones from the child's everyday life at home or school. The therapists therefore knew how to play them, and didn't necessarily need to learn them as they went. But now we are in the 21st century, where the therapy office often has games from our childhoods rather than those of our patients, and they are very different.
If you are a therapist and never intend to learn to play video games and play them with your patients, you should probably stop reading here; the post won't be useful to you and I'll probably annoy you. But if you don't plan on using video games with your young patients I hope you'll consider stopping doing play therapy with children as well. Certainly stop calling yourself a non-directive play therapist, because you've already directed the child's play away from their familiar games and away from this century. I actually hope, though, that you will lean into the places that scare you and try to meet your patients where they are at in their play, and for 97% of boys and 94% of girls that means video games.
Video games like Call of Duty and Minecraft are both very useful in both diagnosis and treatment of patients, as I hope to demonstrate by focusing just on one aspect here, that of player modes. Most video games have a range of player modes, and what the patient chooses can say a lot about their attachment styles, selfobject needs, and object relations.
Solo Play is OK
Like other forms of play, sometimes patients want to play alone, and have me bear witness to their exploits. They may do so out of initial mistrust, or a yearning for mirroring. Solo play is looked down on by some therapists, who often think kids using "the computer" are austitic and/or "stuck" in parallel play. I'd refer you to Winnicott, who taught us that it is a developmental achievement to be alone in the presence of another. (I'd also refer you to my colleague and therapist Brian R. King who has a lot to say about a strengths-based approach to people on the autistic spectrum, on which he includes himself.)
The Many Reasons to Collaborate.
Some patients want to play with me on the same team in first person shooter games. The reasons for this can vary. Some patients want to protect me from their aggression because they are afraid I'll be scared of it like parents, teachers and other adults may have been. Other patients want to be on the same team because they want to have a merger with an idealized parent imago to feel more powerful and able to take on the game. Still other patients, seen in their daily lives as oppositional or violent, want to play on the same team so they can revive me and have me experience them as nurturing and a force for good in the world.
Some patients want to have their competition framed by overall collaboration, meaning that they want to get the most or final "kills" but remain on the same team. Some patients secretly yearn to play on a different team, and may need to "accidentally" change the settings to put us on opposing teams and passively want the game to continue.
Let's Bring On A World of Hurt.
On the other hand, there are a lot of reasons patients want to compete. They may want to see if I can stand their aggression and/or desire to win without being annihilated. They may want to express their sadism by tormenting me for my lack of skill, or alternately project their yearnings for recognition by praising me when I kill them. They may want to see how I manage my frustration when playing, and interpret that frustration as investment in the game and therefore my relationship with them. They may be watching very carefully to see how I act when I win or lose. Do I gloat when I win? Do I make excuses when I lose? How might these behaviors be understood by children and adolescents who often feel like they are chronically losing and behind their peers in the game of education?
More questions arise: Does the patient ask me what mode I want to play or simply decide on one? Do they modulate their anxiety by playing a combat mode but expressing the desire to stay away from the zombie mode? By allowing them to do that am I helping them to learn that sometimes life is about choosing the lesser of two anxieties rather than avoiding anxiety altogether?
Multiplayer and Uninvited Guests
In terms of settings, there is some direction on my part, which is part of maintaining the therapeutic frame. I make it a requirement that we play either locally or in a private game. And of course this sometimes go wrong, with a random player joining us.
What to do then? What if we are on an extremely high level and just terminating the game will do more harm than good? In that case I make sure we are on mute and the our conversation can't be heard by the added player, and then things get even more interesting in the therapeutic conversation: Does the patient have any feelings about the new player's arrival? What do they imagine the usertag "NavySeal69" means anyway? Do we help them when they are down or try to ignore them? How do we feel if they are ignoring us? Do we team up against them?
Minecraft and the Repetition Compulsion.
I could probably write a whole post or paper on this, but for know let's talk about creative mode and griefing. In Minecraft you and other players can build things alone or together. Other players can also "grief" you, meaning cause you grief by destroying your structures and setting you back after a lot of hard work. What does it mean when a patient griefs my building, apologizing and promising not to grief it if I rebuild, then griefs it over and over again? What may be being reenacted here? Are there adults in the patient's life who tear her/him down again and again? When does one give up on any hope for honesty or compassion from the other? What sort of object are they inviting me to become to them; angry, patient, gullible, limit-setting, mistrustful?
I have used the term child or adolescent here, but exploring the gameplay of adults when they describe it to me is often useful as well. I often encourage my adult students or gamer readers to do a little self-analysis on their play-style? What does your preferred mode of moving through video games say about you? What questions does it invite you to explore?
The goal here is not to give you an explicit case presentation or analysis of one hypothetical patient or game. Rather, it is to provide you with a Whitman's Sampler of practice and theory nuggets to give you a taste of the richness you are missing if you don't play video games with your patients, especially if you are a psychodynamic therapist. There is a lot that "happens next" if you engage with your patients in 21st century play that has themes you may find familiar: How do I live in a world that can be hostile to me? Why should I trust you to be any different? Will my badness destroy or repulse you? Will you hurt me if I am vulnerable? These and dozens of other fascinating and relevant themes emerge in a way that never did for me when I forced kids to endure 45 minutes of the Talking, Feeling, Doing Game. And what's more you don't have to remember to take the “What Do You Think About a Girl Who Sometimes Plays with or Rubs Her Vagina When She's Alone?” card out of the deck.
I'm not THAT non-directive. :-)