As parents and professionals in the 21st century, we find ourselves surrounded by technology. Some of the best selling technology is related either directly or indirectly to electronic games. Many children and adolescents find electronic games to be engaging and reinforcing.
Interacting and manipulating with electronic gaming technology in an appropriate and meaningful manner requires a basic set of communication skills, gross and fine motor skills, and cognitive-affective skills. The growing popularity of multiplayer games makes social skills increasingly relevant.
We take advantage of these attributes and use electronic gaming technology as part of our practice of psychology. We teach parents and professionals how to effectively incorporate electronic gaming technology into parenting and intervention plans.
The first documented case of play therapy was in the early 1900's when Sigmund Freud recommended play to the father of a 5 year old patient named "Little Hans." Since that time, play has been used to assess children, teach them empathy, and address emotional as well as behavioral issues.
The first commercially successful use of video game technology was arcade games, such as Atari Pong, released in 1972. Video game technology for the home began appearing a few years later, around 1975, with the development of console-based games. Present day examples include Microsoft's Xbox 360, Sony's Playstation 3, and Nintendo's Wii. Handheld video games first appeared on the market in 1976, and eventually evolved into products like the Nintendo DSi and the Sony PSP, and now are moving into cell phones and IPods. The use of personal computers as a platform for video game technology did not gain widespread popularity until the 1980's.
In 1992, while doing post-doctoral work as a psychotherapist at a residential facility in Philadelphia for children and adolescents with disruptive behavior disorders, Dr. Brian Moyer was faced with the challenge of engaging residents who made it clear that they did not wish to be engaged. Not having a great deal of resources but armed with a laptop and computer games like Monopoly, Wheel of Fortune, and Wolfenstein 3D, Dr. Moyer blended personal computer (PC) video games with therapy as a way of overcoming resistance to the idea of therapy and the stigma that can be attached to it. Playing video games together helped to create a trusting relationship with the therapist and improved treatment compliance.
Dr. Messer began integrating video game technology into the practice of psychology in 2001 while serving on active duty with the United States Navy in a Postdoctoral Fellowship in Child Psychology at the University of Oklahoma. He started with hand-held video games, using them to distract patients undergoing medical procedures in the Hematology-Oncology Clinic. Dr. Messer next used structured group play of console-based video games in 2002 to serve elementary and middle school students with childhood developmental disorders (CDD's) on an overseas military base. The school-based programs were a fun way to build trust, communication, and relationships with peers and involved students playing multiplayer video games that were structured to promote cooperative play and that required teammates to communicate.
In 2006, the school-based video-game program was modified and offered at a commercial electronic gaming establishment in Amherst, New York. As before, the initial focus was on facilitating appropriate peer interactions during group play of video games; in contrast, however, the new program added exercises before and after game play for learning social and coping skills and incorporated trained college student volunteers to socially reinforce appropriate behavior during game play. The new program also began offering a parent support group, led by Mrs. Messer, which met while the children participated in group.
Independently, Dr. Messer implemented a program using structured play of video games at a state psychiatric facility for adults with severe mental illness in 2007. Structured play of PC-based games has been considered to be an evidence-based practice for remediating neurocognitive deficits associated with a wide range of disabilities, from individuals with developmental delays to persons with serious mental illness to persons with Traumatic Brain Injury (see for example, Klingberg et al., 2005 [RoboMemo]; Hogarty, Greenwald, & Eack, 2006 [Cognitive Enhancement Therapy]; Medalia, Revheim et al., 2001 [Neuropsychological Educational Approach to Rehabilitation (NEAR)]). The program substituted off-the-shelf console-based video game technology as a way of promoting intrinsic motivation and task engagement for building basic cognitive functions like sustained attention and effort, active information processing, and impulse control. The use of the Wii gaming console allowed the patients to practice gross motor skills as well. Undergraduate and graduate student interns were trained to facilitate appropriate fine or gross motor movements and social engagement during game play.
We established Electronic Gaming Therapy, Inc. at our current private practice setting in Williamsville, NY, with the goal of integrating video game technology into our clinical practices. Video game technology is not used in every session nor is it used with every client, but it has become a tremendous tool to accentuate a more traditional cognitive-behavioral therapeutic approach with many of our clients.
Upon hearing that we incorporate video game technology in our practice, we typically get two questions. First, how can video games be therapeutic? Second, what type of client benefits from this type of therapy?
For some individuals, the targeted skills are the neuropsychological functions and structures needed to Catch and Send Signals with electronic gaming technology; in other words, the ability to manipulate a controller and interact with software in an appropriate and meaningful manner.
For other individuals, the targeted skills are those neuropsychological functions and structures needed to play video games with others in an appropriate and meaningful manner. Skill training starts with learning to play with an adult, then with a peer, and finally as part of a group activity.
For identified individuals, families, and groups we create digital avatars early in the treatment process. Creating digital avatars is typically fun and promotes relationship building. The process of creating an avatar reveals clinically relevant information on a number of dimensions, including coping and problem solving strategies, relationship styles, social and communication skills, and self-control.
For the designated individuals and families, we typically start all sessions off with a brief (5-10 minute) multiplayer game. This approach encourages participation in therapy by pairing it with the desired activity of video game play. Carefully selected and structured video game play creates a safe and trusting environment, fosters the development of relationships, promotes participation in subsequent phases of therapy. We teach children and parents to utilize video game technology as a behavior management tool by offering the opportunity to play another multiplayer game during the final 5-10 minutes of the session.
For groups, as soon as a client arrives at the practice we encourage him or her to join in cooperative, multiplayer gaming prior to the start of the session. We found that this helps many of our clients begin the transition to group and it provides another opportunity to reinforce appropriate social and coping skills. We use video game technology to present psycho-educational materials for teaching social and coping skills. Because most families are using video game technology, we can set up schedules and procedures for reviewing the material at home. Finally, we use carefully selected and structured multiplayer games to create situations for practicing skills. We teach parents how to structure play at home in a way that promotes social and coping skills.