Can Video Games Be Therapeutic?

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 As a therapist, have you ever considered using video games in therapy? Over the past few years, I have heard the idea of video games in therapy mentioned a few times and have become more and more interested. In discussing play therapy for home-based sessions, one colleague mentioned that he will sometimes use games on his cellphone as a way to engage with resistant clients or provide a reward and enjoyable activity at the end of a session. Attending a conference in Los Angeles a few years ago, I heard a presentation about a video game that could be used to help train ADHD children with focus and attention. And in the last few years I often heard requests from child clients: "Can we play a game on your computer?"" or "Do you have video games here?" One client was constantly bothered by the fact that our agency had a "Game Room" that had no video games. As therapists, we are often taught to connect with our clients through what it is that they value or are interested in. For many children and teenagers today, video games are an important part of their lives.

I am by no means an expert on this topic and am still exploring and considering how I could integrate video games in to therapy, but would like to share some of my thoughts on my own experiences and what others have written. My own interest and experience in playing video games has always been that of a "casual gamer"--such as playing games on my smartphone or tablet, computer games like Plants vs. Zombies, or casual console games like Mario Kart and Guitar Hero.  However, as my clients talk about different games, I try to make an effort to at least learn about and understand the games that they enjoy.  I have also enjoyed reading the blog Gamer Therapist, written by Mike Langlois, in which he discusses the value of video games, being gamer-friendly as a therapist, and incorporating discussion about video games into therapy. I definitely recommend checking it out.

So, is there a way that we can integrate video games in to therapy?  For me, this seems to fall into two categories--being open to discussing video games in therapy and actually playing video games in therapy.  Here are some thoughts on how this could happen.

Discussing online identity and relationships: One of the great thing about online games that are played with others is that it allows someone to try out a new way of being. I have had clients who were shy or socially anxious when interacting with others in person, but online they were able to be more outgoing and confident. Others may be overly accommodating or always nice in person, but online they feel safe to be more aggressive or express anger. For some clients who struggle with developing relationships with others, online gaming and online communities can allow them to build friendships and develop a sense of trusting others. When the therapist is open to discussing online identity and gaming in session, it can lead to important conversations as online/gaming identity can be an integral part of someone. In discussing, the therapist can also help the client explore whether they would like to integrate these online characteristic into their "real world" persona and how they could do so. As an example, say I have a client whose goal is to increase his social interaction. It will be important for me to ask not only about in-person interactions with others each week, but also about online gaming interactions. (Online identity extends to more than just gaming, of course. Many teens who never play video games have an online identity for social networking and discussing this can be an important part of therapy.)

Experiencing creativity and competence: For some clients, video games may be the only thing that they feel they are good at. When children are brought in to therapy, they are often struggling in school, getting in trouble for their behavior, and not getting along with others. Video games can provide an outlet where they are able to feel successful and competent. Unfortunately, gaming is often seen as a waste of time by parents and professionals when it actually could be serving an important function for the client's self-esteem. Some games also allow for a great bit of creativity. One example is the game Minecraft, which involves creating anything you want out of single blocks. This can be very complicated and requires a lot of dedication as you have to accumulate different resources in order to get the result you want. Being curious and interested about what the client has built in Minecraft can be very validating of their creativity and hard work.

Developing skills: Some people have a misperception that playing video games is a "mindless" activity. However, gaming often require a great number of skills, like planning, strategy, problem-solving, evaluating risk, spatial reasoning, and hand-eye coordination. As an example, Mike Langlois explains on Gamer Therapist about how tower defense games require a great deal of executive functioning as one plans, strategizes, weighs strengths and weaknesses, makes choices, saves resources, and learns from past mistakes. In addition, video games--just like any other difficult task--can help children develop a capacity for persistence. No one is able to play a game perfectly at first. In order to be successful in gaming, one must learn new things, make mistakes, tolerate failures, and keep trying, even when it seems incredibly difficult or almost impossible. By recognizing this as a strength, we can validate this in our clients and then help them to extend this ability to other areas of their life. If they were able to work hard to beat a game, maybe they can apply the same hard work and dedication to their schoolwork. Some games also help children to develop their interpersonal skills as they work with others to accomplish a shared mission.  One example is World of Worldcraft, which includes quests that require teamwork in order to be successfully accomplished.

Video games as play therapy: Actually playing video games in session is one area where I am definitely still developing my own values and comfort level. Some therapists will suggest that modern play therapy is incomplete without video games, while others would never even consider this. In exploring this, we must ask ourselves as therapists whether traditional games more valuable then video games in some way. Are Candyland or Checkers somehow more therapeutic than Plants Vs. Zombies or Angry Birds? Is there a difference in playing a physical version of the Battleship game instead of an iPad version?  If video games can provide benefits, just as traditional games do, why not consider incorporating then into play therapy.  One thing to keep in mind may be the difference in games that involve people playing together (as in a game like Monopoly, whether electroic or tra) versus games that are designed for one person (as in video games like Angry Birds).  Another thing to keep in mind is the appearance of what happens in the game.  In Checkers, when I attack the other player, I am only taking away his piece from the game board.  In a video game where I am fighting the other player, it may actually show my character attacking and killing the other players character.  This would need to be considered very carefully at it seems that it would have a significant impact on the therapeutic relationship for the therapist to kill the client in a video game.  Other video games are played with the two players working together, which could be really great in the therapeutic relationship or for a parent and child to play together.  A great example is the cooperative mode of Portal 2 that requires the two players to work together to solve puzzles.  This could provide a wonderful enactment in family therapy as the therapist can see how two family members interact and work together to solve a challenge.

I believe that there is a place for video games in therapy; however, it will be important for the therapist to consider an appropriate way to integrate games, exercising careful clinical judgment and seeking consultation as necessary.  One should also not rely solely on video games in therapy.  There is great value in helping children and families to have a variety of experiences and try new things, allowing them to feel successful and creative in more than one way.  Have you tried using video games in therapy sessions?  I would love to hear thoughts on this, as well as game suggestions that others have found to work well.

Carolyn Mehlomakulu, LMFT, ATR is a psychotherapist in Austin, Texas who works with children, adolescents, and families.  For more information about individual therapy, child counseling, family therapy, and art therapy services, please visit

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