Working Therapeutically with Video Gamers and Their Families Anthony M
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Working Therapeutically With Video Gamers and Their Families Anthony M. Bean Video games are a common form of entertainment, but small percentage of those who regularly play video games engage in excessive use of video games. There is a professional debate about whether excessive video game use should receive a formal diagnosis as an addiction. Video games can also be used as a tool in psychotherapy, and elements of video game activity can be valuable in assessment of personality and domains of psychological struggles. This article presents examples of questions and observations of game playing as a means to engage child and adolescent players in discussion and exploration of more psychologically relevant matter. Your new clients have arrived: two parents and their 15- Anthony M Bean, PhD, earned his doctoral degree at yearold son. The son enters first and flops down on your Pacifica Graduate Institute in Caipinteria, CA. His office sofa, crossing his arms across his chest. His clinical practice is located in Fort Worth, TX, and he parents follow him in, sitting down with exasperated specializes in the therapeutic implications of video looks on their faces. The parents begin to tell you about games and gaming. He is the author of Working with the son's difficulties with video gaming. He is reportedly Video Gamers and Games in Therapy: A Clinician's playing video games from the moment be gets home Guide and The Psychology of Zelda: Linking Our World to the Legend of Zelda Series. from school until late into the night. His grades are ……………………………………………………………………………………… slipping, homework is not being turned in, family time is …… being interfered with, and he is not getting enough sleep at night. They want him to focus more on "the real spread across gender, with 45% of U.S. video gamers world." They do not understand why he wants to play being women. Families have reported that playing online with friends rather than be outside. The video games helps the family spend time together, adolescent reports he does not feel that his parents helps them monitor what they are playing, and is understand him, his priorities, and his game time being used as a positive reinforcement for family playing. He gives a couple examples of how he cannot relationships and socializing (ESA, 2018). even talk to them about his video gaming because they "close up and tell me to go outside." You wonder how to There is a wide range of differing video games. The 20 best help this family. Should you individually work with bestselling video games of 2018 are presented in Table I. A vast array of differing titles spanning the different the teenager or should you work on family dynamics? genres is noted. For instance, there are many action video games (e.g., Call of Duty, Super Smash Bros, Prevalence of Video Gaming God of War), role playing video games (e.g., Red Dead Redemption, Grand Theft Auto, Monster Hunter), and In the past decade video gaming has emerged as the simulation sport video games (e.g., NBA 2Kl9, Madden number one pastime among children and adolescents. NFL 19, FIFA 19) within the top 20 bestselling video Gaming has overtaken other leisure-time activities, such games from that year. This suggests a wide variety of as watching television, for many people of all ages. games are used by individuals. As clinicians, we need to know the differences between the games, as no The gaming industry continues to flourish. Consumer two games are identical, in order to understand their spending increased for the eighth consecutive year, with specific appeal and to use them clinically when $43 billion recorded in 2018 (Morris, 2019). The appropriate. Entertainment Software Association (ESA), an organization that monitors video gaming in the United States, reported that 64% of households own a video game device, 60% of Americans play video games daily, and the average age of a video gamer is 34 (ESA, 2018). Video gamers over the age of 18 represent more than 70% of video game users. Video gamer demographics are nearly evenly Journal of Health Service Psychology, 2019, Volume 45, Jssue 2, 4-6 Table 1. The 20 Bestselling Video Games of 2018 1. Red Dead Redemption II 11. Grand Theft Auto V 2. Call of Duty: Black Ops 4 12. Mario Kart 8 3. NBA 2K19 13. FIFA 19 4. Madden NFL 19 14. Battlefield V 5. Super Smash Bros. Ultimate 15. Super Mario Odyssey Video Game Titles 6. Marvel's Spider-Man 16. Call of Duty: WWII 7. Far C,y 5 17. Dragon Ball: Fighterz 8. God of War 2018 18. The Legend of Zelda: Breath of the Wild 9. Monster Hunter: World 19. Super Mario Party 10. Assassin's Creed: Odyssey 20. Pokemon: Lets Go Pikachu Note. Source: NPD Group, cited in Morris, 2019 There has been growing concern about excessive use of is of sufficient severity to result in significant video games over the course of the last 30 years. This is impairment in personal, family, social, educational, reflected in newspaper repo1ts and other popular media, occupational or other important areas of as well as professional journals in the mental health field. functioning. This concern was originally focused on the adolescent gamer, but increasingly is a consideration about gamers of The pattern of gaming behavior may be continuous all ages as earlier gamers have reached their 20s and 30s. or episodic and recurrent. The gaming behavior and other features are normally evident over a period of at least 12 months in order for a diagnosis to be ICD-10 gave little attention to excessive video game use, assigned, although the required duration may be but in the developing ICD-11 a new diagnostic catego1y shortened if all diagnostic requirements are met has been proposed for video game addiction: "Gaming and symptoms are severe. (Mental Health TAG, Disorder" or GD. The classification would be the first 2017). attempt to implement some measure and diagnosis of excessive or maladaptive video game use. The Topic Most research suggests a rate of gaming disorder at Advisory Group for Mental Health (Mental Health TAG) 1-3% of video gamers, although a few studies have created the following definition of the disorder "Gaming reported rates as high as 8-10% (Charlton, 2002; Disorder," with additional narrower classification terms of Charlton & Danforth, 2007; Choo et al., 2010; Gentile, Digital Gaming Disorder, Internet Gaming Disorder, and 2009; Mentzoni et al., 2011; Morahan-Martin & Video Gaming Disorder: Schumacher, 2000). The variability in incidence and prevalence data suggests there is still a lot of Gaming disorder is characterized by the inability to subjectivity in assessment and diagnosis of gaming resist an intense internal drive to engage in gaming disorder. behavior ('digital gaming' or 'video-gaming'), which may be online (i.e., over the internet) or offline, The problem with the proposed ICD diagnostic criteria manifested by: for gaming disorder is that one could replace "video gaming" with reading, walking, cooking, or dancing and 1) Impaired control over gaming (e.g., onset, create a semantically similar formulation of an frequency, intensity, duration, termination, addiction. It may be that the reason these other areas context); of human delight are not seen as "addictive" is they are more socially acceptable than playing video games. 2) Increasing priority given to gaming to the extent Radio addiction was a topic in the 1930s, and Congress that gaming takes precedence over other interests had hearings in the mid- l 950s on "comic book and daily activities; and addiction." Neither of these were incorporated into formal diagnostic codes. 3) Continuation or escalation of gaming despite the occurrence of negative consequences. The behavior Most diagnoses used in routine clinical practice have pattern been thoroughly and etiologically researched over years or even decades, often in well-developed clinical studies to help sharpen the formulation. But this is not the case in regard to video game addiction (Aarseth et al., 2016; Bean et al., 2017; Carbonell, 2017; Working Therapeutically With Video Gamers and Their Families Ceranoglu, 2010; Krossbakken et al., 2017; Kuss, detrimental and the sole crux of the problem, while their Griffiths, & Pontes, 2016; Przybylski, Weinstein, & children are of an altogether differing viewpoint-citing Murayama, 2017; Quandt, 2017; van Rooij & Kardefelt- parents' lack of understanding of their gaming habits as Winther, 2017). Further research is needed to develop just one example of the parents' lack of understanding of better diagnostic criteria for gaming disorder. them overall. Statements by parents, such as "they need to live in the Nonetheless, this does not stop families from coming to real world" and "why don't they go out and talk to therapy with concerns about excessive video game usage. friends," suggest a misunderstanding of virtual realms and A diagnosis can provide validation for an individual-and the typical daily activities of many teenagers. On the their concerned family-who cannot conceptualize what is other band, it is problematic when adolescents and happening to them. A diagnosis may also provide a younger children fail to complete daily chores or required pathway toward treatment and a clarification of life school homework, miss or avoid family events and other difficulties. The challenge for the clinician is determining social activities, and stay up late into the night (and then when excessive gaming becomes a disorder, or, stated oversleep their morning wake-up time) as a result of differently, when excessive gaming becomes a excessive time spent playing video games. pathological behavior rather than being an adolescence escapism. Clinicians are encouraged to consider the In early conversations with the family, the therapist entire spectrum of the client's functioning, rather than should explore expected responsibilities of the child or just the single behavior of excessive gaming, in making a teen.