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Thinking of using video games therapeutically?

Qualified Counsellor Ellie Finch explores the benefits & key considerations when using video games for working with younger clients.

Perhaps, like me, you’ve experienced the children and young people you work with talk with enthusiasm about games like Minecraft or Fortnite – and could see how much using a video game therapeutically could engage them in counselling?

I’ve been using video games in my private practice with children and young people for the past 2 years and have found it to be a great way to engage children and young people. Sometimes I simply talk about a child’s favourite video game with them; I might ask them what character they like to play, and this can lead to an exploration of their identity. Sometimes I watch a child play and might reflect back to them what I observe. For example, a child with low self-esteem might do something kind for another character in a game and I reflect back to them what I’ve seen of them in the game. Often, I will play the game with the child and together we might play hide and seek, battle monsters, build a castle among many other things.

© Ellie Finch

Games I’ve played with clients include Roblox, Fortnite, Among Us and Animal Crossing. But the game I’ve found most safe, accessible and useful therapeutically is Minecraft.

Before starting to use video games in your practice, there’s a number of important points to consider. I shall map these considerations to the ACTO CYP competences:

ACTO CYP Competency: Psychological Processes relevant to Online Therapy

Ever since I started using Minecraft in my practice I’ve been bombarded with enquiries from parents who can instantly see how it would engage their child in counselling. Often the parents have children who would otherwise not have engaged in counselling if it hadn’t been for Minecraft. However, it’s important to recognise that using a particular video game in sessions might not be suitable for all children. For example, if the child has been struggling with coming off a game to take part in other activities at home, they may struggle with the end of counselling sessions. This can actually be a great opportunity to explore the reasons why they find it hard to come off the game but you may also need to work on setting boundaries around use of games in sessions. In addition, if a client is struggling with not feeling contained in their life, then you will want to consider the landscape of the game you play. For example, Minecraft worlds are enormous and in order to create a more contained space, almost like a sandtray, I provide a physical boundary such as an island or a wall around the space we work in.

© Ellie Finch

I always ask my clients to create a safe place in the game in their first session. This is a place they can come back to at any time if they need to. A safe place can be anything, a cave, a house, a castle…

It also helps to understand the culture of video games and the video game you chose to play itself. For example, terms like ‘griefing’ are useful to know; griefing is a type of online bullying. In Minecraft griefers are players that destroy other players creations. When using Minecraft therapeutically however you can create a private world just for your clients so this can’t happen. In addition, the social side to gaming can be really important to players and the relationships they have through the game are just as significant as their in-person relationships.

ACTO CYP Competency: Assessment of clients for online therapy

Factors to consider when working online using a video game are:

  • Does the place where the child will be having their counselling have good enough internet connection to run the game as well as a video platform such as Zoom?
  • Is the child already playing the game online with other people? If not, you need to work with the parent/carer and child to educate them on online gaming safety, playing on servers with strangers etc. Minecraft Education has an in-built game called ‘Cybersafe: Home Sweet Hmm’ that takes the player through some internet safety challenges and helps the player to come up with strategies to keep safe online: https://education.minecraft.net/en-us/lessons/cybersafe-home-sweet-hmm (This game is available on Minecraft Education and Bedrock editions)

ACTO CYP Competency: Contracting and Boundaries

Having an agreement with the client around the use of a video game (or any digital therapy tool or resource) is essential.

My contract, for example, contains the following:

  • Information about the potential benefits of using Minecraft therapeutically as well as the potential challenges.
  • What they can expect a session using Minecraft to be like.
  • Boundaries such as the way we will communicate, how I will ‘unfriend’ them after each session and that I won’t be inviting anyone else into their private Minecraft world.
  • What we will do if we can’t connect in the game or lose connection.
  • I’m also clear about my level of competency in the game (please don’t feel you need to be an expert player – you need to be familiar with game controls, but most important is that you know how to keep your clients safe in the game).

ACTO CYP Competency: Data Protection

It’s essential to clearly explain any potential data protection risks of each game you play to a client.

I provide a clear, age-appropriate explanation of what ‘data protection’ and ‘GDPR’ mean, along with information about security standards (i.e. does the game have an ISO27001 certificate), where the location data is stored (i.e. outside of the UK, outside of EU, or in the US, for example, where they have different data protection laws).

It’s also important to clearly state how you will take steps to protect your client’s data in relation to the game and the limitations of this.

For example, I save a copy of the world after each session which is saved locally on my computer (and backed up to an external, encrypted hard-drive). My computer is password protected and I have installed anti-virus and firewall. I run updates on my computer regularly to ensure the security measures are up to date.

ACTO CYP Competency: Communication in online therapy

I do not advise using the communication channels within a video game. Instead, I use my usual video platform or the telephone (you may find using the telephone helps with internet connection issues).

I ask my clients not to use the chat function in the game. I also ask my clients to not write anything on signs or boards etc in the game that discloses personal information such as names, locations etc.

You will also need to get used to the idea that if you are embodying a character in a game alongside your client then your movements and body language as that character will be forming part of your communication with your client – much in the same way as our body language in real life forms part of our communication.

ACTO CYP Competency: Creativity in Online Therapy 

Video games provide a great online resource for adapting in-person therapeutic resources.

For example, I use Minecraft much like a sandtray by asking clients to create scenes using items and characters in the game which they can select from a vast inventory (a bit like having rows of miniatures on shelves in your therapy room).

© Ellie Finch

I also have a family tree activity where I ask clients to select different coloured and textured blocks to represent themselves and their family and place them in a tree.

Here are some links to resources and publications about my work:

I have a section in Jessica Stone’s book ‘Digital Play Therapy: A Clinician’s Guide to Comfort and Competence’ on using Minecraft as a sandtray:  https://www.routledge.com/Digital-Play-Therapy-A-Clinicians-Guide-to-Comfort-and-Competence/Stone/p/book/9780367755539

BACP’s Children, Young People and Families Journal featured an article about my work which includes a case study: https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/december-2021/therapeutic-adventures-in-minecraft/

I have made a 10-minute video for parents introducing them to how I use Minecraft therapeutically by taking them on a journey around my Minecraft island that can be viewed on my website here: https://www.elliefinch.co.uk/counselling-using-minecraft

I have a free webinar also available on my website where I introduce how I use Minecraft therapeutically: https://www.elliefinch.co.uk/events

ACTO CYP Competency: Managing Risk and Safeguarding Issues

Top tip: There are three main editions of Minecraft: Java Edition (available on Mac and Windows), Bedrock/Windows Edition (available of PC, iPhone and iPad, Android, and a range of games consoles including Switch, PlayStation and Xbox) and Education Edition (available on Windows, Mac, iPad, and Chromebook)

Just like working online creates more issues around safeguarding and risk; video games can add a few more to consider. You want to be sure that you are familiar with the video game’s security and privacy settings and have them enabled for yourself and have also advised the client and their parent about how to enable these settings. For example, many video games, including Minecraft (excluding Minecraft Education Edition) are part of social media networks like the Xbox Network. This means that unless you have enabled certain privacy settings your clients may be able to see your friends list, see when you are online, what games you are playing and with who etc. I have written two extensive blog posts for parents about keeping their child safe in Minecraft which is also useful for practitioners using Minecraft Bedrock and Java editions: https://www.elliefinch.co.uk/post/essential-steps-for-keeping-your-child-safe-when-they-are-playing-minecraft-bedrock-edition

Last year Minecraft Education Edition became more widely available to purchase and this is exciting news for therapists as, due to it being designed for use in school settings, it is a lot safer to use with clients than Java and Bedrock Editions. I’ve also written a blog post about the pros and cons of using Minecraft Education Edition: https://www.elliefinch.co.uk/post/why-i-m-using-minecraft-education-from-now-on

Playing video games with clients, can provide a great opportunity to talk about online safety and check in with them about their online life. It is essential you do some training in online safety if you haven’t done so already.

ACTO CYP Competency: Endings and Supervision

Endings in video games can be incredibly poignant and meaningful – whether it be taking a screenshot of your characters together one last time or planting a tree together in the client’s world. I ask permission to take screenshots of the client’s work in the game, you can create a document together and use it to review the work at any time, including in the final sessions. It’s also something they can keep.

I’d advise practitioners looking to start using video games therapeutically to seek consultancy and training before starting to work using video games and connect with professional peers already working in this area.

It’s also important that you have a supervisor that either uses video games in their own practice or is open to learning about using video games alongside you.

Next steps

© Ellie Finch

As you can see, there’s a lot to consider when incorporating video games into your practice. There’s also additional factors to consider that sit outside the ACTO CYP competences such as making sure you are working within the terms and conditions of the video game license terms and conditions.

I’ve been inundated with enquiries from parents telling me their children are actually excited about the idea of counselling using Minecraft. And, seeing the huge amount of interest there is amongst counsellors and other professionals in using video games like Minecraft therapeutically, I have been training other professionals and organisations in how to use video games therapeutically and safely with their clients.

You don’t need to be a gamer to use video games therapeutically, but you do need to have some confidence using technology so that you can troubleshoot any technical issues that arise. My Getting Tech-Savvy in Minecraft webinar can help you get to grips with the technical side of using Minecraft therapeutically: https://www.elliefinch.co.uk/shop

I also provide 1-to-1 and small group consultations, bespoke training to organisations as well as an upcoming training course on using Minecraft therapeutically.


Ellie is also part of the team of ACTO CYP therapists who have just updated the ACTO competences for CYP online therapists which were used throughout this blog post

For further information please email Ellie: ellie@elliefinch.co.uk

Ellie Finch

All images used are taken by the author. Ellie Finch’s services are NOT AN OFFICIAL MINECRAFT PRODUCT. NOT APPROVED BY OR ASSOCIATED WITH MOJANG OR MICROSOFT.

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Blog

Play to your strengths

Two autistic members of ACTO challenge all of us to think differently

This blog post is written by two autistic members of ACTO, with over thirty years of experience between us. We both became therapists before we knew we were autistic, and discovering something so essential about the selves we truly are has proved enlightening in understanding the way we work as therapists. But this post is not about Vauna and Max. On Autism Awareness Day it’s about autistic people in general and autistic counsellors and psychotherapists in particular. 

The watchword of Chris Bonnello, an autistic educator, advocate and author, is “play to your strengths”.

That applies to everyone. Beisser’s Paradoxical Theory of Change says that therapeutic change occurs when one becomes what one is, not when one tries to become what one is not. (1) The more we play to the strengths we actually have, rather than chasing those we haven’t, the more we will thrive and grow.

So it also applies to us as autistic, and to us as autistic therapists.

The traditional view of autism

Autism has traditionally been seen / defined as a collection of deficiencies. The traditional view is this:

“Autism spectrum disorder (ASD) is an early onset neurodevelopmental condition that is associated with diverse social, occupational and educational challenges. ASD is characterised by impairment in qualitative social communication and interaction, alongside rigid, repetitive, routine, ritualistic behaviours and adverse sensory responses to certain stimuli.” (2)

An alternative view of autism

However, there are other ways of seeing it.

For example: autism is a way of being, a way of experiencing the world: not in itself a disorder, simply a difference. Many autistic people regard it as not unlike a culture: we have trouble understanding the non-autistic world because it is not our culture, just as the bloggers, born in England, might have trouble understanding the culture of Japan. And non-autistic people have equal trouble understanding our culture. This has been demonstrated very nicely by Crompton et al in their “diffusion chain” experiment (3), is at the heart of Damian Milton’s Double Empathy theory (4), and underpins the neurodiversity model (5): just as the world is biodiverse – and the more biodiverse the better – so humans are neurodiverse. Autistic people are not in any sense inferior, simply neurodivergent – they diverge from the majority, just as a jumping spider that lives on vegetables might be described as bio divergent. It may be unusual, but it’s the one that will survive in a time of food shortage.

The graphic above is Chris Bonnello’s list of autistic strengths (6). Of course, we do not all have all these strengths to the same degree, and people who are not autistic may also have many of them. But it is a useful corrective to the deficiency model.  

For anyone used to the traditional view of autism it may seem counterintuitive that an autistic person should choose to become a counsellor, and unlikely that we should be effective in that field. However, looking at the list of strengths above, it may seem a little less unlikely.

Autism awareness: a perspective

Many autistic people feel uncomfortable about autism “awareness”. Surely, they say, we deserve better than mere awareness? Acceptance at least, if not appreciation? We certainly appreciate our autistic minds and our autistic senses, even if at times they disable us in a society – a world – that is designed by and for people who are not like us.

However, as therapists we know that awareness is not something superficial. When we talk about something being in awareness we mean a full experiencing of that thing, not just a cognitive understanding of it. So maybe on this World Autism Day, rather than reading a theoretical piece on autism as a disorder, read or listen to an actually autistic person talking about our life, our perception and processing of our world.

Why not start with Naoki Higashida’s “The Reason I Jump”? (7) In the words of that so-called low-functioning Japanese thirteen-year-old you will find one of the clearest depictions of the autistic world. That is his world, and that is our world. Come and meet us.

To finish, just to throw some doubt on the stereotype that autistic people are not creative and have no empathy, here’s a wee poem written by one of us about the inner world of a client. The English is a loose translation of the Gaelic.

Cho trom an t-saoghal.

Tha’ n cù a’ teum le muirn

Tha mi’ n dùil, mi’ n dùil.


So heavy the world.

The dog nips in ecstasy

Oh, I wish, I wish.

Authors: Max Marnau and Vauna Beauvais 

Max is an autistic therapist and clinical supervisor, artist and poet living in the Scottish Borders and working with neurodivergent and neurotypical adults.

Vauna Beauvais is an autistic psychotherapist and clinical supervisor, and a coach for adults with ADHD.

Further information: https://www.un.org/en/observances/autism-day/background

References

1. A. Beisser (1970) The Paradoxical Theory of Change. In: Fagan, J. and Shepherd, I.L., Eds., Gestalt Therapy Now, Harper & Row, New York, 77-80.

2. E. Nicholson, ‘How do you know if your client has autism?’ Healthcare Counselling and Psychotherapy Journal, April 2020

3. C.J Crompton et al, ‘Autistic peer-to-peer information transfer is highly effective’, Autism vol 24 (7), 2020, pp. 1704-1712

4. D. Milton, ‘On the ontological status of autism: the ‘double empathy problem’’, Disability & Society, 27 (6), 2012, pp. 883-887

5. Term probably coined by Judy Singer in her thesis, later published as “Why Can’t You be Normal for Once in Your Life?”in Disability Discourse, Mairian Corker Ed., Open University Press, 1999. A discussion can be found in N. Walker ‘Towards a neuroqueer future, an interview with Nick Walker’, Autism in Adulthood, vol 3 no 1, 2021. See also J. Singer, ‘NeuroDIversity – the Birth of an Idea’ Amazon, 2017

6. See website Autistic Not Weird: https://autisticnotweird.com/

7. N. Higashida, ‘The Reason I Jump’ tr K. A. Yoshida and D. Mitchell, Hodder & Stoughton 2014

Categories
Blog

As demand for online therapy grows, self-care has never been so important

ACTO members Jan Stiff and Sarah Worley-James offer some practical advice to therapists and counsellors coping with increased workloads and the complexities of added stress caused by moving from providing face to face to online therapy

Recently we shared to our Facebook page an article written by a therapist, Katerina, who is coming to terms with the significant increase in demand for moving to providing online therapy initiated by the recent COVID pandemic.

The issues raised in the article are of course extremely pertinent ones at this time. So, we thought we would share some of our observations, and some suggestions for online therapists and counsellors to help them with their own self-care.

Firstly it is good to see a blog published on this matter – and one which is openly spoken about. After all, like our clients, we too are human beings struggling with the myriad ways that the COVID-19 pandemic is affecting us personally, as well as professionally.

Let us now consider some of the points made by Katerina – and offer our thoughts.

  • The power of online therapy to enable a new kind of creativity, safety and emotional intimacy.

That sense of “power” that can be interesting for some but equally disarming and frightening for therapists without appropriate training, experience and online supervision.

  • The importance of therapists having their own space set aside for online therapy

Coping with everyday things such as eating and sleeping can be difficult if this is the same space that you undertake your online therapy.

The inappropriateness of not having a sacred space – set aside for online therapy – a space that is safe and confidential and that can be “walked away from” as if locking the office door –  can pose a challenge which then impinges negatively on a therapists life and personal space.

  • The feeling that our profession is not getting any recognition or support

This is a concern for many of us in the profession; comments have been made that therapists have been “forced” to provide online therapy. The increasing effects of COVID and what therapist have “had” to endure (they feel they have had little choice in most cases and need to continue to work to bring in money) are concerning – and is deserving of further debate.

  • Not having an opportunity to say goodbye to clients as a result of end of face-to-face contact

Again, the need for training and appropriate supervision comes to mind here – and the option for therapists to acknowledge that moving to providing online therapy might not be an option that they want to move towards. During support sessions for face to face therapists “forced” to move to working online  – mainly school counsellors – one message I [Jan] shared was that they knew the client best and they knew what they needed.

Also they, as that clients therapist had the autonomy to communicate their concerns with either the schools, training bodies or professional bodies to say that they did not feel competent to practice online if they did not feel it was benefiting their clients. For instance, many were “forced” to provide telephone support because that was deemed “safer” but of course, the lack of ability to make visual assessments caused great concern for some therapists – understandably so.

Within support sessions and teaching we share the following as a way of assessing your needs as a therapist, working online and face to face – it can highlight areas of concern that a therapist, especially one practicing online, might not be aware of.

 

Building resilience 

Research has shown that vicarious trauma within therapists is related to workload and support. Of course individual therapist resilience is also a part of this.

We love this and therapists that it has been have shared with have sometimes been left in awe with how this highlights individual self-care needs, blind spots and issues leading to burnout.

This website has some great info:

https://proqol.org/Home_Page.php

 

Fun activities are important too!

And finally there are some simple things too. Fun activities which can help us all to relax away from our work.

Finding those small moments in the day to take care of ourselves.

That cup of tea sipped whilst listening to relaxing music, a few minutes to colour in a colouring book, do a jigsaw, cook something new.  Encouragement to focus on noticing those small actions that give a message ‘I’m worth taking care of’.  Focusing on gaining a balance, which may look very different to the pre lockdown one, while appropriate to life right now.

All of these may help.

Jan Stiff, online counsellor and supervisor

Sarah Worley-James, online counsellor and supervisor

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ACTO board messages Announcements Blog

Looking for an exciting new opportunity?

Looking for an exciting new opportunity?

The world of online counselling and psychotherapy is changing – and you can help to shape it by joining our team of directors on the ACTO Board

ACTO is always on the look-out for talent and energy to join the Board of Directors. In recent months, our profession has seen significant changes with the huge growth in the practice of online psychotherapy and counselling. We are keen to support that development by broadening our team with new directors.

There are opportunities for members to join our Board as ‘Directors without portfolio’; however we are particularly in need of expertise in the following areas:-

A Director of Training – to help us:

  • improve our training standards;
  • support our Training Organisations;
  • encourage other online training organisations to join the ACTO family.

A Director for Inclusivity/Diversity, to:

  • help us decide what this director should be called!
  • champion issues of inclusion and diversity within ACTO;
  • disseminate awareness and understanding of inclusion and diversity in online work.

An International Director (or deputy)

  • this is a passion of our Chair – but he hasn’t sufficient time to manage it fully:
  • to bring the long-awaited International Directory to fruition, to develop and manage it;
  • to link in with the international organisations devoted to online work;
  • to develop a network of ACTO ‘chapters’ around the world.

If you are interested, please contact the Chair of ACTO at:  chair@ACTO-org.uk for an informal chat.

Adrian M Rhodes

Chair, ACTO

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Blog

New ACTO Chair aims to raise the standards of online therapy

It is easy to do therapy online; but it is difficult to do therapy online well,

Raising standards and making ACTO the go-to place for online counselling and psychotherapy. Those are the two principal goals of ACTO’s new Chair, Adrian Rhodes, who leads the volunteer Board of Directors with representatives from across the profession. And for Adrian, the new role comes at a time of fundamental change as the world adjusts to life during the Covid-19 pandemic, necessitating innovative ways of working for counsellors and psychotherapists.

The lockdown and the introduction of social distancing measures have resulted in a massive increase in the numbers of psychotherapists and counsellors seeking to work online. Earlier this year, ACTO responded by publishing security and privacy guidance for practitioners providing online therapy. However, further work is needed as practitioners and services adapt to the technology and ways of engaging with their clients.

Adrian, who qualified as a psychotherapist in the 1980s, worked as a psychotherapist in the NHS and is also an Honorary Canon in the Church of England, believes that the growth in practitioners and services working online is a positive response to the crisis; however, it offers fresh challenges too, to ensure that a high standard of quality is provided. As Chair, Adrian is committed to leading the organisation in this exciting, albeit challenging, new phase of its history.

ACTO is a body with a clear objective: to support counsellors and psychotherapists who work online. With 15 years’ experience, we believe that this knowledge and expertise is invaluable at the current time.

Clearly, the landscape that practitioners and training providers operate in has been transformed since the start of the pandemic. Since March, many psychotherapists and counsellors have started to work online, some with limited experience and training.  The need to equip our colleagues with the right skills and expertise is therefore urgent. It is easy to do therapy online; but it is difficult to do therapy online well.

ACTO priorities

To make these transformative changes, ACTO will build up its repository of resources and knowledge around online therapy. Furthermore, as an organisation we will drive up standards of practice and training, provide information about working internationally and improve access to key research.

The goal: for ACTO to be the ‘go-to’ place for discussion and debate for psychotherapists and counsellors.

ACTO provides a range of services to its members, including a directory for therapists and supervisors, forums for practitioners to discuss relevant issues and access to digital tools.

If you would like to enquire about joining ACTO or find out more regarding our work, please go to the ACTO website or get in touch.

Adrian M. Rhodes

Chair, ACTO