‘Working with Video Gamers and Games in Therapy’: Book Review

Beata Gubacsi reviews Anthony M. Bean’s Working with Video Gamers and Games in Therapy (Routledge, 2018).

Anthony M. Bean, as “psychologically minded video gamer” (6), reflects on the disparity between, on one hand, the largely negative cultural discourse surrounding video games and, on the other hand, the increasing influence of the video game industry and the growing base of gamers. The latest news revolving around the “premature [labelling] of video gaming as an addictive disorder” by the World Health Organisation and its recent inclusion in DSM-5 depicted video gaming as inherently harmful (2). Considering the discrepancy between this and the bulk of gamers whose everyday experience involves playing video games for entertainment and social interaction, Bean insists on reconsidering the problematic portrayal of video gaming and especially that of video gamers. In this book, instead of “purely statistical evidence” (5), he offers “a deeper and more holistic understanding” of video gaming and the video gamer (2), debunking some longstanding and damaging myths by pointing out that they are not supported with valid  evidence. As a fellow psychologically-minded video gamer (albeit no health professional), I welcome this new approach.

The first half of the book is dedicated to ludology – the study of play and games – understanding video games as a medium as well as a cultural phenomenon. Chapters 1-3 give a brief overview of video gaming, explaining basic notions such as character development, point of view, as well as the history of video games and the taxonomy of video game genres and what kind of personality types they tend to attract. These chapters are the foundation for approaching the complexity of the gamers’ cognitive, emotional and behavioural experiences and responses to video gaming.  They suggest that a large part of gamers’ motivation, as well as the gaming experience, is communication, building and maintaining relationships.

Chapter 4 focuses on this, providing insight into “the intersections of Psychology and Communication studies” (50). Discussing different models of communication and their criteria for the successful exchange of information, Bean argues that video game communication is indeed a sufficient form of contact. It contains verbal communication through electronic devices (headsets) and apps (Discord), and nonverbal communication via a range of gestures performed by in-game characters (57-58). Accordingly, Bean emphasises the significance of avatars for interpersonal communication, conveying meaning between gamers which can be easily understood based on shared interest and experience with virtual worlds. Referring to Sherry Turkle’s The Second Self, he explains that avatars are “both an extension of the self and part of the external world outside of their body” (62). Since avatars provide insight into people’s interactions and motivations, Bean discusses them in terms of object relations theory, “a form of psychoanalytic psychology focusing on the development of psyche in individuals during childhood through adolescence” (63). This is relevant to his clinical approach, which is illustrated with several case studies: “qualities inherent in the character can be extrapolated and used in therapy sessions to internally motivate the clients” (65). With the understanding of how video gamers communicate, Bean begins to explore how video gaming is communicated in the media. Chapter 5 “Society and Video Games” debunks some of the common “myths” around gaming, such as, playing video games make gamers violent. Bean argues that almost all communication regarding video games is coming from a sense of “moral panic”. Stanley Cohen’s term reveals that “moral panic can focus upon anything or anyone at any time, but usually occurs when there is more of a psychological phenomenon or craze which not much information may be known about or there is a spread of misinformation.” (74)

Tying together the dynamics of game genres, character development and object relations psychology, in Chapter 6 “Archetypes”, Bean begins to introduce “the primary theoretical framework employed within his book […] a Humanistic and Jungian Archetypal paradigm of thought” (2). To demonstrate the usefulness of this particular approach, Bean refers to a case study: Greg who is in “a constant state of mistrust in his current surrounding” including his family and his previous therapist. (99) Bean explains that he managed to build rapport with Greg due to the shared interest and language. During the sessions they talked about Greg’s character Handsome Jack and the hero-villain dynamics of the archetypal journey which appeared to be similar to Greg’s own as he was battling with complex trauma. The following chapter gives a detailed description of the nine most common video game archetypes and the personality traits they suggest in the video gamers playing these types of characters: the Orphan, the Warrior, the Healer, the Ranger, Rogue, Spellcaster, Engineer, Athlete and Villain. For instance, the Warrior is characterised by “strength, vigor, stamina”, they are also considered “careless and lacking in thought” (109). Bean explains this archetype in the following way: “when individuals play as a warrior in video games, they tend to exhibit similar characteristics of the warrior in real-life encounters. They are in fact caught by the warrior archetype and use it to grind through their daily lives…Warriors require guidance and nurturing in order to hone their abilities and bring them to a higher side of critical thinking while becoming aware of their emotional power and how to use it appropriately” (111-112). While this is useful to better understand the relationship between real-life gamers and their avatars, it is important to note that there are more than the nine archetypes, and video gamers tend to play and identify with more than one archetype as they play in varying roles depending on the game.

The last three chapters further define the psychological effects and benefits of video gaming. Chapter 8 “The Importance of Play and Imagination” explores why it is worth playing video games. Bean discusses the importance of fantasy and make-believe play in children’s development but he notes it would be a mistake not to consider that “most adults play and use their imaginations on a daily basis” (137), from board games to cosplay (costume play) and LARP (live action role play). Bean argues that playing – in any form – is not merely entertainment but essentially a useful tool to cope with difficult situations in life and anxieties:

“The story of their character is what makes the fear lessen because the video gamer has developed the character…Through the relationship with the avatar the fear has been conquered through the power of the player and the character. By overcoming the fear in the video game, the video gamer has learned a method in which to appropriately appraise a situation and then use tools and experience their disposal to overcome a difficult situation. This same method of defeating a boss [enemy] in a video game can be extrapolated and translated to real life encounters of similar proportions.” (139, original emphasis).

Considering this, video games can be successful learning, developmental and therapeutic tools.

I found Chapter 9 “Understanding Video Gaming as Immersive” the most engaging as Bean was arguing the necessity of distinguishing between an experience of intense immersion and excessive and pathologic use of video games. Immersive gaming is facilitated by the psychological phenomenon of the flow: a state of full immersion. If there’s a right balance between concentration and difficulty level, video gamers can enter the state of flow. Csikszentmihalyi Mihaly’s term describes the gaming experience perfectly, and it explains why video gaming can be relaxing and beneficial for well-being. According to Bean “the culmination of this book and its contents” is Chapter 10 “Working Therapeutically with Video Gamers” (161). He further emphasises the necessity for clinicians to acknowledge biases they might have against gamers and learn about the technical and cultural aspects of video games.  He reiterates that in any clinical scenario it is crucial to understand the client’s worldview and that for gamers, not surprisingly, their personality, experience, imagination and behaviour are shaped largely by video games. He writes, “by having the ability to respond to the client’s video gaming habits from a multitude of perspectives, rapport is gathered quicker, clients feel as if they are being heard, and the progress of clinical therapy ensues” (162). With this he encourages starting discussions between clinicians and the clients and clients and their families.

The very last chapter offers ideas and further readings to facilitate this important work. Bean systematically addresses concerns discussed earlier in the book, for instance “My child plays video games after school with friends, I am worried they will not be social outside of their video games” (167), “How much screen time is too much screen time?” (170), or “Video game addiction is everywhere! Sound the alarm and get these kids help!” (171) and “Playing violent video games will make my child violent!” (171). The way these brief recap/debunking sections are written almost appears as a kind of “script” for clinicians to answer concerned parents’ most burning questions. While he emphasises that gaming in itself is not harmful – in fact it can be beneficial to cope with anxiety, depression and ADHD – he seems to maintain that the parents’ understanding of gaming is required in the process and clinicians have to be prepared to talk about gaming with clients and their families. For this reason, he explains that the Entertainment Software Rating Board, provides a tableau of age appropriate games and an archetype checklist enumerating personality traits linked to common characters found in video games, among other useful resources. It might have gone beyond the scope of the book but it would have been interesting to discuss the extent (or lack) of governance and legislation protecting children (and adults for that matter) against the gaming industry’s exploitative practices and what clinicians and parents, equipped with relevant knowledge of gaming, can do to influence policy and law making.

Bean claims that “this book should be considered a starting point in understanding the video gamer on a more sophisticated level” (7) – and it is a very good starting point. It sufficiently introduces relevant vocabulary and the epistemological framework required to contextualise the gamer and the gaming experience sensitively. The book is a great source book for those who have almost no knowledge of what video games are and consequently might have a negative mental image of video gamers. It is equally beneficial for academics, health professionals and medical students who would like to know more about video games and their cultural and psychological impact, and for gamers and their relatives who are interested in psychology and mental health. While it is incredibly refreshing to read about positive approaches to video gaming, and Bean’s case studies provide useful insights into video games and video gamers in the clinical context, it does not seem to investigate extensively enough the difference between therapeutic and pathological gaming experiences, which would have made his arguments even stronger and the book even more substantial for clinicians.

The review was edited by The Polyphony’s reviews editor Tehseen Noorani.

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