Sunday, October 17, 2010

They're Not Just Playing!

I was called to an area elementary school to perform a psychiatric screening on a 12 year old male threatening to harm the school staff. I was familiar with Alfonzo (not his real name) as a current client that I have screened and worked with over several years. Upon my arrival, I met with Alfonzo and his dad as well as his homeroom and special education teachers and the assistant principal.

As we entered the conference room, Alfonzo sat down and immediately started spinning in his seat. I was quickly reminded of his hyperactivity and my need to direct that energy. I gave him paper and a pencil and asked him to write, draw or fold something for me.

According to the special education teacher, Alfonzo kicked open the front door, flew down the hall into his classroom and dove into his seat. When confronted, he went back out, gently opened the door, walked to the classroom and sat in his seat. The homeroom teacher reported that as Alfonzo was given scissors for a craft project, he told her he would cut her like he did a teacher last year but then said he was “only playing.” And the assistant principal added that at the start of the school year when she asked Alfonzo to remove a straw from his mouth, he complied but only after telling her about the plate in his neck after being shot multiple times.

I asked Alfonzo about these behaviors and he readily admitted to each. I asked him to show me what he had done. One side of the picture was four figures with firearms and the other side eight figures with arms outstretched. I asked him to tell me about the picture. He described the scene as zombies versus the survivors, each zombie with differing characteristics and the survivors as he and his friends.

Being an avid gamer, I knew he was describing the zombies from Valve’s Left 4 Dead series. And I know these are games rated as Mature by the Entertainment Software Ratings Board (ESRB). But what I also remember about Alfonzo is that his father is a former gang member, his brother is incarcerated for a drive-by shooting and several other family members as victims and/or perpetrators of urban violence. The horrors in his front yard have been much worse than what he has witnessed in a video game.

I asked what he likes to do in his free time. He said “go outside to play basketball and tag or play video games.” I asked him what are his favorite video games and he mentioned Grand Theft Auto, Saints Row and Left 4 Dead.

The picture that Alfonzo drew is but one example of creative expression that has sent many school kids to psychiatric facilities around the globe. Too often, it is misinterpreted as a precursor to violence or a cry for help. In this case, Alfonzo’s picture represents his attempt to overcome and conquer his circumstances.

As he chooses and engages in his video game play, we can use that to develop rapport, assess strengths and weaknesses, explore sensitive areas and modify his thoughts, feelings and actions. As therapists are able to integrate music, art and movement into their therapeutic skill sets, video games should be seen as an evolutionary tool for multisensory engagement and behavior change.

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