Implications for Treatment
If we as clinicians are able to understand the experiences of people with gaming addictions, then we will be better placed to help them. Very little research has explored treatment for gaming addiction, and even less has looked at the experiences of gaming addicts who have received treatment. This was part of the reason why I undertook research for my Master's dissertation on exactly this topic. These findings are available online but I wish to discuss the key findings here and specifically the implications that these findings have for clinicians working with this client group. Since completing this research I have had the opportunity to work with and talk to a great number of people experiencing an addiction to gaming which has reinforced my belief in the importance of clinicians understanding and being able to address the themes I will discuss here.
The main findings from my research were that gamers in treatment experienced conflicting feelings of hope and fear. Hope, that they would receive help for what they had identified as a very serious problem in their lives, and fear of judgement, dismissal, shame or not being taken seriously. These feelings are common to most clients seeking therapy or mental health support for many issues, but specific themes emerged from conversations with gamers that were unique to their experiences in treatment. I will discuss these themes and the clinical implications arising from them here.
Judgement
Many people with gaming addictions speak about fear of being judged when seeking treatment. Some describe experiences in which they have been, or have felt judged by clinicians. There are therefore two points here that are worth addressing - expectations of judgement, and actual experiences of judgement.
Because gaming addiction is not an officially recognised diagnosis, many gamers spoke about expecting that they would be judged since they assumed clinicians also would be unaware of gaming addiction as a significant problem. Gamers spoke about fears of being judged as simply having low self-control, as being 'weak', or as embodying 'gamer stereotypes' of being socially awkward and incompetent. Many of these fears reflected the stigma and judgement that have tended to surround other addictions, particularly before these other addictions became more commonly recognised as being psychological conditions outside of a person's direct control. Fear of judgement by clinicians was heightened when working with clinicians who they experienced as having little awareness or understanding of gaming, as these clinicians were perceived as being more likely to see gaming in a negative light. In addition to fears of being judged by clinicians, most gaming addicts expressed fears about being judged by others in their life and having a tendency towards hiding or being secretive about their gaming behaviours because of this fear.
Many gamers also spoke about experiences in which they felt they did experience judgement from clinicians. A number of them described situations in which clinicians stated or implied that they should 'just stop', or that changing their gaming behaviours was a simple matter of willpower. Others spoke about clinicians seeming incredulous about the amount of time that they spent gaming, which they experienced as conveying a sense of judgement.
The implications of this theme are that clinicians need to be aware of gamers' expectations of judgement, and aware of their own thoughts, feelings and assumptions about gaming. Gamers described feeling more comfortable and had lower expectations of being judged when they experienced clinicians as somewhat knowledgeable about gaming, and curious about the gamers' experiences rather than venturing their own opinions or thoughts about gaming. As clinicians, it is important then (as it is with most aspects of clinical work!) that we are able to notice but suspend our own thoughts and feelings about what the client presents, and be curious about understanding and hearing it from their own perspective. There is of course nothing new in this - it should be a part of our work with all clients, but for those of us who are not familiar with gaming it may be helpful to take the time to think about our own beliefs and attitudes around gaming and how these might influence our responses with clients. It will likely also be useful to explore the client's feelings and expectations about how we might react to discussing their gaming, and to acknowledge that there have tended to be historical stigmas and stereotypes surrounding gaming.
Dismissal
A closely related theme that emerged from discussions with gaming addicts was fears and experiences of being dismissed or not taken seriously by clinicians. Again, at least in part due to the lack of any formal diagnosis for gaming addiction, many gaming addicts described an expectation that clinicians would not believe them, or would not recognise their gaming as being a problem. This was mirrored by the reality, where many gaming addicts described experiences of clinicians dismissing their concerns about gaming. A number spoke about clinicians wanting to focus on other possibly related issues such as depression and social anxiety, rather than the gaming itself.
Depending on the person, clients responded to these experiences of dismissal in different ways. Some spoke about feeling that they had to fight hard to be taken seriously, and feeling that they were the 'exerpts' in their own problems, or that they had to struggle to advocate for themselves. Others spoke about becoming shut down by clinicians and going along with treatment plans and suggestions that ultimately proved unhelpful, as they felt that they were not addressing the 'core' issue.
Clinicians therefore need to be aware that for some clients, addictive gaming may be a core issue that is at least in part a cause - rather than a consequence - of other related problems. It is important that clinicians listen carefully (but not blindly!) to client narratives, and be willing to trust client's accounts of their own experiences. Clients reported that when clinicians seemed open to hearing their perspectives, and were curious and challenging about these perspectives without being dismissive, that they felt more supported and able to benefit from treatment.
Belief In Self
From a more positive perspective, clients experienced greater commitment to treatment and described benefiting more when they had a strong belief in self and in the validity of their own experiences. Because many clients did report experiencing judgement or dismissal in their attempts to find treatment, those who benefited the most were those who felt able to continue seeking support despite these experiences. This was often driven by a strong belief in their own perspective.
Clients who felt that this belief in self was mirrored and supported by clinicians described feeling positive about treatment and hopeful about the possibility of change. A number of clients described a point at which they felt they had found the 'right' clinician, which was often associated with feeling that they were being heard and their viewpoint acknowledged by the clinician. Clients also described feeling a greater sense of belief in self and their ability to control or overcome their addiction as they gained greater knowledge about addictive processes in treatment. As they came to understand addiction, they described feeling greater understanding of themselves and greater belief in their capacity to change.
Clinicians can assist clients in recovering from gaming addictions by supporting existing belief in self, and helping clients to see and challenge self-destructive and self-denigrating mechanisms within themselves. Clinicians can do this by taking client experiences seriously, and by inviting clients into a collaborative therapeutic alliance that recognises the client's role as a co-participant and an expert in their own experiences. Where clinicians know little about gaming and gaming addiction, this can be facilitated by asking the client and being curious about their experience with gaming - allow them to teach you what you do not already know. Alongside this, clinicians can help clients develop greater belief in self through some psycho-education about the processes of addiction, if clients are not already familiar with these.
Identity and Belonging
Perhaps because gamers often experience a strong sense of inclusion and belonging through gaming, many gaming addicts in treatment spoke about the benefits of identifying and connecting with others who were also attempting to overcome gaming addiction. The sense of belonging and being needed by others that games offer is a powerful motivator for many, and support groups offer a way for clients to experience this outside of gaming. Even when this was not experienced through group treatment, clients described feeling more positive about treatment and experienced more positive outcomes when they felt a sense of belonging in therapy or within the treatment programme.
Clinicians can facilitate better treatment outcomes for gaming addicts by being aware of the ways in which gaming meets psychological needs for identity and belonging, and helping clients to find other ways to meet these needs. In particular, clinicians will benefit from being aware of support groups and communities that clients can join, such as those listed on the Where To Get Help section of this site. Apart from support groups though, clients also described feeling more confident about overcoming their gaming addiction when they were able to engage in other social activities outside of gaming, and so clinicians may have a role in helping clients identify and build new social opportunities and connections.
Conclusions
Gaming addicts who come to treatment will, understandably, carry a lot of expectations and assumptions about how they will be received. On the other side, we as clinicians will hold our own thoughts, views and feelings about gaming that we bring into the therapeutic relationship. How we manage this as clinicians will depend on our own awareness of our self and our views, and our knowledge about the likely expectations that gaming addicts will have. The more we are able to approach the initial meeting with an attitude of openness and curiosity, the more likely we are to establish an effective working relationship.
Further, the more we are able to really hear the client's account of their own experiences, the less likely they are to feel dismissed and the more likely to feel a sense of belief in their own capacity and ability to change. This can be further supported by helping the client to identify the psychological needs that gaming has been meeting for them, and alternative ways in which they can meet these needs outside of gaming. In particular, gamers likely experience a strong sense of identity and belonging arising from their gaming, and we as clinicians can play a role in supporting them to develop a new sense of identity and belonging that is not tied to this addiction.