SW 2.0: Going Where the Client Is: Exploring Virtual Clinical Social Work Practice

By: Karen Zgoda, MSW, LCSW, ABD

Editor’s Note: This is the final installment in Karen Zgoda’s SW 2.0 series. In the past three years, Karen has introduced THE NEW SOCIAL WORKER’s readers to many innovative uses of technology. I would like to express my sincerest gratitude to Karen for sharing her passion for and knowledge of all things tech with our readers.

It was a dark and not-so-stormy night. At least it was in Boston, where I was physically located, and across the river into Cambridge, where Mike Langlois was. Nancy Smyth was situated in my hometown of Buffalo, NY, and Linda Grobman, publisher of The New Social Worker, was in Harrisburg, PA. Virtually, however, we were all together video chatting in a new Google Plus (G+) hangout. I had never met Nancy in real life, but she had met Mike via their related work. Mike and I had met after connecting over Twitter, and Linda and I met at a social work conference after e-mailing for years.

    The G+ experience raises some interesting questions about learning, social work practice, and human interaction and connection. Geographically, where do they all take place? Are they bound by a ZIP code or physical presence? Don’t they occur where the human connection is, even over a simple text message that shares a funny joke with a loved one? Are the experiences of learning or human connection one size fits all, or are these experiences just as diverse as we are? By extension, why does virtual social work practice have to be such a hard sell to social workers? How might our social work practice also take place and be extended virtually?

    Nancy and Mike are at the forefront of incorporating virtual technologies into their practices. Nancy is the Dean of the School of Social Work at the University of Buffalo, author of the Virtual Connections blog (http://njsmyth.wordpress.com/), and is very passionate about this work. According to Nancy, “technology is all about talking and collaboration,” and it represents a great shift from a more traditional one-way communication model. She considers collaborative technology use as vital to keeping social work competitive as a profession:

We need to learn how to use this stuff to stay competitive and show up on the radar or folks will not select us as a profession. People are looking online for career options and information. We will be left behind.

    Mike is a practicing clinician and author of both Reset: Video Games and Psychotherapy (http://www.amazon.com/Reset-Video-Games-Pychotherapy-ebook/dp/B005KLSUPG/ref=sr_1_1?ie=UTF8&qid=1314920323&sr=8-1) and the Gamer Therapist blog (http://gamertherapist.com/). According to Mike, our clients have already integrated technology tools such as text messaging and social media into their lives. Like Nancy, he agrees that social workers need to better incorporate our clients’ technology practices into our social work practice. Mike adds that our clients shouldn’t be burdened with teaching us technology and roots the process of technology discovery and learning within the social work tradition:

Anytime most people are using something and we refuse to know about it, that’s a problem. It’s important to learn and start where the client is. This is not new, and requiring social workers to stretch into technology is similar to first conducting a home visit. You’re a guest, thrown in, and it’s very difficult. We need to apply the principles of social work to technology–tech is not negotiable anymore. We need to meet people where they are at. Social work has a rich tradition of doing so even when it has been difficult.

    Nancy adds, most importantly:

We are missing out on connections. It’s always about relationships, not the technology. We need to understand some of the possibilities, especially with our clients. Where else can you make connections with thought leaders in our profession and get their opinions?

Second Life

    To that end, Nancy and Mike conduct what is commonly called virtual clinical social work practice. Nancy’s work examines virtual online environments, including Second Life (http://secondlife.com/). Second Life is a virtual environment that is accessed via downloaded software and an Internet connection, and you connect with other people in the form of avatars. According to Merz Nagel and Anthony (2011) (http://www.onlinetherapyinstituteblog.com/?p=1406), an avatar “is a graphical representation of someone, usually a human form” (p. 6). Nancy states that virtual interaction and participation with others can lead to positive results and increased learning both in the client and the therapist:

One of the advantages of virtual worlds is the ability to create simulated experiences that can help us learn something about experiences other than our own, as well as providing an opportunity to help us make sense of our own experience. (Smyth, 2011)

    Nancy further describes in a blog post (Smyth, 2011) what it is like to explore the Virtual PTSD Sim in Second Life and includes screenshots so you can better understand what it is like to explore this virtual place. Nancy points out that virtual environments “raise questions about space, boundaries, connection, and the nature of reality. The environment is virtual, but the feelings are real.”

    Merz Nagel and Anthony (2011) practice what they call avatar therapy in Second Life, which they describe as follows:

The client as avatar and the therapist as avatar meet in a virtual location. This could look like anything, depending on what the therapist has created—a calming office with mood lighting, a beachside location with lapping waves and seals gently playing, a dynamic play room with beanbags to sit on...clients...may choose whatever part of their psyche they wish to represent, from aardvarks to muscle-bound sexual warriors. This in itself presents a dynamic way of exploring one’s psyche or that of the clients and, with careful management and titrating of emotions, many life scenarios can be explored.

    To further explore social work practice in Second Life and other virtual environments, check out the following resources:

Smyth, N. (2010, November 3). The power of virtual placemaking: A transformational memorial. Retrieved from http://njsmyth.wordpress.com/2010/11/03/the-power-of-virtual-placemaking-a-transformational-memorial/

Vernon, R., Lewis, L., & Lynch, D. (2009, Fall). Virtual worlds and social work education: Potentials for “Second Life.” Advances in Social Work, 10(2), 176-192. Direct link at: http://advancesinsocialwork.iupui.edu/index.php/advancesinsocialwork/article/view/236/219

Social Work Spaces in Second Life, http://home.comcast.net/~dbsocialwork/secondlife/slswplaces.doc and their main site, Human Services Media, http://www.hsmedia.biz

In Counseling–Behavioral Therapy in Virtual Worlds, http://www.metanomics.net/show/in_counselling_-_behavioral_therapy_in_virtual_worlds/

“Web therapy” for PTSD? (PBS Frontline), http://www.pbs.org/wgbh/pages/frontline/foreign-affairs-defense/the-wounded-platoon/web-therapy-for-ptsd/

Bond Chapman, S. (2011, January 21). BrainHealth researchers developing unique program for adults with autism and asperger’s [Press release]. Retrieved from http://www.brainhealth.utdallas.edu/index.php/blog/brainhealth-research-studying-autism-and-aspergers

Virtual Human Interaction Lab at Stanford University, http://vhil.stanford.edu/

Gaming

    One of Mike’s specialties is using gaming as a conduit for working with clients, especially since many of his clients are already active gamers. Mike feels that interacting virtually can have real-world impacts:

Playing an avatar can have a real effect; less than 90 seconds of playing an avatar, if you felt it was strong, you would experience feelings of confidence. For example, I will sometimes have a small child who is experiencing bullying play a strong avatar in the AM to help prepare for school and feel and extend their confidence. Doing this virtually can impact their real neurology.

    In fact, Mike often bases his work in gaming and psychotherapy on psychodynamic theory and draws many parallels between them:

My blog readers may note that I frequently draw parallels to psychoanalytic theory and video games...our profession has a rich theoretical history that has grown from individual therapists learning from each other, disagreeing with each other, building on the prior work of each other and diverging from each other. Psychology as a field to flourish has had to frequently “save and continue” [much like when one is stopping and playing a video game over a period of time] by writing these theories down in journals and now blogs, to take stock of what we have learned, but we also have to move forward and continue to challenge pre-existing models. It can never be just save or just continue: To just save would stagnate our thinking and practice, and to just continue would mean we never consider thoughtfully the work we are doing.

    Mike often sees the challenges presented in video games as opportunities for learning, practicing new skills, and as platforms for group problem solving. He feels that learning and practicing these skills will be invaluable for success in our increasingly interconnected, global economy. Mike strongly feels that social workers have a unique opportunity to aid that skill development. For example, in terms of the video game Portal 2 (http://www.thinkwithportals.com/), Mike posits:

Portal 2 is an ingenious game with a pretty simple goal:  Figure out how to get from point A to point B. Okay, so maybe the game, and plot, are a little more complicated....Your character wakes up in the labyrinthian depths of Aperture Industries, now in ruins and abandoned. Except for a homicidal robot who remembers how you tried to destroy her (in the original game) and plans to return the favor.... Portal 2 hinges on the ability to analyze the game environment, think in terms of cause and effect, plan a sequence of events, and rethink failed combinations. In other words, Portal 2 is about problem-solving. If we can begin to present education as more intrinsically rewarding, we will see a lot more persistence. And if we can begin to present learning as group problem-solving, we will see a lot more trust and teamwork, which will set kids up for succeeding in a global Web 2.0 world. Psychotherapists are often uniquely positioned to help with this, but many of us have not embraced the technology and mindset to do this.  We continue to set up sticker charts and give out stars when we could be using Chore Wars (http://www.chorewars.com/) or the WoW Achievement Generator (http://thetural.com/wow/). We could help adolescent patients problem-solve and learn how to use Facebook to enhance their social skills or use Twitter for school projects. 

    To further explore social work practice and gaming, check out the following:

Langlois, M. (2011, January 22). What do gamers and social workers have in common? Retrieved from http://gamertherapist.com/blog/2011/01/22/play-gamers-and-social-workers/

Ben’s Game—Developed with the Make-A-Wish Foundation and Ben Duskin, this game empowers children with cancer to fight cancer in a game environment: http://www.sfwish.org/site/pp.asp?c=bdJLITMAE&b=81924

Online game Foldit helps anti-AIDS drugs quest (BBC News), http://www.bbc.co.uk/news/technology-14986013

Gee, J. P. (2003). What video games have to teach us about learning and literacy. New York, NY: Palgrave Macmillan. Related blog: http://www.jamespaulgee.com/

References

Merz Nagel, D., & Anthony, K. (2011, August). Avatar therapy. The CAPA Quarterly: The Journal of the Counsellors and Psychotherapists Association of NSW, 3, 6-9.

Smyth, N. (2011). Virtual worlds as immersive treatment settings: The PTSD Sim. Retrieved from http://njsmyth.wordpress.com/2011/03/25/virtual-worlds-as-immersive-treatment-settings-the-ptsd-sim/

A Note From Karen:

    It is with a heavy heart that I bid farewell to writing the SW 2.0 column regularly. Unfortunately, I am not able to write the column on a regular basis while wrapping up my dissertation at the same time. I will still write about technology for The New Social Worker as time permits, and will blog about technology and social work at http://www.karenzgoda.org. I hope the column helped you think about integrating technology into your practice in new ways and explore the possibilities these technologies extend. I strongly believe it to be at the heart of innovative social work practice in the future, and look forward to seeing your contribution to the field. Although we won’t get to hang out via the column as often as we’d like, Linda and I are brainstorming ways to continue to provide this information, so stay tuned. Keep pushing the envelope, trying new ideas, reaching out and connecting with one another, and learning new ways to connect with clients and help them help themselves on their journey. It has been my pleasure to interact with you and explore how social workers can use technology better. Learning new things helps us grow and develop as a profession and as professionals, and a proactive attitude toward innovative practice will ensure that we are doing everything we can to help the clients we care about so much.

Karen Zgoda

Karen Zgoda, MSW, LCSW, is an ABD doctoral student at the Graduate School of Social Work at Boston College. Her research interests include the role of technology in social work, the effects of information communications technologies (ICTs) such as the Internet and e-mail, poverty and class, aging, social informatics, socioeconomic development, public policy, and community practice. Karen is the chief editor and founder of EditMyManuscript.com, providing manuscript editing services to students, faculty, and other social work professionals. Her Web site is http://www.karenzgoda.org. You can follow her on Twitter at http://twitter.com/karenzgoda.

This article appeared in THE NEW SOCIAL WORKER, Fall 2011, Vol. 18, No. 4, pages 24-26.