Could ’empathy games’ play a role in treatment?
I occasionally take an interest in the ongoing “GamerGate” controversy, which is odd since the only game console I own is my mid-90s Game Boy loaded with Tetris. This post isn’t about GamerGate, but if you have an interest here’s a link. Although this post is not about GamerGate, it’s always good to read widely (it’s Habit #3 of Michael Seto’s advice to new researchers on this blog!). I would, however, encourage you to read this post by Liana Kerzner, which inspired this one, because it’s a wonderfully-written and objective examination of the issue of misogyny as it relates to video games. It also got me thinking about how we address empathy deficits in sex offender treatment – but we’ll get to that.
First, a little context.
In her deconstruction of issues in applying traditional theories of mass media consumption (in this case particularly cultivation theory and gaze theory), Kerzner argues that, “we can’t assume video games cultivate perceptions of social reality the same way that television does: video games hinge on a give and take between player attitudes and messages delivered by the game.”
This differentiation between passive reception and active participation and the notion that empathy requires an object that generates an empathic response is, I think, directly applicable to the context of cognitive-behavorial therapy (CBT). Kerzner expands on this: “A TV viewer feels no responsibility for the characters in a show. In a game, I feel greater responsibility for not harming the character I’m controlling, and this leads to very different reactions between player and viewer.”
“Video games hinge on a give and take between player attitudes and messages delivered by the game” ~ Liana Kerzner
To exemplify this point, she describes her experiences playing empathy games, a relatively-new genre of video games. In these games the developers tailor the rules and procedures of the game in order to create contexts in which decisions are not only instrumental to further the game’s “plot” (for want of a better word) but also take moral and relational factors into account.
The empathy game Kerzner focuses on in her post is called Papo and Yo. This is a game in which the player plays as Quico; a young boy who has to solve a series of puzzles with his friend Monster, who is addicted to poisonous frogs. Eating a frog causes Monster to act violently – including towards Quico – and the player is required to use Monster’s emotions, good and bad, to the advantage of all.
The game’s designer, Vander Caballero, explains that the game is inspired by his experiences of his father’s alcoholism, and in a 2012 interview with Wired said, “When you’re living with an addicted person, you’re always struggling to save them — knowing deep inside that there’s nothing you can do. We protect others with the desire that our protection of them will reflect back on us. That’s the struggle I want to bring to players.”
In its broadest (and briefest) sense, empathy is the process through which an individual understands and vicariously shares the affect and emotions of another – a human social response to emotional expressions. It is a crucial adaptive process that benefits humans, living as we do in social groups, as it promotes affective communication and pro-social behavior. Having insufficient empathy is considered to play a contributory role in aggressive behavior – although recent meta-analyses (1, 2) have found only weak relationships between empathy deficits and sex offending specifically.
Nonetheless, empathy is ubiquitous in our field. It is invoked in DSM-5 diagnoses of conduct disorder, antisocial personality disorder, and narcissistic personality disorder, as well as descriptions of psychopathy – disorders frequently reported in the forensic mental health context. It also informs our understandings of elevated levels of antisociality in theories of sexual violence (e.g., Seto’s motivation-facilitation model, Ward & Beech’s integrated theory of sex offending, etc).
CBT programs for perpetrators of sexual violence typically include a module designed to address issues of victim impact and empathy deficits.
Furthermore, addressing empathy as it relates to the client-therapist relationship is a key philosophical element of strengths-based approaches to offender rehabilitation (e.g., the Good Lives Model). As Ian McPhail – a much more experienced clinician than I – explained to me, the empathic understanding of the therapist is a key element across the gamut of therapy orientations, since demonstrating empathy as a clinician not only helps a client feel understood but also models empathy in practice. Subsequent to this social-learning process, the client and clinician seek to generalize that interpersonal strategy outside the treatment room. Consequently, whether they be risk- or strengths-based by nature, CBT programs for perpetrators of sexual offenses typically include a module designed to address issues of victim impact and empathy deficits.
So Kerzner’s post got me thinking: how do we ‘teach’ empathy in sex offender treatment? How can we augment that generality we seek outside the treatment room? Could empathy games make a positive contribution to that process?
According to a recent practical review by Tony Ward, “[the] major aim of the empathy module is to encourage offenders to reflect on the impact of sexual abuse on victims and their families. This is achieved through the use of victim biographies, role plays of the index offense, and the assimilation of information about sexual abuse and its consequences for victims.”
There seems to be little opportunity for clients to authentically experience situations requiring empathy and formulate, apply, and rehearse genuinely empathic responses.
It seems to me, however, that these introspective devices and exercises are somewhat artificial, contrived, and abstract. Correct me if I’m wrong, but there seems to be little opportunity in that setting for the client to authentically experience situations requiring empathy and formulate, apply, and rehearse genuinely empathic responses.
This is why I found the concept of empathy games so interesting. Let’s recap Kerzner’s description of the video game experience: “a give and take between player attitudes and messages delivered by the game”. Video games are immersive and afford the player agency – the capacity to act on their environment and to experience the consequences of those actions. In Papo and Yo, the player is not required to empathize with the Monster character, but doing so is beneficial to success in the game. As Kerzner notes, the player needs to assume responsibility for the welfare of the character. There is a concrete object of empathy. Indeed, there are two objects of empathy, Quico and Monster
Thus, perhaps these games represent a unique and engaging way in which to illustrate the concept of empathy to clients and have them actively engage in empathic reasoning and perspective-taking – all in a safe and relevant context. Particularly – but not exclusively – for juveniles and young-adult clients, since they are typically the core audience for video games, or for clients with lower verbal abilities (but adequate visual-spatial abilities).
In Papo and Yo, the player is not required to empathize with the Monster character, but doing so is beneficial to the game… the player needs to assume responsibility for the welfare of the character.
There are some general and specific issues that would need to be ironed out, should we believe that experimenting with empathy games in treatment is worthwhile. Generally, it is important to note that we strive to ensure that practice in forensic rehabilitation is evidence-based. The use of empathy games has obviously not been specifically evaluated for its effect on offender rehabilitation, and so I am not advocating for swapping empathy modules for PS3s and game-controllers just yet. It is true that computer games have been used in psychological treatment though, for PTSD and anxiety for example, and are reported to produce a real and beneficial effect on behavior. Nonetheless, there is no concrete evidence that empathy games either (a) actually do indeed affect empathy and not some other (perhaps related) construct, or (b) affect a change in levels of empathy within the player either in the short-, medium-, or long-term.
Specifically, there would be issues in choosing an appropriate empathy game and ensuring that the client is able to appreciate ‘empathy’ as the intervention in which they are enrolled intends. In the example of Papo and Yo, acting empathically remains ultimately instrumental (as opposed to intrinsic) – to succeed in the game you need to utilize behaviors that would be considered empathic. Therefore, it is not axiomatic that playing the game and engaging in those behaviors demonstrates genuine empathy rather than pseudo-empathy (i.e., affective mimicry) or non-empathic instrumental thinking – doing whatever it takes to win the game with no appreciation of the moral undertone.
Finally, in Papo and Yo, Monster is… well, called ‘Monster’, which is a problematic and less-than-useful label when working with perpetrators of sexual crimes.
Where empathy games could prove useful is by providing a more active, immersive experience of recognizing, understanding, and demonstrating empathy.
In light of this, what I am advocating here is not that empathy games represent an alternative to traditional CBT techniques in sex offender treatment. But when clinicians approach empathy in sex offender treatment, they are oftentimes required to clarify and communicate an abstract and complicated psychological concept by way of abstract and contrived scenarios. Where empathy games could prove useful is in augmenting that process by providing a more active, immersive experience of recognizing, understanding, and demonstrating empathy and what it means to take the perspective of another and be accountable for their welfare.
Quoth therapists Edward Teyber and Faith McClure, “[if] the therapist and client merely talk about the important issues and behavioral options, but the therapist does not actively help the client link these new ways of relating with the therapist to other relationships where the same kinds of interactions are causing problems, change will not occur.”
Empathy games may present a way in which to link behavioral options to interactions with others in an in-vivo therapeutic environment; but, as goes the trope, “more research is needed”.
Elliott, I. A. (2015, November 22). Could ’empathy games’ play a role in treatment? [Weblog post]. Retrieved from http://wp.me/p2RS15-ca.
Want to submit your own post? Click here to find out how!