GamesIndustry.biz Game Changers is a series of profiles on the groups and individuals going the extra mile to make the games industry a better place. These interviews encompass folks from around the world helping to improve conditions and attitudes towards diversity, equity, inclusion, accessibility, mental health and more. You can read more Game Changers interviews here.
Ryan Earl didn't originally set out to become Dr. Mick, a PhD and licensed marriage and family therapist who discusses games and mental health.
In fact, Earl tells GamesIndustry.biz he didn't originally set out to become a doctor at all, beginning university as an advertising major.
"The reason I liked advertising was that it was a way to mix art with the psychological component of advertising," he says. "I thought it was really interesting that you could influence people's decision-making with art."
It was less interesting after he took a few classes in the field "and hated them."
Fortunately, he found his calling in another class that wasn't actually related to his eventual profession. Earl took a sociology course that happened to be taught by a retired marriage and family therapist, who mentioned something about his old clinical work in class one day.
Something in that notion clicked with Earl, so he stuck around after class to ask the professor about the field. He also missed his next class as he spent the better part of an hour picking the professor's brain about the career of a therapist.
"It made me reflect on the fact that when I was in middle school and high school, I would stay up until 2 or 3 am every night on AOL Instant Messenger and there were countless people that would talk to me about issues that were going on in their life and their relationships," Earl recalls.
"I want to destigmatize therapy"
Whatever it was about him that made him such an in-demand confidant in high school, Earl thought it could make him well-suited to follow in his professor's footsteps. He switched majors, transferred schools, and set out on his new career.
After an undergraduate degree, a masters and a PhD, Earl was a doctor, but not yet Dr. Mick.
That didn't happen until 2018, when Earl, as a clinical assistant professor of psychology at Northwestern University, saw tweets from streamers like Dr. Lupo talking about how common it is for people to open up to him, specifying that he is not a therapist.
"And I was like, 'Hey, I'm a therapist. Since I've played games my entire life and written about them academically, I wonder if I could combine those two things.' So I went and built a PC and started, having never really watched Twitch before. And it went from that."
Another nudge toward streaming came from what he calls "a bit of an existential crisis" with his faculty job.
"I always felt it was my dream job, but I felt so limited in my ability to have an impact," he says. "I didn't really feel like I was reaching anybody outside my clients and my students."
His reach through streaming has grown considerably. Dr. Mick now has nearly 16,000 followers on each of Twitch and YouTube, and 145,000 on TikTok. He does a lot of Let's Play content where he assesses popular games like God of War Ragnarok and The Last of Us Part 1 from the point of view of a therapist, pointing out psychological concepts for the audience and talking about characters' relationships and mental health.
He also has more purely educational content on his YouTube channel, like lectures about mental health or a video on how to find a therapist.
Along the way, he also left Northwestern and went into private practice with his wife Ali Earl (also a licensed marriage and family therapist), opening up Starline Therapy and seeing clients in the two states where he's licensed, Nevada and Illinois.
"I think the stigma that exists [about therarpy] permeates through just about any group"
"I want to destigmatize therapy," Dr. Mick says. "My goal is to really make folks who watch my content feel a little bit more comfortable with the idea of potentially seeing a therapist."
He suspects that stigma around therapy among gaming audiences might be slightly more pronounced than in society at large, but not by much.
"I think the stigma that exists permeates through just about any group," Dr. Mick says. "I think it's getting better, but I still see so much of the idea that if you go to therapy you're weak, that your therapist is only interested in you struggling so they can make more money, that you have to have a 'good enough' reason to go to therapy… I think a lot of people still think therapists are these buttoned-up old people that sit with a clipboard while you lay on a couch, and that's just not how it is."
Dr. Mick would be an example of that, typically wearing a backwards baseball hate and sports t-shirt as he streams, and sporting visible tattoos.
"That's how I do my job as well," he says. "When I see clients, I'm dressed incredibly casually. My goal is to diversify a bit of the representation people hold via the stigma, where they look at me and go, 'Holy crap, I could talk to that guy. That guy looks like a fellow gamer and you're telling me he's a therapist and has something to offer with me taking care of my mental health? That's really interesting. Maybe there are more people out there like that.' And there are."
One thing Dr. Mick doesn't do is provide therapy or give assessments on stream, as it would be a breach of professional ethics.
"My credential precedes me always, so I have to abide by my code of ethics at all times, and that comes into my stream with my boundaries, saying, 'Here's the limitations of what I can provide…' Really, the more credentialed you are, the more limited you are in your ability to offer specific information tailored to people's context. I have to stick more to general information and resources."
That said, there are plenty of people on social media without such credentials or boundaries. Dr. Mick thinks of there being three lanes for people to occupy as content creators when talking about mental health. He's in the first lane as a credentialed professional, and it's not a particularly busy lane to be in.
"I know how much work I put into making sure that what I am putting out there is going to be helpful. I know people jokingly say exposure is an artist's worst nightmare because they have to make a living, but for me exposure really is super important"
There are also advocates, people who may be well-read on the subject of mental health and aware of resources, but are most effective in Dr. Mick's eyes as a way to connect people with properly vetted information about the subject as well as actual professionals.
"The thing that's incredibly important for advocates to realize is that if they're not explicitly clear with their limitations and lack of credentials, they run the risk of being co-opted by viewers as being legitimately credentialed professionals," Dr. Mick says.
"And that's where it can get dangerous because if they are not giving out good information, or if they are giving advice that's direct because they can because they don't have a code of ethics to live by, but people are still perceiving them as being in a credentialed position of power, that can really cause problems for viewers. So there needs to be some level of awareness and also being upfront about those limitations and staying in that lane."
Finally, Dr. Mick says there are other content creators who maybe struggle with their own mental health in some way like depression or ADHD, and just want to talk about it so people in the audience with their own mental health struggles might know they're not alone. That's also a wonderful thing, he says, provided they are clear about it just being their personal experience and encourage others to talk to their own doctors or therapists to find what will work for them.
"I think if you have all three of those lanes operating within those lanes, and people really thinking about what that means, it's a wonderful thing because you have this growing conversation about the importance of attending to your brain in addition to attending to other aspects of your health," Dr. Mick says.
Of course, people don't always stay in their lane.
"There's really bad information out there... It gets people thinking they have to have a diagnosis in order to have legitimate struggles"
"Mental health TikTok is an example for me of a place where there is misrepresentation up the wazoo, people are glamorizing mental illness, there's really bad information out there," Dr. Mick says. "I don't think that's good because that muddies the water. It gets people thinking they have to have a diagnosis in order to have legitimate struggles."
As for who helps him do what he does, Dr. Mick points first to his wife Ali "in a very meta and profound way" for the support she has given him and his efforts since day one. Talking more specifically about helping him with the nuts and bolts of content creation, he notes JareOnAir, his "acting manager" who vets partnership opportunities, moderates conversations and other tasks, as well as seanseanseanh, who handles videography for the streams as well as editing and posting to social channels.
"I would not be able to put content out at the pace I put it out if I didn't have the two of them actively helping me," Dr. Mick says.
More help is always welcome though, and Dr. Mick says the industry could help expand his reach with partnerships and exposure.
"What I always come back to is I need eyeballs," he says. "I know that what I offer is good information. I know how much work I put into making sure that what I am putting out there is going to be helpful.
"I know people jokingly say exposure is an artist's worst nightmare because they have to make a living, but for me exposure really is super important.
"As the industry is moving in a direction where mental health is a conversation coming up more often, I think it's really important for companies that have visibility in the content creation space and the gaming space to make sure they are partnering with people who are doing these types of conversation and content ethically, especially if they want to have professionals that are endorsing their product or backing them up."
Dr. Mick also notes he's willing to work with developers to talk about whatever they might be trying to accomplish in regards to mental health, or to consult with them on the use of psychology or depictions of therapy in their games. He'd also like to serve as a resource for platform holders to help them better talk about and focus on mental health, and to create tools for their platforms along those lines.
"There's a mutual partnership there in terms of what I can offer in terms of doing the mental health thing right," he says.
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