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Alex Basche, LMFT - Guest
Alex Basche, LMFT is a psychotherapist based in the SF Bay Area. He works mainly with adolescents and young adults, specializing in the treatment of tech-related behavioral addictions such as gaming, social media, pornography, online gambling & shopping in addition to substance use disorders, as well as frequently co-occurring conditions such as anxiety disorders, ADHD, depressive disorders, OCD, Autism Spectrum, and identity formation issues. In 2017, Alex helped create and found the first in-network Intensive Outpatient Program in the state of California treating technology addiction in adolescents. He has written many therapy groups’ curricula and leads trainings and workshops on topics related to Assessment & Treatment for Process Addictions, Parenting in the Digital Age, Adolescent Anxiety & Depression Treatment and more. Alex serves as a Subject Matter Expert (SME) on the Mental Health Workgroup Advisory Board for Fairplay’s Children’s Screentime Action Network and on the Board of Directors for local nonprofit Adolescent Counseling Services. He continues to co-author and present research on digital addictions and related topics. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D.: (00:24)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including family systems, cognitive behavioral therapy, emotionally focused couples therapy, eye movement to sensitization reprocessing, motivational interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using emotionally focused couples therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma;
Keith Sutton, Psy.D.: (01:26)
And our center for ADHD and oppositional and Conduct Disorder clinic, where we're integrating those four approaches. In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment training and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D.: (02:19)
Today, I'll be speaking with Alex Basche, who is a licensed marriage and family therapist based in the San Francisco Bay Area. He works mainly with adolescents and young adults, specializing in the treatment of tech-related behavioral addictions such as gaming, social media, pornography, online gambling & shopping in addition to substance use disorders, as well as frequently co-occurring conditions such as anxiety disorders, ADHD, depressive disorders, OCD, Autism Spectrum, and identity formation issues. In 2017, Alex helped create and found the first in-network Intensive Outpatient Program in the state of California treating technology addiction in adolescents. He has written many therapy groups’ curricula and leads trainings and workshops on topics related to Assessment & Treatment for Process Addictions, Parenting in the Digital Age, Adolescent Anxiety & Depression Treatment and more. Alex serves as a Subject Matter Expert (SME) on the Mental Health Workgroup Advisory Board for Fairplay’s Children’s Screentime Action Network and on the Board of Directors for local nonprofit, Adolescent Counseling Services. He continues to co-author and present research on digital addictions and related topics. Let's listen to the interview.
Keith Sutton, Psy.D.: (03:35)
Hi, Alex. Welcome.
Alex Basche, LMFT: (03:37)
Hi. Thanks for having me. Happy to be here.
Keith Sutton, Psy.D.: (03:41)
Yeah, I'm so glad you could join us. So, I had learned about you -- I know that you're doing some work on internet screen, kind of, gaming addiction, and particularly with teenagers; and you work over here in the Bay Area; and was really interested in learning more about your work. And this is such a big issue that comes up so much for so many families, as well as I do a lot of work with adults with ADHD and struggling with, you know, kind of screens and, you know, difficulty kind of with procrastination avoidance. So, it's a really big issue. So I'd love to hear about your thoughts and your work and knowledge in this area, but first I'd like to find out about, you know, how you got to doing what you're doing, your kind of evolution of your thinking that kind of got you here.
Alex Basche, LMFT: (04:27)
Yeah, so for me, I've kind of always been working in the field of addiction. And I kept running into early my career just kind of like a lack of resources and certainly a lack of experts to consult. So if I had a client that had, you know, a dual diagnosis, co-occurring anxiety with substance abuse, there was no shortage of people I could reach out to ask for help, resources online. But the second it became anything related to, you know, a digital process addiction or behavioral addiction, or even just digital wellness, was kind of like, just crickets. And that led me on kind of a journey of exploration and reaching out to international communities because a lot of other countries are light years ahead of us in that, as well as other areas of mental health. And I got linked up with Dr. Hillary Cash, who runs a, you know, one of the top programs in the country at reSTART. And she really just was, I mean, amazing in terms of connecting me to resources and people and everything like that. So that really kind of gave me the jumpstart I needed.
Keith Sutton, Psy.D.: (05:46)
Great. Wonderful. Very nice. Yeah. So tell me about yeah, this kind of whole idea, even of an addiction and I think, yeah -- you mentioned process addiction, behavioral addictions. Can you talk a little bit about that, you know, and kind of how that's differentiated in the addiction fields from more of, I guess, a biological addiction?
Alex Basche, LMFT: (06:07)
Sure. So, you know, like, I think for a lot of people, particularly in the Bay Area, right? Growing up in an environment where, you know, not only your family but your peers are kind of constantly pushing the boundaries of excellence and trying to create like a culture of intense competition, you know, obviously creates a lot of pressure. And so when we're put in situations that, you know, generate pressure and stress, right, we tend to want to try and find ways to cope with that. And one of the ways is through using substances, but another way that tends to be more socially acceptable is, using technology. And whether that's, you know, doom scrolling on social media, or trying to connect with people online through apps like Discord, or going on just sort of a deep dive, one might say, on the internet.
Alex Basche, LMFT: (07:06)
Kind of, whatever the version of this is, the sort of results are the same. And that is that it tends to lead us more towards isolation, tends to lead towards more dysfunction because we get stuck in echo chambers, for example, or otherwise, you know, start to discount other parts of our life. So maybe we don't go to the gym that day, right, because we lost track of time and we're too busy, you know, gaming. So that's how it starts, which is how any addiction or dependency starts, right? Is it's subtle, it's insidious. Except when it comes to technology, right, of course, it's not something you can abstain from. And I think that's part of what makes it so tricky. And there's also no drug test, right, to determine, yeah if you've been using it or not.
Keith Sutton, Psy.D.: (08:02)
Yeah. And so, can you say more about like, kind of, the concept of a process addiction say, as opposed to an addiction to a substance, is alcohol or heroin or so on? Because I know that, you know, there's been talk around kind of sex addiction, you know, food addiction, you know, all these kinds of things and kind of a little bit of a differentiation and conceptualization.
Alex Basche, LMFT: (08:28)
Sure. Sure. So, with a process or behavioral addiction, the person is finding that, no matter what they do, they kind of are always compulsively trying to engage in this behavior. And so it starts out again, you know, very insidious, but unlike a substance, right, you know, you can develop something that's habitual, but that also has the added layer of, you know, turning into something that's addictive. And, you know, if you run out of your drug of choice, then that kind of creates an opportunity to potentially well, get clean and sober, but you can't run out of technology. And so, it's an endless supply, but, you know, with any behavioral addiction, again, there's that sort of compulsiveness and behavior and obsessiveness of thought, and there's the added, again, complexity that okay, well, like for example, if someone plays soccer, right?
Alex Basche, LMFT: (09:36)
They're really into soccer. They think about it all the time. It's something that they play a lot of. You wouldn't say they were addicted to it. Even though they might, right, it might seem like, "Okay, this person is really into soccer." And the reason for that right, is that it's not having a significantly negative impact on, you know, more than one part of their life, because that's kind of the, one of the definitions, one of the requirements for an addiction. So, it's not just the compulsiveness right, in the behavior, it's not just the obsessiveness and the thinking, but it also has to have this significant negative effect on their life as well.
Keith Sutton, Psy.D.: (10:17)
Okay. Yeah. And, and tell me a little bit about, yeah, how you're working with clients, or what kind of issues are coming up. I know this is oftentimes a concern for the families that I work with, worried about their child having an addiction to screens, oftentimes having a hard time getting off, getting agitated if they're getting off, also, you know, sometimes sneaking and, you know, all these kinds of things. And I think sometimes there's that kind of question of, you know, how much of this is, yeah, kind of some of the dynamic in the family, and the kind of pushing limits, how much of this is, you know, kind of, something that's an addiction or a biological kind of aspect that's going on? Yeah, would love to get your thoughts on that.
Alex Basche, LMFT: (11:05)
Yeah. It's very tricky, right? It's very hard to kind of tease apart, right, the chicken or the egg. I think, like I was kind of alluding to earlier, particularly in our area in the Silicon Valley, there's just so much of this pressure that young people go through. And so, because of that and because of these very high expectations, what I find a lot of is that there are so many parents who are very high achieving. So they have these high achieving kids, and these kids sail through their school academically, seemingly, sometimes even without much effort. They might just have these remarkable intellect or abilities. And then the challenge kind of intensifies, right, once the academic demand starts to grow. But, by the time you get to that point, they're probably in high school or college.
Alex Basche, LMFT: (12:01)
And so, the parents don't have the benefit of, "Okay, my kid is, you know, six years old and struggling to use their technology, so we're going to, and, you know, struggling in school, so we're going to, kind of slow things down, get them some support, help teach them, you know, more about digital wellness, and ways to kind of moderate their use." So, people often don't realize there's an issue until it's kind of, I don't want to say certainly not too late, but until it's too late to intervene in a way that would prevent, you know, more negative consequences. And I think that's like, one of the biggest issues I see. But also, it's really hard because we're pretty reliant on tech, you know, and it adds a lot to our lives, you know. Certainly, it's not certainly something that's all bad. And I think it's easy to sort of jump to that conclusion that, "Oh, if you're trying to limit the tech use for the gaming, whatever it is, you must think it's terrible."
Alex Basche, LMFT: (13:02)
"You're, you know, or you must be demonizing it." And that often is where the conflict can come in with the parents. So, trying to have better conversations about it, and I'm actually in part of a work group right now, and that's what we're working on, is, "How do we create a set of scripts that parents can use when they're trying to have these difficult conversations?" Because like you said, if these old dynamics are in place where, you know, if, okay, if Johnny's dad brings up gaming as an issue, Johnny's going to get upset, which then makes his mom feel anxious, and so she then gets mad at Dad and suddenly, right, there's all this conflict happening. So, trying to have, you know, safer, saner conversations about it, not from the perspective of, "You have to stop," but more from perspective of, "Hey, balance and harmony, moderation in all things in life. What does that look like when it comes to gaming, or it comes to tech?" And just having that honest, open, coming from a place of curiosity helps to, yeah, that sort of a conversation can really help. And, you know, doesn't mean you're going to get a solution, but at the very least it'll illuminate, right, where maybe some of the needs are that need to be addressed.
Keith Sutton, Psy.D.: (14:27)
Sure. Yeah. So kind of having conversations with the kids around healthy use of electronics and then ideally, you're trying to produce some scripts that maybe can help guide parents in that conversation?
Alex Basche, LMFT: (14:41)
Yeah, exactly. Because, it's just, that's the thing I get asked. I mean, I get a few phone calls a day from parents, and at least one of them will include, "How do I have this conversation? Because every time I try, it just explodes. Or they shut down."
Keith Sutton, Psy.D.: (15:00)
Yeah.
Alex Basche, LMFT: (15:02)
Yeah. So we're hoping to address that need.
Keith Sutton, Psy.D.: (15:04)
Sure. Definitely. So, yeah. So, what are you seeing as patterns with kids and adolescents and families in managing the screens or, kind of, some of the, I guess, factors that play in that make things difficult?
Alex Basche, LMFT: (15:23)
So, one of the, one of the obstacles I've noticed, again, this is more with adolescents and teens, is that when, you know, for a lot of those kids, once they get to the point of, they're thinking about college or they're getting towards the end of high school, they often are so, kind of, ingrained in a lot of these behaviors, that changing them is hard, right? It requires some real work and focus and concentration. But when so much of their relationship to technology is wrapped up in their identity, so for example, someone says, "Yeah, I'm a gamer." Not, "I like to game," but, "I am a gamer." Then trying to convince them to do less of that, let alone that that's actually having a harmful effect, can be an uphill battle. And so, when that sort of situation is occurring, trying to have that conversation more in terms of "Yes, that's one part of your life. And here's, you know, here's a pie chart that has 24 slices, 24 hours in a day. How big of the pie, right, is gaming now? How much of it is school? How much of it is your hobbies, et cetera? And what do you think it might look like if it was 20% better, right? Or if, you know, what do your parents want it to look like, versus what you do, versus what it is?" So just trying to kind of push that sort of thinking and self-examination, but in a way that again, isn't demonizing, isn't shaming, and isn't blaming. Yeah.
Keith Sutton, Psy.D.: (17:13)
Yeah. Definitely. And I tend to find with a lot of the families I work with, sometimes they have a hard time, you know, creating structure around, or there's a hope that the kids might self-regulate. And then, you know, oftentimes we talk about, you know, right, the gaming is very stimulating, right? And there's always the next level to go to, or whatever it might be. So, oftentimes it's hard for the kids to kind of self-regulate. And so, part of our work as parents are helping the kids to be able to regulate, to contain the amount of time that they're spending, and so on, as they're developing that frontal lobe. And then, you know, dealing with that, because oftentimes, yeah, trying to get the kid to stop something that they really want to do or enjoy can lead to conflict.
Keith Sutton, Psy.D.: (17:58)
And then, especially for parents that are struggling to manage that conflict, or maybe they were a kid that just always followed the rules and never kind of pushed back, you know, then we end up getting into a lot of difficulties with that, I think for the families struggling to be able to create some boundaries around the screens or so on. Or, you know, are the kids staying up till like two in the morning, you know, being on screens and not getting sleep. And it's like, talk about trying to help the parents be more involved in managing that, because maybe the kids aren't showing the responsibility to have those freedoms at this point. So instead, they kind of need some scaffolding where the parents are stepping in and then giving them a little room to kind of, you know, try on their own to regulate and then try a little more and kind of get more freedom to, because the ultimate goal is doing it all independently.
Alex Basche, LMFT: (18:52)
Yeah. And that, I think you hit the nail on the head that, just kind of relying on the restrictions on, "Well, I've got, you know, Norton Family or Bark or one of those other programs, and so that's restricting their use." And then, you know, it's set and forget. You know, for one, a lot of the times teens and kids, as I'm sure many parents listening are going to agree, find ways around that. And then, parents try something else or add more on there, and it becomes this kind of like almost cold war arms race. And it perpetuates the very dynamic, right, that we're trying to avoid. Because of course, now it's all filtered through the lens of this oppositional relationship with parents, rather than, "Well, what kind of relationship to tech do I want to have? What's important to me? "
Alex Basche, LMFT: (19:44)
"And do I think maybe I'm using it a little too much or maybe staying up too late? And if so, what would feel better?" And so, trying to kind of shift the conversation in that way is tricky, and that's where, you know, again, that script can come in handy. But I think also, parents having like, in their mind, "Alright, we know that 30 hours a week," let's say, "is too much. Doesn't matter what kind of argument my teenager presents, you know, that ain't happening. But, we would maybe feel okay if it was 10 hours, assuming they were, you know, getting all As," or again, whatever it is, whatever the requirements are.
Alex Basche, LMFT: (20:31)
So, I'll try and push parents to really think about, "Okay, what's the range? Like, what really, you know, not what do you want it to look like, but what, what could you live with?" And, you know, going for progress, not for perfection. And yeah. And so, that sort of approach I find tends to be helpful. But I think generally my goal is just to remind parents that like, "It's okay to struggle. It's okay not to have the answers, right? You know, it's unpredictable, this life we live and especially being a parent. So, you know, asking for help is important to navigate those tough moments, and also trying to find space for some humor, some grace and some compassion along the way as well."
Keith Sutton, Psy.D.: (21:19)
Yeah, definitely. Yeah, and I think that a broader conversation around the values, like you're saying, that there's some balance, like, right, doing school, spending time with family rather than just holed up in one's room, right, getting outside, and these kinds of things. And if those things are happening, then, you know, being able to have screens and, and kind of, again, the time kind of being based on being able to have time for all these different things, rather than sometimes even just getting so focused on the hours or minutes of screen time, really looking at it in relationship to the, how the whole holistic kind of picture looks like that they're ultimately going for to help their kids and support them into, you know, being well-rounded.
Alex Basche, LMFT: (22:07)
Yeah. That, that holistic picture is so critical. Because again, there's this overemphasis on academics and, you know, again, kind of, performing and meanwhile, you know, there's a lot that can get lost. And so trying to again, shape these teens' worlds where there is more of that call for balance and moderation, not just with tech, but kind of with everything. And not over indexing too much in one area, because otherwise it's so hard for them to, you know, figure out who they are and determine their identity. And so, trying to create enough space for that, for them to make mistakes, right, for them to mess up. And I try and really sort of enforce that and encourage that. So again, we've got that, that range of time in that example, but having that range for everything, for the parent, so the teen can have a little freedom and have a little independence and start to figure out who they are and where they fit into the world.
Keith Sutton, Psy.D.: (23:17)
Definitely. Yeah, and can you speak to the issues around, you know, social media and, you know, of course there's the benefits of social media and connecting, but especially for teenagers, you know, it can be something that's kind of really affecting their sense of self, especially many adolescent girls and body image and, you know, all these kind of pieces play in. Can you speak to that a little bit?
Alex Basche, LMFT: (23:46)
Sure. Yeah, you know, social media I think is something that we've, not even just with social media, but with all tech, right, it's so new. I mean, so much of this is so new. And so, it's something that I think everyone is kind of still learning about and still certainly trying to understand and research. But from what we can tell, and thankfully this is becoming more, I find at least, more sort of commonly acknowledged as fact, you know, social media has a place, but it needs to have a much smaller place for the most part. Because especially for teens, we find that it, you know, greatly increases rates of, you know, struggles, right, whether it's a struggle with self-esteem, like you said, or body image, whether it's social comparison or endorsing things like self harm or suicide or drug use, bullying right?
Alex Basche, LMFT: (24:47)
There's, I think, kind of no shortage of issues that we hear about and see about, or see in the news that are getting reported on when it comes to social media. And it's not all bad, right? It's a way for people to connect and to collaborate and communicate and discover things and learn more about each other. It can also be really helpful for people who struggle with in-person socializing. So that's another, kind of, reason I really try and make it so we're not demonizing the gaming. Because if you have, for example, someone on the autism spectrum who struggles with nonverbal communication, it's kind of the great sort of, you know, playing field leveler, right, to have everybody, whether they're neurodiverse or not, you know, just communicating with audio only.
Alex Basche, LMFT: (25:40)
So yeah, and again, similar sort of a principle with typing. So again, not all bad, but also kind of with everything, got to be intentional and due to moderation. It also seems like, because the apps keep changing, right? Like for a while there were those loop boxes and gaming that were kind of functionally gambling. And then that started to go sort of underground. And so it's actually still quite pervasive, it's just that it's now more through like third parties that integrate with the main game. So, similarly with social media, we're also seeing that with apps that are problematic, end up, whether it's intentional or not, farming out those more problematic, yet more profitable services, you know, through third party or user generated content sometimes, or apps or add-ons. So it's tricky, you know, even if you do limit, you know, well one app, you might not realize that it has these, again, like third party programs associated with it.
Alex Basche, LMFT: (26:48)
And what's rough is that the tech industry has been aware of this, you know, they really, they have known this the whole time about a lot of these issues. They're very smart and they employ people that are very smart. And there's a couple of really good books that have come out recently about that as well. So, you just, again, I think the moral of the story is you have to sort of come from that place of curiosity and questioning, not just accept things at face value, that, "Yeah, my kid is going to be fine. They're a digital native, they'll figure it out."
Keith Sutton, Psy.D.: (27:23)
Yeah.
Alex Basche, LMFT: (27:24)
Yeah.
Keith Sutton, Psy.D.: (27:25)
Well, and, and I don't know if you do, I've done this with my own kids as well as, you know, helping families with, you know, clear expectations about privacy and, you know, parents checking in and, you know, seeing what's going on and also having some conversations. You know, I think about it too, it's like, you know, I've talked to parents about, you know, rather than just, you know, the sex talk, you know, talking about, "What do you want in a relationship? What do you look for in a person? How do you..." you know, all these kind of, the values that are within it, same kind of thing with screens and, you know, getting to know and understand what they like about this person they're following on TikTok or whatever it might be, to kind of try to understand the values that the kids have, and also be able to kind of convey and put it into a frame of the values that you're hoping to support with them. And so having that kind of larger conversation rather than just, "Yeah, sure, you can be on the screen," but in instead kind of seeing how it's being used or taken in or processed or such.
Alex Basche, LMFT: (28:29)
Exactly. Yeah. I think just that idea of, you know, coming from, "What are my core values? What values do I want to instill in my kid? And what's common sense? What just feels right or just feels wrong?" You know, gut check, yeah. So, again, I think it comes back to maybe just like parenting, almost like with intention and trying to ensure there's moderation with all things, but also that, again, I don't know, it just like, you know, having that room to make mistakes. I think it's easy to kind of overprotect and it can also be hard to know, right, when you're under protecting. So, it's not an easy thing by any stretch. But, something that I know a lot of the research has been showing, and actually there's some research actually just came out about a month ago about this, that when parents are communicating with each other.
Alex Basche, LMFT: (29:30)
So if, you know, "My kiddo's best friend's parents and I are have, you know, some sort of relationship where we can communicate with each other," then the rates of mental health disorder diagnoses and issues tend to decrease or stabilize. We see their relationship to technology is much healthier. And, you know, the reasons, again, as often can be the case in with research in our field is when you read about it, it's like, "Oh yeah, that makes total sense. Like, oh yeah, of course, of course it makes sense, right?" That when parents are coordinating and they are trying to kind of maintain the same set of rules at each other's houses, it tends to go a lot better. Because if, you know Johnny, like that example I gave, his three buddies who all are gaming together, all have the same bedtime and have the same amount of screen time, then they're going to naturally want to just do it together. They're not going to want to game alone. So it inherently makes it, again, just a social activity, which of course is better, right?
Keith Sutton, Psy.D.: (30:49)
Yeah, definitely. And I think it's so interesting too, with the differing limits in different households. I know I've got a fifth grader right now, and, you know, Fortnite is a big issue with a lot of folks. And I work with another family, they have a fourth grader who, you know, also wanted to play Fortnite and couldn't. And it's so interesting too, because games like that are such a focus and like kind of this cultural phenomenon where the kids are sharing about it and the new update that came out, and so on. And then there's some kids that are feeling left out and, you know, because they're not able to be engaging in this. And so, there's so many kinds of social dynamics that play out in that. And then at the same time, also trying to, you know, help the kids have healthy, you know, relationships to the games. Also healthy relationships around these games that are, you know, more guns and shooting and such kind of focused, and really how to help parents to help kids figure out how to navigate that and help parents figure out how to navigate that, about what's okay or not okay. Or how do we deal with kind of the way that, you know, most of the kids in the, a lot of the kids in the classroom are kind of having access to different games and others aren't, and so on.
Alex Basche, LMFT: (32:09)
Yeah. Gosh, I mean, just hit on a few things because, it's just, it's again, it's so tricky when you're trying to do that, especially because a lot of the schools, at least where we are, are giving these kids Chromebooks. And they're giving them these Chromebooks at quite young ages before, right, their brains are fully developed and they're not, for whatever reason, able to restrict them in a way that the kids cannot easily get around. So what happens is that the school is just, again, like creating this problem, or at least adding to it in ways that are so unnecessary. And so, I think it's like also just so critical that we push back on this because, while of course it is so important that the kids are digitally literate and that they're able to be comfortable navigating the internet and using technology, because again, there's so many benefits to that, of course, it's also just so unnecessary that they, at these ages, these vulnerable ages, are being given this, you know, essentially unrestricted laptop from their school.
Alex Basche, LMFT: (33:32)
Because so much of the time, right, we end up finding that, oh, they were actually, you know, on a game right, when they were supposed to be paying attention, or they download something and they weren't supposed to, or whatever it is. And so like, I think it's also important that parents are making their voices heard about this, because I just cannot tell you how many times I've been asked, "Hey, what can be done? Like, I can't take this device away because it's from the school and they need it for school. They, they literally cannot do their homework without this Chromebook. And I can't put any restrictions on it because it belongs to the school."
Keith Sutton, Psy.D.: (34:17)
Yeah. Yeah.
Alex Basche, LMFT: (34:18)
And it's like, what do you do? So, advocacy has been a big one I've been pushing for with that.
Keith Sutton, Psy.D.: (34:26)
Definitely. Yeah. And I oftentimes will work with the parents. Because I think the parents end up feeling kind of limited like in these situations, like you're saying. Because it's for schools, so they feel like their hands are tied, but also helping to empower them, right, if they need to, if the kids aren't using it appropriately, where they might have to do their homework at the table with the screen showing or something. And, you know, again, the lower the responsibility, the less freedom. So the more kind of supervision from parents to then kind of getting to a place where they are using it appropriately and maybe can have it less like literally supervised where you're looking at it or so on. But I think oftentimes the parents feel like, "Oh, well this is, they have to have this for school, so there's nothing I can do about it." And so then kind of feeling disempowered and almost right, having this aspect of the school come into their home and then feeling like they've kind of lost some control or lost some ability to manage this within their own home.
Keith Sutton, Psy.D.: (35:31)
So yeah, another area that I oftentimes find that, that is big with technology is the aspect of emotional avoidance and being on screens to not think, to not feel, you know, and I oftentimes see this across the age span, but for example, you know, I work with a number of folks where, they're young adults and maybe they were, you know, in school, they ended up not doing well, coming home and they're playing, you know, games until four in the morning, maybe taking a couple community college classes. But, oftentimes, you know, there's anxiety, depression. That's unfortunately just becoming exacerbated by just kind of the avoidance into the screens to not think or feel or, or so on.
Alex Basche, LMFT: (36:19)
This is, again, another one of those huge, huge issues that I think just doesn't get as much of the attention it really needs and deserves. Because these, right, they're no longer kids, they're no longer teens, they're no longer minors. So it just adds another layer of complexity because if they don't want to go to treatment or don't want to go to therapy, you can't really force them because, right, they're over 18. And avoiding discomfort is something that I feel will almost guaranteed make it so the person doesn't end up living the life that they really want because, right, how do we decide that we don't like things the way they are? Right? We don't want the status quo to continue, but we have to be dissatisfied in some way. Right? We have to feel like either something's wrong or something could be better. And that requires there to be some sort of discomfort.
Alex Basche, LMFT: (37:23)
That you have to, again, feel those feelings. And if you don't, then things are static and opportunities are missed and connections are missed. And growth is missed. So when we talk about, "Oh, these are kids that are, or young adults rather, that are, you know, sort of stuck," they're also, of course, stuck developmentally and stuck developmentally and emotionally as well. But in addition, socially, because again, it's so much more comfortable to socialize online. And I think there's a lot of teens that I'll encounter who will say, "Well, why would I meet my friends in person when we can just all be online? It's so much easier." And this is part of why, right, that we miss out on so much and there's so many opportunities that can happen just from, "Hey, we went out to dinner all together and then we bumped into this other group of people and then we started talking to them and then became friends," and so on and so forth.
Alex Basche, LMFT: (38:29)
So yeah, I think just that discomfort avoidance, like you said, is just such a huge hindrance and obstacle. And it kind of goes back to what we were just talking about, where there needs to be room for mistakes, there needs to be room for failure, there needs to be, you know, again, those opportunities for growth. And that's why, you know, taking away all the tech to try and, you know, address this sort of stuck-ness, this life stuck-ness you don't, might be going through, tends not to work necessarily because they haven't developed the coping strategies and ability to regulate their emotions. They haven't, right, kind of developed that yet, because they haven't yet been put in as much of the discomfort, growth moments.
Alex Basche, LMFT: (39:21)
So, taking it away without them first having some of those skills really can hinder success. So instead of just doing the detox, I really like to encourage the young adult and the parents to think about it differently and think about it more in the sense of, "Okay, it's not that you're cutting this out of your life forever," because again, it's kind of impossible to do that, but instead, "You're going to take a break to reevaluate and to run the experiment. You know, let's see what happens when, you know, you don't game for a week."
Alex Basche, LMFT: (40:00)
"Who knows what will happen. Let's see. Let's, let's try it out." Yeah, and I don't want to give a statistic, but I can say the vast majority of the time the teen or young adult will come back and they'll kind of be like, you know, their head is down, they're kind of looking sheepish and they say, "Okay, yeah, it wasn't that bad. Like, okay, actually I was so bored. It was terrible. I was feeling really depressed. And then I like took out these old cards that I used to collect and then that made me think about, you know, this other hobby I was into," whatever it is. So does that mean they now never will game again? Of course not, right? They still really want to do it, but it's just showing them that, "Hey, there's another way, there's a better way to do this. You can have your cake and eat it too, and still feel like, you know, you're moving forward in life as well."
Keith Sutton, Psy.D.: (40:53)
Well, I think that's a great, you know, kind of antidote because, right, it's the boredom, that discomfort that then actually motivated them into action to do something, you know. And I think about, it's like the gaslight on the car or something, like our emotions are trying to kind of tell us something and then sometimes, you know, when we're just kind of avoiding or yeah, go on screens or drink or whatever, to not see it, it's like putting a piece of duct tape over it so that we don't have to worry about it and see it. We keep driving, but then things are kind of worse off. And I think that other piece you're mentioning about like, living the life that we wanna be living, you know, and acceptance, commitment therapy, there's the idea of, you know, going towards one's values despite the discomfort and having the willingness to experience, you know, the different emotional experiences rather than kind of living in avoidance because then you don't go towards your values.
Keith Sutton, Psy.D.: (41:46)
And I treat it similar, especially with the young adults too, you know substance and the way that parents can sometimes, you know, it's a sturdy word, enabling, but sometimes they unknowingly may be supporting the avoidance, you know. And the kid is just avoiding and being on games and stuff and not doing anything. And the parents are feeling kind of helpless, but sometimes needing to bring up the bottom, which means creating some structures around that to get them on track. Which is, you know, feels uncomfortable to be, you know, telling a 21-year-old they can only, you know, be on their, their games until 10 o'clock at night or something. But oftentimes, or at least even this one recent case I'm working with for the depression, the anxiety went down just from beginning to get sleep and, and kind of getting, moving in that direction.
Keith Sutton, Psy.D.: (42:34)
But, so I think that, you know, the parallels with addiction, you know, are so significant there. It also makes me think of an adult that I was working with, with a lot of avoidance and playing video games, but for him it felt like, you know, "They're just video games, right? It's kind of not that big of a deal." But he would start playing at like nine in the morning and play until like two in the afternoon, not get any work done. So I was like, would you, you wouldn't maybe start drinking at nine in the morning, you know, if you had a bunch of work to do. But it was kind of a hard thing to conceptualize for him himself around video games. Not, there's nothing wrong and they're not bad, and not that they should be bad, but at the same time seeing that it was really taking away from, yeah, what he was hoping to do and then leading to kind of, like, a shame spiral.
Alex Basche, LMFT: (42:23)
Yeah. Yeah. No, definitely. I mean, it's easy. It's so easy to kind of fall into that trap of, you know, it's either "Gaming is great and I love it and it's fun and part of my identity, or "It's all bad and terrible and evil." A very black and white thinking, when obviously, right, that's not how life is either. I mean, there's a wide spectrum of gray area. So with, I think something else that you were talking about too, just the idea of parents, kind of, unknowingly contributing. One of the things that I've just learned from talking to parents about this is that so much of the time when, you know, the two parent household when they're talking about the struggles their teen might be having, it ends up getting filtered through, kind of like a lens of, "Well this is your fault, Mom," or, "This is your fault Dad," or, "This is..." right, trying to make sense of it and meaning, and part of that, right, can be attributing blame. And so, something that I've had success with, with parents is saying, "Okay, well, let's say that's true. Let's say it is. What does that change? Right? Like, what's different now that we've assigned that blame?" And it's like, well then responsibility to help. "Well, isn't that part of the family, right? Isn't that what we're all trying to do? Like what you're all trying to do?" And so like, I guess I bring that up just to say that sometimes I'll even start with the parents, because it's so often the case that, you know, this is all interconnected. So starting to work with the parents can of course, right, influence how other teen goes, but more to the point, just like you said with sleep, I will just really try and hammer on that self-care.
Alex Basche, LMFT: (45:26)
Because if the teen or young adult or whoever the human is getting enough sleep each night, they're eating relatively healthy, they're getting some form of, you know, intensive physical activity at least for 20 minutes, two to three times a week at least, and they are getting some sort of socializing, ideally in person, it's pretty, again, don't want to give statistics, but it's typical from what I've seen that we will see a pretty significant improvement just with that. Just because of that. You know, again, seemingly fundamental, you know, life tasks that we often kind of take for granted as just like, a given, "Yeah, I get enough sleep each night, of course."
Keith Sutton, Psy.D.: (46:11)
Yeah. Well, and that's oftentimes the thing that seems very expendable. It's like, "Oh, you know what, I'll just stay a couple hours up later or whatever." Or, and again, sometimes with the screens, because it's so stimulating and reinforcing that it's hard to kind of break free. This has been really an interesting discussion. I mean, there's so many aspects of this, and this is such a huge issue and it's going to be an issue. I was actually, I remember in my son's fourth grade class, they had kind of a day where everybody, you know, wrote things about themselves and almost over half the class said that, "I want to be a YouTuber when I grow up." And it was so interesting that that is the kind of main focus of say, you know, whatever fourth grade, fifth grade, of what I want to be in the future. And so, technology is part of life and how do we help the kids to have a healthy relationship and a more kind of, yeah, rounded, you know, kind of life rather than just getting, you know, totally fixated or again, kind of avoiding life by just sinking into screen or yeah, games.
Alex Basche, LMFT: (47:13)
I honestly, I love it when I hear a kid or a teen say that because then I say, "Okay, let's make it happen. Let's try it out." And a lot of the time when they actually try, it's like, "Wow, this is a lot of work. This is really hard. This is really frustrating. Like, I can't seem to get enough views." And that can be such a great opportunity to then go, "Okay, so maybe this isn't exactly what you wanted to do, but what did we learn from this? What can we gain from this? And how do we kind of harness the discomfort you just went through and the, again, things not working out well that you just went through?" And so it can be such a good, you know, kind of teachable moment learning opportunity for growth as well.
Keith Sutton, Psy.D.: (48:02)
Definitely. Well, thank, so thank you so much for taking the time today. This is great. I really appreciate it.
Alex Basche, LMFT: (48:09)
Yeah, absolutely. Yeah, this is wonderful. Thanks so much for having me.
Keith Sutton, Psy.D.: (48:13)
Great, well thanks. And I'll link to all your information on our site and people can learn more. And yeah, thanks for coming. Take care.
Alex Basche, LMFT: (48:22)
Thank you. You as well. Appreciate it.
Keith Sutton, Psy.D.: (48:24)
Bye.
Keith Sutton, Psy.D.: (48:26)
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Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including family systems, cognitive behavioral therapy, emotionally focused couples therapy, eye movement to sensitization reprocessing, motivational interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using emotionally focused couples therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma;
Keith Sutton, Psy.D.: (01:26)
And our center for ADHD and oppositional and Conduct Disorder clinic, where we're integrating those four approaches. In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment training and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D.: (02:19)
Today, I'll be speaking with Alex Basche, who is a licensed marriage and family therapist based in the San Francisco Bay Area. He works mainly with adolescents and young adults, specializing in the treatment of tech-related behavioral addictions such as gaming, social media, pornography, online gambling & shopping in addition to substance use disorders, as well as frequently co-occurring conditions such as anxiety disorders, ADHD, depressive disorders, OCD, Autism Spectrum, and identity formation issues. In 2017, Alex helped create and found the first in-network Intensive Outpatient Program in the state of California treating technology addiction in adolescents. He has written many therapy groups’ curricula and leads trainings and workshops on topics related to Assessment & Treatment for Process Addictions, Parenting in the Digital Age, Adolescent Anxiety & Depression Treatment and more. Alex serves as a Subject Matter Expert (SME) on the Mental Health Workgroup Advisory Board for Fairplay’s Children’s Screentime Action Network and on the Board of Directors for local nonprofit, Adolescent Counseling Services. He continues to co-author and present research on digital addictions and related topics. Let's listen to the interview.
Keith Sutton, Psy.D.: (03:35)
Hi, Alex. Welcome.
Alex Basche, LMFT: (03:37)
Hi. Thanks for having me. Happy to be here.
Keith Sutton, Psy.D.: (03:41)
Yeah, I'm so glad you could join us. So, I had learned about you -- I know that you're doing some work on internet screen, kind of, gaming addiction, and particularly with teenagers; and you work over here in the Bay Area; and was really interested in learning more about your work. And this is such a big issue that comes up so much for so many families, as well as I do a lot of work with adults with ADHD and struggling with, you know, kind of screens and, you know, difficulty kind of with procrastination avoidance. So, it's a really big issue. So I'd love to hear about your thoughts and your work and knowledge in this area, but first I'd like to find out about, you know, how you got to doing what you're doing, your kind of evolution of your thinking that kind of got you here.
Alex Basche, LMFT: (04:27)
Yeah, so for me, I've kind of always been working in the field of addiction. And I kept running into early my career just kind of like a lack of resources and certainly a lack of experts to consult. So if I had a client that had, you know, a dual diagnosis, co-occurring anxiety with substance abuse, there was no shortage of people I could reach out to ask for help, resources online. But the second it became anything related to, you know, a digital process addiction or behavioral addiction, or even just digital wellness, was kind of like, just crickets. And that led me on kind of a journey of exploration and reaching out to international communities because a lot of other countries are light years ahead of us in that, as well as other areas of mental health. And I got linked up with Dr. Hillary Cash, who runs a, you know, one of the top programs in the country at reSTART. And she really just was, I mean, amazing in terms of connecting me to resources and people and everything like that. So that really kind of gave me the jumpstart I needed.
Keith Sutton, Psy.D.: (05:46)
Great. Wonderful. Very nice. Yeah. So tell me about yeah, this kind of whole idea, even of an addiction and I think, yeah -- you mentioned process addiction, behavioral addictions. Can you talk a little bit about that, you know, and kind of how that's differentiated in the addiction fields from more of, I guess, a biological addiction?
Alex Basche, LMFT: (06:07)
Sure. So, you know, like, I think for a lot of people, particularly in the Bay Area, right? Growing up in an environment where, you know, not only your family but your peers are kind of constantly pushing the boundaries of excellence and trying to create like a culture of intense competition, you know, obviously creates a lot of pressure. And so when we're put in situations that, you know, generate pressure and stress, right, we tend to want to try and find ways to cope with that. And one of the ways is through using substances, but another way that tends to be more socially acceptable is, using technology. And whether that's, you know, doom scrolling on social media, or trying to connect with people online through apps like Discord, or going on just sort of a deep dive, one might say, on the internet.
Alex Basche, LMFT: (07:06)
Kind of, whatever the version of this is, the sort of results are the same. And that is that it tends to lead us more towards isolation, tends to lead towards more dysfunction because we get stuck in echo chambers, for example, or otherwise, you know, start to discount other parts of our life. So maybe we don't go to the gym that day, right, because we lost track of time and we're too busy, you know, gaming. So that's how it starts, which is how any addiction or dependency starts, right? Is it's subtle, it's insidious. Except when it comes to technology, right, of course, it's not something you can abstain from. And I think that's part of what makes it so tricky. And there's also no drug test, right, to determine, yeah if you've been using it or not.
Keith Sutton, Psy.D.: (08:02)
Yeah. And so, can you say more about like, kind of, the concept of a process addiction say, as opposed to an addiction to a substance, is alcohol or heroin or so on? Because I know that, you know, there's been talk around kind of sex addiction, you know, food addiction, you know, all these kinds of things and kind of a little bit of a differentiation and conceptualization.
Alex Basche, LMFT: (08:28)
Sure. Sure. So, with a process or behavioral addiction, the person is finding that, no matter what they do, they kind of are always compulsively trying to engage in this behavior. And so it starts out again, you know, very insidious, but unlike a substance, right, you know, you can develop something that's habitual, but that also has the added layer of, you know, turning into something that's addictive. And, you know, if you run out of your drug of choice, then that kind of creates an opportunity to potentially well, get clean and sober, but you can't run out of technology. And so, it's an endless supply, but, you know, with any behavioral addiction, again, there's that sort of compulsiveness and behavior and obsessiveness of thought, and there's the added, again, complexity that okay, well, like for example, if someone plays soccer, right?
Alex Basche, LMFT: (09:36)
They're really into soccer. They think about it all the time. It's something that they play a lot of. You wouldn't say they were addicted to it. Even though they might, right, it might seem like, "Okay, this person is really into soccer." And the reason for that right, is that it's not having a significantly negative impact on, you know, more than one part of their life, because that's kind of the, one of the definitions, one of the requirements for an addiction. So, it's not just the compulsiveness right, in the behavior, it's not just the obsessiveness and the thinking, but it also has to have this significant negative effect on their life as well.
Keith Sutton, Psy.D.: (10:17)
Okay. Yeah. And, and tell me a little bit about, yeah, how you're working with clients, or what kind of issues are coming up. I know this is oftentimes a concern for the families that I work with, worried about their child having an addiction to screens, oftentimes having a hard time getting off, getting agitated if they're getting off, also, you know, sometimes sneaking and, you know, all these kinds of things. And I think sometimes there's that kind of question of, you know, how much of this is, yeah, kind of some of the dynamic in the family, and the kind of pushing limits, how much of this is, you know, kind of, something that's an addiction or a biological kind of aspect that's going on? Yeah, would love to get your thoughts on that.
Alex Basche, LMFT: (11:05)
Yeah. It's very tricky, right? It's very hard to kind of tease apart, right, the chicken or the egg. I think, like I was kind of alluding to earlier, particularly in our area in the Silicon Valley, there's just so much of this pressure that young people go through. And so, because of that and because of these very high expectations, what I find a lot of is that there are so many parents who are very high achieving. So they have these high achieving kids, and these kids sail through their school academically, seemingly, sometimes even without much effort. They might just have these remarkable intellect or abilities. And then the challenge kind of intensifies, right, once the academic demand starts to grow. But, by the time you get to that point, they're probably in high school or college.
Alex Basche, LMFT: (12:01)
And so, the parents don't have the benefit of, "Okay, my kid is, you know, six years old and struggling to use their technology, so we're going to, and, you know, struggling in school, so we're going to, kind of slow things down, get them some support, help teach them, you know, more about digital wellness, and ways to kind of moderate their use." So, people often don't realize there's an issue until it's kind of, I don't want to say certainly not too late, but until it's too late to intervene in a way that would prevent, you know, more negative consequences. And I think that's like, one of the biggest issues I see. But also, it's really hard because we're pretty reliant on tech, you know, and it adds a lot to our lives, you know. Certainly, it's not certainly something that's all bad. And I think it's easy to sort of jump to that conclusion that, "Oh, if you're trying to limit the tech use for the gaming, whatever it is, you must think it's terrible."
Alex Basche, LMFT: (13:02)
"You're, you know, or you must be demonizing it." And that often is where the conflict can come in with the parents. So, trying to have better conversations about it, and I'm actually in part of a work group right now, and that's what we're working on, is, "How do we create a set of scripts that parents can use when they're trying to have these difficult conversations?" Because like you said, if these old dynamics are in place where, you know, if, okay, if Johnny's dad brings up gaming as an issue, Johnny's going to get upset, which then makes his mom feel anxious, and so she then gets mad at Dad and suddenly, right, there's all this conflict happening. So, trying to have, you know, safer, saner conversations about it, not from the perspective of, "You have to stop," but more from perspective of, "Hey, balance and harmony, moderation in all things in life. What does that look like when it comes to gaming, or it comes to tech?" And just having that honest, open, coming from a place of curiosity helps to, yeah, that sort of a conversation can really help. And, you know, doesn't mean you're going to get a solution, but at the very least it'll illuminate, right, where maybe some of the needs are that need to be addressed.
Keith Sutton, Psy.D.: (14:27)
Sure. Yeah. So kind of having conversations with the kids around healthy use of electronics and then ideally, you're trying to produce some scripts that maybe can help guide parents in that conversation?
Alex Basche, LMFT: (14:41)
Yeah, exactly. Because, it's just, that's the thing I get asked. I mean, I get a few phone calls a day from parents, and at least one of them will include, "How do I have this conversation? Because every time I try, it just explodes. Or they shut down."
Keith Sutton, Psy.D.: (15:00)
Yeah.
Alex Basche, LMFT: (15:02)
Yeah. So we're hoping to address that need.
Keith Sutton, Psy.D.: (15:04)
Sure. Definitely. So, yeah. So, what are you seeing as patterns with kids and adolescents and families in managing the screens or, kind of, some of the, I guess, factors that play in that make things difficult?
Alex Basche, LMFT: (15:23)
So, one of the, one of the obstacles I've noticed, again, this is more with adolescents and teens, is that when, you know, for a lot of those kids, once they get to the point of, they're thinking about college or they're getting towards the end of high school, they often are so, kind of, ingrained in a lot of these behaviors, that changing them is hard, right? It requires some real work and focus and concentration. But when so much of their relationship to technology is wrapped up in their identity, so for example, someone says, "Yeah, I'm a gamer." Not, "I like to game," but, "I am a gamer." Then trying to convince them to do less of that, let alone that that's actually having a harmful effect, can be an uphill battle. And so, when that sort of situation is occurring, trying to have that conversation more in terms of "Yes, that's one part of your life. And here's, you know, here's a pie chart that has 24 slices, 24 hours in a day. How big of the pie, right, is gaming now? How much of it is school? How much of it is your hobbies, et cetera? And what do you think it might look like if it was 20% better, right? Or if, you know, what do your parents want it to look like, versus what you do, versus what it is?" So just trying to kind of push that sort of thinking and self-examination, but in a way that again, isn't demonizing, isn't shaming, and isn't blaming. Yeah.
Keith Sutton, Psy.D.: (17:13)
Yeah. Definitely. And I tend to find with a lot of the families I work with, sometimes they have a hard time, you know, creating structure around, or there's a hope that the kids might self-regulate. And then, you know, oftentimes we talk about, you know, right, the gaming is very stimulating, right? And there's always the next level to go to, or whatever it might be. So, oftentimes it's hard for the kids to kind of self-regulate. And so, part of our work as parents are helping the kids to be able to regulate, to contain the amount of time that they're spending, and so on, as they're developing that frontal lobe. And then, you know, dealing with that, because oftentimes, yeah, trying to get the kid to stop something that they really want to do or enjoy can lead to conflict.
Keith Sutton, Psy.D.: (17:58)
And then, especially for parents that are struggling to manage that conflict, or maybe they were a kid that just always followed the rules and never kind of pushed back, you know, then we end up getting into a lot of difficulties with that, I think for the families struggling to be able to create some boundaries around the screens or so on. Or, you know, are the kids staying up till like two in the morning, you know, being on screens and not getting sleep. And it's like, talk about trying to help the parents be more involved in managing that, because maybe the kids aren't showing the responsibility to have those freedoms at this point. So instead, they kind of need some scaffolding where the parents are stepping in and then giving them a little room to kind of, you know, try on their own to regulate and then try a little more and kind of get more freedom to, because the ultimate goal is doing it all independently.
Alex Basche, LMFT: (18:52)
Yeah. And that, I think you hit the nail on the head that, just kind of relying on the restrictions on, "Well, I've got, you know, Norton Family or Bark or one of those other programs, and so that's restricting their use." And then, you know, it's set and forget. You know, for one, a lot of the times teens and kids, as I'm sure many parents listening are going to agree, find ways around that. And then, parents try something else or add more on there, and it becomes this kind of like almost cold war arms race. And it perpetuates the very dynamic, right, that we're trying to avoid. Because of course, now it's all filtered through the lens of this oppositional relationship with parents, rather than, "Well, what kind of relationship to tech do I want to have? What's important to me? "
Alex Basche, LMFT: (19:44)
"And do I think maybe I'm using it a little too much or maybe staying up too late? And if so, what would feel better?" And so, trying to kind of shift the conversation in that way is tricky, and that's where, you know, again, that script can come in handy. But I think also, parents having like, in their mind, "Alright, we know that 30 hours a week," let's say, "is too much. Doesn't matter what kind of argument my teenager presents, you know, that ain't happening. But, we would maybe feel okay if it was 10 hours, assuming they were, you know, getting all As," or again, whatever it is, whatever the requirements are.
Alex Basche, LMFT: (20:31)
So, I'll try and push parents to really think about, "Okay, what's the range? Like, what really, you know, not what do you want it to look like, but what, what could you live with?" And, you know, going for progress, not for perfection. And yeah. And so, that sort of approach I find tends to be helpful. But I think generally my goal is just to remind parents that like, "It's okay to struggle. It's okay not to have the answers, right? You know, it's unpredictable, this life we live and especially being a parent. So, you know, asking for help is important to navigate those tough moments, and also trying to find space for some humor, some grace and some compassion along the way as well."
Keith Sutton, Psy.D.: (21:19)
Yeah, definitely. Yeah, and I think that a broader conversation around the values, like you're saying, that there's some balance, like, right, doing school, spending time with family rather than just holed up in one's room, right, getting outside, and these kinds of things. And if those things are happening, then, you know, being able to have screens and, and kind of, again, the time kind of being based on being able to have time for all these different things, rather than sometimes even just getting so focused on the hours or minutes of screen time, really looking at it in relationship to the, how the whole holistic kind of picture looks like that they're ultimately going for to help their kids and support them into, you know, being well-rounded.
Alex Basche, LMFT: (22:07)
Yeah. That, that holistic picture is so critical. Because again, there's this overemphasis on academics and, you know, again, kind of, performing and meanwhile, you know, there's a lot that can get lost. And so trying to again, shape these teens' worlds where there is more of that call for balance and moderation, not just with tech, but kind of with everything. And not over indexing too much in one area, because otherwise it's so hard for them to, you know, figure out who they are and determine their identity. And so, trying to create enough space for that, for them to make mistakes, right, for them to mess up. And I try and really sort of enforce that and encourage that. So again, we've got that, that range of time in that example, but having that range for everything, for the parent, so the teen can have a little freedom and have a little independence and start to figure out who they are and where they fit into the world.
Keith Sutton, Psy.D.: (23:17)
Definitely. Yeah, and can you speak to the issues around, you know, social media and, you know, of course there's the benefits of social media and connecting, but especially for teenagers, you know, it can be something that's kind of really affecting their sense of self, especially many adolescent girls and body image and, you know, all these kind of pieces play in. Can you speak to that a little bit?
Alex Basche, LMFT: (23:46)
Sure. Yeah, you know, social media I think is something that we've, not even just with social media, but with all tech, right, it's so new. I mean, so much of this is so new. And so, it's something that I think everyone is kind of still learning about and still certainly trying to understand and research. But from what we can tell, and thankfully this is becoming more, I find at least, more sort of commonly acknowledged as fact, you know, social media has a place, but it needs to have a much smaller place for the most part. Because especially for teens, we find that it, you know, greatly increases rates of, you know, struggles, right, whether it's a struggle with self-esteem, like you said, or body image, whether it's social comparison or endorsing things like self harm or suicide or drug use, bullying right?
Alex Basche, LMFT: (24:47)
There's, I think, kind of no shortage of issues that we hear about and see about, or see in the news that are getting reported on when it comes to social media. And it's not all bad, right? It's a way for people to connect and to collaborate and communicate and discover things and learn more about each other. It can also be really helpful for people who struggle with in-person socializing. So that's another, kind of, reason I really try and make it so we're not demonizing the gaming. Because if you have, for example, someone on the autism spectrum who struggles with nonverbal communication, it's kind of the great sort of, you know, playing field leveler, right, to have everybody, whether they're neurodiverse or not, you know, just communicating with audio only.
Alex Basche, LMFT: (25:40)
So yeah, and again, similar sort of a principle with typing. So again, not all bad, but also kind of with everything, got to be intentional and due to moderation. It also seems like, because the apps keep changing, right? Like for a while there were those loop boxes and gaming that were kind of functionally gambling. And then that started to go sort of underground. And so it's actually still quite pervasive, it's just that it's now more through like third parties that integrate with the main game. So, similarly with social media, we're also seeing that with apps that are problematic, end up, whether it's intentional or not, farming out those more problematic, yet more profitable services, you know, through third party or user generated content sometimes, or apps or add-ons. So it's tricky, you know, even if you do limit, you know, well one app, you might not realize that it has these, again, like third party programs associated with it.
Alex Basche, LMFT: (26:48)
And what's rough is that the tech industry has been aware of this, you know, they really, they have known this the whole time about a lot of these issues. They're very smart and they employ people that are very smart. And there's a couple of really good books that have come out recently about that as well. So, you just, again, I think the moral of the story is you have to sort of come from that place of curiosity and questioning, not just accept things at face value, that, "Yeah, my kid is going to be fine. They're a digital native, they'll figure it out."
Keith Sutton, Psy.D.: (27:23)
Yeah.
Alex Basche, LMFT: (27:24)
Yeah.
Keith Sutton, Psy.D.: (27:25)
Well, and, and I don't know if you do, I've done this with my own kids as well as, you know, helping families with, you know, clear expectations about privacy and, you know, parents checking in and, you know, seeing what's going on and also having some conversations. You know, I think about it too, it's like, you know, I've talked to parents about, you know, rather than just, you know, the sex talk, you know, talking about, "What do you want in a relationship? What do you look for in a person? How do you..." you know, all these kind of, the values that are within it, same kind of thing with screens and, you know, getting to know and understand what they like about this person they're following on TikTok or whatever it might be, to kind of try to understand the values that the kids have, and also be able to kind of convey and put it into a frame of the values that you're hoping to support with them. And so having that kind of larger conversation rather than just, "Yeah, sure, you can be on the screen," but in instead kind of seeing how it's being used or taken in or processed or such.
Alex Basche, LMFT: (28:29)
Exactly. Yeah. I think just that idea of, you know, coming from, "What are my core values? What values do I want to instill in my kid? And what's common sense? What just feels right or just feels wrong?" You know, gut check, yeah. So, again, I think it comes back to maybe just like parenting, almost like with intention and trying to ensure there's moderation with all things, but also that, again, I don't know, it just like, you know, having that room to make mistakes. I think it's easy to kind of overprotect and it can also be hard to know, right, when you're under protecting. So, it's not an easy thing by any stretch. But, something that I know a lot of the research has been showing, and actually there's some research actually just came out about a month ago about this, that when parents are communicating with each other.
Alex Basche, LMFT: (29:30)
So if, you know, "My kiddo's best friend's parents and I are have, you know, some sort of relationship where we can communicate with each other," then the rates of mental health disorder diagnoses and issues tend to decrease or stabilize. We see their relationship to technology is much healthier. And, you know, the reasons, again, as often can be the case in with research in our field is when you read about it, it's like, "Oh yeah, that makes total sense. Like, oh yeah, of course, of course it makes sense, right?" That when parents are coordinating and they are trying to kind of maintain the same set of rules at each other's houses, it tends to go a lot better. Because if, you know Johnny, like that example I gave, his three buddies who all are gaming together, all have the same bedtime and have the same amount of screen time, then they're going to naturally want to just do it together. They're not going to want to game alone. So it inherently makes it, again, just a social activity, which of course is better, right?
Keith Sutton, Psy.D.: (30:49)
Yeah, definitely. And I think it's so interesting too, with the differing limits in different households. I know I've got a fifth grader right now, and, you know, Fortnite is a big issue with a lot of folks. And I work with another family, they have a fourth grader who, you know, also wanted to play Fortnite and couldn't. And it's so interesting too, because games like that are such a focus and like kind of this cultural phenomenon where the kids are sharing about it and the new update that came out, and so on. And then there's some kids that are feeling left out and, you know, because they're not able to be engaging in this. And so, there's so many kinds of social dynamics that play out in that. And then at the same time, also trying to, you know, help the kids have healthy, you know, relationships to the games. Also healthy relationships around these games that are, you know, more guns and shooting and such kind of focused, and really how to help parents to help kids figure out how to navigate that and help parents figure out how to navigate that, about what's okay or not okay. Or how do we deal with kind of the way that, you know, most of the kids in the, a lot of the kids in the classroom are kind of having access to different games and others aren't, and so on.
Alex Basche, LMFT: (32:09)
Yeah. Gosh, I mean, just hit on a few things because, it's just, it's again, it's so tricky when you're trying to do that, especially because a lot of the schools, at least where we are, are giving these kids Chromebooks. And they're giving them these Chromebooks at quite young ages before, right, their brains are fully developed and they're not, for whatever reason, able to restrict them in a way that the kids cannot easily get around. So what happens is that the school is just, again, like creating this problem, or at least adding to it in ways that are so unnecessary. And so, I think it's like also just so critical that we push back on this because, while of course it is so important that the kids are digitally literate and that they're able to be comfortable navigating the internet and using technology, because again, there's so many benefits to that, of course, it's also just so unnecessary that they, at these ages, these vulnerable ages, are being given this, you know, essentially unrestricted laptop from their school.
Alex Basche, LMFT: (33:32)
Because so much of the time, right, we end up finding that, oh, they were actually, you know, on a game right, when they were supposed to be paying attention, or they download something and they weren't supposed to, or whatever it is. And so like, I think it's also important that parents are making their voices heard about this, because I just cannot tell you how many times I've been asked, "Hey, what can be done? Like, I can't take this device away because it's from the school and they need it for school. They, they literally cannot do their homework without this Chromebook. And I can't put any restrictions on it because it belongs to the school."
Keith Sutton, Psy.D.: (34:17)
Yeah. Yeah.
Alex Basche, LMFT: (34:18)
And it's like, what do you do? So, advocacy has been a big one I've been pushing for with that.
Keith Sutton, Psy.D.: (34:26)
Definitely. Yeah. And I oftentimes will work with the parents. Because I think the parents end up feeling kind of limited like in these situations, like you're saying. Because it's for schools, so they feel like their hands are tied, but also helping to empower them, right, if they need to, if the kids aren't using it appropriately, where they might have to do their homework at the table with the screen showing or something. And, you know, again, the lower the responsibility, the less freedom. So the more kind of supervision from parents to then kind of getting to a place where they are using it appropriately and maybe can have it less like literally supervised where you're looking at it or so on. But I think oftentimes the parents feel like, "Oh, well this is, they have to have this for school, so there's nothing I can do about it." And so then kind of feeling disempowered and almost right, having this aspect of the school come into their home and then feeling like they've kind of lost some control or lost some ability to manage this within their own home.
Keith Sutton, Psy.D.: (35:31)
So yeah, another area that I oftentimes find that, that is big with technology is the aspect of emotional avoidance and being on screens to not think, to not feel, you know, and I oftentimes see this across the age span, but for example, you know, I work with a number of folks where, they're young adults and maybe they were, you know, in school, they ended up not doing well, coming home and they're playing, you know, games until four in the morning, maybe taking a couple community college classes. But, oftentimes, you know, there's anxiety, depression. That's unfortunately just becoming exacerbated by just kind of the avoidance into the screens to not think or feel or, or so on.
Alex Basche, LMFT: (36:19)
This is, again, another one of those huge, huge issues that I think just doesn't get as much of the attention it really needs and deserves. Because these, right, they're no longer kids, they're no longer teens, they're no longer minors. So it just adds another layer of complexity because if they don't want to go to treatment or don't want to go to therapy, you can't really force them because, right, they're over 18. And avoiding discomfort is something that I feel will almost guaranteed make it so the person doesn't end up living the life that they really want because, right, how do we decide that we don't like things the way they are? Right? We don't want the status quo to continue, but we have to be dissatisfied in some way. Right? We have to feel like either something's wrong or something could be better. And that requires there to be some sort of discomfort.
Alex Basche, LMFT: (37:23)
That you have to, again, feel those feelings. And if you don't, then things are static and opportunities are missed and connections are missed. And growth is missed. So when we talk about, "Oh, these are kids that are, or young adults rather, that are, you know, sort of stuck," they're also, of course, stuck developmentally and stuck developmentally and emotionally as well. But in addition, socially, because again, it's so much more comfortable to socialize online. And I think there's a lot of teens that I'll encounter who will say, "Well, why would I meet my friends in person when we can just all be online? It's so much easier." And this is part of why, right, that we miss out on so much and there's so many opportunities that can happen just from, "Hey, we went out to dinner all together and then we bumped into this other group of people and then we started talking to them and then became friends," and so on and so forth.
Alex Basche, LMFT: (38:29)
So yeah, I think just that discomfort avoidance, like you said, is just such a huge hindrance and obstacle. And it kind of goes back to what we were just talking about, where there needs to be room for mistakes, there needs to be room for failure, there needs to be, you know, again, those opportunities for growth. And that's why, you know, taking away all the tech to try and, you know, address this sort of stuck-ness, this life stuck-ness you don't, might be going through, tends not to work necessarily because they haven't developed the coping strategies and ability to regulate their emotions. They haven't, right, kind of developed that yet, because they haven't yet been put in as much of the discomfort, growth moments.
Alex Basche, LMFT: (39:21)
So, taking it away without them first having some of those skills really can hinder success. So instead of just doing the detox, I really like to encourage the young adult and the parents to think about it differently and think about it more in the sense of, "Okay, it's not that you're cutting this out of your life forever," because again, it's kind of impossible to do that, but instead, "You're going to take a break to reevaluate and to run the experiment. You know, let's see what happens when, you know, you don't game for a week."
Alex Basche, LMFT: (40:00)
"Who knows what will happen. Let's see. Let's, let's try it out." Yeah, and I don't want to give a statistic, but I can say the vast majority of the time the teen or young adult will come back and they'll kind of be like, you know, their head is down, they're kind of looking sheepish and they say, "Okay, yeah, it wasn't that bad. Like, okay, actually I was so bored. It was terrible. I was feeling really depressed. And then I like took out these old cards that I used to collect and then that made me think about, you know, this other hobby I was into," whatever it is. So does that mean they now never will game again? Of course not, right? They still really want to do it, but it's just showing them that, "Hey, there's another way, there's a better way to do this. You can have your cake and eat it too, and still feel like, you know, you're moving forward in life as well."
Keith Sutton, Psy.D.: (40:53)
Well, I think that's a great, you know, kind of antidote because, right, it's the boredom, that discomfort that then actually motivated them into action to do something, you know. And I think about, it's like the gaslight on the car or something, like our emotions are trying to kind of tell us something and then sometimes, you know, when we're just kind of avoiding or yeah, go on screens or drink or whatever, to not see it, it's like putting a piece of duct tape over it so that we don't have to worry about it and see it. We keep driving, but then things are kind of worse off. And I think that other piece you're mentioning about like, living the life that we wanna be living, you know, and acceptance, commitment therapy, there's the idea of, you know, going towards one's values despite the discomfort and having the willingness to experience, you know, the different emotional experiences rather than kind of living in avoidance because then you don't go towards your values.
Keith Sutton, Psy.D.: (41:46)
And I treat it similar, especially with the young adults too, you know substance and the way that parents can sometimes, you know, it's a sturdy word, enabling, but sometimes they unknowingly may be supporting the avoidance, you know. And the kid is just avoiding and being on games and stuff and not doing anything. And the parents are feeling kind of helpless, but sometimes needing to bring up the bottom, which means creating some structures around that to get them on track. Which is, you know, feels uncomfortable to be, you know, telling a 21-year-old they can only, you know, be on their, their games until 10 o'clock at night or something. But oftentimes, or at least even this one recent case I'm working with for the depression, the anxiety went down just from beginning to get sleep and, and kind of getting, moving in that direction.
Keith Sutton, Psy.D.: (42:34)
But, so I think that, you know, the parallels with addiction, you know, are so significant there. It also makes me think of an adult that I was working with, with a lot of avoidance and playing video games, but for him it felt like, you know, "They're just video games, right? It's kind of not that big of a deal." But he would start playing at like nine in the morning and play until like two in the afternoon, not get any work done. So I was like, would you, you wouldn't maybe start drinking at nine in the morning, you know, if you had a bunch of work to do. But it was kind of a hard thing to conceptualize for him himself around video games. Not, there's nothing wrong and they're not bad, and not that they should be bad, but at the same time seeing that it was really taking away from, yeah, what he was hoping to do and then leading to kind of, like, a shame spiral.
Alex Basche, LMFT: (42:23)
Yeah. Yeah. No, definitely. I mean, it's easy. It's so easy to kind of fall into that trap of, you know, it's either "Gaming is great and I love it and it's fun and part of my identity, or "It's all bad and terrible and evil." A very black and white thinking, when obviously, right, that's not how life is either. I mean, there's a wide spectrum of gray area. So with, I think something else that you were talking about too, just the idea of parents, kind of, unknowingly contributing. One of the things that I've just learned from talking to parents about this is that so much of the time when, you know, the two parent household when they're talking about the struggles their teen might be having, it ends up getting filtered through, kind of like a lens of, "Well this is your fault, Mom," or, "This is your fault Dad," or, "This is..." right, trying to make sense of it and meaning, and part of that, right, can be attributing blame. And so, something that I've had success with, with parents is saying, "Okay, well, let's say that's true. Let's say it is. What does that change? Right? Like, what's different now that we've assigned that blame?" And it's like, well then responsibility to help. "Well, isn't that part of the family, right? Isn't that what we're all trying to do? Like what you're all trying to do?" And so like, I guess I bring that up just to say that sometimes I'll even start with the parents, because it's so often the case that, you know, this is all interconnected. So starting to work with the parents can of course, right, influence how other teen goes, but more to the point, just like you said with sleep, I will just really try and hammer on that self-care.
Alex Basche, LMFT: (45:26)
Because if the teen or young adult or whoever the human is getting enough sleep each night, they're eating relatively healthy, they're getting some form of, you know, intensive physical activity at least for 20 minutes, two to three times a week at least, and they are getting some sort of socializing, ideally in person, it's pretty, again, don't want to give statistics, but it's typical from what I've seen that we will see a pretty significant improvement just with that. Just because of that. You know, again, seemingly fundamental, you know, life tasks that we often kind of take for granted as just like, a given, "Yeah, I get enough sleep each night, of course."
Keith Sutton, Psy.D.: (46:11)
Yeah. Well, and that's oftentimes the thing that seems very expendable. It's like, "Oh, you know what, I'll just stay a couple hours up later or whatever." Or, and again, sometimes with the screens, because it's so stimulating and reinforcing that it's hard to kind of break free. This has been really an interesting discussion. I mean, there's so many aspects of this, and this is such a huge issue and it's going to be an issue. I was actually, I remember in my son's fourth grade class, they had kind of a day where everybody, you know, wrote things about themselves and almost over half the class said that, "I want to be a YouTuber when I grow up." And it was so interesting that that is the kind of main focus of say, you know, whatever fourth grade, fifth grade, of what I want to be in the future. And so, technology is part of life and how do we help the kids to have a healthy relationship and a more kind of, yeah, rounded, you know, kind of life rather than just getting, you know, totally fixated or again, kind of avoiding life by just sinking into screen or yeah, games.
Alex Basche, LMFT: (47:13)
I honestly, I love it when I hear a kid or a teen say that because then I say, "Okay, let's make it happen. Let's try it out." And a lot of the time when they actually try, it's like, "Wow, this is a lot of work. This is really hard. This is really frustrating. Like, I can't seem to get enough views." And that can be such a great opportunity to then go, "Okay, so maybe this isn't exactly what you wanted to do, but what did we learn from this? What can we gain from this? And how do we kind of harness the discomfort you just went through and the, again, things not working out well that you just went through?" And so it can be such a good, you know, kind of teachable moment learning opportunity for growth as well.
Keith Sutton, Psy.D.: (48:02)
Definitely. Well, thank, so thank you so much for taking the time today. This is great. I really appreciate it.
Alex Basche, LMFT: (48:09)
Yeah, absolutely. Yeah, this is wonderful. Thanks so much for having me.
Keith Sutton, Psy.D.: (48:13)
Great, well thanks. And I'll link to all your information on our site and people can learn more. And yeah, thanks for coming. Take care.
Alex Basche, LMFT: (48:22)
Thank you. You as well. Appreciate it.
Keith Sutton, Psy.D.: (48:24)
Bye.
Keith Sutton, Psy.D.: (48:26)
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