6 Things that Therapy Games can learn from Facebook Games

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1. Have clear, visible goals

A good therapy game should have goals the player can work towards. The ultimate goal is the patient’s physical recovery, but especially for children, this is too far out, too abstract.

Instead, the game should provide goals on several levels: as a game as a whole, within a therapy session and finally from moment to moment. Additionally, these goals need to be clearly communicated, and their progress visible at all time; as can be seen in FarmVille 2 with their list of quests that are visible all the time, or Candy Crush Saga, which uses counters and a progress bar to show how many moves the player has left and how many points they made.

Given the fact that actual therapy progress happens gradually over a long period of time and is often hard to perceive, it is important to give patients a sense of progress in other areas. Games can be that area.

2. Hand out rewards

Facebook games are tiny little rewarding machines: they hand out rewards – in form of items, power-ups or just audio-visual spectacle whenever the player does something good. Therapy games have a tendency to skip this part. During play, they merely acknowledge success with a beep, while at the end they usually just jump cut from whatever the player happened to be doing to a stats-filled screen without so much of a warning.

Facebook games however go overboard celebrating the player’s achievements. Every successful action is rewarded with a sound and some particle effect. The end of a game is marked with more fireworks, with more sounds, with voices cheering and laughing and cartoon characters celebrating. The player is showered with gifts: bonus points, achievements, medals and power-ups. They might be just virtual goods, but the can make you happy anyway.

Given the fact that the ultimate reward of therapy is usually far off in the distance, games can provide small stepping stones of feeling successful and being rewarded for the labour in between.

 3. Structure gameplay into distinct bursts of activity

Facebook games not only reward players in sometimes a somewhat excessive manner, but also very often. This is based on the fact that play sessions are kept very short: the player needs to have the feeling that they can abandon the game at any time. Therefore, gameplay is presented in distinct rounds that only take a few minutes to play and are rewarded right afterward. It is the player’s decision to close the browser window at this point or continue playing.

This principle of having short rounds should also be applied to therapy games, and not just because actions can be rewarded more often. By structuring the difficult tasks into short bursts of high intensity, and then immediately rewarding the player with some spectacle, the patient is allowed to rest for a moment and gain strength for the next burst of activity.

Given the fact that therapy games are in most cases physically taxing for the patient, such a pacing provides a training pattern that resembles high intensity interval training, challenging the patient, but still giving them enough time to recover. Having to pay attention for sustained periods of time is incredibly tiring, and therapy games should take this into account.

4. Make patients want to return to your game

When there is something most Facebook games excel at, it must be their mechanics to get players to return to the game over and over. Of course, therapy games are not dependent on players returning – the games are paid for by the clinic, and it is usually the therapists who decide which games the patient will play during a therapy session. Still, it is likely beneficial to therapy if the patient wants to play a game over and over, and through that, improve their skills.

Therapy games could take advantage of some of the mechanics employed by Facebook games in order to get players to return to their game. I. e. by letting players earn objects during gameplay, which then take time to gestate in order to have their full potential. Through this, the player is given a reason to return to the game. These objects do not even necessarily need to have an influence on gameplay. They can just as well be objects that change the environment the game plays in, giving the player an opportunity to explore the game over and over again, while in the same time hinting at the progress the player is making in therapy.

5. Create a social context

Gifting, a common element in Facebook games, can be used in a similar vein to make patients return to already played games. It can be used especially in clinical settings, where therapy devices are usually used by several patients in turn. Giving players the possibility to leave gifts for patients that come after them has the potential to improve the attitude and mood of the following patient (who does not like gifts?) and may give the patient a feeling that they are not completely alone with their affliction, as other patients do have to train as well. Therapy games can be a framework for random acts of kindness.

6. Add a random touch

The last point, as I already pointed out in an earlier article, is the use of some gambling-like elements. These elements can easily add new content to explore, adding replay value to a game that, through necessity, has to be played repeatedly. This becomes even more important when a therapy game exclusively relies on repetitive movement. Just remember the one-armed bandit, which requires the player to make exactly one motion repeatedly; yet the game still keeps the player captivated, purely through its chance-based game mechanic. While there is a growing discussion concerning the ethics of using gambling-like structures in Facebook games (usually in order to monetize them, see Rose 2013 for an in-depth discussion of the topic and its ramifications), I feel that these can be used in therapy games – at least in moderation.

The addictive qualities of these game mechanics should be offset on one hand by the fact that patients need to work against their affliction, which is usually exhausting work for them, and on the other hand that therapy games are, at least in a clinical setting, supervised when played. As such, therapists can take actions as soon as they feel that it gets out of hand.

In summary, it seems clear to me that therapy games can learn a lot from Facebook games. After all, Facebook games are created with mass appeal in mind, and, what’s even more important, target directly middle-aged adults (and not just, as people might assume, children and teenagers). Just because they are adults does not mean they don’t like playing games. As a matter of fact, today’s slightly younger grown-ups already belong to a generation that were raised on a steadily growing diet of video and computer games, and they keep playing to this day. As such, they know “how games work” and will expect nothing else from therapy games. By taking hints from Facebook games, therapy games can easily become better games, and through that, become better therapy games.