Games That Heal: D&D as a Form of Therapy (2022)
Growing up, I had a pretty bleak childhood and was detached from pop culture and usual teenager shenanigans. My mother wouldn’t allow me to collect Pokemon cards, watch cartoons or play video games, thinking they would affect my grades. As a result, I never knew about Dungeons & Dragons until I was in college when one of my friends invited me to play with a group over the weekend. Throughout his explanation of the “tabletop role-playing game,” I couldn’t help but think about that one IT Crowd scene of Moss explaining the game to an incredibly uninterested Jen.
Honestly, I had a hunch that I was headed for a lame evening: nerds huddled around a table, rolling dice, playing make-believe with worlds about fairies and elves. Regardless, not wanting to hurt my friend’s feelings, I rolled up to his house that Friday and made up my mind to have my character die as soon as possible so I’d have an excuse to go home early.
We started by passing around character sheets and rolling dies to establish points for attributes like strength, intelligence, dexterity and charisma. Brilliant. I was already bored and picking at the cheese puffs and pretzels, checking my watch and waiting for the actual game to start. Once the game eventually began, though, boredom slowly became intrigue when my friend, the Dungeon Master, gave us scenarios with comical outcomes like robbing an entire town for supplies because we had no money. I began to realize just how much freedom and potential the game actually offered. In the end, I decided to stick around to watch the game even after my character’s unfortunately premature death.
Being more accustomed to video games, I was familiar with games that established specific, restrictive elements that were used to complete objectives. For example, in an FPS, or first-person shooter, players are given guns to, obviously, shoot people with very little deviations to the formula.
However, D&D relies on players’ choices to solve open-ended situations. For example, an enemy stands in your way. You could be straightforward and fight the guy or you could try to charm him, poison him and proceed to rob his gullible corpse. Perhaps its this open-endedness and freedom of choice that made it popular in one of the unlikeliest of places: the therapist’s office.
Therapy? How?
While it may sound far-fetched, the mechanics of D&D actually allow for unique treatment opportunities that target an assortment of behavioral and developmental issues.
Dr. Megan Connell, a board-certified licensed clinical psychologist and “Certified Geek Therapist” in Charlotte, NC, uses D&D therapy groups geared towards different audiences from children to teenagers to even former active duty veterans. She also offers teletherapy, or video therapy through VOIP, available to 28 states (sorry, New York).
Her different groups also have different objectives. For example, Connell’s “Self-Rescuing Princess” group, targeted to females of all ages, mainly focuses on female empowerment where “girls are given the opportunity to play a strong, self-assured character.” Meanwhile, her Veteran’s group for former active duty members focuses on “building identities outside of being an adventurer while still getting to pay homage to the skills and abilities that one spent years honing.”
During a 2018 PAX West panel talk called “Roll for Healing - Therapeutic Game Master Round Table”, Connell stated, “One thing that I do is that I ask all of my players to make a character that is strong in something they feel weak in, but I don’t specifically ask what that thing is or have them tell me what it is. But, also, as a psychologist, I know, no matter what kind of character you make, your issues are going to come out and does come out at the table and then gives you these wonderful opportunities to start working through things.”
Michael Reisner, a Counseling Services Clinician at Mount Saint Mary College in Newburgh, used to have his own private practice in New Paltz, called D20 Therapy. For several years, he worked with people who did not fit with “dominant culture” or societal norms, saying, “The people who wanted to work with me were super nerdy and already reading crazy sci-fi, fantasy literature.” For Reisner, then, D&D therapy was the perfect opportunity to “make a space where people could explore themselves and get a safe space to try out different ways of being.”
Reisner played a specific version of D&D called “Old School Revival”, which drew inspiration from the earlier days of the game. “D&D has gone through a lot of evolutions. Some people made these very rule-heavy games to try to protect themselves from people who go on power trips. But the oldest version has considerably fewer rules and is a lot more about creativity. Your character sheet is a basis for ideas,” said Reisner. In other words, rather than playing the game in the conventional sense with an emphasis on attribute numbers and combat, Reisner used characters’ stats as opportunities to solve issues through other means.
“I think it was really for people who were trying to figure themselves out and didn’t really have access to other non-dominant cultural spaces,” said Reisner. “A lot of people I worked with became less shy and figured out, through their characters, how to identify their own emotions and ways of handling them. I think it was very successful. A lot of people found it to be a very safe space and made very cool changes.”
Similarly, Connell said, in a 2017 PAX Unplugged panel, “I like having people build characters — especially my clients who are trying to reinvent themselves. I work a lot with teenagers. One of the things with teenagers is that sometimes they feel pressure to conform to a certain identity that’s not comfortable for them. So, I like to theoretically introduce the concept of Dungeons and Dragons, saying, ‘There are these magic classes and there’s these fighting classes. Which one do you feel more like,’ and helping them to build through a character. It can be a lot of fun for them to verbally go through what it would be like to make that character.”
Both Reisner and Connell shared a common interest in allowing clients to create tailored characters that reflected their strengths and weaknesses and had those characters interact in a safe, detached environment. While D&D therapy may be a newer concept, its therapeutic techniques have actually been around for decades.
What Kind of Therapy is it?
Rather than classifying it as a singular entity, D&D therapy can be seen as an amalgamation of several therapeutic techniques: play therapy, fixed-role therapy, and narrative therapy.
Play therapy, according to the Association for Play Therapy, is “the systematic use of a theoretical model to establish an interpersonal process wherein trained play therapists use therapeutic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development.” Don’t worry, it’s not as complicated as it sounds. Essentially, play therapy refers to the therapeutic practices of play to help clients — usually children — express themselves and explore their issues.
Dr. Jonathan Raskin, SUNY New Paltz Department of Psychology Chair and Professor, said, “A lot of play therapists I know seem to use play as a way into a child’s emotional world. The child can act out their feelings through play in ways that they might not communicate because a kid is not likely to come in and say ‘I’m feeling really sad because of X,Y and Z,’ but they might act the conflicts out through play.”
D&D, being a tabletop game, can appeal to older clients, offering similar therapeutic benefits of play and creating avenues of communication for those who struggle verbally. Raskin said, “You’re probably not going to do D&D therapy with a six year old because they might not be up to that task. But for a teenager, they sometimes have a hard time articulating their concerns, too. Any form of play or role-playing can be a way for them to help them do that.”
Narrative therapy, according to GoodTherapy, is “a method of therapy that separates a person from their problem. It encourages people to rely on their own skills to minimize problems that exist in their lives.” However, narrative therapy is more nuanced than that. According to Karl Tomm’s “Externalizing the Problem and Internalizing Personal Agency”, narrative therapy has two key components as the name suggests.
“Externalizing the problem.” What does that mean? Tomm presented an example of therapist Michael White, the creator of narrative therapy, treating a child with encopresis — or soiling. White refers to the encopresis as “Sneaky Poo”, personifying and externalizing the problem as a separate entity from the patient. From there, White may have asked questions about ‘Poo’ to both the child and the parents like, “When your son has been tricked by ‘Sneaky Poo’ into making a mess, what happens to you?” or “”Have you ever had the experience of ‘Poo’ sneaking up on you and catching you unawares, say by ‘popping’ into your pants when you were busy playing?”
Then, after externalizing the problem, White would begin getting the client to “internalize personal agency”. In other words, White would guide the client to find solutions and “defeat” the personified problem. For example, Tomm described how clients suffering from schizophrenia could be asked, “If it was possible to do so, would you like to limit the influence that schizophrenia has on your life? ... How did you manage to defy schizophrenia’s instructions to avoid people and come to this meeting today?”
Due to the storytelling nature of narrative therapy, D&D could be used to personify and externalize problems as characters or enemies within the game. “D&D therapy could incorporate anything from any approach, but it makes sense that it would be drawn towards narrative because narrative therapy is about storytelling and D&D is a game all about telling a story together,” said Raskin.
However, Raskin also mentioned a form of therapy that aligned closer to D&D’s mechanics as a role-playing game: fixed-role therapy.
Fixed-role therapy, according to Common Language for Psychotherapy Procedures, “encourages the client to enact a new role to try out alternative views of the self and the world.” Simply put, fixed-role therapy is role-playing in which clients create an alternative persona with a different name, or a fixed-role sketch, and act out as their new character for several weeks. How does that work within an actual therapeutic setting, though?
“Jim is the client and is the kind of person who is very shy: never talks to anybody and spends all his time alone at home. The therapist might rewrite it and say, ‘Bill is the kind of person who tends to be quiet and can feel shy at times but when Bill really wants to engage with people, he seeks them out anyway.’ Then, you say to the client, ‘Hey, Jim, here’s your homework this week. I want you to play — you’re just acting. I want you to do what Bill would do,’” said Raskin, who has experience using fixed-role therapy for patients dealing with a variety of issues like depression.
“Maybe the client is Jane. When Jane is depressed, she lays in bed and can’t get over the feeling of sadness. Instead, we do Sarah (the fixed-role sketch). Sarah is the kind of person who, when she feels depressed, acknowledges the feeling, but gets on with her day.”
With role-playing at their cores, D&D and fixed-role therapy share common interests and processes like the character sheets and fixed-role sketches and the self-insertion of players as their characters. “D&D’s kind of a more detailed version of fixed-role therapy. Let’s create a character who’s different from you in some way? How would that character act? That character stood up and was courageous and fought the dragon. If you were like that character in real life, how would you face some of the challenges you’re facing,” said Raskin.
Both Reisner’s and Connell’s approaches also seemed to derive from fixed-role therapy in which they encouraged their clients to explore different identities within the safe, experimental spaces offered by D&D. “To the extent that D&D does involve storytelling, you can see where it might be able to be synced up with narrative therapy and fixed-role therapy. As part of this larger personal construct therapy, we have certain ways of construing of making sense of the world. All therapy, regardless of the problem, intends to help the person construe in new ways and then test those constructions out through everyday behavior. So, it emphasizes this idea, not just to create the fixed role, but try it out — test it,” said Raskin.
Where Can I Find D&D Therapy?
Being a newer form of therapy and due to the niche nature of the treatment, D&D therapy specialists are scarce. Furthermore, because the game is generally played in an in-person group setting, finding a D&D therapist is even more difficult. While an actual therapist may be helpful in guiding clients, there are also alternatives to utilize some of therapeutic aspects of D&D therapy.
Nowadays, websites like Roll20 allow people to organize and play D&D sessions together with a webcam and microphone. VOIP applications like Discord have servers dedicated to looking for and playing with others online. D&D-related Facebook groups like this and this also often put out posts looking for potential players.
Those who want to play in-person with physical groups can often find D&D sessions being held at comic book or special interest stores as well. In Ulster county, stores like POW Card Games & Comics in Port Ewen and October Country Comics in New Paltz hold trading card game and D&D tournaments throughout the week.
While finding D&D therapy sessions may be difficult, there will always be opportunities, both in-person and online, for people to engage with others and utilize the therapeutic strengths of D&D to tackle issues they may be facing.
