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Sunday, June 23, 2024

How Therapists Are Using Tabletop Games to Help People

As tabletop role-playing games (or TTRPGs) continue to grow in popularity, mental health professionals have been adapting them to enhance their practices. In a therapeutic setting, TTRPGs like Dungeons & Dragons (D&D) give clients a safe space to explore everything from gender to social skills—and have fun while doing it.

How Game Therapy Started

Adam Davis founded Game to Grow with Adam Johns in 2017 to offer therapeutically applied TTRPGs to their clients and help other mental health professionals do the same.

Davis had a background in drama therapy and education, and Johns was working as a private practice therapist when the duo started running TTRPGs in a therapeutic context.

“We were running a small organization, a couple of groups a week helping 12, 15, maybe 20 kids a week in our groups,” Davis says. “And then we realized we could do even more if we were a nonprofit.”

The organization grew to include more providers and now serves around 150 clients, Davis says. These clients use TTRPGs to work through a range of issues, from exploring identity to addressing real-world conflict.

From there, Game to Grow developed a more formal methodology that they now use to train other mental health professionals and educators on how to implement TTRPGs in their work.

“A lot of therapists and educators speak the languages of gamers and therapists, or the language of educators, but they don't know how to bridge those things,” Davis says. “So we talk about aligning in-game scenarios to treatment outcomes and educational outcomes.”

Geek Therapeutics, like Game to Grow, offers training for mental health practitioners in how to run therapeutic tabletop role-playing games. Anthony Bean founded Geek Therapeutics after getting a degree in psychology at a time when a lot of “secret geeks” weren’t as open about their interests in games and other geeky ventures.

While pursuing his master’s, Bean realized that he and his friends were already using D&D in their own lives to process what was going on outside of the game. After a bad day, he and his friends would ask what their character would do in that situation.

“We started using this with clients,” Bean said, “and it helped them blossom tremendously, in ways that we didn't expect.” After being asked frequently to present on the role of geekdom in therapy, Bean decided to record and distribute his methodology.

This methodology is what differentiates the work of organizations like Geek Therapeutics and Game to Grow from games one might play at home with friends. Geek Therapeutics has a Code of Ethics, and therapists trained in its method are held to the same standard as they would be for any other form of therapy. Confidentiality and informed consent, for example, are applied to these games as they would be in other group therapy settings.

Therapists participating in the Game to Grow method must run a certain number of games before they can be formally certified. Both organizations give therapists the opportunity to work with other certified game masters, as well as TTRPG experts.

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Bean still GMs for some clients about once every other week and tailors his games to the players. “I really focus on certain objectives and goals that they need to learn, whether it's working with the autism population or  working with some group of depression, anxiety, social skills,” Bean said. “You name it, we can create an entire story arc based on what their needs are.”

Who It’s For

TTRPG therapy can be valuable for a variety of populations, including people with a history of trauma, people exploring identity, and people who struggle socially.

Raffael Boccamazzo, a clinical psychologist, quickly realized while playing D&D as a teenager that the characters he played were often a form of wish fulfillment. “They were kind of suave, they were socially aware, they were very with it in a way that I wished I was,” Boccamazzo said.

Boccamazzo was diagnosed with autism at 35 and said that D&D provided a safe framework to practice various social scripts he was able to translate into his real life. Playing D&D also gave Boccamazzo a core group of friends, many of whom he is still in touch with.

“It was amazing to have that sort of stable friendship, but on top of that, it was fun,” Boccamazzo says. “And I got to feel powerful in a way that I just didn't in my day-to-day life.”

In a therapeutic context, Boccamazzo says role-playing can make the process of going to therapy less challenging. “It's way easier for me to go and engage in a process that I find enjoyable, as opposed to going to somebody's office knowing I'm going to talk about some very painful, very difficult things directly,” Boccamazzo says. “If something's fun you're gonna go to it again.”

Bean says TTRPG sessions with therapists can allow clients to try out new gender identities and presentations. For younger people especially, he says, it gives them a space to become more comfortable with that part of themselves. “It just transforms their ability to feel like their opinion matters and who they want to be also matters,” Bean says. “And I think that's the power of being able to work with gender roles there.”

For Devon Hayakawa, TTRPGs provided an opportunity to explore gender by playing characters with different identities. Even when the character arc wasn’t centered on gender, “it offered a safe space for me to try on those different pronouns and take risks I might not have felt comfortable with in real life,” Hayakawa explains.

D&D isn’t the only game that players can use to better understand themselves. For Beth Levitt, the game Ten Candles helped them come to terms with their own mortality. The game is played in complete darkness, with the exception of 10 candles. A candle is extinguished at the end of each scene, and by the time the last candle blows out, all the characters around the table are dead.

Levitt and the people they were playing with chose the setting of a cruise ship stranded in the middle of the ocean. Despite the characters’ hopeless condition, “they never gave up hope,” Levitt said. At the end, they came to accept that the game was worth playing, even though death was inevitable.

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“Our mortality is actually what gives things meaning and motivates us to do anything at all,” Levitt said. “For a long time I was more of a destination person than a journey person, and I think that's really shifted, in part thanks to this game.”

Role-playing can be especially helpful for people who've experienced trauma and oppression. Cassie Walker, a clinical social worker and trauma specialist, sees games and role-playing as a valuable way to connect with clients and demonstrate that therapy doesn’t have to be serious or painful.

“Trauma disconnects us from ourselves, and one of the first things we get disconnected from is our imagination and creativity,” Walker says. Tabletop games allow their clients to reconnect with their imaginations, as the structure of the games provide some comfort and encourage people to start thinking about what could be rather than what is.

While many people who participate in geek therapy are children and teenagers, many therapists—including Walker—work with adults. Walker wants therapy to be a space that can be fun and energizing for clients.

“Therapy is so important and has so much potential for healing, but the colonization of our health and wellness and minds have made it into such a stale, static, depressing thing,” Walker says. “I laugh with my clients, I cry with my clients. We play games, we explore what’s fun with them.”

How to Get Involved

Geek Therapeutics has a directory of certified Geek Therapists on its website. In addition to TTRPG therapy, some providers offer forms of geek therapy, including therapeutic video games and less structured role-playing. These therapists provide services in the US as well as internationally, and many accept insurance.

Game to Grow has several in-house therapists who offer individual therapy. They currently offer their services exclusively through telehealth.

For those interested in leading group sessions and helping others, Geek Therapeutics offers training for mental health professionals, including therapeutic game master training. The nine-week course includes training from professional game masters, some of whom were writers for Wizards of the Coast, the company behind Dungeons & Dragons.

“It can be very intimidating since they have 30 years-plus experience,” says Bean. “But they're also amazing to work with and to really gain a masterful insight, because they are the masters of their craft.”

To supplement the Game to Grow Method, Davis and Johns created Critical Core with other mental health professionals and creatives. The game kit provides teachers, parents, and mental health professionals with all the resources needed to run a TTRPG, including adventure modules, prewritten character sheets, and a facilitator guide designed to incorporate therapy into the games. The game is modeled after D&D, but it removes many of the rules and intricacies that can make TTRPGs intimidating for new players.

“We are wanting to remove some of that complexity to make it more about the narrative storytelling, life-magic of narrative social play,” says Davis.

You don’t have to be a therapist to participate, either. Both organizations also offer training for people who are not mental health professionals, like teachers, parents, or anyone looking for a way to connect with themselves and others through gaming.

Geek Therapeutics’ Certified Geek Specialist program helps participants better provide support for their peers and students through the lens of TTRPGs and fandom more broadly. The course is self-guided and offers more than 80 hours of content for those participating.

Game to Grow offers two forms of training outside of its Certified Therapeutic Game Master program—community training and educator training. Davis says the educator training is more aligned with educational goals than therapeutic ones, integrating Common Core and 21st Century Skills. The community training is for everyone who doesn’t fall into the category of educator or mental health professional.

Boccamazzo is the clinical director at Take This, an organization focused on decreasing stigma and increasing support for mental health in games. Boccamazzo also provides training on the applied use of role-playing games in clinical and learning settings. He notes that playing a TTRPG in and of itself doesn’t constitute a therapeutic practice, even if the GM is a mental health professional, so keep that in mind.

“The game is not the therapy,” Boccamazzo says. “It's the therapy that’s the therapy, using the game as a vehicle.”

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