Dungeons and Dragons May Be Providing Therapy to Players

Several months ago I interviewed clinical psychology student Nicolette Rodriguez about being a “play therapist”. She is a therapist that implements Dungeons and Dragons in her regular sessions. Due to a series of missteps on my part (i.e. absent-mindedness) I have just now put together the contents of that discussion. This is a copy of our email communication. Nicolette preferred this means of communication. Thanks, Nicolette! I hope you can forgive me for taking so long to post this content. It was great learning of a practical purpose for D&D and I was happy to see there is empirical research that supports this claim. So, without further ado…find out below how Dungeons and Dragons may be providing therapy to players!

Could you share your earliest experiences with Dungeons & Dragons? When did you first learn about it? Do you have a particular edition you prefer most and do you have a favorite setting and character class/race?

• My earliest experiences with D&D wasn’t until later in life. I had an ex that loved it and that furthered my interest in it. I first learned through googling, like I do everything. It caught my interest because I have always liked games such as WoW and supernatural things so, this felt right up my alley. Currently, I like the 3rd edition, but I have been spending my time with the newest edition. So, my favorite location is Neverwinter. My go to classes are rouge and wizard and my go to race is elf! I really stick to what I like in real life; nature, magic, and creation.

What drove you to choose psychology as your major? Likewise, what drove you to focus on clinical psychology for your masters degree?

• I have always loved psychology and I think it’s from learning more about my own mental health and taking classes. I got my undergrad in psychology and know that I needed to continue if I wanted to get a ‘real’ job in psychology. So, I decided for clinical psych because it would allow me to continue on and get my Psychology Doctorate, if I wanted. I could also get my Marriage and Family therapist license, which would enable me to work with kids, which are my favorite.

How long have you been a “play therapist”?

• I have been doing forms of play therapy for two years with middle school kids. However, I specifically do DIR/Floortime therpay currently. After I graduate and get my license, I am hoping to work for or start a gaming therapy group.

As a play therapist, do you serve as a Game/Dungeon Master? Or do you bring in someone else to DM so you can be a host or facilitator?

• I usually play as the Dungeon Master! It’s where I feel more comfortable. Since I am autistic, I don’t have the best imagination and I can have anxiety if I am with a new group (of friends, not students). So, it allows me a safe barrier. It also allows me to guide the session in the best way for each person. However, bringing in another student is helpful for everyone because it really changes the dynamic of the group.

Would you like to share a favorite moment or success story related to play therapy?

• I have a kid that has been in and out of the hospital since he was born due to needing a liver transplant. He misses at least 2 days of school a week so he can go to the hospital. Encouraging him to bring him friends to play a game with us, was pretty easy. However, once he saw how much there was to it, he got discouraged and didn’t want to join. I made a deal with him that after the first 10 minutes, if he still didn’t want to play, then we would stop. After 5 minutes he was laughing and thinking harder than I have ever seen him! It really allowed him to open up, use creative thinking, and opened up his communication with me, as well as his friends.

When are some of the earliest known instances of using role-playing games as a form of therapy and was it D&D or some other game?

• In my experience, I first used Adventure Time Card Wards, since I knew my client loved the show. However, I knew his cousin would be there so, I brought Munchkin, which was another big hit. I decided to bring in D&D if I could ever get his friends to come over at a time I was free.

How can you identify a patient who may benefit from role-playing?

• Almost anyone can benefit from playing as a form a therapy, in general. For role-playing, someone who may have anxiety, depression, social reservations, or even suicidal would greatly benefit. Basically, anyone that is in their head a lot, would be a great candidate, since it would help teach them healthy skills.

Can anyone run a “therapeutic” Dungeons & Dragons session or is there risk that it could be ineffective or, worse, do more harm than good by a careless DM? What controls do you use to ensure the therapy isn’t counter-productive?

• I definitely don’t think ‘anyone’ can, but many groups of D&D act as therapy sessions, even without the intention. However, if someone were to purposefully run a D&D group for therapeutic reasons, definitely get someone with a psych background, has worked with that population, and preferably, has a degree in psychology or counseling.
• To be sure a session is best as it can be for all people, you really need to check in with people and monitor how they’re feeling. This may be hard if this is everyone’s first time and you’ve never worked with them. However, if everyone is having a good time, it’s reasonable to assume you’re doing good work!

Are sessions strictly players needing therapy? Or do you sometimes have a mix of players in need and players that don’t have a need for therapy?

• This depends on the people in group. I really love to bring in family and friends, since it also teaches the family better ways to interact with their family member or friend. Working with all people who need it as a session is also great, too. however, I usually make sure they will be able to catch up and understand the rules 100% before putting them into a game with other people. This is because I want to eliminate as much anxiety as possible.

What differentiates a “normal” D&D campaign from a therapeutic one? Are sessions and story arcs designed for players’ specific needs? Or is it more open-ended where the player(s) may do as they desire?

• As stated earlier, many people who get together a weekly D&D group, are going through things in a therapeutic way. However, I definitely take great care in making my story arcs to cater to each person within the group. As well, I try to put people of same skill and understanding within the group so there isn’t too much miscommunication or bumping of heads. Depending on the group, I may make it so that I can hit on certain things like allowing someone to take control or the group needing to be extra team work oriented. However, I will also leave it open ended if I have worked with that group multiple times and I know how they play.

What sort of skills should a good therapeutic DM have?

• Definitely being emphatic, knowing your clients, and being fun. You need to be able to pick up on what your clients on dishing out; are they anxious, do they not understand what’s happening? You also need to know how your clients play; are they more likely to be the sidekick, fall to the wayside, not have much to say when the spotlight is on them? You need to know how to curb those behaviors instead of letting it play out and isolate the player. You also need to be fun! I am a very sarcastic and blunt person, which kids seem to really like so, I use that to my advantage.

What sorts of things should the DM avoid (i.e. Certain content and/or overly graphic/violent details)?

• Again, this depends on the group. With kids, I don’t go too in depth, unless I know their history, and stay pretty light-hearted. With adolescences and teenagers, I can go way dark since many of them are seeing these things or even experiencing these feelings. I want to normalize, validate, and educate. However, if I know clients have trauma, I will avoid those arcs and slowly introduce them in multiple sessions.

How would you determine if a session was “successful”?

• If everyone in the group comments on having a good time and feeling accomplished, that is generally the easiest indicator. I also like to ask clients how it went privately, or have them journal about it. This allows me and then to see progression.

Are there risks or dangers even with successful sessions? Such as a child revealing dark matter or the session becoming overly emotional.

• I haven’t really had this happen and have it be ‘bad’. If something dark or emotional is admitted, it’s usually with a group that has been doing this for awhile and doing it together. As well, other people can validate or question the other person, which may help them unpack or think of it in a new way.

Aside from obvious things like suicidal ideation, what are some examples of reportable incidents a DM should keep in mind?

• Most, if not all, people doing this will be mandated reporters so, there are things we must report such as child abuse or elder abuse. So, if a client is consistently bringing up abuse in their character or doing it to others, it could be a red flag that you should look into. As well, before starting every session I definitely go through the do nots such as, no rape, child abuse, or suicide. However, some clients have been through a lot and you need to be mindful of the issues they may bring up, which are still valid.

Are there things about D&D as therapy that you think is poorly understood and/or unresolved?

• I definitely think it’s misunderstood in general. This could be an American cultural thing though. Therapy, in general, isn’t the most highly looked upon thing so, adding D&D into the mix doesn’t always help. D&D also can have it’s own toxic ‘bro’ culture, that as a woman, especially a queer brown autistic woman, I see a lot. I’ll have clients that tell me they went to a tournament or a local shop and they were made fun of or turned away. I know there are great people that D&D and I hope the culture expands.

Are you aware of any key scholars or practitioners that are advocates for (or detractors against) this sort of therapy?

• Play therapy in general, is a pretty big thing, but only thought about for ages 3-11. Melanie Klein was one of the first to start using play therapy in her sessions. Structured therapy was developed by Gove Hambidge, which focused on introducing situations and working through them. Filial Therapy expanded on this, conducted by Lousie and Bernard Guerney. I am not sure of too many people that are exactly for specifically D&D therapy and more may be against it, especially since they don’t know about it or have assumptions. However, as far as I am concerned, play therapy has been received very positively and has been expanding.

Is there any empirical research that you can point to that supports the usefulness of this kind of therapy?

• There are a few articles about this, and even specifically D&D! Here are all the ones I found W.A. Hawkes-Robinson, Blackmon, Wayne D., Sherry Turkle, John Hughes, Lee I. Ascherman, Jason Steadman

In your judgment, how can role-playing games in general—and D&D in particular—be more purposeful without FEELING like therapy?

• I think they most D&D games are played purposefully, especially since there is so much going into just one game. I also think a good DM won’t make the session feel like a therapy session, but like a ‘regular’ game.

And, finally, why does D&D therapy “work”?

• I believe D&D Therapy works, because it doesn’t feel like therapy to most people! Especially to kids. Even just saying, “we’re going to play” has completely different connotations than, “we’re going to talk/go to therapy”. It enables everyone to come into it with a neutral, maybe even positive, mindset instead, of an anxious or negative one. This automatically produces better results. As well, people are able to work through issues, without really working through their issues. Such as when we read fairy tales, we’re able to see ourselves as the hero and work out how we would defeat the dragon. Having our characters work through real problems, builds up our skills to use in the real world.

*Nicolette Rodriguez is a Master of Clinical Psychology candidate with Antioch University and After School Site Coordinator for New Los Angeles Charter School in Los Angeles, California. I’d like to thank her once again for granting me this interview. But more importantly, I would like to express my utmost respect and gratitude for the work she does. Therapy, in any form, is a tough job. But I can think of no other role that can be as important as an effective therapist.

Have you ever partaken in a play therapy session or series of sessions? I’d love to hear about this from the perspective of the player. Please let me know if you’d like to share anything. We would love continue raising awareness for Dungeons & Dragons and therapy alike. What better way than with D&D Therapy Stories?