Tabletop Threapy:

I am not, by any means, a Dungeon and Dragons expert. But I can admit to a couple accomplishments in the area: starting my own D&D group about a year and half ago and continuing to help organize sessions; writing my first (very short) campaign; and preparing, now, to try my hand as a game master for the first time. Like any fantasy-obsessed neuro-divergent I’ve taken to tabletop roleplaying like a duck to water and the hyperfixation is real.

As I’ve grown more familiar – watching critical role and dimension 20 videos online, reading the literature, googling when I should be sleeping – I have naturally been reflecting on what it is exactly about this game that has drawn so many people in? The collaborative structure, the escapism, the random nature of dice rolls which keeps these narratives surprising and unpredictable, or maybe the personal levels to which we bond with these characters and stories? D&D is in many ways a unique experience, and a unique social atmosphere which allows us to explore imagination and relationships in completely new ways. I wonder if roleplaying games like D&D don’t offer us a new social avenue through which we can experience our friends and ourselves. As I’ve explored these questions I’ve also observed the challenges and growth in my own experience of the game. 

The assumption has been made that D&D’s escapism leads to players being less in-touch with reality. That it might even lead to people developing maladaptive behaviours. But recent literature actually argues the opposite of these concerns (Henrich & Worthington, 2021). Doing the research (Think About Thoughts Counselling Groups has an interesting information page about D&D’s therapeutic benefits), reflecting on my own experiences, the stories I’ve heard from clients and friends, I’ve come to the conclusion that there is something potentially very beneficial for mental health and relationship development in the D&D world. So here are my thoughts on that.

Social Skills - Exposure and Practice

Anyone who has tried to create or join a D&D group knows that it’s not easy bringing together a handful of people that get along well enough to play cohesively and are organized enough to commit to regular meetings. The hardest part of D&D is just getting it off the ground. I believe this is because the game brings with it unexpected social challenges that come to a head right at the beginning, and then linger as the game goes on. D&D groups require organization and communication – that means knowing your boundaries and being able to place them confidently with the group, accepting and negotiating with others’ boundaries in a competent way, and making reasonable sacrifices as necessary without offense, exploitation, or defensiveness derailing the process. It means outlining expectations, asking the relevant questions at the right time, delegating and leading in turns as appropriate. These things aren’t easy for everyone, and it can be difficult to know early on who has the experience and confidence to pull off these conversations and who doesn’t. 

But the challenge doesn’t stop there. D&D can come with a lot of pitfalls like sexism, gate-keeping, and racism left-over from previous versions of nerd culture (Henrich & Worthington, 2021). And, perhaps just as unpredictable as the initial problems are the issues that develop slowly over time. I’ve heard stories from clients and friends both about groups that got together and immersed themselves in a campaign, only for very real betrayals and disrespect to surface, sessions-deep, which irreparably tore the group apart. Role-playing allows us to step outside of our usual social restraints. We can experiment in a way like never before with pushing boundaries - magical and social alike – to see how the other players and the narrative reacts. In some ways, our true colours really start shining through. Without practiced empathy skills or a solid foundation of self-awareness, boundaries are easily pushed way too far. New versions of people you thought you new come to light. Relationship dynamics that had before stayed buried are dug up. Old resentments and new irritations accumulate. Tensions rise.

More than anything, D&D requires flexibility: flexibility in expectations (of characters, campaigns, story arcs, and even session frequency), in boundaries, in communication, in time management and energy management. Flexibility about all these things coming from all the other players. Patience for waiting weeks or months before we get to enact a scene or develop a character arc. And flexibility is, and will remain to be, one of the hardest social skills available to us. Because flexibility requires giving up control, and no one likes that. If you're prone to anxiety or anger or judgement then tabletop roleplaying is guaranteed to trigger these behaviour patterns because it demands us to let go when our most basic instincts are telling us to hold on. I know that I, myself, often feel anxious before, during, and after my D&D sessions, and it is an ongoing challenge to remain mindful of these feelings while keeping them from impacting the gaming experience (for myself or my group-mates).

And yes these are difficult barriers to navigate, but maybe that’s why we love it so much. With every challenge comes a learning opportunity, a chance to practice skills that maybe don’t usually get practiced. And with every risk comes a chance for potential reward. Yes, D&D groups crash and burn, but when you find one that works and lasts you don’t just create an extremely satisfying gaming experience, you create a space for relationships to strengthen. Take my social anxiety for example, which comes up every session. But every session I get more used to the feeling, more comfortable with the self-consciousness and vulnerability I feel, and more skilled at managing it. I know that if I keep at it that eventually it will cease to be a problem at all. And imagine that? An Autistic with a troubled social past and no social anxiety to be seen. That’s a mental health goal worth working towards, discomforts and all.

Dungeon Master Requirements

At the time of writing this I haven’t actually been a dungeon master. But I have been preparing for it, researching it, discussing it, and reflecting on it. And I am realizing that while being a D&D player does require social skills and confidence, being a D&D game master may very well require social expertise. First because a DM does all the things a player does, but more so. When tensions rise, when miscommunication happens, when boundaries are set, it is the responsibility of the DM to navigate, manage, resolve, communicate and confirm for the sake of the rest of the group. Keeping everyone on the same page and making sure everyone is happy. While creating and leading a campaign, all these group dynamics and interactions need to inform the process so no one feels left behind or deprioritised. So everyone gets time to speak and has control over the gaming experience. The DM is in charge of keeping the group in balance. The kinds of leadership skills required for navigating group dynamics are hard to come by (and don’t we all wish that our managers and parents had them automatically?). 

Leadership skills are also necessary for the game itself - literally leading the group through an unknown world with challenges and resources found along the way. Not to mention the organization necessary to competently prepare for and direct sessions. Suffice it to say, it’s a challenging undertaking. But clearly a rewarding one: for the potential to build confidence, to practice all these skills which can then be applied to work and relationships at home, to broaden imagination and creativity, to competently manage emotional regulation in yourself and with the rest of the group. There’s a real social power attached to DMing, and when used responsibly, who knows how many doors it might open up?

Personal Development Through Character Arc

The social aspect of tabletop roleplaying is broad and complex. But so is the individual, personal experience of it. Creating a character can be a challenging personal task. The questions we ask ourselves about personality, background, and ability act as a sort of indirect, super in-depth self-reflection exercise. It isn’t a far jump to assume that the characters we create and subsequently bond to might represent previously unexplored facets of ourselves. That with some investigation those characters could lead to insights in our own personalities and histories and stories - our values, beliefs, hopes, and fears. After all, the way we conceptualize a character is based entirely on the way we conceptualize a person.

As we move through D&D campaigns we are then faced with questions about how our characters change over time, how they respond to and relate with other characters, how they think and feel about a variety of encounters. Many D&D players are very intentional about these decisions - and that kind of intentionality draws on a lot of the same skills that I spend my sessions with clients developing. Skills like emotional awareness (of yourself vs. your character vs. the other players); or forethought (knowing how everyone might respond to a behaviour or statement you make using your character's voice or not); or self-reflection (considering what options are available to us, the potential consequences attached to them, and where our instincts might be leading us).

I think roleplaying tabletop games could, if we want them to, if we’re intentional about it, act as a catalyst for growing social and personal expertise. A way for us to reflect on ourselves, via our characters, our session planning, our decisions in roleplaying interactions, between sessions. A way for us to be intentional and thoughtful about how we’re responding to, both in and out of game, the various encounters placed before us. Put this way, it makes me think of how my therapy sessions with clients function, that maybe there are some parallels between these processes: the process of creating mental health and the process of creating satisfying characters and campaigns.

D&D in the Therapy Room

It has come to my attention that D&D is not just therapeutic on its own, but that it has even been incorporated into actual therapy practice. Character creation is like personalization - an intervention therapists use to create a face or body or voice for a feeling or concept or person (like fear, the inner child, or the grandfather we never knew) which had previously lived inside of us. It allows us to feel that we concretely understand a thing - its power and its limits. And it helps us create distance and boundaries between ourselves and that thing so, for example, my fear might have less of an influence over me. If inclined, the therapist and client could use D&D parameters to this aim. Or a pre-established D&D character could be used in the same way, if the process is reversed, by asking clients what inspired their character, what part of them is being expressed. (For those of you familiar with parts work, that could also apply.)

There is also something to be said for using D&D sessions as an example or practice space for social skills that could be applied anywhere or with everyone. Clients who have described their D&D sessions to me have given me insights to the way they respond to different social challenges which then gave us avenues for developing social skills. This is a place where clients might practice making observations about the group to take back to the therapy room. Was offense meant by this statement? How did the others respond? Are my group-mates noticing the same things I am about the emotional atmosphere, the implication of particular words, or the patterns arising in our communication? And what does it mean if they aren’t? After a new strategy has been devised and committed to, D&D gives clients an opportunity to put their new skill to the test. Whether it’s boundary placement, empathy practice, or general communication, all of it is applicable.

And while I’m not sure yet, and there isn’t much research, I am suspicious that D&D could also act as a framework for narrative therapy. Narrative therapy is a medium where the language we use to describe ourselves and histories is the lens for understanding and the tool for change. And D&D is, to an extent, a narrative-creating game. Either by exploring a campaign the client created or participated in, or by asking them to write a campaign inspired by their own history, I believe D&D narrative making has the potential for therapeutic narrative work.

So, D&D has been entering therapy conversations between myself and my clients, yes, and can be used as a filter or framework for therapeutic interventions. But there are articles about therapists and counselors using D&D game sessions as actual group counselling and psychotherapy: following gameplay with reflective conversation, creating opportunities for social skills building and communication practice, boundary placement, anxiety exposure, and community building. D&D has been successfully used as an intervention for gender exploration, self-esteem, impulsivity, psychosis, identity conceptualization, emotion skills, neuro-diversity and trauma processing (Demopoulos, 2023; Eisenman, 2021; Gourdeau, 2023; Hayward, 2024; Henrich & Worthington, 2021; Markus, 2023). More than all that, it makes therapy fun! And if therapy is lacking in anything, it’s fun.

“The game itself serves as this sandbox… There's a sort of psychological distance between you and whatever you're engaging in.” - William Nation who created one of the counselling groups mentioned (Gourdeau, 2023).

Supportive Sources

Conell., Megane, 2023, Tabletop Role-Playing Therapy: A Guide for the Clinician Game Master: https://www.amazon.ca/Tabletop-Role-Playing-Therapy-Clinician-Master/dp/1324030607

Demopoulos., Alaina, 2023, Facing the demons: can Dungeons & Dragons therapy heal real-life trauma? Published by the Guardian: https://www.theguardian.com/society/2023/mar/21/dungeons-dragons-therapy-psychologists-mental-health

Digital Doc Games, 2021, Role Playing Games For Social Skills Training - Dr. Raffael Boccamazzo Interview: https://www.youtube.com/watch?app=desktop&v=70Em9L5KKC0&t=2s

Eisenman, 2021, Bridging the Isolation: Online Dungeons and Dragons as Group Therapy during the COVID-19 Pandemic: https://www.csac-vt.org/who_we_are/csac-blog.html/article/2021/03/31/bridging-the-isolation-online-dungeons-and-dragons-as-group-therapy-during-the-covid-19-pandemic

Goudreau., Claire, 2023, Tabletop therapy: How Dungeons & Dragons can improve mental health published by John Hopkins University: https://hub.jhu.edu/2023/12/04/dungeons-and-dragons-therapy-group/

Hayward., Jaclyn, 2024, People of SFU: Stories told as the dice roll – supporting students through gameplay: https://www.sfu.ca/dashboard/faculty-staff/news/2024/03/people-of-sfu--stories-told-as-the-dice-roll---supporting-studen.html

Henrich & Worthington, 2021, Let Your Clients Fight Dragons: A Rapid Evidence Assessment regarding the Therapeutic Utility of ‘Dungeons & Dragons’: https://www.tandfonline.com/doi/citedby/10.1080/15401383.2021.1987367?scroll=top&needAccess=true

Markus., Jade, 2023, How Dungeons and Dragons is making its way into therapy: https://www.cbc.ca/news/canada/calgary/dungeons-and-dragons-therapy-calgary-1.7065300

Thinking About Thoughts Counselling Group, D&D Therapy: https://thinkingaboutthoughtscounseling.com/dd-therapy/