• Greg Schoeneck

Dungeons & Dragons & Therapy

Updated: Jul 14

What are the therapeutic applications of Table Top Role-Playing Games for therapy?



First of all, you have to understand what a table top role-playing game is, if you are going to have any idea or perspective about how it could be used in therapy. So, let’s start there. A table top role-playing game is game where players create and take on the roles of characters and are placed into a story initially imagined by a unique player sometimes called a “Game Master (GM)” a “Dungeon Master (DM)” or, my favorite the “Storyteller”. The Storyteller works with the other players to tell the story by providing the rest of the players with the ability to interact with the world, it’s cast of characters, and the environment in general. Btw, about 90% of this is all done in the player’s imagination. Taking them on adventures or missions to explore and build this imagined world and themselves and their characters together.

Most people have one name to hang on when it comes to table top role-playing games and that is Dungeons and Dragons. This is one of the first, if not the first for sure, and was invented right here in Wisconsin where I am from and was just the beginning. A lot of people have a lot of different feeling when the words Dungeons & Dragons is said, and maybe I will get into that at some other time. The “Satanic Panic” around Dungeons and Dragons was real in the 80’s and all of us who were playing felt it in their own way. But there has been a lot of evidence now that has come out about how ridiculous and unfounded all of that was.

Dungeons & Dragons is one setting with its own set of rules about how the game will be played, what the characters can do and how they can interact with the world that the DM has created. But there are countless other systems and settings out there if it is a genre there is a game for it, you want to be a vampire or werewolf like in Twilight, no problem. You want to be darker like Anne Rice, no problem. You want to hunt those things in a modern world like the Winchesters in Supernatural, I got you. Maybe you want to be a superhero and join the Avengers or the Justice League, for sure we can do that. There are even some great games coming out that imagine, what if there was no colonization of North America? (Coyote & Crow, so cool) They imagine a whole new history and the characters within that alternate time line now and in the past. So, you can play as real or as fantasy anytime in time anywhere you can imagine for a setting.

Hopefully that gives a little explanation of what a table to role playing game is. One more thing this all takes place with players sitting around a table (or a virtual table). Looking and talking to each other and the Storyteller for the most part imaging how things are playing out and talking to each other and to the Storyteller in character.

If you’re a clinician you are already seeing how powerful this could be on so many levels; just at baseline of any table top role-playing game you have the development of executive functioning skills all table top role-playing games have rules, some more complex than others, and require players to do quick math during game play as well as how they develop their character. It also just naturally develops social skills; communication in general, working together as a team, imagining how other people think and feel, etc.…

Let’s go deeper though and see who we could use table top role-playing games more intentionally in therapy to help with specific challenges that individuals might be struggling with;

Social Skills for people on the spectrum? It is very hard sometimes to get teens and young adults to go to a group to sit around and learn about and practice social skills. The scenarios are contrived, and they know this, it is usually boring for them when they get there and it is hard to get someone to go and keep going. A table top role-playing game is just natural, it is fun, and there is space between you and your character. Your character might say something awkward, not you, so there is less room for embarrassment and all the same practice. The Storyteller (therapist) can target characters (clients) and challenge them with specific social skills in game that they are looking to build and are at a deficit at in real life, giving them opportunity to safely practice and build confidence.

Let’s get deeper now.

Self-Regulation and growth for at risk or justice involved young people? The idea behind all table top role-playing games for a Storyteller is to get you players invested in the story and invested in their character. So what does that do to a person when their character is in peril or their character is disrespected or betrayed or tricked? A player can become ALMOST as upset, hurt, or angry (dysregulated) as when it happens to them in real life. This gives the Storyteller (therapist) and the other players (client’s or youth) a chance to help another regulate in real time in real life. It doesn’t get more helpful than this people! On top of that you can slow down time to make better choice, start thinking as a team, and start practicing what it means to feel good about doing good things and being successful! Think a team of newly formed superheroes working to save their neighborhood.

Family therapy? What if we do some role reversal in therapy here. The teens are leading the group and the parents are the team members who don’t want to listen or can’t follow instructions. How does that open up conversations about what is going on in real life within households? It allows us to really discover and explore interactions and practice healthier communication skills in real time while having fun. This is everything family therapy needs to be and is sometimes like pulling teeth to get going in traditional family therapy.

Now I could go on and on; but if you have a clinical mind you are already there. And if you need more ideas or want to read more see what we are doing with table top role-playing game groups at The Therapeutic Workshop www.thetherapeuticworkshop/ttrpgs

This is GREAT! Why isn’t everyone doing this?

There are a couple reasons but I think the biggest this is ignorance. People have no idea what table top role-playing games are so connecting it with therapy or how it could be therapeutic is beyond them.

Status quo I think is another. The mental health and justice system are slow to change. They want to just keep doing what they are doing because that is easier, even when it is broken and less or not effective.

Funding is huge. A Table top role-playing game therapy group should be small to let everyone have a chance to interact and benefit from it. On top of that they are usually long sessions, at least two hours maybe two and half. So, no insurance company will pay a therapist enough to run any group for 2.5 hours for four or five people. It’s just not cost effective so people who are doing this are usually just passionate and are probably losing money.

Skill Set. It is hard to find a good Storyteller and hard to find a good therapist, but finding both in one can be even harder. While I actually think a good therapist is a good Storyteller and should have a good imagination and flexibility. They also have to be a gamer and / or want to learn how to run some pretty complex systems when it comes to using table top roleplaying games for therapy, and be good enough to do both at the same time.


The Therapeutic Workshop is working hard to bring these creative therapy services to people and start to collect data and evidence around the efficacy of this framework. On top of that we are working to try and “manualize” some of these sessions for certain issues so that therapists less familiar with table top role-playing games can more easily utilize this frame work effectively.


The adventure continues and The Therapeutic Workshop continues to develop and provide creative therapy services that we know work and are not your typical therapy services. We work hard for our clients to be creative and appreciate our clients who are also motivated and creative. We believe in the modern idea of psychotherapy, that therapy is for everyone and should be accessible and relatable to by the people we are here for. That’s why we do Table Top Role-Playing Game Therapy, Walk and Talk Therapy, Nature and Ecotherapy, and believe in bringing ourselves to the sessions which means bringing pop-culture and “Geek Therapy” as well.


If this topic interests you please check out my other blog posts and maybe this one about utilizing Dungeons and Dragons and Table Top Role Playing Games to work with At Risk and Justice Involved Young People.


#TTRPGtherapy #GeekTherapist #D&DTherapy #creativetherapy

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