How Dungeons and Dragons is making its way into therapy

Sarah Atkinson's official job title is child and youth counsellor, but every so often she also goes by game master.

Atkinson works at Discovery House, which helps women and children who are fleeing domestic violence. The Calgary organization is testing a new program that uses Dungeons and Dragons and other tabletop role-playing games in a group therapy setting.

Dungeons and Dragons, also known as D&D, is a role-playing game where people go on quests while developing their own character. A game master or dungeon master — in this case, Atkinson — leads by describing scenarios, guiding the group and enforcing the rules.

"Sometimes when kids experience really difficult things, it helps them to take on a different role, to be somebody else for a little bit, to work through some of those themes," Atkinson said.

D&D has seen a resurgence in popularity, and has been depicted in television shows and movies like Stranger Things and this year's Dungeons & Dragons: Honor Among Thieves.

Chris Pine plays Edgin and Michelle Rodriguez plays Holga in Dungeons & Dragons: Honor Among Thieves. (Aidan Monaghan)

It's also being used as a tool in correctional environments, schools and hospitals.

In group therapy at Discovery House, Atkinson said a player can create a character that has characteristics and personality traits they aspire to, or their character could represent something they're struggling with.

"If you take a young person who has a history of victimization or abuse or something like that, they can work through some of those themes by playing a warrior who maybe doesn't experience those same things or maybe experiences it in a different way," she said.

Discovery House provides a place to stay for families who are fleeing domestic violence. (Discovery House)

"But it's taking place in sort of that creative space, that imaginative space, so it feels safer," she said.

But, she said, each player gets a card they can flip over if things feel too heavy and they need to take a step back.

At Simon Fraser University in B.C., David Lindskoog, a registered clinical counsellor, uses D&D in group therapy sessions mostly with students who are experiencing social anxiety.

Using a pre- and post-session assessment tool on about 80 students, he said students experience an average of 25 to 30 per cent reduction in the severity of social anxiety symptoms.

The sessions are typically quite structured and usually about 60 to 90 minutes long.

David Lindskoog is a registered clinical counsellor at Simon Fraser University in Metro Vancouver. He uses Dungeons and Dragons in group therapy sessions. (SFU Health and Counselling)

"The gameplay itself requires a lot of interaction and social skills, communication, problem-solving, creativity, imagination," he said.

The program also has a waitlist each term.

"It can be kind of tough to get students to commit to groups, oftentimes the individual services are more in demand. So the fact that this one has a waiting list pretty much every term is kind of a bit of a testament to what the experience is like in the group for folks," he said.

Megan Ann Connell, a psychologist who uses Dungeons and Dragons as part of her practice and wrote a book on tabletop role-playing therapy, started playing the game in middle school.

Connell, who lives in Charlotte, North Carolina, said she took a long hiatus from the game but fell in love with it again after becoming a trained psychologist.

In D&D, a player goes on quests while developing their character. (Unsplash/Clint Bustrillos)

"I recognized as I was playing, I was running into a lot of the things I struggled with, and so I had made characters that wouldn't struggle with some of the things I do," she said.

"I was like, 'Oh, how interesting that my stuff is still showing up in the character, even though it's not me' … that's where I started going down this rabbit hole of utilizing this game as a tool for therapy."

Many groups use it to teach social skills to kids with ADHD and autism, Connell said.

"However, we've been able to broaden it and utilize tabletop role-playing games to teach a wider variety of therapeutic skills," she said.

Her work often focuses on assertiveness training and building strong peer relationships.

Megan Ann Connell is a North Carolina psychologist and the author of Tabletop Role-Playing Therapy. (Submitted by Megan Ann Connell)

"There's just a lot of different tools and techniques that you can utilize and fold into the game."

Connell said D&D can be applied to a broad range of experiences, and it's not clear if it's more effective for certain disorders because that research hasn't been conducted.

She said those types of studies are just starting to pick up.

Dungeons and Dragons first came out in 1974. Connell said that in the early 1980s, there were a number of therapists and school counsellors who started to notice that tabletop role-playing games were helpful to their students and their clients.

While not a widely held belief anymore, the game was once considered a danger to society. Many became fearful of Satanism or Satan worship in the early 1980s, and D&D was pulled into that panic, spurred on by television pundits, anti-D&D campaigners and evangelical Christians.

"With the satanic panic, people stopped using it as an intervention tool. And so it wasn't until the fifth edition released we started really seeing that starting to pick up," Connell said.

"It's a very, very new intervention style, even though the gaming system itself has been around for quite some time."