Staff Perspective: Helping Clients Slay their Dragons through Therapeutically Applied Role-Playing Games (TA-RPGs)
When the world shut down in 2020, I found freedom and healing not in my living room—but in a forgotten forest, as a chaotic hero with a big sword and even bigger self-doubts.
It is early March of 2020, and an unprecedented event is taking place around the world. A global pandemic on a scale that few living today have ever experienced has halted daily life as we know it. The world has shut down and for many of us the way we interact with our jobs has changed drastically.
It was probably about six months into the pandemic that I realized how much the isolation and separation were degrading my mental health. I felt, much like many, a longing for connection, conversation, and to just be with other people. As the pandemic pushed on, my mental health further declined, and my depression became more and more apparent.
In September of 2021, a former colleague and now friend of my partner reached out and asked us if we would like to join a D&D (Dungeons & Dragons) group they host that plays online weekly. Neither of us had ever played D&D, but as fans of the sci-fi and fantasy book and movie genres, it was not a hard sell. We joined our first session, often referred to as Session Zero, where we talked about the type of character we would want to play, picked our class (what type of player we are), and developed back stories. The DM (Dungeon Master also sometimes referred to as a GM or Game Master), gave us a bit of back story for the campaign and walked us through the mechanics of the game.
After that first session, I was hooked. Now four years later, we are playing two times a week, and in three different campaigns (one of which I am the DM for). In D&D I have found an outlet, an escape, and a community that I never expected to find. One of the things that I enjoy the most about D&D is how, as a group, we all craft the story and drive the direction of the campaign. The DM is the guide, but we are all storytellers.
I have no doubts that joining this D&D group and playing weekly is what helped me get through the isolation and sadness that was brought on by the pandemic. This group and this game provided me an outlet for my stress and frustration, a distraction from the responsibilities of daily life. It helped me improve my ability to compartmentalize my life and my day which over time had struggled from a blending of my work and personal lives.
Fast forward to December of 2024, I was attending a Behavioral Health Summit in Manchester, New Hampshire and had the opportunity to sit in a session about TA-RPG (Therapeutically Applied Role-Playing Games), something I had never heard of.
While many are familiar with tabletop games, like Dungeons & Dragons as hobbies, TA-RPGs use these same frameworks within a clinical context to promote therapeutic growth. TA-RPGs are designed to help facilitate social connectedness, explorations of identity and self-concept (through game character development), and practice with coping strategies and mindfulness in a safe and controlled environment. TA-RPG is based on Frame Theory and provides multiple frames for a patient to engage, including the players existing in the real world, the rules and norms of the game, the perspective of the player character, and the ability to see and experience situations from an alternate perspective or roleplaying scenario.
Frame Theory posits that individuals can interact with a story through multiple lenses—simultaneously navigating reality, game mechanics, and character embodiment. This allows for reflective distance and emotional safety during difficult therapeutic content. For instance, in the two campaigns that I play in, I play two very different characters: one is very confident and sure of himself, he lacks fear, is quick to run in and save the day and he thinks of consequences only after the fact; the other is quite the opposite, she is reserved, quiet, and calculating, often taking time to think about every possible outcome of hers and the group’s decisions and actions. In both characters there are facets of my personality, but each of them embodies something different, something that perhaps I want for myself, or that I try to avoid. When playing these characters, I get to explore life circumstances from a perspective that is different than the way I (Brian) would typically perceive them. There is so much power in being able to change our perspective, especially when cognitive dissonance keeps us stuck in a misinterpretation of the world around us, feeding into our experiences of depression, anxiety, and even trauma.
There has been recent research into TA-RPGs and their associated benefits, specifically with veteran populations as a means of addressing post-traumatic stress in a new and novel way. The Minneapolis VA partnered with a program called “Roll for Growth” which has shown to be effective in reducing depression, aggression, anxiety, and social avoidance after just 12 weeks of gameplay. Another program “Hope for the Warriors” utilized D&D to help combat social isolation during the pandemic to foster camaraderie and connection among veterans struggling with their mental health.
As a clinician, I am always looking for ways to engage clients in therapy and have found the creative and expressive therapies to be particularly good at ‘cracking the shells’ of some of those more resistant clients, especially the military ones. If you're curious about how TA-RPGs might fit into your own clinical toolbox, the best way to start is by sitting down at the table, whether that is virtually or in person. You might look for a local or online D&D group to join to get a feel for the mechanics of the game, character interaction, and collaborative storytelling. D&D groups often welcome beginners, and there's no substitute for firsthand experience. Finding a D&D group can often be accomplished by visiting a local gaming store and comic shop for in-person games, or by searching online forums for virtual groups. You can also watch videos of D&D play from YouTube channels like Critical Role, and Dimension 20 to further familiarize yourself with gameplay and story-telling. Once you’ve immersed yourself in the world of roleplaying, consider pursuing more formalized training through organizations like Game to Grow or Geek Therapeutics. Who knows, you might even find that that your next therapy tool isn't on a bookshelf—but in a dice bag.
Dr. Megan Connell has written an excellent book called “Tabletop Role-Playing Therapy: A Guide for the Clinician Game Master” which is a helpful resource for clinicians that are interested in learning how TTRPGs (Tabletop Role Playing Games) can be used in clinical settings, and how gaming impacts clients’ experiences.
Additionally, Geek Therapeutic offers a 36-hour Therapeutic Game Master Course that teaches you everything you need to know about running Therapeutically Applied Role-Playing Games with clients.
Gone are the days of leather sofas, stuffy offices, and “How does that make you feel?” questions, now is the time for innovation in therapy, and what better way to engage clients in treatment, especially our veteran and service member populations than through game play. Go forth and conquer those dragons, and may all your dice rolls be Natural 20s!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Brian Ludden, Ed.D., LMHC, LPC, , is a Military Behavioral Health Counselor at the Center for Deployment Psychology (CDP) within the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Suggested Reading and Resources:
Baker, I. 1., Turner., I. J., & Kotera, Y. (2022). Role-play games (RPGs) for mental
health (Why Not?): Roll for initiative. International Journal of Mental Health and
Addiction, 21, 3901-3909. https://doi.org/10.1007/s11469-022-00832-y
Connell, M. A. (2023). Tabletop Role-Playing Therapy: A Guide for the Clinician
Game Master. Norton Professional Books
Kilmer, E. D., Davis, A. D., Kilmer, J. N., & Johns, A. R. (2023). Therapeutically
Applied Role-Playing Games: The Games to Grow Method (1st eds.). Routledge
www.GeekTherapeutics.com
- “We offer evidence based certifications to clinicians, social workers, professionals, parents, teachers, and students on how to use Geek Therapy to unlock the best version of your clients and ourselves. We bridge the gap between geeks and therapists to create practical and innovative therapy sessions that anyone can implement in their practice.”
- “Game to Grow was originally founded in 2017 by Adam Davis, MAEd, and Adam Johns, LMFT. Davis and Johns met in graduate school at Antioch University Seattle and began using games to improve lives in 2011. They combined their respective training and expertise in family therapy, education, and drama therapy with their years of experience as gamers and facilitators to develop what would become the Game to Grow Method of Therapeutically Applied Role-Playing Games. For several years Davis and Johns ran a small two-person operation serving youth in the greater Seattle area. After four years running these groups, along with their respective other work in public schools and in therapeutic practice, Davis and Johns founded Game to Grow to expand the impact of the game-based methods they had developed.
Game to Grow officially launched via a successful crowdfunding campaign and was able to hire and train new facilitators to expand services. In 2020, as a response to emerging challenges related to COVID, Game to Grow shifted groups virtual. Now no longer confined by geographic regions, group services expanded to meet the need of participants worldwide. Around the same time, demand increased for training in Game to Grow’s unique approach, and our training program was launched. Game to Grow has now provided training and support to over 1,200 professionals..
When the world shut down in 2020, I found freedom and healing not in my living room—but in a forgotten forest, as a chaotic hero with a big sword and even bigger self-doubts.
It is early March of 2020, and an unprecedented event is taking place around the world. A global pandemic on a scale that few living today have ever experienced has halted daily life as we know it. The world has shut down and for many of us the way we interact with our jobs has changed drastically.
It was probably about six months into the pandemic that I realized how much the isolation and separation were degrading my mental health. I felt, much like many, a longing for connection, conversation, and to just be with other people. As the pandemic pushed on, my mental health further declined, and my depression became more and more apparent.
In September of 2021, a former colleague and now friend of my partner reached out and asked us if we would like to join a D&D (Dungeons & Dragons) group they host that plays online weekly. Neither of us had ever played D&D, but as fans of the sci-fi and fantasy book and movie genres, it was not a hard sell. We joined our first session, often referred to as Session Zero, where we talked about the type of character we would want to play, picked our class (what type of player we are), and developed back stories. The DM (Dungeon Master also sometimes referred to as a GM or Game Master), gave us a bit of back story for the campaign and walked us through the mechanics of the game.
After that first session, I was hooked. Now four years later, we are playing two times a week, and in three different campaigns (one of which I am the DM for). In D&D I have found an outlet, an escape, and a community that I never expected to find. One of the things that I enjoy the most about D&D is how, as a group, we all craft the story and drive the direction of the campaign. The DM is the guide, but we are all storytellers.
I have no doubts that joining this D&D group and playing weekly is what helped me get through the isolation and sadness that was brought on by the pandemic. This group and this game provided me an outlet for my stress and frustration, a distraction from the responsibilities of daily life. It helped me improve my ability to compartmentalize my life and my day which over time had struggled from a blending of my work and personal lives.
Fast forward to December of 2024, I was attending a Behavioral Health Summit in Manchester, New Hampshire and had the opportunity to sit in a session about TA-RPG (Therapeutically Applied Role-Playing Games), something I had never heard of.
While many are familiar with tabletop games, like Dungeons & Dragons as hobbies, TA-RPGs use these same frameworks within a clinical context to promote therapeutic growth. TA-RPGs are designed to help facilitate social connectedness, explorations of identity and self-concept (through game character development), and practice with coping strategies and mindfulness in a safe and controlled environment. TA-RPG is based on Frame Theory and provides multiple frames for a patient to engage, including the players existing in the real world, the rules and norms of the game, the perspective of the player character, and the ability to see and experience situations from an alternate perspective or roleplaying scenario.
Frame Theory posits that individuals can interact with a story through multiple lenses—simultaneously navigating reality, game mechanics, and character embodiment. This allows for reflective distance and emotional safety during difficult therapeutic content. For instance, in the two campaigns that I play in, I play two very different characters: one is very confident and sure of himself, he lacks fear, is quick to run in and save the day and he thinks of consequences only after the fact; the other is quite the opposite, she is reserved, quiet, and calculating, often taking time to think about every possible outcome of hers and the group’s decisions and actions. In both characters there are facets of my personality, but each of them embodies something different, something that perhaps I want for myself, or that I try to avoid. When playing these characters, I get to explore life circumstances from a perspective that is different than the way I (Brian) would typically perceive them. There is so much power in being able to change our perspective, especially when cognitive dissonance keeps us stuck in a misinterpretation of the world around us, feeding into our experiences of depression, anxiety, and even trauma.
There has been recent research into TA-RPGs and their associated benefits, specifically with veteran populations as a means of addressing post-traumatic stress in a new and novel way. The Minneapolis VA partnered with a program called “Roll for Growth” which has shown to be effective in reducing depression, aggression, anxiety, and social avoidance after just 12 weeks of gameplay. Another program “Hope for the Warriors” utilized D&D to help combat social isolation during the pandemic to foster camaraderie and connection among veterans struggling with their mental health.
As a clinician, I am always looking for ways to engage clients in therapy and have found the creative and expressive therapies to be particularly good at ‘cracking the shells’ of some of those more resistant clients, especially the military ones. If you're curious about how TA-RPGs might fit into your own clinical toolbox, the best way to start is by sitting down at the table, whether that is virtually or in person. You might look for a local or online D&D group to join to get a feel for the mechanics of the game, character interaction, and collaborative storytelling. D&D groups often welcome beginners, and there's no substitute for firsthand experience. Finding a D&D group can often be accomplished by visiting a local gaming store and comic shop for in-person games, or by searching online forums for virtual groups. You can also watch videos of D&D play from YouTube channels like Critical Role, and Dimension 20 to further familiarize yourself with gameplay and story-telling. Once you’ve immersed yourself in the world of roleplaying, consider pursuing more formalized training through organizations like Game to Grow or Geek Therapeutics. Who knows, you might even find that that your next therapy tool isn't on a bookshelf—but in a dice bag.
Dr. Megan Connell has written an excellent book called “Tabletop Role-Playing Therapy: A Guide for the Clinician Game Master” which is a helpful resource for clinicians that are interested in learning how TTRPGs (Tabletop Role Playing Games) can be used in clinical settings, and how gaming impacts clients’ experiences.
Additionally, Geek Therapeutic offers a 36-hour Therapeutic Game Master Course that teaches you everything you need to know about running Therapeutically Applied Role-Playing Games with clients.
Gone are the days of leather sofas, stuffy offices, and “How does that make you feel?” questions, now is the time for innovation in therapy, and what better way to engage clients in treatment, especially our veteran and service member populations than through game play. Go forth and conquer those dragons, and may all your dice rolls be Natural 20s!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Brian Ludden, Ed.D., LMHC, LPC, , is a Military Behavioral Health Counselor at the Center for Deployment Psychology (CDP) within the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Suggested Reading and Resources:
Baker, I. 1., Turner., I. J., & Kotera, Y. (2022). Role-play games (RPGs) for mental
health (Why Not?): Roll for initiative. International Journal of Mental Health and
Addiction, 21, 3901-3909. https://doi.org/10.1007/s11469-022-00832-y
Connell, M. A. (2023). Tabletop Role-Playing Therapy: A Guide for the Clinician
Game Master. Norton Professional Books
Kilmer, E. D., Davis, A. D., Kilmer, J. N., & Johns, A. R. (2023). Therapeutically
Applied Role-Playing Games: The Games to Grow Method (1st eds.). Routledge
www.GeekTherapeutics.com
- “We offer evidence based certifications to clinicians, social workers, professionals, parents, teachers, and students on how to use Geek Therapy to unlock the best version of your clients and ourselves. We bridge the gap between geeks and therapists to create practical and innovative therapy sessions that anyone can implement in their practice.”
- “Game to Grow was originally founded in 2017 by Adam Davis, MAEd, and Adam Johns, LMFT. Davis and Johns met in graduate school at Antioch University Seattle and began using games to improve lives in 2011. They combined their respective training and expertise in family therapy, education, and drama therapy with their years of experience as gamers and facilitators to develop what would become the Game to Grow Method of Therapeutically Applied Role-Playing Games. For several years Davis and Johns ran a small two-person operation serving youth in the greater Seattle area. After four years running these groups, along with their respective other work in public schools and in therapeutic practice, Davis and Johns founded Game to Grow to expand the impact of the game-based methods they had developed.
Game to Grow officially launched via a successful crowdfunding campaign and was able to hire and train new facilitators to expand services. In 2020, as a response to emerging challenges related to COVID, Game to Grow shifted groups virtual. Now no longer confined by geographic regions, group services expanded to meet the need of participants worldwide. Around the same time, demand increased for training in Game to Grow’s unique approach, and our training program was launched. Game to Grow has now provided training and support to over 1,200 professionals..