Psychology at play: How tabletop gaming can tackle trauma
Therapeutic dungeon master Megan A Connell on how role-playing games can be incorporated into outpatient settings
A kindly Dungeon Master dishing out sage advice to gangs of adventurers, helping them navigate difficult and overwhelming environments, surroundings and situations?
We’re thinking of this guy, right?
Well, better update your references and get them out of the 80s. Geek psychology is a therapeutic intervention that makes effective use of popular culture to foster a sense of understanding and belonging, particularly embracing the interests of patients and clients.
Step forward Megan A Connell. Having served as a psychologist in the US army for several years, Megan is now a licensed psychologist and therapeutic dungeon master. A video and tabletop game fan, Megan uses gamification strategies in her practice and is the author of Tabletop Role-Playing Therapy: A guide for the clinician game master, which explores why immersive tabletop RPGs can be a powerful therapeutic tool. Indeed, some studies have demonstrated that cognitive behavioural therapy (CBT) delivered through the medium of TTRPGs can reduce anxiety and improve social skills.
So, what do these sessions involve and who would they suit? We spoke to Megan to find out more.
Firstly, can you tell us about your role as a therapist and what the role of a therapeutic dungeon master is?
MC: As a therapist in an outpatient setting I largely work with individuals and groups on a wide array of issues to include trauma, anxiety, depression, adjustment, learning challenges and autism. When I run my applied gaming groups my job is to run a fun and enjoyable game that allows for roleplaying opportunities to help the individual clients practice skills that they are working on as part of their therapy.
How do you tailor sessions for individuals? Do you role-play around people’s interests or experiences, or can it be more generalised?
MC: Though in some sessions I’m going to be more focused on the needs of an individual, generally speaking most of those in my groups have similar treatment goals that they are working on. This allows for one encounter to allow for several group members to practice desired skills.
Talking therapy and CBT don’t suit everyone. Yet for many people it can feel like the only forms of therapy that gets offered to them when they see a doctor about mental health. How can tabletop therapy be promoted so it can be provided to people who may suit it, and how can patients get an understanding that this may be something that could help them?
MC: I would like to address the first statement you made about talk therapy and CBT being the only services offered. This is not accurate. Many medical doctors only know about CBT and therefore recommend it. If you search through therapists on webpages such as Zencare or Psychology Today, you will find hundreds of therapists providing other modalities of therapy such as acceptance and commitment therapy (ACT), family systems therapy, narrative therapy, eclectic therapy, and more.
Further, there are many alternatives to traditional talk therapy, such as music therapy, art therapy, movement therapy and so on. It seems that all alternative creative arts forms of therapy, to include applied gaming, are not well known enough to be recommended regularly.
The way to change this can be a challenge, as there need to be a sufficient number of therapists in an area to provide services to clients, and the local referral sources need to be familiar with the populations that can be served by the therapy and the evidence on the effectiveness of the modality.
For any client wanting to seek therapy but are not certain about what would best suit them, I recommend making some calls and meeting with several providers. Most providers will do a free 15-minute call to allow you to ask some questions and get to know them a bit. This will also give clients the opportunity to ask about alternative forms of therapy the provider might offer.
Yes, I guess the point I'm making there relates to the UK where – on point of contact when the need for therapy arises – CBT and talking therapies are the ones offered free via the NHS, but it takes a lot more digging to discover other forms of therapy as, in my experience, these are seen as a catch-all. And if the the awareness of other therapies is not there, then the risk is that people may just go through whatever issues they're dealing with thinking 'therapy doesn't work for me' without ever discovering that the type that could work wonders for them even exists in the first place…
MC: There are now likely hundreds of types of talk therapies out there. For most folks their primary doctor is the referral source for therapy.
Most doctors don't spend time learning about the different types of therapies and are only educated a bit (likely three hours of training maximum) on how CBT is used to help treat a wide array of disorders.
In an ideal world, medical doctors would be trained on all the different types of therapy out there and what works best for what disorders, personality types and so on. That just isn't realistic.
It can be challenging to look for and find help and having to do research on your own is difficult. Looking through articles on places such as the Mayo clinic can help one better understand what types of therapy there are out there and how one can go about finding a therapist. Finding a good therapist is a difficult process and it can take a lot.
‘The game allows for those with anxiety to take social risks that they might not otherwise take in their day-to-day lives’
How can role-playing games help those with anxiety issues, social or otherwise?
MC: When engaged in a role-playing game, the client has taken on the persona of their character. Therefore, any actions that are taken within the game are not those of the player, but rather the character.
Thus, the game allows for those with anxiety to take social risks that they might not otherwise take in their day-to-day lives.
The change to practice skills, such as talking with someone, can globalise to their daily lives and help them practise and build on skills that they might otherwise avoid.
I’m autistic and have found gaming helps me in a social setting as there’s a shared set of rules, fewer misunderstandings and there’s more of a monotropic focus so conversations don’t ‘get away’ from me. Have you found that this kind of therapy works more with neurodivergent individuals, on average?
MC: What you are explaining as to why TTRPGs work so well for you is what is the underpinning of our clinical understanding of why they can be such a helpful tool for neurodivergent individuals.
However, research at this point is lacking. So while we have a strong theory as to how applied TTRPGs can be used to help those on the autism spectrum, and other neurodivergent folks, we do not, as of the time of this interview, have strong imperial evidence to support the theory.
I am hopeful that studies that are ongoing currently will soon be published and can help us better know and understand how to most effectively use applied gaming to help our clients.
How much does someone’s RPG character tell you about their own personal character during a session?
MC: Character creation relies on a lot of factors that can make answering this question quite difficult.
If the person has played TTRPGs and the gaming system that you are using a lot, they might have a lot of different character ideas that they want to try out, and there might be little overlap with the person playing them.
If the character is a regenerated character, there isn’t much you can gleam from that character about the person.
Now, how the player plays their character can tell us much about how the player sees the world, and how they view relationships in the world. An applied game master can use these observations to reflect back to the player what they are seeing as something for the player to reflect upon for themselves.
‘When building a group you want to ensure you have a group that can work together well at the table’
What did you learn from writing Tabletop Role-Playing Therapy?
MC: A great deal! Looking more into the literature on narrative therapy and game theory was wonderful.
When writing a book such as this it is fascinating to find the small details that draw you in. For example, defining what is a game, and what elements need to be in place for there to be a role-playing game. Understanding how to take bits of research form various fields and weave it together to help lend support for applied gaming was a true delight.
In a group situation there may be varying sensory needs around the table – for example, someone’s need for a fan to regulate their body temperature may conflict with someone who then either feels too cold or finds the noise from the fan distracting. What’s your advice for resolving such issues?
MC: Talk with your players. When building a group you want to ensure you have a group that can work together well at the table. Talk through compromises and ideas.
Sometimes some groups are not good for everyone and that is OK. This is why session zero is so vital. It helps to address potential problems and find solutions well before any dice are rolled.
The Generations Games’ has a focus on family board games – what does playing together as a family provide that may be hard to replicate with other pastimes?
MC: Playing games as a family allows for everyone to connect without screens and to have natural conversations around the gaming table. We can see how one another think and reason, we can also see how they view social situations. It can bring out creativity and cooperation.
Gaming together is a wonderful activity for families and I am especially a fan of cooperative games with your family as no one is the winner, we all win or lose together.
Do you have any favourite games that you like to play with other family members?
MC: So many! Dominion is one of my all-time favourite games. I also love Flamecraft, Boop, Wingspan, the Forbidden series, Wrong Party, and Everdell, just to name a few.
For more information about Megan Connell’s work, visit meganpsyd.com
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