IAmA Therapist who uses D&D as a form of group therapy! AMA

Love the idea. How do you handle the violence in dnd? There is always a chance someone could relive their trauma during some of these campaigns. Do you create them from scratch based on personnel trauma or alter a premade one?

Thanks for teaching us!

My descriptions of violence aren't particularly gory or graphic and I strongly reward players who find non-violent solutions to problems. That's part of the goals for my sessions. We do get to do some fireballin' on some bandits or some orcs, but I try to keep it as PG as possible.

There's actually a REALLY AWESOME resource called the Monte Cook Consent in Gaming sheet, and DMs/GMs can use that to get an idea of their players' triggers and stuff, to avoid descriptions of traumatic violence. I basically don't do anything on that list anyway because ew.

I have an intake & screening form I've prepared where I ask for relevant information to therapy, so I can be prepared.

I create my campaigns from scratch and then improv the heck out of them, but they each have mental health themes and goals. Sometimes the players don't even realise that they're learning to manage anxiety while hunting a monster that feeds on fear. ;)

Saved. This is a fantastic read. I'll look into it more when i have time. Thank you and i wish you the best of luck in your practice!

Thanks for the wishes - it's definitely an odd niche to advertise and I've gotten a small share of "wait, what, seriously? How?" responses to talking about it.

After the AMA is over and you have any questions you're more than welcome to reach out via the page and ask. :)

I wrote my masters thesis on DnD as group therapy and ran a year long group for teen boys in a residential setting. Still one of my favorite things I've ever done

Thats AWESOME. Outstanding work. :)

Sometimes the players don't even realise that they're learning to manage anxiety while hunting a monster that feeds on fear

My face right now is that of the Sudden Realization meme guy. That's quite clever!

It was therapy all along!

Hey, so as some one who dm's for his friends a fair bit, and also having taken a BA in psych and gotten very involved with a peer counselling program, I've actually put a fair amount of thought into the relationship that needs to occur between HP and actual violence in the game. Years ago on reddit I found a post that was talking about different ways to actually connect HP to what was happening to characters, and one suggestion I saw that was very eye opening is taking "damage" doesn't have to mean your character is taking bodily damage, and in fact it makes a lot more sense in the context of the game when this isn't the case too! This DM talked about they assume that for a good chunk of you HP bar, say the first 50 to 75 percent, the damage you take is more reflective of the strain of combat on the body then it is cuts or bruises.

For example leta say a goblin swings a club at a full HP character and they take 4 damage. In narration that might look like "the goblin swings at you, and while you manage to get your shield up to block, your block angle is poor, and the force of the blow travels heavily up your arm, leaving it numb for a few seconds and a little shakey, you take 4 damage". Or for a rouge "the goblin launches a swing at you, and while you do dodge it, the dodge isn't graceful, and you nearly fall over a few times and have to really exert yourself to finish it standing in place, your legs are shaking and your breathing deeply, take 4 damage". If you outline this system with players first, it really does start to make a lot more sense, particularly how short rests can restore so much HP, because what your gaining isn't magically healed wounds after 4 hours, its that the rest has given you back stamina and energy, some of your pulled muscles have started to feel better, you elevated that strained ankle, ect. And this is cool because you can set different damage thresholds for how damage actually translates to violence in game. If extreme violence is a big trigger for some players, maybe combat never even looks like that! Fireball doesn't have to leave charred burned horror in its wake, maybe dropping someone to 0 HP with a fireball means they have some mild burns and pass out from heat stroke.

I hope this help you run games that make your players feel safe and are more constructive for them!

I've also seen it described not as a measure of bodily health, but as a measure of your 'heroism'.

The answer to the question "How long can you keep taking/dodging/rolling with the hits before you just can't anymore?"

Oooh, big Uncharted vibes with that, I love it.

I don't know if your comment was intended to hint at that, but Naughty Dog has explained how Nathan Drake in the Uncharted series can take so many bullets and not immediately die, and heal automatically after a few seconds of not being hit - he's not a powerful being and he doesn't wear armor or anything, right?

So the way they explain it is your "health" is Nathan Drake's luck; he keeps being lucky and very barely scraping by the bullets fired his way. However, push your luck too much and a bullet will hit you, killing you instantly.

It's a really cool explanation, I liked that.

Yus, I've seen the description of how Nathan's "luck" works and i think it's a really cool mechanic.

Someone had their pet dragon rape my pc once... That was pretty uncomfortable

I cannot imagine what led someone to make that play, and I'm sorry that the DM allowed it. That would have been incredibly uncomfortable!

Have you ever watched/ were inspired by the D&D episodes of Community? If not, in two episodes they play D&D and kind of stumble backwards into D&D therapy both times, one to help a person deal with depression and suicidal thoughts, and another to help a Father and Son reconnect after years of separation. I always thought that was a really neat idea after seeing those episodes, really glad to know it's actually being used. Keep up the amazing work.

I haven't yet. Community has been on my to-watch list for a long time, but we know how those get. Are they episodes I can watch without much prior knowledge of the characters?

I just rewatched it, it actually introduces the characters in a fantasy style voiceover. You can get by on the intros and knowing their general sterotype:

• "Jeff the liar" is a selfish, fast talking lawyer
• "Annie the Dayplanner" is an anal-retentive, neurotic mess
• "Troy the Obtuse" is a lovable idiot, basically a golden retriever in human form
• "Shirley the Cloying" is both prude but sweet Christian mom and sassy black lady
• "Abed the Undiagnosable" is on the autism spectrum and communicates almost solely through pop culture references.
• "Britta the needlessly defiant" is an insufferable overly-progressive liberal
• "Pierce the Insensitive/Pierce the Dickish/Grandpa the Flatulent" is an old, miserable, racist, sexist asshole.

Good lord there's a lot going on there. I'll put it on the list! But now that I think of it I'd love to see Brooklyn 99 do something similar. Thatd be a blast. /u/TheTerryCrews has been a guest on Critical Role though and that's awesome.

Yes you can. I’m saying this from firsthand experience. My friends recommended community and it was on my “to watch” list as well. I heard about the dnd episode and watched that ahead of watching the series.

I'll see if I can find it. Thanks for the recommendation! I love throwing in a sneaky reference to stuff I like during sessions. My most recent session featured a wizard named Usidore (Hello from the Magic Tavern) but with the voice of Joe Lycett.

And the IT Crowd!

And THAT is why the game uses a twenty-sided die.

This is a real new and interesting way of therapy.

Do you use the same method for people who are addicted to gaming or do you go back to normal methods of approach?

I have no idea how I'd go about doing it, but I'd love to actually brand this as a treatment for videogame addiction! It's still got gaming elements, and it can fit into popular gaming genres (fantasy, scifi, superheroes), but involves regular social contact with people, as well as exploration of ones' own values, interests and passions.

It's definitely on the more long-term to-do list. Currently I encourage my groups to engage in some kind of creative arts, writing, drawing, painting, between sessions, especially if it's of scenes from the session, or of their character and their backstory.

That's really a great thought process for it - hope that eventually you'll make it work.

Thank you for exploring different aspects of therapy to adjust for quite a particular target audience!

It's been my absolute pleasure, this whole project has been a blast. My passion is providing forms of therapeutic support in fun ways, so I run therapy Minecraft and D&D, and I offer other RPGs like Star Wars or a superhero RPG called Masks: A New Generation. I'm tinkering with Animal Crossing: New Horizons, but I'll need a better island before I'm confident enough to let people in :D

Another question - what do your peers in the industry think about this? Have you had any particular insights?

An overall positive response! My immediate peers are folks I went to university with and we've worked together for a couple years now. We have an early-career peer support group and we help each other get set up in our practices. They're excited to see me finding my way as a therapist, which is kind of a big deal for us.

Other than that, I get a lot of polite responses, or heaps of enthusiasm, especially from therapists who are nerds themselves, or work a lot with kids (and nerds like myself, who are big kids) and really vibe with anything the kids can connect with.

I was SO ANXIOUS about the initial Pop Culture Competence project that I kept it separate and anonymous for about a month, cos I was scared folks would call it silly or unprofessional. After getting some really amazing feedback and enquiries from people with big job titles, I opened up as a Full Time Nerd Therapist and began just diving on in. It took a lot of confidence to make that move that I didn't think I'd have had - I was so worried, but now, it's everything.

I’m really sorry I’m like this but I have a copy editing tip for your tag line on your blog.

It should be “from a therapist WHO didn’t.” This is one of my lil pet peeves, you’re a human, not an object, so don’t refer to yourself as “that.”

Please ignore if you wish.

My proofreader has obviously betrayed me.

Thanks much!

Masks was a lot of fun when my group played it! Was a good time getting to be an angsty teenager again.

I'm lowkey not looking forward to that. :D

Hi! Not OP but I wrote a paper on video game addiction in college so while I'm def not an expert, I did learn that Japan and a few other countries in Asia have treatment centers that use LARPing and other in-person RPGs as part of their treatment plans for video game addiction. Agoraphobia can also develop alongside it and this is a way to help treat both issues at the same time.

Ooooh! I'd love to see that sometime! I really think LARP or RPGs are a potential treatment method here.

People like to joke and meme about how their regular D&D sessions are like therapy but what’s something that you’ve learned that could make these “regular” games better/more therapeutic/etc.?

I'm actually going to talk about this at a panel in Perth at Swancon next month, but here's a brief list of the things I do, that everyone can do.

> Use the Monte Cook Consent in Gaming sheet to get an idea into the triggers their party may have, or for themes and descriptions of acts to avoid.

> Use the sheets designed for folks with dyslexia, to support your players with reading difficulties! Found at GeekNative.

> Talk with your party, get feedback and be open to taking it onboard. I've heard a few stories about parties becoming uncomfortable for players when confronting themes are part of the campaign and it's been tough for them to manage.

> Give people time to plan ahead - if possible, give players a bit of a heads up about things they might be able to think about doing in the next session. It might relieve some performance anxiety of being put on the spot.

I am so, so happy to see the dyslexia character sheet on this list.

I absolutely loved it and as soon as I saw it I printed out a bunch and will be using them as my main character sheets from here on out. I strive to be supportive and inclusive and they're truly wonderful sheets.

Do you adhere to the rule set pretty strictly or have you made your own tweaks?

For example, what's your policy on (perma) death? Some guy starts a game, rolls a 1, and gets yolked by the first rat he encounters. Do you let him reroll or are you like "Despite rats having never killed anyone in the kingdom of Greythorne, the rat manages to find your jugular and bites it open and you bleed out. The end. See you next session."

I definitely run pretty loose with the rules, and seek to encourage and reward creative thinking and expression. I've got tweaks to the rules that allow players to bypass skill checks and other rolls if they can show evidence that it'd work (such as chemistry or physics knowledge), or to bypass say, a psychic attack by a vampire or other such entity, describe some resilience & mental health wellbeing strategies.

I have had one character who would have had to make a death save during his first round of combat. Thankfully it was the entire group's first session of D&D and the bandit's attack roll was done behind my screen. Instead of a crit he just hit normally, and we used that as a lesson to explain the game's mechanics on taking damage, positioning and maybe ways out of this situation they'd found themselves in.

Dave Arneson (the guy that created D&D for the most part) would have loved this. He was always rules light when I played with him, meaning he was fine with bending the rules to not intentionally kill a PC when it wasn't warranted. Not that he didn't kill PCs, but it definitely was less and less as time went on. Even between the time I played with him when I was 16 and 21 he made major changes - in the second time, players that were dropped to negative HP were just at zero unless a coup de grace was given. Those would've been player kills in the first game.

Thats so heartwarming to hear <3

I'd rather give characters an opportunity to learn and grow from a mistake rather than get one-shotted by a bandit in their first session.

Cool thanks. I think there's great value in your work and lot of people will benefit.

I'm hoping, hey. It's still early days, I only started offering this service in September, so it's still growing! But it's been an amazing experience and the support I've received for it has been absolutely wonderful.

Wow. This is a fantastic idea. I have never heard of this. Are you finding your clients to be exclusively "nerdy" or do you try to open it up to a wide variety of individuals?

At this point, with Stranger Things and Critical Role being the successes that they are, D&D isn't any longer a weird, fringe nerd activity. Most shopping malls here in Perth, where I live, will have somewhere that sells the latest rulebooks and expansions.

My groups are open to anyone, but I've had the most engagement with nerdy folks who understand D&D and the tabletop RPG concept.

Edit: It's definitely a growing field of work, and especially during Covid-19 lockdowns when forms of social engagement are more needed than ever, there's a growing number of RPG / D&D therapists exploring therapeutically-applied roleplaying games.

What makes D&D therapy different from regular D&D?

It's run by a therapist who's doing it for therapy. :)

The main difference is that there's therapeutic goals and aims, with monitoring of goals as the campaigns progress. I create campaigns and modify game mechanics to be conducive to the needs of the group, from something as simple as social/emotional education, to managing depression and anxiety.

It's as different to normal D&D, as a casual chat is to traditional talk therapy.

I'm a DM of many years now, and noticed long ago the therapeutic aspect of the game. My good friend an co-DM is planning on going to school to become a therapist soon. I'm curious where I could learn more about the specifics of your approach. Are there any resources online?

Theres a few! Game to Grow is a US-based non profit organisation who provides training in this area.

And Geek Therapy Community on Facebook, an awesome group who provide nerdy resources

https://gametogrow.org/

This is gorgeous shit. I'm in discussions with a LPC friend of mine about bringing Tarot cards into his mindfulness classes and retreats. I might be in your place in ten years. Pathways of healing through trauma come in many forms.

Healing takes us places we never expected. I'm a high school dropout who had to quit school due to mental health issues, I never expected to not be depressed, let alone working as a gaming therapist!

I've joked with my players that D&D is basically "Therapy with math", but this thread has really opened my eyes to how much good it can do with people.

And social studies! I have heaps of social studies based world building.

What part of the play seems to make an impact? I saw a video about larp helping people, can I imagine this similar?

Edit: the video I am talking about

https://m.youtube.com/watch?v=bXNGFb2p90k

The creative approach to obstacles and problem-solving, and the safe projection of issues and experiences onto their character. It's really good for social skills and confidence.

I'd love to learn more about therapy larp! I could see that mixing in occupational, physical and speech therapy goals.

Any advice on how to provide meaningful emotional experiences without being cheese?

Embrace the cheese!

Building relatable NPCs and plot lines your characters can get investment in will lead to authentic emotional experiences.

Ah, yeah, that's well and good, but I'm talking about when you're planning ahead? Not when you're in the moment.

You do this for a purpose. When you're crafting a session, I assume that you do so with an intention.

How do you plan for that without it seeming hamfisted, cheesy, etc. An example would be great.

One of my campaigns is Mystery of the Phobovore. The phobovore is an entity that feeds on fear, stress and anxiety. As the game progresses they have to learn ways to build their mental fortitude and prevent this creature from feeding on them.

the safe projection of issues and experiences onto their character

Can you elaborate on this? Do you mean e.g. if someone has a depression they can make a character with depression and that helps them? How?

(Also, do you say a person has depression or a person has a depression? Non-native speaker here :P)

They would be a person who has depression, yes.

Do you ever have people who ask sensitive questions, for a "friend", but you're pretty sure they're asking for themselves? Same principle.

Do you let your patients create their own characters? How do you make sure their real life issues are addressed? How do you make sure each get equal therapy time?

Yup! It's their time to express, and even creating a character can really set the stage for some amazing conversations and looking into values, beliefs and interests.

I debrief with them, and also trust that they're being open and honest with me. We can't "force" or "make sure" of things without pushing boundaries or comfort zones, so there's an element of trust required.

D&D is small group work, 3-5 players, so mentally keeping track of activity between players isn't difficult. I do a lot of turn-taking stuff, but it's always worth noting who the quiet ones are, or if there's been any change in levels of activity in the current session when compared to previous sessions.

That's such a neat way to do therapy!

Have you looked into other brands of tabletop roleplay games? There's a game called "Masks: a New Generation" which is teen superhero themed, and instead of hit points you check off one of five emotional conditions (afraid, angry, guilty, hopeless, and insecure). For example if the villian hits you then you might decide it made you feel insecure because you couldn't protect yourself.

If you have a condition it gives a negative to some of your rolls, so there's incentive to clear them. To 'heal' another player has to do a move called comfort and support to talk to you about your feelings and see if you open up and share a vulnerability. Or you can do self destructive things which affect everyone else and the story, such as run away to clear the afraid condition.

Everyone I've played with has found it is such a good learning tool for working with relationships in the real world and learning to talk about feelings in a productive way. Also it's a fun game!

I ordered Masks when it was on sale last week! I'm really jazzed, I've seen such AMAZING stuff from that game and I think it would be absolutely perfect for a group of older teens. I'm really excited for it to come in and get a real grasp on how to run games. I like the resources it gives to write superhero stories!

This is the greatest idea ever holy shit.

What was your inspiration? How did this idea hit you?

I wish I could claim to be the OG! But there's folks in the USA who've been doing it for about ten years now to my knowledge.

During my degree I read about folks in the US running similar stuff! I thought it was a really nifty way to look at therapy. I mean, why shouldn't it be fun and creative? I put it aside as a "later" thing during my degree and then worked on the traditional therapies.

Last year I started a blog resource that explains nerdy stuff to non-nerdy therapists, which is now called Pop Culture Competence, because there's plenty of therapists who work with kids who don't know about anime and videogames and stuff, so I thought I'd make reference material so they can better connect with their clients.

After a week or so I got a DM asking if I offer D&D therapy. And I thought to myself, "why don't I run D&D therapy?" So I spent a month or so hashing out what that'd look like and got into it. It's been fun as heck!

Do you have any links to the other groups running these things? I'm a nursing student in a psych clinical and would live to use this as a reference point for one of my projects.

Game to Grow are a USA-based nonprofit organisation and provide training in this! I found their training not long after I got started, and their work was really affirming that I was on the right track.

https://gametogrow.org

I remember seeing the Games to Grow panel at PAX unplugged 2018! It was so interesting to see how games like D&D had help people and do real good in the world!

I'm hosting a panel here in Perth soon! I'd love to catch a Game to Grow panel sometime!

Have there been any scientific papers written on the efficacy of this form of therapy? (I've never done group even though it's often been recommended to me.) I wonder if a trained therapist could use it to help me, I've always loved D&D but haven't played since my youth.

Here you go, my dude! Game to Grow, a US-based non-profit, have a solid list of articles and books for your reading pleasure.

https://gametogrow.org/resources/research/

This is an evidence-based form of group therapy, which is fantastic because if it wasn't, a lot of us couldn't do it, as various ethical standards restrict us from using therapies which haven't shown efficacy in studies.

Thanks :)

Maybe I'll give therapy another go, I'll show her this.

Best of luck, Morkani! It's available as an online form of therapy if you're still in an area affected by Covid-19 or lockdowns. Stay safe out there!

Did you get this idea from the IT crowd?

Negatory to both. I was asked last year if I provide this service, and was really into it when I looked into it! Some of the research for RPG therapy predates both series. :)

This is awsome!

I designed an entire roll playing game very similar to D&D but does not require or use miniatures and is more story based, designed specifically for players that had limited or no real history with D&D. I created an entire new rule book and leveling chart as well as different stats, combat, magic, prayers, classes etc. Then created a huge map and started adding towns and quest ideas... It stayed dormant for a while as I had no one that I thought would be ever interested in playing or even talking about it with my friends and family... so it just stayed in my computer...

Then one day I had some of my family over after not seeing siblings and cousins for years and one of them said almost jokingly "I know this may be lame.. but would any of you ever want to play a d&d game or something?"

After I watched a couple people respond "oh I would love to but have never played" i took the opportunity and jumped in and told them what i had been working on secretly for years...

Turns out not only they were interested, but several of their coworkers were ecstatic at the idea of joining and when I sent them character cards and the rule book they immediately filled it out and started sending me their schedules they were open to play.

2 years later and many quest and sessons done... it is without a doubt the most fun we have had together and the closest we have all been in years.

There really is something special about being part of a story together and letting you work out your thoughts and decisions behind a character that you could not otherwise express.

If anyone ever allows you to record a sesson (preferably mock, as not to open to much up about their personal life journey and struggles) I would love to see how it plays out.

Good luck either way in your endeavours!

That sounds awesome! I'd love to see it, I love the more narratively-driven games. I don't use minis or a battlemap, and instead require attention, focus and imagination to drive the scene, with a dry-erase board for battles just to keep track.

I'm looking at starting a serialised D&D therapy podcast! I'm waiting to be a bit more confident in showing the world what it looks like in person, but I've had people express an interest in being part of that party. Doing some serious research now into what privacy and confidentiality procedures we can implement in such a setting.

Hi, I think it's a cool idea to use D&D and other associated cultural facets in order to give therapy to others. It may be not be a mainstream idea, what as long as it can help others, then more power to you.

My question is: are you religious? Has running your therapy groups inspired you to become more spiritual or has anything from D&D lead you to be influenced in a spiritual way?

I can't say that I've really looked into D&D as a form of spiritual or religious expression. Even my Paladin PC is more sworn to the cosmic concepts of truth and justice as opposed to a particular deity.

Do you think it helps people open up more? Or does the fun get in the way of serious conversations sometimes? And just curious, do patients see it more as D&D or more as therapy?

Yes to both. Some players definitely just engage in it as D&D over therapy. But sometimes that social connection is what they need. Not all therapy is for clinical issues, some folks just need connection, and peers, and a safe, nonjudgemental space to explore in.

Others definitely project onto their characters and learn vicariously as the sessions go on. It's a mixed bag.

What a fascinating idea! Can you give any examples of in-game situations that you have used to help address social anxiety or depression?

There is a great beast... the Black Wolf of Anhedonia. The creature is drawn to feelings of loss and despair. Only with the light may it be banished from the lands.

Social Anxiety is a regular work, as the game involves speaking up in front of people.

How do you deal with the problems of murderhoboism and video game...ism; and how they relate to character alignment as opposed to player alignment?

Any tips to help players get into character easier?

Since going online, I find these are getting harder to deal with as a DM. In person, it's always on point. But I've been finding players just have a hard time of it when playing online (due to covid)

The last time my players started looking like they'd kill anything nearby with a pulse they received a Perception check which resulted in a description of a guy who was uncannily similar to John Wick in appearance. They got the point that being aggressive towards random people could have unexpected results, and that's not even bringing in the city guard.

I have rules about how player characters have to resemble their player in some way. They don't have to share what those ways are with everyone, but I want a number of traits and flaws which are also their real traits and flaws.

Hi! I am an art student and teacher (art education) and for my thesis I am currently my researching ways to incorporate (parts of) d&d into my lessons (and council sessions). I've recently started, and I find the subject super fascinating. I want to use it to help students (middle school) grow their confidence, combat social anxieties and help them in solving problems. Most of all, i want to encourage creativity and creative thinking (it is art class after all).

I was wondering, do you have any tips in starting a dnd group with those goals in mind? I want to create a safe environment for the kids, where they can be themselves, but I'm having trouble turning off my teacher mode. If you have any tips, please let me know!

(I've already found your research page, and those scientific papers are a godsent!)

Hit up Game to Grow! Otherwise, if you're working at a school, follow the proper policies & procedures, like talking with the student support team or your principal or whoever can okay a social club, and just put the word out that you want to run mental health D&D sessions. I casually mentioned it during a talk at a local high school and got about fifteen kids asking when we could start. I couldn't offer it there at the time but the interest was there.

Question Do I have to roll perception to find my father? Or is it more of a passive perception check

I think it's a DNA check, and I wish you luck on your adventures.

Thank you for doing this AMA!!!

I'm a psychology student interested in peer facilitation groups. I am always looking for new ways of setting up support groups. There's not enough therapists for the total mental health burden of my community, and I think it's important for us to support each other even when there are not enough professionals to go around.

Do you have other resources that cover peer-facilitation in general?

I wish! I don't have any close to hand, as peer work hasn't been a big focus of mine. I recommend joining Therapists Toolbox or other Facebook groups full of therapists and seeing who has support materials for peer work.

This is fantastic! I used D&D with some of my students on the spectrum who we found to have no friends and really struggled with social. Any thoughts on this group?

I ended up having to let the RP essentially their favorite Anime characters but it worked out for the most part.

That's a bit focus in the field, providing social / emotional learning opportunities to autistic kids. Game to Grow are actually working on a D&D 5e Lite version of th egame called Critical Core which was made explicitly to support students on the spectrum. I backed it on Kickstarter, I can't wait!

How is Old Man Henderson supposed to help someone mentally let alone killer GM's?

We don't play Call of Cthulhu, as a starter. I've thought about running some Dark Heresy but for the life of me I can't find therapeutic themes in the grim dankness of the far future.

How do you organize your games? I'm aware of D&D groups being run with friends but would your clients have to join together?

Or would it be based off what they need, and can double as a support group/has targeted storylines, like a D&D ver of a ED support group.

Would you let a new client join in on an existing game you are currently DMing? How would that work itself into the storyline?

I organise my games via e-mail and via my professional page. People make enquiries and I sort them into groups based on age, needs and location. Those groups come together. It's a support group as well as the tailored D&D therapy.

I'd let a new client join in, and have done so before. I usually write them into the plot and we go through icebreaker exercises to get them into the team headspace. :)

Do you have any key modifications to the rules that make it more psychologically accurate somehow? For instance, I could see certain concepts like alignment clashing with contemporary understanding of antisocial behavior... or concepts like the ability scoring system clashing with contemporary understanding of skills and aptitude.

I don't use alignment. I feel like it detracts from the complexity of the human experience, although I'm always happy to talk about why players might try to roll an Evil-aligned character. But part of my sessions involve learning about neuroflexibility and the fluidity of identity and values. I can't just say "You're good/evil/neutral" and have that be it. Players are free to be people.

Do you have any trouble with people seeing it as dumb or 'evil'?

Friend of mine used to run a game after school for some students in junior high. Best thing ever. Skills for math, socialization, reading- all in a fun environment.

Honestly I haven't run into any negativity with it so far, and I've been pretty open about it on Facebook and stuff. I think the worst I've gotten is a politely indifferent "oh, that's nice."

I mean except the negativity which generally comes from people who don't hold mental health workers in much esteem but hey, can't let them get us down, y'know?

It's such a fun space and really gives me a lot of freedom to explore some fun learning content too. Bit of maths, bit of humanities. My homebrew world, Advantasia, has the same weather cycle as Australia does - a six season model used by the First Nations people, the Nyoongar tribe, the traditional owners of the land where I work.

http://www.bom.gov.au/iwk/calendars/nyoongar.shtml

Australia has six seasons?? Summer, hot summer, death summer, everything's on fire summer, construction, slightly less hot?

I live in the southwest of the continent, and the Indigenous peoples who've lived here for over sixty five thousand years have an unparalleled understanding of the weather and the land. Schools still teach the "Summer, Fall, Winter, Spring" model, but there's a growing awareness of more accurate models for depicting seasons.

Hello! Thank you for showing up. I'm writing a thesis on books derived from DnD, namely fantasy books such as Dragonlance or Salvatore's Legend of Drizzt. Have you noticed your clients being into reading fantasy literature? About how often? Has anyone explicitly mentioned a known title? Only asking for approximations, not a precise percentile. Thank you very much!

LitRPG is a big thing right now so D&D fanfiction and campaign stories are probably the biggest thing I find in my players. Sorry I can't be more help on this one.

I'm working on a novel to set the stage for the lore of my homebrewed setting, but that's still some time away.

I am actually really interested in the behind the scenes workings of this.

How it is implemented? How do you work out a cost analysis? How you connect within a group setting etc?

The reason being, I am looking at a career change due to Covid. I have been putting some serious thought into mental health therapy and combining it with my other passion which is cars.

The aim as a sort of "Tools and Talk" group therapy where blokes (and girls) would feel more comfortable opening up in an environment that is focused around cars and a garage setting.

I strongly believe that one of the few positives of the global pandemic is that it will force a lot of governments to take a much closer look at mental health and I feel that by combining something that I am passionate about (the cars and the workshop environment) and opening it up to a group therapy environment that is less typical and "clinical", I could really do some good.

I'd love to hear your thoughts on this and wish you all the best with your therapeutic D&D campaigns!

It's implemented in-person, I'm incredibly lucky and privileged to be living in Perth, Western Australia, who haven't been strongly impacted by Covid and we've been on a strong road to recovery for some time now. I was running in-person services in September, although I did learn how to run the game on Roll20 and Zoom incase of second wave incidences.

Cost is a tricky one, I looked at what group programs were out there in my local area at the time, got some advice from others in the industry, and then lowered my prices because A) I'm trusting people to buy into a new and weird idea, and B), I don't believe mental health support should be as damn expensive as it is.

Best of luck with your tools and talk group! That sounds incredibly valuable for blokey types who aren't going to come into the therapy room. You should connect with your local Men's Shed, if you have one.

"That sounds incredibly valuable for blokey types who aren't going to come into the therapy room."

Thank you! This is precisely the kind of demographic that it would be aimed at. Those who are open to the idea of mental health but either have apprehensions or misconceptions about what therapy is. Even if my services can be used as a stepping stone for them to become more comfortable seeking more specialized therapy in a more conventional setting, then I would consider that a worthy process

I came to mental health to support men's mental health but even with my background in construction I'm not blokey enough. I'm definitely a nerd therapist.

Given the nature of drugs in gaming (take drugs, get addicted, get cured via potion, healer, God, etc) how do you address the similarities and differences?

It hasn't come up, to be quite honest. But I wouldn't offer easy ways out which are reductive of real-world issues, and even getting support from a deity isn't going to involve a snap of the fingers, but real work drawn from addiction therapy.

Hi! My sister in law is a Psychologist and has a TON of Psychologist friends. My brother runs a weekly D&D game just for them to blow off steam, and he is always amazed at how they, as caregivers, tend to choose fighters and barbarian types as their characters — they don't want to be healers. They want to FIGHT! They want to SMASH!

Any thoughts on that, and what can be learned from the way patients or people, in general, choose to design their characters?

Oh I often play a necromancer or a paladin so I can't really relate. I feel like certain classes appeal to certain people because of their values, and there's definitely a conversation that could be had with people who do have those recurring themes.

It must also be nice, as a therapist, to have a simple solution to the problems in front of you. A big heckin axe. We don't do "simple" in mental health, so being a barb or fighter must be a nice change of pace.

This is wild- I just watched Cynical Reviews video on the awful D&D films and discussed how some people use it as therapy.

Do you still face shenanigans with the few people that still believe its a gateway drug to Satanism?

I'm wholly prepared to face them but it hasn't come up yet. I'm incredibly grateful for that, though. I feel like those people may not exactly exist in the same places I advertise my sessions. I feel sorry for them though, this is a really fun form of therapy, and an outstanding and creative game.

Are you the guy from this post? They're a mental health professional who runs D&D sessions for four people on the spectrum. If not, maybe you two should exchange ideas!

That isn't me, but I'll have to give that article a read! There's a few of us out there, and probably more than I'd expect. Not every therapist is really into marketing the stuff they do.

https://www.youtube.com/watch?v=tDsOaES9lUw

Satine Phoenix had an episode that covered some of the psychology and therapy aspects of this (think there is another one with the gal as well). It made me think if there was a broader practice for this kind of thing.

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How do you deal with "problem players"? It seems like the options of "boot them out of the group" would be hard to deal with for a few reason.

I don't believe I have any "problem" players, just players who may need some additional support with things. :)

Okay this is awesome! This is something a fellow rehab therapist introduced me to and something I'd love to incorporate more into my practice. Do you have any advice to someone who runs groups on the reg but has little background in roleplaying games? Awesome work :)

Wing it. Make a cheat sheet for all the basics - saving throws, combat rolls and stuff. Your players can help carry some weight by knowing their spell mechanics and stuff.

Oh my god, I'm not the only one who thinks this way. Can we be friends? I'm a graduate student in counseling interested in creative approaches to counseling as well as psychotherapy in pop culture. I'm taking group counseling this semester and I'm developing a group proposal that uses brazillian jiu jitsu to integrate play therapy, group therapy, and expressive arts. But prior to settling on that, I was seriously considering developing a D&D proposal given I played it for years and saw the many parallels.

I'll look you up on social media!

Let's be pals!

I know one part of D&D where there will always/often have that one person who will try to roleplay as a flirty character. If anyone had played as that character how would you go on about that in terms of NPCs and the PCs themselves? Had there been anyone who have submitted this character?

How hard is it GMing/DMing a therapy group? I believe it is difficult just in a regular setting, but as therapy? I think that would take much more work, I have to give kudos to you

Sorry for the amount of questions lol I'm very intruiged and find this concept cool!

I haven't had a horny bard player yet. I guess it's a matter of time, but my groups often want to play the cooler, flashier classes like Sorcerer or Paladin.

It's a bit harder than standard group therapy because you have to do voices, plan a story, and keep a narrative on-track while in the therapy headspace. But it's fun and I wouldn't do it any other way.

What if the patient doesn't like the fantasy genre or boardgames?

Its an opt-in program people elect to be part of. If its not for them, but they sign up anyway, they're free to withdraw at any time.

Really good idea. Considering that D&D can easily be the means of actions without consecuencies, it can truly show you what kind of person you got in front of you.

Also, how many "bards" have you talked to?

Or how our classes can be expressions of our traits and values. Before becoming a therapist I almost exclusively played Paladins.

Haven't had any bards yet. I'm glad. I've got a Wizard in the team who has some absolutely fire insults though, I'm tempted to let him take Vicious Mockery regardless.

Are you taking new patients?!?

I am! My socials are at the top of the page, feel free to reach out.

As a diehard anime fan I find that a lot of anime reinforces toxic social traits like ideas of masculinity, ideas of women, sexual harassment/violence etc. how do you go about those kind of topics ?

In sessions it hasn't yet. If I'm consulting another therapist on an anime series I will bring it up, such as the more ick moments of Sword Art Online's ALO arc.

But tbh, I'd challenge them, have a conversation about the way people are portrayed vs the way they are in real life, and support critical exploration of toxic tropes.

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I have not, but I'd be very happy to learn more about supporting people who live with psychosis, especially if this is the sort of thing that can help them.

Game to Grow are a USA-based noprofit and provide training in this! However, I'm looking at putting together a training course for people in my city, Perth, to learn in-person and in a context with relevant information, especially regarding scope of practice, and workplaces.

Aside from the subject, ive been thinking about getting a degree in psychology and being a therapist. I like listening and helping people through their problems, how much work is it and are you able to live comfortably?

That depends massively on where you live. Different parts of the world have different requirements for practice - some areas just want a brief diploma, others want a doctorate. It really depends on where you want to go, too. You may set out to become a Psychologist PsyD and realise that your passion is more for supporting people in need, in more of a social worker role.

Many who enter the field find a new direction to go in once they start to realise the current focus area and needs. I started out wanting to work in men's mental health and now I'm leaning more towards youth therapy and LGBTQIA+ affirming support & advocacy work.

Thesis: Every Pen&Paper RPG round is a therapy session. Objections?

I'd say "has the potential to be beneficial to one's wellbeing", if only to beef up your word count.

But seriously, I feel like we know a least one person who has D&D as their form of regular therapy session. I'm just hoping to provide that opportunity intentionally.

How did you convince people to pay you money to play D&D all day?

By being a therapist and a massive nerd. Also a LOT of trust, admittedly. This is new and weird and I'm incredibly thankful for the people who trusted in this enough to take those first few sessions.

But this isn't what I do all day, this is just something I run a couple times a week. At other times I do traditional therapy, or youth work & mentoring, a bit of crisis work. This is a passion project. :)

This is really awesome. :)

D&D really helped me come out of my shell in college and deal with social anxiety. I'm pleased to see therapists embracing it as a tool.

QUESTION:

Have you explored other systems outside of D&D, such as those outside a traditional sword and sorcery realm (e.g. Starfinder, Savage World)?

My first campaign was done in the No Thank You Evil! game, a d6 RPG made for kids. We ran a superhero campaign which I tried to make really campy and Golden Age.

Ah my two loves coming together needy games and counseling! Any research yet? I'd like e to see this as a valid form of therapy

Absolutely buckets of it, some of it dating back quite some time. I feel like this isn't a "new" thing in as much as it's an "emerging" thing. Happy reading!

https://gametogrow.org/resources/research/

When I run non-theraputic games, I find DnD's focus on "killing monsters" to be kind of restrictive.

Are you running DnD (and not, idk, Burning Wheel or Masks or Hearts of Wu Lin or Scum and Villany) because it's what you're familiar with as a DM? Because it's what's most marketable? Or is the mechanical focus on tactical combat helpful for pursuing therapy goals?

D&D is definitely the more familiar, marketable game. Last year I ran sessions using No Thank You Evil, a kids RPG, and they still called it a D&D session. It's the flagship RPG. I've bought Masks and I'm waiting for it to come in the mail, I'm really excited to explore the themes and narrative structure in therapy! I also really want to do mindfulness and mentoring/education sessions using the Star Wars d6 RPG. I'm really keen on getting Monsterhearts 2 eventually because I've heard it does representation wonderfully.

For now though, I don't do a lot of combat in D&D, and really focus more on the storytelling, worldbuilding and narrative arcs of the players.

Please tell us about successful cases where you used these games and shows to help people. How does a session work? What do people do in it? Do they play competitively sometimes or only as part of the same team? Are there viewing sessions for anime and what do they get out of it? Are there games or shows that you have to avoid because they might instead cause negative reactions to the people? Are there games and shows you always use because they've been proven to be helpful?

Confidentiality applies so I can't give you too much on "successful cases", but I can see great change in groups when they start to creatively solve problems rather than resorting to combat.

Sessions work as a standard D&D game, with game mechanics and storyline elements tailored to the group's needs. The group are part of the same team and have to work competitively or the next enemy they face is gonna take advantage of a divided group.

I don't use a lot of shows or anime in therapy, instead what I do is blog about them so other therapists can have a resource to access for when they decide to do so.

Ever have people fake needing therapy just to get in on a game?

At the end of the day, I charge therapist rates, and there's way cheaper ways to get into a game than faking mental health needs to get into one of my sessions. But that's something to explore, too. How desperately does this person need connection that they'd pretend to be unwell, and pay a therapist, to play games with other people? Seems like someone who'd benefit from the social therapy of the game.

My son (5yo) goes to play therapy and he has loved it. I’ve learned a lot just by listening and a few discussions with his therapist. I’m a big DnD nerd, what would be the best things I can do to create a safe environment for my son to explore role playing games?

Get the Hero Kids RPG or No Thank You Evil, both really slimmed down d6 games for kids! Base a story on something he's into, like Star Wars or superheroes, and give him the freedom to tell the story he wants to tell, and encourage him along. Build the trust and the safety of the space will follow.

Hero Kids RPG is free right now. https://www.drivethrurpg.com/product/106605/Hero-Kids--Fantasy-RPG

Hi! I'd love to chat with you for an interview for my nonprofit Neurodiverse Gaming.

Do you have any experience using D&D as a form of group therapy for those with developmental/intellectual disabilities?

Almost exclusively. I've recently written an article and shared tips on supporting players with dyslexia, dyscalculia and dysgraphia in sessions. Feel free to DM me on socials!

https://counsellingwithmike.com.au/2021/03/29/supporting-reading-and-writing-difficulties-in-roll-for-growth/

Do you think it’s healthy to use fantasy escapism as a vehicle for personal development and growth? Isn’t there a risk of people using D&D to further retreat into their delusions?

Great question! Typically my players aren't delusional or at any kind of risk for roleplaying to worsen their mental state. I do a lot of work with autistic kids, as well as disengaged young people. Sessions revolve more around social skills, anxiety and depression.

As someone with autism, you’re doing saintly work. Thank you.

I'm just trying to find ways to support folks and connect with them in safe and comfortable ways. Thank you for your kind words, and thoughtful question. Have a wonderful whichever-time-of-day it is for you right now. :)

Is the D&D thing a marketing angle?

Is this AMA a marketing angle?

It this ethical?

I'll hang up and take my answer off the air.

In order of appearance:

1) No, Wizards of the Coast don't pay me any money. I lowkey wish they did but that'd be a conflict of interest and I'd have to decline.

2) Not really, I thought it'd be a cool way to spend my WoW Server being down for maintenance night while I prepare for tomorrow. Whenever I talk about D&D therapy it's met with a lot of enthusiasm and I thought it'd be cool to share that vibe with Reddit.

3) I've only engaged in some light smart-assery in this thread and things should be as ethical as I can make it.

Is CBT (Cock & Ball Torture) an effective form of therapy?

I'm not that kind of dungeon master.