“It’s time…to roll for initiative.”
The game master watches from behind their screen as the table full of players check their character sheets and reach for dice bags. An assortment of colorful 20-sided dice clatter on the table and numbers are called out.
It’s a scene that could take place anywhere: a school, library, game store, or dining room. Tabletop roleplaying games (TTRPGs) like Dungeons & Dragons have been in the mainstream for years. Shows like “Stranger Things” or podcasts like “Critical Role” have helped bring basement nerd culture to the limelight.
But this table is more than the typical hobby. The game master going over notes behind their screen is a therapist, and the players rolling their dice are their patients. The popularity of TTRPGs has spread into other industries. One niche seeing more application of gaming culture is healthcare, specifically psychotherapy.
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Experts worldwide are studying and applying the imaginative roleplaying aspect of gaming in therapy. Straight Arrow spoke with Alyssia Merrick, a researcher at James Cook University in Australia, about their work in the field and how these programs operate.
“Through sort of the engagement of challenges within tabletop role-playing games, whether that be fighting a dragon or picking some locks, you engage with short-term successes,” Merrick said. “You feel better within your own self-esteem, but you also feel improvement within your own self-efficacy, which is your ability to sort of handle life’s challenges. You can sort of take these little boosts in confidence and apply it to your own external world.”
In the team’s research, Merrick described self-efficacy as the belief “that one is capable of performing a specific behaviour, or set of behaviours, when called for in challenging situations.” Self-esteem is a person’s “positive or negative attitudes and evaluations of themselves.”
Basically, it’s what you believe you can do, and how you think about yourself.
TTRPGs can generally be boiled down to a combination of roleplay, luck and puzzles. A “quest” can be as simple as a collection of interactions with non-player characters (NPCs) to figure out who has been stealing fruit from a market stall, or as complicated as unraveling a curse holding an entire kingdom hostage. The movement of the game is directed by a game master who guides the players through the various scenes of combat or conversation.
In creating and roleplaying an imaginary character, no matter how different from you they are, pieces of yourself tend to shine through. Some call this concept “bleed,” and it can go both ways. The bleed may be in a goal, flaw, strength, personality or experience.
“By taking on these characters you learn, either directly or indirectly, different things about yourself and the others around you.” Merrick said, “We’ve had people mention how it was a great way for them to sort of experiment with coming out as queer via doing it as their character and seeing the positive responses from the other players at the table as their own characters, and then realizing ‘this is a safe space for me to be myself.’”
While TTRPGs, especially when led by an experienced therapist, can bring social benefit to players, there are limits to how much can be interpreted by a medical professional from a character sheet or a player’s actions.
“I would not use this as a tool for assessment or diagnosing or anything like that.” Mackenzie Amstutz, a TTRPG enthusiast and adult mental health therapist with Northwestern Medicine, said in an interview with Straight Arrow. “I think it’s more of a working therapy tool in helping people reach their goals.”
Amstutz said she could learn from the client’s character play, but they need to be internally motivated. Observing the gameplay doesn’t give a clear snapshot of their mindset.
”That would never give me enough information about who I’m observing,” she said.
As with many tools and exercises, the use of TTRPGs in therapy has its limits. But applied correctly, roleplay in a therapeutic setting can help bridge the gap between people and allow patients to interact in a relaxed setting. Pretending to be a hero with others, taking those imaginative risks in a safe space, could be of benefit to patients’ mental health in the real world.
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