In the heart of Seattle, a gathering of teenagers sit around a wooden table. It’s covered with character sheets, Dungeons and Dragons (1974) player manuals, and hand-drawn graph paper maps. Pencils, pewter figurines, and dice of various shape are scattered about. The players’ attentions are transfixed on the words of their charismatic game leader, Adam Davis. Davis has a decade of life experience over his players, but communicates with a youthful energy and utter commitment. His role is vital, building the fictional world for these players to fill with their unique characters. Through collaborative storytelling and rolls of the dice, they’ve built an epic fantasy saga. As Davis describes their latest adventure, his hands expressively gesture from behind a cardboard partition.

In passing, this evening of Dungeons and Dragons doesn’t look out-of-place. Similar games like it are found in countless libraries, school classrooms, and basement hangouts across the nation. But this quest holds special significance. Just a few months ago, these players were absolute strangers—all teenagers who suffer from underdeveloped social skills. Some are on the autism spectrum, others have simply struggled to find their place in life. They’ve come together under Wheelhouse Workshop, an innovative therapy company founded by two licensed therapists, Adam Johns, and the aforementioned Adam Davis. Through a blend of drama and recreational therapy techniques applied to tabletop role-playing games (RPGs), they’ve helped dozens of kids who often go untreated by mainstream psychotherapy.

Medieval torture chamber, via Wikimedia

Tonight’s quest involves fears and phobias. Before the start of the session, Davis has all of the participants write down their character’s greatest fear on a piece of paper. Their team has been overtaken by a spirit, who will show them each a vision of their worst nightmares. The other adventurers will share the hallucination, and must talk their compatriot free from the draw of evil—whispers in the corner of their mind.

Davis flips the first piece of paper. The character (a dwarf obsessed with cheese) fears a world without her beloved dairy treat. A Wonka-esque torment ensues. The players see a world where everything is made of cheese but turns to ash as soon as it crosses the dwarf’s lips. The group laughs and talks their friend away from the spirit’s lure. It moves down the line.

The next player insists his character fears nothing more than hurting his friends. Davis takes the Necromancer down a bleaker path. “You see your friends stretched out on torture racks, and see your arm holding a knife up to their skin. You feel a strong desire to hurt them, to make them bleed.” The player recoils slightly, while the other three shout words of encouragement that will spin in the Necromancer’s mind. “You don’t have to do this! This isn’t you!” The player pauses, breathing deeply. “But what if this is me?” He sits quietly and considers the character. He considers himself. The Necromancer sets down the weapon, and the next vision begins.

The spirit enters the last player. Davis lifts the remaining piece of paper, which simply says “My greatest fear is being alone.”

“You look down. You wear the clothing of an elven ranger, and you’re standing under a tree in a desert. There’s nothing in any direction, as far as you can look. Just sandy flat terrain in every direction. You are completely alone.”

The player’s reactions are subtle, and muted. He stays silent, but his eyes show deep contemplation. His eye line darts away from the gaze of the group. After a beat, the other players fill the silence.

“You’re not alone.”

“Your friends are always with you.”

“We’re here with you no matter what, even if you can’t see us.”

The spirit is vanquished.

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Wheelhouse Workshop has hosted countless sessions like this over the past three years. Currently, they’re managing five games every week. Each one carefully designed to develop the social skills each player is struggling with.

Wheelhouse Workshop began when Johns and Davis—both lifelong tabletop game players—realized that collaborative RPGs had untapped potential for narrative therapy. The technique they developed encourages patients to separate themselves from their problems, often by putting them in a less threatening context. This achieves something called ‘aesthetic distance’, where the patient feels removed enough from their issues to feel comfortable discussing them, while maintaining a level of appreciation. In the field of Drama Therapy (of which Davis has a Master’s degree from Antioch University), aesthetic distance is achieved through improv games or scene work. But for patients suffering from social issues, those practices often prove ineffective.

via Reddit

“There’s some resistances that might come out of doing a drama group, specifically with our demographic of kids dealing with social anxiety, awkwardness,” Davis said. Re-enacting social situations through a dramatic lens works for many patients, but the kids of Wheelhouse Workshop often resist opening themselves in such a way: “If I had them in a drama group, they wouldn’t show up.”

Adding rules, structure, and genre to a narrative therapy session allows these patients to experience that vital distance. When their character experiences an issue that is relevant to the patient’s real struggles, the patient is able to face it with a buffer provided by the fiction. Kids who may never open up in a direct conversation with a therapist can find a voice in their character.

With this comfort established, Johns and Davis can craft fictional adventures that challenge kids to use the social skills that they struggle with. A player with a history of off-putting body language may find her character at a fancy dinner party, and witness how their behavior makes others react. Another who feels hesitant to speak up may find their character with a unique ability to communicate with ghosts, giving them an important communication role within the party.

Pairing social skills development with D&D may seem like an obvious fit, especially since RPGs have always been associated with the socially downtrodden—stereotypes about D&D being an antisocial activity have permeated the mainstream for decades. However, it’s now easy to see that the game has always been therapeutic for those who fall outside societal lines.

“People who grow up highly interested in fiction and having a certain flexibility of identity—who willingly place themselves into other fictional words and embody characters—are often seen as abnormal or disruptive to the status quo,” said Sarah Lynne Bowman, a professor at Richland College who wrote her dissertation on the power of role-playing games. “Co-creating a fictional universe together without an audience, having no expectation of profit, and playing a different role than one normally does in society can feel threatening to the mainstream.“

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Davis, Johns, and Bowman are all part of a growing community that is working to make tabletop gaming standard practice for a variety of psychological issues.

Jack Berkenstock is one of the founders of the Bodhana Group, a nonprofit organization that advocates for this cause. They’re the founders of Save Against Fear, an annual tabletop gaming convention in Pennsylvania that focuses on RPGs as a healing force. For five years, they’ve attracted hundreds of local players for a weekend of gaming and enlightened discussion. What initially started as a simple fundraising event for Bodhana has grown into an annual gathering for therapists, game creators, and players interested in the deeper potential of roleplay. Though some attendees have still needed some convincing upon arrival.

“We’ve had presentations that are all about telling people [to not] be afraid of this idea of therapy in your D&D,” notes Birkenstock. His work has often brought him in conflict with players who worry that using tabletop games for this purpose is a ‘corruption’ of the medium. “We’re not trying to suck [the fun] out with some cosmic straw. The model of play therapy demands the game be engaging and fun. ”

Photo of D&D pieces, by Carsten Tolkmit, via Flickr

Save Against Fear has played host to deep conversations on how role play gives a unique perspective into the psyche. Sessions have dug into deep questions, like what character creation can say about a player. ”What is a person viewing as an indicator of strength? What do they view as positive or beneficial qualities?” Birkenstock said.

“Everyone plays their character for a reason,” Davis remarks. “Every decision in [the character creation process] allows them to include some part of themselves.” These rogues, barbarians, and dwarfs are an outlet to experiment with untested social skills and roles. It’s proven a remarkable tool that has just as many educational purposes as therapeutic ones.

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Hawke Robinson is the leading force behind RPGResearch.com, a growing database that serves as a central resource for collected sources on the many uses of tabletop games in therapeutic and educational services. Robinson himself came to psychology later in life, pursuing a degree in Recreational Therapy after retiring from his career in the technology sector. A lifetime tabletop game player, Robinson was quick to pick up on their unseen potential.

“In all the textbooks, they said over and over that there’s lots of great competitive games, and there are physical cooperative games, but a dearth of cooperative tabletop games for recreational therapy,” Robinson said.

The wish to fill this need has pushed Hawke’s research efforts, including running games with groups from varying backgrounds. This has included sessions with the physically and mentally disabled, collecting longitudinal survey data on the impact of play.

Currently, he’s working on a custom-built trailer to bring these sessions to new areas without worrying about space restrictions. One session he has planned for early next year was designed around a group of children and adults with high-functioning autism in Tacoma, Washington. It was developed in association with Partnerships for Action, Voices for Empowerment (PAVE). While these participants are capable enough to have fallen outside government care, they still rely on their parents for many daily necessities. Transportation has been a regular struggle, with many of these people experiencing high intimidation when using public transportation. In the past, PAVE has attempted to educate those in need through personal lessons with public transit employees, and guided tours of the system. However, few participants showed meaningful progress.

To tackle the issue, Robinson has planned a hybrid tabletop/live-action RPG loosely inspired by Marvel’s Agents of SHIELD series. Players take on the role of a SHIELD task force, who have received intel that a super villain intends to spread a noxious, zombifying gas through the city’s buses and trains. But to avoid panic, the government has insisted the problem be solved without shutting down the system. After creating characters and receiving a debrief, players engage with a tabletop campaign. On paper, they travel the city by bus and train, follow leads, and unravel a vast conspiracy that threatens to turn Tacoma’s population into the living dead.

By setting the tabletop game in their hometown, Robinson has integrated the real-life bus maps, schedules, and habits into the campaign. A player who has avoided using the bus their entire life due to anxiety can confront that fear through role play, learning necessary behavior in the process. “The game isn’t about the bus, the game is about beating the bad guy,” Robinson said. “Learning how to use the bus is just a means to an end. By giving them this goal, we can keep them engaged enough to teach them what they need to know. If it’s fun, they’ll do the hard work.”

Once every player has demonstrated confidence in their skills, they move into the live-action segment. Individually, each player takes the bus (accompanied by a guardian) to a central depot at a predetermined time. They meet and engage in a cross-town scavenger hunt, following clues to stop the outbreak. By the end, the skills and comfort level achieved with the game should give players the confidence to integrate it into their daily routine.

“The main philosophy of recreational therapy is [that] we make it so people will stick to the therapy they need to better their quality of life,” Robinson notes. He brings up comparisons to the physical therapy asked of patients regaining their mobility. “They dread the therapy sessions, and after they stop seeing the therapist, they stop doing the exercises.” The muscles atrophy, and patients find themselves in a vicious cycle. These same trends show themselves in psychotherapy. The progress made fades without use. Integrating an activity that holds appeal gives patients a reason to engage with the healing process. Short-term satisfaction is key to seeing long-term results.

Robinson’s research has seen him bring various forms of game-enhanced therapy to many groups, from teens leaving juvenile detention facilities (finding new social circles outside of gang life), to patients recovering from traumatic brain injuries (regaining vital motor skills). But for these healing practices to become normalized, qualified Game Masters are needed.

In addition to his research and volunteer work, Robinson has developed a certification regime for leading therapeutic game sessions. Ideally, it could ease the curve for therapists who don’t have a lifetime of game experience, who wish to integrate tabletop RPGs into their practice. By setting professional standards, the groundwork is laid for more formalized research and development.

The desire for standards is a primary concern for Johns and Davis, who hope that, by communicating with other practitioners, therapeutic RPG sessions could become as standardized as dramatic therapy. From there, the technique could be applied to countless other mental hurdles—from Attention-Deficit Disorder to Post-Traumatic Stress Disorder. But for now, the practice will continue to grow from the fringes.

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Header image: Beholder, by Steve and Shannon Lawson, via Flickr