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May 23, 2018 DRAFT

WIZARDS, WARRIORS,
& WELLNESS
The Therapeutic Application of
Role-Playing Games
by
Jack Berkenstock Jr., MHS & Baron Blakley
WIZARDS, WARRIORS,
& WELLNESS
The Therapeutic Application of
Role-Playing Games
by
Jack Berkenstock Jr., MHS & Baron Blakley

© 2019 by The Bodhana Group

Cover art and “Heroes of the Game” art by Jeremy and Tori Thilo/Toriborealis Pictures and Goods
“RPG Dice” by jpneok is licensed under CC 1.0
Photography by Doug Hilton Photography
Page layout by Baron Blakley
Edited by Doug Hagler

Visit www.thebodhanagroup.org for more information about The Bodhana Group and its programs & services,
which include training, consultation, and therapeutic groups utilizing tabletop board and role-playing games
for education, skill building, and therapy.

Special thanks to: Richard Thomas, Adam Davis, Adam Johns, Hawke Robinson, Ben Parkinson, Dr. Rafael
Boccamazzzo, Dr. Megan Connell, Dr. Sarah Lynne Bowman, L. Mike Fields, “Lucius” and “Marcus,”
Game to Grow, RPGResearch, Onyx Path Publishing/Pugsteady Games and Eddy Webb (Pugmire),
Monte Cook Games, and Shanna Germain (No Thank you Evil).
Also thanks to all the friends, fans, and citizens of the Bodhanaverse!
Welcome to the World of Therapeutic Role-Playing Games ___________________ 1
What Do We Mean by “Therapeutic Role-Playing Games?” ___________________ 3
What Are the Therapeutic Benefits of Tabletop Role-Playing Games? ___________ 4
Social skills ______________________________________________________ 4
Creativity________________________________________________________ 5
Empathy ________________________________________________________ 6
Critical thinking & Problem solving _________________________________ 6
Resilience ________________________________________________________ 7
Education _______________________________________________________ 8
Initiative_________________________________________________________ 8
Fun _____________________________________________________________ 9
Conflict resolution—Bringing it All Together _________________________ 9
What Do You Do in a Tabletop RPG? _____________________________________ 10
First, choose a game ______________________________________________ 11
Create a character________________________________________________ 11
Build a party ____________________________________________________ 12
Where do you meet? _____________________________________________ 13
Ground Rules ___________________________________________________ 14
Who will GM? __________________________________________________ 14
How often are you going to meet? _________________________________ 14
Play the game ___________________________________________________ 14
Possible Applications for Specific Diagnoses/Conditions ____________________ 16
Attention Deficit-Hyperactivity Disorder ___________________________ 19
Anger Issues ____________________________________________________ 20
Anxiety ________________________________________________________ 21
Autism Spectrum Disorder________________________________________ 22
Depression _____________________________________________________ 24
Learning Disabilities _____________________________________________ 25
Social Skills Deficits ______________________________________________ 26
Trauma-Informed Care ___________________________________________ 27
Things to Remember____________________________________________________ 29
Dragons, elves, wizards, warriors. Dungeons, castles,
caverns, tombs.
Brandon was a shy kid. But that didn't mean
These are some of the most popular images of he didn't want friends.
tabletop role-playing games, as portrayed by the kids
playing Dungeons & Dragons on the hit Netflix He didn’t look people in the eye. He
show Stranger Things, but they are just the tip of the withdrew from social activities. He sometimes
iceberg. Tabletop role-playing games (RPGs) long got so overwhelmed that he’d cover his head
ago expanded beyond the typical fantasy tropes, and with his arms and scream to be left alone.
in recent years there has been an explosion of new
games and gaming environments. There are games But he didn’t actually want to be alone.
for fans of science fiction, horror, westerns, comic
books, cartoon characters, and much more. What he wanted was a way to connect to
peers who were starting to move on in ways
And while you may imagine the typical RPG player he couldn’t quite grasp.
as a nerdy kid in their parents’ basement (not that
there’s anything wrong with that!), the hobby This isn't a story about “curing” Brandon. He
actually attracts all kinds of people. Hollywood has made peace with the unique set of
actors Vin Diesel, Dwayne “The Rock” Johnson, strengths and struggles that autism has given
Drew Barrymore, and Mike Myers all play, as do him. This is a story about how Brandon found
filmmakers Jon Favreau, Kevin Smith, and Joss a game he loved, and how that game - by its
Whedon. Stephen Colbert is also a long-time player. very nature - helped him develop friendships
They play because they know how fun it is to sit and the skills to manage them.
around with a group of friends and create a story
together. RPGs are pure fun, plain and simple. And it's also the story of a group of battle-
hardened adventurers, who fought their way
But as tabletop RPGs are enjoying their renaissance, through an army of orcs to rescue the king.
there is a growing awareness that they are more than
just a great way for friends to have fun together. Role-playing games can actually be good for you! You
may already have seen articles reporting how RPGs can be used to help reinforce skills learned in
therapy, such as social interaction or emotional recognition and management (for example, this from the
BBC, which quotes our Executive Director, Jack Berkenstock). At The
Bodhana Group, we are putting these ideas into practice.

The Bodhana Group was founded in 2009 by a group of therapists and


direct support professionals who had worked together for years in a
residential treatment facility for male youth. We had seen boys in the
facility benefit from role-playing games, and at the gaming convention
we held as our first fundraiser we heard countless stories of how
gaming helped people. For some, it was as simple as being inspired to
read role-playing game books. Others talked of creating characters with
personal traits that they themselves wished to share. Still others told of

WIZARDS, WARRIORS, & WELLNESS 1


The Therapeutic Application of Role-Playing Games
their difficulties fitting in and making friends,
and how their gaming group became the life-
saving social group they needed. Tabletop role-playing games bring together a
small group of people to create an adventure
The Bodhana Group advocates the use of that is both a story and a game. That
tabletop gaming as a directed therapeutic and adventure could involve dragons or starships,
clinical practice that can benefit personal monsters or spies, superheroes or cartoon
growth as well as enhance social and animals. The only limit is their combined
educational services to individuals and families. imagination.
Basically, we believe that the inherent benefit
one gets from playing games can be focused Most of the players take on the role of
and utilized to make one better. Better at math characters in the adventure, while one player
or reading. Better at socializing or emotional serves as the gamemaster (GM). The GM
expression. Better at coping skills. Better at life. manages the adventure, keeping the story
moving while presenting the other players
You may know someone who could really with challenges to overcome and a host of
benefit from the therapeutic qualities of RPGs. imaginary characters with whom they can
Perhaps you are the parent of a child who has a interact.
hard time fitting in. Maybe you are a leader of a
youth group, some of whom have social skills Throughout the game, the players face a series
or communications deficits. Maybe you are of challenges and use their wits, planning,
living on your own in a new place, and you creativity, and teamwork to overcome those
struggle with meeting new people. We believe challenges. Along the way, fun will be had,
that tabletop RPGs can provide you with a snacks will be eaten, and dice will be rolled.
super-fun activity that could also help you with
some of those challenges.
always recommend that use of RPGs as a
In this short book, we would like to tell you therapeutic tool should be partnered with
about the kinds of therapeutic benefits RPGs traditional sessions for maximum benefit.
can provide, give you a brief overview of how
you can get started playing RPGs, and discuss If you or someone you know needs clinical,
ways that RPGs can help individuals with therapeutic treatment, you should get help from
specific diagnoses. We are not suggesting that a trained therapist. But the benefits inherent in
RPGs are a replacement for therapy. Rather, we tabletop role-playing games can support the
work being done with a therapist. For
individuals whose needs are subclinical,
tabletop RPGs provide an opportunity to get a
therapeutic benefit while having a great time.

2 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Most people who play RPGs aren’t doing it
because they want to develop these life skills, of
Tabletop RPGs involve imagination, creative course. They play for the same reason people
problem-solving, risk-taking, and lots of have always played games: they are fun. But
socializing. As with any activity, the more you there are people who really need to develop
do it, the better you get. In the case of RPGs, these skills, for whom it does not come
that means improving skills that will benefit naturally. For some people, learning skills
you throughout your life. through traditional methods might not work.
For these people, participation in an RPG can be
You will gain these benefits whether you are a way to learn and practice skills in a safe and
actively trying to do so or not. Meet with a friendly environment. For them, RPGs can be
group of people for three or so hours a week, therapeutic.
share food and games with them, and work
with them to achieve shared goals. As weeks We want to again clarify that we are not
and months pass, you will get better at teaching how to “do” therapy, or what we
communicating your thoughts to those people. would define as clinical use of RPGs. Role-
You will get better at solving problems. You playing games can be used as a form of therapy
will get better at seeing things from the in a clinical setting, but only under the guidance
perspective of other people. And that will of a trained therapist. Someone who does not
happen naturally, in the same way that you have training in therapy should not attempt
learned how to order a meal at a fast food therapy.
restaurant, or how to behave when sharing an
elevator with strangers. By “therapeutic,” in this case, we mean,
“beneficial.” We see RPGs as therapeutic

WIZARDS, WARRIORS, & WELLNESS 3


The Therapeutic Application of Role-Playing Games
because they are a way to learn and practice
social and problem solving skills. Role-playing
Player - A person who is engaging in a role- games can help you discover things about
playing game by playing one or more characters. yourself, and develop skills like emotional
management, creativity, personal expression,
Character – An individual within the story of and critical thinking. RPGs are also therapeutic
the game, just like a movie, book, or video game. in the sense that they give players the simple
pleasure of interacting with others in a fun
PC - (Player Character) - A character portrayed activity.
and controlled by a player who is directly in-
volved in the larger narrative.

NPC - (Non-Player Character) - A character who We’re going to focus on seven particular
is portrayed and controlled typically by the ga- therapeutic benefits of playing RPGs, each one
memaster. NPCs are usually characters in the tied to one of The Bodhana Group’s seven
background of the narrative, or those who help Heroes of the Game:
move the story along or assist the PCs.

Party—Usually refers to the collection of PCs Mr. Meeple (Social Skills)


undertaking the adventure.
Alice (Creativity)
GM - (Gamemaster) - A generic term used in
many games for the person, or persons, who
portray the world in which the story takes place, Metta (Empathy)
portrays characters apart from the PCs, and has
final say on how rules are to be applied in the
game. Games use different terms for this role, Sagan (Critical Thinking)
and sometimes this role might be shared by
multiple or all of the players.
Rowe (Resilience)
Session - The term usually used to describe one
set period of time during which players sit Christa (Education)
down to play. Often ranging from one to four
hours or more, multiple sessions of play can fol-
low the same storyline and the same characters. Tesla (Initiative)
In some games, a single session is a complete
story from beginning to end. Social Skills
Tabletop RPGs involve players getting together
Campaign - A longer story arc, which is a con- and interacting face to face. Players who
nected series of many sessions. Campaigns are struggle with social skills see other players
typically designed to tell a larger story. They can modeling social behaviors, and have the
be of varying lengths, with some campaigns opportunity to practice those skills in a safe
lasting a year or more. Consider it akin to a sea- space through playing the game.
son of serialized television shows.

4 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
What are some of these social skills we are Part of the challenge in games, then, is learning
talking about? For one, learning to advocate for how to 'play well with others,' both in-character
yourself. Some people have difficulty and out-of-character.
expressing themselves in a group. They might -Sarah Lynn Bowman
feel that what they have to say isn’t important, The Functions of Role-Playing Games
or they might be afraid someone will say their
ideas are stupid. Maybe they had that happen consequences, but the adventure continues,
in the past. But being able to advocate for whether it is the next leg of the adventure or the
yourself is a critical life skill. How limited next character you create. Games are filled with
would your life be if you could not explain to a choices for you to make and for your party to
person that they are sitting in your ticketed seat, discuss.
or tell a waiter that your meal is undercooked,
or ask a harried store clerk for directions to the The flip side of speaking up is listening to
restroom. When people feel inadequate to others. If you’re looking at your ticket wrong,
manage minor conflicts, they begin to self-limit you want to fully listen to the explanation the
their life experiences. They simply won’t travel first time and avoid spending ten minutes
alone, won’t go out to dinner, won’t put arguing because you didn’t hear the other
themselves in situations where they might have person point out your ticket is for Row M, not
to ask for even the simplest directions. Row N.

Gaming groups can be a great way for people to Meanwhile, you are also developing and using
develop these skills. The safe space of a game other skills, such as waiting your turn, looking
provides a platform where you can start slow at issues from other perspectives, reading and
and simple. One of the reasons is that within the interpreting facial cues, and organizing your
game you can make a choice and the thoughts to formulate your response. These are
consequences affect your character and not you. just a few of the basic, critical social skills that
It’s all pretend; you will survive any mistake. role-playing games help develop for all players
You may be unhappy with the in-game - whether or not the players are actively seeking
the opportunity to practice. And learning these
skills doesn’t seem like learning because you are
focused on fighting orcs and crashing through
the gate, or stealing the dossier from the
General.

Creativity
Players work together to create characters and
then use those characters to tell an engaging
story. The question of “what happens next” is
answered by the decisions the players make
during game sessions. Every aspect of the game
encourages the players to imagine their
characters, the characters their friends have
created, and the world in which they are
interacting.

WIZARDS, WARRIORS, & WELLNESS 5


The Therapeutic Application of Role-Playing Games
Some players go even further, creating all new ...three types of empathy can be identified. For
worlds and cultures and filling them with fun example, compassionate empathy can be
and engaging characters. Some players enhance demonstrated by player-characters responding kindly
their creativity through drawing their to other characters. Cognitive empathy can manifest
characters or writing stories about them. Other itself through players knowing how other characters
player explore creativity through making props, are feeling by observation or spectatorship, or through
wearing costumes, or using accents or a funny interacting with other characters. Emotional empathy
voice to talk like their character. is similar to cognitive empathy, but in addition to
knowing how other characters are feeling, the players
Empathy feel these emotions as their own.
When players take on the roles of imaginary -Tim Marsh
characters, they learn how, in the game, to care From the essay “Vicarious Experience",
about the things important to the character. in Gaming as Culture
They learn to consider that while a particular
goal or reward is not something important to
them as players, it could be very important to Critical Thinking & Problem Solving
their character. At the same time, they see that The players’ characters encounter a wide range
there are things that are important to another of obstacles as they pursue their goals. The
player’s character that are not important to their players learn to think of different possible
own, and they learn that the game is more fun solutions to those problems, and then they get
when all the players care about everyone’s to act those solutions out. This also helps a
characters. RPGs can also teach empathy by person explore not only one solution but the
using characters and adventure storylines to possible consequences of different ways to solve
show how people might feel after going a problem. The wide open environment and
through a loss, or a victory. We can share a infinite possibilities for different stories allow
variety of emotions in this way. for an equally wide array of problems and
solutions. Some of the challenges require

6 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
finding clues, searching for patterns, and disappointment of something not going the way
coming up with unique ways to approach an we intended, or not succeeding at a task we
issue using what is available. There is no end to were attempting. Resilience is a very important
the ways we can explore social challenges, logic skill to develop for continued success in life. It is
puzzles, and even the strategy of combat. what helps us dust off and try again when we
do not accomplish a goal right away, or try
Players learn to not only devise and consider something new after other attempts were not
multiple solutions to the problems they face, fruitful.
they also learn to plan out the steps of those
solutions in advance. They learn to keep track of One of the simplest ways that role-playing
their in-game resources, so that they know what games develop this is through the random
tools they have available when challenges arise. nature of dice. Sometimes we roll the numbers
And they learn to manage those resources, to we need, and we’re able to accomplish our goal.
ensure they are still available in the critical But when the dice do not roll the way we would
moment. If you are face to face with a hydra, like, “the show must go on.” As players we seek
you want to be sure you haven’t already used ways to keeping moving forward, to deal with
up your fireball spell. the consequences of the dice. Flexible thinking
can free us from patterns and push us to
Some RPGs use miniatures, maps, and terrain, consider other options.
which also help develop critical thinking
through planning out battles and strategizing Life is like this, giving us obstacles that we must
attacks. find ways around. Sometimes, we just need to
accept that we cannot have what we wanted.
Resilience For individuals who have a hard time developing
Another of the unique skills that role-playing this skill, RPGs offer the opportunity to practice
games help us develop is resilience. This skill is in a safe environment. In this way, failure in the
all about being able to deal with adversity and game can sometimes provide the greatest
difficulties. This can be as simple as the benefit to us in the real world. Even though

WIZARDS, WARRIORS, & WELLNESS 7


The Therapeutic Application of Role-Playing Games
...although the method is diverse enough for games that are set during specific periods in
educators to apply to any field, role-playing is human history, games that feature other
especially suited for social studies, including history, cultures, and some games even feature real-
religion, government, and economics. world science and technology as part of the
-Sarah Lynne Bowman powers you can use.
From “Educational Live Action Role-playing
Initiative
Games: A Secondary Literature Review",
In the real world, we say a person is “taking
in The Wyrd Con Companion Book 2014
initiative” when they are the first person in a
situation to make a decision or take action. In
what we wanted did not happen, we can still RPGs, initiative usually refers to the turn order
move forward and we will be okay. for players during the course of the game, but it
is based on the same concept: whichever
Education character takes the “most” initiative (meaning
Games can teach us more than just social skills rolls the highest number) gets to go first.
and problem solving. Games can teach us a lot
of the same concepts and information that we Initiative is drive and commitment, taking into
learn in a classroom. First and most obviously, consideration the risks and rewards of a given
RPGs are a great way to stimulate reading and situation. In stories of great heroes, they face
comprehension. When we are looking through a incredible odds and risk the possibility of
rulebook, we are not just ge ing exposure to failure because their goal is important to them.
new words. We are also learning how one rule In RPGs, players frequently take risks through
connects to another rules. We are reading the the characters with the hope of greater rewards.
words at the same time as we are seeing the Those rewards may be in-game treasure, or they
larger picture of the rule within the context of may simply be the fun and excitement of taking
the game. The desire to become be er at the action in the face of danger.
game, and the love of the game’s se ing, can
provide the reading incentive some individuals
need.

Many RPGs also exercise math skills, through


adding dice rolls, initiative tracking, hit points,
and other game stats. Players don’t need
advanced math skills to play these games, but
those games do provide a continual opportunity
to practice basic arithmetic. Players will
naturally seek to be able to make calculations
more quickly, simply to keep the game moving.
And for those players that are interested, RPGs
also provide an opportunity to learn more
advanced statistical concepts.

Further still, some RPGs are set not in fictional


universes, but historical worlds. There are

8 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Games give the opportunity to take risks in a To increase 360 degree immersion, approximately
way that is unlike other activities. Players can 350 hired role-players (and the Army calls them as
learn to take risks in a situation where the such) play the parts of merchants, Afghan police
consequences can impact their immediate officers, family members, security forces, imams, and
enjoyment of the game session, but do not insurgents or Taliban fighters.
involve real danger. And they also learn that if -Aaron Vanek
they don’t make a decision and take an action, From “Inside the Box: The United States
they miss out on opportunities. Going through Army’s Taxpayer Funded Larp",
a game session in which nothing actually took in The Wyrd Con Companion Book 2012
place because the players spent the whole time
hemming and hawing over what to do is
frustrating, and that frustration encourages RPGs are just one of many fun activities in their
players to make decisions that move the game lives. But there are some – often the ones who
forward rather than be paralyzed by “analysis most need to develop some of the skills above –
paralysis.” This practice in the game can help who struggle to find their place. There are many
players take initiative in their own lives. players who look back at their time playing
RPGs as the only time things felt “right” during
Fun difficult periods in their lives. For these players,
It’s last on the list, but it’s perhaps the most the joy of the game will be the most important
important benefit, because it makes the others benefit. Sometimes, the simple escape of
possible. Playing tabletop RPGs is simply a fun pretending to be someone else for a few hours
way to interact with friends – or even strangers. acts like a miniature vacation and can be a
The fun of creating and playing in a story, valuable downtime activity to relieve stress and
laughing about the outlandish things done by build natural supports, the network of friends
the characters, and cheering as they accomplish we can come to during tough times.
a difficult mission – all of this is why people
play tabletop RPGs, and why they have been Conflict Resolution - Bringing it All Together
playing them for over forty years. For some, These skills are not learned one by one, but are
instead practiced all together, with the different
skills overlapping just as in “real life.” The
creative solutions to a problem are developed
and discussed at the table, as a group. As
players learn about each other’s characters, they
are interacting socially, practicing the give and
take of conversation. And the fun of the game
pulls it all together. Players don’t practice social
skills as part of a structured exercise. They do
not feel forced to participate in a group therapy
or life skills class. They practice their skills
because it makes the game more fun.

This mix of skills combines to teach and then


practice conflict resolution. In life, conflict is
inevitable. Part of life is learning to manage

WIZARDS, WARRIORS, & WELLNESS 9


The Therapeutic Application of Role-Playing Games
interpersonal conflicts in a positive, non-
combative manner. But some people have a
very difficult time learning that skill, and they We want new players to feel comfortable and
try to avoid conflict at all costs. Of course, confident when they play an RPG for the first
avoiding conflict means they are avoiding time, and we hope the information here helps
opportunities to learn and practice their achieve that. But don’t let our obsessive need
interpersonal skills, and the cycle continues. to be helpful fool you – this isn’t hard! If
you’ve found a game you can join, chances are
Like any group, gaming groups run into you can ask for a pregenerated character and
conflict. Fortunately, this is a skill that just jump in with both feet. Your fellow
therapeutic RPGs are particularly good at players and the gamemaster will answer any
developing. The lessons in social skills, questions as you go along, and in no time
empathy, problem-solving, and critical thinking you’ll be playing like a pro.
all combine when we resolve conflict. Even
better, RPGs create a safe situation in which you But, we also know that some people like to
can learn to negotiate interpersonal conflicts. know everything they can about something
The conflicts you must resolve are usually new before they try it. That can be particularly
happening to your character, not to you. This true for people who could get the most benefit
gives you some distance from the negative out of therapeutic RPGs. Hopefully the
aspects of the conflict, and helps you not to take information here will help all our readers to
the conflict personally. At the same time, you, get all the benefits of playing these games.
as a player, might have disagreements with
other players about the best way for your
characters to overcome the challenges of the
game. These disagreements give you the If you are wanting to start playing an RPG, it
opportunity to practice the skills you have been can seem a little daunting at first. But honestly,
developing throughout the game. that would be true if you wanted to suddenly
start playing football every week, without
knowing much more than “they look like they
are having fun.” With RPGs, you can at least go
in knowing that you will not end up with
bruises or pulled muscles.

The Bodhana Group’s Heroes of the Game represent the therapeutic benefits of role-playing games.

10 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Whatever RPG you pick will have its own One resource that is becoming more and more
rulebook telling you how to play, but there are popular are online servers that host tabletop
some things that will be broadly true whichever RPGs. You use a website to play RPGs, kind of
game you pick. like a really large online kitchen table. This
might make learning a game easier if you don’t
First, Choose a Game have access to a local group. Examples of these
The RPG that people are most likely to have include Roll20 and Fantasy Grounds.
heard about is Dungeons & Dragons, or D&D. It
is a great game, no question, and it has been Create a Character
most players’ introduction to tabletop RPGs. If you are playing in an RPG, what you are
But there are many, many more options, and really playing is a character who moves through
you should not feel you are limited to D&D. the world of the RPG: encountering dangers
There are games for fans of horror, science and discovering wonders, taking actions and
fiction, westerns, comic book heroes, and more. solving problems, all while interacting with
There are games based on licensed characters, other characters whose actions can have a big
and games aimed specifically at younger impact on your success.
children. There are games that have a lot of
detailed rules, and there are games with Your character in the game is similar to the
relatively few rules other than to have fun. protagonist in a movie (but with an ensemble
cast! – see sidebar). They will be a driving force
Most likely, a new player is going to choose a in the story of the game, one whose actions help
game based on what their friends are playing, determine how the story will progress.
or what games are being played in a local game Choosing who your character will be – your
shop or school club. After they play for a while, role, in this role-playing game – is an important
they may decide there are other games more to decision. For some players, creating a character
their liking. There are no wrong answers here. is their favorite part of the game. In fact, players
might spend hours creating characters that they
But maybe your friends are not playing RPGs never get around to actually playing in a game,
yet, and you don’t live near a game shop. If you simply for the fun of imagining what their new
are looking to find a game to start with your hero – or villain – could be and do.
friends, or for your kids, or for a youth group,
start by looking for a game that you can play for One thing to keep in mind while creating your
free. You can find PDFs online that give you a character is the difference between the player
free, introductory version of just about any and the character. You are the player, an actor
popular role-playing game. They will also be taking on an improvisational role. Your
geared toward new players, helping you ease character is that role. And much like a film actor
into the rules of the game. When you are might not be at all like the role he or she plays
starting out, we strongly recommend you take on film, you might be nothing like your
advantage of these resources. Most games have character. You might be shy, anxious, or
introductory adventures to help learn the depressed, but your character can still be the
system. A lot of these adventures even include bravest, toughest marshal in the Wild West.
text for beginners. Conversely, you might have no problem with
snakes, but you might find it a lot of fun playing

WIZARDS, WARRIORS, & WELLNESS 11


The Therapeutic Application of Role-Playing Games
Build a party
So you’ve picked your game, you’ve made your
When you are playing your character, how do character, and you’re ready to jump in and play
you speak “in character?” the game. The best part of RPGs is getting
together with your friends. But what if your
Some players refer to their characters actions friends don’t play RPGs?
and speech in the third person: Talla tells the
guard that she’s the Duke’s niece, trying to Well, you could try to change that, for starters.
bluff her way inside the gate. After all, it wasn’t so long ago that you didn’t
play RPGs either. Talk to a couple of friends
Other players speak in first person: I go to the who you think might be open to it, share your
guard and say, “My uncle, Duke Cornwell, gaming materials, invite them to start a game
told me to come see him at once!” with you. If you are interested in playing a
fantasy-based game like D&D, any friend who
There’s no right or wrong way, and most loves the Lord of the Rings and Hobbit movies
players do a little bit of both, whatever strikes is a good bet. Sci-fi and horror fans are also
them in the moment. likely to be open to trying genre-themed games,
even if it’s not their preferred genre.
a character who is afraid of them, a’la Indiana
Jones. If you are a parent of a child who wants to play
but has trouble reaching out to friends, consider
You are not your character, but your character is making a game part of a themed party. For
a part of you. Perhaps it’s the part of you that example, if your child has friends over to watch
dreamed of casting spells or sword-fighting on a Lord of the Rings movie, those are friends
rooftops. Perhaps it’s the part that dreamed of who might be interested in playing a game as
escaping the stress and frustrations of day-to- dwarves, elves, and wizards. After a couple of
day life to set forth on an adventure. No matter hours of battling orcs and trolls, at least some of
what, the character you design can serve a those kids will be hooked.
valuable role in helping you explore new parts
of your personality If none of your friends are interested, get a new
group of friends. No, we’re not saying dump
Some actors take roles that allow them to your old friends – just add to the pool of people
pretend to be something so they can feel what it who are lucky enough to know and interact
is like to be another person and they do this to with you. Contact your friendly local gaming
learn more about life. Sometimes we can choose store; they are likely to have tables set up for
a character that maybe has personality traits we games, open to the public.
don’t. If you’re kind of shy, playing a character
that is very smooth and suave can help you see The store can also tell you about organized
more about what you think that is like. You can games promoted by game companies. For
practice asking someone out, or practice example, the D&D Adventurer’s League
expressing anger. program, promoted by Wizards of the Coast, is
an organized, public-play system, in which
players show up at game stores every
Wednesday to play a 1-2 hour game session.

12 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
The Pathfinder Society, from a company called
Paizo, does something similar.

Organized play is not for everyone; it is in


public, and participants usually start out
playing with total strangers. That can be
difficult for a lot of people, especially
individuals diagnosed with anxiety or other
conditions that can make it difficult to meet new
people. But it can also be rewarding; you might
find it is easier to meet new people in such a
setting, where everyone is focused on the same
GMs prep for their games in the organized play
goal of getting together to have fun playing a section at Save Against Fear 2017.
game. After a few weeks you could find
yourself looking forward to seeing these people game for just one or two children at a time. You
who started out as strangers. One strategy that can add others in as your child is ready. If you
might make it easier to get started is to find one give your child the chance to become
friend or family member who has some interest comfortable with the game before including
in trying out the game, and then the two of you others, you also give them the opportunity to be
go to the organized play session together. the game’s “expert” among their friends. For
children with special needs, this kind of
In fact, if you have even one friend or family confidence boost can be a big help in managing
member who is interested in playing, you don’t anxieties.
have to go anywhere to get started. Although
game rulebooks will often recommend that you Where do you meet?
have four, five, or even more players in the Maybe you or one of your friends has enough
game, many players first started playing in a space to fit a good-sized table for you all to
gaming group of two people. crowd around, but maybe not. And often,
people who have more space are often sharing
Starting small isn’t a bad idea. If your first game that space with roommates or family, who
has a group of seven first-time players sitting might not be so happy to have their home taken
around the table… well, you will still probably over by gamers once a week. If none of the
have a lot of fun. But the game itself might be a players has the space, you can try a gaming
confused mess. If you and one to three friends store. Many will have space set aside for their
can spend a few game sessions figuring things customers to play games. Public libraries also
out, that will help larger game sessions go more often have meeting rooms available for any
smoothly. group to use. If you are a student, your school
may be able to provide space, as well.
You might find this is particularly true if one or
more players has issues with anxiety, attention If you are a parent trying to get a group
deficit, anger management, or social skills. If together for your child, talk to his or her school
you are a parent introducing this game to your about starting a gaming club. You might even
child who struggles with similar issues, it will make the happy discovery that such a club
be to your benefit to start with you running a already exists, and can provide your child with

WIZARDS, WARRIORS, & WELLNESS 13


The Therapeutic Application of Role-Playing Games
easy access to gaming and to new friends. If A party member’s death or devolvement might upset
there is no club yet, you can probably help get a players or might, alternately, provide a sense of
club started if you find a teacher willing to release and humor. Some players remain detached
sponsor it. observers through such a process and can laugh at
the predicaments of their characters, while others fly
One consideration in deciding where to meet: into rages or experience a deep sense of melancholy
food. RPGers can burn through food like a high at their character’s demise.
school football team, so it is a good idea to plan -Sarah Lynn Bowman
for food in advance. If you are not meeting in a The Functions of Role-Playing Games
player’s home, food might not even be an option
during the game, so players should plan may find that another player really likes the idea
accordingly. Libraries in particular frown on of creating the story and running the game. Or
pizza and soda. maybe several of you take turns as GM. But you
will need to figure that out.
Ground Rules
Ground rules refer to the general ways that the If you or one of the other players has attention
game is played. In particular, here we are deficit issues, you might find that being the GM
referring to rules for behavior around the table. is the perfect way for you to enjoy the game. The
A basic example is the question of whether to GM has no downtime during the game, when he
allow phones and tablets allowed at the table. or she might otherwise be distracted by a
They can be distractions, but for some players cellphone. The GM always has something to do,
with attention issues, fiddling on their phone and gets the immediate reward of engagement
helps them to stay at the table. with the other players.

A bigger issue, particularly if some players have How often are you going to meet?
difficulty with anxiety, anger management, or If there are just two or three of you playing, you
social skills in general, is how players treat each might can get by with an ad hoc, “we’ll play
other. Depending on the emotional maturity of when we can” agreement. But if you have a
your players, you may want to establish rules larger group, you’ll want to come up with some
with regard to teasing and other behaviors. kind of schedule for when the group will get
Some examples include: No abusive language; together. And you’ll want everyone to agree to
No physical touching; No teasing players when make every effort to show up for games, to be
they are upset or having a difficult time with respectful of each other player’s time.
what is happening in the game; and, Let other
players make their own choices. If you are a parent planning to run the game for
your children, be aware that although it seems
Who will GM? like it will be easy to play “when we can,” some
Every gaming group will need someone to run children struggling with anxiety or autism
the games. It doesn’t need to be the same person spectrum disorder might still need the structure
every time, but it does need to be someone of a scheduled game night.
reliable. Usually the person who most wants to
get the group together to start gaming becomes Play the Game
the GM. Odds are, since you’re reading this, that The details will vary somewhat according to the
will be you. But once the group gets going, you game, but the basics will hold true. The GM

14 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
describes a situation in which the characters
find themselves, and the players describe how
their characters act in that situation. Earlier we said The Bodhana Group has seven
Heroes of the game. Actually there are eight!
So the GM explains that the party’s goal of Hawk represents a player’s dexterity, a quality
entering the duke’s castle is stalled by that doesn’t usually get much of a workout in
recalcitrant guards blocking their path. What do tabletop RPGs.
the characters do? Try to persuade the guards to
let them in? Lie about who they are? Try to But a Live Action Role Playing game, or LARP,
sneak past the guards in the dead of night? provides the opportunity for players to add
Draw swords and attack the guards? Give up physical activity to their role-playing
and find something else to do? All possible experience. Players might try to mimic their
choices, and each will have an impact on the characters’ stance, walk, and mannerisms. Some
story’s direction. LARPs include running across battlefields to do
combat with foam weapons. Often players
Whatever they choose to attempt, are the dress like their characters, and in some games,
characters successful? There will likely be dice- they actually set up environments like towns
rolling to find the answer. The dice provide a and camps that allow the player to move
random element, so you always feel like around and interact like they are living in the
anything can happen. fictional world.

Succeed or fail, the GM describes the results, LARPS can provide an opportunity to roleplay
and the cycle continues. The GM describes the difficult conversations, or to help players see
new situation, and the players figure out what the world from another person's perspective.
their characters will do. Back and forth it goes, Some LARPs use these simulated settings to
as together they create – and star in—their own really feel what it is like to live life in a different
story. time period, or a different country.

Playing the game is the environment where


therapy starts to take form. By playing your
character and interacting with other players and
characters from the story, you explore different
roles and can thus learn about yourself and
others. By playing through specifically-
designed challenges around goal areas, you are
able to apply critical thinking and rehearsal to
problem-solve various situations. A therapist
skilled in designing in-game encounters can
make them resemble opportunities and
challenges we face in our daily lives. Practicing
these skill in the game is a fun and engaging
way to practice skills, and is similar to the
practice of clients exploring their options in
individual sessions via talk therapy.

WIZARDS, WARRIORS, & WELLNESS 15


The Therapeutic Application of Role-Playing Games
(including theme, genre, and content) do not
intensify or worsen the problems of the
DISCLAIMER – We want to be as clear as individuals receiving treatment.
possible that we are not trying to teach you how
to “do” therapy. Nothing here is intended to be Although we provide information during this
a prescriptive recommendation or advice on section on potential uses of RPGs as a tool for
administering treatment. We do not advocate therapy, these inclusions are for the purpose of
trying to treat serious mental health conditions helping illustrate how games can be used for a
unless you are a trained or licensed therapist or variety of purposes. Attempting to do therapy
counselor. Although we make a lot of good without proper training or experience can be a
connections between the benefits of role playing dangerous prospect. When a therapist uses any
and certain challenges, using these connections tool - including role-playing games - to actively
to help ameliorate the difficulties associated address specific diagnosed conditions, they can
with mental health disorders requires clinical trigger emotional reactions that may be
experience, gaming experience, and oversight connected to trauma or may create situations
and supervision. where the person responds with challenging
behaviors. If you are not trained with how to
Therapy should be provided by trained respond to these situations, you can cause
therapists, and therapists who want to include emotional trauma or potential injury to that
RPGs as part of their formal practice should persons or others around them.
make sure they understand the ins and outs of
the games they use. It is critical that Even talk therapy, when used to actively
practitioners make sure that aspects of the game address an individual's therapeutic needs, can

16 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
lead to emotional reactions that should be Each section below will include a brief
handled by a trained therapist. But talking with Description of the diagnosis and some of the
friends, like playing tabletop RPGs for fun, is an challenges that come along with having that
uplifting activity that provides emotional particular diagnosis. How RPGs Might Help
benefits. We are not saying you should not play explains how RPGs could help address those
RPGs with these individuals unless you challenges, and Potential Adjustments are a list
yourself are a trained therapist, just that you of suggested adaptations and modifications that
should not try to actively use the game as a can be made to the games, based on the needs
clinical therapeutic tool. and particulars of the diagnosis. These could
include changes to the rules, the gaming
For individuals challenged by certain diagnoses environment, or the type of game, to make play
or conditions, the use of role playing games easier or more meaningful. Some individuals
could be an appropriate adjunct to treatment, with these diagnoses could find these
but anyone playing RPGs can experience the adjustments helpful, but others will not. We
baseline beneficial, therapeutic effects that the stress that individuals with mental health
game naturally provides without any directed diagnoses are individuals nonetheless, and
clinical application. Everyone experiences there is no one-size-fits-all approach.
positive benefits from participating in fun,
creative activities with friends. That’s just part Although part of the purpose of this chapter is
of being human. And everyone also benefits, to designed to be speculative, and hopefully will
varying degrees, from practicing the problem- assist in developing and facilitating research,
solving and social skills that are an integral part this chapter has also been based on the work
of role-playing games. We feel good when we and experience of The Bodhana Group. We
solve puzzles and beat challenges. have provided services for children, teenagers
and adults for a variety of the conditions and
In particular, if you are a parent struggling to challenges described in this chapter. We have
help your special needs child reach their used these techniques to work with groups
potential, and if you are longing to find a fun, focused on exploring grief and loss, groups
social activity for that child, role-playing games focused on dealing with anxiety and
might be what you are looking for. depression, and groups addressing the
challenges related to Autism Spectrum
The most important thing to keep in mind if Disorders. The Bodhana Group is one of several
you have players struggling with social skills or organizations developing and fine-tuning this
mental health issues is to be sensitive to those approach so it can be more helpful in current
struggles. If an aspect of the game appears to be and future application.
seriously upsetting a player, be willing to make
adjustments to make the game enjoyable for As with any form of suggested therapy or any
that player. For example, if the player’s counseling approach, benefits will differ
character has been knocked unconscious, and depending on a variety of circumstances. We do
the player is becoming visibly upset about “just not suggest that the playing of role-playing
watching” while the others continue to play, let games could take the place of traditional
them control one of the villains or supporting therapy. Rather, therapeutic role playing is an
cast until their character is back on their feet. adjunct or companionate therapy, intended for
use in collaboration with traditional forms of

WIZARDS, WARRIORS, & WELLNESS 17


The Therapeutic Application of Role-Playing Games
therapy and as an enhancement to therapy. Role the difference between game and real life would
playing games offer unique ways to approach be key parts of using therapeutic gaming with
challenges people face as a result of having a someone who has this diagnosis.
particular diagnosis.
For therapists, when deciding whether or not to
Before going into the various diagnoses, we use therapeutic gaming with a patient, the
should note that there are cases in which the use impact that participating in an imaginative and
of RPGs might not be advisable. These engaging narrative could have on the person
situations are not globally discouraged, but should always be explored and reviewed, not
these conditions have vulnerabilities that might only initially, but on a continuous basis as well.
bring about adverse reactions or counter- It is important to check in with the patient, and
indicated results. see what applications from the game can be
used in their real life. This conversation helps
One of these is schizophrenia, or schizoaffective set the expectation that the two are exclusive
disorder. Persons with this diagnosis may have but interconnected. This is akin to any other
difficulty stemming from abnormal thought form of therapy, where the practitioner must
processes or deregulated emotions. Persons maintain that the therapy is indeed helpful to
might believe things that are not rooted in fact the client and above all, not harming or
as truth. Part of the risk with this diagnosis is endangering them. The Bodhana Group is in the
that the person might not be able to understand process of developing and writing a manual for
the difference between the game and real life. clinicians and therapists on more applied
Also, certain delusions, hallucinations, or clinical use of therapeutic gaming. The Bodhana
emotional beliefs might take on a grander Group also collaborates and interacts with other
significance from the experience of the game. professionals using this approach around the
Perhaps the interaction between two players world, to share ideas and strategies, explore
might bleed over into reality and the conflict safeguards, and develop and establish research
doesn’t end when the dice are packed up. The and best practices to this emerging modality.
construction of the narrative and how to signify

The Bodhana Group leads a therapeutic RPG session.

18 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
AD(H)D – Attention Deficit Disorder (with A theory of mind is the conceptual mental
Hyperactivity) framework of one person as developed and adopted
Description: ADD, and ADHD, can present a in the mind of another... Role-playing allows
lot of challenging behaviors. Most of the participants to take theories of mind one step
concerns that typically come from this disorder farther. Instead of merely [imagining] what
are racing thoughts, hyper-kinesis, difficulty another might think, the player is forced into
focusing, interrupting others during situations where he or she must make decisions 'as
conversation (impulsivity), difficulty regulating if' they were that person.
emotions (especially when excited or agitated), -Sarah Lynn Bowman
and overstimulation. The Functions of Role-Playing Games

How RPGs Might Help: Socially, children with Listening to the plans of your teammates and
ADD/ADHD can get into trouble due to their strategizing together improves focus, attention,
difficulty in taking turns or demonstrating and communication.
patience. The structured nature of role-playing
games helps promote waiting one’s turn and Also, the visuals provided by maps and
thinking through situations. The flow of play miniatures can help to cement thinking into
within an RPG provides a framework for something more concrete. RPGs can be played
people working together while taking turns. without these tools, but the physical
Most games resolve this through the use of representation of a board and pieces can help to
“initiative,” which is a mechanism in the game lock thinking down, for those who need it. It
that determines who goes in what order. takes the racing thoughts in the brain and gives
Usually, the initiative order changes over the them physical form to aid in focus.
course of the game, giving each individual
player a chance to go first, which helps keep the Potential Adjustments: Some individuals with
experience fresh and not formulaic. ADD/ADHD struggle with overstimulation, in
which the brain can become so flooded with
When playing an RPG with a group of people, information that focusing on one thing can be
there usually is a lot going on. This can be a difficult. These players might be helped by
boon to players who cannot slow their mind limiting subplots so there is one focused goal at
down, by creating a parallel environment one time, building the adventure step by step.
where creative, “outside of the box” thinking This would allow the player to focus their
prevails. While waiting for their turn, the attention. You also might give the player in
players are encouraged to pay attention to what question a personal goal. This gives a central
other members of their party are doing. As they point of focus as well as providing a way to
progress, players learn that by using time encourage paying attention to the flow of the
between turns wisely, they can be more game so they can pick up on valuable clues
effective - and have more fun - on their own relevant to their experience.
turn. They are also participating in the social
experience of watching, talking about, and Some players might find the seated nature of
laughing about what happens on each other the game difficult. A simple solution is to let
player’s turn. Players are encouraged to see these players stand up and walk around as the
their adventuring party as a team, and for that game goes on. Sitting is a convenience that most
team to succeed they need to work together. gamers prefer, but it is certainly not required by

WIZARDS, WARRIORS, & WELLNESS 19


The Therapeutic Application of Role-Playing Games
the game. Providing breaks when players need Anger Issues
them also helps clue to facilitator learn what Description: Anger issues are an amorphous
motivates and demotivates certain players. term that can describe a multitude of issues,
either with dealing with anger internally, or
Some of the challenges in RPGs can be handled difficulty in how someone expresses anger.
by the characters simply running in “guns-a- Some people with anger issues can be explosive
blazin’.” But in many other cases, that when frustrated or angry. Others can internalize
“strategy” is likely to be unsuccessful. their anger into self-destructive behaviors.
Impulsive players can become frustrated if they Either way, dealing with frustration and anger
want action but the situation calls for planning. is a very formative skill that if not developed
A good solution here might be to allow the can lead to greater problems as time goes on.
adventure to have more flexibility in its Anger could create interpersonal difficulty with
completion so that many different creative friendships which in turn could create self-
solutions could be applied. esteem issues.

You could also build ways to reward players for How RPGs Might Help: Individuals with anger
being patient during the session by letting them issues can have problematic reactions to being
roll an extra die when they attack to confronted with problems to which that cannot
demonstrate how taking your time helps build see a solution. As we’ve noted, RPGs help
better strategy. This could encourage more players develop problem-solving skills. In
patient reactions and planning on the part of the RPGs, missions usually do not have to have just
players in controlled situations, exploring one solution. Well-designed challenges can
frustration and coping skills meant to manage instead provide a menu of opportunities for
that feeling when possible solutions are not conflict resolution, providing the player with an
fruitful. opportunity to practice thinking through
situations.

The GM could run the game in a way that


presents challenges that could be resolved
through talking it out and negotiating. This
provides a rehearsal period where the player is
actually practicing the skill of talking, but again,
it is in a safe environment of the game, with no
real world consequences.

RPGs provide a lot of in-game conflict and


sometimes the players do not agree on the
resolution. The individual players will need to
learn to solve their disagreements peacefully,
and they will be encouraged to do so by the
desire to “get back to the game.” This provides
a learning environment, but also provides the
person playing with other perspectives.

20 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Because stories involve universal situations and
character types, they can easily be crafted to
represent the same situations and personalities Neuroplasticity refers to the brain’s ability to
that players encounter in life. And the game reorganize and change throughout life. Learn-
provides a safe space in which the player can ing isn’t limited to your childhood years.
work with that material without it seeming too Adults as well as children and youth can learn
personal or being too close to what the player and improve social skills and more. Regular
actually feels. We call this distancing ourselves, gaming sessions can help!
and the character is a great shield as well as a
great doorway into what we feel. recognize anger, control anger, and express
anger. You can then use language to distance
Potential Adjustments: One of the challenges players from the emotions of the game, such as
we have with using RPGs for anger issues is saying “your character is feeling _________, but
that the context of the adventure, depending on what are you, the player feeling?”
chance, could initiate frustration or agitation.
Every gamer has had that session where the Anxiety
dice just did not go your way and it seems like Description: Anxiety is a general term that is
the GM is stonewalling every suggestion you used to describe when a person feels intense
have. One of the biggest attractions for many feelings of excitability or tension that can also be
people to RPGs is that the games have an expressed as lack of focus, fear, or feeling
element of randomness, attributed to the dice overwhelmed and out of control of events in
and the fact that you are dealing with people one’s life. Anxiety is something that we all feel
around the table. For individuals with anger from time to time and we normally describe it
issues, the potential for unexpected failures or as stress. Most people experience stress and
frustrations could make the scenario volatile. anxiety as temporary occurrences caused by
relationships, work, or other outside factors.
Establishing ground rules for the table, as well When someone has a clinical concern with
as instituting a process for conflict negotiation, anxiety, these symptoms can arrive without a
will help to make sure the emotional clear cause. These effects can be quite impactful
atmosphere does not become violent. For and lead to difficulties and challenges in life,
example, you could establish a time-out signal. ranging from panic attacks to indecision and
You set a token in the middle of the game table, feelings of failure. These feelings can even
and whenever a player grabs the token, the interrupt relationships, jobs, and overall quality
game stops. This creates a safe space everyone of life.
understands.
How RPGs Might Help: Role-playing games
The game could allow for a way to create offer a unique opportunity for treatment in that
scenarios where clients can use breathing we can use the framework of the story to
techniques and other coping skills to deal with rehearse and expose people to situations that
anger around the table. One great aspect of the mirror what we encounter in life. In this way we
game as we have discussed is that players are can selectively create situations that encourage
exploring feelings and ways to respond to specific emotional reactions. This can be
situations in the guise of their characters, so partnered with strategies that the client
they have a chance to rehearse ways to practices and learns during other therapeutic

WIZARDS, WARRIORS, & WELLNESS 21


The Therapeutic Application of Role-Playing Games
ASD – Autism Spectrum Disorders
Description: Autism has many challenges that
heavily depend on the individual. Most
commonly, individuals with an Autism
Spectrum Disorder face social skills challenges,
ranging from simple interactions to complex
social greetings and reading of social cues.
Other challenges they can face include
a achment to routine, sensitivity to change,
sensitivity to sensory inputs (overstimulation or
understimulation), fixations or intense
preoccupations, and difficulties recognizing the
impact of their actions. They also often
Bodhana introducing new players to RPGs. experience a deficit, or developmental delay, in
“theory of mind.” This term refers to the ability
sessions. For example, if we are teaching to understand how the thoughts, beliefs, and
someone to identify their symptoms of anxiety, emotions of other people are different from
we match this with teaching them ways to one’s own, and that these differences can affect
address their anxiety, perhaps through the use how other people perceive, and react to, the
of relaxation techniques. The game can help us world around them. The degree to which
create situations that generate stress. The player someone on the autism spectrum experiences
can then practice those relaxation techniques at any of these challenges varies greatly.
the table. The game offers a controlled se ing
that can help the client use a skill under the How RPGs Might Help: As we’ve said, RPGs
supervision of a clinician. are inherently social activities. Groups of
diverse people ge ing together can be a
Potential Adjustments: Obviously the creation veritable classroom for social learning. You
of stressful situations must be handled gently. A have the opportunity to meet and interact with
therapist should always be mindful of the level a varied group of people. Through this, you
of mastery of the person, and any session of have many professors that can help to reframe
therapeutically-intentional role-playing should learning moments and provide examples to
include a mechanism for pausing or enhance learning. The social aspect also gives
interrupting the flow of the game if the player is the chance for unlimited opportunities to test-
having difficulty. Some systems do a good job run scenarios and learn without real world
of creating tension naturally without the use of consequences. Rehearsing these scenarios could
emotionally charged or sensitive material. The be a wonderful tool by which to try out
horror RPG Dread, by The Impossible Dream, different responses and then talk about what
uses a Jenga tower to resolve actions the player was different from one a empt to another.
wants to accomplish. The more difficult the
action or a empt is, the more blocks need to be Additionally, many aspects of the game can
removed. This creates natural tension that can initiate conversation, so social interaction isn’t
be used to offer chances to practice skills to limited to conversations between characters.
reduce bodily responses of stress and anxiety, The cha er can be stimulated by anything from
such as rapid heartbeat and racing thoughts. “Where do we go next?” to combat strategy.

22 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
The attachment to routine some persons with an the mood of their games, but some players with
ASD diagnosis face is potentially mitigated by an ASD might be sensitive to certain tones.
the simple randomness of the dice. The result
from actions can be wide and varied, stretching Because individuals on the autism spectrum
from success to failure, and the interpretation of might not interpret social cues as expected, they
the die roll can help with the degree of change could have difficulty solving in-game riddles
you want to help a person get acclimated to presented by the gamemaster. This is
through playing. Finding ways to creatively particularly true if the GM is speaking in
explain why an attempted skill did not succeed character. This, along with a tendency to think
can aid in understanding how the unexpected concretely, could make riddles unnecessarily
might occur. This is similar to an approach challenging and potentially frustrating. You can
called social stories, in which a sample scenario address this by allowing players to roll dice to
is written and reviewed that includes see if their characters (rather than the players)
descriptions of a social situation, with social can figure out the riddle.
norms and common reactions a person might
expect to encounter. They are rehearsed and You want to also be careful with regard to
then used to stimulate discussion to enhance interpretation of rules. Sometimes people with
learning new skills and perspectives. ASD have difficulty accepting unfortunate
circumstances or having unexpected situations
Given some of the challenges that might result occur. Rules can complicate these situations if
from concrete thinking for those with ASD, the they are not clearly agreed upon. Sometimes the
use of miniatures and maps can be a helpful aid way that rules are written can be interpreted
to visualizing what is going on as well as help differently depending on the way they are
with some critical thinking skills with regards to written. Seek out these rules ahead of time and
consequences and choices. figure out how they might be interpreted, to
enable more of a black and white ruling. Also,
Potential Adjustments: One of the greatest try to find out in advance what circumstances
difficulties in introducing some individuals on would greatly upset the ASD player if they
the autism spectrum to RPGs is also the one of happened to their character (e.g., death, mind
the primary challenges you are trying to control). Then, at least during the early stages of
address. If a person is too concrete in his or her helping them to learn and appreciate the game,
thinking, that person might have trouble with
the more abstract portions of the game.
Therefore, introducing such an individual to the
hobby should follow an individualized
approach, and be a gradual and fluid process.
The concept of RPGs could be introduced
through video games or board games with
similar elements.

You want to also be sure you know some of the


particulars of the person playing in your game.
Sometimes Gamemasters use music to heighten
Superhero RPG at Save Against Fear 2016

WIZARDS, WARRIORS, & WELLNESS 23


The Therapeutic Application of Role-Playing Games
don’t let those circumstances occur. Learning to RPGs are inherent in the game. Very similar to
deal with adversity and the unexpected is best how we were able to use storytelling to create
done by introducing it in smaller doses. tension and stress, we can also create stories
that contain powerful imagery and themes
Depression about sadness. These stories help evoke
Description: The condition of depression refers emotion much in the same way that a movie
to a set of difficulties stemming from a does, but in this case, the game allows the
persistently de-elevated mood or lack of interest person, through the agency of their character to
in activities. This might involve anything from make changes and respond to the situation
feeling fatigued, feeling a low level of without full real world consequences.
excitement, lack of pleasure, or in some extreme
cases, feelings of desperation that might include Potential Adjustments: We must always be
suicidal thoughts. It is felt that one of the causes aware of and responsive to the level of
of depression is chemical imbalance, where the adjustment of the material and consider where
brain does not create sufficient levels of the client is in their path of healing. Depression
chemicals needed for maintaining emotional as a diagnosis is a condition that has many
regulation. Depression can also be caused by causes. Depression can be chemically driven or
social factors, crisis or trauma situations. situationally driven, and depending on the
person managing this condition, it can be a
How RPGs Might Help: RPGs can help short or long-term experience of connected
someone develop a proactive response within symptoms. Games on their own might not heal
the paradigm of depression simply by depression, but they might provide a
providing a group of supportive friends. One of framework by which the player can recognize
the common theories about depression is that what is happening to them during a depressive
the isolation or reduced activity sometimes episode. This might help them in life to
associated with depression hurts more because recognize and be able to work through the
it removes one of the best solutions - contact feelings and sensations. The game also provides
with others. That contact with other people can a grounding point to help the person move
heal or reduce depression’s symptoms. This is away from focus on the feelings associated with
an example of how the therapeutic benefits of depression to a more active pursuit. Being able

Bodhana staff and volunteers at Save Against Fear 2017.

24 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Pugmire - Good Dogs developing great skills.

to switch thoughts is a valuable tool to Some games, especially those for children, can
managing depression. also help with skills like abstract thinking and
creative problem solving. The thrill of the game
Learning Disabilities can engage the player and drive them to want
Description: The term “learning disabilities” to learn and work through the challenge.
includes a wide and varied array of difficulties
and challenges that involve the way a person Potential Adjustments: Rulesets for may
interprets, stores, encodes, retrieves, and utilizes systems can be simplified. You can start by
information. Information can be represented by choosing a system that matches where the
words numbers, colors, spatial relationships, person is, or playing a variant that offers some
concepts, and ideas. This can be anything as challenge for the player. One way to do this is to
basic as the value of numbers, the way they are start with a basic version of the rules, then add
written, working with any number process more aspects and rules variants as the player
(adding, subtracting, etc.), or the order in which gets better with the game. Repetition is a great
they are written. Disabilities involving words learning tool.
can involve phonetics, syntax, writing the
letters, comprehending the words, or even The game No Thank You Evil!, from Monte
stringing together ideas into paragraphs and Cook Games, actually has three levels of play
sentences. that can interact in the same game. As players
better understand the game, they can take on
How RPGs Might Help: RPGs generally more complex characters. There are red, green
involve a lot of numbers and reading. That and blue level characters that add more aspects
doesn’t mean a non-reader can’t play, but the to a character to be able to customize the
ability to read will take a player deeper into the experience to the learning level of the player.
game, enriching the experience. Players will And because the three levels of play can interact
want to read the rules about their characters, to at the same game, the characters for individual
better understand them. During the game, they players can advance in complexity at the rate
will usually be working with numbers to some appropriate for each player.
extent in order to judge the level of success or
failure of their character’s actions. RPGs use a
range of mechanics and resolution systems. .

WIZARDS, WARRIORS, & WELLNESS 25


The Therapeutic Application of Role-Playing Games
Social Skills Deficits characteristics of a fictional person. The player
Description: Social skills difficulties can come talks, acts, and interacts through the character.
from a variety of sources; sometimes the deficits The player knows that they are not the one
are related to a clinical diagnosis, and interacting with the king, their character is, and
sometimes the trouble comes from simple that distance provides a cushion for taking
shyness. Social skill difficulties include being social “risks.” If a conversation goes badly, the
unable to read social cues, difficulty making eye king is angry with the character, not the player.
contact, not knowing how to behave in common
social situations, or being afraid to talk to Furthermore, the game is based on players
others. These difficulties can be due to an talking to each other, working on plans, sharing
inability to understand subtext, not knowing information, and cooperating. All of the normal
how to start conversations, difficulty skills that are practiced when you get any group
maintaining friendships, and an inability to of people together are practiced and refined
communicate feelings within a relationship. while playing an RPG as an inherent quality of
the game. The game requires players to act
How RPGs Might Help: Again, playing together as they are engaged in a combined
tabletop RPGs is an inherently social activity. A effort. They have a shared goal, so they must
small group of players who may or not know collaborate or face the possibility of failure!
each other well gathers around a table to
become immersed in an imaginary adventure in Potential Adjustments: While RPGs offer the
which they must overcome their differences, in chance for development and practice of social
order to work together to combat a common foe skills, there is also the potential, as with all
or obstacle. This encourages teamwork and therapies, to push a person too far. The roots of
collaboration which includes not only difficulties with social skills are many. Some
discussion, but also dealing with adversity and people are shy, some people have trouble
disagreement. constructing what they want to say, and some
people have trouble interpreting what they
More importantly, role-playing games can hear. This can mean that in a group of seven
require a player to get “into character.” This people, everyone can be operating on several
means taking on the personality and different communication ability levels.

No Thank You Evil helping to heal through play.

26 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
Cosplayers at Save Against Fear 2017.

Some players might be very outgoing and control the way that people respond to it. Your
social, and love engaging with everyone. story or setting may not re-initiate trauma, but
Sometimes these people can be great role something another player says might do just
models and teachers. At other times, they can be that. Some people do not feel comfortable
intimidating and intrusive, and even sharing their stories of trauma or their
frightening to players who are not as engaging. situations, so other players at the table might
The challenge is to balance your group. The not know.
group should be encouraging and supportive,
so that no player “hogs the spotlight.” The Another consideration is that similar trauma
therapist should also make sure to carefully can affect individuals in dramatically different
construct the adventures to give chances for ways. One person could be mildly upset.
everyone to have something to contribute. Another could be driven to tears thinking of
their situation and how they have been hurt.
Trauma-Informed Care Additionally, we rarely know for certain
Description: Trauma Informed Care is a without having been told what can trigger
framework of understanding, recognizing, and someone. For some people things as basic as
responding to the various effects of trauma. smells, songs, and voices can be powerful
This includes being mindful and aware of triggers that make a memory from the past
possible histories of trauma in an effort not to re seem as vibrant as if it happened only
-initiate them. This is usually something that yesterday. Persons unknowingly re-engaging
occurs in people who have experienced severe traumatic material without appropriate
situations of trauma in their lives. Some rehearsal could have very varying degrees of
examples could be anything from surviving a reactions. Also, therapists require special
fire or a car accident to physical or sexual abuse. training to deal with more extreme forms of
The main worry in this situation is that through trauma. Once again, non-therapists should not
some story element of the game, you could attempt to “do therapy” for these or individuals
unknowingly replicate someone’s trauma. This with any other clinical diagnosis.
could cause the person to re-experience the
trauma, and with that possibly the pain of the How RPGs Might Help: Having said this, the
trauma. Part of the problem with trying to very structure and design of a role-playing
utilize trauma-informed care within a creative game can yield substantial benefits for people
setting like a role-playing game is that while with histories of trauma. Role-playing games
you can control the setting, you cannot always from one perspective are about escape and

WIZARDS, WARRIORS, & WELLNESS 27


The Therapeutic Application of Role-Playing Games
fantasy. Players are able to engage a fictional helps them recognize their body’s early
world pretending to be someone they create to warning system to when they are feeling
interact with the world presented. This is very intense emotions. The therapist can use that
similar to therapeutic techniques in which the moment to allow them for practice self-calming
participant rehearses potentially traumatic or strategies and coping skills.
difficult material in practice environments with
trusted participants. Potential Adjustments: Game adventure
scenarios can be customized to take into
RPGs can offer this same benefit with the added account the stressors a person is dealing with
bonus of providing a fictional narrative to and present these in whatever format or genre
utilize metaphor, allegory and symbolism to would be most engaging for the person,
work through complex issues. The built in allowing the fun of the activity to help engage
mechanic to the game of it being acknowledged the participant who would be learning concepts
as play space can allow it to be a safe space while playing. These sessions could then give
where the character can be created with impetus to deep conversations in which the
attributes the person may wish to gain for person analyzes how the game session went
themselves and maybe talks about other options the
character could have taken, exploring the
This allows for the player to use the character as realms of problem solving and critical thinking
an avatar of sorts. The character is a shielding while mixing in elements of emotional content
element, providing an additional layer of with regard to how the player thinks the
protection that allows the person to tackle character might feel about what occurred.
difficult situations. The player can rehearse Again, this must be applied with caution
different responses to stressors and still learn towards those with trauma histories and can be
lessons that can be taken back to the real world. altered and designed ahead of time with the
The game world can show options and potential participant. It takes on the form of a staged
pitfalls of choices and decisions but without the practice session. Always this must be done with
real world consequences. It is very much like a the permission and consent of the participant,
session that models play more than deep under the supervision of a licensed therapist, as
clinical dialogue. One simple example with any recommended therapeutic approach.
therapists can use is to use the story to help a
player feel their physical reactions to stress. This

28 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
We will be creating a manual for full application Brandon’s Star Wars expertise served him
of this approach, but in the meantime, here are a well through fourth grade. Most kids his age
few considerations for clinicians considering were also Star Wars fans, and his knowledge
this unique approach of clients or even if you of the most esoteric trivia meant he always
are a parent wanting to use games for skill had a tool to enter conversations. But as he
building and the inherent benefits of RPGs: got older, his friends’ interests moved on.
Brandon couldn’t keep up with their interests
Know how to run a game – If you are just going in sports, camping, or social activities. He felt
to play an RPG yourself, you will be fine left behind.
learning the rules as you play. But if you intend
to implement RPGs as an adjunct or When he was eleven years old, Brandon
companionate therapy in collaboration with started playing Dungeons & Dragons. At first
traditional forms of therapy, you need to know just with his dad, then with siblings. Then at
how to run a game. First, understand what goes his twelfth birthday party, he introduced the
into running an RPG. There is a fine art to the game to a group of long-time friends that he
craft of presenting adventures to a group of was starting to think he had little in common
people in a way that is engaging and fun. You with anymore. It was a big hit.
will need to be comfortable creating a story that
others can add to, and portraying believable And though Brandon loved the game most
characters with whom the players can interact. when those old friends got together, he
You will guide that story so that it grows into surprised his parents by playing games at a
one that is both engaging and therapeutic. convention, and then at a local gaming store.
Eventually Brandon was introducing the
You will also need to know the specific rules of game to new friends, even creating a gaming
the game system you are running. Rules can be club at his school and taking on the role of
a challenge when running RPGs and they can GM.
advance or slow down the story. The rules are
designed to help resolve conflict and in a large That hasn’t solved every problem in his life.
way give the world a bit of reality and He still experiences anxiety. He can still be
significance. So make sure that you understand resistant to trying new experiences, and he
the process of play with an RPG or you will find can still be overwhelmed in stressful
it tougher to run an adventure that someone can situations. But he has a game he loves and
benefit from therapeutically. Therapists friends with whom to share it. A game that
uncomfortable with the rules of the game may has served as a bridge to new relationships,
focus too much on the therapeutic aspects, to and has given him the confidence to stand in
the detriment of the players’ fun If they’re not front of a group of peers and lead them on an
having fun, they won’t play. imaginary journey.

We strongly recommend if you are unfamiliar He’s happy.


with RPGs, go to a local game store or a
convention and start by simply playing. Find

WIZARDS, WARRIORS, & WELLNESS 29


The Therapeutic Application of Role-Playing Games
out what the fun is all about and learn the flow Always have permissions, and if working with
from people who enjoy the hobby. someone under the age of 18, make sure to be
able to explain the process and the benefits with
Know your players – Understand the the parents of the clients.
challenges and interests of the persons for
whom you are running the game, especially if Be clear about your goals - Make sure that you
the RPG is being used therapeutically (as an have discussed with the client (and their
adjunct to traditional therapy). This helps you parents when applicable) what the goals of
identify the therapeutic focus of the game, and playing the game will be. You will be applying
also helps you decide what system to run or some creativity to how you insert the aspects of
what genre to use. You might be trying to use a the goals into the game, but the player should
fantasy setting with someone who really is into know what you will be using. An important
science fiction. You also want to make sure that example is, when treating aspects of emotional
you know the type of story the person wants to or sexual trauma, you need to have the
play. Some RPGs are very serious, some of them agreement of the player to use that sensitive
are very light and humorous. Also make sure, material in the game.
as with any form of treatment, that your client is
agreeable to using RPGs as adjunct therapy. Work with a partner - We recommend you use
Investment and involvement in treatment is one therapeutic games with a partner. One partner
of the strongest predictors of treatment efficacy. runs the game, while the other observes. This
This approach is something a person might allows the partner running the game to focus on
have very specific opinions about. The person creating an experience that is both fun and
might feel that a game is immature for them or therapeutic. That activity will usually require
they might not like being involved in a group.

30 WIZARDS, WARRIORS, & WELLNESS


The Therapeutic Application of Role-Playing Games
most of that partner’s attention, especially when be helpful. For other participants, asking after
they are new to role of gamemaster. the game allows the flow of the narrative to be
more immersive and give content for individual
The observing partner may participate in the session or reflection. Work with the client to
game, perhaps taking over the role of a determine what they consider to be most
character with whom the players’ characters beneficial. This also helps to increase
interact, or some other role that allows them to investment in the process.
be engaged while also paying attention to how
the players respond to the game. They can take Never, never, never forget the fun – As we have
notes or make observations about what occurs said, when intentionally using RPGs to obtain
in the game and in the players as the game therapeutic benefits, there is a real risk that
progresses. They can watch for a player having therapist will focus so much on the therapy that
a difficult emotional reaction to what is being they eliminate the fun. If the players are not
played out in the game. Again, this is having fun, they will not be invested in the
particularly important in the case of working game. If they are not invested in the game, they
with sensitive material. Your partner can also will become frustrated by the activity and they
act as an intermediary when a person feels are unlikely to receive any benefits.
uncomfortable. While the player might be In fact, it is better that the gaming session be fun
hesitant to speak up if aspects of the game for the player/patient than it is to be therapy-
become upsetting, an observant partner can focused. If you focus on the therapy to the
intervene on their behalf. And finally, if you are exclusion of fun, neither is likely to be achieved.
not as knowledgeable about the rules of the If you set aside therapy goals for a session and
game, your partner can help keep things going focus on the players having fun, they will still
when you need to look up a rule. gain the benefits inherent in having fun in a
social activity.
Make sure to connect the game to real life and
the goals of the client - A good clinician using So get out there and have fun!
this method will help show how the lessons
learned in the game can be used in the real
world. Showing a person how they learned
social skills that can be used in their day-to-day
is part of the process that helps maintain the
therapeutic quality of the game. If the player
needs to improve social skills, you can easily do
this in conversations within the game - talking
to a shopkeeper about a broken sword, trying to
get information from a reluctant bartender, etc.
These actions serve as a rehearsal for self-
advocacy and the appropriate expression of
anger and other emotions. After the game
session you should remind the player of those
in-game experiences, and point out that they
can take those same actions in their daily life.

One consideration you might want to make


before you establish the group is how invasive
you want therapeutic questions or reflections.
For some people, the more direct form of asking
how they feel about events in the game might
Draft 2/20/2019

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