Therapeutic tabletop role-play gaming

Domain VIII · Creative & expressive arts therapies · Adam Johns, Adam Davis · 2017 · Seattle

What it is

Therapeutic tabletop role-play gaming is a family of approaches, not one manualised therapy: a clinician runs a structured tabletop role-playing game (TTRPG, e.g. Dungeons & Dragons 5th Edition) for a small group, with the game master (GM) acting as therapist and the story built to give players…

Format

• Kilmer et al. (2023) organise the Game to Grow method around a transtheoretical approach, choice of game system, population considerations, case conceptualisation and treatment planning, group development and therapeutic factors, session design, facilitation strategies, the qualities of the…
• Goals: suitability, individual goals, risk, readiness for group, and any topics that must be excluded.

Who practises it, and how they are trained or regulated

• Professional frame. There is no regulated profession or protected title of "therapeutic game master"; Game to Grow has run training courses (current availability). The method is a clinical application only when delivered by a clinician licensed or registered in their own discipline (e.g. psychotherapist, counsellor, psychologist, social worker; drama therapists via NADTA RDT in the US or HCPC registration with BADth…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• shaming; keep feedback on choices, not people.
• players who always show green; check them individually at the break.
• rules arguments taking over sessions; a setting tone that clashes with a group's lines.
• one dominant player, cliques formed outside the group, and pairs with a history of conflict.
• goals so abstract they cannot be seen in play; players who feel watched rather than supported.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.