Dungeons and Dragons at 50: how the role-playing game may soon be used as a form of therapy

By Dr Sören Henrich, lecturer in forensic psychology at Manchester Metropolitan University.

Originally published on The Conversation.

Dungeons and Dragons (D&D) is crossing a new frontier, as the game may soon be used as a form of psychological therapy. Over the last five years, I have researched possibilities for the game’s clinical implementation, as well as potential hurdles.

The therapeutic interest in the game only arose in the last five years, when D&D experienced a renaissance. Once a niche nerdy interest, it now has flourished into a multi-million dollar business, including a new movie franchise.

Several organisations used the rise in D&D’s popularity as the perfect opportunity to marry mental health with fun. This includes, for example, the US Critical Role Foundation, which supports creativity and empowerment in disenfranchised children. In the UK, youth group the Scouts encourage their members to learn skills of entertaining by facing fantasy adventures.

My colleagues and I reviewed the existing research and found it backed up the idea that playing D&D can have therapeutic benefits. Our own findings showed that the game increases confidence, helps people to express themselves and makes them feel connected. For children, the benefits are even more promising, increasing their empathy, creativity and strategic thinking.

Playing safely

So with all these benefits, why are some therapists so hesitant to use D&D in their sessions?

One reason is that the game still suffers from the hangover of its initial reputation. Released in 1974, there was something of a “Satanic panic” around the game, which was seen by some as a cradle of Satanic occultism.

The game’s aesthetic, including a 20-sided dice which looks like a pentagram and a so-called “dungeon master” who guides the collaborative storytelling of the players, likely added to those misconceptions. But psychologists who researched the personality types of D&D players in the 1990s with a view to interrogating their alleged criminal tendencies didn’t find a pattern of disturbed loners.

Despite this, some clinicians still view playing D&D as cause of mental health issues.

Another reason for the hesitancy is that there can be a real risk involved in using D&D in therapy with no proper plan in place. In cases of confronting previous, distressing experiences, role-playing can be an incredibly immersive tool. We know this based on the work of psychologists already using therapeutic role-playing that is not game-based.

For example, a therapist and client could imagine how it would feel to confront the client’s past abuser with the skills they have since learned. This can only be a safe way of reprocessing past events, if enough safety tools are in place. This includes the therapist’s thorough understanding of the issues, a realistic goal for improvement that is grounded in the client’s needs and a range of effective coping skills. Otherwise, the client’s issues might get worse, as they might feel unsafe, overwhelmed or unable to continue the therapy.

This mimics an increased awareness in the D&D community of trauma. It is not uncommon that players start their adventures with a so-called “session zero”. This is a meeting of the players where expectations and limits around the game are set, to ensure everyone feel safe at the table.

In the game, players are guided by the dungeon master who sets the scene, poses challenges and narrates the characters and scenarios the players meet. Players respond to this in character. This includes rolling the dice and adding bonuses from their character sheet. The higher the number, the more likely is it that they succeed, for example, talking themselves out of a sticky situations with a scheming merchant or landing the finishing blow against a creepy cave monster.

But even failures can be fun, propelling the story forward in unexpected ways. The player characters are working together as an adventuring party, offering resources, distracting enemies or any other combination of creative shenanigans to reach their goals. An adventure can take months if not years and usually only concludes if the “big bad evil guy” is defeated.

For now, the adventure is set by the dungeon master to appropriately challenge the characters, weaving their backstory into the plot for twists and turns. When a psychologist guides an adventuring party, these plot points could be motivated by the work they have done with their clients in the past.

The rule of thumb is that, while your character will feel unsafe during the adventure, as a player you should not. More research is needed to understand how this can be translated into safe and accessible guidance for professionals. But with a community that is comfortable having those candid conversations and already equipped with skills applicable to therapy, the conditions are ripe with potential for psychologists to use D&D in their interventions.

And the passion seems to be catching on amongst psychologists. Since our research in 2023, at least 16 theoretical guidelines have been published, drafting ideas or sharing anecdotes of good practice.

And more importantly, more research is being released showing successful implementation in the community and even in forensic services. I personally can’t wait for our clients to embrace their inner elves, sorcerers, or dungeon delvers and to start my therapy with: “You all meet in a tavern …”