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RPGs as therapy: How fictional worlds help vulnerable people explore real-life emotions

The support workers using roleplaying to manage trauma, addiction and loss.

Image credit: Rupert Greyling from The Goblin's Chest, taken by Steve Best

Much like the players that love them, tabletop roleplaying games come in a wide variety of shapes and sizes. Within these games players can explore what it feels to inhabit another character; for a short time living, thinking and feeling as their new persona. Tabletop RPGs are a rare opportunity to explore what it might feel like to be a teenager searching for their missing friend, a sword-wielding femme fatale duelling their lover or a squirrel doctor that knows which flowers cure gout.

Anyone who has played RPGs for a while has a story of that one character they remember vividly. A huge part of this sensation is the very real feelings many of us experience while we live inside these characters. No matter how silly and surreal these characters may be at first, it’s difficult not to feel a real connection with them. I know at least one person who has spent most of a therapy session unpacking the tragic death of their half-elf ranger Horseshoes Dingleberry. (That person was me.)

Tabletop RPGs have a certain quality that appeals to many of us in a way that is hard to put into words. They can be joyful, silly, tragic and sincere. Some might call it je ne sais quoi or the even more embarrassing “Power of Imagination” but some have a more serious word for it: therapeutic.

Content warning: This article touches on discussions of grief, homelessness, addiction and trauma. External links may also contain similar content.

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As a support worker that sometimes dabbles in board games I don’t often fit in at industry networking events. Dozens of times someone has excitedly explained their upcoming Kickstarter to me, only for me to respond with the joy-killing reveal of my day job. “So what’s it like working with victims of human trafficking?” they might ask, desperately hoping I don’t actually tell them. But at a recent opening for an indie RPG press in South London I met another person with the same telltale tired eyes and well-worn lanyard.

Across the UK a network of support workers are joining together to highlight the power of tabletop roleplaying. Working with everyone from prisoners to people affected by homelessness, these specialists are using RPGs as a new tool for exploring a host of themes with those they work with.

Dr Gary Colman is one of them, a clinical practitioner with a long history with RPGs. “I’ve been playing since the late 1970s,” he says (though he doesn’t look it). “I was aware that in the US there was a lot of work being done on therapeutic gaming. […] I work one day a week as a GP providing end-of-life care to homeless people in London and initially I was curious if any studies had been done with this group”.

Using roleplaying in a therapeutic setting builds upon decades of research highlighting the benefits of drama therapy. | Image credit: Steve Best/Game Therapy

As Dr Colman began to explore using RPGs with his clients, he found that others in similar fields had also begun to discover the therapeutic benefits. People working within mental health, in prisons and with people with educational needs across the country were already using roleplay as an informal therapy practice.

Driven by the passion of those running the groups, the first acts of therapeutic gaming were informal: done without any set structures, outcomes or methodology behind them. “Research into game therapy has been done before, but not on any scale in the UK,” says Dr Colman. From discovering the work others were doing, he set out to improve the standard of these games and create a support network to help RPGs become a real tool for practitioners. That group, Game Therapy, now works to promote roleplaying as a valuable tool for clinical practitioners.

It was easier to get them together to talk about how a fictional character might feel than to get them to talk about their feelings around other boys.

Providing vulnerable people the space to have fun is a worthy cause in itself, but Game Therapy has found that a science-based approach can help create a method with real tangible impact. “There are decades of science demonstrating the evidence of drama therapy in managing psychological trauma,” explains Dr Colman. After realising the similarities between roleplay and drama exercises, Colman and some friends began to build RPG sessions which were informed by the work that had come before them.

The project currently runs a regular group with survivors of modern-day slavery and people experiencing homelessness and/or addiction, and are working on a pilot for military veterans. Through looking at gaming as a tool for recovery, the project has outlined two different approaches: “therapeutic gaming”, the sort of engaging and enlightening game that anyone can experience in a normal setting, and “game therapy” - a more formalised game run by a clinician or psychologist with specific outcomes in mind. Both methods have their benefits, and both can be introduced into an informal and play-focused environment without players feeling alienated by the idea that they are being tricked into therapy.

“We are gathering data on the benefits of the projects and will be publishing the research,” Dr Colman states. But the real impact of the group’s work can be easily understood by the words of those they’ve worked with. “I enjoyed playing someone different; playing a brave character instead of just running away,” said one player who had played D&D as part of their recovery from addiction and homelessness. “I can see how playing different people and facing challenges could help me to become more confident.”

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Though Game Therapy is at the bleeding edge of this new approach, the team aren’t alone in their aims. While the data (and money) to support these games is slow to materialise, the passions of many game masters means that RPGs are becoming an increasingly common phenomena across different fields.

“Prisons were a perfect place for RPGs,” says G, a former support worker with youth prisoners. “Many of the boys I worked with had never done anything like that.” After a few weeks, their once-a-week roleplaying campaign had grown to a chaotic eight players. They discovered, entirely by accident, that it was one of the best ways to get the teenagers to open up in any way. “It was easier to get them together to talk about how a fictional character might feel than to get them to talk about their feelings around other boys.”

With every GM I spoke to for this piece, the same thing came up again and again: RPGs provide a safe space to explore feelings. It is difficult for many vulnerable people to connect with their emotions - trauma, mental health, cultures of shame or simply a lack of space can all contribute towards marginalised people being “closed-off” - while a mountain of evidence shows that connecting with feelings can support better recovery and development in all kinds of issues.

Becoming a different character for a few hours can help players express their emotions more openly. | Image credit: Steve Best/Game Therapy

When drama therapy was first explored in the 1920s it provided a rare space for marginalised people to access their feelings. It didn’t immediately demand deep exploration or empathy, but built these skills over time. Through slow but steady sessions, people of various backgrounds could begin to understand their feelings, express themselves better and process difficult emotions together. In a similar way today many GMs are discovering that their games provide the same opportunities to grow these important skills.

“It didn’t feel weird at all to hold a eulogy for a fictional wizard,” says Julia, a palliative care worker who also runs a support group for people who have lost partners. “It felt completely natural in the moment.” Julia never set out to use RPGs in her work but, like many others, stumbled into its potential by accident. When she set up a game for some coworkers and friends she soon saw how effective it could be.

Over the course of a few sessions each character grew from the generic tropes they had put little thought into during the first session. “My character was, I think, a sort of tribute to my partner,” says Dan, one of Julia’s players. “He had all the attributes I loved in [my partner]. He was calm and level-headed. He never rushed into a decision.” Dan’s partner passed away in 2019. He eventually returned to the group after a few months away for one last game. “It was like saying goodbye to him again,” says Dan. “I went home and cried all night. I think it helped me to understand what [my partner] might have felt like before he died. […] It was like closure”.

My character was a sort of tribute to my partner. It was like saying goodbye to him again. It was like closure.

The reason so many of us feel such a strong emotional connection to our characters is because those emotions are very real. The laughter experienced is real, the tension felt is real, the sadness felt is real. In these fictional worlds very real emotions emerge - in some cases they inspire people to grow in their own emotions too.

The future of RPGs is an exciting prospect for many players, but in some corners of the world passionate and dedicated people are building spaces that do so much more than just entertain. People like Julia, G and Dr Colman are taking the very best the hobby can offer and working towards something spectacular and healing.

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