Facing the demons: can Dungeons & Dragons therapy heal real-life trauma?
I am Goldie, a druid with long white hair and the half-human, half-horse body of a centaur. I walk into a lush, green forest with my constant companion, a goat named Penny. As we tread down a winding pathway, we start to smell the rotting stench of decay. Then we see it: the corpses of other animals, decayed beyond belief, spores poking from their bodies. There are mushrooms everywhere.
It’s a little after 9pm and I’m sitting at my kitchen table in Brooklyn, Zooming into to a fantastical journey led by Megan A Connell, a licensed psychologist who uses Dungeons & Dragons during therapy groups. She’s leading me through a round of the popular tabletop game to help me notice patterns of behavior.
We journey onwards. A little red structure appears, she tells me. I walk to the window and peer in, just enough to get a glimpse of who is inside while staying covert about it. I see an angry monster pacing back and forth. His face looks melted. He’s made up entirely of mushrooms that appear to be spiking straight out from his chest. She asks: do I want to approach him? No, I definitely want to run away from the crazed mushroom man. I turn on my heels, and gallop directly in the other direction.
Dungeons & Dragons has long been a haven for outsiders, and its evangelists say the game helps them build a community and let their imaginations roam. Since its creation in 1974, D&D’s reach has expanded far beyond basement gatherings and high school lunch period meet-ups. There are now over 13 million active players worldwide, thanks in part to its inclusion in the plot of Netflix’s Stranger Things and a pandemic-era boom in remote playing. A forthcoming action comedy, Dungeons & Dragons: Honor Among Thieves, starring Chris Pine, will lure more fans into the franchise.
D&D diehards might tell you that no Hollywood blockbuster can compare with the theater of the mind, which is where the game thrives. Using only dice and a rough roadmap of how the game will go, players sit around a tabletop and dream up scenarios for their characters, relaying them through storytelling. You may steal treasure, kill goblins, or cast wicked spells. As players often say, the only limitation is your own imagination. According to Connell, this makes D&D an ideal conduit for therapy.
During our session, Connell tells me that I have a sense of curiosity that can lead me to danger – but enough self-preservation to know when to back away. (Any similarity between my game and a certain HBO mega-hit series featuring killer fungi is purely coincidental. After we play, I remind Connell that bacteria-carrying mushrooms are also the villains in The Last of Us – she had forgotten.)
According to practitioners, D&D can be used to treat everything from exploring gender – you can take on a character whose identity is completely foreign from yours – to recovering from traumatic events. “Trauma disconnects us from ourselves, and one of the first things we get disconnected from is our imagination and creativity,” Cassie Walker, a clinical social worker, told Wired last year. Roleplaying has the potential to lighten up therapy sessions, and invigorate clients whose expressiveness may have been dulled by past events.
Today, Connell is especially interested in working with young women and girls to use the game to build self-esteem and assertiveness through play. “It’s a great place to practice skills and step into those aspirational traits to be the person you want,” she said..”
Connell first encountered the game as a child growing up in rural Maine. Her middle school friends mostly appreciated the chance to escape into their characters.
“I have to put air quotes around this: we ‘played’ D&D,” Connell said. “I think we only ever played like two games. For us, it was a lot about making the characters. We talked about how cool they were, and all the adventures they got to go on.”
After a long hiatus from roleplaying games – Connell tried becoming a musician, then switched to music therapy, ending up as an army psychologist treating soldiers with PTSD in Iraq and Fort Eustis, Virginia – Connell fell back into a regular D&D game night with her family.
“Psychologists are historically bad at taking care of themselves, since we work on taking care of everyone around us,” she said. “D&D was a game where I could unplug my brain and have fun. It recharged me, and I found it therapeutic.”
Related: ‘Why can’t anyone make a decision?’ My first time as a D&D Dungeon Master
Connell began listening to a D&D podcast that featured an interview with Raffael Boccamazzo, a Seattle-based psychologist, who used the game to teach social skills to children on the autism spectrum.
She learned that therapeutic D&D was a burgeoning field. The practice Game to Grow, also based in Seattle, was founded in 2017 and now serves 150 clients. Another company, Geek Therapeutics, teaches therapists how to use the game in their work, and has a growing rolodex of “therapeutic game masters” based around the country.
But Connell says there is not enough clinical research to back up what she sees in her practice. She’s about to release a book, Tabletop Role-Playing Therapy: A Guide for the Clinician Game Master, which is full of disclaimers. “It’s ridiculous how much I had to say, ‘We don’t have research on this, and we don’t know exactly what’s going on,’” she said. During her book research, Connell found that there were a few case studies and pilot programs using tabletop therapy to teach social skills in the early 1980s, and the findings seemed “promising”. But then the research just dropped off. Connell believes this was because Satanic panic almost killed D&D, as concerned parents and law enforcement tried to stamp out anything that seemed remotely connected to the occult.
In 1979, a D&D prodigy and college student named James Dallas Egbert III went missing and was later found dead. Detectives ominously theorized that the game made him experience delusions that led to suicide. Mazes and Monsters, a subsequent made-for-television movie loosely based on the case, starred a very young and rather cherubic Tom Hanks. 60 Minutes aired a segment on a supposed rash of violence blamed on D&D, and a parent of a fan who had killed himself unsuccessfully sued its creators.
After that moral panic, studies into its effectiveness were shelved. Researchers only returned to studying therapeutic gaming in the 2000s.
More foundational studies are required to track exactly how D&D helps patients. But Connell says she’s seen it work. “I’ve had several players talk to me about how getting to roleplay saying no helps them do it in real life,” she said. “It can be really powerful learning how to stand up for yourself and have boundaries, and doing it in the game can really help translate a lived experience.”
Before we begin our session, Connell asks me if I have any phobias that I don’t want to show up in the game – if I’m afraid of spiders, for instance, she won’t make the main villain a giant tarantula. I say I’m game for anything except mice or rats, as I’m currently dealing with an infestation in my kitchen … which is also where I’m Zooming into our meeting from.
But Connell does want to see how my character, Goldie, will interact with something she’s afraid of – hence the murderous mushroom man I came upon in the forest. “If your character confronts something, and you’re able to talk about it later, you can learn what helped your character through a panic attack, and brainstorm how to help yourself later when you’re experiencing anxiety,” Connell explained.
After I decide Goldie wants to make a run for it, Connell asks me to roll the 20-sided dice. She’s making a “survival check” for my character – and luckily, I’m able to find a path out of the dark woods. I get away from the fungi contagion and come upon a clear stream that leads to a small hamlet. What does my character want now? Food, I reply, and I head into the town center toward a communal oven.
There, I encounter a halfling – a Tolkien-esque hobbit with pointed ears, often a sign of good luck. Using an accent that wouldn’t sound out of place in a community theater production of The Banshees of Inisherin, Connell plays out our conversation. The halfling has heard of the mushroom blight a few miles south. He offers me a paltry amount of food and some silver pieces to lead a search party back down to the mushroom man’s hideout. Will I go? Absolutely not. Goldie wants to stay in the town and rest for a while.
We played a short game, and I didn’t have any psychological breakthrough, but I imagine regular players might find the process therapeutic.
It felt slightly ridiculous to picture myself – er, my character – traipsing through a forest wearing what I basically imagined to be a Daenerys Targaryen costume from Spirit Halloween. But there was something relaxing about adopting a character. It was a low-stakes way to test out behavior that the real me didn’t have to commit to trying. I think about how Connell uses D&D to teach young women and girls social skills and boundary-setting. I can see how that might work.