Andrew Seng is a licensed therapist but his work bag looks a little different than most clinicians. In it, he has a monster manual, a “Non-Player Character” guide, a map – and most importantly – 14 sets of dice.
These supplies travel with Seng whenever he does therapy sessions. That’s because, twice a week, he meets with two different groups for structured, therapeutic sessions of Dungeons & Dragons. One group is for adults and the other is for 13 to 17-year-olds.
Dungeons & Dragons, or D&D, is a tabletop role-playing game where each player designs a unique character that navigates fantastical challenges. It’s been around for 50 years and has spawned countless TV shows and podcasts (including one on KOSU). But Seng says it can also be used for things like emotional regulation, personal development and symptom reduction.
“It kinda, like, hijacks the brain,” Seng said. “[Patients] are learning new skills without realizing that they’re learning new skills, through practical application in a fictional world.”
In session, Seng, along with his co-therapist, will create custom-made scenarios to fit the needs of the players. That way, patients can meet their demons – sometimes literally – and learn healthy coping skills.
For co-therapist Charlie Heitland, who works with Seng for the adult group, that’s what it’s all about.
“We don’t learn skills on the fly in stressful situations,” he said. “We learn them in calm, when we can practice safely.”
One of the patients Seng and Heitland work with during D&D sessions also comes to a separate grief group Heitland hosts. There, she’s struggling with the death of her grandparents. Heitland says she has never spoken of them negatively but he has always suspected a different kind of pain lying under the surface.
“And then we get to this D&D group,” Heitland said, “and Andrew creates this scenario where they’re all stuck in a room and they have to get out but enemies are coming in. Everyone’s coming in to kill them. The only way out is through.”
At the end of a session, Heitland said they always devote some time to processing what happened during the game. He asked the players if they had ever felt stuck with everything going wrong around them in real life.
“And this person immediately raises their hand and is like, ‘yes, sometimes my grandparents were like that,’” Heitland said. “And it’s like that was something she couldn’t say in grief group; couldn’t realize that was a difficult time in her life even though she love[d] her grandparents. But I think that realization helped her grieve and also helped her kind of contextualize that traumatic experience.”
He says it can be important to grieve someone as they actually were, not just as you wish they were.
According to researchers, the benefits of D&D aren’t exclusive to a therapy setting.
Orla Walsh is PhD student at University College Cork in Ireland. She was the lead researcher on a study about how playing D&D impacts mental health. Walsh interviewed players across three countries and conducted qualitative research. She found that many used the game to do something she called ‘exploration of self.’
“Almost every single person we spoke to had something in their life that they really wanted to explore or to talk about,” she said. “But they didn’t want to do it as themselves because they were too anxious or they were too worried about people’s reactions.”
One player designed her character to be extremely confident. Then, she emulated her D&D character in her new, mostly male workplace. Another player practiced coming out in a game before doing it for real.
Walsh’s research also suggests D&D helps players socialize and connect with others. D&D games create common experiences and require players to spend a lot of time together. A single ‘session’ usually takes about three hours to complete.
Lakin Wolever is the final member of Seng’s team and she helps run the D&D group for 13 to 17-year-olds. She said many of the young teens struggle to make friends or are bullied at school, but she has seen their social skills advance over the course of the D&D sessions.
“I saw great self-esteem build and that is probably my favorite part of doing it with kids – seeing their voice. A lot of these kids don’t have one, and that’s why a lot of them come to therapy because they don’t feel like they have control in their lives,” she said. “And when you put kids in a room that are all having the same struggles, I mean, you see them modeling each other and immediately their social skills are increasing.”
Wolever said her patients have started to talk to each other in the lobby before sessions start – something they didn’t have the confidence to do before.
Seng, Heitland and Wolever all said role playing games like Dungeons & Dragons naturally lend themselves to work well in a therapeutic setting. Seng also said D&D increases access to mental health care – it can be a good option for people who have different thought processes or otherwise might have been therapy-resistant.
Now, Seng is starting his own practice where he’ll continue to host D&D therapy sessions, along with individual talk therapy.
"This is therapy first," Seng said. "What do people need to work on? What do we need to develop? How are we going to assist in that? It is client development. It is the individual that matters."
