What is Dungeons and Dragons?
Dungeons and Dragons (D&D) is a tabletop role-playing game that has been around since 1974 and enjoyed by many. Essentially, D&D is a storytelling game where one person (the dungeon master) creates a story, and players create characters to navigate the fantasy world together.
The beauty of D&D is anything can happen; there is no single way for the story to unfold. Players have freedom to make their own choices, and those choices can completely change the trajectory of the story. One small decision can lead to the story in a completely different direction.
The game allows for imagination, consequence and exploration to take the lead, which is what makes this experience so engaging for players. Players aren’t just passively watching a story happen they are actively a part of creating it.
But D&D can offer more than entertainment. The collaborative nature of the game creates opportunities for connection, self-expression, problem-solving, and practicing skills in a supportive environment, which makes it the perfect environment for therapeutic change.
How does Dungeons and Dragons Become Therapeutic?
The therapeutic element of D&D is the implementation of experiential therapy. Experiential therapy is an action-oriented approach that allows clients to learn a variety of skills and gain insight through action rather than just talking about it.
Traditional therapy often involves talking about experiences, thoughts, emotions, and behaviours. While this can be incredibly valuable, some skills are easier to understand when we have the opportunity to actually practice them repeatedly.
Therapeutic D&D creates opportunities for this kind of practice within a fictional and supportive environment.
For example, imagine a player who experiences social anxiety. Rather than simply talking about communication or assertiveness, they might play a character who is confident, socially skilled, or in a position of leadership. During the game, they may have opportunities to initiate conversations, communicate their needs, set boundaries, collaborate with others, or make decisions under pressure.
This experience allows clients to see what it’s like to use these skills and how others may respond when they do. Not that your friend who crosses boundaries and a barbarian are going to react the same way to you saying “no, that doesn’t work for me”, but you get the picture.
The fictional nature of D&D can allow for a sense of safety and emotional distance. Someone may find it easier to navigate challenging experiences in real life if they already have experience with similar ones through their character.
These experiences can then be connected back to the individual’s real-world goals and experiences with the guidance of a trained therapeutic facilitator.
The Benefits of Therapeutic Dungeons and Dragons
On its own D&D can provide individuals with opportunities for community, connection and creativity. For many players, sitting around a table every week with a group of people can create meaningful friendships and a sense of belonging.
Research has also begun to explore the potential mental-health benefits of D&D. Walsh and Linehan (2024) examined D&D as both a form of social interaction and a potential therapeutic tool. Their research identified five themes related to the benefits participants experienced:
- Escapism: D&D can provide a temporary break from everyday stressors and challenges. Stepping into a fantasy world can give players an opportunity to relax, recharge, and experience something outside of their usual routines.
- Exploration of self: Playing a character can provide opportunities to experiment with different ways of approaching problems, navigating relationships, and responding to challenges. Players can practice skills and explore aspects of themselves in a fictional environment.
- Creative expression: D&D provides an outlet for imagination and creativity. Players contribute to the story, develop their characters, solve problems in unique ways, and have opportunities to contribute to the experiences of others.
- Social support: D&D creates opportunities to build community and maintain friendships. The game can provide a structured and supportive environment where people can connect with others through their character and as themselves.
- Routine: Regular gaming sessions can provide structure and consistency. Having a predictable time to meet with others and participate in a shared activity can create a sense of comfort.
When a therapeutic component is intentionally integrated into the game, D&D can become more than entertainment. It can create a space where individuals can connect while also practicing and developing social, emotional, and cognitive skills.
What Skills can D&D help develop?
Because D&D is inherently collaborative and problem-solving focused, it provides opportunities to practice a wide range of skills.
Depending on the goals/needs of the group and the way the game is facilitated, therapeutic D&D may support the development of:
- Collaboration: Working toward a shared goal with other people, negotiating different ideas, and contributing to a team.
- Empathy: Considering what another person or character may be feeling, thinking, or experiencing.
- Perspective-taking: Looking at a situation from another person’s point of view and considering alternative interpretations.
- Attunement to others: Noticing social cues, emotions, reactions, and changes in the group around you.
- Flexible thinking: Adapting to unexpected situations and considering multiple solutions to a problem.
- Executive functioning: Practicing planning, organization, working memory, impulse control, decision-making, and shifting between tasks.
- Safe failure tolerance: Learning that making a mistake does not have to mean the end of the story. In D&D, failure can become part of the adventure and an opportunity to try something different.
- Communication: Practicing expressing thoughts, asking for help, communicating needs, and listening to others.
- Social connection: Developing relationships and experiencing a sense of belonging within a consistent group.
One of the unique aspects of D&D is that many of these skills are naturally occurring as a part of the game. Players are focused on the adventure while getting an opportunity to learn these skills.
What Mental Health Presentations Might Therapeutic D&D Support?
Therapeutic D&D may be incorporated into work with individuals experiencing a variety of social, emotional, and cognitive challenges. Depending on the individual and their therapeutic goals, it may provide opportunities to practice skills related to:
- Social and Generalized Anxiety
- Depression and social isolation
- Low self-esteem and self-confidence
- Executive functioning challenges
- Communication difficulties
- Interpersonal challenges
- Building and maintaining social connections
It is important to recognize that therapeutic D&D is not a replacement for evidence-based mental-health treatment. Rather, it can be one approach that a qualified mental-health professional may incorporate into their therapeutic work.
The goal isn’t simply to play a game. The goal is to use the game intentionally to create opportunities for learning, connection, reflection, and skill development.
What Happens in a Therapeutic Dungeons and Dragons Session?
So, what does a therapeutic D&D session actually look like?
While every group and adventure is different, a therapeutic D&D session typically combines the familiar elements of a D&D game with intentional opportunities for therapeutic intervention. Sessions may be facilitated by one or two facilitators; one facilitator may even play a character.
A session may begin with a check in, giving players an opportunity to share how they are doing and identify anything they want to focus on. The group then moves into the adventure portion itself, where players interact, solve problems, navigate challenges, and make decisions together.
The Dungeon Master/therapeutic facilitator can intentionally create situations that encourage players to practice specific skills. A player might need to communicate with an NPC (Non-Player Character), work through a disagreement with another character, tolerate an unexpected change in the plan, or collaborate with the rest of the party to solve a problem.
Afterward, the facilitator may lead a debrief to support the processing of these new learnings.
Questions might include:
- What is something that stood out to you?
- What was challenging today in the game?
- What helped you navigate these challenges?
- What’s something you’re proud of yourself for from today’s session?
- What is something another player did that you appreciated?
Questions are tailored to support the exploration of the specific skills the facilitator has planned to focus on that session.
This process of experience, reflection, and practice is an important part of what makes therapeutic D&D different from simply playing D&D with friends.
The Power of D&D
D&D is about stories, and stories can give us a unique way to explore who we are and how we relate to others.
A character can make a mistake and keep going. A party can disagree and find a way forward. An unexpected obstacle can require players to think differently. Someone who is usually quiet may discover that their character has a voice they didn’t know they could use.
These moments can create meaningful opportunities for growth.
Therapeutic D&D brings together the creativity and connection of role-playing with intentional therapeutic support. It offers individuals a space to experiment, practice, make mistakes, connect with others, and discover new possibilities, all while being part of an adventure.
Island Clinical Counselling has D&D groups for youth and young adults. Stay tuned for a new group for youth in Duncan in November, 2026. Check us out and join today!
Written by Kaitlynn Fawkes
References
Walsh. O., & Linehan. C. (2024). Roll for Insight: Understanding How the Experience of Playing Dungeons & Dragons Impacts the Mental Health of an Average Player. International Journal of Role Playing, (15), 36-60. https://doi.org/10.33063/ijrp.vi15.321