Social Work with Groups

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wswg20

Table-top role-playing games as a therapeutic

intervention with adults to increase social
connectedness

Matthew S. Abbott, Kimberly A. Stauss & Allen F. Burnett

To cite this article: Matthew S. Abbott, Kimberly A. Stauss & Allen F. Burnett (2022) Table-top
role-playing games as a therapeutic intervention with adults to increase social connectedness,
Social Work with Groups, 45:1, 16-31, DOI: 10.1080/01609513.2021.1932014

To link to this article: https://doi.org/10.1080/01609513.2021.1932014

Published online: 21 Jun 2021.

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SOCIAL WORK WITH GROUPS
2022, VOL. 45, NO. 1, 16–31
https://doi.org/10.1080/01609513.2021.1932014

Table-top role-playing games as a therapeutic intervention

with adults to increase social connectedness
a
Matthew S. Abbott , Kimberly A. Staussb, and Allen F. Burnettc
a
Abbott Counseling, LLC, Denver, Colorado, USA; bSchool of Social Work, University of Arkansas,
Fayetteville, Arkansas, USA; cSchool of Arkansas School of Social Work, University of Arkansas,
Fayetteville, Arkansas, USA

ABSTRACT ARTICLE HISTORY

Research shows that social connectedness is decreasing and Received 19 February 2021
loneliness increasing in the United States, subsequently result­ Revised 12 May 2021
ing in a health crisis due to the anxiety and depression these Accepted 15 May 2021
attributes can cause. There is evidence that clinicians have KEYWORDS
difficulty treating individuals experiencing social anxiety and social anxiety; loneliness;
there is need for intervention strategies that lower treatment role playing games;
barriers. There has been scant research recognizing the use of dungeons and dragons;
table-top role-playing games to incorporate when treating table-top games
social anxiety. The current manuscript describes a year-long
group using Dungeons and Dragons in a therapeutic setting
and explores perceptions from participants who experienced
this group. Core concepts of the model and lessons learned
from the developers are described for clinicians who hope to
incorporate such a model. Participants described increased con­
fidence in social situations, particularly with boundaries or mak­
ing mistakes. Secondly, the skills practiced in the game were
transferred into real-world experiences. Implications for future
research and limitations were described.

Within the United States, an estimated 15 million Americans are affected by social
anxiety disorder (Ruscio et al., 2008). Additionally, over a third of adults over the
age of 45 report feeling lonely, with growing evidence recording decreased face to
face interactions and increased loneliness and depression (Anderson & Rainie,
2018). Particularly during COVID-19, the rise in loneliness is a concern (Killgore,
Cloonan, Taylor, & Dailey, 2020). Moreover, Holt-Lunstad (2017) describe the
effects of loneliness within the United States as a public health crisis, highlighting
how social connections result in lower mortality rates.
Despite the increase in loneliness and social anxiety, more than 80% of those
with social anxiety disorder do not receive treatment (Anderson et al., 2015).
Practitioners who work with individuals who suffer from social anxiety have
sought to lower barriers to treatment through the use of online platforms such
as telehealth therapy (Gershkovich et al., 2017). Despite the currently available

CONTACT Matthew S. Abbott [email protected] Abbott Counseling, LLC, 2238 S. Broadway,

Denver CO 80210,
© 2021 Taylor & Francis Group, LLC
 SOCIAL WORK WITH GROUPS 17

treatment options, research suggests the need for more interventions to increase
social connectedness and address social anxiety.
Since research has shown that those with social anxiety are hesitant to engage in
treatment, two social workers developed and implemented an intervention using
a table-top role-playing game, Dungeons & Dragons (D&D). While exploring the
literature, the developers found minimal examples regarding the use of D&D in
the therapeutic setting, but what did emerge was a connection to working with
adults that experience social anxiety. Moreover, there was little to no research
completed within the group psychotherapy literature regarding the use of D&D
within a group therapy setting. The developers recognized the limited research on
models using this method, so they began collaborating on the implementation of
this technique in a group setting with seven adults experiencing social anxiety. The
developers believed that using a game that requires teamwork and collaboration,
along with role-playing, could serve as an effective group intervention to address
social anxiety and loneliness. Additionally, utilizing a well-known role-playing
game can encourage those suffering from social anxiety or isolation to engage in
treatment if presented with a seemingly less intimidating therapeutic method. This
manuscript describes the minimal research in this area, the role-playing invention
strategy implemented, the lessons learned documented throughout the process,
and results from qualitative interviews to explore the impact of this practice
model.

Literature review
Table-top role-playing games

Daniel MacKay (2001, pp. 4–5) defines a role-playing game as “an episodic and
participatory story-creation system that includes a set of quantified rules that assist
a group of players and a gamemaster in determining how their fictional characters’
spontaneous interactions are resolved”. A group of players comes together to
create a story. One of the players acts as a gamemaster who arbitrates rules and
decisions as well as provides narrative elements to which the players respond.
D&D was the first commercially available table-top role-playing game created
(Peterson, 2012), and it is also the most popular of such games.
The structure described above corresponds to Elkonin’s (2005) hypothesis that
taking on a role and enacting relationships is the basic unit of play. However,
unlike childhood play, there is a formal rule structure to guide the actions that
players are performing. The group cooperates to create the narrative of the game,
and creative problem-solving is encouraged. An advantage to this type of game are
the bonds formed amongst players.
18 M. S. ABBOTT ET AL.

Table-top role-playing games as therapy

Moreno and Jennings (1934) initiated the idea of playing roles within
a therapeutic context and labeled this psychodrama. Moreno is also one of the
pioneers of the concept of group psychotherapy (Bromberg & Moreno, 1957).
Nickerson and O’Laughtlin (1980) explored the use of games and game theory in
therapy for children and adolescents. After these approaches, Zayas and Lewis
(1986) used D&D with a group of boys, ages eight and nine, from different
backgrounds in a neighborhood center setting to foster social skills development.
The researchers found that D&D validated group cohesion, rehearsal of group-
problem solving skills, and enhanced individual self-esteem through support from
group members. Later, Blackmon (1994) used D&D with a patient diagnosed with
a schizoid personality disorder. This patient found the structured fantasy provided
by D&D to express his inner self in a guided and safe manner.
More recently, Rosselet and Stauffer (2013) observed that table-top role-playing
games used in conjunction with Adlerian play therapy facilitated social develop­
ment in gifted children and adolescents. Also, there were higher self-reported
levels of empathy in those who participated in fantasy role-playing games (Rivers
et al., 2016). Rivers et al. (2016) hypothesized that these games train and encourage
empathy-related skills such as perspective-taking. Lastly, Gutierrez (2017) sur­
veyed practitioners who were implementing table-top role-playing games in their
practice. The practitioners conveyed that table-top role-playing games applied to
clients of all ages were a useful form of exposure therapy, could be used in group
settings, and allowed for tailoring the narrative to fit the client.

Examples of similar practice in group social work

There is a healthy synergy between psychodrama and group therapeutic
interventions, which allows both practices to enhance each other (Skolnik,
2018). The structured approach to psychodrama provided by tabletop role-
playing games and the group dynamic helps realize these benefits. Walsh et al.
(1991) found that applying structured fantasy to group interventions allowed
for more engagement for children who were reluctant to engage in the
therapeutic process. Reynolds (2011) found that improvisation and expression
with a leader’s guidance allowed for rich group interventions. While Reynolds
referred to drama therapy with children, this approach can be modeled using
tabletop role-playing games. Finally, Zayas and Lewis (1986) used Dungeons
and Dragons in a social work group setting with diverse adolescents and found
that it developed group cohesion and mutual support.
 SOCIAL WORK WITH GROUPS 19

Gaps in literature

While some of the studies hypothesized or used interviews to explore the use
of these types of therapies with adults, there is minimal research using table-
top role-playing games with adults as a therapeutic intervention. Besides, while
studies report that social skills interventions are beneficial for clients who
experience social anxiety or social isolation, the research is lacking in explor­
ing the use of table-top role-playing games to address these issues.

Theoretical underpinnings
Pro-social theory

Prosocial theory highlights the potential of table-top role-playing games to

increase social efficacy and address social anxiety and isolation. Prosocial
behavior is a broad concept within the field of psychology. The concept of
prosocial behaviors has shifted and changed over time but is generally under­
stood as voluntary behavior intended to benefit another (Schroeder et al.,
1995). Utilizing D&D in a group setting requires a certain level of reciprocity,
and Dovidio (1984) posits that reciprocity can help individuals maintain their
positive self-image or achieve their goals. Additionally, prosocial behaviors can
impact an individual’s ability to empathize (Dovido & Banfield, 2015).
Moreover, these researchers assert that socialization influences the range of
empathy a person can experience for others. This assertion aligns with Rivers’
discovery of higher levels of empathy reported when using fantasy role-playing
games (Rivers et al., 2016).

Role play theory

Role-Play Theory is a functional lens to understand the impact of role-playing

games in a therapeutic setting. Role-play as a term has varied over time and
received other labels such as psychodrama and sociodramatic play (Moreno &
Jennings, 1934). Role-Play Theory has primarily been understood through the
study of how play influences child development. The developers utilize
a broader scope of Role-Play Theory to understand the impact for adults
using a table-top role-playing game. Specifically, Role-Play Theory helps
explain how TTRPGs can increase social skills (Adams, 2013). Additionally,
role-play can act as imaginary exposure to certain social situations to allow
participants to practice problem-solving and increase social confidence
(Bowman, 2007; Gutierrez, 2017).
20 M. S. ABBOTT ET AL.

Conceptual model: using table-top role-playing games as a therapeutic

intervention

Initially, the program developers shared an interest in D&D and began to discuss
possible positive therapeutic benefits of using this intervention within a group
therapy setting. The developers wanted to create a group using D&D to help
clients who struggle with social anxiety, isolation, and difficulty interacting with
peers. Additionally, the developers wanted to utilize TRPGs with this clientele due
to an increasing portion of the U.S. population experiencing social anxiety and
loneliness (Holt-Lunstad, 2017). As seen above, research suggests that role-playing
groups can increase one’s perceived social connectedness (Gutierrez, 2017;
Hawkes-Robinson, 2008; Kōhei, 2019). Very little literature was found related to
using D&D within a therapeutic group setting, particularly for adults who experi­
ence social anxiety or isolation. As a result, the developers gathered the limited
collection of literature related to role-playing within a group settings and devel­
oped the Role-Playing Skills Group (RPSG).

Group model

The primary purpose of the RPSG was to create a less intimidating group
therapy environment to decrease social anxiety and isolation while increasing
interpersonal effectiveness for participants. The developers sought to recruit
participants whose primary diagnosis was social anxiety, and presented with
difficulty with interpersonal interactions, depression, and perceived them­
selves as feeling socially isolated. Additionally, the developers wanted to
engage participants who had been hesitant to join a “typical” group therapy
setting in the past. From the developer’s perspective, a “typical” group therapy
setting included a group of individuals that regularly met with the expectation
of sharing their struggles and concerns. In contrast, the developers wanted to
create a model that did not communicate the expectation or need for an
expression of personal challenges or issues.
The group consisted of 7 participants, initially with more women repre­
sented, and the age range was between 18–45. Moreover, the participant’s
mental health history and life experiences were diverse, with members parti­
cularly expressing a history of trauma, anxiety, and depression. Most of the
participants reported no previous experience with table-top role-playing
games. Throughout the first year, the 7 participants consistently came and
were engaged in the group.

Group structure and sessions

The structure of the group included weekly 90-minute meetings. During the initial
group, the facilitators gave a brief introduction of D&D, and reviewed the group’s
 SOCIAL WORK WITH GROUPS 21

norms and expectations. In the first group, some members shared their motiva­
tion or goals for starting the group. Responses included perceived negative
experiences in previous group settings and an interest in finding a group to feel
more comfortable. After the participants reviewed the norms, expectations and
asked questions, the individuals in the group started to work on their characters.
To play D&D, each participant must develop their character for role-play.
Their character does not have to reflect how individuals perceive themselves
but can be any type of character they want to create. Some participants’
characters were inspired by an individual’s favorite story, movie, or book,
and some reflected aspects of themselves or what they aspired to be. The first
2–3 sessions were less structured as group participants focused on the creation
of their characters, asked questions, built rapport, and engaged in giving and
gaining feedback about each participant’s character. During the character
creation process, some members were able to share reasons for developing
their character in a certain way. For instance, some wanted their character to
display specific personality traits and quirks. It was crucial for some partici­
pants that their character had experienced a painful or traumatic past that
shaped the character. According to some participants, these events and char­
acteristics were like their own. The character creation process is an integral
part of the role-play experience. Even though it was not expected, some
members chose to introduce their character and backstory to the group.
Some members did not but revealed aspects of their character over time.
The facilitators intentionally set aside 2–3 sessions to create characters because
as mentioned above, this stage is essential, and enough time must be invested.
Following the rapport and character-building stage, the group followed
a semi-structured format of initial check-ins and engaging in role-playing of
the established group objectives. Group members may have formally estab­
lished these objectives, or the objectives may have unfolded as the session
continued. Ultimately, the group exercised their self-determination during
role-play to articulate and act on objectives toward a potential goal in the
story. Additionally, a debrief of the session occurred during the last 10–
15 minutes of each session.

Table 1. Recommendations and resources.

Recommendations Resources
● Previous knowledge and experience playing role- ● Attend conference: Save Against Fear-https://www.
playing games thebodhanagroup.org/about-the-convention
● Exploring similar role-playing games that may be ● Jack Berkenstock Jr. and Baron Blakley (2019)
applied in a therapeutic group setting Wizards, Warriors, and Wellness: The Therapeutic
Application of Role Playing Games.
● Consult with clinicians that have implemented ● Attend TTRPG training: https://courses.geektherapy
group therapy strategies using table-top role- training.com/and http://new.rpgtherapy.com/work
playing games shops/summary-list-of-workshops
● Joining a local gathering to participate in D&D to ● Facebook Group RPGrow – Applied Table-top
gain knowledge, familiarity, and gauge interest for Discussion Forum.
applying in a future therapy group.
22 M. S. ABBOTT ET AL.

Throughout the year, the facilitators created a setting for the group, includ­
ing fictional cities, continents, history, and maps. Online resources and guide­
books were also incorporated to help create this fictional setting (see Table 1
for these examples). One of the facilitators was the “dungeon master” (DM)
and guided the game and narrated aspects of the story. The DM explained to
the group what their characters see and hear. The game world was not under
the control of the group members. Before beginning the storyline, the facil­
itators acknowledged that role-playing could feel uncomfortable and unna­
tural, especially to participants who had never engaged in a role-playing game
before. The members had control over the decisions of their character, but the
DM narrated the outcome in conjunction with the player’s dice rolls.
To participate in D&D effectively, each member used a set of at least seven
dice. The dice ranged between a four-sided dice up to a twenty-sided dice. The
dice determines the outcome of a player’s action. For example, if a player decided
to attack a monster within the game, the player would roll the twenty-sided die,
and if their rolls were high enough based upon the difficulty of the particular
encounter, their character would succeed with their attack. Each participant was
free to make any choice they believed their character would choose within the
established world. For this group, members decided to engage in a storyline that
included being hired by a local university professor to investigate issues with
a city’s trade roads that are constantly being robbed. The DM also presented
“hooks” for storylines in which the players could choose to participate. An
example of a hook used for this group included the characters participating in
the city’s local tournament games during an annual festival. This added hook
provided more opportunities to facilitate team challenges that involved all group
members, and different scenarios for team members to use their unique char­
acteristics. such as strength, intelligence, stealth, and weaponry. For example,
one member had a unique ability to speak with animals and during
a competition that involved wrangling animals she was able to display her
skill. This participant noted that it was exciting and empowering to use
a unique skill that she admired within her character to support the group.
The developers created the storyline presented above. As suggested earlier,
there were options to use and follow official guidebooks or purchase storylines.
These internet options come with predetermined maps, cities, non-player char­
acters, and adventures. The developers utilized these online resources to inform
and develop the presented encounters and non-player characters, but the story­
line was developed independently. The developers also created a unique story­
line for familiarity during sessions and to allow for small encounters for the
group that would include all members. Including all the members in these
activities also allowed for collective collaboration and was perceived to increase
the connection to one another. Furthermore, the developers employed their own
experiences in playing the game to expand the scenarios.
 SOCIAL WORK WITH GROUPS 23

This creative process is typical for individuals acting as the DM while playing
D&D. For each group session, there was an element of unpredictability as group
members role-play and interact with aspects of the storyline. As a result of this
collaboration, the storyline can go in many directions. Additionally, group
members can spend extra time interacting with certain characters or settings
longer than expected. For example, within this group, the DM planned an
encounter to solve a mystery. It was expected to take about half of the session,
but instead, it lasted two entire group sessions. Over the year, the group
completed the initial task of solving the trade route conflict. The group traveled
out of the city, through deserts and mountains. The group also encountered
hostile creatures along the way, working as a team to defend themselves. While
in the mountains, they uncovered a group of kobolds (small humanoids that
appear like little dragons) who were robbing travelers and traders. The group
defeated defined enemies and dealt with the conflict. After the group completed
the initial task of solving the trade war issue, they stumbled upon a new mission
of helping a trapped underground civilization of orcs and humans escape the
mountains. Following this adventure, the group’s last formal engagement was
competing in a festival of talents, fighting, and games to win treasure.

Methodology
Since minimal research has been completed using D&D as a specific thera­
peutic intervention, an exploratory, qualitative methodology was most appro­
priate for exploring the lessons learned on this new practice model. The
information obtained comes from ongoing notes used during the development
and implementation of the D&D group and semi-structured, qualitative inter­
views from three participants. The journal notes and discussions were com­
pleted by the two developers throughout the year-long pilot program, which
documented program activity and reflection comments on the group process.
Secondly, two researchers not affiliated with the implementation and devel­
opment of the D&D group, completed qualitative interviews to measure the
successes and impact of this model.

Data collection and analysis

All of the participants agreed to participate in the interview process but only
three participants were interviewed from the original seven members. The
two researchers were not able to connect with some of the group partici­
pants due to the contact information not being adequate or the participant
moved. The interviews were governed by a guide and focused on the
participants’ perceptions of the: 1) reasons for attending the group, and 2)
the impact of the group. See Figure 1 for the questionnaire. A content
analysis (Lincoln & Guba, 1985) was completed on each transcript to
24 M. S. ABBOTT ET AL.

Questions for Semi-Structured Interviews

1. How old are you now?

2. How long have you been attending this group?

3. Do you come pretty consistently?

4. Can you tell me why you first began attending the group?

5. Can you describe if the group has impacted you? If so, how? Has that impact continued? If so,
how?

6. If so, can you describe some specific experience or memory you have of the group that you
believe was helpful?

7. Can you give me specific examples of how you have reacted or responded to a circumstance in
your life in a different way because of what you have learned in the group?

8. Is there anything you would like to change about the group process? How can the group be
enhanced to achieve its goals?

9. What might you say to someone that is thinking about going to this group, but is still unsure?

Figure 1. Questions for semi-structured interviews.

identify emerging themes. Each researcher independently completed the

initial analysis. This involved an open coding process identifying major
themes and subthemes by noticing reoccurring words, or ideas. These
were then highlighted or underlined and subsequently, the two researchers
discussed and collapsed these themes. This collaboration on theme develop­
ment is helpful in a crystallization process because the themes are viewed
from different perspectives and enhances the credibility of findings
(Janesick, 2000). The transcript themes were then reflected on in combina­
tion with the program notes taken over the year. The analysis method used
allowed the research team to develop more nuanced details of lessons
learned during this pilot group process. In summary, validity and trust­
worthiness were enhanced by using independent coders, an audit trail, and
a research team. The research process was approved by the University’s
Institutional Review Board.

Lessons learned: the process

Throughout the year, many lessons were learned while facilitating this group.
These lessons can be utilized by others who are hoping to present such
a group. First, the authors of this manuscript believe it was helpful to have
two facilitators for a similar group. This co-facilitation allowed one to serve as
 SOCIAL WORK WITH GROUPS 25

the DM while the other played another character, enabling them to interact
with the group members. This splitting of responsibilities permitted the facil­
itators to adequately oversee the numerous dynamics within the game while
having space to observe and intentionally interact with group members. One
of the facilitators had more experience playing D&D and filled the DM role
due to their expertise and knowledge. The other facilitator was able to interact
with other group members as a team player and, therefore, could observe more
attentively than the DM at times.
Moreover, the facilitator who did not play the DM initiated interactions within
the role-play that the facilitators believed would be pertinent for practicing conflict
resolution, effective communication, and teamwork. For example, some partici­
pants displayed hesitation and nervousness when presented with multiple options
or situations that required decisiveness in the game. Specifically, while exploring an
underground cave, the DM constructed a condition in which the players’ acciden­
tally’ triggered a trap of sand rapidly filling the tunnel and the players needed to
make decisions quickly, or their characters could become trapped. The facilitators
reflected with the group members after the encounter about their experience. Some
members reported that they were initially unsettled, and others said that even if
their character made a mistake, it was exciting, and the pressure to make the “right”
decision was not as intense.
The facilitators also learned that modeling flexibility within each weekly meeting
was necessary. As presented above, the group members chose to engage in parts of
the storyline that were unexpected. This unexpected engagement required spon­
taneity from the DM to empower the players to interact with the world of their
choosing. Not only did flexibility allow the DM to fulfill their role effectively, but
group members also appeared more engaged and excited to navigate unexpected
encounters. If potential facilitators have rigid expectations during each role-play
session, the therapeutic group process may become impeded.
As the group continued, the members’ connectedness and cohesiveness
appeared to grow from the facilitators’ perspective. Specifically, group mem­
bers began to check in with one another and some members of the group
offered rides to other members if transportation became an issue. Before the
start of the group, the members did not personally know each other. After
a few months, participants in the group appeared to have developed mean­
ingful relationships that were supportive of one another.
Based on the interviews, the researchers learned that a D&D group was
appealing to those who had suffered from social anxiety for many reasons. All
the interviewees reflected they were previously isolated and fearful of making
mistakes, particularly in social situations. As a result, the participants confirmed
they struggled to find meaningful connections with others and society in general.
One participant stated, “I’ve been struggling, still am struggling with anxiety,
unable to cope with society essentially, struggling with depression, suicidal
thoughts, things like that.” Two participants particularly struggled with anxiety
26 M. S. ABBOTT ET AL.

around making mistakes and subsequently losing control. They reflected that
even minimal stress or difficult issues would be problematic for them.
Consistently the participants commented that the D&D group was appealing
because they could work on their issues without the expectation of having to voice
or express how they felt. This disconnect from having to voice these emotions to
strangers was described by the participants agreed to join the group in the first
place. One participant stated:
A regular therapy group is just sitting and talking, maybe some little paperwork or
worksheets, or whatever. That is honestly a little childish. Sometimes-–especially with
anxiety–it’s hard to speak out and say, ‘Hey, this is what’s going on, this is what I’m
fighting. I feel like I’m not as good as other people because of my anxiety.’

Similarly, another interviewee reflected, “I’ve done group therapy before, and
it’s really been nicer to do something that’s not specifically talking about our
feelings all the time because I don’t often like to unless it comes up or feels
important.”

Lessons learned: the members

Practice being a stronger version of self

In this exploration, the participants of the interviews unanimously perceived
their participation in the D&D group was helpful in numerous ways. By
playing their character and interacting with others in the game, they com­
mented that a more robust version of themselves emerged. The subthemes that
emerged included an increased ability to confront and make mistakes without
debilitating stress or anxiety, and increased confidence in themselves.

Confidence. The interview participants stated that many in the group had
difficulty standing up for themselves because of a lack of confidence. For
example, one participant described a time where a particularly reserved
group member found her voice, “Her character stumbled over that for a ­
good minute or two. Then finally she found her confidence and said, ‘Don’t do
that shit’ and just stood up for herself. It was beautiful, and we all cheered.”

Confrontation. Similar to the subtheme above, all the participants surmised

the group gave them opportunities to practice the skill of confrontation. All
reflected that this was difficult to do in real life. An example of this seen during
the game includes:
Dungeons and Dragons, again being the catalyst, it’s not the players necessarily doing
these things. It’s the players getting the characters to do these things. So, the character is
completely fictional; they can do whatever they want to. If they want to stand up to this
bully that has been pushing them around, they can go up and sock them in the face.
 SOCIAL WORK WITH GROUPS 27

Another participant described her character practicing confrontation. She

stated, “I still suck at confrontation and conflict, but I got to practice a little
with my character. So, I told her off. My character told her character off. In real
life, I feel like I should not be upset with people. I hold back a lot. I do not have
a right to complain or express frustrations.”

Mistakes happen/freedom. As presented above, some of the participants were

“frozen” in fear of making mistakes, particularly in social situations. One partici­
pant described challenges with ruminating on decisions or errors. An example of
this includes, “So I get issues with feeling emotionally charged about mistakes and
things and so it’s sort of helped to decouple trying to attempt things from the
emotions.” Because of the way the game is played, with elements of chance and
spontaneity, the participants described becoming more comfortable with making
decisions and letting go of things easily when “chance” did not go their way. One
interviewee described her fear of making mistakes and feeling hesitant in her real-
life to make decisions. She stated, “I have a tendency to believe everything is my
fault and understanding that sometimes things don’t go well and I realize that ‘oh
well, it’s ok, I roll play.’” She continued to explain some reflection and growth,
“Having a character and learning they don’t have to be perfect. We’re all learning.”

Ability to transfer skill set into the real world

As with all therapeutic processes, the goal is to take what you have learned
throughout the intervention into your subsequent interactions with others and
society in general. The researchers were interested in exploring whether the skills
mentioned above, became relevant and transferred into the participants’ interper­
sonal relationships outside of therapy. All three interview participants reflected on
examples of the transferability of the skills learned or practiced above. One
participant commented, “For instance, I was telling my psychiatrist it doesn’t feel
like we connected and there’s issues and other stuff going on. It’s like I think I need
to be seeing someone else. But it still feels like I’m being mean.” This person went
on to explain that they were able to advocate for themselves in changing psychia­
trists. Another participant eloquently described a long-standing problem he had
with his mother and the difficulties with both confrontation and confidence. He
went on to describe his growth and a recent experience with his mother, where he
stood up for himself. He stated, “I’ve been standing up for myself against my
mother – that’s a very sticky situation, she forced me to attend a church where they
bullied us relentlessly. And so that is where my confidence issues lie because I was
told multiple times a week that I was worthless, and she allowed that.”

Feedback for future D&D group implementation

The facilitators established interest and knowledge of the game were incredibly
helpful for the development and implementation of the group. D&D was
28 M. S. ABBOTT ET AL.

developed as a table-top role-playing game and is currently not standardized

as a group therapy intervention. Because this is the case, it was easier for the
facilitators to blend their clinical experience and knowledge of D&D. After
facilitating this group for approximately one year, the developers acknowledge
that practitioners with little to no previous experience playing role-playing
games can have trouble implementing a role-playing skills group if using D&D
similarly to this group. Based on this recognition, the developers present
recommendations and resources for practitioners in Table 1.

Future directions and conclusion

In the summer of 2018, two social workers came together over their interest in
incorporating D&D into their therapeutic work. Together, they noticed a high
incidence of young adults experiencing social anxiety and isolation, and
a demographic trend supporting this challenge (Holt-Lunstad, 2017). Regardless
of the scant literature, the developers were able to incorporate various public
resources and personal knowledge to implement a therapeutic group using D&D
as its framework. Addressed in the findings are ways in which the participants
believed the group was impactful and the lessons learned throughout the process.
This served as a valuable feedback loop for future groups and others attempting
this methodology. Future research should continue to bring this therapeutic
technique to the forefront better to understand the challenges and efficacy of this
method.
The Role-Playing group members’ experiences offer valuable insight into the
strengths that a group like this can offer practitioners. The participants all reflected
they were looking for a different way to participate in the therapeutic process but
were not looking forward to the traditional model of sharing and expressing their
deep pain and histories. This sentiment is similar to Walsh et al. (1991) findings
with children who were reticent to become involved in the therapeutic process.
Throughout the group, they witnessed the growth in themselves and others.
During gameplay, these changes were displayed as participants observed increased
confidence, and an ability to confront or speak up, all of which were difficult for the
group members outside of the group. Lastly, the participants consistently espoused
that the skills learned and practiced in the group helped them with interpersonal
issues and conflicts they had in their lives. These findings are consistent with
previous articles on the subject (Gutierrez, 2017; Kōhei, 2019; Zayas & Lewis,
1986). Consequently, playing a character, either someone they aspire to be or
similar to themselves, availed them the opportunity to practice interpersonal
challenges they see in their lives.
 SOCIAL WORK WITH GROUPS 29

Implications for social workers

This creative intervention reflects the principles social workers deem as essential,
the central importance of human relationships and connection. Particularly during
COVID, there is a necessity for creative interventions to enhance and maintain
social connectedness. The experiences of individuals in this article convey the
importance of personal empowerment through connection. The model presented
provides an alternative framework for clinicians to implement a creative group
intervention for difficult to engage populations. In order to better understand the
effectiveness of this group, further research should use quantitative measures to
explore correlated mental health outcomes related to this intervention.
Additionally, further research could explore the alternative locations and age
ranges that this intervention could be implemented, such as schools, in-patient
units, adolescents, online platforms, etc.

Limitations

This manuscript description and the data for this study was gathered from a small
convenience sample of only one group of Role-Playing group participants. The
information gathered yields exploratory data that can be used to bolster the future
use of this therapeutic technique for this particular set of individuals. Despite these
limitations, this manuscript and small study fills a gap in the literature and can
serve as a resource as others attempt to implement this therapeutic strategy in their
practice.

Disclosure statement
No potential conflict of interest was reported by the author(s).

ORCID
Matthew S. Abbott http://orcid.org/0000-0002-4047-4038

References
Adams, A. S. (2013). Needs met through role-playing games: A fantasy theme analysis of
dungeons & dragons. Kaleidoscope: A Graduate Journal of Qualitative Communication
Research, 12(6), 83. http://opensiuc.lib.siu.edu/kaleidoscope/vol12/iss1/6
Anderson, J., & Rainie, L. (2018). The future of well-being in a tech-saturated world. Pew Research
Center. https://www.pewresearch.org/internet/2018/04/17/concerns-about-the-future-of-
peoples-well-being
Anderson, K. N., Jeon, A. B., Blenner, J. A., Wiener, R. L., & Hope, D. A. (2015). How people
evaluate others with social anxiety disorder: A comparison to depression and general mental
30 M. S. ABBOTT ET AL.

illness stigma. American Journal of Orthopsychiatry, 85(2), 131–138. https://doi.org/doi:10.

1037/ort0000046
Blackmon, W. D. (1994). Dungeons and dragons: The use of a fantasy game in the psychother­
apeutic treatment of a young adult. American Journal of Psychotherapy, 48(4), 624–632.
https://doi.org/10.1176/appi.psychotherapy.1994.48.4.624
Bowman, S. L. (2007). The psychological power of the role-playing experience. Journal of
Interactive Drama, 2(1), 1-15. http://www.interactivedramas.info/archive/IDJ_2_1_2007_
01.pdf#page=7
Bromberg, W., & Moreno, J. L. (1957). Forward. In The first book on group psychotherapy (p. v).
Beacon House.
Dovido,J.F.,&Banfield, J. C. (2015). Prosocial behavior and empathy (Vol. 19). Elsevier.
Dovido,J.F. (1984). Helping behavior and altruism. An empirical and conceptual overview.
Advances in Experimental Social Psychology, 17. 361–427 New York NY: Academic Press
Retrieved from.https://doi.org/10.1016/S0065-2601(08)60123-9
Elkonin, D. B. (2005). The psychology of play preface: The biography of this research. Journal
of Russian and East European Psychology, 43(1), 11–21. https://doi.org/doi:10.1080/
10610405.2005.11059245
Gershkovich, M., Herbert, J. D., Forman, E. M., Schumacher, L. M., & Fischer, L. E. (2017).
Internet-delivered acceptance-based cognitive-behavioral intervention for social anxiety
disorder with and without therapist support: A randomized trial. Behavior Modification,
41(5), 583–608. https://doi.org/doi:10.1177/0145445517694457
Gutierrez, R. (2017). Therapy and dragons: A look into the possible applications of table top
role playing games in therapy with adolescents. Electronic Theses, Projects, and
Dissertations.527. https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?article=1609&con
text=etd
Hawkes-Robinson, W. (2008). Role-playing games used as educational and therapeutic tools
for youth and adults. Tratto da Academia, 1, 38. https://www.researchgate.net/publication/
237074784
Holt-Lunstad, J. (2017). The potential public health relevance of social isolation and loneliness:
Prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4), 127–130.
https://doi.org/doi:10.1093/ppar/prx030
Janesick, V.J (2000, April 24). Intuition and Creativity: A Pas de Deux for Qualitative
Researchers.In Annual Meeting of the American Educational Research Association, New
Orleans, LA.http://citeseerx.ist.psu.edu/viewdoc/download .
Kōhei, K. (2019). Employing tabletop role-playing games (TRPGs) in social communication
support measures for children and youth with autism spectrum disorder (ASD) in Japan: A
hands-on report on the use of leisure activities. Japanese Journal of Analog Role-Playing
Game Studies, (1), 23-28. https://repository.kulib.kyoto-u.ac.jp/dspace/handle/2433/244246
Killgore, W. D, Cloonan, S. A., Taylor, E. C., & Dailey, N. S. (2020). Loneliness: A signature
mental health concern in the era of COVID-19. Psychiatry research, 290 113117.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.
MacKay, D. (2001). The fantasy role-playing game: A new performing art. McFarland.
Moreno, J. L., & Jennings, H. H. (1934). Who shall survive?: A new approach to the problem of
human interrelations. Nervous and mental disease publishing co.
Nickerson, E. T., & O’Laughtlin, K. B. (1980). It’s fun—but will it work?: The use of games as
a therapeutic medium for children and adolescents. Journal of Clinical Child Psychology, 9
(1), 78–81. https://doi.org/doi:10.1080/15374418009532955
Peterson, J. (2012). Playing at the World: A history of simulating wars, people and fantastic
adventures, from chess to role-playing games. Unreason Press.
 SOCIAL WORK WITH GROUPS 31

Reynolds, A. (2011). Developmental transformations: Improvisational drama therapy with

children in acute inpatient psychiatry. Social Work With Groups, 34(3–4), 296–309.
https://doi.org/10.1080/01609513.2011.558820
Rivers, A., Wickramasekera, I. E., Pekala, R. J., & Rivers, J. A. (2016). Empathic features and
absorption in fantasy role-playing. American Journal of Clinical Hypnosis, 58(3), 286–294.
https://doi.org/doi:10.1080/00029157.2015.1103696
Rosselet, J. G., & Stauffer, S. D. (2013). Using group role-playing games with gifted children and
adolescents: A psychosocial intervention model. International Journal of Play Therapy, 22
(4), 173–192. https://doi.org/doi:10.1037/a0034557
Ruscio, A. M., Brown, T. A., Chiu, W. T., Sareen, J., Stein, M. B., & Kessler, R. C. (2008). Social
fears and social phobia in the usa: Results from the national comorbidity survey replication.
Psychological Medicine, 38(1), 15–28. https://doi.org/doi:10.1017/S0033291707001699
Schroeder, D. A., Penner, L. A., Dovidio, J. F., & Piliavin, J. A. (1995). The psychology of helping
and altruism: Problems and puzzles. U.S.McGraw-Hill.
Skolnik, S. (2018). A synergystic union: Group work meets psychodrama. Social Work With
Groups, 41(1–2), 60–73. https://doi.org/doi:10.1080/01609513.2016.1268522
Walsh, R. T., Richardson, M. A., & Cardey, R. M. (1991). Structured fantasy approaches to children’s
group therapy. Social Work With Groups, 14(1), 57–73. https://doi.org/10.1300/J009v14n01_06
Zayas, L. H., & Lewis, B. H. (1986). Fantasy role-playing for mutual aid in children’s groups.
Social Work With Groups, 9(1), 53–66. https://doi.org/doi:10.1300/J009v09n01_05