Rolling for initiative takes on a new meaning this week at Discovery house, as a new pilot program to use table top role playing games as a way to provide therapy for youth and families gets underway.

And just like every Dungeons and Dragons character, there are some serious stat lines behind the effort.

“It’s a really amazing therapy modality, or method, that really allows people to approach challenges and things they’re going through from a little bit of distance,” said Sarah Atkinson, a Child and Youth Trauma Therapist at Discovery House.

“We go through bad things when we have ongoing trauma; when we struggle in our lives it can be hard to talk about. Like I don’t want to sit there and bare my soul to someone necessarily unless I know them, unless I trust them—and kids who are experiencing or who have gone through a lot, doubly so.”

The way the therapy works is by having the participants role-play as a hero through a story, with the safety and structure of a game.

“This is a nice way to allow them to take on some roles to try something and to be vulnerable without having to be personally vulnerable, said Atkinson.

Although not new as a therapeutic method—Dungeons and Dragons has been used as a games-based therapy tool since the 1970s—shifting attitudes around the game has opened it up as a mainstream addition to other forms of game therapies like video games or board games.

A recent 2023 meta-study of the use of role-playing games as therapy entitled Let Your Clients Fight Dragons: A Rapid Evidence Assessment regarding the Therapeutic Utility of ‘Dungeons & Dragons’ found that there was little to no evidence of negative outcomes from using D&D as a therapy tool, and some evidence of positive outcomes from its use.

Among the positive outcomes found by the study were the potential for greater empathy, higher creativity, and personal growth.

That is, so long as the patient playing Dungeons and Dragons actually wants to. A stance that Atkinson said Discovery House takes with any of the forms of therapies offered, not just D&D. A few different games were on the planned pilot list to see what worked best.

“Here at Discovery House, we work hard at engaging the whole person, and understanding the trauma impacts like physiological arousal, the way our body responds to other stress, and all of that,” said Atkinson

The first pilot took place on Dec. 11, with eight participants, followed by a second scheduled round to occur on Dec. 15.

Each of those players who did decide to take part was given their own set of tabletop role-playing dice to keep, something Atkinson said could serve as a memento to help participants to remember a spotlight of good in some dark times.

Play is good for everyone

Atkinson said that approaching children with play is valuable because play itself is valuable—not enough adults play—and is a way to engage patients in a way that helps to move beyond that issue of trust.

“I think that when we approach children, we need to approach them playfully and we need to approach them and engage them at their level. Not very many, eight, nine, ten, twelve-year-old boys are going to want to sit down and have a heart-to-heart with me,” she said.

“What I’m aiming to do at the table is to really explore some of our values, what are we bringing, and why are we bringing it.”

Leslie Hill, Executive Director of Discovery House, said that every single one of the families that the organization provides services to has on some level, been subjected to trauma.

She said that working from a brain science model first, allows them to address and mitigate the damage done by that trauma.

“For all of our programming, we really want to understand the family’s experience of it, and how it’s helping them to achieve whatever their goals are. So the goal might be processing their experience, or it might be increased self-esteem or self-empowerment,” Hill said.

“We have people who support families through all kinds of play. It might be colouring, it might be art, it might be playing with dolls… but all of that’s done through a lens of supporting the individual to heal, to build their resiliency, to build up for kids things like fine motor coordination and language development so that families and the children, in particular, can heal.

The decision to explore the possibility of using D&D as a therapy tool, said Hill, came about as a result of wanting to explore something that might have value for families.

“We look at the evidence base behind something, we look at the research, we look how it might value a family. And then if it’s creative, then we want to try it out and see how it works for the families,” she said.

“Our counselling team, which Sarah is a part of, helps them to explore that and heal from it… so that when the families leave here, they have the skills that they need and the healing so that they can move forward with their lives.”

Helping to address real life issues, safely and in context

Part of the unfortunate reality that also exists for many clients, is that the trauma they have faced has been caused by violence.

Violence, however, is an inescapable part of role-playing games like Dungeons and Dragons.

“I think when we try to ignore the reality of violence, we do ourselves and our clients a disservice. What we know about kids who have experienced violence is they’re more likely to use that violence. So they’re not a stranger to this, and I think hiding from it isn’t helpful,” said Atkinson.

She said that safely setting ground rules for play, and setting an obvious difference between real-world violence and imaginary fantasy violence makes a difference.

“We ask each participant, is there something you’re not comfortable with? In some cases, it’ll be like ‘well, no animals can die, right?’ That’s a big one for kids, and that’s fair. We accommodate where we can,” Atkinson said.

“The other part of it is that because this takes place in sort of that liminal space, that imaginative space, I’m not going to put a ton of gore, a ton of things that are inappropriate into my play. But if they imagine it, then what’s scarier: the monster that you can’t see behind the door, or the monster that you do see, right?”

She said that the games also allow for that sort of fantasy violence to be worked through with peers in a playful setting.

“What we know about play is when we engage ourselves in whole brain play, we can’t hide who we are or what our issues are. You really see that come to the table where a kid who’s maybe got some social skills issues,” Atkinson said.

“Those issues are going to show up at the table, and they’re going to be able to work through them with the feedback from the peers with where I take the story with the monsters we fight.”

She used the hypothetical example of a 10-year old boy who has experienced violent trauma, decides to be a warrior.

“What can be learned for him by playing as a warrior in battle? That’s going to be so specific to the person to the game, but there’s so much to explore and so much to dig into,” Atkinson said.