Healing Through Fantasy: Dungeons & Dragons as Therapy

In this episode of ‘Convos from the Couch’ by LifeStance Health, we talk with therapist William Acton about using the role-playing game Dungeons and Dragons (D&D) as a therapeutic tool. Acton shares his background and how his love for storytelling led him to integrate D&D into his practice. He explains the basics of D&D and how he adapts the game for therapy sessions, helping clients address issues like social anxiety, anger, grief, and more.
Acton discusses the therapeutic benefits, such as improved communication and acceptance of failure, and the flexibility of D&D to meet various therapeutic goals. He also describes his training through Geek Therapeutics and mentions the broad applicability of tabletop RPGs in therapy.
Nicholette Leanza:
Welcome to Convos from the Couch by LifeStance Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life.
Hello, everyone. Welcome to Convos From the Couch by LifeStance Health. I’m Nikki Leanza, and on this episode I’m excited to be talking with therapist William Acton. And he’ll be sharing with us how he uses the role-playing game Dungeons & Dragons as therapy. So welcome, Will, great to have you on.
William Acton:
Hey. Thank you for having me on. Yeah.
Nicholette Leanza:
Yes. Really curious about this, wanting to know how you use it as therapy. From here on out, instead of saying Dungeons & Dragons, which is a mouthful, we’ll be calling it D&D. So tell us a little bit about yourself and what got you into D&D.
William Acton:
Sure, yeah. Basic starters. So I’m from Springfield, Illinois, have been here pretty much my whole life, land of Lincoln, all that stuff. But outside of being a therapist, I’ve always been, basically I call myself a story nerd. So I love movies, music, reading, and I’m also big into community theater. I just finished a production of Rent, which went amazing. I know, it was so good, but I’m almost like a story collector in a way. And I just really appreciate people either sharing their stories or sharing a story that they’ve created in their mind. That just has always been the common denominator of all my hobbies.
So D&D is just another branch of that. So it really, that kind of love for that sort of tabletop role-playing game like D&D and a few other ones, I think it started in college.
So around that time, my friends and I, we were watching Stranger Things, which featured D&D in it. And then also, I was getting really into Lord of the Rings and Game of Thrones and even some D&D podcast itself, like Critical Role, Dimension 20, things like that. And I just kept seeing it coming up over and over again, and so my friends just decided to try it. And after a while, we were playing in different campaigns of D&D or some other types of games. And eventually I decided, “Hey, I want to run my own campaign.” And I am pretty much the forever dungeon master, the leader of the game. Basically, my friends, they forced me to run all the games from here on out, which I love it, so it’s okay.
Nicholette Leanza:
I was going to say, I don’t think you… You don’t mind that, right?
William Acton:
Hey, no, I love it. I love it. Yeah. But yeah, it originated in college, but it just had just exploded. Actually, the pandemic was actually one that really pushed that because we’re all at home alone and trying to just figure out something to do. And I found a group of friends and we did online games and I had plenty of free time over the pandemic, so-
Nicholette Leanza:
As we all did.
William Acton:
Yes. So just really expanded that because that was also my social outlet too, just having that space to just hang out with friends really, so yeah.
Nicholette Leanza:
So important, especially during that time. For sure.
William Acton:
Absolutely. Yeah. Yes.
Nicholette Leanza:
So as we dive into it a little bit more, so what is D&D and how does the game work?
William Acton:
Sure. So D&D, probably one of the most famous types of what’s called a tabletop role playing game or TTRPG. At its core foundation, what it is, it’s a collaborative storytelling game. It’s improvisational. It does use mechanics such as character sheet and it’ll tell you different statistics of how to do different things. But one, the thing that really it’s probably most known for is the dice rolling system. So it uses d20 and a bunch of other numbered dice. I actually have one here, this is a big one.
Nicholette Leanza:
Oh, look at that.
William Acton:
Yeah, this is most often a paperweight, but I like it. But it’s a 20-sided-
Nicholette Leanza:
So just to specify, d20, it has 20 different facets to it. Is that correct?
William Acton:
Yes. Yes, exactly. And it’s numbered one through 20 and you will roll these when you want to determine whether your character succeeds at something or fails. So if you get a one, you failed. If you get a 20, you succeeded, or somewhere along those lines. This kind of implements a bit of randomness to the game and it also naturally lends to successes and failures being a part of the story. And that’s what kind of sets it apart from some different types of games, say like a regular board game, it’s just, oh, move your character three spaces. This kind of has failure adds an integral part of the story.
So the way that these games usually work, so players will go, they’ll create a character, usually they’ll talk to the dungeon master, which is the name for the leader of it, and understand the concepts of what the campaign or the giant story arc it’s going to be. They’ll create the character, they’ll go through all the different mechanics of what spells or items or things like that they have.
But really, at its core, D&D is a giant toolbox to tell the story. So there are different games that are really nitty-gritty, medieval, very Game of Thrones. There are other ones that are very silly and goofy like Monty Python. And it can be anywhere in between.
So the way that I like to use it as far as therapy is I just have my clients, whether in person or online, they create characters that are either the ideal version of themselves, so it represents some sort of positive characteristics that they want to embody more of, the flawed version of themselves, so this is some sort of characteristics that they maybe don’t like and want to role play fixing that, or the dynamic self, which has a little bit of both. That’s the one that I typically prefer because it’s a little bit more well-rounded, but I let my clients choose any of that.
I walk them through their character creation, because I’ve had some clients that have played D&D since it came out in the ’70s and other clients that this is their first time ever really doing anything about it. So I walk them through it and really it’s about 90 minute sessions of D&D. A lot of it is the same as what it would be in a casual setting. The only difference is the way that I set up these types of scenarios is to foster some sort of therapeutic skills out of it. So things like communication, accepting that you may do everything right and you may still fail. Even challenging grief and loss with some of this stuff. It really is so flexible that it can be adapted to any client’s needs.
And it’s fun both as a therapist and also just as an enjoyer of D&D, because really, you do get the sort of fun sides of it and you can be funny and goofy a bit. But you also really do get to go through this role play of what these people are actually going through in their lives and really give them a safe space to process what they’re going through in their lives.
Nicholette Leanza:
And I think that’s the key right there, giving them this safe space. Even it’s a safe space for them to process what they’re going through in their life, but also at the same time having fun with it too, it sounds like.
William Acton:
Exactly, yes.
Nicholette Leanza:
Great blend of both.
William Acton:
Exactly. And I have a lot of them, of my clients that are dealing with some sort of social anxiety. And this is a place for them, basically it forces collaboration and for people to maybe challenge each other and say, “Hey, I think that maybe we should do this instead of that.” And it gives them that opportunity to perhaps fail at being the perfect speaker or convincing somebody. But really, the consequences are really low and it’s practice for the real world.
Nicholette Leanza:
Yeah, it’s a great practice. Yeah, and a safe place to do it. Yeah.
William Acton:
Exactly. Exactly. So it’s so much fun that I’ve had it before where a client, he’s, “I’m having fun, but I’m not for sure about the therapy side of it.” And once I talked to him about it, I was like, “When you came in, you weren’t necessarily ready to talk to other people. You weren’t the type of person to stand up for yourself. You just went with the flow.” And once he realized that, he’s like, “Man, I was distracted by how much fun I was having that I missed out. Yes, I have been doing all these things.” And that is really the ultimate point of having this at the therapeutic tool is it’s making it fun, but they’re applying it without even realizing that they’re applying it.
Nicholette Leanza:
Oh my gosh.
So how did you get trained to do this?
William Acton:
Yeah, so I initially just had heard from some other counseling friends and even some people at LifeStance when I mentioned I like Dungeons and Dragons, that they’re this program through Geek Therapeutics that offered essentially a training class on how to be a therapeutic game master. So I looked it up and back almost a year ago now, I had signed up for this class, it was a nine-week class. And it walked through how to work on documentation things and even just how to apply different therapeutic techniques to this framework, how to organize sessions, how to talk about character creation, basically everything. And we even had a chance to sit down with people who have been trained in this for years and we got to lead our own sessions with them and get feedback from them.
Nicholette Leanza:
Oh, that’s great.
William Acton:
It was a phenomenal course, I loved doing it, especially too, just getting to understand the other counselors in the world that are going to apply this in different settings. So there’s one guy that’s doing it in a school setting for middle schoolers.
Nicholette Leanza:
Oh, wow.
William Acton:
One that had lived in Hawaii after their tragic wildfires and was using that to bring the community together. And it just really fascinating. The nice thing too, that program is endorsed by American Psychological Association.
Nicholette Leanza:
Oh, that’s great.
William Acton:
Association of Social Work Board, NBCC. They’ve all have looked at this and approved it for continuing education and they’ve even have done their own research as far as how TTRPG, that the whole can be applied to therapy and how beneficial it is.
Nicholette Leanza:
Gosh, I’m pretty sure that any therapists out there or clinicians out there who just heard that is probably going to be going to the website and checking it out especially-
William Acton:
Absolutely.
Nicholette Leanza:
… [inaudible 00:10:22] continuing education for it too. That’s amazing.
William Acton:
Absolutely, yeah. That was the nice thing, it was 36 continuing education hours. Definitely was nice for as I kind of approach my license renewal.
Nicholette Leanza:
Yeah, definitely.
William Acton:
Yeah.
Nicholette Leanza:
So which types of clients can benefit from D&D therapy?
William Acton:
Yeah, really so many. I’ve already mentioned social anxiety is probably one of the biggest ones that I’ve dealt with with this type of therapy, but I’ve also worked with people with anger issues. I have an example of how that works.
I’ve had a player that played as the Barbarian, which is their melee class. And one of the features of the barbarian class is they rage. And kind of setting up encounters where you can’t win your circumstance by just getting angry, you have to step back and not use violence. So anger is definitely a big one.
Grief and loss. I’ve had a client that was dealing with kind of guilt that somebody that he know had committed suicide in his life and he felt like he should have seen the signs. And his character in our campaign was a war chieftain who let his troop into a battle where they lost and he was processing sort of those types of feelings together as well.
It’s great for depression as well, for really a number of different things. Really, the one things that kind of are not good for if somebody had been active psychosis and having things like that, that really just boils down to the role-play nature of it. What we definitely don’t want to happen is we’re role-playing a scenario and somebody with their symptoms, they think that this is real. Or even the opposite side, they have such a hard time getting engaged into the session that their symptoms are preventing them from interacting with the group.
But really, anything else, that’s a nice thing with this is that since it is this toolbox, it can be adapted to a number of different circumstances. And I usually meet with the clients before to talk to them about, “All right, so what are your goals through this?” Majority of them it’s social anxiety, at least somewhere in there, or just anxiety about failure or things like that, that seem to be the most common that I see. But a lot of people have multiple different things that they’re working on at the same time.
What’s nice about me meeting people though and working with them is as the story goes on, I can pull different things out and apply it. And I usually have a general idea of how I want the story to go, but it changes as the players may say something in one of the first few sessions that gives me an idea of how I might maybe challenge them a little bit down the road. I’ve had clients where there’s one person who seemed to be the leader, and so maybe a few sessions down the road, I may do something with their character to make them incapacitated. So now the other people who have been wanting to work on leadership and advocacy, they are now forced into that role.
Nicholette Leanza:
Wow, that’s brilliant, Will. That’s great.
William Acton:
Yeah, so it is so flexible and that’s what I love about it, that there isn’t a step-by-step, okay, session one, you’re doing this. Session two, you’re doing this. It really is so open and flexible that from group to group, I could be running the same general framework of the campaign and it’s going to be two totally different experiences.
Nicholette Leanza:
Yeah. Oh my gosh, that’s great.
William Acton:
Yeah.
Nicholette Leanza:
What are some of the therapeutic perspectives behind it?
William Acton:
Sure. So one of the primary ones is ACT, so acceptance commitment therapy.
Nicholette Leanza:
Yeah.
William Acton:
Yes, I love it. And that one, it’s D&D or Tabletop RPGs and ACT go hand in hand because both of them are emphasizing the fact that challenges are inevitable, that we can’t necessarily change what happens to us, but we can change how we respond to it. Accepting that failure is natural and failure is not something to be afraid of, that it’s a natural part of life. All of these things are things that happen in D&D.
You may have the perfect speech to motivate the boss and you roll a two and it just doesn’t work and there’s nothing that we can really do about that. But accepting that these types of difficulties do happen and sometimes bad things in the world just happen. Acknowledging that the emotions that we have are totally okay. You are allowed to have these emotions. How you act on those emotions is up to you. That is one of the primary ones and that’s the one that in the class that I took, that’s one of the ones that they highlighted the most common or the most likely form of therapy to apply with this.
It is open though to so many other ones. So they talked about cognitive processing therapy or CBT with it. Using this framework within this role of challenging these maladaptive ideas, which I’ve done a few times. I’ve had in a session, for example, a illusionary figure is kind of telling them all of these negative thoughts about themselves. So I’ve had almost a mirror image of themselves are saying, “You’re not worthy, you’re not good enough.” And I’ve had them basically, in order to pass through the challenge, they have to say, “No, you’re wrong.” And-
Nicholette Leanza:
Oh my God, that is so good. That [inaudible 00:15:37]-
William Acton:
Yes.
Nicholette Leanza:
What great practice then for them to translate it into their real life.
William Acton:
Exactly. Exactly. And it’s fascinating sometimes. In some early sessions, you may hear somebody say, “Oh, I’m not as good at this as somebody else.” And to basically turn that right back around on them in later sessions so that way they do find that inner strength to say, “No, you’re wrong. I am good enough.” And with that ACT of, “Yeah, no, I am good. I am going to make mistakes and that’s fine. That doesn’t change my worth.”
And applying all these together, I pull a lot of ACT, I do pull a little bit of CBT into it as well. And really, it is play therapy as well, even though it may not be your sand table type of play therapy, it is play therapy as well. But those are the primary ones.
The lovely thing with this, as I mentioned earlier, it is peer reviewed and it’s being more researched as time goes on. So there’s a study, I have it pulled up, and I’m probably going to get the last names wrong, Arenas, Vidwani and Rahul from 2022. They saw that tabletop RPGs and therapy have very complimentary nature. And that in their studies, those that use some sort of applied tabletop RPGs into therapy tend to have better results than traditional therapeutic approaches. Yes, there are obviously tons of rooms to expand on this type of research topic as it’s still is a new topic and it’s still being researched and applied and everything, but what’s out there already is showing a lot of promise.
And one of the nice things too, so this is a recent one that’s more broad, but Bean in 2023 said that just geek culture as a whole can really just help foster that therapeutic alliance, which that’s such a key part in any form of therapeutic approach. Without that, any of the other approaches fall away. But they have found that is helping a lot with therapy as well.
And D&D definitely falls into that category of geek culture as well. So really just building that sort of human connection really, it’s such an integral part. And meeting your clients with their hobbies, because there is a lot of D&D fans out in the world and they get to connect with their hobbies in a therapeutic way, and it’s so powerful.
Nicholette Leanza:
Definitely. Now, what if some people were concerned about the imagery related to D&D?
William Acton:
Sure.
Nicholette Leanza:
How do you handle that?
William Acton:
Yeah, so that was a major thing in the ’80s, especially when D&D was first coming up in its popularity, but it’s carried over now, the Satanic panic of the ’80s, ’90s. So really, a lot of different types of media was under scrutiny for satanic practices or witchcraft or the occult, and D&D was always been in the crosshairs of that. D&d does feature demons, some demonic imagery, spells, witchcraft. It does not endorse satanism or teach people how to use spells or anything like that.
But the biggest thing with D&D is that just because it’s featured in there doesn’t mean that it has to be in your game. It is such a wide toolbox where, for instance, this past weekend I ran a D&D session with my friends and we were saving Santa Claus. So we ran a Christmas theme type of session and we’re saving him from some elves decided to revolt. And there is really nothing about the demons or anything else in there. If there’re imagery that people don’t like, you don’t have to use it. That’s the nice thing with D&D. It’s such that wide framework.
Also D&D is not the only tabletop RPG out there. So there’s a system that’s called the Fate System, F-A-T-E. And that is such a wide tool where I’ve done a game that was called Rock Apocalypse, and it was like Scott Pilgrim style. You battled with band battles and battle of the bands and you might be a guitar player or whatever.
Nicholette Leanza:
That’s fun.
William Acton:
It’s still uses kind of that framework though, the collaborative storytelling with it. So really, overall, my overall point with that is that just because it features that doesn’t mean it has to be used. And it definitely isn’t an endorsement of any of the things in there. It just is the setting and that setting can change depending on who wants to be in it and what they want to see in it.
Nicholette Leanza:
Any other takeaways you’d like to share?
William Acton:
Sure. So like I said, there’s some other tabletop RPGs out there. And really, whether it’s D&D or some other type of tabletop RPG or even just some other art medium out there, so art therapy or music therapy, I’m a big proponent, as I mentioned, I’m a storyteller. I love stories. And just finding those different ways within therapeutic practices to just allow people to share their own story or whatever story they have just within them, I think it’s a huge area that can be explored and utilized, whether it’s D&D or anything else. And I’m happy that LifeStance has allowed me the opportunity to do this because it is a niche area, but it’s fascinating and just useful for so many people.
Nicholette Leanza:
Oh my gosh, definitely sounds like it. Can you take a moment to plug the groups you run?
William Acton:
Yes, absolutely. Currently, in the new year in 2025, so I will be running this D&D group. It will be, I believe, on Thursday nights from 5:00 to 6:30 PM Central time. So if you’re in Illinois, you can look us up because as long as you are somewhere in Illinois, this one will be virtual, so you could be anywhere and still join. I will also be running a LGBTQ support group on Wednesday nights. That one will be in person. It’s very generalized, just come and get that support from the community.
Nicholette Leanza:
Right. Oh my gosh. Thank you so much.
William Acton:
Absolutely.
Nicholette Leanza:
I feel like I want to go and get trained in this and I-
William Acton:
Absolutely.
Nicholette Leanza:
… [inaudible 00:21:33] before we recorded, I’d say one time several decades ago.
William Acton:
You need to play again.
Nicholette Leanza:
Yeah, you got me all-
William Acton:
Yes, absolutely.
Nicholette Leanza:
I think this is fabulous. Thank you again for sharing. [inaudible 00:21:46].
William Acton:
Yeah, thank you for having me on.
Nicholette Leanza:
All right, take care.
William Acton:
All right, thank you. You too.
Nicholette Leanza:
I also want to thank the team behind the podcast, Jason Clayden and Juliana Whidden, with a special thank you to Jason who edits our episodes. Thank you for listening to Convos from the Couch. Take care, everyone.