A band of travelers wanders into a dusty tavern, midday sunlight streaking through the grimy glass of the windows.

Their weapons rest in a magically sealed chest at the door, out of reach, per the tavern’s rules. The travelers murmur among themselves over their dinner of piping hot soup— this tavern’s alternative to alcohol. Spoons scrape bowls as they eagerly dine, when suddenly, danger!

Skeletons burst from the floor and windows, and the weaponless travelers scramble to defend themselves with chairs and soup spoons—except for one, who raises his forearms, covered in runic tattoos, and summons his weapons to himself. Or at least, he tries. 

This was the beginning of a Dungeons & Dragons quest led by Adam Davis and Adam Johns several years ago. Davis and Johns are now co-founders, executive directors and lead facilitators of Game to Grow, a nonprofit group in Washington that uses roleplaying and tabletop games like Dungeons & Dragons as a therapeutic model. 

The adolescents who participate in groups like those facilitated by Game to Grow struggle with various challenges such as anxiety or trauma. Some also fall on the autism spectrum, like the player who attempted to summon his weapons.

Tabletop roleplaying games like Dungeons & Dragons create scenarios that often mirror players’ real-life struggles, while maintaining a separation between the player and the character, Davis said. 

For instance, when the tattooed character was challenged to thwart the  attacking skeletons, the player was distressed at his character’s failure to summon his weapons. But after he was reminded that this was the character’s failure and not his own, he was able to calm down. This victory was then affirmed as the player’s own. 

The struggles are placed on the characters instead of the players, but it is the latter who feel triumphant when the characters succeed.

“We [can] take times when players [are] feeling frustrated [and] hitting their challenge points [and] give those challenges to the character rather than the player,” Davis said. “It provides this great opportunity for the player to take a step back and have some perspective.” 

This separation between player and character has various monikers, including the term “therapeutic avatar,” said Jack Berkenstock Jr., MHS, executive director of the Bodhana Group, a Pennsylvania-based organization that advocates and practices the use of tabletop gaming as a therapeutic tool. 

Another term is “aesthetic doubling,” said Sarah Lynne-Bowman, author of “The Functions of Role-Playing Games: How Participants Create Community, Solve Problems, and Explore Identity.”

“They get to play a character, which allows them to have some distance, personally, from what is happening. If their character fails, it’s less stigmatized than if they were to fail,” said Lynne-Bowman, who uses roleplaying as an education tool in her classrooms at Austin Community College, Richland College and Ashford University. 

No matter what avatar the player chooses, the principle remains the same: Players are able to invest as much of themselves into the characters as they please, letting them experiment with various actions that might be helpful in confronting their own real-life challenges. 

Like the students participating in Game to Grow groups, young people on the autism spectrum suffering from anxiety or trauma are just a few groups who can be helped by playing tabletop games, according to the RPG Research Project—a group that studies the effects of roleplaying and develops its own therapeutic and educational roleplaying campaigns. 

According to Johns, tabletop roleplaying games provide people on the autism spectrum with an ideal combination of clearly defined rules and a need for flexibility.

Dungeons & Dragons gives a distinct outline of how to perform actions like attack, but also demands that players navigate specific social situations. For example, when a non-player character­­— or a character controlled by the Dungeon Master— lies to one of the players’ characters, Johns said he might ask the player what behaviors, like avoiding eye contact, indicate that they are being lied to. The next time a non-player character lies to that player, the Dungeon Master might mimic those behaviors, so the player learns to read that body language. 

Similarly, Hawke Robinson, recreational therapist and founder of RPG Research, will explain physical actions when leading tabletop  groups with those on the autism spectrum.  

“For some people on the spectrum, it’s hard to read facial expressions,” Robinson said. “So I will say things like ‘he gives you a very stern look,’ and then I give them a very stern look. I’ve vocalized it, I’ve acted it, and now they can create an association between that facial expression and description.”

Robinson has also designed several tabletop role-playing campaigns specifically for those on the autism spectrum, using the model to help participants with practical life skills. One game’s narrative is a mystery set in the 1940s in which participants investigate clues that involve tapping into various civic resources, such as hospitals and fire departments. Another game has participants study public transit schedules and city maps of their hometown to track down leads.  

For children with anxiety, Johns has found that Dungeons & Dragons offers a repetitive exposure to the participant’s fears. This builds confidence over time, while the therapeutic avatar or aesthetic doubling technique lets the player step away from the situation to prevent them from getting too emotionally involved. 

“When you’re experiencing anxiety, if you take a moment to think about the situation, your thoughts, feelings and options, you can be more successful,” Davis said. “Anxiety is something that floods, and when you’re flooded, it’s hard to think rationally and listen to your emotions. There’s something really nice about [the ability to pause things in the game].” 

Olivia’s House, a grief and loss center for children in  York, Pennsylvania, had the Bodhana Group work with a group of children who had lost family members to drug abuse or drug dependency. Berkenstock conducted a tabletop campaign in which the children worked to break up a drug ring. 

 “We didn’t force them to put themselves into their character at all,” Berkenstock said. “It wasn’t like, ‘Let me smack you in the face with the therapy hammer.’ It was in the background, so they could invest as much as  they wanted.”

The children were confronted with whether or not to destroy the rampant street drug in the campaign, despite components of the drug acting as medicine for a non-player character. The players ultimately decided to alter the drug so it could still be used medicinally, but the non-player character still died. 

“We said to the kids, ‘What do you think your loved one … would think about your character’s decision?’” Berkenstock said. “Again, not your decision. We allowed that separation. It wasn’t you that made that choice; it was that character identity.” 

According to Berkenstock, while people of any age could benefit from therapeutic roleplaying games, he has found adolescents to be the most receptive to the model. 

“There’s something fantastic about adolescence because there’s still a lot of capacity and willingness to play and puncture the need to be cool,” Johns said.  “That is really important to embracing the play of the experience. A lot of adults have a larger challenge of embracing that you’re playing a dwarf  in a fantasy world that might involve silly and strange things. The stars [are aligned] right for adolescents.” 

Johns also explained that teaching players how to translate skills learned in-game as their character  to their real-life experiences is a delicate balance. 

“A lot of what we’ll do is have them think about aspects their characters have that they would like to have,” Johns said, “or aspects their characters have that they would like their characters to [change]. Then we ask them to, in their daily life, when they’re feeling a challenge or a struggle, say, ‘What would my character do in this situation?’”