Ok so I know that there is a joke that when you can’t afford a therapist just play dnd and I’m genuinely curious if you could or have used D&D in therapy to help clients. Even if you don’t have experience in the subject I’m curious to hear people’s views. Also massive thanks to therapists everywhere for helping me and so so so so so many others get through hard stuff:)

I wouldn't simply or glibly say D&D = therapy.  However, there are a number of organizations and individuals that promote TTRPGs, including D&D, for having some mental health benefits.  For instance, I don't think they're unique in this space, but the nonprofit Games to Grow actually trains and networks "therapeutic game masters" (I think they may be of solely therapist/social work/certain education speciality GMs).  Art therapy, play therapy, storytelling and drama therapy are all things in the mental health landscape, so therapeutic gaming shouldn't be too surprising since TTRPG draws from all those activities that can also be practiced as therapy. EDIT: Silva's link is an excellent summation of the value of TTRPG to developmental psychology and there's a lot of work on how gaming can be a tool to both mental health practioners and educators working at the intersection of development.  

Plenty of gamers also include gaming as part of their self-care inventory, but that's very different from therapy with a practitioner; and I wouldn't presume any given game I'd sit down at would necessarily confer the benefits of seeing a therapist or other mental health professional.

I think part of the issue behind this question is that "therapy" encompasses a broad range of methodologies addressing a broad range of conditions which themselves have a broad range of severities.  Gaming definitely can't address all of them, so I guess when it comes down to it the answer to the question "Could you use D&D for therapy?" is "Sometimes."       

To close on glib though, for some people TTRPG is a de facto religion or faith, and there are some therapists who subscribe to the notion that therapists often perform roles that in many cultures were historically addressed through religion and faith leaders, so logically....  

D&D can potentially be a form of therapy.

But you need to have someone who understands what the patient needs and how to help them.  You can't just go in thinking that buying sourcebooks is a substitute for counseling.

Thanks for all the answers ya’ll, that is quite interesting and I think I agree that D&D can be used as therapy sometimes but I don’t think you can live your life only projecting your issues onto your character for the DM to figure out.

I have read stories about teachers using D&D to help kids who otherwise have trouble or are scared of social engagement. They find it much easier to interact as they are portraying a character.

D&D could be beneficial to one’s mental health - it provides a social environment, problem solving, and other benefits -  it I do not think it would be a useful therapeutic tool for a number of reasons.  

Play therapy - which is in a large part what therapeutic D&D would be built around -  is a form of therapy wherein the treating psychologist observed a subject at play, looking for insights about the subject’s mental health that might come out through their play.  It is almost exclusively used among children, particularly children who might not understand the normal psychologist- patient relationship and would not benefit from regular therapy. Reportedly it has been used with teenagers and adults (mostly with those whose mental state is that of a child), but it is hardly a widespread or overly accepted practice. 

There lies the first hurdle - there is no real reason to believe D&D therapy would be superior to regular therapy for individuals who can sufficiently understand how regular therapy operates (and those who cannot likely cannot grasp all the rules of D&D).

Your second problem is going to be the amount of input others have into D&D - the player is not the only one driving their game experience and actions can be influenced by the DM or others in the group, making its value to the therapy highly suspect. 

There also will be the fact that D&D is all about stepping into a different character - sometimes a worse or better version of ourselves; sometimes someone completely different.  Again, that will limit its use as to a therapist.

All told, D&D is great and can be a boon to someone’s wellbeing - but as a device of therapy itself, I would be incredibly suspect of its utility. 

Quote from Houligan >>

I have read stories about teachers using D&D to help kids who otherwise have trouble or are scared of social engagement. They find it much easier to interact as they are portraying a character.

I actually attended a Webinar this week, the first of a series co-sponsored by WotC and the International Literacy Association talking about just that.  Panel consisted of teachers, education researchers, and non profit org promoting gaming in education spaces.  I think there's a balanced recognition that WotC, whatever benevolence associated with its intent also provides educators Essentials or Starter Kits to grow their market.  But, at the same time the benefits of TTRPG (not just D&D) reported by everyone from researchers to classroom teachers regarding TTRPG's benefits in developing, SEL (social emotional learning), genre literacy, graphic data presentation etc is compelling.

Quote from Caerwyn_Glyndwr >>

D&D could be beneficial to one’s mental health - it provides a social environment, problem solving, and other benefits -  it I do not think it would be a useful therapeutic tool for a number of reasons.  

Play therapy - which is in a large part what therapeutic D&D would be built around -  is a form of therapy wherein the treating psychologist observed a subject at play, looking for insights about the subject’s mental health that might come out through their play.  It is almost exclusively used among children, particularly children who might not understand the normal psychologist- patient relationship and would not benefit from regular therapy. Reportedly it has been used with teenagers and adults (mostly with those whose mental state is that of a child), but it is hardly a widespread or overly accepted practice. 

There lies the first hurdle - there is no real reason to believe D&D therapy would be superior to regular therapy for individuals who can sufficiently understand how regular therapy operates (and those who cannot likely cannot grasp all the rules of D&D).

Your second problem is going to be the amount of input others have into D&D - the player is not the only one driving their game experience and actions can be influenced by the DM or others in the group, making its value to the therapy highly suspect. 

There also will be the fact that D&D is all about stepping into a different character - sometimes a worse or better version of ourselves; sometimes someone completely different.  Again, that will limit its use as to a therapist.

All told, D&D is great and can be a boon to someone’s wellbeing - but as a device of therapy itself, I would be incredibly suspect of its utility. 

You speak in the hypothetical where in fact TTRPG therapy, like play, art, drama and storytelling and group therapy, only the first of which is largely limited in practice to children, are actual practices.  I'm curious as to the basis of what seems to be conjecture based on conjectures of something you call "regular therapy."

The question wasn't "is D&D superior to therapy"?  The OP was asking whether D&D can be used in lieu of therapy.  My own response to that was that there are in fact mental health and developmental psychology professionals who see TTRPGs as promising tools but at the same time I wouldn't say gaming is inherently therapeutic in and of itself (much like many of the techniques employed in therapy).

I will admit, I probably could have used the more accurate “established therapies” over “regular”.  That said, I stand by my overall point - D&D has too many systemic elements that make it a bad clinical tool.  Contrary to  what you assert, that is what the OP is asking - if you reread the post, you will see that your "in lieu of therapy” reading of the OP is presented as an old joke, which the OP uses as a launching off point to ask “if you could or have used D&D in therapy to help clients.”  The use of the word “clients” clearly indicates the OP is “genuinely curious” as to whether D&D could actually be used by individuals engaged in the practice of providing therapeutic services; nor the “in lieu of” integration of the post you espouse. 

As I said, I do not think it has much utility in the context of actually helping clients, except insofar as it provides a structured, social program. There are just too many factors at play with D&D to make it particularly insightful from a clinical perspective - too many elements that might materially bias the treating professional’s understanding of the client.

I have participated in actual group therapy with D&D, with the DM being a licensed therapist. I think it's valuable, certainly for social practice, and for getting comfortable dealing with situations where you fail at what you attempt to do (yet still survive). It isn't a replacement for individual therapy, it isn't going to be appropriate for everyone.

Regular old D&D groups can be helpful for developing social skills but it's asking too much for a DM to act as a licensed therapist when they've had no training in it.

It can be a form of therapy to train social skills and keep social contacts intact. But I also think, it works as a therapy only for people who are genuinly interested in fantasy related content. I person who has no interest in "stuff that is not related to the real world" would not benefit from any therapeutic effect D&D might otherwise have.

There's a bunch of people actually doing that.

I heard there's some kind of outside link prohibition on the forums so i wont link anything but there's been some high-profile panels on the subject (they're on YouTube), as well as a group of therapists who play on twitch, a DnD playing therapist that has a podcast among other things.  In addition to therapy, it's been used for troubled and incarcerated youth.

Quote from Caerwyn_Glyndwr >>

I will admit, I probably could have used the more accurate “established therapies” over “regular”.  That said, I stand by my overall point - D&D has too many systemic elements that make it a bad clinical tool.  Contrary to  what you assert, that is what the OP is asking - if you reread the post, you will see that your "in lieu of therapy” reading of the OP is presented as an old joke, which the OP uses as a launching off point to ask “if you could or have used D&D in therapy to help clients.”  The use of the word “clients” clearly indicates the OP is “genuinely curious” as to whether D&D could actually be used by individuals engaged in the practice of providing therapeutic services; nor the “in lieu of” integration of the post you espouse. 

As I said, I do not think it has much utility in the context of actually helping clients, except insofar as it provides a structured, social program. There are just too many factors at play with D&D to make it particularly insightful from a clinical perspective - too many elements that might materially bias the treating professional’s understanding of the client.

Again, is this based on your experience as clinician, specifically in a mental health / therapy context?  Or are you simply conjecturing and ignoring the fact I and one other poster has mentioned that TTRPG is actually being used in a therapeutic context?  Again, there are established, and fairly well funded practitioners doing this work.  Is your, from what I can tell, conjecture aware of their existence?

Quote from Matunus >>

It can be a form of therapy to train social skills and keep social contacts intact. But I also think, it works as a therapy only for people who are genuinly interested in fantasy related content. I person who has no interest in "stuff that is not related to the real world" would not benefit from any therapeutic effect D&D might otherwise have.

You're right, but D&D isn't the be all and end all of TTRPG and in both the gaming therapy and gaming as educational tool TTRPGs are used as tools.  In fact one therepeutic gaming org produced their own in house game system to facilitate therepeutic gaming run by therapists with little ttrpg experience.  

Okay, full disclosure I have had personal experience with group therapy. I'm an alcoholic in recovery (just over three years sober currently) and I spent six weeks in an in-patient chemical dependency rehab center and then did about five months of additional out-patient treatment ranging from 12-20 hours a week. Most of that treatment focused heavily on group discussions and activities under the leadership of a certified counselor, most of whom had extensive experience with the subject (quite a few were in recovery themselves). Anything I say here is going to be filtered through my experiences there as this is something that has, without embellishment, had an enormous effect on my life. 

For the most part you don't find yourself in a residential treatment facility unless you have a serious problem that brings with it a host of other effects and behaviors that affect your ability to function smoothly, pleasantly, and even safely in general society (without going into details I was pretty close to literally drinking myself to death and was an absolute mess in every sense of the description). Being surrounded by other people with the same kind of issues is a huge part of helping one address their problems, being able to recognize attitudes and behaviors in others then compare them to yourself. It also encourages and facilitates empathy in people who have often become socially isolated and disconnected from others, as well as confidence and a willingness to open up and actually communicate in a meaningful way. This is, in my personal opinion and experience, why recovery programs that focus on peer meetings (such as Alcoholics Anonymous and Narcotics Anonymous) tend to be as successful as they often are when someone participates in them in good faith. A common mantra in such programs is "You can't get help until you want help" and the group engagements were a huge part of me even realizing what kind of help I needed and then convincing me that it could work. It's like introspection by way of using one's peers as a mirror, recognizing traits and behaviors they have from the outside viewpoint and then realizing that you do the same things, often for similar if not identical reasons. It's also important to point out that, particularly in a clinical setting, a properly trained counselor who keeps everyone focused on the relevant issues is a major part of this process. 

I don't think that D&D (or any TTRPG) would be an appropriate replacement or substitute for therapy, but under the proper circumstances I could easily see it being a beneficial addition and augmentation to a therapeutic program. All the bullet points that Sillvva included in their original response to the OP are things that group therapy often heavily focuses on, and a properly managed game of D&D can further those goals. I can tell you from personal experience that people trying to recover from addiction often really do need to relearn how to just get along with other human beings. The same goes for people coming out of incarceration (no personal experience but there's quite a bit of overlap between addicts and inmates) because the ways that experience affects how one perceives and interacts with others is an entire can of worms that I'm not even going to try getting into here; suffice it to say that describing people fresh out of prison as "having difficulty adjusting" is often a gross understatement. If the DM is also a qualified therapist or counselor who is creating and encouraging situations for players to act out situations relating to the sorts of issues the particular group should be working on, D&D can be a great way to facilitate that. And that's in addition to the general points of just getting along, following rules, taking turns, and generally being respectful to peers (all things that at least some people in therapy really need help with) that were covered in those bullet points. 

TLDR: a game between players with similar issues and DMed by an actual, qualified therapist as part of a larger counseling program can definitely be helpful in a therapeutic manner. Just playing D&D or other TTRPGs in general can be a good way for many people to just practice general social skills in a relaxed and comfortable situation. But just playing D&D with your friends or random strangers is in no way a valid substitute for actually talking to qualified medical professionals if you feel you need therapy. 

There's an idiom that comes up often in this discussion that I think holds some merit; "D&D is therapeutic, but it's not therapy". What that means is that therapy is something that should be practiced by professionals and while D&D (or TTRPGs or just roleplay) can be a tool that they can leverage. However it's important to remember that D&D itself, in the absence of a professional, is not therapy itself and shouldn't be approached as such. This is less aimed as the OP, and more those who might possible misinterpret the notion of D&D as a therapy tool.

However, D&D can be incredibly therapeutic as a means of socialisation, identity exploration, and social skill development. I wouldn't never knock D&D in that application.

Quote from MidnightPlat >>

Quote from Caerwyn_Glyndwr >>

 Again, is this based on your experience as clinician, specifically in a mental health / therapy context?  Or are you simply conjecturing and ignoring the fact I and one other poster has mentioned that TTRPG is actually being used in a therapeutic context?  Again, there are established, and fairly well funded practitioners doing this work.  Is your, from what I can tell, conjecture aware of their existence?

As a clinician, no; what I am is an attorney who represents the local child welfare agency and other local health agencies in issues such as child abuse (which often involves clinical work for both the parents and children) and stemming from adult mental health difficulties.  In addition to spending the bulk of my day dealing directly with clinicians, it is necessary I keep up to date with accepted practices and methods, to advocate for or against their use at Court.  Though most of my casework involves the extreme end of mental health difficulties, I also do work related to more mainstream mental health challenges, mitigating some of the bias handling extremes might cause. I will, however, admit that it is my job to be risk-adverse in advising mental health providers, which tends to establish bias toward established and recognised practices. Whether you think that is sufficient experience to provide insight is up to you, and you can feel free to discard my every thought if you would like.

Hiwever, if you reread the anecdotal post from the individual who said they had used D&D in a therapeutic session, you will see it specifically corroborates what I have been saying since my first post - that it has merit for one’s mental health, but is not a full replacement for established therapeutic practices. As the user said, the use of D&D was part of a greater group therapy strategy and could not be a substitute for individual therapy.  The underlying element of their post is that D&D has merit in improving mental health (and likely an element of making folks more open to one another in their group therapy sessions), but is not being used as a full replacement for established therapeutic practices. 

As I said, there are mental health benefits to D&D - and I could see a therapist utilising it as part of their greater therapeutic plan for its mental health and socialisation benefits - but I would be highly skeptical using it as an evaluative tool or as a full replacement for more established forms of therapy.  

D&D is like taking a walk, having a good friend or (most pointedly) having a hobby.

These are things that can help your mental health. They generally do, whether you are in need of professional help or just a generally happy person. D&D even has qualities that in some ways make it better for improving your mental health than others.

But it must be made very clear and emphasised: D&D is not something you can do in lieu of actual therapy or professional help. If you are anywhere near the level of needing actual help, thinking D&D might "cure" you on the cheap will not heal you and just prolong your suffering. If you think you may have broken your arm, you don't take vitamins, you go to hospital and get it checked out. Same here. D&D may help, but if therapy is entering the picture, then you need to get checked out.

I just don't want people getting false hope of avoiding intervention. When you're in that situation, you can grasp on to anything to avoid getting things dealt with by a professional.