May 27, 2025

Therapeutic Tabletop RPGs: A Conversation with Dr. Megan Connell

TTRPGs can be a powerful tool for emotional growth.

Tabletop role-playing games have come a long way from being dismissed as a nerdy (or even Satanic) pastime. For Dr. Megan Connell, they are a powerful tool for emotional growth, communication, and healing. As a clinical psychologist and co-founder of HealthQuest Innovative Therapeutics, Dr. Connell has made it her mission to explore the incredible overlap between TTRPGs and therapy.

We sat down to talk about her book, the growth of therapeutic gaming, the role of game masters in clinical settings, and the future of games as tools for personal development.

From Character Sheets to Clinical Insight

Dr. Connell’s journey began like many others, playing with friends in middle school on notebook paper instead of character sheets. Years later, she began noticing that some of her in-game decisions and character development reflected deeper aspects of her real-life personality.

Those insights led to a career-long exploration of how role-playing can surface important themes for healing and growth. As one of the first psychologists using TTRPGs in therapy, she refined her techniques through collaboration and eventually documented what she learned in her book, Tabletop Role-Playing Therapy: The Guide for the Clinician Game Master.

How Therapy Looks at the Table

If you watched one of Dr. Connell’s sessions, it might look like any other RPG. But beneath the dice rolls are carefully structured goals and tailored encounters that support individual growth. A player struggling with anxiety might be encouraged to take the lead in group conversations. Another might work on self-advocacy by role-playing a character who can set boundaries.

Everything is done transparently, often with group discussion built into the session. As Dr. Connell shared, one of her favorite tactics is to tie leveling up to progress on therapeutic goals. Experience points aren't just for slaying dragons anymore. They can be for learning to say no, speaking up, or resisting the urge to apologize excessively.

Communication at the Core

Dr. Connell prefers the term "communication devices" over "safety tools" to describe tools like pause buttons, vibe checks, and player lines. These tools support transparency and give players a way to signal when they're uncomfortable or confused. Whether someone needs a quick bio break or wants to express discomfort with a storyline, communication devices provide a structured way to do it.

The importance of these tools is underscored by the power imbalance between players and the game master. As Dr. Connell explained, it's crucial to create an environment where everyone feels respected and heard.

What Makes Games So Effective?

Gaming, particularly in therapeutic settings, taps into the psychology of "flow." Drawing from the work of Mihaly Csikszentmihalyi and Lev Vygotsky’s zone of proximal development, Dr. Connell explained that games are designed to challenge players just enough to keep them engaged and growing.

Whether you're learning to plan multiple steps ahead in a board game or practicing boundary setting in an RPG, you're rehearsing real-life skills in a safe, engaging space. One player in a therapeutic group even reported finally learning to say no to their friends after weeks of playing a character who modeled that behavior.

Beyond Dungeons and Dragons

While her book focuses on D&D, Dr. Connell emphasizes that many systems can be effective in therapy. She is especially excited about culturally rooted modules and supplements, like Coba (inspired by Central American myth) and the Ilo Sina Una setting from Hit Point Press, which highlights Filipino and Polynesian cultures.

These tools do more than create immersive gameplay. They offer players opportunities to learn about cultures and belief systems through narrative and character exploration.

Where Do We Go From Here?

Research in the field of therapeutic gaming is still developing. Dr. Connell hopes that future editions of her book will include updated findings and fewer calls for additional studies. For now, she and her peers continue to build frameworks, host trainings, and refine practices.

Her next project focuses on board games as tools for developing real-world skills like impulse control, long-term planning, and communication. Whether you are a clinician, game master, or simply a curious player, there are more ways than ever to use games for growth.

Final Thoughts

Games are for everyone. And they aren't something entertaining that only exists in a vacuum. It is a place where players can safely rehearse the kind of people they want to become, learn how to advocate for themselves, and build confidence in ways that spill over into daily life.

As Dr. Connell put it, play is vital across the lifespan. And in a world where connection and purpose are harder to find than ever, RPGs and board games may offer more than we realize.