For many, the fact that video games are now the most popular form of entertainment is tainted by the specter of addiction. But a growing class of clinicians see the universality of video games as an opportunity rather than a threat. The mental health professionals on PAX East’s “Empowering Gamers” panel consider familiarity with the medium essential to connect with the people in their care.

“Games are tools,” said Dr. Ryan Kelly, a clinical psychologist and the head of G33ks Like Us. “We find ways to use them for good and find ways to make sure they don’t become hurtful, like anything else.” Parents are quick to blame consoles, but according to Kelly, they tend to be an escape, not the root cause. “The games, although problematic at that point, aren’t the main problem,” he explained. “We have this tool that they get so much catharsis from, that they have friends on – we’ve got something for them to work toward and something that means something to them.” And despite the fearmongering around addiction, that level of investment means games can be almost uniquely effective means of building trust and modifying harmful behavior when used correctly.

With a doctorate in clinical psychology and a masters in game design, Dr. Kelli Dunlap is particularly well equipped to bridge that gap. She describes games as an “easy rapport button” for her clients, especially teenage boys who wouldn’t otherwise be interested in opening up to her – or anyone. In the case of one adolescent at her practice, “No one else had been able to get him to do anything” – but after a conversation about the “Halo” universe, “We were best friends. He wouldn’t shut up and didn’t want to leave! Games are usually pooh-poohed by adults as something that’s bad,” she said. Recognizing their genuine significance opens up a range of possibilities for connection and change. In 2019, she said, “Games are a cultural competency.”

That’s not to say applying them therapeutically is without its challenges. “There are thousands of games out there. I know I’m too old to pick up a new Twitch shooter, and I’m at peace with that,” Dunlap joked. Her solution, both for herself and other mental health professionals, is an unorthodox one: a series of clinicians’ guides to games ranging from “Fortnite” to “Minecraft,” with themes and discussion prompts based on the titles her clients care about. “Asking someone what they play and why they play it provides some of the most valuable data,” she said. “That’s better than any projective test or assessment.”

For Dr. Chelsea Hughes, a psychologist who works as a researcher at Riot Games, gaming has proven particularly helpful when talking to clients from marginalized communities, providing an important jumping-off point for conversations about privilege and identity. “There is so much power in having the opportunity to present however you want,” she said. “Video games give us an opportunity to explore who we are, not just as ourselves but what we present to the world.”

Even a mobile game like “Farmville” can be a force for good. Dr. Sarah Hays of Save Point Behavioral Health had a client who struggled with obsessive-compulsive disorder and played “Farmville” endlessly. Rather than taking it away from him, she set him a challenge: he had to play without organizing his crops. “He was upset about his strawberries for weeks,” she said, laughing – but the exercise achieved exactly what they’d hoped. “It stopped him from chronically, compulsively playing ‘Farmville’ to make his life feel in control.” For another patient who struggled with social anxiety but loved MMORPGs, she set the task of saying three sentences to anyone he encountered in the world. He, too, resisted at first but ultimately benefited from the intervention. “Part of it is that you have to get uncomfortable to grow and change. Gaming softens the difficulty of the process, but still gets to the core of vulnerability.”

For Kelly, the other panelists, and the burgeoning community of “geek counselors” they represent, it’s a matter of channeling gamers’ passion productively: “Not to get rid of It, not to shame it, not to pathologize it – just, ‘How do we use this?’”