I first heard Kelli Dunlap speak at PAX Prime 2014 in the panel “Giving Through Gaming: Making the World a Better Place,” and her stories blew me away! Here’s a PhD who happens to be a knowledgeable and avid gamer and who has used her gaming experience to help her clients in some amazing ways.

She says she first became interested in the interaction between video games and mental health while studying psychology as an undergraduate. She graduated with her Bachelor’s in psychology from American University and then pursued her doctorate in clinical psychology. Her doctoral dissertation is titled, “Mediating Factors in the Relationship Between Video Games and Mental Health.”

I know kids who’ve experienced play therapy. It’s an established therapeutic technique, right?

Yes. Play therapy is a thoroughly researched and empirically supported treatment modality. Just like “camping” in video games (a tactic where a player stays in one place to gain an advantage), it is a legitimate strategy.

Do you think what you do with video games falls into the play-therapy model, or is what you do different from that?

As with all things in psychology, it depends! There are many different types of play therapy. For example, a non-directive play therapist would never use a board game, much less a video game, in therapy. However, a play therapist with a more directive orientation would have no issue using a board game during a session. Ultimately, the underpinning of play therapy is that play is the natural language of the child and that children can express themselves through play effectively and with less distress. Given that definition, I feel video games can be used as a play therapy technique. When talking about or playing video games with my clients, I am always listening for themes, stories, and feelings projected onto the characters; providing validation; and fostering an environment where the child feels heard, understood, and accepted. When doing therapy work with a child that involves video games in some way, I actually rely more on my training in play therapy than on my knowledge as a gamer (although that last part is quite helpful)!

In the PAX panel, you said knowing video games made you a “god” to kids. That made me laugh. But it’s true, right? Kids are impressed and happy with adults who actually know about video games and enjoy them?

That was a bit hyperbolic, but it really is amazing how sharing my knowledge and experience with video games frequently cracks even the thickest oppositional attitude. I do not think it is specifically video game knowledge though; rather, I think one of the most therapeutic things anyone can do is to take an interest in something the child likes. It just so happens that most children in the U.S. play and enjoy video games, so I have a bit of an advantage.

I think what makes video games special is that there is still a stigma against them and those who enjoy them. Gamers are often labeled as “nerds” or “geeks” in a way that is meant to be derogatory. Many of the parents I work with blame video games for their child’s problems and routinely impart to the kids that video games are bad, worthless, or a waste of time. For example, I was working with a child with some severe self-esteem issues. He loved Pokémon, and so I brought in my Nintendo DS and had him teach me one of the new games. (I told him in my day there were only 151 Pokémon—he didn’t believe me.) Afterwards, I spoke with his mother about how we had played together, and during this time he had been able to communicate effectively, give direction, take on a leadership role, and—an accomplishment for any child with an ADHD diagnosis—sit still for the entire 50-minute session. His mother was pleased and stated, “Oh, I’m glad you play with him. I don’t play with him on those things. I don’t understand those video game things.” Ouch.

When I am able to share my gaming knowledge and experience with a child, not only am I establishing commonality and rapport, I am validating the child and their experience while simultaneously working to de-stigmatize the label “gamer.” If, as a parent or provider, you can talk about your latest Minecraft build or your favorite Halo map, that’s great. But I think the most important part, the god-like part if you will, is not passing judgment on children and showing a genuine interest in what is important to them.

You talked about how video games can be a way in—a tool for reaching kids who are in distress. Why do you think that works?

As I mentioned above, taking a genuine interest in the child and their interests in incredibly therapeutic in its own right. Almost every single child I saw in the last year played video games and found them to be an enjoyable pastime. I often equate having an interest in video games as having an “easy button” for rapport building because so many children game and love to talk about the games they play. Knowing what game they are playing and why they play can be a huge help in getting a deeper understanding of what is going on in the child’s life. Video games can be effective because, like traditional play therapy modalities, you are having a conversation in the child’s natural language of play. Most children love to talk about the video games they play once they realize you have a genuine interest and will not judge them. I had one young boy who loved Minecraft. We used paint and crayon to create Minecraft characters and give them attributes. My character had +10 resilience-bound shield to deflect unkind comments, +15 onyx armor for strength, and a diamond sword of challenge to slash down negative automatic thoughts. My client’s character had boots of flight so he could run fast. He also had a charm for climbing trees to escape, and used a bow and arrow so he could attack opponents from afar. Lastly, he had a cloak of invisibility. This naturally led into a conversation about why his character needed to run away, hide, and escape. The parallels between what his character experienced and what he was currently experiencing were evident. This same kind of technique is commonly used in traditional play therapy, but with dolls or toys.

In short, video games used in this way can be a way to help children in distress because it is applying traditional tried-and-true play-therapy principles in a modernized way.

You told one story about a boy who everyone thought was ADHD, and you found out something different. Can you tell that story?

I was working with a child diagnosed with ADHD. He had difficulty sitting still, talked a great deal without really saying anything, and bounced from topic to topic. He presented as happy, always smiling, and reported that things at school and home were fine. However, when we started talking about the games he played, he began to talk about how his brother was always better at him in everything, and how his brother often deleted his games, teased him for being at a lower skill level, stole or broke his games, and called him terrible names. Over time, talking about how his brother treated him lead to conversations about how his parents treated him and the discord and chaos that was rampant in the house. It became clear that ADHD was not the primary problem this young boy was facing and that his hyperactive behaviors seemed strongly linked to his home life conditions. Talking about this material was very hard for him. I relied on his love of Pokémon as a means of modeling and teaching coping techniques (e.g., Would Ash Ketchum give up? How would he handle a challenge? Did Ash ever feel sad or scared? What did he do then? As Pokémon evolve, they get stronger. How can you evolve and get stronger, too?) as well as reward him for working through the session. The last 20 minutes of every session was dedicated to playing Pokémon on his DS, talking about what Pokémon he’d caught during the week, which Pokémon had evolved, and which gym leader he’d defeated. In this way, video games allowed me to quickly establish a therapeutic relationship, understand an experience he was unable to verbalize, help him develop coping mechanisms to deal with a very difficult and scary situation, and remind him of what it felt like to be happy, accomplished, and accepted.

Do you have other stories about how you’ve been able to reach kids through video gaming?

I have many, many stories. I think my favorite, though, was when I was doing an initial session with a boy around 13 years old. He had been brought in by his mother and he desperately did not want to be there. He glared, snarled, said “no” to every question. Near the end of the session I noticed his shirt said “All day I dream about video games.” I asked him about his shirt and he was defensive, likely expecting me to either feign knowledge or discourage him from playing. I told him I played video games and he said, “No you don’t, you’re a girl.” Now, it might not have been my finest moment, but that comment really ticked me off, and so I retaliated with my gaming resume—that I play in tournaments, attend conventions, speak on panels, and personally know people who make AAA blockbuster titles. Again, not my finest moment, but it proved effective. He suddenly became very interested in how I obtained my gamer status, what games I played, who else I knew in the gaming industry, and if I’d ever played the list of games he enjoyed. This opened up a dialogue and effectively moved me from “one of them” to someone he could talk to.

Are there some types of issues kids have that video games are of particular help with?

I love using video games to address self-esteem issues. Video games are a medium that is well suited to this task. Video games are based upon the principle that nothing is impossible if you keep trying. They teach resilience in the face of failure, as you will fail repeatedly while playing any video game. No video game is impossible. Coyne (2011) even found that girls who play video games with their fathers showed decreases in aggression and internalization of emotion regardless of the kind of game they played. In short, daddy-daughter video gaming session strengthened the relationship bond and fostered happier, more well-adjusted girls.

Do kids sometimes get so engrossed in a game that it’s difficult to talk to them about other things going on in their lives?

Kids often become engrossed in a great many things that make it difficult to talk to them about anything else. Gaming is no exception. I had one child in particular who would spend the entire session talking about his Pokémon, their battles, and his latest Pokedeck addition if I let him. After two or three sessions of this, he and I made a deal that we could talk Pokémon during the last 15 minutes so long as we talked about school, homework, family life, etc., for the first part of the session.

Are parents and other therapists resistant to your use of video games in therapy? If so, how do you handle their objections?

There is a lot of resistance toward video games in the professional sphere. For example, when I was applying for my training placements, I was advised to exclude my video game interests because it would make me seem unprofessional or not serious. I have had several peers and even supervisors question my research into video games and the use of games in therapy. I have handled their objections by sharing obscene amounts of research on the topic until their eyes glaze over. But for the most part, my peers and supervisors have been more curious about my work than anything else.

I have had parents voice concern over the use of video games in therapy, but typically after providing them psychoeducation based upon research and how I use games in a therapeutic manner, they tend to acquiesce. I have never had a parent tell me that I could not use this approach with their child. In fact, most parents are relieved when I tell them my background.

Have you written articles about video games & therapy? If so, can we read them? 🙂

I have one published article from when I was completing my advanced practicum at the Veterans Administration. I designed a 20-module group-therapy project on developing and promoting resilience in veterans. The modules were designed with game elements, such as leveling, quest completion, boss battles, epic rewards, etc. Although video games were not available, I did encourage the use of smartphone apps for my group participants as part of their “quests” (aka cognitive behavior therapy homework).

At some point I will be working to get my dissertation published…

I have also done a few presentations on my dissertation and on mental health and gaming in general, which are available on YouTube.

I read an article about some therapists who use superheroes to reach kids. Do you know of books or articles or other resources that cover the use of video games in therapy?

There’s a 2010 article by Ceranoglu published by the American Psychologocial Association (APA), which provides an overview of the use of video games in therapy. To my knowledge, though, most books and articles focus on the impact of games on children in general rather than their use in psychotherapy. This is due in part to the therapeutic application of video games being a relatively nascent topic. Most of the research I’m aware of specifically on video games in therapy comes from video games created for just that purpose. SPARX, Treasure Hunt, and Nevermind are three examples of games developed specifically to be used in a therapeutic setting; they deliver therapeutic constructs in a video game format.

Of course, there’s always “Reality is Broken” by Jane McGonigal. It’s not therapy-specific, but it is, in my opinion, the seminal piece of work on the benefits of gaming and how gaming is making the world a better place.