During the challenging era of COVID-19, many young people experience the kind of isolation that can affect healthy social development. This is especially true for young people who were already struggling with significant psychological problems before the pandemic. Telemedicine group therapy, in which role play is used, offers a hopeful opportunity to promote individual growth in a group context.
Stage design
If one of us logs in to the Zoom session 10 minutes earlier, an image of a cat appears immediately. Martin waited all morning for the group to start. He appears briefly and shows us his cat, Betty, who is sitting on his lap, before turning off the video so that only the photo of Betty is visible.
Gradually everyone else joins in and our game begins. Martin is committed to the group; He's never missed a session and is always early. In Dungeons and Dragons and other role-playing games, party members play fantastic adventurers who work together to overcome obstacles and earn rewards. The moderator tells a story and the group members describe how their characters react.
Martin plays an elf magician named Sylvan who has a cat (also called Betty) as a magical animal companion. Martin was a bit shy at first, but has integrated into the group and participates in joint decisions. He also loves talking about Sylvan's cat and backstory. Martin joined the group following the COVID-19 order in spring 2020 after we moved to a virtual environment. As with some of the others in the group, this is Martin's only social contact outside of his family.
The therapeutic group enables structured social interaction – a place where people can connect, practice social skills and modulate their inner and outer world. Many of the young people we work with suffer from social anxiety, depression, or lack of social skills. Experiencing a safe social environment in which to experiment to become someone else enables them to develop connections that can be both an antidote to loneliness and an opportunity for growth.
The COVID-19 pandemic was a time of isolation. Young people in particular have fewer opportunities for social development and schools cannot offer as many opportunities for social contact. Telemedicine group therapy with role play provides opportunities for social connection and building resilience that may not be possible in person during the pandemic.
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Collaborative creativity
Role playing games occupy a place in pop culture as a niche interest, but their popularity has increased in recent years and therapists have begun to further implement the games as a group therapy modality for older children and adolescents. In role-playing games, a moderator describes an imaginary world and the participants (playing characters) describe their actions in this world. Sometimes success and failure are based on dice, but the creativity and cooperation of the players are also crucial in helping a group achieve its goals within the world. The game has many decision points and any player can change the course of the story.
Martin's character Sylvan blew up treasure chests with fireballs, cheated on goblins by pretending to be their grandmother, and hatched a dragon egg. Martin's creativity affected the world for himself and the other players, creating new circumstances and changing the direction of the story.
During the game, the moderator prepares the stage: “You are entering the pirate's cave. If you go inside you will see a couple of pirates standing guard. "
The group members discuss how they would like to respond. Should they fight the pirates or try to sneak past them?
"Let's trick them", Maya suggests enthusiastically. Maya is shy in real life, but in the game she plays a tough thug who likes to smash doors. Martin's character is cunning and mistaken. He likes the idea and they work together to find a trick.
Martin's character says: “We are poor pirates who got lost in the tunnels. Can you explain the way to the ship for us? “He rolls the dice to see if he can convince the pirate guards to let them pass.
Traditionally, role-playing games are played personally, sitting at a table with cards from the adventure setting, rolling dice and telling the story together. However, it is possible to play the games remotely via video conferencing and using online platforms. In recent years, the use of remote role-playing games has increased dramatically. The virtual medium offers new advantages during the COVID-19 pandemic and in times of physical distancing. It translates surprisingly well into a telemedicine group therapy experience. Martin, who is struggling with social anxiety, told the moderators: “I prefer to play online. I can turn off my video. "
The origins of change
In the many groups that we have led with colleagues, we have observed the emergence of group dynamics and interactions between group members, which have influenced the decisions of the members and their participation in the group. A certain group dynamic becomes apparent through the interaction of the group members with one another or through the progress of the group over the course of many meetings. Other patterns arise from the development of individual group members and their effects on the group.
We were particularly impressed with the memory of Kendra, who had a very clear idea of how the game should go on. She wanted so much in control of the narrative that she soon began to frustrate the other players.
"Can I roll the dice to convince Maya to give me her gold?" Asked Kendra. She prioritized stealing gold or impressing pirates controlled by the GM rather than helping the other characters.
This led to frustration among the other group members. Some members began to remain silent. One spoke up furiously against Kendra and suggested that the characters of the group members fight against Kendra's character. The group's frustration turned into a discussion and Kendra eventually changed her character's behavior completely, deciding that her character had to work with the group and eventually save them to sacrifice themselves for the common good.
She said, “I want my character to help the group, but the shift needs to make sense for their character arc. She can't just change clothes overnight. "We had numerous discussions about what it might mean for your character to develop.
We asked the other group members what they liked about the game and another member said: "Working together as a team." The emotional message felt palpable. We were thrilled that the young participants were able to lead this discussion themselves and process it as a group with only minimal prompting from the adult moderators.
In role-playing games, the players describe the actions of their characters, while the game master describes the rest of the world and the people who inhabit it. The world is imaginary and visual aids are optional. In a therapeutic group, this system enables group members to examine the construction of identity and control group dynamics. Therapy groups for adolescents support the essential task of identity development in the context of relationships with peers and adults.
Similar to any good therapeutic group, what happens in the context of the game often reflects the life of the members outside of the game. If the GM is also a therapist, ask questions like "How are you like or different from your character?" and "Why did your character make that decision?" Make the game a clinical experience. The character's avatar allows each group member a safe distance over which to explore, process, experiment, fail, and be successful.
Group trial as an adventure
Role-playing games have long been an effective group therapy method, but creating a shared imaginary world offers unique opportunities during the COVID-19 pandemic when we cannot safely assemble in person.
Each age has different developmental tasks to complete, and during the pandemic these tasks were either interrupted or required notable changes in the way we carry out them. As schools postpone the way education is delivered due to the pandemic, the level of social interaction has been significantly reduced. Overall, we spend more time isolated from others and young people have fewer opportunities to develop socially. Role-playing, a highly engaging activity, enables social experiences through telemedicine in ways that may be currently impossible in person.
Role plays involve goals, conflicts, decisions and relationships. Young people can do something together by doing tasks that require creativity and teamwork. Playing every week creates routine and ritual. Having a group means that young people have regular contact with adults and their peers outside of their immediate family.
Games can be customized for different ages and needs. Children and young people can develop leadership functions and practice resilience. The technology required to play the game online can cause malfunction and frustration, allowing participants to be patient and troubleshoot. Because the games are fun and silly and upbeat, the fantasy setting can provide anyone with a much-needed break from the stress and grief of the present world (or a way to come to terms with grief and loss as characters can die too).
This innovative form of group telecommunication offers the possibility of including young people who otherwise might not actively participate in a group process. It also offers the opportunity to help maintain interpersonal relationships with group members who urgently need to develop social skills. Right now, during the pandemic, we can offer something that simulates living and striving in close proximity to others. These challenging times require innovation. Therapy can become exactly what kids need: a safe but exciting place where they need to be challenged to grow. In other words, an adventure.
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Related reading from the CT archives: "The power of virtual group therapy in a time of quarantine"
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Per Eisenman ([email protected]) and Ally Bernstein ([email protected]) are community mental health advisors in the youth and family service program at the Addison County Advisory Services in Middlebury, Vermont. Since 2015 and 2018, respectively, they have been leading therapeutic groups for young people who use role-playing games. At the start of the COVID-19 pandemic, they switched these groups to telehealth.
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It should not be assumed that opinions or statements in articles appearing on CT Online represent the opinions of the editors or guidelines of the American Counseling Association.
