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  • Writer's picturePaul Matthew

Gaming as a Cultural Resource in Pluralistic Therapy

How many of us have heard or overheard people saying there was no such thing as mental health when they were younger or that people with depression or anxiety are just “Making it up”. My fellow therapists will know all too well the phrase “I don’t really need help, my doctor sent me”. The truth is that everyone experiences mental health difficulty at some point in their life and that’s at the very least. We can all benefit from seeing a therapist at some points in our life.

What if you could tell those that think Mental Health is just a 'modern' thing or just for other people, that attempting to understand and treat mental health is almost as old (and respected) as the treatment of physical ailments? The first part of this blog is intended to be a subtle reminder of just that. The second part, I'm going to look at Gaming in Pluralistic Therapy.

Ancient Babylonia and China

The ancient Babylonian doctors had very accurate descriptions of depression ( While the Babylonians didn’t use the word Depression, they had doctors who treated for a condition loosely translated to “Distress”.

There are also documents which describe one condition (which sounds very much like bereavement or depression) as “Broken Heart” and even describes people who feel they are 'dying' of the 'broken heart', one notable one in a letter from a man who had fallen out of favour with the court of the king ( There are descriptions of mental distress, lack of sleep, cognitive difficulty. Doctors in ancient Babylonia, treated these as if they were ailments similar to physical ailments. While the treatments were very different to the talking therapies of today and we can in no way argue that they had a better understanding of mental health, the attitude towards mental health was in some places more accepting than some of the attitudes we face today or at very least, faced in the not so distant past..

As early as 1100 BCE the idea of a ‘Balance with Nature’ or balance of ‘Yin and Yang’ was part of common understanding in Chinese medicine ( The idea that mental illness was a result of an imbalance with nature and treatment included using herbs, acupuncture and “emotional therapy”. The Chinese also attempted to draw a line between emotions and the human being and how the community can support those who were suffering this “imbalance”.


Now let those self-same people I mentioned in the beginning tell you that computer games “rot the mind” or “encourage violence”. The very same sorts of people said in the 19th Century that trains would cause “Instant insanity” (

I have always been a gamer, and am aware of the risks. Like most things, gaming should be done with limits and breaks. It is obviously not healthy to game for days on end but studies have shown that gaming can reduce stress and anxiety and increase brain function (

A few years ago, I met a young client who had severe anxiety, she wouldn’t enter social situations, she couldn’t even go to the shop without her sister accompanying her. When she came for her appointments, she sat in the reception area and wouldn’t approach the reception. Luckily, I was well aware of how daunting this could be and I approached her cautiously and sat down so as not to make her feel uncomfortable. I explained who I was and asked if she was my 2pm appointment.

The first few sessions we sat in silence a lot of the time and slowly she got to know me and trust me and we began to talk. It took a little while for her to bring her presenting problems to me, but in those first few sessions I realised that it was therapeutic in itself for her to speak to a new person. She’d often remark that she didn’t know why or how she could talk to me (a compliment I hold on to this day). As she became more open with me, we talked about her support network, and her cultural resources (

Week in, week out as a sort of check in ritual for the first few minutes we’d talk about a game she played on her computer. Often it was an introduction to a mindfulness technique or grounding exercise before the body of the counselling session, or just a warm up exercise. She’d tell me how this game made her feel relaxed, and how thinking about new strategies and approaches she was going to adopt in the game got her through a particularly noisy or stressful meeting or got her on the bus that day (something that wasn’t necessarily guaranteed when her anxiety took over).

For me, it’s very much the same, especially in the pandemic. I find myself unwinding after holding the space for my clients, by spending an hour or two gaming. My thoughts are clearer afterwards. I do feel sharper the next day and noticeably less anxious if I game the night before a meeting

There are articles and studies showing gaming can help with PTSD, Anxiety, Depression and other presenting issues ( Going one further an American Psychological Society article suggests Gaming can be a useful tool developing the therapeutic relationship (

Other Games in Therapy

It’s been long established in child therapy that play can be a crucial tool in therapy. I don’t think that necessarily stops with children. Board games, fantasy games, card games and other popular games can have a therapeutic affect and help people in therapy.

Dungeons and Dragons for instance has proven to help teens open up ( It has it’s meaning as a cultural resource or mindfulness technique too. You get that same sense of escape from a fantasy game like Dungeons and Dragons that you do with a good book or film. Except maybe there’s an added helpful element in the social interaction and perhaps heightened escapism created by a good ‘dungeon master’. There are many possible applications in group therapy too.

I like to lean on the idea that the client is the expert. If they express an interest in Gaming, then I make that part of the therapy discussion, if they are a ballet dancer, I make that part of the discussion. It’s important that we remember that people are individuals and our approaches can’t always be out of the box and for non-therapists, if our partners turn to gaming when they are stressed, encourage it, it could be what helps their mental health.

Whether an active part of therapy, or a few hours to help relax after a long day, it’s safe to say that perhaps it’s time we consider gaming for its opportunities, like we do with music and other methods of entertainment.


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