Defense Date


Graduation Date

Fall 12-16-2022


Immediate Access

Submission Type


Degree Name





McAnulty College and Graduate School of Liberal Arts

Committee Chair

Elizabeth Fein

Committee Member

Russell Walsh

Committee Member

Rachel Kallem Whitman


Autism Spectrum Disorders, play therapy, gaming, therapeutic gaming, clinical ethnography, disability, theory of mind


This qualitative study is a video-cued multivocal ethnography that analyzed the clinical reasoning and perspectives of psychotherapists using Tabletop Role-Playing Games (TRPG) as a therapeutic treatment for children and adolescents diagnosed with Autism Spectrum conditions. With a growing number of TRPG therapists nationwide using this modality in their clinical practices, this study aimed to develop a clearer understanding of the ways in which their therapeutic orientation, gaming practices, and knowledge of Autism Spectrum Conditions informs their use of TRPG psychotherapy with Autistic clients.

Research that focuses on clinical decision-making and the knowledge that informs clinical interventions and technique generally refers to these as “clinical reasoning”. By observing therapy and interviewing therapists about their clinical practice, this study collected data about the different types of clinical reasoning TRPG therapists use when working with Autistic clients. Through the use of video-cued multivocal clinical ethnography, one TRPG therapist was observed and interviewed as she conducted TRPG therapy with Autistic clients and described the clinical reasoning behind the design and implementation of this treatment modality. Using ethnographic semi-structured interviewing and Brief Structured Recall (BSR), the video footage of the TRPG therapy served as a video cue for interviews with three other TRPG therapists, allowing the therapists to authentically reflect on the theoretical underpinnings behind their clinical judgement and decisions.

As Autism psychotherapies have been expanding to include approaches integrative of behavioral as well as psychodynamic orientations, TRPG therapy as a “semi-directive” treatment offers an emergent treatment option that integrates directive and non-directive approaches to Autism treatment. TRPG therapists discussed the ongoing tension between non-directive and directive approaches to treatment, which simultaneously mirrored historical debates between these two approaches in play psychotherapy for Autistic patients. The results of this study reveal how TRPG therapists’ perspectives diverge from mainstream and previously held clinical views on Autism diagnosis and treatment. The results of this study show the alternative ways in which TRPG therapists view Autism symptomatology (i.e. sensorimotor needs, Theory of Mind, sociality) and the evolving nature of Autistic comportment that emerges through and is mediated by player immersion in the gaming space and interactions with the game’s structure and mechanics. Operating both as Dungeon Master and Therapist, the TRPG therapists discussed how they simultaneously utilized and integrated these multiple roles with competing paradigmatic perspectives while grappling with gaming, clinical, and cultural perspectives of Autism diagnosis and Autism treatment.