Co-op Therapy: Using Video Games to Connect with Teen Clients

By iThrive Games
April 20, 2018

In my therapy practice, I've found that the best way to reach a client is by speaking his or her "language." When it comes to talking to teens, I don't just mean speaking English or Spanish. I mean speaking fluently about the latest trends, songs, and games.

I once worked with a client who did not want to participate in therapy at all. He just sat there. This is not uncommon, especially for teens brought to therapy against their wishes, but I had some ideas on how to help him open up. I was an in-home therapist at the time, so I was able to observe this client's home environment and easily find things in it to ask him about. In this case, what I chose was the client's GameCube. I asked him about his favorite games and whether he'd be up for playing one of them together. He ran and grabbed two controllers.

Nintendo GameCube, 2001. Image source

We played Dragon Ball Z: Budokai, a fighting game. I was excited to play because we both loved "Dragon Ball," an anime (Japanese cartoon) about martial artists saving the world. The first time we played, I won and he reacted with some playful trash-talk — "Oh, I'll get you next time!" — and we both laughed about it. He seemed to be having fun until I won again.

I noticed he seemed to be getting angrier every time I won, so after a few games I let him win. He became obnoxiously excited, taunting and teasing me for losing. I realized he could benefit from working on social skills and emotion regulation, things that were not on his treatment plan. Stepping into his world by playing a game he loved revealed to me several issues that needed to be worked on to help him thrive, things that previous observation had not brought to light. Finding these things out was a net positive, but continuing to play a game in a way that triggered angry or obnoxious responses was not going to help. So I decided that we would play together, not against each other.

My client didn't have any cooperative games — ones where we could play on the same team together — so I stopped by a Gamestop and picked up some used games for him to choose from. The one he wanted to play was Star Wars Rogue Squadron III: Rebel Strike, which also happened to be one of my favorite games.

Players work together to take down a Star Destroyer. Image source

Rebel Strike is a space-combat simulator set in the Star Wars universe that includes a cooperative 一 or "co-op" 一 mode that would let us play together rather than against one another. This was a great game for us to play because it has no versus mode (a gameplay mode where players compete with each other), only a "story mode" where the roles are equal and the play cooperative. Everything we did would help each other progress toward the goals of each mission. When we started playing, my client didn't seem to understand what was going on or what we were supposed to do. This was a great opportunity for me to fly ahead of him and ask him to follow me. It allowed me to teach him how to play, what the buttons did, and what the objectives were. I was able to be supportive and provide guidance in a way that he was open to.

Once he got the hang of things, we played the game as intended: Take out enemy TIE fighter ships and turrets and explode the Death Star. The important thing is that we did it together. We weren't competing anymore. It didn't matter who shot down more TIE fighters or destroyed the most turrets because ultimately we both won. This was very different from playing against each other in a fighting game.

These experiences helped build our therapeutic relationship; my client understood I was on his team and he began to open up to me while playing.

A few years later in my private practice, I had another client who did not want to open up at first. I asked him about his favorite things to do and playing video games, especially Minecraft, was at the top of his list.

Minecraft is available on many devices, so I was able to explore different ways to integrate it into our sessions. We started with the mobile version. My client had Minecraft on his phone and he asked if he could play during a session. It wasn't ideal because he was playing on his own and it seemed like his way of getting out of being there. So we tried a few different things. We agreed that he could earn game time at the end of the session if he participated. This often works with younger children but it turned out it wasn't a good fit for this teenager. He figured out quickly that he could sit silently for the entire session, or at least until it was time to play.

I tried the opposite approach and let him play at the beginning of the session for a set amount of time, during which we could talk about what he was building. Having something in common to talk about and something else for him to focus on while we talked helped establish a relationship, to lower some of his defenses, and to move toward more open sharing. A tentative peace treaty had been reached.

"Playing together - and not against each other - built trust, and I was able to show my teen clients that I was there to support them using their language."

It wasn't until we started playing together that we began to really make progress in building rapport and working toward our goals. I had an Xbox 360 in my office, so we were able to jump into a Minecraft world together. This is something my client was used to doing at home with friends and family and I immediately noticed that he was more relaxed and he seemed more comfortable with this setup. It was great to see that he was in his element. Exploring a world together, walking through the same space, we were finally able to communicate clearly. Maybe it was the setting, the fact that he trusted me now, or both, but we were finally able to get to work on our treatment goals.

In both of these examples, games were the client's preferred "language." Playing together — and not against each other — built trust, and I was able to show my teen clients that I was there to support them using their language. Using play and games in therapy to facilitate skill building and rapport is well documented, and video games are one digital extension of that approach.

For any mental health providers interested in using games, here are three quick tips for using games in therapy with teen clients:

  • Use games as an icebreaker and relationship builder: Asking about games teen clients like can be a great way to kickstart a therapeutic relationship with them. Demonstrating a genuine interest in something a teen is passionate about is always a good way to build rapport, whether it's games, books, or something else that you both like. For me, both talking about and playing games in therapy has been a great way to help my teen clients feel relaxed and trusting enough to talk to me and become open to addressing challenges.
  • Use gameplay as a window into habits and behaviors: Games can bring out behaviors or difficulties you may not otherwise see in action and can serve as a jumping-off point to work on developing adaptive skills. Games let players face defeat and frustration in a pretty low-stakes way. Those difficult emotional experiences are great opportunities to connect and work on building awareness and skills.
  • Mine games for their personal meaning to your clients: Not everyone has the resources or the know-how to have a dedicated gaming console in the office, and that's okay! Asking questions about what games teen clients like to play, giving them space to relive fond gaming memories, and analyzing the themes or narratives in a game can provide great insight into a teen's internal world.


About the Author

Josué Cardona is a mental health and technology expert. He runs, a website that celebrates the intersection of Geek culture and mental health. Josué has a background in biomedical engineering and a master's degree in mental health counseling. He operated his own psychotherapy and coaching practice for two years.