Dungeons and Dragons: the use of a fantasy game in the psychotherapeutic treatment of a young adult.

A schizoidal young man made a methodical attempt at suicide. He revealed a paucity of object attachments leading to profound isolation. His early upbring led him to extreme isolation of affect and a fear of fragmentation. His inner life was not safely reachable by conventional therapy. After he became involved in playing a fantasy game, Dungeons and Dragons, the therapy was modified to use the game material as displaced, waking fantasy. This fantasy was used as a safe guide to help the patient learn to acknowledge and express his inner self in a safe and guided way. The patient ultimately matured and developed healthier object relations and a better life. The theoretical underpinnings of this process are explored, both in dynamic terms and in terms of the biologic correlation and equivalence of dreams and waking fantasy. The utility of this game as a vehicle for treatment of selected individuals is discussed.