What video game-assisted therapy can look like in practice — face-to-face, online, and in groups. A clinician-focused guide to hardware, confidentiality, Minecraft editions, Roblox boundaries, and therapeutic intent.
If you work with children or adolescents — especially neurodivergent young people — there is a good chance some of the most natural, unforced, insight-rich conversations you have had in a therapy room happened while both of you were looking at a screen, not directly at each other.
That is not an accident. It is part of what the medium makes possible.
I am writing this from the overlap of research, clinical training, and practice development. My own systematic review examined Minecraft-specific therapeutic interventions for autistic young people, and I later used that knowledge, alongside clinical training and community-building skills, to help develop a Minecraft-related social connection group with support from The Kidd Clinic. That experience shaped the central argument of this guide: games are not therapy by themselves, but they can become powerful therapeutic media when held with clinical intent, ethical boundaries, and proper facilitation.[1]
Video games can reduce the social demand of eye contact, provide a shared activity that anchors attention without forcing it, and create real-time opportunities for decision-making, frustration tolerance, collaboration, boundary-setting, flexibility, and repair. These are not abstract therapeutic targets. They happen inside the play itself: when a young person loses, restarts, builds, negotiates, destroys, repairs, avoids, insists, collaborates, or asks for help.
For autistic and ADHD young people in particular, game-based work may lower the demand of traditional face-to-face conversation, support multiple communication modes, and offer a sense of agency that talk-based therapy can struggle to provide.[2][3][4] Voice, text, movement, shared attention, avatar behaviour, world-building, and parallel play can all become clinically meaningful channels of communication.
Research in this area is still developing, but it is promising. Zayeni, Raynaud and Revet's systematic review found that both commercial and purpose-built video games have been used as therapeutic or preventive tools in child and adolescent psychiatry, with evidence across a range of presentations, while also emphasising the need for stronger study designs.[2] Jiménez-Muñoz and colleagues reviewed video game-based interventions for autistic people and reported improvements across cognitive, social, emotional-recognition, and motor domains, alongside high engagement and completion rates in many studies.[3] Therapeutically applied Minecraft groups have also been described as a way to support social engagement, confidence, and communication for neurodivergent young people.[4][5]
The mental health context matters. Autistic young people experience high rates of co-occurring anxiety and other mental health difficulties. Reviews report particularly high rates of specific phobia, social anxiety, generalised anxiety, and separation anxiety among autistic children and adolescents.[6][7] For some young people, a game-based medium may offer a more tolerable entry point into therapeutic work than sitting opposite an adult and being expected to "talk about feelings" on demand.
None of this means every session should be a gaming session, or that games replace therapeutic skill. The game is not a shortcut around clinical formulation. But when a young person walks into your room and the thing they most want to do is play Minecraft with you, that is not automatically avoidance. It may be the most direct route into the work.
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The simplest version is a Nintendo Switch connected to a television in the therapy room. A big screen matters. It makes the game visible, shared, and part of the relational space rather than something private happening on a small device. The therapist can sit alongside the young person, controller in hand, and play together.
In that setup, you are not "just playing". You are co-regulating, narrating, observing, modelling, and joining. You might notice how the young person responds to losing, how they invite or reject help, how they manage turn-taking, whether they tolerate ambiguity, how they communicate frustration, or what kind of world they build when they are given control.
iPads can also work well, especially for Minecraft. Bedrock Edition runs natively on iPad and supports multiplayer options that can work well in clinics, schools, and group settings when the network allows it.[8] Two iPads side by side can sometimes be enough: one device hosts, the other joins. It is portable, familiar, and does not require a television.
The key decision is what hardware your practice can realistically support. Consider whether you have:
A practical starter kit is a Nintendo Switch with a dock and HDMI cable, two controllers, and a copy of Minecraft. That gives you face-to-face co-play on a large screen with minimal IT overhead.
Online video game therapy expanded during COVID-19, and many clinicians found it worked better than expected — particularly for young people who were already more comfortable online than in a waiting room.[9]
The setup is usually split-attention rather than truly split-screen: the video call remains open while the client and clinician join the same game, server, world, or browser-based activity. The young person plays on their own device, the clinician plays on theirs, and the therapeutic conversation occurs around what is happening in the shared activity.
This is where platform choice becomes a clinical and ethical decision.
A game is not just a game. It may involve accounts, usernames, friend lists, chat functions, public profiles, private servers, moderation systems, age settings, screen recordings, direct messages, and data collection. Those features can have confidentiality and boundary implications.[10][11]
Browser games are useful because many require no accounts, no downloads, no installations, and no friend lists. You open a browser, choose a game, and play. For a telehealth session where you want a quick shared activity — a racing game, puzzle game, drawing game, or cooperative challenge — browser-based platforms are often the lowest-friction option.
The therapeutic value is not usually in the game itself. It is in the shared experience: the laughter, the narration, the competitive moment, the frustration, the repair after someone loses, or the way a young person explains the rules to you.
Browser games are especially useful for:
The trade-off is depth. Browser games tend to be simple and disposable. They rarely offer the sustained identity, world-building, collaboration, and project-based work that games like Minecraft or Roblox can provide.
Roblox is where many young people already spend time. It is a large platform of user-created games, social spaces, avatar customisation, group identity, and peer culture. For some children, asking them to show you Roblox is like asking them to show you their neighbourhood. It can reveal what they value, where they feel competent, how they relate to peers, and what social rules they are navigating.
But Roblox requires careful ethical handling.
Roblox accounts can involve usernames, profiles, connections, chat settings, private servers, content maturity settings, spending controls, and visibility settings.[10][11] If a therapist creates a Roblox account and connects with a client, the therapeutic relationship may become partly visible through platform infrastructure. Depending on settings, a client may see the therapist's username, profile, avatar, connections, or activity. Other clients could potentially identify each other if the therapist uses the same professional account across multiple clients.
There are practical mitigations, but none remove the issue entirely.
A safer approach is to use a dedicated professional account that is separate from any personal gaming. The account should not contain personal information, should not use the therapist's private username, and should have privacy settings reviewed regularly. Clinicians should also consider whether a private server, supervised in-session play, or family-managed account connection is more appropriate than a general friend connection.[10][11]
Before using Roblox therapeutically, families should understand:
This should be documented in the consent process. The ethical principles are not new: informed consent, transparency, confidentiality, boundaries, scope of practice, and clear management of between-session contact. The platform is new. The principles are not.
For a broader look at how modern gaming platforms are designed to influence behaviour, including the monetisation and social dynamics young people encounter, see Gaming Microtransactions, Loot Boxes, and Battle Passes in Australia.
Minecraft is probably the most therapeutically versatile commercial game currently available. It supports open-ended creative play, collaborative building, survival challenges, problem-solving, planning, emotional regulation, social negotiation, and family work. It can be used in individual therapy, dyadic work, parent-child sessions, sibling sessions, family therapy, and small groups.
For neurodivergent young people, Minecraft can offer a lower-demand social environment with multiple communication modes and a high degree of personal control.[4][5] It also has cultural reach. Minecraft has been one of the most widely played games in the world, with Microsoft reporting 126 million monthly active players in 2020.[12]
The evidence base is still small but growing. Minecraft-specific therapeutic literature includes group-based interventions, parent and clinician perspectives, family therapy applications, and exploratory uses of Minecraft for social communication, anxiety exposure, emotion recognition, and trauma-related work.[4][5][13][14][15]
My own systematic review of Minecraft-specific therapeutic interventions for autistic young people found only a small number of eligible studies from a much larger initial pool.[1] That pattern is important: Minecraft is clinically promising, but the research base remains early-stage. Most studies are small, pilot-based, qualitative, uncontrolled, or proof-of-concept. The strongest claim we can make is not that Minecraft therapy "works" in a generalised evidence-based-treatment sense. It is that Minecraft appears to be a clinically useful, engaging, and feasible medium that warrants more rigorous study.
One study often worth highlighting is Gerhardt and Smith's case study, which explored how the narrative component of trauma-focused CBT was adapted using Minecraft for an 11-year-old child with autism spectrum disorder.[14] This is clinically important not because it proves Minecraft is a trauma treatment, but because it shows how an established intervention can be adapted through a medium that makes narrative, distance, control, and engagement more accessible for some autistic children.
One consistent finding across the literature is engagement. Young people often want to attend, participate, and return.[3][4][5] That matters clinically, especially for populations who may have had repeated experiences of therapy as socially demanding, adult-led, compliance-focused, or irrelevant.
But Minecraft also has a version problem every therapist needs to understand.
There are two main editions: Java and Bedrock. Java runs primarily on PC and Mac. Bedrock runs on consoles, iPads, phones, and Windows devices. They are different editions with different multiplayer ecosystems. Minecraft's own guidance makes clear that players need to launch the edition their friends are using; Java and Bedrock are not simply interchangeable in the same multiplayer space.[16]
For individual sessions, this is manageable. You match your setup to the client's platform.
For groups, it becomes a real barrier.
If one participant has Java and another has Bedrock, they generally cannot simply join the same LAN world. There are technical workarounds, such as GeyserMC, which allows Bedrock clients to connect to Java servers, but this requires server infrastructure, configuration, maintenance, and technical confidence that many therapy practices do not have.[17]
This is why platform standardisation matters. If you are running Minecraft therapy groups, decide early whether you are a Java practice or a Bedrock practice, and communicate that to families before enrolment. For face-to-face groups, iPads running Bedrock are often the simplest option: they are portable, familiar, and easier to standardise across participants.
Therapeutic gaming groups can be incredibly rewarding. They are also logistically brutal.
The technical layer alone is significant. You need compatible devices, a functioning network, a game that supports the right number of simultaneous players, and a plan for when something goes wrong. Something will go wrong. A device will crash. Someone will lose connection. A world will fail to load. One player will update and another will not. A controller will stop pairing. A child will forget their login. The Wi-Fi will block multiplayer.
The social layer is harder.
Games have rules, and young people have strong preferences about those rules. In Minecraft, conflict may emerge around Creative versus Survival mode, whether PvP is allowed, whether someone can break another person's build, how resources are shared, who gets to lead, who is "cheating", and what counts as fair. In Roblox, it may be which experience to play, who chooses, who follows, who leaves, and whether the group stays together.
These moments are therapeutically rich. They contain negotiation, compromise, autonomy, rigidity, fairness, frustration, repair, leadership, rejection, and belonging. But they need active facilitation. Without a clinician who understands both the game mechanics and the group dynamics, the game can amplify dysregulation as easily as it supports connection.
Practical recommendations for groups:
The game should not be treated as a reward at the end of group. It is the group medium. That means it needs structure, containment, boundaries, and clinical purpose.
Some of the most predictable problems in game-based work are not about whether the young person likes games. They are about the clinician underestimating the medium.
When these mistakes happen, the problem is usually not the game. It is a mismatch between clinical intention, platform knowledge, and the practical setup needed to hold the work safely.
If you work in a larger practice, school, university clinic, or health service, your network may not support therapeutic gaming without IT involvement.
Many managed Wi-Fi networks restrict device-to-device communication. Some block game traffic. Some prevent personal devices from joining the same network as staff devices. Some restrict app installation. Multiplayer may require bandwidth, compatible versions, firewall permissions, and sometimes specific network settings.[8][18]
Before you plan a gaming therapy program, check:
This is boring, but clinically important. Getting it wrong means discovering in front of a client that the game will not connect. That can be frustrating, dysregulating, and avoidable.
The game is not the therapy. The game is the medium.
The therapy happens in the clinical noticing:
"I noticed you gave that player all your resources. What was happening there?"
It happens in modelling:
"I'm getting frustrated that I keep dying here. I'm going to pause, breathe, and try again."
It happens in co-regulation: sitting beside the young person while they navigate something difficult without immediately rescuing or correcting them.
It happens in reflection:
"What was it like building that together? Did it feel different from building alone?"
It happens in formulation:
"When the rules changed suddenly, your whole body seemed to go into threat mode. I wonder whether that happens outside Minecraft too."
It also happens in the choice of game, the boundaries around the platform, the structure of the session, the consent process, and the conversations with families about what gaming is for and what it is not.
Video game therapy is not babysitting. It is not "letting them play because they will not talk". It is not a reward for compliance. It is a legitimate therapeutic medium when used with clinical intention, ethical care, and appropriate formulation.[2][9][19]
It just also requires knowing what Bedrock Edition is.
The evidence base for video game therapy — and Minecraft specifically — is promising but limited. Most studies use small samples, vary widely in intervention design, and lack large randomised controlled trials.[2][3][1]
The field needs:
It also needs neurodivergent leadership. "Nothing about us without us" applies here as much as anywhere else. Autistic and ADHD people should be involved not only as participants, but as collaborators shaping the research questions, intervention design, acceptability measures, and definitions of success.
The question is not simply whether games can make therapy more engaging. The deeper question is whether games can help therapy become more accessible, relational, flexible, and respectful for young people whose communication, regulation, and social participation do not always fit traditional clinical formats. For more on how neurodivergent practitioners and clients navigate systems not built for them, see Neurodivergent Clinicians: Navigating a Profession Not Built for Us.
If you are building a clinical practice that works with neurodivergent young people, illustrated psychoeducation handouts and structured clinical resources designed for exactly this kind of work are available on PsychVault.
For visual psychoeducation on topics covered in this post, I also share neurodiversity-affirming resources on TikTok: @ethonsmoth.
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