In this blog post, we hear from CASTT Gamer Brian Quinones, EDD, LPC as he reflects on using a two-facilitator model for TTRPG groups. To see what Brian and GATE, LLC are up to check out their website here.
When CASTT asked me to write a post about why GATE, LLC uses the two-facilitator model with our TTRPGs, the nerd in me lit up. Since we started picking up interns, the whole Master and Apprentice joke came to mind.
Our company has access to intensive in-home contracts through New Jersey Medicaid. As time passed, working in the home, I would refer the clients to social skills groups. I got tired of hearing how none were available. After many talks, we asked why we don’t run groups ourselves?
Intakes
When someone first requests our services, we do an assessment not just for their therapeutic goals but their interests as well. Usually, during the first four or five sessions, we link clients with a clinician to develop rapport and assess their playstyles and willingness to join with others. During this time, we might also check to see if other services, such as Neurofeedback, might suit the client. We aim to lower anxiety about meeting and joining with others when possible.
The Early Groups
Our contracts with the state allowed us to have one clinician or state-cleared paraprofessional for every two clients. After a while, we started to see what games produced good flow for all involved. But you could tell when someone’s anxiety was getting to them, and we needed to come up with emergency strategies.
Anxiety and Violence
What do you do when your client can go from anxious to violent in the blink of an eye? Who protects the other clients, and who attempts to de-escalate the potential aggressor? Often, we had clients with a history of violence in their lives, multiple traumas, and a willingness to go from confusion to aggression at the slightest provocation. I remember one time a client was menacing and attempting to bully one of the other kids. I had to talk him down. He honestly thought I was trying to protect the other kids from him. He had no clue that if he had triggered one of the other boys in that group, he would have been the one leaving with a black eye. If for no other reason than increasing overall safety in session, having two clinicians or more for groups is vital.
The Apprentice
In-home has several problems: travel, trying to get a client/family to be willing to sit still for a one- or two-hour session. What do you do with that time? You start incorporating different modalities and approaches to help your clients. In New Jersey, we use The Wrap Around Approach, which aims to get your clients to link up with as many community supports as possible. We didn’t see our work as a crutch but as building scaffolding to help clients reach new heights. The idea is, “It takes a village to raise a child,” this means you are looking for as many ways as possible to connect the family to services. We started using Cognitive Behavioral Therapy as our backbone, then combined it with roleplaying games, groups, and our work with neurodiverse populations.
After that first year, we felt we needed something else, so we looked into Play Therapy. Researching, training, and talking about what I learned to others in the office helped set us straight. The play was the language used to promote change, allowing it to dovetail easily into our roleplay and board gaming groups. Don’t get me wrong; it wasn’t a perfect fit by any stretch of the imagination. While bringing these strategies together, I added ideas from Autplay, Adlerian Play Therapy, Prescriptive Play Therapy, and Cognitive Behavioral Play Therapy.
The Master
When COVID-19 began, many of our clients were low-verbal; their self-stimulating behaviors included biting and spitting on the floor. We could no longer see them in person, and they would not be a good fit for our online groups. Like many people during the pandemic, things changed, and we adapted. We started focusing more on supervision and consultation at all company levels whenever possible. Find someone to teach you, one you can train, and find at least one person to walk alongside. As you continue to help other professionals grow, you can see the areas you need help from your supervision/consultation. Recently I was lucky enough to find a psychologist in New Jersey that is also a play therapist. Dr. Heidi Kaduson, the author of Prescriptive Play Therapy, became the master I needed to study under to help GATE improve.
Groups and the Rule of Two
Over the years, we have maintained at least two therapists per therapeutic storytelling group. As you can imagine, it is beneficial to have someone who can pick up and play a part in the story and another who can help out if things do not go as planned. There is another benefit to supervision. Having two clinicians provide a clear picture of what is going on in groups helps the consultation’s brainstorming process. It is much easier to notice if there are potential safety or HIPPA compliance weaknesses with an extra set of eyes. In New Jersey, in-home contains a paraprofessional (bachelor’s Level), professional (master’s level), and fully licensed clinician. As a supervisor, watching others take turns teaching one another at different clinical levels helps all the group members grow.
Conclusion
We quickly realized we needed to be multimodal and multidisciplinary. We still adhere to the rule of two. Rather than solely supporting our clients, we also focus on developing therapists and interns through group and individual supervision. Some styles and techniques cleanly adapt to both the client and clinician, and if we maintain a growth mindset, we can grow the profession and our clients healthily.
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