Gaming mediated therapy- emerging evidence-based practice
Children’s mental health services in the UK are under unprecedented strain. Waiting lists are long, thresholds are high, and many young people struggle for months or years before receiving support. A young person struggling with their mental health typically costs the nation over £4,000 a year to support.* Imagine a young person who has received many interventions such as traditional play therapy, family worker support, talking therapy at school or from the specialist mental health service and none have positively impacted that child. Now double the bill. Perhaps they have a social worker too or are waiting to receive an assessment for neurodivergence. These are the young people we work with. Atrium Clinic supports young people and their parents to use gaming as an enabler of improved family relationships and to provide a bridge to other social, functional achievements.
The deterioration in young people’s mental health since Covid * is well recognised, but the trajectory started before that *. Technology and gaming use has quadrupled in a similar period with around 38.5 million people using gaming in the UK, including 93% of young people including young adults. There are benefits and disadvantages associated with gaming for young people’s development. Parents and professionals at most need of guidance and support in how to manage these new tools in life have found themselves without clear navigation routes.*
Many young people now identify the digital space as an area where they are more confident than in ‘reality’ (*according to a survey from Internet matters, 2022) and a further government review (*2019) showed declining social confidence in pre-school children but also revealed the benefits of the internet and gaming for children. Those who struggle more are likely to be from socially and poorer households and neurodivergent groups, according to research *. They are also at greater risk of falling behind at school in the general areas of community participation and educational access. Their gaming and online interests, their identified preferred way to engage and learn, are often dismissed and shamed at school and other institutions in which they engage.
Gaming has dramatically changed people’s leisure time and provides an obvious vehicle to deliver the next wave of mediated therapies, for those who do not benefit from traditional therapies and cost the nation most*. These young people are struggling emotionally, socially and behaviourally in ‘reality’* but are often digitally accomplished. Their parents/mentors feel judged and unprepared*, to realise the benefits of gaming to their wider development, reduce the chance of harm and continue to support their wellbeing seamlessly. * There is a a paradox in our society in that we recognise the growing future employment trends in technology and gaming industries but continue to shame young people for whom it is their best and first developing competency.
The gaming industry market is currently worth £5.5 billion in the UK alone*. Despite representing only 0.85% of the world’s population, the UK has the 5th biggest gaming market by value. In the international market the reach of gaming follows the reach of technology with China, Singapore, India, Malaysia all growing their markets exponentially. The need to develop corresponding mediated therapies for mental health ‘struggles’ recognises that current standalone computerised CBT therapies typically experience an early dropout rate of 54%* in service users and are not suitable for young people who need to build social confidence and interpersonal skills through real relationships and who struggle to talk about their difficulties. *
Atrium Clinic set out to make the problem part of the solution and to reconnect young people who are struggling in their school community or in society (such as those in the justice system), improve their wellbeing and support those professionals who support them. We ran a study to integrate gaming into therapeutic work and developed clinical guidance to refine best practice based on our evidence.
Supplementary approach rather than an alternative
Traditional talking therapies are not always developmentally appropriate for young people, particularly those who struggle with emotional literacy, attention, or verbal expression. Digital game-based approaches build on the principles of person-centred approaches and play therapy while meeting young people in a medium that feels familiar, safe, and motivating. Rather than replacing the therapeutic relationship, digital play becomes a shared space in which connection, regulation, and meaning-making can occur.
Game-based therapy uses structured digital play to help clients externalise and process emotions, practise problem-solving, and develop social and emotional skills. Platforms such as Minecraft can function in ways similar to sand tray or creative therapies, offering symbolic representation, narrative construction, and opportunities for co-regulation within a therapeutic frame.
The intervention
A supervised, digital game-based therapy programme was delivered to young people aged 7 to 25 across schools and community settings. Young people were typically struggling to stay in the classroom, or had been excluded from school or college and many had either/ and bereavements, neurodivergence, traumas and historic difficulties that had not responded well to traditional talking therapies. Some were already in the criminal justice system. Sessions were facilitated by Atrium’s trained Masters level therapists and our psychology team who used the digital environment intentionally, based on our prepared clinical guidance rather than allowing free play alone. Therapeutic aims included emotional regulation, resilience, social understanding, and expression of internal experiences.
The flexibility of the digital format allowed young people to engage at a pace that suited them, while therapist supervision ensured clear boundaries, safeguarding, and therapeutic containment. All our therapists and psychologists are clinically supervised and the Atrium protocol guides our practice. Parents and teachers were involved in the study so that the therapeutic work could continue between sessions and after the professional intervention had ended.
What we found
Young people showed meaningful improvements in emotional wellbeing following the intervention. Measures of psychological distress indicated significant reductions, suggesting that young people felt less overwhelmed and more able to manage difficult emotions. Changes were particularly notable for males, a group who often engage less readily in traditional talking therapies.
Parents/ teachers and youth workers also reported improvements in children’s social functioning and overall mental health. This is a crucial finding for practitioners, as it suggests that therapeutic gains transferred beyond the therapy session into everyday relationships and learning /reality-based environments.
Clinical reflections
From a counselling perspective, several themes emerged:
- Engagement first: Digital play lowered the barrier to engagement, particularly for young people who were anxious, avoidant, or resistant to conventional therapy.
- Safety through distance: The digital environment provided emotional distance, allowing young people to explore difficult themes indirectly and safely.
- Therapeutic presence still matters: Outcomes were strongest when therapists were actively attuned, reflective, and purposeful in how the game was used.
- Not a replacement, but a tool: Digital game-based therapy works best as an integrated approach, complementing existing therapeutic models such as CBT, relational therapy, and trauma-informed practice.
- We don’t recommending gaming therapies for the majority of young people currently, who already can engage with traditional talking, arts/drama/exercise/mindfulness based approaches.
Implications for counsellors
Digital approaches are not a panacea, nor are they appropriate for every young adult or child. However, when used ethically and intentionally, they offer a powerful addition to the therapeutic toolkit. For counsellors working with those who have a history of trauma, neurodivergence, in institutional and community settings, supervised digital play may help bridge gaps in access, engagement, and relevance for those who struggle to find their voice in traditional therapy spaces.
Atrium Clinic is now starting to train others and work in new spaces to bring these approaches to those who need them most.
Contact Sara for more information sara@atriumclinic.co.uk
