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Alexander S. Gelernter, Psy.D., is a 2026 graduate of the Psy.D. Program in Clinical Psychology at Antioch University, New England

Dissertation Committee:

Vincent Pignatiello, PsyD, Chairperson

Elizabeth Aronson, PhD, Committee Member

Justine Monthony-Eaton, DO, Committee Member

Keywords

Autism Spectrum Disorder, ASD, sexual and gender minorities, SGM, LGBTQ, role-playing games, RPG, tabletop role-playing games, TTRPG, therapeutically applied role-playing games, TA-RPG, qualitative research, young adults

Document Type

Dissertation

Publication Date

2026

Abstract

Individuals with Autism Spectrum Disorder (ASD) who also identify as sexual and gender minorities (SGM) may experience intersecting challenges related to communication, social belonging, masking, identity development, and access to affirming clinical spaces. Although role-play and therapeutically applied role-playing games (TA-RPGs) have been described as promising experiential approaches, limited research has examined how ASD/SGM individuals themselves understand role-playing games (RPGs) or evaluate their possible therapeutic use. This qualitative study explored how young adults with ASD level 1 who identify as SGM describe their experiences with RPGs and how they appraise the potential usefulness, risks, and conditions of TA-RPG. Five participants completed semi-structured interviews, which were analyzed using reflexive thematic analysis. Five themes were identified: (a) When the World is Tight, Play Opens Space; (b) Belonging as the Condition of Possibility; (c) Rehearsing the Self Through Character; (d) Structure as Scaffolding and Barrier; and (e) From Strengths-Based Reframing to Therapeutic Fit. Participants described RPGs as meaningful spaces for identity exploration, social connection, emotional restoration, and strengths-based reinterpretation of autistic and SGM self-understanding. At the same time, they emphasized that these benefits were not inherent to RPGs; safety, group composition, consent practices, accessibility, structure, and facilitator competence shaped whether play felt affirming or harmful. Findings support a “fit under conditions” model of TA-RPG, suggesting that therapeutic application may be promising when grounded in neurodiversity-affirming, SGM-affirming, accessible, and ethically facilitated practice. This dissertation is available in open access at Antioch University Repository and Archive (https://aura.antioch.edu) and OhioLINK Electronic Theses and Dissertations Center (https://etd.ohiolink.edu)

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ORCID iD: 0009-0007-1396-4430

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