Nordic Larp as a Method in Mental Health Care and Substance Abuse Work: Case SÄRÖT

: The SÄRÖT Trilogy was a pilot project that involved testing and developing Nordic larp as a method in mental health and substance abuse work. The project took place in southern Finland in autumn 2020 and illustrated the experiences of individuals with mental health and/or substance use disorders and their bystanders (friends, family, and other close ones). Data was collected from all three larps and from their preparations and follow ups, aiming to understand:


INTRODUCTION
SÄRÖT (Finnish for "rifts," "fractures," or "distortions") was a pilot project intended to test and develop Nordic larp (i.e., live action role-playing) as a method in mental health and substance abuse work.It consisted of three Nordic larps that illustrated and vocalized the experiences of mental health patients, substance abusers, and concerned on-lookers (that is, the people closely connected to them, such as family and friends).Data was collected from the SÄRÖT larps, their preparations and follow-ups, with the goal of exploring these questions: By answering these questions, I aim to further develop SÄRÖT larps into a recuperative method and a therapeutic tool for handling difficult mental issues and supporting the wellbeing of the participants.

THE NATURE OF WELL-BEING
As a phenomenon, "well-being" is difficult to define.According to the World Health Organization (WHO), well-being is something that correlates with the surrounding culture and society, and is influenced by various individual, social, cultural, economic, material, and political variables (WHO 2015; see also Saari 2011, 10).It is related to an individual's needs and their fulfillment, as well as opportunities for participation in the environment.It also means living in a way that enables feeling the meaningfulness of one's own life (Lehikoinen & Vanhanen 2017, 15).According to sociologist Erik Allardt, having, loving, and being are the basic components of well-being, relating to fulfilling basic needs, creating social connections, and expressing oneself (Allardt 1976, 17-21).
The concept of individual well-being is thus understood to encompass the ability to identify and meet one's own needs, but also being able to pursue opportunities for reaching one's full potential (Ketovuori 2011, 107).Because of its connection to self-expression, we can see that human agency is central to well-being.This establishes a link between well-being and the arts, which create space for participation, doing something meaningful, and functioning as a part of something bigger (Pirnes & Tiihonen 2010, 207;Virjonen & Rouhelo 2018, 9-14).
In the research tradition of the arts and well-being, it is common to perform qualitative research and case studies about experiences, emotions, and other subjective topics.In such research, investigators rely upon individual estimations or accounts of their experience of their own well-being (Nenonen et.al. 2014, 236;Lilja-Viherlampi and Rosenlöf 2019;Lehto 2021).In this research, I also rely upon a respondent's self-estimation of their own well-being.

THE TRANSFORMATIVE POWER OF LARP
Nordic larp is a type of role-playing game where players create, enact, and govern the actions of their characters, defining and pursuing their own goals, with great freedom to choose their actions, using their own bodies as the physical tool for enactment (Leppälahti 2009, 25;Zagal and Deterding 2018, 47).The players act, think, and even experience emotions as their character.They dress up as their character and perform actions in a surrounding that supports the illusion of something that is not real.Nordic larp is participatory by nature and has been previously compared to theatre and playing (Stenros 2010;Montola 2012;Stenros 2015;Lehto 2021).SÄRÖT thrives from the tradition of Nordic larp.The three larps are set on specific settings, and revolve around certain, serious themes.SÄRÖT applies Nordic larp in an attempt to increase well-being.
The idea of being in a role or role-playing as something transformative and therapeutic is not new; pretend-play to increase understanding of oneself is found even in animal behavior.In the 1920s, Jacob Levy Moreno, the father of psychodrama, started to explore roles as social structure.This led him to investigate role-playing within therapeutic processes, resulting in psychodrama and, later, sociodrama (Moreno 1946).Psychodrama focuses on experiences and agency of an individual, whereas sociodrama shifts focus to societal issues, interaction, and group dynamics.They are both executed in group situations (Stenros 2015;Montola 2012, 102;Diakolambrianou 2021Diakolambrianou , 2022a;;2022b).Carlson (2004, 75) argues that role-playing enables players to test reality, which then teaches responsible behavior in the real world.According to Theodore Serbin and Vernon L. Allen (1968), the key moments happen outside of the role-play itself, i.e., at a debriefing workshop or feedback session, where the therapist or counselor helps the participant develop their social and psychological skills by guiding their introspective reflection.This approach to using role-play as therapy is called replication therapy (Serbin and Allen 1968;Carlson 2004).Diakolambrianou, a psychotherapist, uses larp in psychotherapeutic practices, wherein she emphasizes the importance of post-game therapeutic reflection when done for psychotherapeutic purposes (Diakolambrianou 2021;2022a;2022b).Moreno (1946), Serbin andAllen (1968), andCarlson (2004) use "role-play" to mean simulating situations with participants taking on assumed roles within them; they generally do not regard therapy as play in the same sense as does, for instance, Nordic larp.In recreational larping, bleed is a commonly occurring phenomenon, where the experience of playing incharacter feeds back into everyday life, and vice versa.For example, enacting strong emotion in game might persist as psychological arousal post-game, or the fact of once having been in a psychiatric ward might make the in-game feeling of being there more complete (Montola 2010, 154-156;Bowman 2015;Connell, Kilmer, and Kilmer 2020).In recreational larps, bleed usually happens without clear intention or design, but with SÄRÖT, this is in fact one of its purposes.
Nonetheless, the SÄRÖT larps, besides being role-playing games in the Nordic larp tradition, also connect to the therapeutic vision of role-play.They combine the idea of roletaking from Moreno and Carlson with Serbin and Allen's interest in "what happens after the role" as a fundamental aspect of therapeutic workshop thinking.SÄRÖT also has similarities to Ties that Bind, a larp designed by Alexandros Alexiou, which has been offered as a paradigmatic example of a psychotherapeutic larp (Diakolambrianou 2022a).They both intend to explore interpersonal relationships and behavior for therapeutic or healing purposes, and stipulate that a mental health care professional should always be present.
To be sure, SÄRÖT larps are not intended as a form of psychotherapy, but rather a method for increasing well-being.SÄRÖT is designed to be a transformational container-a setting that is designed to be a safe space and enable transformation, growth, self-reflection, and understanding.It relies on trust, consent, and peer support.As a transformational container, SÄRÖT should offer an opportunity to engage in facilitated self-exploration, learn of oneself in relation to surrounding society, and gain an opportunity to transfer these insights into the player's own life (Bowman and Hugaas 2021).In this sense SÄRÖT is reminiscent of Viola Spolin's drama games which can be used for both therapeutic, pedagogical, and well-being purposes (Spolin 1963;Spolin Games Online 2018).
SÄRÖT also derives from the tradition of arts and well-being.Instead of trying to "solve" the participants' problems, SÄRÖT focuses on increasing awareness, perspective, and well-being as a more complex phenomena through experiential work.It does not include a direct skills-teaching component common in some psychotherapy approaches, such as cognitive behavioral therapy approaches (Bartenstein 2022).As such, it could be useful for addressing mental health care needs and could also be employed by mental health and peer support NGOs.
International Journal of Role-Playing -Issue 15

SÄRÖT
SÄRÖT was developed by the author and a psychiatric nurse, Janna-Riia Koivu.I am a community educator (BA) and a culture producer (MA), currently conducting my PhD about role-playing games and well-being.I have 16 years of larping experience both as a player and a game designer.I have previously explored larp as a method in youth work and reminiscence work (Lehto 2016;Lehto 2019a).At these previous projects, as well as during my own years in recovery, I have noticed the potential of larp as a method in addressing difficult issues.As a mental health activist, I also wish to break the silence about mental health issues and utilize my own experiences in my work.Janna-Riia Koivu and I came up with a concept of a larp trilogy addressing three difficult themes in a sensitive way.These themes-mental health, substance abuse, and the experiences of a bystander-became the main topics for one larp each, although they were all present to some degree in all three larps.We wanted to base the SÄRÖT trilogy on real stories, memories, and experiences, in a way similar to the reminiscence larp Do You Still Remember the Day?, which enabled deeper understanding of self and memories to its participants.
In this case, the larp situations, and especially being in a role, offered the players adequate distance to safely explore their own limits by comparing their memories and experiences with those of the characters they played, leading to natural self-reflection and to increased understanding in a peer-supportive situation (Lehto 2019a).With SÄRÖT, we wished to explore what kind of transformative experiences these realistic larps would provide to participants, having faced similar themes in their own personal or professional lives, and how the SÄRÖT experience would impact their well-being (Lehto 2021).
The work of designing SÄRÖT began in the summer of 2020 with collecting, via public and anonymous questionnaires, real stories and experiences about mental health, addictions, and substance abuse, in order to obtain different perspectives on these topics.All the characters and settings of SÄRÖT are based on these real-life stories.The larps are set in different situations where mental illness and addiction are experienced.The intention was to make SÄRÖT as realistic as possible, to avoid any harmful stereotypes, and to approach the situations in an understanding and empathic way.We also used our own experiences in the game design (e.g., in an attempt to set the game spaces as realistically as possible), but also tried to avoid bias caused by our own experiences.The objective was to create realistic representations and combine them with therapeutic workshops, as well as a follow-up, that support recovery before and after the runs.
The larps were then played during autumn 2020.Each lasted for four hours and had mandatory workshops before and after the game.Each run had eight participants and two organizers (community educator and a psychiatric nurse).Most participants had a personal connection to mental health or substance abuse issues.They were recoverees, bystanders, and professionals, but some participants did not report any connection to such background.The participants included experienced larpers as well as beginners (including first timers).Several participants attended more than one part of the trilogy.Altogether there were 18 different participants.
The first of the three larps, Osasto I2 (Ward I2), was set in the everyday life of a psychiatric ward.The game's main themes were mental health issues and experiences from psychiatric treatment, and the characters were patients and nurses at the psychiatric ward.In addition, there were a few non-player characters (NPCs): visiting side-characters such as family members and loved ones of the patient characters, and a doctor.The NPCs were played by the organizers.Their purpose was to support the game and deepen the experience of the players.
The second game, Katkon jälkeen (After Rehab), was set during the birthday party of a 35-year-old man suffering from alcoholism.All 10 characters addressed the topic of substance abuse with their own perspectives, situations, and opinions.Many of them also address mental health issues, experienced personally or as a bystander of a loved one.The organizers also played characters in the second larp.
The third larp, Ensimmäinen Joulu (The First Christmas), is set on the first Christmas after a family member's suicide, focusing on the experiences of the bystanders.In this larp, several characters also suffer from mental health issues and/or substance abuse.Societal themes such as transferring mental health issues between generations and the culture of not speaking are also strongly present.
While the perspectives to the SÄRÖT themes changed between the three larps, all themes were interrelated and were addressed in each part.These problems also often overlap in real life.SÄRÖT thus had off-game elements supporting well-being and safe self-reflection for the participants.
It was evident from the beginning, that with such intense themes and deep purposes, special attention to safety measures needed to be paid.Firstly, trigger warnings, including a clear message of not to apply to the game if it felt too heavy, was clearly visible on the website.There were also links to organizations offering help to anyone in need (e.g. a phone number to the crisis phone).The participants were also asked about their triggers and off-limit topics in their application sheets, and these topics were either not included in the larps at all, or the situation was discussed individually with the player.Also, the players were told before the larp to avoid these triggering themes.Simulation systems with intimacy, violence and substances were used and practiced before the games, as were safe words.A separate off-game room with a psychiatric nurse available was maintained at each set.The participants were told to listen to their own boundaries, and to have a low threshold for going off-game.In the postgame workshops, the participants were facilitated in sharing their important moments from the larp, writing messages to their character, and reflecting differences between themselves and their character.Two thank-you and follow-up emails were also sent to the players: one for each larp individually and one for the whole trilogy.They included remote workshop instructions about writing a letter to the character.All the messages also included links to further psychiatric help.

Data Gathering
Data about participant experiences were collected from the SÄRÖT larps to better understand its impacts on the player's well-being, and the transformative aspects of SÄRÖT, but also to enable further development of SÄRÖT into a recuperative method and a therapeutic tool for handling difficult mental issues.The thematic questions of this study aim to explore the personal experiences of the participants and to find common denominators and patterns in these subjective experiences.
Email interviews were one of the chosen methods.These consisted of a set of questions that the respondents were asked to reply, reflecting their experiences during the SÄRÖT larps.The set of questions was sent to the participants immediately after the larps, and there was no time limit for the replies.The intention was to generate post-reflectivity as a part of the transformative process in the participants.I decided to conduct the interviews via email instead of in person, because, according to Lucy Gibson ( 2010), e-mail interviews enable answering over a longer period and at the respondent's own pace.Also, one of the main principles of SÄRÖT was accessibility, and email-interviews flexibility respected that.
For the same reason, I included free feedback as a method.Some of the participants were not able or willing to answer the email interviews but wanted to take part in the research.They gave feedback via voice messages or messenger.
During the larps I gathered data by observing the workshops and conversations before and after the larps, as well as my findings in a diary.According to Tuomi and Sarajärvi (2009, 81), observation is often used to explain and deepen the information collected by other methods.Observation and reflection of spontaneous situations, of what has just happened, is often used in research situations that include interactions and happenings.Observation was also the only way to record the spontaneous conversation and bursts of emotions happening at the setting, which are also essential in understanding the phenomena.

Data Analysis
I analyzed the gathered data by using method triangulation.This means I interpreted the results parallelly, in comparative manner, deepening the results discovered by one method with another method.Method triangulation is often applied when the research has a limited group of respondents, or when trying to understand a new phenomenon better, and it is commonly used in case studies (Laine et al. 2007, 24).In addition, I used contextualist theme analysis.Braun and Clarke (2006, 6) define thematic analysis as a method for identifying, analyzing, and reporting themes or patterns within data.Although it only minimally organizes the data set, it tends to describe it in rich detail.Often it also goes even deeper, offering interpretations of the research topic (see also Boyatzis 1998).Thematic analysis as a method is divided in three sub-methods: realist, constructionist or contextualist method.Realism focuses on analyzing experiences, meanings and reality of participants, constructionism studies these things in relation to operating within society.Contextualist theme analysis is a mix of these two.It acknowledges not only the realism of the participants (their experiences, meanings, reality), but also the ways individuals make meaning of their experience, how this all relates to broader social context.(Braun and Clarke 2006, 11).

Ethics
The ethics of SÄRÖT as a larp-trilogy, as well as this research, have been carefully considered throughout the process.Having previously experienced heavy and triggering situations in recreational larps, we were aware that the SÄRÖT larps could be potentially triggering and even harmful to some of the players if executed carelessly.A case study with a small number of respondents and such personal research topics also causes some risks regarding participant privacy issues and potentially even safe research participation.
Janna-Riia is a psychiatric nurse, and I am a community educator, which means we both are either mental health care or counselling work professionals, with extensive experience in working with vulnerable target groups.At the beginning of the project, we decided to have as much professional insight in SÄRÖT as possible, and since our aim was to create a method usable for the topical NGOs, we decided to turn to them.SÄRÖT partnered up with several topic-related NGOs to ensure easy access to further information and actual help for participants (and anyone else) if needed.The SÄRÖT website had clear links and a "HELP" button, where you could find someone to talk to from Mieli ry with just one click.At the game sites, we also used the NGO procurers as props.The co-operation with the NGOs was strongly present throughout the project, and info about their services was also made available at the public SÄRÖT art exhibition (Galleria Barker 2021).
All players were informed of the serious nature of the SÄRÖT larps from the beginning and given specific trigger warnings.They were told not to sign up to SÄRÖT larps if they felt like the topics were too close to home, triggering or still sore in their personal lives.It was important that the participants felt ready to dive into these topics.Also, the game was only for adult players.All participants were informed that they may at any point cancel their participation in SÄRÖT.Several potential players asked further questions about SÄRÖT larps before signing up, and we answered in detail, reassuring their decisions on whether to sign up in SÄRÖT.
We also paid special attention to safety in the game design.Pre-game work, and especially post-game work are essential for not only the transformative experiences to reach their full potential, but even more importantly, in creating a safe space for both play time, as well as the neutral space (that used to be the game space) after the game.Special attention was paid to getting out of the role after the game and turning the heavy experience into a positive resource in the debriefs facilitated workshop.In addition to always having a psychiatric health-care professional available (in-and off-game), all three larps had dedicated off-game spaces, and an off-game contact (also a community educator, other than the game master) available at the set, in case someone wanted to take a break from the game.Safe words and simulation techniques were used (for intimacy, violence, drugs, substances), and the players were also given advice to step back from intense situations with a low threshold.Everyone agreed before the games that it was okay to go off-game if someone felt like it and they also could turn to the organizers and the psychiatric nurse at any point before, during, or after the game.
All participants were also aware of the data being gathered and the research being conducted from the larps.They were asked to sign a research permission and informed about the research practices (e.g.data storing), as well as their rights regarding the study (e.g.anonymity of the research, their option not to take part, or drop out of the study at any point).Knowing the intensity of larp as a method, a statement was also asked and received from the Tampere University's ethical board.

Before the Larps
The first set of data was collected when the participants arrived at the game locations.At this point, the locations were new to the players, and they knew that they would be larping there shortly.In my research diary, I write about the atmosphere in the beginning of all three larps being eager and expecting.Before the first larp, participants expressed their urge to larp again, after the break caused by COVID-19.The second larp was more difficult to organize due to many cancellations under the corona restrictions.Nevertheless, we had players for all characters, and they were eager to play.For organizing, the third larp was different from the other two, since its participants were very active before the game on social media: posting pictures, developing their characters and their relationships, and networking.In addition, a Christmas dinner was prepared to be served in the larp.
According to the email interviews, 8/10 respondents felt positively about getting ready for the larp.One of the respondents was relatively neutral and one described having a stressful week before the larp.Others used words like anticipation, eager, positive, interested.The participants of the third larp describe their preparation in more detail.They seem to be quite committed in researching background for their role: "I spoke to [] … about being a cantor and I managed to build a great basis for my character's behavior and attitude towards life."( 8) "I made a diary for my character's deceased daughter and found a picture of her in pixabay."(9) One of the respondents reported being worried about maintaining the line between simulation and real life, for instance, hurting oneself.Another one reported listening to a comedy podcast to shake off the preparation for the larp.One of the players was just happy to finally wear something Christmassy.
Waiting for the game to start has been described as fun, social, and exciting.The respondents report chatting with other participants, agreeing about shared history between characters, thinking about if the themes will be too hard, listening to the playlist they made for their character, and slowly getting ready to dive into the character.

During the Larps
According to my research diary, the atmosphere of the first SÄRÖT larp was realistic, like in a real psychiatric ward, with "a lot of laughing and crying."One of the respondents wrote in the e-mail interview, "I got to re-live my experiences from at a psychiatric ward.In this game the ward was smaller, and the community even closer…My hospital-period back in reality lasted for three weeks, and I was afraid to go back home, just as my character [was] now" (3).Another feature the respondents found reminiscent to their real-life experiences was the relationships of the characters: "My character was very close to another character and playing this relationship as a part of the ward-experience was amazing" (3).Another player remembered "a letter from a loved one.My character interpreted it as a break-up, although that was not the intention.I got to cry out the pain and it felt purifying" (4).Several respondents also pointed out specific moments, like putting a mandarin in a microwave, seeing the doctor, playing a game of cards, hiding a knife, comforting a friend, or talking to their roommate.All of them also write about the importance of the character's thoughts or emotions: being anxious about electric treatment, being impulsive, an active decision not to give up, reacting to the news from a doctor, crying over a phone call or a letter.
The second larp was also intense, and heavier than the first one.I also played a character in this larp and wrote to my diary: My game turned out to be about the difficulty for an alcoholic to admit that they have a problem, because admitting it would mean admitting one needs to change their whole life, not just the drinking.When alcohol defines your whole way of life and all your social relationships, giving it up feels impossible.It is not allowed even as a thought.
The game crawled under my skin and probably it happened to others as well.If Jari (my character) is this blind to his problems, then maybe I am to mine as well?Maybe not about alcohol as Jari, but eating, or toxic relationships?
Once again, people reminisced about their character's actions, but the focus was upon their thoughts and emotions.According to the email interviews, this time the emphasis was on negative emotions, such as sadness, anger, heartbreak, guilt, an urge to pretend everything is okay, and the need for a substance.One of the players wrote in their email-interview: In the game my character and his previous girlfriend had a conversation, where my character tried to make her quit drinking.The bargaining where the girlfriend started: 'What if I just drink one?Or two?Four isn't that much, is it?'It was heartbreaking.I have had a similar conversation in real life" (6).
Another player wrote: "In this game I got to see different problems that people face in their everyday lives" (7), mentioning specifically the anger that they felt when their old bully did not remember them, and feeling sad and a little guilty seeing the sister of an alcoholic being so worried about her sibling.
According to my diary, the third SÄRÖT larp felt most enjoyable to me personally.
The players were very natural and genuine in their characters and the family dynamic felt immensely real.It was just like a real family.All the characters were broken in their own ways, trying to support one another, but still sometimes getting devastated by the grief.I do not comprehend how so many emotions fit in just four hours: sadness, grief, longing, love, caring, loneliness.And eventually talking, which enabled understanding, giving and receiving help, and noticing that others carry the same burden as you, and that it can be shared.The game ended on a note of hope.
Other players describe the atmosphere as genuine, relatable, safe, and emotional.Especially the intensity and closeness of the family were mentioned in several responses.Many respondents found comfort during game from the discussions they had before the game with other players: For instance, a player that was nervous about playing a controversial character wrote: (While playing the character) I felt this sense of security that, that I (outside of character) have not been able to endure before.(Another player) told me before the game, that they would protect me if someone else turns against me… Even now I feel like I do not need to survive alone.Before, I had to.(8) Another player (10) wrote in detail about the emotions and thoughts experienced, when their character felt unseen, unworthy, unimportant, eventually self-destructive and finally ended up hurting themselves.They also describe how they received help, tied up the wounds together with another character, and had the opportunity to genuinely confront one another International Journal of Role-Playing -Issue 15 and reply with honesty to, "How are you?"Another respondent describes the transformation of the atmosphere beginning as stiff, turning into a storm of anxiousness, shifting to sharing and togetherness and hopefulness.

Immediately After the Larps
According to the research diary, the most impactful moments happened right after the games, during the post-larp workshop and free conversations, in all three cases.I have described these moments as significant and most important.The workshops consisted of a facilitated self-reflection that guided the player away from the character, identifying differences between oneself and the character, and sending messages to the character.The guided reflections transferred interesting moments from the game into impactful realizations.In addition, the shared game experience enabled a peer-supportive free conversation amongst the group, even with no other shared background.In all three cases the players continued the conversation after the workshop on their own initiative, turning the discussion to their own experiences and similarities between themselves and their characters.
After the first larp, the participants discussed mainly about their (or their close one's) mental health history in a deep, peer-supportive manner.After the second game the players had long self-reflective conversations about their experiences of substance abuse.One of the players realized that they need help and talked about this to another player.They had already found out about the possibilities of seeing a nurse.After the third game and the workshop the conversation was yet again deep, supportive, understanding, and caring.People -most of them strangers aside from the larp experience that happened the same day -talked very openly about their own past difficulties and supported one another.In addition, a player that participated in the second part also shared that they had realized their unhappiness in working life because of participating in the second larp.They had applied for a new job and gotten a call for the interview.I have also written a note that says, "It is curious how playing together for 4 hours enables talking openly about topics that one stays silent for 10 years in a working community." The participants have described their feelings about the moments after the larps as (positively) relieved, tired, happy, sentimental, immersed, freed, awesome, empowered, and satisfied.Several respondents wrote about how they are happy to be themselves again.Many also wrote about how sorry, supportive, or otherwise emotional they feel for their character.One of the respondents wrote: I could do it.I did not break.I am able to face these things now that I am better, and the wounds are not sore anymore.(4) Their feelings after the workshop were described as touched, communal, tired, satisfied, liberated, healed, and relieved.Several respondents wrote that they enjoyed talking to other players after the game.At the moment of going home, most of the players were tired and thinking about the game and conversations during and after the game.

Afterwards
According to the email interviews, the participants were still thinking about their experience a few days after participating.Wishful, empowered, satisfied, good, tired, and whole are some of the words used to describe the respondent's feelings.One of them was left thinking about the human mind, and heredity of mental health issues.Another respondent thought about what their character could have done differently if they had more knowledge about the situation.Several respondents were left thinking about the conversations that happened after the games, one even thinking how they could help another player.Another one wrote that they now realize how lucky they are not having mental health issues.Several respondents reported the sense of opening emotional locks or realizing new things about their lives or relationships.
After all three larps, the conversations were free and intense.After the second game, three different people came to speak to one and the same player about their situation and realizing a need for transformation."The players were feeling very emotional after the game and because the group was small enough, we were able to have some extremely important conversations… I told about my own mental health background.I believe that this lowered the threshold for these people to come and talk to me." In retrospect, seven of the 10 email interview respondents also felt like participating gave them tools or perspective to their own life, healing process or work.One of them wrote, "I got tools and easing in living with my PTSD."Another felt like the perspectives they got from the game situations might help them with addressing their own difficulties.Someone else wrote that they now see their privileges better.Another has a new perspective for meeting an anxious person in a working situation.
In less formal, free feedback a participant that took part in all three larps wrote, "SÄRÖT-larps made me see that I have problems, but that it is ok, and they are survivable."Another one wrote, "On top of my mind lingers a feeling that others think that I'm nice… Somehow, now it is easier for me to receive positive feedback and to actually believe it."One participant reported processing their own trauma (loss of a mother) through the character, and "finally finding peace."

DISCUSSION
SÄRÖT was transformative in several ways.The interviews, observation and free feedback vocalize the transformation.Respondents reported for instance a change in a way they see themselves, the situation they are in, or their need of help.A new willingness to discuss their situation or seek help came up in several feedback comments and interviews.Some reported having processed their own traumas (for instance loss of a mother or handling their PTSD).Professionals reported gaining new perspectives and tools for their work.Likewise with psychodrama, sociodrama, replication therapy, CBT larp, and psychotherapeutic larp, drama, role-play or larp may generate a therapeutic transformation, increase understanding of self, and (often after some time) enable going through or push towards therapeutic processes (Bartenstein 2022;Diakolambrianou 2021;2022a;2022b;Spolin 1963).In this kind of larp, it is essential that an easy access to professional help is available when the need for it emerges, which, in some cases, might take some time (even months).Respondents also reported making active changes in their lives because of participating in SÄRÖT, such as applying for a new job, getting help for mental health issues, or turning to social workers.These are examples of the concrete transformative nature of the processes initiated by SÄRÖT.
According to the data, the participants attributed the transformativity to several elements of SÄRÖT.Firstly, attending a larp is impactful and transformative in itself-International Journal of Role-Playing -Issue 15 especially during a global pandemic.People are excited about seeing each other and doing something immersive and inspiring, even if it is marketed as serious and not funny or entertaining.In the framework of cultural agency, the transformativity of attendance itself is easily understandable.According to Simon (2010), the key to the transformativity of cultural agency lies in the fulfillment of the person's needs to contribute and succeed (19)(20)(26)(27).Also, participation, in the sense of functioning together with others as a part of something bigger, and the sense of meaningfulness as an actor both increase an individual's well-being (Pirnes and Tiihonen 2010, 207;Virjonen and Rouhelo 2018, 9-10).The positive impacts individual gains from a cultural agency depends also on their level of involvement as experiencers, partakers, and actors (Tomka 2013, 261;Virjonen and Rouhelo 2018, 10;Lehto 2019b;2021).The third SÄRÖT larp underlines this notion: it is described as the most realistic one, and it is also the one where the players were most active before the larp-they took charge of their own cultural agency, creating a stronger experience for themselves.Acts of building the character, such as creating a playlist or writing a diary of a deceased daughter also made the larp experience deeper and more personal (see Tomka 2013, 261;Virjonen and Rouhelo 2018, 9-10;Pirnes and Tiihonen 2010, 208;Simon 2010, 19-27;Lehto 2019a;Lehto 2021).
During the SÄRÖT larps the most transformative moments seem to emerge when the interacting with another character feels emotional or is somehow attached to the player's own life experiences -when bleed happens (see Montola 2010;Bowman 2015;Connell, Kilmer, and Kilmer 2020).Also, moments when something meaningful happens, such as harming oneself, ending a relationship, a call from mother, are transformative.Often these two happen simultaneously.The togetherness in experiencing these transformative moments with someone is also experienced as transformative and sometimes therapeutic in itself.Talking, vocalizing, and impersonating the character's emotions and thoughts seem to be important.Immersive moments, when the in-game-family feels like a real family or an active falling apart happens over choosing alcohol over relationship, seem also impactful and thought-provoking.Such moments are transformative on two levels: during the event and during the post-reflection.Also following other characters and listening to them seems to evoke realizations (of self) and eventually transformation in post-reflection.The atmosphere itself is also described as transformative, creative, trusting, peer-supporting, reflective, and open, as a transformational container should be (Bowman and Hugaas 2021).As Carlson says it, SÄRÖT met reality in a way that allowed us to find, test and develop tools and empowerment in our own lives (2004,75).These all are also elements that occur in most recreational larps and describe the transformative features of larp as an activity.
Then again, in the case of SÄRÖT, the most therapeutic parts in all three larps were the facilitated debrief workshops and post-game conversations, similarly to Serbin and Allen's (1968) replication therapy.In the workshops the participants got to share their important moments from the larp, write messages to their character and reflect differences between themselves and their character.After each workshop, the participants initiated a deep, peersupportive conversation around the game themes.The availability of someone to talk or write to, even some weeks after the games was important.So was knowing where to turn to when someone realizes they need help, in other words, professionalism.However, the players did not seek to speak to the mental health professional or counselor at the location, but spoke to one another in a peer supportive manner.All players knew that the intention of SÄRÖT was to evoke transformation and even therapeutic processes, but their natural choice was to find peer support.This indicates that when used in an NGO setting, where peer support groups are already an established practice, serious methodological larps like SÄRÖT could work as a natural catalyst for peer-supportive conversation.
It appears that a part of SÄRÖTs transformative nature was caused by the fact that SÄRÖT had a therapeutic goal and the participants were aware of it.This was essential in the creation of a transformational container (Bowman & Hugaas 2021).The participants knew what to expect; they did not come to SÄRÖT just to have fun, but to explore and reflect.Hence, they were also willing to focus and discuss after the games.Being used as a method made SÄRÖT impactful as a method, and the participants' openness to the process enabled its efficiency.
SÄRÖT does have potential to become a purposeful tool for the relevant organizations, and it could also be applied for pedagogic and therapeutic purposes, in a manner reminiscent of Viola Spolin's drama games (Spolin 1963;Spolin Games online 2018).To get there, it would need to be further developed with its practitioners, whether NGOs, counselors, pedagogues, or therapists.However, if executed carelessly, SÄRÖT could potentially be triggering and even cause harm to some participants.Hence, it is always necessary to have a mental health professional present and possibly a counselor ready to react for safety reasons.For these reasons, the game material will not be openly published.Then again, it is also important for this person not to control the space too intensely, for the natural peer-supportiveness to emerge.It is also important to facilitate delicately the post-game reflection towards the therapeutic purposes: healing, increased understanding, and fruitful conversation.In addition, in its current form, SÄRÖT needs an experienced larp organizer.Developing SÄRÖT into an easily executable package is possible but needs further game design.It could also be further developed into a service or a series of products.
As a case study, the amount of data in this research is limited and applies to SÄRÖT trilogy.However, it evokes further questions.Larps are often experienced as impactful and possibly transformative.The results of the SÄRÖT case study suggest that if the players know about the larp's therapeutic purposes, it brings additional value.In this case, the specific facilitation of the pre-and post-workshops were also important.This suggests that that there could be differences between the transformativity of recreational larps and therapeutic larps.It would be interesting to investigate this comparison, not only qualitatively, but also in a quantitative manner, with a longer timeframe, and a larger number of respondents.Simple questionnaires, such as WHO5, could be one possibility for gathering such quantitative data.WHO5 has been successfully used to measure change in (experienced) well-being in art therapy groups (Zubala et al 2017;Topp et al 2015).Setting recreational and therapeutic larp in the context of arts and well-being could offer some interesting tools for larp researchers.On the other hand, in attempt to understand the transformativity of immersion, I'd like to see the underlying mechanisms of the larp-related phenomena to be researched in the context of other art forms.This could include questions such as whether bleed happens in drama therapy or in music therapy, and comparing their transformativity to that of larps.

CONCLUSION
SÄRÖT was a pilot project, testing and developing Nordic larp as a method in mental health and substance abuse work.The SÄRÖT trilogy illustrated the experiences of mental health patients, substance abusers, and their bystanders.The larps took place in southern Finland, autumn of 2020.
Data was collected from all three larps by multiple methods, including observation, workshops, email interviews, and free feedback.In the data sets gathered by the interviews, International Journal of Role-Playing -Issue 15 observation, and free feedback, the respondents reported moving onwards with their inner processes, changes in the way they see themselves or experience their current situation in life.Some respondents also took action to better their situation.
SÄRÖT had several features that enabled transformativity, both in the gameplay situations, as well as off-game.Firstly, the cultural agency of attending a larp as a player is transformative in itself-especially in the times of a global pandemic.The depth of the impact of the experience is also dependent on the participants' own level of activity, according to the principles of cultural agency.Secondly, the most transformative experiences during the SÄRÖT gameplay seem to have been tied to emotional interplay with other characters, in the game coming close to oneself or the occurrence of bleed, and memories of its impactful moments, sense of togetherness, self-expression, and deep immersion or empathy towards the character.The overall atmosphere was also described as transformative and healing.Thirdly, as a method, SÄRÖT had off-game elements supporting the well-being and safe self-reflection for the participants.Each larp was followed by a facilitated workshop and a peer-supportive conversation, initiated by the players themselves.It was during these conversations that some of the players realized and vocalized their need for help or a change in their lives, and actions have already taken place.All participants were also aware of SÄRÖT being a method and having therapeutic goals.The participants willingness to dive into the process was also essential to its efficiency.
SÄRÖT does have potential to become a purposeful tool for the topic related NGOs, but it could also be applied for pedagogic and therapeutic purposes, reminiscent of Viola Spolin's drama games (Spolin 1963;Spolin Games online 2018).However, it requires further user-orientated development.Developing SÄRÖT into an easily organizable package, service, or a product could also be possible.
Kerttu Lehto is a community educator, culture and landscape researcher (M.A.), and Ph.D. researcher at Tampere University's doctoral programme of Information Studies and Interactive Media.Her Ph.D. work addresses role-playing games (RPGs) and well-being.Simultaneously, she works at Turku UAS as a Senior Advisor, coordinating and preparing Creative Europe projects, and working in the Taikusydän National Arts & Health Coordination Centre in Finland.She first attended and organized larps and tabletop RPGs in 2006, has studied them since 2013, and been a larp entrepreneur from 2017 to 2022.In her previous work, she has applied and studied larp in e.g.reminiscence and youth work.