Table Tennis as Therapy
Sometimes, meaningful therapeutic work happens outside of the traditional therapy space and beyond words. For clients living with trauma, overwhelming anxiety, depression, ADHD, social-skills challenges, or neurodivergence, the traditional therapy room can feel intimidating and overwhelming. I have found that table tennis may offer a helpful alternative.
In my experience and perusal of the literature, table tennis, as with broader sports participation, offers many potential benefits including improved coordination, executive function, attention, inhibition, and social behavior.
Table tennis, in particular, can become an alternative but effective setting for therapy: a small, playful space where clients can practice focus, resilience, emotion regulation, social connection, and self-compassion. There is a therapeutic value in how the activity is framed, connected to the client’s life, and reflected upon. Table tennis provides a less threatening interpersonal environment within which clients can develop trust and work on issues in both direct and symbolic ways. There is a back and forth to the rhythm of play that is non-verbally analogous to a conversation. And the small space required for play allows for conversation if desired.
The game should be adapted to the client’s physical ability, sensory needs, trauma history, and emotional tolerance. As with any treatment modality, it should be introduced with informed consent.
As I have become more proficient at table tennis, I have noticed a shift in my own psychological relationship to play, competition, and self-esteem. The speed of the game—the rapid succession of points, the brevity of rallies, and the almost immediate resumption of play—leaves little room for prolonged self-reproach. There is simply not enough time in competition to dwell on a missed shot, a lost point, or a moment of embarrassment. The pace of the game requires moving on quickly and remaining present in each new moment. In this way, table tennis efficiently trains several capacities central to psychological functioning: attentional flexibility, frustration tolerance, affect regulation, recovery from error, and the ability to re-attune to the present moment.
The way a person plays table tennis—or any game—can also be viewed as a kind of projective test. Psychological dynamics emerge quickly: one’s relationship to winning and losing, taking risks, aggression and restraint, dominance and accommodation, as well as self-consciousness and spontaneity. The game reveals various aspects of self-image, communication style, passivity, performance anxiety, and sensitivity to shame. In this sense, table tennis becomes a remarkably rich arena for observing physical, psychological, and relational dynamics. Because the distance across the table is not much greater than the distance between therapist and client in the office, play is easily suspended for therapeutic intervention.
Introducing table tennis as an adjunctive treatment modality offers several potential clinical benefits. It can provide a less threatening context in which clients may begin to speak about vulnerable aspects of their inner lives. It offers a concrete, embodied way to notice psychological processes as they arise in real time. And it creates opportunities to work with attention, frustration, inhibition, risk, competition, shame, resilience, and interpersonal attunement in vivo, rather than only retrospectively through verbal reflection.
Two examples of table tennis as an adjunct to treatment follow.
Jimmy
At 14 and a freshman in high school, Jimmy had learned to hide—except for the all too frequent times that he was bullied. Then, he felt like an open sore, crying, scurrying away, or having an angry meltdown. Jimmy was on the spectrum: good analytic skills, but a bit clumsy, socially awkward, anxious, and depressed. The bright red acne scattered on his pale-skinned face didn’t help. He was an easy target for bullies who enjoyed the entertainment value of seeing Jimmy have emotional meltdowns. More recently, even mild teasing overwhelmed Jimmy, and he predictably reacted with all the aggregated pain of years of bullying, much to the satisfaction of his bullies.
Having given up on being able to help their son and frustrated with the ineffectiveness of the school counselor, his parents had made Jimmy come to therapy under threat of losing his phone. Like most adolescents Jimmy depended on his phone to connect with his “friends.” By “friends” he meant his one friend, Maddie, the only kid in his grade that didn’t see Jimmy as a loser.
In our family intake session, Jimmy refused to talk. His parents provided his history while Jimmy looked out the window and clasped his hands tightly together and gritted his teeth. They had given Jimmy their best advice: “It will get better” and “You just have to not react.” That hadn’t helped. Nor had talking to the school counselor who told Jimmy to stand up to the bullies, something beyond his capabilities. Given his dissatisfaction with counseling and his frustration with his parents’ platitudes, Jimmy understandably wanted nothing to do with therapy. He would have bolted had he felt brave enough.
As a family psychologist, I was accustomed to presentations like Jimmy’s. I knew I needed to treat him differently than his school counselor and his parents. I knew that asking him to be vulnerable talking about being on the spectrum and being bullied would trigger his trauma and reinforce his feelings of helplessness. He’d become even more withdrawn. I needed to meet him where he was and subvert his negative expectations for our doctor/patient relationship. He needed to get out of the stigma-filled office. He needed to feel safe; he needed to feel validated.
After confirming in our initial individual meeting that he was entrenched in his resistance to talk therapy, I invited Jimmy to play some “ping pong.” Our office has a ping pong room for a good reason: I am a table tennis fanatic. I play 3-4 times per week, take lessons, and have competed in local, state, and national tournaments. But why invite Jimmy to play?
Ping pong is both like table tennis and significantly different. Same ball, same table, same scoring system. Some rules are different. For example, the serve in table tennis requires you to throw the ball straight up from the palm of your hand a minimum of 6 inches. (Some pros throw the ball to a height of fifteen feet!) The paddle is the same size in both games, but the kind of rubber sheets on the blade and its thickness impart shockingly dissimilar speed and spins on the ball.
The intensity of play is vastly different. First, table tennis is a physically demanding (Olympic) sport that involves powerful strokes, quick lateral movements, and training both fast- and slow-twitch muscle fibers. Second, it requires acute mental focus: reading spin, predicting angles, adjusting position, coordinating rapid motor responses, and developing strategy.
It’s a sport that tends to provide a level playing field, not favoring gender, size, or age as much as other sports. Lastly, table tennis is quick, points lasting for just a few seconds. Daniel Amen, M.D., opines that table tennis is the best sport for your brain.
When Jimmy realized that his choice was to sit on the office couch and talk about his feelings or play ping pong, Jimmy quickly agreed to play. He had played basement ping pong as many kids have and thought there wasn’t much to it. Jimmy had no idea what he was about to experience.
We made our way to the ping pong room. The table is only nine feet long by five feet wide, providing easy opportunities for social interaction. Although Jimmy hadn’t considered it, talking during ping pong is expected. Jimmy selected a paddle with the standard smooth rubbers facing outward with a high level of tackiness. He had never seen a good table tennis paddle and was immediately intrigued. I described the differences in the wooden blades and thickness and types of rubbers. We had our first conversation without Jimmy being defensive, guarded, or sullen.
Our first session ended on a positive note without a “therapeutic” word or uninvited instruction on how to hit a forehand. I used to worry that this type of “intervention” was not, in fact, an intervention and could be considered unethical. Was I simply enabling a resistant client? I have reconsidered and now believe it is one of the best ways to establish therapeutic rapport in some resistant clients. Our first challenge in therapy is creating a safe environment, and safety may be achieved across a ping pong table.
Jimmy returned for the second session with improved energy. He had decided that ping pong was better than therapy! I was happy to answer questions about speed, spin, and serves. I said he could call me Coach V. He had looked up YouTube videos about table tennis and had told Maddie about it. We were building a relationship! At our third meeting, Jimmy asked if he could invite Maddie to play. He accepted my suggestion that he teach Maddie the things I was teaching him, that his teaching her would reinforce what he was learning for himself.
Subsequent sessions became increasingly about direct and indirect life lessons generalizable from the game of table tennis. We talked while on opposite sides of the table. For Jimmy talking with a coach while playing ping pong wasn’t therapy. He enjoyed learning the game. By developing competency in something new, Jimmy was gaining self-confidence. He contemplated joining the ping pong club at school. For Jimmy to even consider that step meant that his self-esteem was improving. Jimmy learned to counter my drop shots at the table while also learning strategies to counter the insults dropped by his classmates.
He was learning to be more present in the moment. Not ruminating about his past poorly executed table tennis shots or worrying about the next shot, improved his concentration. Experimenting with various strategies is an enjoyable part of the game. Because table tennis is so fast, he had opportunities to try out new strategies every few seconds. He was quick to embrace the analogy to trying different strategies of standing up to bullying to see what worked.
Jimmy was able to appreciate that he could let go of moments when he was bullied or teased and review them later for ways to respond. He began to frame those painful social incidents as learning opportunities rather than reinforcing his belief that he couldn’t handle them and could only retreat in fear and shame. His depression evolved into sadness for the losses he experienced by being bullied. He began to reframe bullying and teasing as a problem to be solved rather than an inviolable truth about his worthiness and a forecast of his future. Jimmy became less reactive to the bullying and described the bullying as becoming less frequent and less intense. He knew he wasn’t giving the bullies what they wanted, and even though he still felt unfairly targeted, he felt more in control. He became more adept at discerning what he could control and what he could not.
After three months, Jimmy terminated from therapy. He gave me a ping pong ball with an inscription. Not “Thanks, doctor,” not “Thanks, therapist,” but “Thanks, coach.” I’m okay with that.
Alice
Alice was 23 years old, bright, attractive, articulate, and anxious. I was in my first year as a licensed psychologist in private practice. Alice’s presenting problem, which she readily introduced in her first session was that she slept with almost every man she met. She felt compelled to seduce them, and having accomplished that, would lose interest and move on to the next man. The pattern left her feeling ashamed, empty, and confused by her own behavior. She wanted to break the cycle. I silently wondered if she thought I could be her next conquest.
As a newly minted psychologist, I knew something about compulsive behavior, but mostly from textbooks. I understood the language of compulsion, anxiety, shame, and repetition but had little lived clinical experience with how those forces unfold in the office. I remember sitting with her and feeling the limits of my training. Fortunately, I had learned what to do when I didn’t know what to do: ask more questions.
As I asked about other aspects of her life, Alice revealed that she had always feared competition. I thought that there might be some shared psychological dynamics with those two issues. Alice felt powerless, lacked a sense of physical and emotional control, and felt ashamed with both.
I decided, with her consent, to first address her fear of competition. To be honest, as a young clinician, it seemed like the safer choice. For the next few weeks, we spent the first few minutes of each session in my office discussing strategies for learning to compete in table tennis. The game provides frequent opportunities for having to manage feelings about competition. Because the table is only nine feet long, talking while playing is easy and feels natural. During the process, often pausing play, we addressed Alice’s anxiety about competition, her fear of losing control, her fragile self-esteem, and, of course, the required physical skills for table tennis.
Addressing competition gave us a concrete and manageable place to begin. It offered a way to work with anxiety, self-esteem, control, and shame without immediately engaging with the more sexually loaded material.
For the next several weeks, we spent the first few minutes of each session in my office talking about the mechanics of table tennis and cognitive approaches to competition. Learning the correct strokes, positioning, and tactics meant leaving her comfort zone about physically competing and developing strategies for managing her emotions. We discussed how one learns to compete, how to tolerate making mistakes, how to remain present after losing a point, and how to keep playing without collapsing in shame.
Beneath the surface, we were working on much more than a game. Table tennis became a kind of laboratory. It allowed Alice to experiment with competition in small, manageable doses. She could practice being watched without feeling humiliated. She could miss a shot and discover that nothing terrible happened. She could lose a point and remain in relationship with the person across the table. She could feel tension in her body and learn that tension did not have to become panic. She could want to win without feeling that her desire made her bad, needy, or exposed.
As she improved physically, something began to shift psychologically. Alice learned to drive both her forehand and backhand shots. She began to enjoy the speed of the game, the quick decisions, the playful aggression, and the satisfaction of meeting the ball cleanly. More importantly, she began to enjoy herself in a competitive situation. She was no longer only defending against shame. She was participating. She was trying, failing, adjusting, laughing, and trying again.
This brought her tremendous relief. The relief was not simply about table tennis. It came from discovering that competition did not have to mean humiliation, and that wanting to win did not make her dangerous or unlovable. She could enter an exchange with another person without having to control the outcome completely. She could be active without being seductive. She could be engaged without becoming ashamed.
When Alice arrived for her next session, I had planned to ask about her compulsive sexual behavior. She had a different agenda. To my surprise, she said she felt ready to terminate therapy. She explained that during therapy, several unexpected things had happened. While she was learning to play, she had realized that she was not able to seduce me. This was not a rejection or a failed conquest as she might once have experienced it, but a revelation. She discovered that she could have a relationship with a man that did not have to include sex. She could be seen, taken seriously, challenged, and supported without having to become sexually active.
Alice shared that she had begun dating someone and, for the first time in memory, was intentionally refraining from having sex. This was not because she felt ashamed of her sexuality, but because she wanted to know whether psychological intimacy could develop without physical intimacy. She was finding that she could remain present with a man without rushing to seduction as proof of her worth or to gain control.
In a follow-up session one month later, Alice had maintained her progress. She no longer described herself with the cruel label she had once used—“the town bike.” That phrase had represented the depth of her shame and the way she had come to confuse her behavior with her identity. By then, she seemed able to hold a fuller, more compassionate view of herself.
Looking back, I have often thought about Alice and about how much I learned in that first year of practice. I had imagined that treatment required me to know exactly what to do. Instead, I learned that therapy sometimes begins with knowing what not to do: I couldn’t replicate interactions in which she felt shame, powerlessness, and loss of control. In helping Alice learn to compete at a table tennis table, I helped her discover a different kind of relationship with a man—one in which she did not have to seduce, surrender, or disappear to matter. Table tennis is known for its quickness and specialized skill set. It’s not a coincidence that Richard Nixon’s Ping Pong Diplomacy in 1971 was central to improving America’s relationship with China.
***
Table tennis, and my relationship to it, has been instrumental in my learning not to linger on my own deficiencies, poor decisions, and performance anxiety. I am much more likely to focus on the present moment, forgive my mistakes, and maintain an emotional balance in my play. I continue to play the game and learn, and relearn, lessons about myself. While still a work in progress, I am happy to have found ways for me to grow across a ping pong table and for ways to help others.
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