Many adolescents experience difficulties in engaging directly with traditional face-to-face therapeutic approaches (BMA, 2006). Recent research suggests that computer assisted mental health interventions may provide one potential way of working more successfully with adolescent clients. Research also suggests that the choice of technology is a key factor in the success of computer assisted interventions. For example it is suggested that a??a quality therapeutic process will actively engage the clienta??s participation, by involving their interests, strengths and ideas. Similarly, technologies are most likely to prove effective if they are designed to be client-centreda?? (Coyle, Doherty, Sharry, & Matthews, 2007). Whilst much attention in recent years has focused on the negative effects of computer games, a review of literature and an initial pilot study (Coyle, Matthews, Sharry, Nisbet, & Doherty, 2005) has provided strong initial indications that appropriately designed games may have potential to assist in adolescent interventions. Therapeutic games offer the opportunity to engage with adolescents through a medium with which they are comfortable. A recent UK survey reported that 53% of eleven to fourteen year olds play games four times a week or more, and that 44% play for more than one hour at a time (McFarlane, Sparrowhawk, & Heald, 2002). Further surveys in the US and the UK indicate that under-16a??s rank computer gaming as their number one entertainment form (Gentile & Walsh, 2002; Pratchett, 2005). This chapter first reviews previous research on the use of computer games in therapeutic settings. The potential benefits of games are also discussed. For example are games just a useful icebreaker, or can then assist in other ways? Can they, for instance, assist in improving client engagement and the client-therapist relationship? By way of example we discuss Personal Investigator, a game recently developed for use in professional therapeutic practice. The chapter ends by taking a more speculative perspective on future directions for therapeutic gaming.