The majority of literature on video gaming in relation to psychological therapies revolves around video game addiction (Kuss, 2015), violence (jagodzinski, 2006), prosocial behaviour (Passmore & Holder, 2014), gender (Todd, 2012), and the incorporation into mental health care (Ceranoglu, 2010). However, video game play can also be viewed from a psychotherapeutic perspective as a transitional space (Winnicott, 1953) that is utilised to mediate internal and external reality. Internal representations of important people, and events from the client’s life may be expressed through their video game characters (avatars) appearance and in game actions (Mittlböck, 2015). Through the process of a hermeneutic literature review the intersection between psychotherapy and video game play was further explored. From this a number of themes emerged, such as: the impulse to critique and contradict, the avatar as a subversion of the death drive, imagination as a way of transcending the gap between the virtual and non-virtual, the collective as a counter to the curating of minds, the reality of collective dreaming, the perverse as the authentic expression of the personality and the mask as an escape from the oppression of everyday life.