Although there is a large body of research on the effects of unstructured group therapy among college students, there is inconclusive research on how implementing tabletop roleplaying games (TTRPGs) as a structured activity affects group cohesion for therapy groups made up of college students. Participants were adult, full-time university students who are seeking therapy at the university counseling center. This study measured the effectiveness of therapeutically applied TTRPGs in group therapy with a mixed-methods approach. Participants took the Outcome Questionnaire-45 (OQ-45) to measure psychological functioning, the Group Questionnaire (GQ) to measure group cohesion, and answered five qualitative questions to describe their group experiences. A series of linear regressions and means comparisons identified differences between treatment and control groups followed by a qualitative thematic analysis of participants' group experiences. The study yielded the following results: (a) groups had statistically suggestive improvements in their psychological functioning (p = 0.947), (b) groups had significant improvements in their group cohesion (GQ TS p < 0.0001, GQ NR p < 0.0001, GQ PB p < 0.0001, GQ PW p < 0.0001); (c) there were no significant quantitative differences between treatment and control groups; and (d) identifiable themes in group member comments. This study indicates that therapeutically applied TTRPG (TA-TTRPG) groups are as effective at treating mental health symptoms as unstructured interpersonal process groups are with additional qualitative benefits. These findings suggest that clients of university counseling centers might benefit from participating in TA-TTRPG groups as they do from participating in unstructured interpersonal process groups.