Table 2.

Characteristics AT interventions.

References	Applied means and forms of expression	Art materials	Therapist behavior	Supposed mechanism(s) of change
Bazargan and Pakdaman (2016)	Painting sessions. Subjects had 45 min to 1 h to draw. In the end, subjects had 15 min to talk with the therapist and other members about works, feelings, interests, and events. Topics: warm-up activities using painting and coloring, learning about art media, general topics, first childhood memory/family relations, and the directed mental image, visualization, dream and meditation, anger releasing.	Cardboard and acrylic paint and drawing materials	No information given	Reveal what they have inside; leads to new activities and enhances experiences; provides an individual with opportunities through which they can freely express their feelings, affections, needs, and knowledge; achieving a feeling of security toward unpleasant memories of a traumatic event; emotions and thoughts are influenced by conflicts, fears, and desires, and painting allows patients to express them symbolically; offering opportunities to regain a sense of personal agency; explore existential concerns; reconnect to the physical body
Beebe et al. (2010)	Opening activity, discussing the weekly topic and art intervention related to chronic illness, art-making, opportunity for the patients to share their feelings related to the art they created, and closing activity. Inclusion of specific art therapy tasks designed to encourage expressions, discussion, and problem-solving in response to the emotional burden of chronic illness.	A variety of materials/techniques were offered, including clay, papier-mâché masks, paint, paper decoration forms, and markers.	Patients are encouraged by the art therapist to express their thoughts and feelings through art materials and interventions.	Helps to cope with troubling feelings and to master a difficult experience; experiences and feelings can be expressed and understood; being able to establish distance between themselves and their medical concerns; processing emotions through art, understanding that their problems are separate from themselves and that the children have an identity outside of their illness
Beh-Pajooh et al. (2018)	The subjects had a white sheet of paper to paint freely. At the end of each session, the students explained their painting briefly in the group.	Painting equipment: marker, color pencil, crayon, gouache, and water; white piece of paper	No information given	Effective because it is enjoyable for children; able to express their emotions (e.g., grief, fear and anxiety), feelings (e.g., whishes), and thoughts through projection, which leads them to achieve social adjustment
Chapman et al. (2001)	The CATTI (Chapman Art Therapy Treatment Intervention) begins with a graphic kinesthetic activity, followed by a series of carefully worded directives to elicit a series of drawings designed to complete a coherent narrative about the event (trauma). After completing the drawing and verbal narrative, the child is engaged in a retelling of the event using the drawings to illustrate the narrative.	Minimal art media	Children's emotional expressions are validated by the therapist as normal responses to the traumatic event to universalize their experience and reduce anxiety. During the retelling, numerous issues are addressed, including but not limited to misperceptions, rescue and revenge fantasies, blame, shame and guilt, coping strategies, treatment and follow-up plans, traumatic reminders, and reintegration strategies.	Facilitation of the integration of the experience into one's larger, autobiographical life narrative; facilitating the expression and exploration of traumatic imagery as it emerges from memory and finds form; utilizing the integrative capacity of the brain by accessing the traumatic sensations and memories in a manner that is consistent with the current understanding of the transmission of experience to language
Freilich and Shechtman (2010)	The child undergoing the therapy selects a topic, and the materials, for a project of interest. When necessary, conducting role-playing and guided discussions are used to increase efficacy.	Materials needed for art projects, such as paper, paints, pictures, journals.	The therapist assists and supports the youngster in carrying the project out. The therapist's role is to help the child identify a meaningful experience, a difficulty, or a conflict. In the process of working on the art piece, the therapist encourages the child to express related feelings and concerns, to explore them, and to reflect on them.	The subject(s) selected in art therapy is a reflection of important issues in the child's life that cannot be expressed directly; reflection leads to the development of insight the selection of goals for change; focusing on emotional exploration of difficulties; identifying problems; sharing problems with the therapist; cathartic experiences that lead to an increase in self-awareness and insight; focusing on an exploration of emotions and reflecting on them
Hashemian and Jarahi (2014)	Painting therapy (not further described)	Not described	Not described	Adjustment to their surroundings and therefore changing their inappropriate behavioral patterns; indirect communication with children
Kymissis et al. (1996)	Synallactic Collective Image Therapy (SCIT): drawing of a picture. Afterward, a brief presentation and voting one for discussion. The originator gives a title, offers association to it, and says how he/she felt before and after drawing. Other members give their associations. The resulting overlapping of the patient association was the collective image, which represented the basic theme of the session.	Drawing on 12 by 18 inches construction paper with pencils and colored markers.	The therapist takes an active role, directing and encouraging group members in the art activity. The therapists made sure group rules for orderly behavior were maintained.	The opportunity to freely present thoughts and feelings in a non-verbal way, within the structure of the group; the availability of the drawing as a non-verbal channel of communication helping regulation of the level of anxiety, enjoying the group; using artwork facilitated the group process
Liu (2017)	All sessions contain two domains: externalizing the problem and finding solutions. The experience associated with stress is drawn on small white paper. The future solution contents will be drawn on colorful, larger paper. All artworks were gathered and reviewed at the end of the intervention (last session) together with the parents.	Small white paper and large colorful paper; a variety of materials/techniques was offered, including drawing, painting, stress ball making, paper cutting, and paper folding	The therapist asks for what is better. The clients “stated needs for today” are related to overall goal(s) for therapy. The client is complimented for his strengths/resources. The therapist askes exception/difference questions. Scaling questions are being asked. Coping questions related to the client's abilities that emerged are being asked. Feedback on the helpfulness of the session is asked. The miracle question is being asked. The client is asked, “what else” was better in today's session. The families are given compliments about their contributions as the session ended. The client is asked to draw what they wish to draw/make but related to their problems. The therapist elicits the client to talk about the drawing and express their feeling. The therapist embeds most of the solution-focused questions and skills in the art-making process and guides the conversation. The therapist monitors that the drawings or the handcrafting are related to the intervention goal and that the session's drawing is focused on future, positive, and brightness.	SF-AT is a combination of Solution Focused Brief Therapy with Art Therapy. SF-AT group therapy in this study adopts a synthesized version of the constructivism theory and psychodynamic theory. This study also uses systems theory to frame the design of SF-AT and elucidate the mechanism of change. SF-AT addressed anger, stress, and emotional issues; non-judgmental acceptance and unconditional care to build rapport and facilitate change; therapeutic alliance; a practice promoting strength-based and positive perspective; empowerment by the strength-based treatment; positively construct information and experience; through positive cognitive construction and social construction, clients can build a new way of problem viewing and solving; this can help with negative thoughts and social impairments
Lyshak-Stelzer et al. (2007)	Trauma-focused art therapy (TF-ART). Scripted trauma-specific art activities (directives) for each session. Each participant completed at least 13 collages or drawings compiled in a handmade book format to express a narrative of his or her “life story.” The activities sought to support the youth in reflecting on several questions: What is the difference between feeling safe and unsafe with (a) your peers in the hospital; (b)peers on the street; (c) a staff member; (d) adults in your community; (e) peers at home; and (f) adults at home? When are feelings of fear and anger helpful, and how can they lead to increasing safety? What makes a place safe or dangerous? Can you contrast dangerous activities that you have engaged in during the past with safe activities? What made them safe or dangerous? A second phase of the protocol focused on sharing trauma-related experiences and describing coping responses. On the last session, each presented the book in its entirety to his or her peers.	Collage technique, drawing; making a book	Each adolescent was asked at the beginning of the session to do a “feelings check-in” describing how he or she was feeling in the moment using a single word or sentence, and a “feelings check-out” at the end of the session. After the art-making period, during which minimal discussion took place, the youth were encouraged to display their artwork to peers. They were encouraged but not required to discuss dreams, memories, and feelings related to their trauma history and symptoms. A second phase of the protocol focused on sharing trauma-related experiences and describing coping responses. For example, they were asked to share “some of the words that others have used to hurt you or help you in the past”; to describe nightmares, bad dreams, distressing memories, and flashbacks, as well as strategies used to cope with them; and to discuss traumatic “triggers” that served as reminders of trauma memories or feelings, along with coping strategies.	Exploring fundamental experiences associated with safety and threat; creating an opportunity for ways of orienting to safe and dangerous situations using non-verbal representations; imaginal representations used as the basis for verbalizing the associated experiences in a supportive social context; art products as a starting point for sharing traumatic experiences reduces threat inherent in sharing experiences of trauma by permitting a constructive use of displacement via the production of imagistic representations
Ramin et al. (2014)	A diversity of topics and means. Including: Image-making and imaginary drawing. Children started to image-making then draw whatever they prefer in their imaginary area; Children play-act and draw simple bad/good feelings in the group setting; Overall, drawing and discussing/exploring the result. At the ninth session, all the children worked on a group project to bring closure by drawing a ceremony on a large paper together with comments. At the end, a small exhibition of artwork was made.	Drawing on large paper, not further described.	An active role of the art therapist, for instance, recognizing dysfunctional ideas and beliefs children hold about themselves, their relations or interactions with the environment, and helping children identifying and restructuring them by using self-monitoring, problem-solving strategies, and learning coping responses and new skills.	A cognitive-behavioral approach. Non-verbal expression that is possible in art therapy is a safe way; imagination in combination with art-making; in art therapy, children can manage difficult emotions such as anger; art therapy can improve emotional understanding and anger management; in art therapy interventions children can learn coping responses, new skills or problem-solving techniques, increasing sense of belonging, to offer a non-threatening way and to communicate complex feelings and experiences.
Regev and Guttmann (2005)	The participants in control group B (art therapy group) created art projects, which were handled in an art-therapy fashion. Each meeting was divided into two parts. In the first 20 min, the children could freely choose to work with any of the available art-project materials and create (or continue to create) whatever they wanted. Then the work would stop, and the children would gather in a circle to discuss a child's (in turn) project.	A variety of materials	The art therapist supervised the group. Led by the art therapist, the discussion focused on questions such as: “how was the project done,” what it reminded the creator of, if it was similar to or different from other projects that he/she had made, if it reflected the way he/she felt that day, if it reflected anything that was happening in his/her life, and what he/she could learn from the project about himself/herself.	Artwork as a medium for self-understanding; artwork as a defense mechanism; artwork helps to ease personal difficulties; artwork helps to achieve emotional relief; artwork helps to achieve positive self-concept
Richard et al. (2015)	The intervention includes four sets of facial features (eyes, noses, mouths, and brows) representing four different emotions (happiness, sadness, anger, and fear), as well as a mannequin head. The participant was asked to create four different faces, representing happiness, sadness, anger, and fear. The participant was directed to choose a mouth, nose, eyes, and brows (in that order) that represented the correct emotion.	Four sets of facial features (eyes, noses, mouths, and brows); a mannequin head. Facial features were molded with Super Sculpey. Scotch, Adhesive Putty was used to attach the facial features to the Styro Full Blank Head. On the head paint was applied.	The participant was directed to choose a mouth, nose, eyes, and brows (in that order) that represented the correct emotion. For example, the researcher asked: which one of these mouths do you think would be a happy mouth? The participant received two attempts at choosing the correct feature. If the correct feature was chosen, the researcher responded: yes, that is a happy mouth! If an incorrect feature was selected, the participant was redirected with a statement such as: I do not think that is a happy mouth. A happy mouth has ends that turn upward. Then the participant made a second attempt at selecting the correct feature. If this attempt also failed, the therapist directed the participant to the correct feature.	By using three-dimensional materials to recreate emotions with facial features first the Kinesthetic /Sensory level is engaged through touch, next the Perceptual/Affective level is activated as the face is directly constructed with the materials, and possibly the Cognitive/Symbolic level can be mobilized to reinforce the identification of emotions; art activities involving tactile experiences help dissociative children connect through the ability to touch and create; information processing occurs at each of the first three levels on the ETC: Kinesthetic/Sensory, Perceptual/Affective, and Cognitive/Symbolic
Rosal (1993)	Two forms of art therapy: Art as therapy group (a) (experimental): unstructured, the children were encouraged to use the media and be creative with them. Cognitive-behavioral art therapy (b) (Control): use of specific objectives, a stated theme, specific media, and discussion topics. Basic structure: muscle relaxation, imaginary activity, clean up, discussion. Use of cognitive-behavioral principles: behavior contingencies, imagery, modified desensitization, problem-solving techniques, relaxation, stress inoculation, verbal self-instruction.	In both groups, the materials ranged from paint, drawing pencils and pens to clay, collage and construction parts.	Art as therapy group (a): The therapist was active, yet nondirective, by controlling the environment through manipulations of ambiguity and anxiety. Therefore, if tensions in the group were brought to a dangerous level, the therapist intervened through clarifying issues and helping the group find alternatives to the problem. The therapist also assisted any child who was having difficulty with a specific medium. Cognitive-behavioral art therapy group (b): delineated verbal instructions, directions for art media.	The intervention art as therapy could change LOC perceptions through the process of creating art and the experience with the art as a vehicle for discussion and feedback from others. The type of group therapist behavior was based on Whitaker and Lieberman's interpersonal interaction approach to group therapy. Intervention concerning cognitive-behavioral art therapy. The act of producing art may reinforce or enhance internal LOC (Locus of Control) perceptions; each line placed on a paper is the direct result of the child's behavior; A child's movement is reinforced visually by the mark that is produced; there is a direct link between behavior and outcome; drawings are derived from inner experiences The inner experiences may be perceptual, emotional or cognitive processes that are transformed into visual display Without even examining the content, a drawing is a tangible record of internally controlled behaviors; in art therapy, these tangible records are discussed, further reinforcing a child's inner experience.
Schreier et al. (2005)	Chapman Art Therapy Treatment Intervention (CATTI): one-to-one session at the child's bedside, completion 1 h. Starting: drawing activity. Drawings are used, creating a narrative about the event; the child can discuss each drawing. Then a retelling of the event, using the drawings to illustrate the narrative.	Minimal art media for drawing.	The child is encouraged to discuss each drawing. During the retelling, numerous issues are addressed, including misperceptions, rescue and revenge fantasies, blame, shame and guilt, coping strategies, treatment and follow-up plans, traumatic reminders, and reintegration strategies.	The art intervention offers an opportunity for the child to sequentially relate and comprehend the traumatic event, transport to the hospital, emergency care, hospitalization, and treatment regimens, and post-hospitalization care and adjustment; the drawing activity is designed to stimulate the formation of images by activating the cerebellum.
Siegel et al. (2016)	Patients selected buttons, threads, and words with which they constructed their Healing Sock Creature. The imaginary creatures were sewn and stuffed with magic bean, sand, or fiberfill. Children placed wishes inside the Healing Sock Creature to express their feelings.	Unused hospital socks and small kidney dishes to place buttons and threads. Sewing materials, magic beans, sand, fiberfill.	The therapist becomes the co-creator under the direction of the child by forming a bond of trust as the child shares their design ideas, which may include conversations about symbolic meanings of buttons or colors or threads.	The creative process, exploring deeper meanings in a patients experiences; integrating psychotherapy with multi-arts, the intermodal approach can help children access, process, and integrate traumatic feelings in a manner that allows for appropriate resolution, to reduce stress; this therapy uses imagination, rituals, and the creative process; a symbol can hold a paradox that the rational mind cannot fully explain; choosing a special button or writing a wish mirror, characterizes the child's psyche at this crucial moment; it enables the child to visualize and let go of troubling and unanswerable questions, thus relieving suffering
Tibbetts and Stone (1990)	Individual artwork (not further described).	-	The central focus of the art therapist was to assist the subjects to increase in the present their sense of personal power and responsibility by becoming aware of how they blocked their feelings and experiences anger. The approach was non-interpretive, with the participants creating their direct statements and finding their meanings in the individual artwork they created.	Non-interpretive. The art therapy approach utilized in the present study was consistent with the principles of gestalt. The primary role of the therapist as listening, accepting, and validating; art therapy is an integrative approach utilizing cognitive, motor, and sensory experiences on both a conscious and preconscious level; it initially appears less threatening to the client.
Jang and Choi (2012)	Each session had the following phases: introduction, activity, and closing. In the introduction phase, the participants greeted one another, did some warm-up clay activities, and were introduced to theme-related clay techniques. In the activity phase, they did individual or group-based activities making shapes using clay. In the closing phase, feedback about their performance was exchanged.	Clay	The art therapist asks questions. No further information provided.	To shed a sense of helplessness or depression with their physical movement of patting or throwing clay pieces in the activities; the continued and repeated experience of pottery-making throughout the sessions contributed to bringing about a positive change in the regulation and expression of emotions; the plasticity of clay made it easy for the participants to finish their clay work successfully; curiosity, toward the process through which a clay piece was transformed into glassy pottery and molding techniques or kiln firing that were learned in each session were factors that contributed to the positive changes; the plasticity of clay also enabled the participants to get a sense of control over the material because they could change the shape as they wished, which contributed to a positive evaluation of their own performance; witnessing the transformation of a piece of clay to complete, glassy pottery, combined with the positive feedback given to the participants, caused a sense of achievement and optimistic outlook on the future.
Khadar et al. (2013)	Painting therapy	Not described	The art therapist is present and does not impose interpretations on the images made by the individual or group but works with the individual to discover what the artwork means to the client.	The child makes art in the presence of his or her peers and the therapist, this exposes each child to the images made by other group members on both a conscious and an unconscious level; to learn from their peers and to become aware that other children may be feeling just like them; make meaning of events, emotions or experiences in her life, in the presence of a therapist; the process of drawing, painting, or constructing is a complex one in which children bring together diverse elements of their experience to make a new and meaningful whole; through the group, they learn to interact and share, to broaden their range of problem solving strategies, to tolerate difference, to become aware of similarities and to look at memories and feelings that may have been previously unavailable to them; the image, picture or enactment in the art therapy session may take many forms (imagination, dreams, thoughts, beliefs, memories, feelings); the images hold multiple meanings and may be interpreted in many different ways.
Khodabakhshi Koolaee et al. (2016)	First session: Initial introduction, declare short objective of sessions. Second session: Collaborative painting among therapist and child: make a closer contact with children. Third session: Technique of children's scribble: reduce resistance and anxiety in children. Fourth session: Photo collage: Increase cooperation during the treatment process. Fifth session: Drawing with free issue: emotional discharge. Sixth session: Drawing the atmosphere of the hospital and the inpatient portion: express anxiety of children related to atmosphere hospital. Seventh session: Drawing family as animal: evaluate the attitude and relationship of children with family. Eighth session: Anger collage for expressing children's anger and aggressiveness. Ninth session: Drawing with free issue: express emotion. Tenth session: Evaluate the effectiveness of drawing on aggressiveness and anxiety. Eleventh session: Follow-up session.	Photo collage, drawing. Not further described.	Not described	Painting provides opportunities to communication and non-verbal expression; it can serve as a tool to express the emotions, thoughts, feelings, and conflicts; anxiety symptoms of children emerge in metaphorical symbols such as play and painting; drawing permits the children to convey their thoughts and dissatisfaction with environment-related to the hospital, they can express their emotion in safe atmosphere: drawing improves anger management and emotional perception with learning the accurate coping response, the techniques and problem-solving skills, and provides the non-invasive way to communicate in a complex emotional situation.
Pretorius and Pfeifer (2010)	Four themes: (1) Establishing group cohesion, and fostering trust by group painting, guided fantasy with clay, and story-making through a doll. (2) Exploration of feelings associated with the abuse by drawing feelings, drawing perpetrators, placing of these in boxes. (3) Sexual behavior and prevention of revictimization by role-playing and mutual storytelling (4) Group separation by painting, drawing, or sculpting feelings associated with leaving the group	Paint and drawing materials, not further specified, and clay.	Therapeutic behavior based on the existential-humanistic perspective, and incorporated principles from Gestalt therapy, the Client-centered approach, and the Abuse-focused approach	Group psychotherapy can ameliorate difficulties encountered in the use of individual therapies with sexually abused children, including an inherent distrust of adults, fear of intimacy with and disclosure to adults, secrecy and defensive behavior; group therapy also offers children the opportunity to realize that they are not alone in their experiences and that other children have had similar experiences, this realization may be a great source of relief that helps reduce the sense of isolation; art therapy involves a holistic approach in that it not only addresses emotional and cognitive issues but also enhances social, physical and developmental growth; art therapy appears to help with the immediate discharge of tension and simultaneously minimize anxiety levels; the act of external expression provides a means for dealing with difficult and negative life experiences; art therapy, therefore, not only assists with tension reduction but also with working through issues, thereby leading to greater understanding; Group art therapy acknowledges the concrete thinking style of latency-aged children and accordingly provides an opportunity for non-verbal communication; contact with group members may also decrease sexual and abusive behaviors toward others.
Ramirez (2013)	Six interventions were repeated twice: (1) Predesigned mandala template/complete design. (2) Create self-portraits (3) Design a collage. (4). Mold clay into a pleasing form, which could be an animal, a person, an object, or an abstract form. (5) Visualize a landscape from imagination and paint it. (6) Arrange a variety of objects in a pleasing orientation and draft the still life with a pencil	Color pencils, markers, crayons, and oil pastels; charcoal, ink, or mixed media, clay; acrylic paints or watercolors	The therapist facilitates the creation of the artistic product and is supportive. The art therapist suggests expressive tasks in a manner that shows respect for their way of reinventing meaning and involves subject matter that is of interest to the teen.	The creative process involved in artistic self-expression helps people to become more physically, mentally, and emotionally healthy and functional, resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, handle life adjustments, and achieve insight.
Steiert (2015)	The given theme was Heroes; no further information provided	An extensive range of different materials was available. There was wood, stone, plaster, and a comprehensive selection of paint and drawing materials, also felt and other textiles.	Decisions on what to do, which materials to use were discussed with the patients. The shaping of the heroes was supported by talking about this, viewing comics, searching images, watching videos. For dealing more intensely with the heroes, suggestions from the therapist were given.	The processing on a symbolic, playful and imperious level, gives the child the opportunity for a gradual approach for their conflicts, without defense mechanisms undermining it; heroes and heroic stories support children and adolescents not just in their childhood development but have potentially also a positive influence on processing disease; in the children and adolescents can find their emotional reality and find solution options for the handling of these conflicts' themes.
Wallace et al. (2014)	Expression of feelings by mandala drawing and painting. Exploration of changes in family functioning by a family drawing with pencils, markers, and oil pastels.	Paint, not further specified; drawing materials such as pencils, markers, and oil pastels	The art therapist provided general art therapy guidelines such as that there are no mistakes or a right or wrong way to express themselves in art. The art therapist encouraged the participants to explore the art materials, to relax, and to have fun. The art therapist inquired about colors and feelings depicted and asked the participant to share examples of why each feeling had been or was being experienced. The art therapist normalized and validated the siblings' feelings, provided support and empathy.	Art therapy may offer a non-verbal means of communication, an emotional outlet, and a source of empowerment and control for this population; art therapy can assist children in communicating difficult feelings and in reducing symptoms of anxiety and posttraumatic stress; art therapy can stimulate the verbalization of hospital experiences and resolving anxiety and fear-provoking thoughts; art therapy offers an opportunity for making choices; the process of creating art may provide a sense of control for siblings during a time when many decisions are beyond their control; the intervention group had significantly lower PTSS, it appears that the siblings gained mastery and processed their emotional responses; art therapy assisted in reintroducing control into the healthy siblings' life and allowed them to express and process the challenges and changes that they were experiencing; art therapy allowed the siblings to express emotion without resorting to words; art therapy seems to have assisted the healthy siblings in gaining a level of comfort that facilitates asking questions, which can result in an effective educational intervention.
Walsh (1993)	AFI (art future-image intervention): Clients met together, formulated plans for a future identity, and created a future self-image caricature poster from an enlarged polaroid photograph and a career/body-image packet designed by the researcher.	Polaroid photos; drawing materials.	Not described	Identity formation; promotion of qualities associated with psychological health: (a) exploration of various career options, (b) decision-making, and (c) identity achievement.
Chaves (2011)	Creating therapeutic art books	A diversity of materials, not further specified	The art therapist offers the individual social support; the therapist never criticized the participants work, attempted to avoid giving art instruction, and created a safe and accepting environment.	The creation of art books is a way for individuals to “visually” document their journey throughout their hospitalization and recovery process. Through art-making, especially within the contained boundaries of a book, individuals are provided with a bridge that can help them move toward their authentic selves. Through books, individuals can track their recovery process chronologically, can review their emotional progress, and can choose what they want to create, without their creations being judged by others. The books are a definite shape, and the books can be closed, they act as a container for the individual's emotions, thoughts, and sense of self. The book becomes an investment in everyone's recovery and a reflection of their process.
D'Amico and Lalonde (2017)	The sessions employed art-based interventions using the art-based interventions focused on developing self-expression, creativity, and the consolidation of social skills through art-making, discussion, play, and collaborative projects.	Various two- and three-dimensional art materials	Therapists employed various art-based techniques and training strategies to increase student practice and performance of desired social behaviors. If any child required additional instruction for a particular social skill or problem behavior, a therapist addressed this in a more individualized manner in the therapeutic group session. The art therapists created a variety of opportunities for the children to cooperate and to build cohesion among group members. The art therapists used these and other therapeutic activities to help the children improve their social functioning and work through personal issues, while providing them with opportunities for behavioral practice to enhance self-esteem and well-being.	It provides opportunities to solve social problems visually and in a concrete and creative way; it offers a way to learn information in an unconventional, non-verbal, comprehensive, and expressive manner through rich sensory experiences with a variety of art materials; the combination of art and therapy is pertinent to address the individual's feelings of anxiety, depression, and frustration through empathetic listening, visual feedback, and using creative projects to build a trusting relationship; art therapy can empower children to become active participants in their treatment, and to use their creativity in a meaningful and productive manner.
Devidas and Mendonca (2017)	Art therapy included theme drawing, theme painting, making future portrait, freehand drawing, clay modeling, scribble drawing, paper bags making, preparing stuffed toys, finger painting, and attach a drawing to a balloon.	Drawing and painting materials including finger paint (not further described); clay, materials for making paper bags; stuffed toys	Not described	Art can raise the self-esteem and promote psychological comfort; Art is the language of mind; emotions and feelings can be best expressed through art
Epp (2008)	Conversation skills are practiced in an unstructured manner (10 min), with leading questions. Then a structured art activity (30 min), with instructions and next unstructured free time (20 min).	A variety of materials and activities is used.	Cognitive-behavioral strategies are used throughout the group therapy session. An example of this would be a therapist asking a student, “When you are frustrated/happy, what do you say to yourself? What is your self-talk?” Usually, the group is led in a brainstorming exercise to discover ways to change self-talk to improve feelings or make better choices \with difficult feelings. Social skills are “taught” by therapists who carefully watch how children approach or do not approach each other, intervening in a helpful, non-threatening, concrete manner so that the children learn how to structure their playtime in a social context.	Cognitive-behavioral strategies are used. Through the child's art, the therapist can gain insight into what the child is experiencing, which is information that is not readily available through verbal means; art therapy as a component to social skills training may increase the willingness of children to participate because art is an activity that they find acceptable; art therapy offers a way to solve problems visually; it forces children with autism to be less literal and concrete in self-expression; it offers a non-threatening way to deal with rejection; it replaces the need for tantrums or acting-out behaviors because it offers a more acceptable means of discharging aggression and enables the child to self-soothe; use of icons, symbols, and social stories help the children to remember what they were taught; when children and therapists collaborate to custom-make these symbols, icons, and stories for each child's unique challenges and goals, the children take ownership of them and integrate them into their internal experience; Comic strips are drawn by the teacher and then used to “teach” to the children, with discussion and analysis of the portrayed events. Children who are visual learners take in this information in a way that stays with them
Hartz and Thick (2005)	The specific art therapy interventions used during the study included magazine collage and yarn basket-making. The same projects and an identical selection of materials were provided to all participants, regardless of the intervention approach. All participants received group therapy with their core group 5 days a week as their primary treatment and participated in several adjunctive therapies weekly (including art therapy). A majority also had monthly family therapy sessions, facilitated by their core-group leader.	A variety of materials, including magazines and yarn, for basket making.	In the art as therapy (a) approach, the design potentials, technique, and the creative problem-solving process were highlighted. Artistic experimentation and accomplishment were emphasized. In the art psychotherapy approach (b), a brief psychoeducational presentation was employed, and abstraction, symbolization, and verbalization were encouraged. During facilitation, personal awareness and insight were emphasized.	Art as therapy (a) focuses on developing mastery, creating structure, and sublimating conflicts to strengthen the ego; the confidence and authenticity that participants reported suggest the development of meaningful and supportive relationships; experiencing growth and mastery in art therapy provided participants with an experience of success and pride transferable to other areas of their lives. Art psychotherapy (b) is a cognitively based approach that emphasizes insight and involves some verbal processing of the art products
Higenbottam (2004)	Group activities included several spontaneous art sessions as well as some group directives inspired by the writings of Ross (1996); Ruiz (1997); Riley (1999), as well as Daley and Lecroy's (2001).	Not described	The art therapist is a group facilitator and a cultural mediator. Encouraging the client's creative expression as well as teaching and modeling coping skills. The students were given opportunities to make their own decisions during the group, and there were no group rules per se. The therapist set some rules to prevent art therapy time being used for gossip. Handouts with developmentally appropriate or topical information were given. As the group evolved and certain subjects or questions arose, handouts evolved to reflect this.	Art therapy is a modality that commonly diminishes adolescent resistance; art therapy group for adolescent females, focusing on self-esteem and body image can provide the opportunity for action, expression and discussion at a time when such explorations are most important to development; adolescent art therapy groups provide a necessary forum where teenagers can safely express themselves, exert independence and make safe decisions.
Jo et al. (2018)	A manualized art intervention program: Sessions 1 to 3 consisted of the “getting to know” stage, sessions 4 to 8 were the “releasing” stage, and sessions 9 to 12 were the “soaring” stage. The “getting to know” stage focused on easing the tense atmosphere by building a rapport between the therapist and children, as well as helping the children become more familiar with the material and gain an awareness of their inner self. The “releasing” stage was designed to help the children experience the freedom of feeling and relieving their pent-up feelings through expression. It also dealt with their relationships with the parents and siblings within the family. The “soaring” stage focused on providing positive feedback in the form of hope for the future and positive awareness of one's current self.	All three stages used a variety of materials and activities.	Not described	The art intervention is a tool that can be effective in helping people overcome difficult experiences and psychologically cope by encouraging emotional expression via art; this intervention can be particularly effective in children since it allows those who are unable to accurately verbalize their thoughts and feelings to convey these more comfortably; it is assumed that a significant improvement in self-esteem might help children recognize themselves positively through expressing their feelings freely and offer greater emotional support; the externalizing problems scale and its aggressiveness subscale, emotional instability, and other categories showed a significant decrease, which is believed to be the result of the children sublimating their aggressive energy through their artwork, resulting in greater emotional stability.
Pifalo (2002)	Sessions 1 and 2: Group puzzle mandala. 3: Creation of two lists of feelings. 4: Creation of a “container” for these feelings/several materials. 5: Drawing of “roadmaps.” 6: Puppet making. 7: Clay representation of significant people. 8: Making of a bracelet. 9: Designing a safe place. 10. Sharing creations of products in the group	A variety of materials, including puzzle mandala. Drawing materials. Materials for making a puppet; clay; materials for making a bracelet	The art therapist “offers a container” that allows the freeing up of visual or kinesthetic imagery, and still allows sufficient emotional distance from overwhelming pain. The art therapist acts as a witness to the trauma. The role of the art therapist was to facilitate the negotiation of a safe passage between the poles of constriction and intrusion in discussions between the girls.	A combination of art therapy and group process. The images that participants created individually and as a group gave a voice to the powerful emotions that they had previously suppressed; the stultifying bonds of silence and secrecy- the powerful weapons of the perpetrator-were broken as each girl found the courage to identify her feelings and speak them aloud within the safety of the group; both the group members and the images that they created bore witness to their rage, grief, pain, and loss; the artwork allowed the group members to create containers for their rage and their tears.
Pifalo (2006)	A combination of art therapy, cognitive behavioral therapy, and group process to address the therapeutic issues related to childhood sexual abuse. Not further specified.	A variety of materials, not further specified.	Not described	Cognitive-behavioral therapy offers clear-cut goals for trauma-focused therapy; art therapy “cuts to the chase” in a way that talk therapy alone cannot because art therapy does not rely strictly on a verbal mode of communication; art therapy is uniquely suited to promote basic goals of crisis intervention involving cognition and problem-solving, and ventilation of affect; the use of image-based interventions such as creating containers to express and release powerful emotions, making maps to organize a coherent trauma narrative and set future goals, using multiple media to illustrate the photographic nature of traumatic memories, and graphically representing internal and external sources of support, provides an opportunity for traumatized children to express what they may not yet be able to verbalize.
Rowe et al. (2016)	The art therapy interventions delivered within the sessions were tailored to the client's specific needs and therapeutic goals, as established by the client, the family, and the therapist (not further described).	Not described	Art therapists worked with their clients to form therapeutic goals during initial sessions, followed by both structured and unstructured weekly art therapy sessions (not further described).	Art therapy is an effective psychotherapy for traumatized individuals based on the theory that trauma is stored in the memory as imagery, and art-making is an effective tool for processing these images; ATI's school-based art therapy program is uniquely suited to serve its adolescent refugee clients because a perceived sense of safety at school and of school belonging protects against PTSD, depression, and anxiety; the program seeks to develop clients' strengths as well as ameliorate negative symptoms associated with the refugee experience, such as depression and anxiety
Saunders and Saunders (2000)	Not described. Different for all individual subjects.	Not described	The therapeutic relationship between client and therapist is one that must be developed and nurtured by the art therapist to facilitate the therapy process. Both the product and the associative references may be used by the therapist to help the client find a more compatible relationship between his/her inner and outer world. A positive therapeutic relationship. Ultimately, the art therapist guides his/her client through to the therapeutic goals determined by the nature of the client's assessed needs.	Art therapy uses the modality of art media to help clients express their thoughts, feelings and experiences; the use of art as therapy implies that the creative process can be a means of both reconciling emotional conflicts and of fostering self-awareness and personal growth; creating a work of art provides the client with a vehicle for self-expression, communication, and growth; process, form, content and/or associations become important for what each reflects about personality development, personality traits, and the conscious behavior and unconscious motivation; art therapy is the modality of choice for helping children, and adults, who find it difficult to verbalize their feelings and to acknowledge them to themselves because of their age, developmental level, lack of trust, fear of acknowledging the unknown, or mental illness. One of the central features of art therapy is its ability to help children become more communicative about their feelings and less likely to either internalize them in unhealthy ways or to act them out in destructive ways.
Sitzer and Stockwell (2015)	Students engaged in art therapy combined with CBT and DBT modalities. Students learned to listen, describe their artwork and personal experiences, give feedback and encouragement to their peers.	A variety of materials and activities was used; not further described	The art therapist provides a safe and protected space so that the child can model the experience of positive affect regulation.	Art therapy combined with CBT and DBT modalities. Communication skills are the main vehicle of change, from the development of trust in module one, through mindfulness module six; students learned to listen, describe their artwork and personal experiences, give feedback and encouragement to their peers; art therapy provides the medium and expressive capacity to elicit several positive resilience characteristics; the activation of positive emotions, increasing emotional self-efficacy, and improved self-esteem walks lock-step with resilience; Mindful mandalas are a quiet, non-verbal art directive designed to facilitate a meditative experience; post-artwork discussion includes review all skill-sets taught in the program: identification of beliefs that contribute to optimism, emotional regulation skills, and stress management, communication skills, mindfulness thinking.
Stafstrom et al. (2012)	Each session included a different discussion topic and art activity designed to enhance positive adjustment to epilepsy. (1): Self-portrait inside/outside box, drawing, and collage. (2): A memory or feeling about epilepsy, drawing and painting media. (3): Mandala of personal symbols, drawing media (4): A dream or goal for the future, diorama with digital photo portraits, mixed media.	Drawing materials; materials to make a collage; painting materials; digital photos; mixed media	Each session is facilitated by an experienced art therapist (not further described).	Art is a projective technique that can be used to assess the emotional and psychological challenges that affect children and adolescents; artwork allows children to express their feelings in a way that they may find difficult verbally; artistic creations contain symbols and metaphors that articulate the importance of a disorder in a child's life and experience; children often find expression through art to be empowering and enjoyable.

ATI, Art Therapy Institute; CBT, Cognitive Behavioral Therapy; DBT, Dialectic Behavioral Therapy; ETC, Expressive Therapies Continuum; LOC, Locus of Control; PTSD, Post Traumatic Stress Disorder; SF-AT, Solution Focused Art Therapy.