My 7 Go-To Art Therapy Ideas for Teens Who Hate 'Talking About Feelings'

After a decade working with teenagers who'd rather do anything than "talk about feelings," I've discovered that My 7 Go-To Art Therapy Ideas for Teens Who Hate 'Talking About Feelings' consistently break down barriers where traditional approaches fail.

"I can't draw" or "This is childish" – sound familiar? These aren't just deflections; they're protective shields. Thankfully, art therapy offers a powerful, nonverbal way for teens to process feelings, relieve stress, and build self-awareness. The beauty of these therapeutic activities lies in their ability to bypass verbal resistance while still addressing what matters.

Art therapy is incredibly beneficial to teenagers who struggle to express themselves verbally. Through creative expression, teens can work through trauma, address mental health problems, and enhance their overall well-being. Instead of forcing conversations that feel uncomfortable, these art therapy activities provide a safe, non-judgmental space where teens can express themselves freely without fear of criticism or failure.

I've curated these seven techniques specifically for professionals working with resistant teens. Each approach addresses common challenges like stress and anxiety, low self-esteem, trauma, depression, and poor emotional regulation. What makes these ideas particularly effective is that they can't be easily evaluated as "good or bad", removing the performance pressure that makes many teens shut down.

Let me walk you through the art therapy approaches that have transformed my practice – no artistic talent required, just an open mind and these proven protocols.

The Map of My Territory

Image Source: Two Writing Teachers

Map-making has fascinated humans throughout history, but I've found its power as a therapeutic tool for teens particularly remarkable. When words fail, a map can speak volumes about a teen's inner world.

The Map of My Territory: The Concept & The Problem It Solves

The "Map of My Territory" activity invites teens to create visual representations of their personal geography—the places, emotions, and experiences that shape their world. Unlike traditional maps, these are emotional landscapes that reveal what matters to them.

This approach draws from research on "place mapping," a technique developed to document teenagers' experiences and perceptions of their environments. The mapping produced through this method portrays how teens interact with everyday places beyond their home, creating what researchers call a "microgeography" of experience.

For teens struggling with:

• Difficulty articulating complex emotions

• Feeling misunderstood or invisible

• Trouble identifying emotional patterns

• Resistance to direct questioning about feelings

The genius of territory mapping lies in its indirectness. Many teens who shut down when asked "How are you feeling?" will eagerly map the emotional landscape of their life if given the right framing. Furthermore, the mapping process has an inherent emotional dimension that can be therapeutic for individuals participating in the process.

The Map of My Territory: My Script

When introducing this activity, I keep it casual yet purposeful:

"Today we're going to create something I call 'The Map of My Territory.' Think about it—we all have physical places we go, but we also have emotional territories. I'm curious about your map—the places that matter to you, where you feel different emotions, where you spend time, and how all these connect. This isn't about artistic talent; it's about mapping what's meaningful to you."

I offer simple materials: large paper, markers, colored pencils, and stickers. Then I provide prompts:

"You can interpret this as deeply as you wish, depending on your comfort level. Some choose to map the events throughout their lives leading to now, while others might literally map their route to school today. There's no wrong approach."

As they work, I emphasize that this is about process, not product—their map can be revisited and reimagined repeatedly.

The Map of My Territory: The Clinical Lens

From a therapeutic perspective, this activity operates on multiple levels. Creating personal maps brings a sense of power and control back into a teen's life when events threaten to fragment their world. The process enables teens to concretize their lived experiences and reflect within a supportive environment.

Research has identified four main therapeutic benefits:

1. Development of self-compassion

2. Fostering of kinship amongst participants

3. Increased creative thinking and flexibility

4. New perspectives on life events and transitions

The map becomes what therapists call an "external representation"—a physical object that makes abstract emotional experiences tangible and discussable. In essence, it's a powerful reminder that "the map is not the territory"—our perceptions and interpretations of reality are subjective and can be redrawn.

The Map of My Territory: Adaptations

This versatile activity can be customized in numerous ways:

For deeply resistant teens, start with a literal neighborhood or school map and use emoticon stickers to mark places associated with different feelings. This creates a less threatening entry point.

For trauma-focused work, invite mapping of "before" and "now" territories, or "safe zones" versus "caution areas."

With groups, each teen can create individual maps, then identify commonalities and differences, fostering connection through shared experience. Place mapping proves especially effective at encouraging discussion among participants and ensuring equitable participation.

For younger teens, simplify by using a house metaphor—if your feelings were rooms in a house, what would they look like? Who's allowed in which rooms?

One client nearing discharge created a treasure map with ports by the sea, symbolizing her transition back to other realms of her life. Another drew her life as book covers, with the final book—representing post-therapy—having an undetermined content and a release date matching her discharge.

Clay vs. Anger

Image Source: YouTube

Working with resistant teens has taught me that anger often lives in the body as much as in the mind. Clay offers a uniquely effective medium for channeling and transforming this powerful emotion through physical engagement.

Clay vs. Anger: The Concept & The Problem It Solves

Clay therapy harnesses the therapeutic power of touch and tactile expression to address anger management. The resistive nature of clay makes it exceptionally effective for teens who struggle with:

• Difficulty verbalizing intense emotions

• Physical manifestations of anger (muscle tension, clenched fists)

• Impulsive or destructive urges

• Poor emotional regulation

• Internalized anger

The brilliance of this approach lies in how clay responds to physical energy. As teens knead, pound, and reshape the material, they're literally transferring their emotional energy into something constructive. Moreover, clay provides immediate sensory feedback, creating a kinesthetic experience that releases tension while simultaneously stimulating and discharging energy through movement.

Research shows that manipulating clay for just five minutes produces greater negative mood and anxiety reduction compared to other interventions. Additionally, studies indicate that participants working with clay using bare hands (versus wearing gloves) show measurable improvements in mood and overall well-being.

Clay vs. Anger: My Script

When introducing this activity, I keep my language straightforward:

"Today we're going to experiment with something different. This clay responds to whatever energy you give it—pressure, movement, temperature. I'm curious what happens when you let your hands express what might be difficult to say in words."

I then provide simple instructions:

"There are no rules except to notice what's happening—both in the clay and in your body. You might start by just pressing and folding it, feeling its resistance. Some people find it helpful to create something that represents their anger, while others prefer just working with the material itself."

During the process, I offer gentle prompts: "What's it like to work with the clay? What are you noticing about how your hands want to move? Is there a difference between slow, controlled movements and quicker ones?"

Clay vs. Anger: The Clinical Lens

From a therapeutic perspective, clay work operates on multiple levels. The physical act of manipulating clay engages the major senses—touch, sound, and even smell—connecting teens with their inner experiences.

The effectiveness stems from several mechanisms:

First, clay provides a safe outlet for the physical urges that often accompany anger (clenching, hitting, gripping). When teens experience anger through physical sensations like muscle tightening or flushed cheeks, clay offers a constructive channel for that energy.

Second, clay work grounds clients in the present moment. The sensory engagement interrupts rumination and pulls attention to immediate physical sensations, supporting mindfulness.

Third, the malleability of clay offers metaphorical significance. Teens experience both control (shaping something) and release (pounding, cutting) simultaneously. This parallels healthy anger management—containing emotion while finding appropriate expression.

Research confirms these benefits, with studies showing clay manipulation produces greater mood improvement than alternatives, especially when given structure and purpose.

Clay vs. Anger: Adaptations

This versatile approach can be modified in numerous ways:

For highly resistant teens, start with simple stress-ball exercises using the clay before moving to more expressive work.

For group settings, incorporate parallel play where teens work individually but in proximity, reducing performance anxiety while maintaining connection.

For trauma-focused work, pair clay with guided visualization, creating objects that represent both the anger trigger and potential resolution.

For younger teens, introduce the "clay volcano" technique where they build a structure representing how anger builds before erupting.

For teens who prefer structure, suggest specific projects like creating containers to "hold" difficult emotions or sculpting symbolic objects that represent what their anger feels like.

One client initially refused all therapy activities but would quietly manipulate clay during sessions. Gradually, this tactile engagement became his entry point into expressing what words couldn't capture about his home situation.

Comic Strip of My Inner Critic

Image Source: Dragonfly Spirit Studio

The inner critic—that persistent voice of judgment we all carry—speaks especially loudly in adolescence, when teens are most vulnerable to harsh self-evaluation. Comic creation offers a powerful way to externalize and examine this often destructive inner dialogue.

Comic Strip of My Inner Critic: The Concept & The Problem It Solves

This technique invites teens to create a visual narrative that personifies their inner critic as a character interacting with a representation of themselves. By turning abstract self-criticism into concrete images and dialogue, teens gain perspective on thoughts that might otherwise feel overwhelming.

This approach addresses:

• Persistent negative self-talk

• Difficulty recognizing destructive thought patterns

• Shame around self-criticism

• Reluctance to discuss feelings of inadequacy

The genius of comic strips lies in their ability to create emotional distance. Research indicates that revisiting difficult experiences through sequential art can provide a form of catharsis for the creator. Furthermore, the comic format allows clients to represent themselves, others, and even their disorders pictorially through the creation of avatars.

Comic Strip of My Inner Critic: My Script

When introducing this activity, I maintain a conversational tone:

"We all have that voice in our head that criticizes us—I certainly do! Today, I'd like us to try something different: giving that voice a character and creating a short comic about it. What sorts of things does your inner critic say to you? Maybe things like 'That's the stupidest-looking drawing ever!' or 'Why can't you ever learn?'"

I then provide simple instructions:

"First, decide what your inner critic might look like as a character. It could be an animal, monster, teacher, parent, or anything else. Then, draw a conversation between you and this critic. Don't worry about artistic skill—stick figures work perfectly! What's important is capturing the conversation."

Throughout the process, I emphasize: "Remember, your inner critic isn't a separate entity; it's an aspect of yourself. You are the one saying these things to yourself, usually mimicking things others have said to you."

Comic Strip of My Inner Critic: The Clinical Lens

From a therapeutic perspective, this technique operates through several mechanisms. Primarily, it helps teens externalize problematic thinking—creating what art therapists call "a container around those experiences". Each panel functions as a figurative container for potentially overwhelming psychic material, allowing clients to approach issues with a feeling of control or mastery.

The process facilitates metacognition—thinking about thinking—as teens observe their critical thoughts from a new perspective. Consequently, they begin to recognize that they can "talk back" to their inner critic rather than passively accepting its judgments.

Comic creation naturally engages what Williams calls "reauthoring"—allowing clients to revisit and reshape their experiences in ways that simply talking through them cannot. Additionally, this visual narrative approach supports exploration of relational dynamics, embodied knowledge, and patterns that might otherwise remain invisible.

Comic Strip of My Inner Critic: Adaptations

This versatile approach can be modified in numerous ways:

For digital natives, online comic creators provide structure for teens uncomfortable with drawing. During telehealth sessions, teens can share their screen while creating, enabling real-time therapeutic discussion.

For group settings, sharing comics can normalize inner criticism and inspire new ways to respond. One student reported, "I didn't realize that I could talk back. I don't have to listen to my inner critic!"

For resistant teens, start with examining published comics about mental health before creating their own. Comics like Grant Snider's "How to Quiet Your Inner Critic" can serve as helpful models.

For ongoing work, comics can become a regular check-in tool. As one student noted, "We could do this project every year because my inner critic is already changing".

Fundamentally, this technique helps teens recognize their inner critic as a character whose script they can rewrite—shifting from passive reception of criticism to active engagement with their thoughts.

The Mask for the World

Image Source: Thirsty For Art

Masks have existed since ancient times, serving purposes from protection to performance, concealment to celebration. In therapy, they offer a powerful metaphor for the personas we all wear—making this technique uniquely effective for teens reluctant to verbally explore their identities.

The Mask for the World: The Concept & The Problem It Solves

Mask-making invites teens to create physical representations of their inner and outer selves. The concept draws from Jung's work on "persona"—a term actually derived from the Latin word for "mask"—referring to the practical personality we present to the world. Simultaneously, Jung noted we often repress characteristics deemed unacceptable, creating what psychology calls the "shadow".

This technique addresses:

• Difficulty expressing authentic feelings

• Identity exploration struggles

• Social masking behaviors

• Need for safe self-disclosure

What makes mask-making so effective with resistant teens is how it provides emotional distance while acknowledging a universal experience. Throughout adolescence, teens often feel pressured to "mask" their true thoughts and feelings to avoid judgment or fit in. This masking behavior, although providing temporary social acceptance, frequently leads to emotional exhaustion, burnout, and disconnection from one's authentic self.

The Mask for the World: My Script

I introduce this activity straightforwardly:

"Today we'll explore something everyone does—wearing different 'faces' in different situations. We'll create masks with two sides: the outside shows how you think others see you or how you present yourself to the world, and the inside represents aspects of yourself you keep private."

I provide practical instructions:

"There's absolutely no wrong way to approach this. You can use any materials that speak to you—paint, magazine cutouts, fabric, words, symbols. What matters is that it feels authentic to your experience."

As they work, I gently prompt: "Consider what parts of yourself you show freely versus what you keep hidden. Is there a cost to maintaining this separation?"

The Mask for the World: The Clinical Lens

From a clinical perspective, mask-making operates through several therapeutic mechanisms. First, it helps teens gain distance from their problems, creating space for reflection. The physical mask becomes an "intermediate object" facilitating communication about difficult topics—particularly valuable for adolescents struggling with direct verbal expression.

Research confirms mask-making's effectiveness in promoting self-knowledge and emotional expression. In one study with adolescents, mask-making was among the most significant therapeutic experiences, with 31.3% reporting increased awareness and self-knowledge, 20.8% experiencing empowerment, and 17.7% feeling calm, relief, and well-being.

Neurologically, this approach is particularly valuable for processing emotional material. As Walker notes, traumatic experiences can shut down the brain's speech and language centers, creating what she calls "speechless terror". Art therapists have observed that masks help bypass this verbal blockage, allowing expression of feelings that might otherwise remain inaccessible.

The Mask for the World: Adaptations

This versatile technique can be modified for various contexts:

For family therapy, masks provide anonymity that helps family members express thoughts and feelings more freely without fear of others' reactions. The covered face filters negative impacts of non-verbal communication and introduces a relaxed environment.

For trauma-focused work, create "before/after" masks or masks representing different emotional states. One variation explores emotions associated with specific experiences: "Make a mask that expresses an emotion you find uncomfortable or hard to trust".

For identity exploration, suggest a "duality mask" expressing inner conflicts through a divided face design. This helps teens explore inconsistencies between what they feel/think versus what they say/do.

For group settings, sharing masks creates powerful normalization. When teens reveal their "inner masks," they often discover peers have entirely different (and more positive) views of their outward-facing selves.

Masks ultimately help teens understand that all humans wear different faces in different contexts—and that integrating these aspects is part of healthy development.

Collage: 'Where I Spend My Energy'

Image Source: Nexus Teen Academy

Collage holds a unique place in my therapeutic toolkit, offering even the most artistically reluctant teens a way to express themselves without drawing skills. Unlike techniques requiring technical ability, collage speaks directly to our natural tendency to curate and organize meaning through images.

Collage: 'Where I Spend My Energy': The Concept & The Problem It Solves

The "Where I Spend My Energy" collage invites teens to create visual representations of what occupies their time, thoughts, and emotional resources. Through magazine cutouts, photographs, and found objects, teens assemble a tangible map of their priorities and pressures.

This technique effectively addresses:

• Difficulty recognizing energy drains versus sources of vitality

• Challenges with self-awareness about priorities

• Reluctance to verbalize feelings about responsibilities

• Need for concrete visualization of abstract concepts like "energy"

What makes collage particularly effective is how it bypasses initial resistance. Art therapists note that collage can feel safer than other media because it lands on the resistive end of the creative spectrum, engaging logical thought processes first before moving into emotional territory. Furthermore, many teens who insist "I can't draw" readily engage with collage, as it eliminates the intimidation of creating representational images.

Collage: 'Where I Spend My Energy': My Script

When introducing this activity, I maintain a casual, inviting tone:

"Today we're exploring something we all experience—how we distribute our energy throughout our lives. I'm going to provide magazines, scissors, and glue. Your task is to create a collage showing where your energy goes—what fills you up and what drains you."

I then provide straightforward guidance:

"Browse through these materials and pull out any images that speak to you about your energy—things that excite you, things that exhaust you, places where you feel most yourself. There's no right or wrong approach here—it's about connecting with what jumps out as you look at the images."

As they work, I might prompt: "Notice which images you're naturally drawn to—sometimes our hands know things before our minds do."

Collage: 'Where I Spend My Energy': The Clinical Lens

From a therapeutic standpoint, the collage process mirrors the therapy journey itself. Both involve examining surface levels while exploring deeper layers underneath. This parallel process helps teens conceptualize therapy itself.

The effectiveness stems from several mechanisms:

First, collage enables emotional distancing. One 16-year-old client divided her poster board into light and dark sections, later explaining it represented feeling "split between who everyone wants me to be and who I really am"—an insight that might never have emerged through talking alone.

Second, the act of selecting, arranging, and attaching images requires decision-making and investment. Research shows this activity transforms the therapy relationship from potentially confrontational to genuinely collaborative, with teens becoming active participants rather than passive recipients.

Third, collage creation releases brain chemicals that help overcome sadness, depression, and stress. This physiological benefit occurs regardless of artistic outcome.

Collage: 'Where I Spend My Energy': Adaptations

This versatile approach can be modified in numerous ways:

For identity exploration, suggest a "forms of energy" collage examining different types of energy (emotional, creative, physical) in the teen's life.

For gratitude work, focus specifically on creating a collage of things the teen is thankful for, helping shift attention to positive aspects of life.

For group settings, have teens share their collages to identify common energy drains and sources, fostering connection through shared experience.

For teens with limited mobility, digital collage using an iPad offers the same therapeutic benefits without requiring manual dexterity.

3-Speed Drawing

Image Source: Mental Health Center Kids

Pacing reveals what words often conceal. I've discovered that varying the speed of creative expression can unlock insights that remain hidden in conventional therapy approaches.

3-Speed Drawing: The Concept & The Problem It Solves

The 3-Speed Drawing technique involves creating three consecutive drawings of the same subject under different time constraints: slow (5 minutes), medium (2 minutes), and fast (30 seconds). This approach addresses:

• Perfectionism and overthinking

• Difficulty accessing spontaneous expression

• Anxiety about "getting it right"

• Disconnection from emotions

This method proves effective because time constraints bypass conscious censorship. Research shows that timed art activities help reduce anxiety by shifting focus from outcome to process, fostering mindfulness and spontaneity in adolescents.

3-Speed Drawing: My Script

I introduce this activity straightforwardly:

"Today we'll try something that shows how different speeds affect what we express. You'll draw the same subject three times—first slowly, then medium-paced, finally quickly. Notice what changes each time."

As they work, I might add: "No judgments about quality—what matters is observing how speed influences what appears on paper."

3-Speed Drawing: The Clinical Lens

Therapeutically, this technique operates on multiple levels. First, it creates emotional distance—teens focus on the time challenge rather than feeling exposed. Subsequently, it reveals emotional patterns—typically, slower drawings show calculated self-presentation while faster ones reveal underlying feelings.

3-Speed Drawing: Adaptations

For group settings, participants can compare their three versions, noticing common patterns in what emerges under time pressure.

For anxiety-focused work, extend the exercise by analyzing which speed felt most comfortable and why.

For trauma processing, begin with abstract shapes before moving to emotional content, gradually building comfort with expression.

Song/Music Video as an Art Object

Image Source: Frontiers

Music and visual imagery connect deeply with adolescents in ways traditional therapy often fails to reach. Throughout my practice, I've discovered music videos serve as ideal entry points for teens resistant to typical therapeutic approaches.

Song/Music Video as an Art Object: The Concept & The Problem It Solves

Music videos represent one of the most influential visual culture forms to impact youth since television's emergence. They provoke, tell stories, and convey meaning through densely textured images and sound - making them perfect therapeutic tools for teens struggling with:

• Emotional expression barriers

• Identity formation challenges

• Social isolation following difficult experiences

• Resistance to traditional therapy formats

Indeed, research confirms that utilizing popular media content can effectively address mental health crises among youth. Notably, UCLA researchers found teens become more motivated to seek mental health information after viewing story-driven media.

Song/Music Video as an Art Object: My Script

I introduce this approach straightforwardly:

"Today we'll explore something you likely already enjoy—music videos. Sometimes analyzing or creating visual interpretations of music helps express things that feel impossible to say directly."

Song/Music Video as an Art Object: The Clinical Lens

Music therapy employs music to address physical, emotional, cognitive and social needs. Fundamentally, it strengthens life skills and emotional processing, with research supporting its effectiveness in boosting motivation and self-expression.

Song/Music Video as an Art Object: Adaptations

Sessions may include writing songs, analyzing existing videos, or creating visual responses to meaningful music. For example, teens processing anger might benefit from drumming exercises as emotional outlets.

Comparison Table

Conclusion

Art therapy offers a powerful alternative when traditional talk therapy hits a wall with teenagers. Through these seven techniques, I've witnessed transformations in teens who initially crossed their arms and refused to engage. These approaches work because they honor resistance rather than fighting against it.

Creating maps, manipulating clay, drawing comics, making masks, assembling collages, speed drawing, and exploring music videos—each provides a different entry point for teens to express themselves without feeling exposed. Teens communicate volumes through these methods, though they might never articulate those same thoughts directly.

Most importantly, these techniques establish a foundation of trust between therapist and teen. After a decade in this field, I've learned that progress happens when we step away from forcing verbal expression and instead offer creative alternatives that feel safe.

Art therapy fundamentally succeeds because it changes the therapy dynamic. Rather than positioning ourselves as experts extracting information, we become curious collaborators, discovering meaning alongside our teenage clients. This shift often makes all the difference for resistant teens.

You certainly don't need artistic talent to implement these approaches. Actually, your willingness to engage imperfectly alongside teens models vulnerability and authentic expression far better than technical skill ever could.

The techniques shared are based on my professional practice as a credentialed art therapist. Using art therapy interventions requires specific training and ethical consideration. Clinicians should operate within their scope of practice, obtain proper training and supervision for clinical techniques, and adhere to their state licensing board regulations and ethical codes.

Key Takeaways

These seven art therapy techniques provide powerful alternatives for reaching teens who resist traditional talk therapy, transforming resistance into creative expression and therapeutic breakthrough.

• Art bypasses verbal resistance - Creative activities allow teens to express complex emotions without direct confrontation, making therapy feel safer and less threatening.

• Process matters more than artistic skill - Focus on the therapeutic experience rather than artistic outcome removes performance pressure that causes many teens to shut down.

• Physical engagement releases emotional tension - Techniques like clay work and speed drawing provide kinesthetic outlets for anger, anxiety, and stress stored in the body.

• Visual metaphors create emotional distance - Maps, masks, and comics help teens explore difficult feelings indirectly, making overwhelming emotions more manageable and discussable.

• Time constraints unlock spontaneous expression - Timed activities like 3-speed drawing bypass perfectionism and conscious censorship, revealing authentic feelings that careful planning might hide.

These evidence-based approaches work because they honor teenage resistance rather than fighting it, establishing trust through collaborative creativity instead of extractive questioning. The key is stepping away from forcing verbal expression and offering safe creative alternatives that naturally lead to therapeutic insights.

FAQs

What if a teen completely refuses to engage in any art-based activity?

This is more common than you might think. My approach is to first validate their resistance: "It makes sense that this feels weird or pointless." Then, I shift the focus to the materials themselves in a low-pressure way. I might say, "You don't have to make anything. Just see what the clay feels like to squeeze," or "Let's just flip through some magazines and see if anything catches your eye—no pressure to create." Often, engaging with the materials without a defined "task" is the first step. The goal is to reduce the performance anxiety, not force participation.

How do I handle a teen who is overly critical of their own artwork?

This is a golden clinical opportunity! Instead of offering empty reassurance ("It looks great!"), I lean into curiosity. I'll ask: "Tell me about the part you're most critical of. What were you hoping it would look like?" or "If this drawing had a voice, what would it say it's trying to do?" This redirects the focus from aesthetic judgment to meaning and process, often revealing the same critical inner dialogue that shows up in their daily life. It provides a direct in-road to work on their self-criticism.

I'm not an art therapist. Am I practicing outside my scope by using these techniques?

This is a crucial ethical question. You are not practicing art therapy if you are using art in therapy as a tool for communication and assessment. The key is in your intent and framing. You are not interpreting the art like a trained art therapist would. You are using it to facilitate conversation and understanding. Always present it as an alternative way to communicate, focus on the process over the product, and let the client be the expert on what their creation means. When in doubt, seek supervision and clearly state in your documentation that you used "art-based interventions" to facilitate dialogue.

Some of these activities, like mask-making, seem like they could bring up intense emotions. How do I ensure the emotional safety of my client?

You are right to be cautious. My rule is to always provide an "escape hatch." I explicitly state: "You are in control of how much you share. You can stop at any time, and you are never required to explain or show me anything you create if you don't want to." This gives the client a sense of safety and control. I also ensure we have enough time at the end of the session to process and ground, and I'm prepared to pivot to a stabilization technique if the activity becomes overwhelming. The container of safety you build is more important than the activity itself.

How do I document these art-based sessions for insurance purposes?

I document the process, not the product. My notes focus on the clinical rationale and the client's engagement. For example, instead of "Client made a mask," I write: "Used mask-making activity to explore themes of identity and social presentation. Client engaged non-verbally for 20 minutes, noted difficulty choosing colors for the 'public' side, which facilitated discussion about performance anxiety. Intervention aimed to externalize and examine internal conflicts." This demonstrates medical necessity and the therapeutic work done, aligning with requirements for codes like 90837.