Peer-reviewed article
Patterns of creative technique use in child and youth psychotherapy in Germany: an exploratory mixed-methods survey including identity-informed practice.
Birnkammer S, Applewhite B, Altmann Y, Zubala A, Kringelbach ML et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how 98 child and adolescent therapists in Germany use art-based techniques in routine practice, including their application with racially minoritized youth. Overall, 62% of therapists reported using creative techniques, primarily to improve emotional access, engagement, and communication. Therapists reported significantly lower confidence and preparedness when working with children of color, and most lacked training in racism-informed practice. The findings suggest that while art-based techniques are valued tools, their use in work with marginalized populations is constrained by limited training and institutional barriers.
Key points
- 62.2% of therapists used art-based techniques; 51.0% used them exclusively and 11.2% combined them with music-based methods
- Art-based techniques were primarily used as transdiagnostic, process-oriented tools targeting emotional access, engagement, nonverbal communication, and experiential processing
- Therapists reported significantly lower perceived preparedness in contexts with children of color, alongside reduced endorsement of art-based techniques for relationship-building and nonverbal communication
- Only 17.3% of therapists reported receiving racism-informed training and 4.1% received training on racial trauma
- Barriers to use included limited training, institutional constraints, and uncertainty about structuring and integrating techniques
Limitations
This is a cross-sectional survey based on self-report from therapists in Germany and the United Kingdom, so it cannot establish causation or objectively measure the effectiveness of techniques. The study describes patterns of practice and therapist perceptions but does not measure outcomes for children or adolescents themselves.
Abstract
Background Creative and arts-based techniques are increasingly integrated into child and adolescent psychotherapy, yet little is known about how they are applied in routine practice and whether their use differs when working with racially minoritized youth. This study examined the prevalence, clinical functions, and contextual positioning of art-based techniques among therapists in Germany, with a focus on identity-informed applications in work with clients of Color and clients from Black ethnic groups. Methods This study reports data from the German arm of the CREATE project, an online cross-sectional mixed-methods research initiative conducted in Germany and the United Kingdom. Therapists working with children and adolescents (N = 98; Mean age = 36.60, SD = 9.84) completed quantitative items on use, goals, and perceived preparedness across client contexts (general vs. PoC vs. Black), and provided open-ended responses on strengths, challenges, and barriers. Quantitative analyses used descriptive statistics and non-parametric within-therapist comparisons; qualitative data were analyzed via framework analysis. Results Overall, 62.2% of therapists reported using art-based techniques (51.0% exclusively; 11.2% combined with music-based methods). Use was most frequent in individual settings and was primarily described as transdiagnostic, targeting emotional access, engagement, nonverbal communication, and experiential processing; diagnosis-specific mentions were less common (most often anxiety, ADHD, depression, and trauma-related symptoms). Therapists with experience working with BIPoC clients and with non-binary clients were more likely to use art-based techniques. Within-therapist comparisons showed significantly lower perceived preparedness in PoC contexts, alongside reduced endorsement of art-based techniques for relationship-building and for supporting nonverbal communication of difficult-to-express experiences. Qualitative findings highlighted benefits for communication, emotional expression, access to avoided topics, and self-efficacy, while barriers centered on limited training, institutional constraints, and uncertainty about structuring and integrating techniques. Only 17.3% reported racism-informed training and 4.1% training on racial trauma. Conclusions Art-based techniques are widely valued and used flexibly in German routine child and adolescent psychotherapy, predominantly as transdiagnostic, process-oriented tools. However, their positioning in minoritized contexts appears shaped by lower therapist preparedness and limited racism-informed training. Integrating structured training in creative techniques alongside culturally responsive and racism-informed psychotherapy may support more confident, relational, and identity-informed application in diverse youth populations.