Group Art Therapy: Creating Side by Side with Others at the Same Table

What is group art therapy and how does it differ from individual work? Read what happens in a session, the confidentiality rules and who it may suit.

Imagine eight people seeing each other for the first time around a large table. In the middle are pastels, old magazines, scissors and a huge sheet of paper. Nobody is quite sure what to do; one person picks up a pencil and puts it down again, another stares out of the window. Group art therapy often begins with an uneasy silence like this, and over time it can turn into the relief of realising you are not alone at that table. In this article we explain what art-based work carried out in groups involves, how it differs from individual work, what happens in a session, and the safety and confidentiality principles that adults thinking of joining should know about.

What Is Group Art Therapy?

Group art therapy is a way of working in which visual art materials such as drawing, painting, clay and collage are used for psychological purposes, with several participants and accompanied by a trained facilitator. Participants create in the same space, sometimes on their own and sometimes together; they then look at what has emerged together and share their experiences.

This work has two roots. The first is art therapy: the idea of expressing feelings through images, colour and shape before words. We have explained this basic logic in detail in our article what is art therapy. The second is group therapy: the idea that when people come together with others going through similar difficulties, their sense of isolation may lessen, and that by listening to others they can come to understand themselves better. You can read about how group work generally functions in our article on group therapy.

In group art therapy these two roots come together. The materials become an intermediary that makes talking easier; the group becomes the witness and mirror of what is created.

How Does Group Art Therapy Differ from Individual Work?

In individual work, all the attention is directed at the person themselves. In a group, several different dynamics come into play:

• A sense of commonality: Seeing your own feeling in someone else's picture can make you say, "So I'm not the only one going through this." This is a powerful experience, especially where feelings of shame and loneliness are intense.
• Learning by observing: Watching how someone else gets in touch with a difficult feeling can give a person the courage to approach their own.
• Living out relationships at the table: When you are painting on a shared sheet of paper, someone entering your space, you pulling back or pushing forward can let you see the patterns of your everyday relationships on a small stage.
• Less direct focus: For some people, having all the attention on them in a one-to-one meeting is challenging. In a group, attention is spread out; a person can speak when they feel ready.

On the other hand, groups also have limits. The time available for each participant is shorter, and very personal and heavy topics cannot always be explored in enough depth in a group. For this reason, for some people group work may be more suitable as an option that accompanies individual support.

What Happens in a Group Session?

Every group is structured differently, but a rough outline might look like this:

1. Opening: Participants share how they are feeling in a short round. Sometimes even this is done not with words but with a chosen colour.
2. Invitation: The facilitator suggests a theme or an exercise. For example, "A burden you are carrying these days", "A place that gives you strength", or free work without a theme.
3. Creating: Participants work individually or on a shared surface. There is little talking during this time; usually you hear the sound of pencils and the rustle of paper around the table.
4. Sharing: Anyone who wishes shows what they have made to the group and talks about it. Rather than interpreting, the others share what they see and what they feel.
5. Closing: The session ends with a calm close that gathers together the feelings that have surfaced.

Let's say a forty-five-year-old woman whose children have moved to another city for university, and who suddenly finds herself alone with the silence at home, joins a group. In the first sessions she draws only small flowers squeezed into a corner and says during sharing, "I didn't really manage to make anything anyway." One day, during an exercise where people take turns adding to a shared sheet, the participant next to her draws a fence around her little flower. At first she is surprised, then she laughs: "I suppose I'm always hiding behind something too." In the weeks that follow, this sentence becomes the starting point for talking about her own space and her own wishes.

Why do shared drawings reveal so much?

One of the exercises groups often use is the shared picture, to which everyone contributes on the same large sheet of paper. At first glance it looks like a simple activity, but a small society soon forms on the paper. Some people settle straight into the middle, others stay at the edges. Some continue someone else's line, others fence off their own corner. Some get angry when paint is spread over something another person has drawn, while others say nothing at all.

These reactions are not a "test", and nobody is labelled on the basis of them. But during sharing, participants may notice their own experience: "I always chose to stay at the edge, and that's what I'm like at work too," or "When someone came into my space, I couldn't say so." These realisations open the door to the person becoming curious about their own ways of relating. A shared picture can make visible in a few minutes a pattern that might not emerge for months in a verbal discussion.

A picture made in a group does not belong only to the person who made it; every pair of eyes that looks at it can help that person see themselves from a new angle.

Who Might Group Art Therapy Be Suitable For?

Art-based work carried out in groups can be done with different aims and with different groups. For example:

• People who share a similar life event: transitions such as bereavement, chronic illness, migration or retirement
• Adults experiencing loneliness and social disconnection
• People who find it hard to express their feelings in words but who could draw strength from being with others
• Supportive programmes added to usual treatment in hospital, rehabilitation or community mental health settings

In the following situations, however, an individual assessment may be more appropriate before, or instead of, group work:

• People who have recently experienced severe trauma and are not yet ready to open up about it in front of others
• People in an acute crisis or experiencing suicidal thoughts
• People who find it very hard to maintain boundaries in a group, or who are very strongly affected by other people's experiences

The aim of this distinction is not to exclude anyone, but to find a framework that suits a person's needs at that time. Many groups hold a short preliminary meeting before someone joins in order to assess this suitability together.

What can you expect when you go to the first session?

It is entirely natural to feel nervous before the first session. Thoughts such as "Everyone will draw better than me", "I don't know what to say" or "What if I cry?" are common. A few practical points can ease this anxiety:

• Paint and clay can get on your clothes; wearing comfortable clothes you won't mind getting dirty makes things easier.
• First sessions usually begin with introductions and a discussion of the group's rules; deep topics are not tackled straight away.
• You don't have to talk about anything. Simply working and listening is also a beginning.
• You may feel tired or emotional after the session. Setting aside some quiet time for yourself that evening can help.

It is also worth remembering this: the fact that group members are different from one another is not a problem but a richness. People of different ages, professions and life experiences creating at the same table can make it easier for a person to look at their own story through different eyes.

Group Safety and Ethics: Confidentiality, Interpretation and Ownership of the Work

For group art therapy to be a safe experience, it depends on certain principles that are discussed at the outset and accepted by everyone.

Confidentiality: What is said and the work that is made in the group does not leave the group. This rule applies to all participants as well as to the facilitator. Telling a participant's story in another setting damages trust, even if no name is given.

No imposed interpretations: Interpretations such as "This black cloud is your depression" or "This house is really your mother" are not expected either from the facilitator or from the other participants. The meaning of a picture is determined by the person who made it. Group members only share their own observations and feelings, such as, "This blue gave me a feeling of spaciousness."

The work belongs to the participant: The work produced belongs to the participant. It may be kept, photographed or shared on social media or in an exhibition only with the person's explicit permission. For work made jointly, this permission requires the consent of everyone who contributed.

Not taking part is also an option: Nobody is forced to do or share an exercise. Saying "I just want to watch today" is a legitimate way of taking part in the group.

Preparing for strong emotions: Creative work can open up unexpectedly intense emotions. That is why it is important for sessions to be framed by a safe opening and close, and, where needed, for the facilitator to meet separately with a person after the session.

What Does Research Say About Group Art Therapy?

Some of the research on art therapy has been carried out in a group format. A health technology assessment published in 2015 examined 15 randomised controlled trials with adults experiencing non-psychotic mental health problems; in 10 of them, a significant positive change in mental health symptoms was found in the art therapy group compared with the control group. However, the same assessment stresses that the quality of the studies was generally low.

Another review published in 2018 looked at 27 quantitative studies conducted with adults between 2000 and 2017; it noted that, although promising results were seen in different areas such as cancer and other medical conditions, trauma, older age and everyday difficulties, methodological limitations were significant. In Turkey too, art therapy interventions delivered in groups are a subject that has begun to be studied in postgraduate theses.

When reading these findings, it is important to bear in mind the following: most studies are small, blinding is not possible because participants know what they are taking part in, and results rely heavily on self-report. In short, art-based work carried out in groups is a supportive and promising option, but it does not replace psychotherapy or, where necessary, medical treatment.

One further distinction needs to be made here. In recent years, many group events have been held under the name of "art workshops" in cafés, cultural centres or company events. These events can be enjoyable, social and relaxing; painting together, meeting new people and taking a break from the daily rush are all valuable. But such gatherings are a self-care and hobby activity, not a therapeutic process. Therapeutic work has a defined framework, confidentiality rules, a trained facilitator and a structure that takes participants' mental health needs into account. Both experiences can be valuable; what matters is knowing which one you are joining and adjusting your expectations accordingly.

When Is Individual Support More Appropriate?

Creating in a group can do you good, but some signs may point to the need for closer, individual support:

• If you experience intense distress, sleeplessness or restlessness lasting for days after group sessions
• If a topic raised in the group has brought a heavy past experience back to life
• If low mood, hopelessness or anxiety is significantly affecting your daily life
• If topics you want to talk about but cannot raise in front of others are building up

If you are having thoughts of harming yourself or ending your life, call 112 (emergency services) in an emergency.

Individual therapy offers a space where topics opened up in the group experience can be addressed more safely and in more detail. In structured approaches such as cognitive behavioural therapy (CBT), tools such as drawing or imagery can also sometimes be used to recognise and express emotions. Where needed, an assessment by a psychiatrist can also be part of this process. For some people, group and individual work complement each other; which one is suitable and when depends on the person's needs.

Frequently Asked Questions

Do I need artistic talent to join group art therapy?

No. The aim of the work is not to produce an aesthetic object, but to express and share feelings. Drawing a stick figure, tearing and gluing paper or simply leaving patches of colour are all meaningful contributions.

I'm worried about others in the group interpreting my picture. What happens then?

In a well-run group, nobody interprets your picture; participants only share their own impressions. If you don't want to share, you don't have to show your picture. You can also voice this concern at the start of the group.

How many people are in a group, and how many sessions does it last?

This varies according to the group's purpose and the setting in which it is run. Some groups are closed and limited to a set number of sessions, while others are open to new participants. Finding out about the group's structure and rules before joining helps you clarify your expectations.

Can I join the same group as a friend?

This depends on the group's rules. Being in the same group as someone you know reassures some people, while it makes it harder for others to open up. It is helpful to talk about this with the facilitator before joining.

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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