Comics and graphic therapy

1. Introduction

Version followed: comics-based art therapy as US art therapists describe it (Carlton and colleagues at Drexel; Houpt, Bloom and Shaffert as reported in McCreight's 2017 Counseling Today article), plus the structured comic formats named below: Phang's single-image-versus-comic protocol (2021), Comic Strip Conversations (Gray, 1990, as summarised in a UK local-authority guide), the Comic and Recovery reading group (Parc Sanitari Sant Joan de Déu, 2019), co-created single-panel comics (Healing Panels, London, 2026) and the psychoeducational comic Mostly Sunny (Croatia, 2019). The chapters of Carlton's edited volume (2026) are not drawn on; only its table of contents is. [source: McCreight 2017; Woodslane listing of Carlton 2026; Phang 2021; Peterborough SEND guide; Toribio Prieto & Boix 2022]

Comics and graphic therapy is not one manualised therapy. It is a family of practices, mostly within art therapy, narrative therapy and the graphic medicine movement. Clients make or read sequential art: images arranged in sequence (panels) that tell a story, often with words in speech or thought bubbles. Scott McCloud's definition, images in sequence that tell a story or convey information, is the one practitioners use. [source: McCreight 2017; Castle 2010 abstract]

Core idea of change: putting experience into panels does three things. It externalises the problem as a drawn character, separate from the person (borrowed from White and Epston's narrative therapy). It contains overwhelming material inside bounded frames the client controls. It re-sequences the story, so the client can revisit events, change how they are shown and decide what they mean (re-authoring). Clients who struggle to speak, read or write well can still build meaning, because the medium combines words and images. [source: McCreight 2017 citing Houpt, Williams, White & Epston; AATA Institute course N/NY-0716; Breuer 2023; Phang 2021]

Professional frame. No separate profession, credential or registration for "comics therapy" was found. [uncertain] When comics are used as art therapy, the art therapy rules apply. In the UK, "art therapist" and "art psychotherapist" are protected titles registered with the HCPC, and the professional body is BAAT. In the US the professional body is AATA and credentials such as ATR-BC come from ATCB; the AATA Institute course carries ATCB credit. Other countries have their own bodies, for example the Canadian Art Therapy Association, whose representative endorsed Carlton's book. Counsellors and psychotherapists without art therapy training may use simple comic exercises inside their own model; McCreight's article is written for counsellors. They should not call this art therapy, and should get art-therapy supervision or training before using art for trauma processing. [source: AATA Institute course page; Hachette listing; McCreight 2017; HCPC/BAAT from brief's professional frame] [synthesis for the scope-of-practice line]

2. Framework

No published phase model specific to comics therapy was found. [uncertain] The structures below are the ones the sources describe. The overall arc is [synthesis] organised around them.

Typical arc (individual work) [synthesis, built from McCreight 2017 and Phang 2021]:

Engagement and demystifying (sessions 1–2). Goals: agree what "comics" means for this client, reduce drawing anxiety, test materials and seating. Move on when the client will make simple marks (stick figures, bubbles) without long hesitation.
Externalising and containing (roughly sessions 2–6). Goals: draw the problem as a character, use panels to hold difficult material, draw avatars of self and others. Move on when the client can talk about the drawn problem with some distance, and can stop and close a page without leaving distressed.
Sequencing and re-authoring (middle phase, open-ended). Goals: tell a past problem as a comic; try alternative panels, endings or character dialogues; identify problems, solutions, themes and alternative self-stories (Houpt's aims for the six-panel journal). Move on when the client produces alternative or preferred sequences, and uses comics between sessions if it suits them.
Consolidation and ending. Goals: review the body of work, decide what happens to the pages (kept, stored, taken home, shared), and possibly make a closing or "where I am now" comic.

Session format [source: McCreight 2017 citing Bloom and Houpt]: individual sessions of ordinary length, with art-making stopped about 10 minutes before the end. This helps the client come back to a fully present state and leaves time to clear up. Session count is not fixed in the sources. [uncertain]

Structured formats with their own published structure:

Comic and Recovery Group (Sant Joan de Déu, 2019): a closed group of up to 8 people, run in yearly cycles of about 3 months. It is organised around the five recovery stages of Andresen, Caputi and Oades (moratorium, awareness, preparation, rebuilding, growth). Each published graphic novel gets two sessions: an introduction, then pooling of members' contributions. Reading the book between sessions is the homework. The article says there were 12 sessions in total, although five books at two sessions each makes 10. [uncertain] Outcome measure: STORI. [source: Toribio Prieto & Boix 2022]
Phang's protocol (2021): one session in which the client draws a past problem first as a single image, then as a comic, then compares the two. Delivered online over Zoom with non-clinical adults. [source: Phang 2021 abstract]
Comic Strip Conversations (Gray, 1990): a short, as-needed, one-to-one conversation tool, one situation per strip. [source: Peterborough SEND guide]
Healing Panels (Ji and Dharia, 2026): four drop-in participatory workshops that are open to all and need no drawing experience. [source: Lewisham Arthouse page]

3. Guiding principles

[source: McCreight 2017 unless otherwise tagged]

The person is not the problem; the problem is the problem. (White & Epston, as quoted by McCreight.) Draw the symptom as its own character, never as the client.
Panels are containers. Use frame edges to set how much material is opened at once. One panel can hold one experience.
Structure paces the work. A fixed number of panels (for example six) slows down disclosure and makes patterns easier to see. Fit the structure to the client's history, coping tools and motivation (Houpt).
Skill is irrelevant. Stick figures count. Name the "fourth-grade slump" (MK Czerwiec), the age when many people stop believing they can draw, so clients stop comparing themselves. [also source: Maggio 2019; Peterborough SEND guide: the strip is a working document]
Avoid vague, high-intensity prompts. Bloom warns that a prompt like "draw your darkest fear" can backfire. Prefer bounded, specific prompts.
Do it yourself first. Make comics, and try your prompts in the client's seat, before you assign them. This is how you come to understand resistance.
Language lowers threat. Say "stories using words and pictures" if "comics" intimidates the client (Houpt).
The client controls the representation. They decide what is shown, how, and what it means. That control is the therapeutic point. [source: Breuer 2023; McCreight 2017 citing Williams]
Artwork is confidential clinical material. Do not display it. Store it as a protected record (McCreight cites HIPAA). Decide its fate with the client.
Leave time to come back out. Stop making work before the end of the session.
Good materials prevent frustration. Reliable pens, markers and pencils. Avoid messy media in an office setting; brush-tip markers give some of the feel of paint without the mess.
Meet the client's level. Comics work across reading levels and can be adapted to developmental needs and goals. [source: AATA Institute course page]
Comics are narrative, and can be projective, but not diagnostic. [source: Castle 2010] Treat content as the client's story to explore, not as evidence. [synthesis]
Reading comics is also an intervention. Published graphic novels can be used as shared texts for reflecting on recovery, for hope and for a shared language. [source: Toribio Prieto & Boix 2022]
Clinician fluency matters. Read comics, study cartooning texts (McCloud, Eisner, Brunetti), attend workshops, and keep your own practice or response comics. [source: McCreight 2017; Maggio 2019; Carlton 2026 Part Three title]

4. Intervention inventory

The step-by-step instructions below are my operationalisation of what each source describes. The sources give aims and outlines, not scripts. Where steps go beyond the source, they are tagged [synthesis]. All example language is illustrative.

4.1 Defining the medium and lowering the drawing threshold

Purpose / when: first session, or whenever a client says "I can't draw". It reduces intimidation and comparison. [source: McCreight 2017 citing Houpt and Czerwiec; Maggio 2019]
Steps:
1. Ask what comics mean to the client: which ones they have read, and what they picture when they hear the word.
2. If the word is off-putting, reframe it as stories told with words and pictures.
3. Name the common loss of drawing confidence in late childhood (the "fourth-grade slump"). Say that stick figures, boxes and bubbles are enough.
4. Show the basic toolkit on scrap paper: a box (panel), a stick figure, a speech bubble, a thought bubble. [synthesis for 4]
5. Offer a low-stakes warm-up, such as doodling while you talk, before any personal prompt. [source: Maggio 2019 on doodling as an entry point]
Example language (illustrative): "This isn't about drawing well. A box, a stick person and a bubble saying what they think is a full comic. Want to try one about how you got here today?"
Watch for: apologising for the drawing, erasing again and again, freezing. It is working when the client makes marks without commentary on quality.

4.2 Setting up the workspace and materials

Purpose / when: before the first art-making session. [source: McCreight 2017 citing Bloom]
Steps:
1. Sit in the client's chair and try drawing there yourself. If it is awkward, add a lap desk, move supplies closer or use a coffee table.
2. Stock good-quality pencils, fine liners, markers and paper. Pre-printed panel grids (for example 3, 4 or 6 boxes) are optional. [synthesis for grids]
3. Avoid messy media such as paint in a talk-therapy office. Brush-tip markers give a painterly effect with less mess.
4. Plan to stop art-making about 10 minutes before the end.
5. Decide in advance where artwork will be stored securely.
Physical safety [synthesis]: alcohol- or solvent-based markers need ventilation and are best avoided with people sensitive to fumes. Use child-safe, non-toxic markers with children. Keep craft knives and scalpels (used for zines and collage) supervised or swap them for safety scissors where self-harm risk exists. Use glue sticks rather than solvent glues.
Watch for: frustration with poor materials, and physical discomfort that ends work early.

4.3 Externalising the problem as a character

Purpose / when: when a client fuses with a symptom ("I am anxious", "I'm just broken"). It creates distance and agency. [source: McCreight 2017; narrative therapy of White & Epston as cited there; Maggio 2019]
Steps:
1. Ask the client to name the problem as if it were a character ("the Worry", "the Fog").
2. Have them draw it: what it looks like, its size, where it stands relative to the client's own figure.
3. Give it a speech bubble: what does it usually say to them?
4. In a new panel, show a moment when the problem was smaller or the client resisted it. [synthesis, drawn from narrative-therapy practice of looking for unique outcomes]
5. Talk about the character, not the self: when it shows up, what feeds it, what weakens it.
Example language (illustrative): "If this anxiety walked into the room as a character, what would it look like? What would it be saying in its bubble?"
Watch for: the client drawing the problem as themselves. If so, gently separate the two figures. It is working when the client refers to the problem in the third person and can describe its tactics.

4.4 Panels as containers

Purpose / when: for material that feels overwhelming. The frame gives control over how much is opened. [source: McCreight 2017]
Steps:
1. Agree with the client that one panel holds one experience, or one part of it.
2. Let the client choose panel size. Small panels can be used to keep material small.
3. Offer to leave panels blank, or to show only the outside of a scene: a door, a house, a time stamp. [synthesis]
4. At the end of the work, "close" the page. Fold it, put it in a folder, or leave it in the therapy room. [synthesis]
Example language (illustrative): "We'll only put as much in this box as you want. You can draw just the door of that room, not what's inside."
Watch for: spilling beyond the frame, a rising pace of disclosure, signs of dissociation. It is working when the client stops at the panel edge and leaves calmer.

4.5 Avatars of self, others and the disorder

Purpose / when: to depict people and symptoms as characters, which allows perspective-taking and safer distance. [source: McCreight 2017]
Steps:
1. The client designs a recurring avatar for themselves. It can be human, animal or object.
2. They add avatars for key others and for the problem or disorder (see 4.3).
3. Reuse the avatars across sessions so a cast builds up. [synthesis]
4. Explore choices: size, expression, distance between characters.
Example language (illustrative): "Let's create a character who stands for you in these stories. It doesn't have to look like you."
Watch for: strong reactions to drawing a particular person, such as an abuser. Let the client use a symbol or an empty outline instead. [synthesis]

4.6 Character dialogue for conflicting thoughts

Purpose / when: for ambivalence or a decision point. Two or more characters voice the competing positions. [source: McCreight 2017 citing Houpt]
Steps:
1. Identify the decision or the conflict.
2. Create a character for each side, for example "the part that wants to drink" and "the part that wants to stay sober".
3. Draw them facing each other across a series of panels, exchanging speech bubbles.
4. Add a final panel in which the client's own avatar responds to both. [synthesis]
5. Tailor it to the client's history, coping skills and motivation, as Houpt advises.
Example language (illustrative): "Give each side its own character and let them argue it out in bubbles. What does this one say back?"
Watch for: one voice dominating, or a harsh critical voice escalating. Slow down, and add a compassionate or wise third character if that suits the client's therapy model. [synthesis] It is working when the client can hold both positions and articulate a choice.

4.7 Six-panel comics journal (Houpt)

Purpose / when: ongoing structured journaling. It paces the work and helps the client spot problems, solutions, themes and alternative self-stories. [source: McCreight 2017 citing Houpt]
Steps:
1. Give a six-panel grid, in session or as homework.
2. The client records a day, event or theme across the six panels.
3. In session, review it together: what is the problem panel, where is any solution, what repeats across journals?
4. Over weeks, look for themes and draw alternative versions of key panels. [synthesis for 4]
Example language (illustrative): "Use these six boxes to tell me about one moment from your week, beginning to end."
Watch for: panels that are always identical (stuckness), or escalating content. Change or shrink the task. It is working when alternative self-stories start to appear in the panels.
Note: this is distinct from Lahad's Six-Part Story Method, a separate six-frame story structure from drama therapy. Its sources are not drawn on, so it is not described here. [uncertain]

4.8 Short daily comic diary (3–4 panels)

Purpose / when: a light, regular self-observation practice between sessions. [source: McCreight 2017 citing Shaffert's own daily practice]
Steps:
1. Each morning the client draws a 3–4 panel cartoon capturing the present moment.
2. Keep it short. Unfinished is fine.
3. Bring a selection to session if the client chooses. [synthesis]
Example language (illustrative): "Just three or four boxes each morning: what's happening right now, as a little cartoon."
Watch for: perfectionism turning it into a chore. Allow missed days. Note that Shaffert describes this as his own practice, not a tested clinical protocol. [uncertain as a clinical intervention]

4.9 Single image versus comic of a past problem (Phang)

Purpose / when: narrative deconstruction of a past difficulty. Phang found the comic format brought out how participants represented time and movement in their story. Tested with non-clinical adults online. [source: Phang 2021 abstract; full thesis not drawn on] [uncertain about exact prompts and timings]
Steps:
1. The client draws a past problem or challenge as a single image.
2. The client then draws the same problem as a comic, in sequence.
3. Compare the two: what does the sequence show that the single image did not (before and after, turning points, movement)?
4. Explore turning points and how the story could continue. [synthesis for 4]
Example language (illustrative): "You drew the problem as one picture. Now tell it as a comic: what happened first, then next? What do you notice comparing the two?"
Watch for: re-experiencing as events unfold in sequence. Use 4.4 containment. It is working when the client sees change over time or identifies points where they acted.

4.10 Sequential comics alongside trauma processing (adjunct)

Purpose / when: after sessions of an established trauma therapy, to draw the images that came up and develop them into a narrative the client controls. Breuer describes doing this as a client alongside EMDR combined with art therapy. This is a first-person account, not a protocol. Ian Williams (graphic medicine) also suggests that revisiting trauma in sequential art can bring catharsis and re-authoring. [source: Breuer 2023 abstract; McCreight 2017 citing Williams]
Steps [synthesis, derived from Breuer's account]:
1. Only do this within a trauma treatment the client is already stable in, and that you or a colleague are trained to deliver.
2. After a processing session, invite optional sketches of images that surfaced. Keep them rough and short.
3. Over later sessions, the client can develop the sketches into sequences, choosing what is shown, from whose viewpoint, and how it ends.
4. Explore what the client now decides the event means.
5. Sharing the work beyond therapy (Breuer later spoke publicly) is a separate, later decision. Weigh family and stigma consequences with the client.
Example language (illustrative): "If any images stayed with you from today, you can sketch them, roughly, only if you want to. You decide what goes on the page and how the story is told."
Watch for: retraumatisation, intrusive images between sessions, compulsive drawing that keeps the client in the memory. It is working when drawings shift from the moment of trauma toward aftermath, survival and meaning.

4.11 Single-panel visual-metaphor comic, co-created (Healing Panels)

Purpose / when: a short, self-care-oriented visual narrative built on a visual metaphor. It suits people with no drawing experience and community or workshop settings. The method was developed by artist-researcher Jiahao (Jill) Ji and co-delivered with art psychotherapist Kavisha Dharia, with comic artists also involved. [source: Lewisham Arthouse Healing Panels page]
Steps [the page gives no exercises; steps below are synthesis]:
1. Ask for a metaphor for the current experience ("my anxiety is like…").
2. Sketch it as one panel, with an optional caption or bubble.
3. Where an artist co-creates, the participant directs and the artist helps render. Check that the participant approves the final image.
Example language (illustrative): "If this feeling were a picture in one frame, what would be in it?"
Watch for: the participant feeling the artist has taken over their image. Arts-in-health boundary: the page presents these as self-care and reflection workshops, not therapy. Refer participants who need therapy on to it.

4.12 Graphic-novel recovery group (reading-based)

Purpose / when: adult mental health services. Published graphic novels are used to reflect on personal recovery, build a shared language, locate oneself on the recovery path, set goals and build hope. [source: Toribio Prieto & Boix 2022]
Steps (as published, paraphrased):
1. Recruit up to 8 people from inpatient, day-hospital, community services and lived-experience organisations.
2. Map the cycle onto the five recovery stages (moratorium, awareness, preparation, rebuilding, growth), with one comic per stage. The comics used were Spanish titles: Historias del Barrio (Beltrán), Los combates cotidianos (Larcenet), Las calles de arena (Paco Roca), El Nao de Brown (Dillon) and Desmesura (Balius & Pellejer).
3. Session A: introduce the work and the themes to explore.
4. Between sessions: members read it and note elements of personal recovery.
5. Session B: pool contributions. The facilitator points to specific scenes to help the group identify key elements: hope, resilience and support factors, meaning and purpose.
6. Measure with STORI before and after.
Example language (illustrative): "Which panel in this chapter felt closest to where you are in your own recovery right now?"
Watch for: reading barriers (offer reading aloud), content that mirrors a member's crisis too closely. It is working when members link scenes to their own goals.

4.13 Psychoeducational comic for children's emotional literacy (Mostly Sunny)

Purpose / when: prevention of mental health and behavioural problems with children and young people. A purpose-made comic is used to start conversations about feelings. [source: Parać et al. 2019 abstract] Evaluators found the comic helped young people connect with their feelings and talk without fear of judgement, and that its short, eventful form made it easy to use. The detailed procedure is not drawn on. [uncertain]
Steps [synthesis]: read the comic together; pause at emotional moments; ask what a character feels and how the young person would know; relate it to the young person's own experiences only if they choose.
Example language (illustrative): "What do you think she's feeling in this picture? How can you tell?"
Watch for: disclosures (follow safeguarding, section 5).

4.14 Comic Strip Conversations (Carol Gray)

Purpose / when: a social-understanding tool created by Carol Gray in 1990, alongside Social Stories. It is used with autistic people and others with social communication difficulties, typically in education. It uses simple drawings, symbols and colour to make thoughts, feelings and intentions visible. Uses include social skills, understanding others' behaviour, coping with change or distressing events, anxiety or anger, planning future events, and reassurance. Gray's own book is not drawn on; this follows a UK local-authority guide. Comic Strip Conversations is a trademarked method. [source: Peterborough SEND guide] [uncertain about fidelity to Gray's current edition]
Steps (paraphrased from the guide):
1. Build a personal dictionary of symbols with the young person (stick figures, talk bubbles, thought bubbles), and agree a colour key for basic emotions.
2. Start with a positive situation. Use one situation per strip.
3. Draw the boxes in advance, following the order of events.
4. The young person leads and draws. The adult asks a few simple questions: where they were (they draw themselves), who else was there, what they were doing, and what each person said and thought.
5. Review the strip one drawing at a time.
6. Look for solutions: redraw panels with alternative actions. Older pupils can weigh pros and cons.
Example language (illustrative): "Where were you when it happened? Can you draw yourself there? What do you think your friend was thinking? Let's put it in a thought bubble."
Watch for: the adult taking over the drawing. It is working when the young person can describe others' likely thoughts and pick an alternative response.

4.15 Comics as narrative and projective exploration

Purpose / when: for clients who work better non-verbally. Sequential art can work both narratively and projectively. [source: Castle 2010 abstract]
Steps [synthesis]: offer an open story prompt in panels ("a character facing a problem, and what happens next"). Explore the client's own associations to characters and outcomes.
Limits: no validated scoring system for comics is described in the sources. Do not interpret content as diagnostic evidence of disorder or abuse. [synthesis]

4.16 Digital comic creation

Purpose / when: for clients more comfortable with digital tools. McCreight notes that graphic-novel software developed through DARPA and Kinection helped combat veterans with PTSD symptoms, which led to the Warrior Stories Platform. [source: McCreight 2017] Platform details are not drawn on. [uncertain]
Steps [synthesis]: use any comic-layout app or template. Apply the same containment and privacy rules; check where files are stored.

4.17 Therapist's own comic practice and response comics

Purpose / when: ongoing, for clinician fluency, empathy for client resistance and reflective practice. Carlton's book includes a section of short comics by art therapists chronicling their experiences as reflective practice. [source: McCreight 2017 citing Bloom; Maggio 2019; Hachette and Woodslane listings for Carlton 2026, Part Three]
Steps [synthesis]: keep a private comics journal; make comics in response to sessions for supervision (anonymised); try every prompt yourself before using it.
Watch for: confidentiality in any published reflective comics.

5. Handling problems

The sources address only a few of these problems: resistance from drawing anxiety, poorly chosen prompts, materials, time and privacy [source: McCreight 2017]. Everything else here is my own guidance. [synthesis]

"I can't draw" / resistance to the medium. Name the fourth-grade slump. Show that stick figures are enough, and reframe as stories in words and pictures [source: McCreight 2017]. Then [synthesis]: offer to draw the boxes yourself, let the client dictate while you draw stick figures (as the adult guides in Comic Strip Conversations), or switch to reading an existing comic (4.12) or collage. Never insist; drawing is optional.
A prompt backfires (sudden distress). Bloom warns that vague, intense prompts can backfire [source: McCreight 2017]. Response [synthesis]: stop drawing, turn the page face down, ground the client in the room, then narrow the next prompt: smaller panel, outside of the scene only, or a safe-place panel.
Overwhelm or retraumatisation in trauma narratives [synthesis]. Before sequencing trauma, check stabilisation: affect regulation skills, no current crisis, a trauma model you are trained in. Watch for dissociation and flooding. Use panels as containers (4.4). Allow skipping the worst panel (draw "before" and "after" only). Close the page and leave it in the room. Stop art-making about 10 minutes before the end [source for timing: McCreight 2017]. Do not do trauma sequencing in open or drop-in groups.
Stuck clients (same panel every week, no alternative story). [synthesis] Change the structure: fewer or more panels, draw from another character's viewpoint, draw "the next panel" or a panel one year from now, or use character dialogue (4.6). Houpt's emphasis on spotting problems, solutions and themes gives a review frame [source: McCreight 2017].
Non-adherence with comic journals. [synthesis] Shrink the task (one panel, two minutes), allow missed days, and treat skipped pages as information rather than failure. Consider whether homework fits this client at all.
Perfectionism or the art becomes the goal. [synthesis] Set time limits, use pens (no erasing), and refocus on the story rather than the craft. Clients who are trained artists may need a deliberately unfamiliar or rough format.
Ruptures around the artwork. [synthesis] Examples: the client feels judged by your look or comment, or you misread a drawing. Repair by asking rather than interpreting ("tell me about this panel"), name your mistake, and give the client the final word on meaning. Never display work [source: McCreight 2017].
Disclosure of abuse or risk in a comic. [synthesis] Respond as to any disclosure: listen, do not lead, record what was drawn and said verbatim, and follow your safeguarding procedure. With under-18s and adults at risk, follow local mandatory-reporting rules and do not promise secrecy. A drawing or comic is not evidence of abuse on its own. Do not interpret images as proof, and do not ask leading questions about drawn content.
Suicidal or self-harm content in panels. [synthesis] Treat it like a verbal statement: carry out a standard risk assessment and safety plan. Do not just analyse it as imagery. Supervise sharp tools (see 4.2).
Children and young people. [synthesis] Get parental consent and the child's own assent, age-appropriate. Agree with carers what will and will not be shared, including artwork. Use larger panels, fewer frames, pre-drawn grids and non-toxic materials. Comic Strip Conversations suits autistic children and is child-led [source: Peterborough SEND guide].
Group settings. [synthesis] Agree group rules on not commenting on drawing skill, on confidentiality of shared pages, and on members choosing not to show work. In reading groups (4.12), plan for members whose reading level or concentration limits them [source for group format: Toribio Prieto & Boix 2022].
Sharing or publishing a client's comic. Breuer found public sharing helpful, but it carried stigma risks [source: Breuer 2023]. [synthesis] Get explicit, written, revocable consent, delay decisions until after the trauma work, anonymise, and discuss family and online consequences.
Online delivery. Phang ran comic-making over Zoom [source: Phang 2021]. [synthesis] Agree that the client will show work to camera and where the page will be kept afterwards. Make sure the client has privacy at home.
Scope of practice. [synthesis] If you are not an art therapist, keep to simple structured exercises within your own model, avoid deep interpretation of imagery, and seek art therapy supervision. Refer to an HCPC-registered (UK) or credentialed (e.g. ATR-BC, US) art therapist for art-centred trauma work.

Sources

Sources:

Books and works cited (not drawn on in full):

Carlton, N. R. (Ed.) (2026). Comics, Zines, and Graphic Novels in Art Therapy: Illustrating Stories. Jessica Kingsley / Hachette.
Gray, C. (1994; revised edition). Comic Strip Conversations. Future Horizons.
White, M. & Epston, D. (1990). Narrative Means to Therapeutic Ends. Norton.
Czerwiec, M. K. et al. (2015). Graphic Medicine Manifesto. Penn State University Press.
McCloud, S. (1993). Understanding Comics; (2006). Making Comics.
Andresen, R., Caputi, P. & Oades, L. (2006). Stages of recovery instrument (STORI). Australian & New Zealand Journal of Psychiatry.

Further reading (not drawn on): the full Phang thesis PDF and Gray's own text. A copy of Gray's text on a school-district site was not used, because its authorisation is unclear.

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