Patterns of creative technique use in child and youth psychotherapy in Germany: an exploratory mixed-methods survey including identity-informed practice.

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 ( 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.