Exploring Art-Based Drawing for Non-Verbal Emotional Expression Among Malaysian Adolescents with Histories of Sexual Assault.
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Abstract
Objectives: Adolescents who experience sexual assault often encounter difficulties in verbally expressing traumatic experiences, particularly during the early stages of post-disclosure counselling. Non-verbal and developmentally appropriate interventions may support emotional communication in this context. This qualitative exploratory study aimed to examine the use of an adapted Art Drawing House–Tree–Person (ADHTP) activity as a non-diagnostic expressive medium to facilitate non-verbal emotional expression among adolescent sexual assault survivors.
Material and Methods: The study involved six female adolescents aged 13–15 years from Pahang, Malaysia. Data sources included participants’ drawings, brief post-drawing narrative reflections and counsellor observational notes collected during a single-session intervention. Thematic analysis was employed to identify recurring expressive patterns across the House, Tree and Person drawings.
Results: Findings revealed consistent themes among participants. The House drawings reflected cautious engagement with the environment and indications of fragile identity development. The Tree drawings suggested emotional vulnerability, life challenges and emerging resilience processes. The Person drawings highlighted relational sensitivity, prosocial orientation and ongoing meaning-making following traumatic experiences. This study contributes to trauma-informed counselling practice by demonstrating the potential of ADHTP as an expressive, non-diagnostic intervention that supports emotional articulation, identity exploration and relational processing among adolescent sexual assault survivors during early counselling engagement
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References
Abdul Latiff, M., Fang, L., Goh, D. A., & Tan, L. J. (2023). A systematic review of factors associated with disclosure of child sexual abuse. Child Abuse & Neglect, 135, 106564. https://doi.org/10.1016/j.chiabu.2023.106564
Ali, S., Pasha, S., Cox, A. et al. Examining the short and long-term impacts of child sexual abuse: a review study. SN Soc Sci 4, 56 (2024). https://doi.org/10.1007/s43545-024- 00852-6
Bailey, C., Shaw, J., & Harris, A. (2024). Adolescents and sexual assault: A critical integrative review. American Journal of Community Psychology. https://doi.org/10.1002/ajcp.12740
Berberi, A. (2025). Exploring therapeutic factors: A philosophical inquiry into art therapy's role in healing attachment insecurity in an adult population (Graduate project, M.A.). Concordia University. https://spectrum.library.concordia.ca/995880/1/Berberi_MA_F2025.pdf
Buck, J. N. (2019). The house-tree-person technique revised manual. Ishi Press International.
Cohen, E. D., & Cohen, G. S. (2018). Counseling ethics for the 21st century: A case-based guide to virtuous practice. SAGE Publications.
Cor, D. N., Saltis, M. N., Doughty Shaine, M., & Streeter, L. (2025). Our ethical duty: Assessing the competencies of counselors-in-training for counseling with transgender and gender expansive clients. Journal of LGBTQ Issues in Counseling, 19(3), 271–285. https://doi.org/10.1080/26924951.2025.2472929
Edward J. Alessi & Sarilee Kahn (2022): Toward a trauma-informed qualitative research approach: Guidelines for ensuring the safety and promoting the resilience of research participants, Qualitative Research in Psychology, DOI: 10.1080/14780887.2022.2107967
Garner, D., Carvalho, J. D., & Spears, B. (2025). Childhood emotional, physical and sexual abuse as predictors of adult behavioral outcomes: Implications for trauma-informed clinical practice. Journal of Social Work and Social Welfare Policy, 3(2), 175. https://doi.org/10.33790/jswwp1100175
Grennan, S., Matthews, M., Penketh, C., & Wild, C. (2024). Thinking about drawing as cause and consequence: Practical approaches in time. International Journal of Art & Design Education. https://doi.org/10.1111/jade.12542
Gülüm, İ. V., Dilekler-Aldemir, İ., İkizer, G., & Karanci, A. N. (2025). The temporal dance: How therapist presence and alliance evolve across early sessions of psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 98(4), 1017–1032. https://doi.org/10.1111/papt.70001
Gussak, D. E., & Rosal, M. L. (Eds.). (2016). The Wiley handbook of art therapy (2nd ed.). John Wiley & Sons.
Haeyen, S., van Hooren, S., & Hutschemaekers, G. (2015). Perceived effects of art therapy in the treatment of personality disorders, cluster B/C: A qualitative study. The Arts in Psychotherapy, 45, 50–57. https://doi.org/10.1016/j.aip.2015.04.005
Heijman, J., Wouters, H., Schouten, K. A., & Haeyen, S. (2024). Effectiveness of trauma- focused art therapy (TFAT) for psychological trauma: Study protocol of a multiple- baseline single-case experimental design. BMJ Open, 14(1), e081917. https://pmc.ncbi.nlm.nih.gov/articles/PMC10826536/
Jean-Berluche, D. (2024). Creative expression and mental health. Journal of Creativity, 34(2), https://doi.org/10.1016/j.yjoc.2024.100083
Lavania, C., & Ballal, D. (2025). The application of expressive art therapies for survivors of child sexual abuse. Psychological Trauma: Theory, Research, Practice and Policy. Advance online publication. https://doi.org/10.1037/tra0001947
Maddox, G. A., Bodner, G. E., Christian, M. W., & Williamson, P. (2024). On the effectiveness of visual arts therapy for traumatic experiences: A systematic review and meta-analysis. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.3041
McCallum, R. S. (Ed.). (2013). Handbook of nonverbal assessment. Springer. https://doi.org/10.1007/978-1-4615-0153-4
McTavish, J. Q. (2018). Using trauma and attachment-informed art therapy to promote healing in children in the welfare system: A literature review (Master’s thesis, Lesley University). Lesley University Digital Commons. https://digitalcommons.lesley.edu/expressive_theses/24 Digital Commons at Lesley
Miles, L. W., Valentine, J. L., Mabey, L. J., Hopkins, E. S., Stodtmeister, P. J., Rockwood, R. B., & Moxley, A. N. H. (2023). A systematic review of evidence-based treatments for adolescent and adult sexual assault victims. Journal of Interpersonal Violence. https://doi.org/10.1177/10783903231216138
Milkins, B., Milroy, H., Boutrus, M., Pace, G., & Ohan, J. L. (2025). “Wait with me until it’s over”: A reflexive thematic analysis of adolescents’ coping with dissociation. European Journal of Trauma & Dissociation. https://doi.org/10.1016/j.ejtd.2025.100600
Othman, A. (2021). Analysing drawing in non directive play: A case of a 6 year old girl with emotional problems. Malaysian Journal of Paediatrics and Child Health, 27(2), 83– 90. https://doi.org/10.51407/mjpch.v27i2.149
Santillo, G., Morra, R. C., Esposito, D., & Romani, M. (2025). Projective in time: A systematic review on the use of construction projective techniques in the digital era—Beyond inkblots. Children, 12(4), 406. https://doi.org/10.3390/children12040406
Sheng, L., Yang, G., Pan, Q., Xia, C., & Zhao, L. (2019). Synthetic House Tree Person drawing test: A new method for screening anxiety in cancer patients. Evidence-Based Complementary and Alternative Medicine, 2019, Article 5062394. https://doi.org/10.1155/2019/5062394
Shepp, V., O’Callaghan, E., & Ullman, S. E. (2019). Interactions with offenders’ post-assault and their impacts on recovery: A qualitative study of sexual assault survivors and support providers. Journal of Aggression, Maltreatment & Trauma, 29(6), 725–747. https://doi.org/10.1080/10926771.2019.1660443
Soma, C. S., Baucom, B. R. W., Xiao, B., Butner, J. E., Hilpert, P., Narayanan, S., Atkins, D. C., & Imel, Z. E. (2019). Coregulation of therapist and client emotion during psychotherapy. Psychotherapy, 56(4), 455–467. https://doi.org/10.1080/10503307.2019.1661541
Sony, E. A., Ali, E., Cletus, O. A., & Agbakhamen, C. O. (2025). Ethical standards in research: A professional imperative. Zenodo. https://doi.org/10.5281/zenodo.14875237
Strang, C. E., Hass-Cohen, N., Bokoch, R., & Vaisvaser, S. (Eds.). (2025). The arts therapies and neuroscience. Frontiers Media SA
Tenny, S., Brannan, J. M., & Brannan, G. D. (2025). Qualitative study. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470395/
Zhai, Y., & Prescod, D. J. (2024). Promoting multicultural and social justice counselling competency of international counselling students. Counselling and Psychotherapy Research, 25, e12803. https://doi.org/10.1002/capr.12803.