A Literature Review of Drawing Therapy in Group Counseling

: Drawing therapy style expressive art therapy in a branch, for mobilizing the group atmosphere and member participation has a positive role in promoting, than the language has a more powerful expressive power and perspective. Based on the principle of projection, the subconscious mind of an individual can emerge in an unrestricted manner, and drawing is not limited by the age, race, language, cultural level, cognitive ability of the visitors, etc. Through guidance, the group leader can promote the individual to better self-exploration and self-awareness. In group counseling, drawing therapy can be used as a technique in growth and therapeutic group counseling. This paper will provide a comprehensive review of the application of drawing therapy in group counseling to provide a basis for understanding the current status of group counseling and grasping the direction of future counseling.


Definition of Drawing Therapy
Regarding the concept of drawing therapy, there is no uniform provision at home and abroad, and there are mainly the following views.The British Association of Art Therapists defines painting therapy as: with the assistance of an art therapist, through painting, molding and other art media, engaging in the visual expression of the mind, through which the mind expression of the thoughts and feelings that exist in the heart but have not been expressed, to the outside world (Haoqi, Maiqing, 2007).The American Art Therapy Association's interpretation of painting therapy is that it is a form of psychotherapy mediated by painting activities (Liu, Zhonghua, 2008).Painting therapy has been practiced in China since ancient times (Ruimin Zhang, Yuhui Wang, 2013).In ancient times, ancestors used murals to express their observation of the world and exploration of life.In Chuang Tzu's book, it was suggested that meditation using art could lead to transcendence.During the Sui and Tang dynasties, Dr. Mo used paintings to treat Emperor Yang with remarkable results.However, the real use of art therapy in China was carried out by Jia Ming and others at the Shanghai Mental Health Center in 1989 and 1990, respectively, to treat psychiatric patients with painting art, and both achieved better results, after which art therapy was gradually and deeply used in China.

Projection Theory
In the psychoanalytic school, individuals have the tendency to unconsciously attach the psychological processes occurring in themselves to the object (Dai Haiqi, Zhang Feng, Chen Xuefeng, 2007).In the process of painting, the members' unconscious, unable to express in words, repressed emotions, thoughts, and desires will be presented in the creation of the work, so that the group leader can better understand the members through the work, and help them to carry out the work of self-growth.

Brain Lateralization Theory
In Practical Clinical Psychiatry, Shi (2009) points out that drawing therapy is based on the division of labor between the two hemispheres of the brain and the theory of mental projection.Physiological psychology research on brain function has found that the division of labor between the right and left hemispheres of the brain is asymmetrical, with the right hemisphere of the brain playing a major role in the processing of image information, spatial orientation, music perception, and understanding of emotional attitudes, while the left hemisphere plays a major role in reading and computation.This theory has also been demonstrated in studies of schizophrenia.Based on this theory, the effect of drawing therapy will be more significant when dealing with emotional disorders and traumatic experiences that are mainly characterized by emotional distress (Pengyan Bai).

The Mechanism of Action of Drawing Therapy
Painting therapy is to stabilize and regulate emotions by allowing patients to generate free associations through painting, and to treat psychological disorders or correct behavioral problems in the process of pursuing artistic beauty (Liu, Zhonghua, 2008).Painting psychotherapist ROBIN (1998) proposes that the material for attention, imagination and thinking is mainly images based on visual representations; most traumatic experiences exist in the deeper layers of memory, repressed and not easily realized, and it is difficult for us to extract them in words, and thus difficult to treat.The Ministry of Culture pointed out in the 2012 Chinese government work report; the symbolic and value-neutral nature of the art of painting itself makes the patient's expression extremely covert, allowing the patient to project deep inner motives, emotions, values, etc. into the paintings in a safe environment, as well as releasing early repressed memories, relieving bad emotions, solving problems, and perfecting the personality.In addition, the creative process provides patients with a new way of looking at the problems they face (Wei Yuan, 2006).

Improvement of Emotional and Cognitive Functioning
Xia Yu (2023) included a total of 13 papers involving 775 adult patients with malignant tumors, and conducted Meta results indicating that drawing therapy can effectively alleviate anxiety, depression, and fatigue symptoms in adult patients with malignant tumors, and improve the quality of life of the patients.Li Cowpea Le (2023) found that the application of drawing therapy in the emotional regulation of students in higher vocational colleges and universities in the field of health found that the experimental group had a significant improvement in all negative emotions after drawing therapy.Cai Jin (2022) found that in a study on the effects of drawing therapy on chemotherapy-related nausea, vomiting and anxiety in breast cancer patients, the levels of anticipatory nausea and vomiting, acute nausea, delayed nausea and vomiting, and anxiety in the experimental group were lower than those in the control group at different points in time after the intervention, and that the drawing therapy was effective in decreasing the degree of chemotherapyrelated nausea and vomiting and in improving the anxiety of patients with breast cancer.Zhou Ying (2022) found that painting therapy was effective in treating children with mood disorders, and could reduce patients' SAS and SDS scores.265 cases of adult patients with schizophrenia in the art group intervention study found that the experimental group patients' SDSS scores were lower than those of the conventional group after intervention, and the same group's SDSS scores were lower than those of the pre-intervention group, which could improve their negative symptoms and enhance cognitive and social functions, and play an important role (Xu Jinjing).function, playing an important role (Xu Jinqiang, Wang Ge, 2022).In an intervention study of 428 subhealthy young people's psycho-emotional and executive functioning, after the intervention, SES scores and positive mood scores of the observation group were significantly higher than those of the control group, and negative mood scores were significantly lower than those of the control group, and the group painting therapy improved the psychological state of subhealthy young people (Shi Kun, Yuan Hui, 2022).
After 6 courses of painting group therapy in schizophrenia patients, it was found that the group painting intervention with aripiprazole can effectively improve the mental state and social function of SZ patients, alleviate clinical symptoms, reduce impaired cognitive function, and improve the quality of life and medication adherence (You Hao, Niu Zhuqing, Wu Xuewen, 2023).Wang Ning et al. (2018) implemented group drawing therapy for 30 adolescent inpatients diagnosed with depressive episodes 2 times/week, 90 min/session, for a total of 8 sessions, and found that the scores of symbol coding test, labyrinth test, visual memory test, emotion management test, and sustained manipulation test in the drawing group were better than those of the control group.Tian Tao (2019) used cognitive therapy combined with group painting to intervene in college students with depression, and found that the scores of "awareness of the nature of suicidal behavior", "attitude toward the suicidal person", "attitude toward the suicidal person's family members", "attitude toward euthanasia" of the observation group were higher than those of the control group after the intervention, which indicated that cognitive therapy combined with group painting therapy could effectively improve the cognitive function of college students with depression, improve self-esteem level, and improve sleep.It shows that the combination of cognitive therapy and group painting therapy can effectively improve the cognitive function of college students with depression, increase the level of self-esteem, improve the quality of sleep, and reduce negative emotions.

Improvement of Self-concept and Social Functioning
Jane Fuping (2022) showed that group painting art therapy can significantly reduce the level of social anxiety of leftbehind children, and has a positive effect on improving their self-focus and external attention.Yufang Bi (2022) found that group counseling with mandala painting was effective in reducing the anxiety level of socially anxious college students and improving their self-esteem and self-acceptance.Meng et al. ( 2022) used drawing group counseling designed according to self-awareness to implement drawing group counseling for hearing-impaired students once a week for a total of eight times.After drawing group counseling, the self-awareness level of students in grades 3 to 9 was higher than that before counseling, and the social adaptive ability level of hearingimpaired students in grades 3, 4, 5, 6 and 8 was higher than that before counseling, which showed that drawing group counseling was effective in improving their self-awareness and improving their self-acceptance.The results suggest that drawing group psychological counseling can further affect the level of social adaptive ability based on improving their selfawareness.Yang Jingjing (2022) used group painting therapy combined with dance to intervene in 65 patients with depression, and the results showed that the observation group's total effective rate, self-efficacy scores, and quality of life scores were higher than those of the control group, and that the therapy was effective in improving their self-efficacy and quality of life, and in improving their depressive negative emotions.Group painting art therapy intervention can effectively improve the self-efficacy and social functioning of schizophrenic patients, and also promote the improvement of quality of life, with obvious effects (Yan Minling, Zeng Dongmei, 2020).Junior high school students with poor peer relationships in a middle school were divided into a theme drawing group and a free drawing group for 7 weeks of group drawing counseling.The results showed that group drawing counseling had a positive effect on improving the self-concept of junior high school students with poor peer relationships, and that positive interventions on the self-concepts of junior high school students with poor peer relationships could help them improve the quality of their peer relationships (2021).

Enhancing Mental Health and Improving
Coping Styles In a study exploring the effects of drawing group counseling on the mental health level and coping styles of medical students, it was found that drawing group counseling can improve the mental health level and problem-solving ability of college students (Shi Dandan, 2020).Huang Chunjuan (2015) used group drawing therapy to intervene with hospitalized neurological patients, and found that the experimental group was significantly better than the control group in terms of improvement in psychological coping ability during the same period of hospitalization.Mainly in the improvement of physical and mental coping response, the improvement of coping mode, and the improvement of coping resources, group painting significantly improved the physical and mental health of the subjects.

Prospects of Drawing in Group Psychotherapy
Painting in the therapy group support for the group, in the relevant literature combing found that the painting therapy for the group is mostly facing special problems of the group, such as: depression patients, schizophrenia patients, patients with cancer, etc., or psychiatric patients, etc., and these special groups of the internal differences are also larger, and did not further differentiate, so in the future practice, we should be in the more consideration of the group of individual differences, and this therapy can be in the future practice, we should in the more consideration of the group of the Individual differences, and the therapy can be carried out for more general groups, such as in primary and secondary schools, colleges and universities to promote the use of the one hand, on the one hand, can carry out universal mental health education, but also can be combined with the theme of psychological counseling, psychological support for the counterparts.Painting therapy can also be combined with art education to promote mental education with aesthetic education and deepen aesthetic education with mental education, creating a new model of integrated classroom and promoting integration and innovation in the psychological classroom.
Increase the diversity of drawing therapy in group counseling.At present, drawing therapy is usually used alone in group counseling, but we can consider combining it with other expressive art therapy techniques, art has commonality, and other expressive art therapies, such as sand tray therapy, music therapy, dance therapy and so on, have their own advantages and unique features, for example, in the thematic counseling, combining music and drawing, using music to promote the members to carry out the emotional catharsis in the drawing, or using dance therapy to promote the members to carry out the emotional catharsis, or using dance therapy to promote the emotional catharsis.For example, in thematic group counseling, music and painting are combined to promote the emotional catharsis of members in painting, or dance to increase the level of painting and show more meanings of painting.