CREATING A NEW YOU

1

Creating a New You:
Using Character Creation and Comics for Identity Development in Queer
Neurodivergent Adolescents
Kimberly Bennett
Department of Counseling, Pennsylvania Western University
COUN 7550: Introduction to Art Therapy Research
Dr. Penny Orr
August 8, 2025

CREATING A NEW YOU

2

Abstract
This paper examines the clinical application of character and comic creation with Queer
neurodivergent youth with the focus on identity development within a group setting. The
curriculum workbook is built on research including adolescent development, personality
development, and inclusions of geek interests in its approach. The workbook includes character
templates where participants can rate their characters skills and qualities on a 1-10 scale for
strength or importance and comic interventions to encourage identity exploration. The
curriculum workbook includes four main topics focusing on the actual self, the ideal self,
narrative therapy through comics, and a final group project where small groups work to write
and draw their own comics involving overcoming a problem. Further research is needed to
examine character creation beyond current use in video games or virtual spaces, as well as
continue to explore geek interests within clinical applications.
Keywords: adolescents, art therapy, autism, avatars, character creation, comics, geek
therapy, identity formation, queer

CREATING A NEW YOU

3

Table of Contents
Creating a New You: ____________________________________________________ 1
Using Character Creation and Comics for Identity Development in Queer Neurodivergent
Adolescents _________________________________________________________________ 1
Abstract ______________________________________________________________ 2
Table of Contents _______________________________________________________ 3
Creating a New You: ____________________________ Error! Bookmark not defined.
Character Creation and Comics for Identity Development in Queer Neurodivergent
Adolescents _________________________________________ Error! Bookmark not defined.
Problem Statement and Justification ______________________________________ 7
Person-Centered Theory _____________________ Error! Bookmark not defined.
Roger’s Theory of Personality Development ______________________________ 7
Jungian Theory _____________________________ Error! Bookmark not defined.
Jungian Personality Development ______________________________________ 9
Internal Family Systems (IFS) _________________________________________ 10
Terms Related to the Study ____________________________________________ 11
Conclusion ___________________________________________________________ 13
Section II: Literature Review _____________________________________________ 14
Adolescent Development ______________________________________________ 14
Physical Development ______________________________________________ 15
Intellectual Development _____________________________________________ 16
Vygotsky. ________________________________ Error! Bookmark not defined.
Socioemotional Development _________________________________________ 18

CREATING A NEW YOU

4

Outcomes of Identity Development in Adolescents_________________________ 19
Queer Youth ________________________________________________________ 21
Identity Development _______________________________________________ 22
Supports and Protective Factors _______________________________________ 23
Avatar Use with Queer Individuals _____________________________________ 24
Neurodivergence and Autism ___________________________________________ 25
Intersectionality of Queer and Neurodivergent Populations ____________________ 26
Discrimination _____________________________________________________ 27
Treatment ________________________________________________________ 29
Creative Interventions for Queer Neurodivergent Adolescents _________________ 30
Art Therapy _______________________________________________________ 31
Art Therapy with Queer Individuals _____________________________________ 32
Narrative Therapy __________________________________________________ 33
Comics and Graphic Medicine ________________________________________ 35
Fictional Characters Usage and Creation ________________________________ 37
Character Creation and Avatar in Clinical Applications _______________________ 40
Avatars and Character Customization __________________________________ 40
Video Games and Avatars ___________________________________________ 41
Video Games. ___________________________________________________ 42
Tabletop Role Playing Games (TTRPGs) and Live Action Role Play (LARP). __ 44
Common Themes in Avatar Usage and Character Creation__________________ 45
Self-representation. _______________________________________________ 45
Identity Exploration. _______________________________________________ 45

CREATING A NEW YOU

5

Conclusion ___________________________________________________________ 46
Section III: Methodology _________________________________________________ 47
Purpose Statement ___________________________________________________ 47
Population and Setting ________________________________________________ 47
Intended Audience ___________________________________________________ 48
Curriculum Structure __________________________________________________ 49
Curriculum Outline ___________________________________________________ 49
Chapter 4: Curriculum __________________________________________________ 52
Summary of Research ________________________________________________ 53
Limitations _________________________________________________________ 55
Suggestions for Future Research ________________________________________ 57

CREATING A NEW YOU

6

Chapter 1: Introduction
Adolescents are a population that grapple with rapid changes in their body, functioning,
and social environment, amidst a growing need for independence (Human Development
Teaching and Learning Group, 2021). Queer and neurodivergent adolescents experience these
changes like their peers but face additional challenges related to their minority identity statuses
(Johns, 2009; Vogel et al., 2024). Intersectionality of queer and neurodivergent populations is
high (Warrier et al., 2020), but current research and treatment modalities for these individuals
are sparce (Hillier et al., 2020; Vogel et al., 2024; Wallisch et al., 2023). These populations
experience limited access to treatment and ill-informed service providers due to stigma and
discrimination, which discourages engagement with needed physical and mental health
treatment (Wallisch et al., 2023; Warrier et al., 2020). Alternative treatment methods like art
therapy, narrative therapy, and comics help address the developmental task of identity
development and exploration (Shobe, 2024; Venkatesan & Peter, 2018; Vogel et al., 2024).
Additionally, interventions using character creation encourage exploration through external
means (Stuckey & Noble, 2010; Venkatesan & Peter, 2018). This research briefly discusses the
needs of Queer neurodivergent adolescents, outlines the contents of the curriculum workbook,
and includes reflections in the discussion section.
Purpose Statement
The purpose of this research is to create a curriculum for use by an art therapist within a
group setting to address the unique needs of Queer neurodivergent adolescents. This resource
is designed to help create a safe environment for guiding these youth through identity
exploration and development using art and narrative interventions (Venkatesan & Peter, 2018).
The integration of geek culture and artistic interventions helps create distance from potential
past trauma, reduces discomfort related to stigma and discrimination, and allows for external
processing (Mulholland, 2004). Externalization through creative means allows youth to explore

CREATING A NEW YOU

7

topics which may be too intense to discuss (Grossman et al., 2006). Depicting experiences in an
autobiographical way while incorporating pop culture through inclusions of fantasy and fiction
may resonate more with Queer neurodivergent youth. Integrating interests like geek culture may
encourage participation and create unique opportunities for exploration and play within a safe,
contained setting (Grossman et al., 2006).
Problem Statement and Justification
Research reflects increased rates of overlap between Queer and neurodivergent
identities (Vogel et al., 2024; Warrier et al., 2020), though most studies examine these
populations separately. Research focus tends to be on intersectionality and discrimination, as
well as support systems related to complex identities (Hillier et al., 2020; Vogel et al., 2024;
Wallisch et al., 2023; Warrier et al., 2020). Little research has focused on addressing limitations
of support and resources accessible to Queer neurodivergent youth (Hillier et al., 2020; Vogel et
al., 2024). There is a paucity of research that investigates how new or existing resources can
tap into current contemporary culture to make treatment more approachable and interesting for
Queer and neurodivergent youth (Bartenstein, 2024; HeySummit, 2022). Queer neurodivergent
youth are discouraged from treatment due to stigma and prejudice (Hillier et al., 2020). The
integration of interests, like geek culture, reduces barriers to treatment and increase
participation. Limitations in current supports and resources call for the creation of tools to
expand treatment modalities for Queer neurodivergent youth. Drawing on creative outlets and
geek culture helps make treatment accessible and enjoyable while addressing the unique needs
and challenges of Queer neurodivergent youth. As clients work through identity development,
geek culture can assist them in creating social support, draw on their strengths and interests,
and engage clients who may not respond well to current interventions.
Theoretical Foundations
Carl Roger’s Theory of Personality Development

CREATING A NEW YOU

8

Person-centered Theory is a theoretical approach introduced by Carl Rogers in 1951
with a focus on how biological processes and the response from others inform our personality
(Gillon, 2007). Rogers’ theory of personality development drew on infancy and the initial
interactions with the world (Gillon, 2007). He states that infants interact with the world through
biological drives early on, like hunger, gestures, and physiological responses without selfawareness, with these processes happening internally with an external expression, like
movement or crying (Gillon, 2007). When infants react to these biological drives, they are
perceived and responded to by a caregiver through these external expressions, where the
caregiver gives meaning and relates to the infant’s processes (Gillon, 2007). As the infant grows
and matures, they grow awareness and knowledge around these biological processes and they
become more experiences of the self, rather than just of the body, which eventually develops
into a self-concept built on consistent characteristics integrated into their experience, rather than
separate characteristics that cannot be broken down into individual concepts (Gillon, 2007).
Rogers stresses that personality and self-concept development involve experiencing
biological drives, as well as a new drive Rogers calls for unconditional positive regard (Gillon,
2007). Unconditional positive regard relates to the warmth and messages within another
person’s response to our outward expressions. Responses that make an individual feel warmth
and nurtured, like a caregiver’s response to meet an infant’s needs, help create security in
emotional responses like anger, sadness, and other emotions (Gillon, 2007). A negative
response or being ignored by a caregiver can lead to a negative lens of the self-concept,
leading to beliefs like “I am not liked when I get angry” (Gillon, 2007, p. 32). This grows into selfregard, where the infant starts to view their self-experiences in relation to the positive regard
they evoke from others, which can cause discomfort in emotions like anger that may not elicit
positive regard from others (Gillon, 2007). Conditions of worth begin to emerge, which involves
evaluating self-experiences based on if they are associated or not associated with positive

CREATING A NEW YOU

9

regard. This can result in beliefs that self-regard is conditional and based on what
characteristics may evoke positive regard from others (Gillon, 2007). These beliefs related to
self-concept shape behavior and may lead to behaviors like avoidance from situations that may
not evoke positive self-regard or internal rewards, even if they may be positive for the child.
They may view enjoyable activities like play as a waste of time, as it may take away from other
activities that foster positive regard, like studying (Gillon, 2007). These views contribute to
development and functioning into adulthood. Rogers also stresses that as individuals develop,
they function within the two value systems of the biological systems and the self. Misalignment
between these value systems can lead to incongruence, with significant incongruence leading to
issues of denial or distortion of experiences (Gillon, 2007). These experiences can be integrated
into the self-concept to help find equilibrium, or the concept of self can be fractured which can
lead to psychological issues (Gillon, 2007).
Jungian Personality Development
Carl Jung was a psychoanalyst and student of Sigmund Freud who pursued his own
theory separate from his teacher, as he viewed Freud’s approach as not universal and did not
focus on individual growth (Ekstrom, 2004; Niaz et al., 2019; Tarzian et al, 2023). His approach
focused on the concepts of the impact of trauma, interpretation of dreams, free association,
symbolism, and archetypes (Jones, 2013; Ladkin et al., 2018). Jung focused on individuals,
defining individuation as “integrating both conscious and unconscious aspects of one’s
personality to achieve wholeness and self-realization" (Tarzian et al., 2023, p. 4; see also
Ladkin et al., 2018).
Jung continued with this theory of more universal human experiences with this later
informing his theory of personality types (Jung, 1961). His idea of personality was based on a
predisposed type where biological influences and environment (nature & nurture) together
would lead to a healthy expression of personality, though there is no pure type but opposites

CREATING A NEW YOU

10

with preferences (Blutner & Hochnadel, 2010). Jung’s theory of the Self was an archetype of
wholeness, including both the conscious and unconscious (Blutner & Hochnadel, 2010). His
personality theory was based on four main psychological functions all people have: thinking,
feeling, sensing, and intuition exhibited by introversion or extraversion (Blutner & Hochnadel,
2010). These four qualities vary on preferences individuals commonly operate under and the
combination of these preferences determines personality. Thinking, a rational function, is
opposite from Feeling, an emotional response; sensing involves gathering information via the
senses, opposite from intuition where a lot of information is integrated beyond the senses
(Blutner & Hochnadel, 2010). While individuals may vary in how they exhibit these qualities, a
superior function is chosen due to what is preferred, though there are secondary functions that
support the superior function, and tertiary functions that are less developed (Blutner &
Hochnadel, 2010). Jung also was sure to introduce the concept of “shadow”, indicating more
negative aspects to personality that still contribute to overall cognitive functioning (Blutner &
Hochnadel, 2010). Characteristics of this theory create a possibility of 16 different outcomes
based on preference combination, now commonly known as the 16 types (Blutner & Hochnadel,
2010). This personality theory was later integrated into the Myers-Briggs type indicator (MTBI)
and Singer-Loomis inventory of personality (SLIP), which are commonly used assessments to
this day (Blutner & Hochnadel, 2010).
Parts Work & Internal Family Systems (IFS)
The theory of IFS identifies that the mind is not a whole entity but is comprised of
multiple sub-personalities or parts that have their own “history, outlook and approach, ... own
idiosyncratic beliefs, characteristic moods and feelings, and ... own relationship with other parts”
(Sweezy & Ziskind, 2013, p. xviii). Parts typically fall under three general roles: managers,
exiles, and firefighters. Managers are a protective part that focuses on safety and organization
and may focus on perfectionism, worry, caretaking, or discouragement to protect the overall

CREATING A NEW YOU

11

system (Sweezy & Ziskind, 2013). If the manager’s actions are extreme, they can also inflict
harm to the overall Self. Exiles include injured parts that hold “emotional pain and dysfunctional
beliefs about their worth and lovability that threaten the equilibrium protectors crave” (Sweezy &
Ziskind, 2013, p. xviii). Exiles can overtake managers and blend with the overall Self and their
views and pain can impact on the overall functioning and perception of the individual (Sweezy &
Ziskind, 2013). Firefighters are the third part that act as protectors and address issues with
exiles who take over other protective parts. Instead of strategy like the managers, firefighters
use more aggressive methods of coping in order “to put out the emotional fire at any cost”
(Sweezy & Ziskind, 2013, p. xviii). These extreme behaviors can include maladaptive behaviors
like substance use, risky sexual behaviors, self-harm and suicidality, and other extreme
behaviors.
IFS takes a different view toward symptomology, viewing behaviors that may be
pathologized as protective behaviors for the system (Sweezy & Ziskind, 2013). Parts can
manifest as internal experiences, like internal voices, images, or sensations, or even memories
(Sweezy & Ziskind, 2013). These parts work in tandem to help maintain equilibrium. When
balance is off and a part may become dominant, other parts may emerge to help work to restore
equilibrium. The Self in IFS is defined as the unblended state of the individual, with Self-energy
being used to show the flow of energy from the Self to Parts (Sweezy & Ziskind, 2013). IFS has
a fluid view of the Self and Parts, identifying that parts are never completely unblended and can
fluctuate in degree of blending with the Self and other parts in the system (Sweezy & Ziskind,
2013).
Terms Related to the Study
Avatar
A character or iteration used to interact with an environment. Avatars are often
customizable to the user including aspects of physical presentation, personality, background,

CREATING A NEW YOU

12

and morality. Avatars can be used in virtual spaces, online spaces, or vessels used to interact
within a game or world like Tabletop Role Playing Games (TTRPGs), Live Action Role Play
(LARP), fictional literary or artistic work. They often include some likeness to their user or
creator.
De-Roling
A transition, ritual, or activity used for individuals to get out of the character they are
embodying. Commonly seen in drama therapy, live action role-playing, and online settings
where an avatar is used to transition back into themselves and their personality. De-roling also
acts as a way to reflect on sessions, integrate what was learned and incorporate this into their
daily life.
Fandom
The fans of a particular person, team, fictional series, et cetera, regarded collectively as
a community. Members can level in interest intensity and be involved in one or multiple
communities/fandoms.
Geek Culture
Pop culture involving interests' counterculture from the mainstream. Often associated
with items as early as the 1970s/1980s stereotype including interests of comic books, Role
Playing Games (RPGs) with common themes like fantasy or science fiction.
Geek culture can include any current contemporary interests that may vary but can include
literature, media, comic books, anime, manga, Live Action Role Play (LARP), subcultures
(steampunk, goth, horror), tabletop and video games, card games, et cetera.
Original Character (“OC”)
A distinct character created by an individual for various purposes like creating artwork,
animations, literary works, merchandise, or role-play with others. Designs can include different
levels of detail including background stories, physical designs, voice-claims through different

CREATING A NEW YOU

13

media, mood boards, et cetera. Original characters may be created as personas of their creator
used similarly to an avatar, in relation to a fandom or pop culture work, or within a world or
project created by the individual.
Conclusion
The developmental task of identity formation for Queer neurodivergent adolescents can
be compromised by both internal barriers like stigma and external barriers like unsupportive
environments. Gaps in research and resources, as well as stigma and discrimination limiting
access to physical and mental health care, call for the development and research of
interventions designed to meet their unique needs. Drawing on person-centered,
psychodynamic, and IFS frameworks to create a comprehensive resource to foster identity
development and exploration within a safe, community environment will help address dire needs
within this community. The following chapter will detail the population barriers and strengths, as
well as current and emerging research for creative interventions that may make treatment more
efficient and approachable for these vulnerable youth.

CREATING A NEW YOU

14

Section II: Literature Review
Adolescence is a period of human development marked by numerous changes in
physical, intellectual, and emotional development amidst broader shifts in social and educational
environments and roles (Human Development Teaching and Learning Group, 2021). All
adolescents confront these developmental challenges, with individuals in minority groups
encountering additional difficulties due to their identities (Harvey & Fish, 2015). Stress related to
these developmental tasks may be exacerbated due to the intersection of minority identities that
often create or intensify new challenges related to overall development (Hillier et al., 2020;
Warrier et al., 2020). Notably, Queer youth and neurodivergent youth encounter similar
developmental challenges to their peers in addition to stigma and discrimination due to their
identities (Hillier et al., 2020). Barriers like stigma, prejudice, and lack of resources can make
these populations more vulnerable to adverse physical, social, and mental health outcomes
during this sensitive developmental period (Hillier et al., 2020; Loy-Ashe, 2023; Warrier et al.,
2020).
Adolescent Development
Adolescence is associated with the onset of puberty and lasts until around age 19,
involving rapid changes in physical, intellectual, social, and emotional development (Sawyer et
al., 2018). Due to these changes in all areas of functions, adolescents gain a new
developmental task to help prepare them for future independence in adulthood. Adolescents
work through the developmental task of identity exploration and formation within the context of
developmental and environmental changes (Erikson, 1980). Depending on the adjustment of the
adolescent, the task of identity formation will be mostly resolved by early adulthood or remain
unresolved due to factors connected to exploration and commitment (Marcia, 2010).
The period of adolescence was invented from technological advances and global shifts
in culture impacting the roles of teenagers over time (Fasick, 1994). This global shift occurred

CREATING A NEW YOU

15

due to an imbalance in population caused by high birth rates and high death rates of both
children and parents. Increased family sizes and risk for loss of family members led to the
breakup of households. Improvement in agriculture practices caused a decline in birth and
death rates and an increase in overall family stability and smaller family size (Fasick, 1994). As
family size, stability, and longevity increased, the workforce shifted away from child labor in
factories and farms, keeping children and adolescents in education and with their parents until
they complete school (Fasick, 1994). This societal change placed an increased emphasis on a
child’s formal education, enabling them to develop crucial learning skills, habits, self-discipline,
and training for other factory jobs and trades (Fasick, 1994). The transition from the workforce to
education transformed the developmental tasks of adolescents to focus on identity exploration
and formation related to developing skills, self-training, and identity with different career paths in
the future.
Physical Development
Adolescent development is associated with physical maturation and body changes that
occur between ages 8 to 14. Changes in physical appearance include rapid overall growth and
increases in both height and weight between both sexes (Human Development Teaching and
Learning Group, 2021). Primary and secondary sexual characteristics begin to develop during
this time, including changes in reproductive organs like the beginning of menarche and
spermarche, and physical signs develop that indicate sexual maturity externally (Human
Development Teaching and Learning Group, 2021). Changes for adolescents who were
assigned female at birth include the development of breasts, widening of hips, and growth of
pubic and underarm hair, whereas those assigned as male at birth develop broader shoulders,
lower voice range, and hair growth under the arms and in the pubic area.
The age of onset of puberty has shifted over time within different cultural groups
(Human Development Teaching and Learning Group, 2021). Adolescents assigned female at

CREATING A NEW YOU

16

birth who have early puberty may experience more mental health issues including substance
use, eating disorders, depression, and early sexual behavior (Human Development Teaching
and Learning Group, 2021; Wiesner & Ittel, 2002). Adolescents assigned male at birth may
experience rapid change in emotional functioning that causes instability in mood (Human
Development Teaching and Learning Group, 2021). Early maturation was correlated with
harsher or inconsistent disciplinary measures from parents (Ge et al., 2002). Early maturation
was also linked to likelihood to associate with others considered deviant who engage in highrisk behavior, make poor choses, and show poor impulse control and judgement (Ge et al.,
2002). Both sexes may also face difficulties with peers which may include teasing or withdrawal
due to late maturation (Jackson & Bosma, 1992). Early or late maturation can also increase
adolescent insecurities and doubts due to the range in physical differences (Pledge, 2004).
Intellectual Development
Puberty, with the surge in hormones, creates a stage of rapid development in
adolescent’s cognitive and intellectual skills (Human Development Teaching and Learning
Group, 2021). Adolescents experience changes in general attention and selective attention,
working and long-term memory, and processing speeds. In Piaget’s theory of development,
adolescence marks the final stage of development called formal operational thought, marked by
the development of abstract thinking (Piaget, 1971). Adolescents develop the ability to consider
abstract and hypothetical concepts outside of reality, leading to the development of deductive
reasoning and planning skills (Human Development Teaching and Learning Group, 2021). Their
understanding of abstract concepts allows for propositional thought and comprehension of
multiple messages. They can begin to understand message deliveries like satire, metaphor,
sarcasm, analogies, and puns (Human Development Teaching and Learning Group, 2021).
Metacognition is an additional skill adolescents gain, allowing them to reflect on their own
cognitive processes. Finally, adolescents begin to understand relativism, or that everything is

CREATING A NEW YOU

17

relative, which leads to questioning of processes. They become more aware of different
perspectives, self-reflection and self-consciousness (Human Development Teaching and
Learning Group, 2021).
While adolescents gain additional cognitive skills that allow for complex thought,
processing, and reflection, there are also other developments that challenge their thinking. This
increase in the consideration of others’ perspectives can lead to adolescent egocentrism which
is “the inability to distinguish their perspective of what others think of them and what people
actually think in reality” (Human Development Teaching and Learning Group, 2021, p. 255).
This focus on others’ perspectives may also connect to the idea of an “imaginary audience” or
anticipating others’ reactions to them in different settings (Human Development Teaching and
Learning Group, 2021, p. 255). Adolescents worry they will become the center of attention,
which may lead to reluctance to engage in social settings and an increase in privacy due to
always feeling observed and judged by this imaginary audience. Adolescents also begin to
develop personal thoughts and feelings that differ from parents’ and authority’s previous
opinions, which can drive their behavior and make them appear resistive (Human Development
Teaching and Learning Group, 2021).
In addition to feeling pressured and watched by others, they may also feel that they are
of great importance to others, usually due to the imaginary audience concept, which causes
them to believe that no one else can understand what they feel due to their own unique
experience. This can lead to beliefs about invincibility and belief that they are outside
constraints others may face, like consequences, punishment, or greater risks like death. This
misbelief of invincibility or lack of consequences can lead to risky behaviors contrary to
consequences they may think they will not face (Human Development Teaching and Learning
Group, 2021).

CREATING A NEW YOU

18

Adolescents also face shifts in intellectual development related to their increase of
importance to the social environment. Vygotsky’s theory of development incorporates the
broader social context of an individual related to their intellectual development (Jakobsen &
Fischer, 2023). His theory focuses on how social interactions and cultural processes influence
the development of higher functioning in thinking and language skills. Vygotsky identifies the
concept of the “zone of proximal development” where learning and skill development can occur
(Jakobsen & Fischer, 2023). The zone of proximal development (ZPD) includes three levels of
knowledge: a zone on information they can learn independently, a zone of information they can
learn via tools and knowledge from others (ZPD), and knowledge that is outside of the
individuals reach even with these tools (Jakobsen & Fischer, 2023). The ZPD is reached
through scaffolding, which includes supporting the individual with assistance during the
beginning of learning a new task or concept when needed. The ZPD and scaffolding relates to
the developmental task of identity exploration and formation of adolescence. This period of
human development is marked by increased importance of peer relationships and social support
compared to the past which may have included more familial support. The shift of support to
peers undergoing similar experiences allows for exploration of culture within their developmental
group and exposure to new cultural ideas within this group. Scaffolding can be achieved by
creating opportunities or support to encourage adolescents to enter the ZPD related to identity
to allow for them to explore and work towards resolution of this task (Jakobsen & Fischer,
2023).
Identity Development
Erikson’s theory of personality focuses on eight development stages over the lifespan
from birth to old age (Erikson, 1980). Adolescents are tasked with developing a healthy identity
and concrete sense of self or they risk falling into role confusion (Erikson, 1980). This primary
task includes risk taking in order to explore and define different potential identities that they may

CREATING A NEW YOU

19

embrace within an age where exploration is appropriate and encouraged. Marcia (2010) outlines
four identity statuses adolescents can experience during this developmental task: identity
diffusion, identity moratorium, identity foreclosure, and identity achievement. Identity diffusion is
the lack of exploration and commitment to an identity. This can lead to the adolescent’s lack of
connection with others, loss of purpose and direction in life because of not successfully
accomplishing this primary developmental task. Identity foreclosure is the commitment to an
identity but an absence of exploration. This status may appear as if adolescents are following
the path that adults or others have made for them, but they may have missed an opportunity to
explore their identity for themselves. They may make a commitment to an identity that may not
fit who they truly are which means they may not feel connected to that identity. Identity
moratorium is when both the exploration and commitment to an identity are missing. The
adolescent suspends their own beliefs in order to explore available identities and expressions
which may increase feelings of anxiousness, inadequacy, and fear of failure. Marica (2010)
stated that most teens experience identity moratorium. Identity achievement is when an
adolescent is able to commit to an identity after exploration. Identity exploration is a long
process where most individuals experience some extent of identity moratorium, before
concluding at identity diffusion, identity foreclosure, and identity achievement. Few tend to
resolve this conflict to identity achievement even by the end of the adolescent life stage (Marcia,
2010).
Outcomes of Identity Development in Adolescents
Identity exploration and formation begins during adolescence where individuals can
practice small acts of commitment and decision-making related to their identity which ultimately
prepares them for adulthood where stronger commitments are expected (Waterman, 1982).
However, identity foreclosure and identity moratorium can le to negative outcomes if not
resolved by the end of adolescence. Identity foreclosure has been linked with negative

CREATING A NEW YOU

20

outcomes like anxiety and avoidance of new situations, often resulting in the individual feeling
their locus of control is external rather than internal. Instead of developing their ego identity,
self-acceptance, and the ability to make decisions and commitments, identity foreclosure can
lead to externalizing their locus of control and decisions and values being determined by others
(Harris-Ray, 2024). Meeus et al. (2012) examined identity status among adolescents within a
longitudinal study to see the process of identity development. It was noted that individuals in
achievement and early identity closure had appropriate levels of psychosocial adjustment and
low levels of depressive symptoms and delinquency (Meeus et al., 2012). Classical identity
moratorium was related to the most negative psychosocial adjustment levels in the study and
high levels of depression and delinquency (Meeus et al., 2012). In this study, both the identity
diffusion and identity moratorium group reflected the highest levels of depressive symptoms and
delinquency (Meeus et al., 2012). Identity moratorium was indicated by indecisiveness, weak
commitments, high levels of reconsideration, and low levels of psychosocial adjustment, which
can impact adult performance if it persists beyond adolescence (Meeus et al., 2012). Identity
moratorium was also associated with maladaptive symptoms and behaviors including selfrumination (Luyckx et al., 2008), substance use (Luyckx, 2005), anxiety (Crocetti et al., 2008),
and depression (Meeus, 1996).
Identity formation can also be complicated by intersectional identities like being Queer or
neurodivergent, where individuals may have insufficient social, medical, or community support
to develop a healthy identity (Hillier et al., 2020). Lacking crucial pieces to identity formation like
labels to help with self-understanding can be damaging to self-esteem (Hillier et al., 2020).
Marginalized youth also experience the same developmental task as their peers, but with added
challenges like stigma, oppression, and individual family or cultural traits that can impact their
resolution of this task (Harvey & Fish, 2015). Successful identity formation within marginalized
youth can reduce risk related to suicide, potentially leading youth to be less likely to consider

CREATING A NEW YOU

21

suicide (D’amico et al., 2015). Marginalized youth may also face both unsupportive and
supportive environments, leading to situations where they may experience identity conflicts and
inconsistency dependent on the context they are in (Mehus et al., 2018). The added task of
identity management across contexts can lead to more frustration and isolation for Queer youth
(Watson et al., 2015). Additionally, Queer youth may face difficulties like having to conceal their
true identity in some or all contexts, which can lead to self-isolation, lower self-esteem, and
negative mental health outcomes (Heck, 2015; Mongelli et al., 2019).
Queer Youth
LGBTQIA+ is an umbrella acronym used to identify individuals exhibiting different sexual
orientations or gender identities. The acronym is made up of common identities, including
lesbian, gay, transgender, queer, questioning, intersex, and asexual, with the “+” as inclusion for
additional diverse sexual or gender identities. While the term includes specific identities in the
community, it is not all-inclusive. The term “Queer” will be used for the rest of the paper as a
more inclusive umbrella term, being sure to include all identities under this community that are
not specified in the term LQBTQIA+. Identifying as Queer was originally labelled as a mental
health disorder (LaSala, 2013; Needham & Austin, 2010). Over time, society became more
accepting to Queer individuals, but marginalization continues to exist despite growing
acceptance (LaSala, 2013; Needham & Austin, 2010).
Gender-diverse and Transgender youth often experience dysphoria, or a feeling of
discomfort due to their gender expression differing from their biological sex (The Mayo Clinic,
2025). The Mayo Clinic (2025) identified that dysphoria can develop in childhood or can
manifest later in life. Mental health professionals and doctors are sources for support for gender
dysphoria via psychoeducation, treatment options, or interventions, but can be ill-informed on
Queer issues and misdiagnose these symptoms as anxiety, adjustment disorder or depression
(The Mayo Clinic, 2025). Gender-diverse and Transgender youth are harmed by misdiagnosis

CREATING A NEW YOU

22

due to receiving inappropriate or insufficient psychoeducation, lack of referrals to proper
treatment modalities, or ill-fit interventions (The Mayo Clinic, 2025). Gender-diverse and
Transgender youth are left feeling more marginalized and burdened by mental health issues
and stress due to difficulties receiving adequate care (Hillier et al., 2020; The Mayo Clinic,
2025). Queer youth are more predisposed to vulnerability than their peers, as they are two times
more likely than heterosexual individuals to have a general mental health disorder and are two
and a half times more likely to face specific mental health concerns like depression, anxiety, and
issues with substance use (Hong & Skiba, 2025).These individuals are four times more likely to
have a suicide attempt than their heterosexual peers (Hong & Skiba, 2025). Queer individuals
are exposed to more stigma within various environments in their life, which can lead to
challenges in expression of issues like gender dysphoria. Queer youth are restricted access to
services due to internal and external stigma, perpetuating more with physical and mental health
(Hillier et al., 2020; Moagi et al., 2021). Queer youth are often rejected by close family or
support systems due to their identity, significantly increasing their likelihood for maladaptive selfharm behaviors, depression, substance abuse, and suicide (Jordan, 2020).
Identity Development in Queer Youth
Queer youth are expected to understand and integrate their evolving Queer identity into
their self-concept while working on their developmental task of identity development (Johns,
2009). These children are rejected within some parts of their life while struggling for peer
acceptance and fitting in, leading to the development of a negative self-concept. External
supports like Queer adults present in a queer adolescent’s life can provide benefits.
The Trevor Project conducted a survey, concluding that a majority of Queer youth reported
having at least one Queer role model in their life, which correlated with positive outcomes like
higher protective factors and higher feelings of a positive life purpose (The Trevor Project,
2024). The Trevor Project (2024) reported that an increase in feelings of having a positive life

CREATING A NEW YOU

23

purpose was associated with a decrease in reports of suicidal ideation, attempting suicide or
self-harm. Queer youth experience higher risks for homelessness, risky sexual behavior,
addiction, bullying, school violence, and suicidality compared to their heterosexual peers
(Harvey & Fish, 2015). Queer youth whose identity intersects with another minority group were
found to have higher rates of drug and alcohol use in the home partially due to lack of support
by the family and the family’s own chronic stress (Austin & Craig, 2013). Queer adolescents,
who are minors, lacked agency to independently gain access to treatment, community supports,
and even identity expression due to unsupportive parents or community. Some Queer youth
opted for invisibility or not coming out about their identity to those around them, but this was
created challenges like lack of self-understanding, exploration, and expression of their identity
(Harvey & Fish, 2015). Because of factors outside of the youth’s control and risk related to their
Queer identity, Harvey and Fish (2015) hypothesized that “some Queer youths are forced to be
other than who they are and actively prevented from developing into the people they have the
natural potential to become” (p. 400).
Supports and Protective Factors
Parental and community support can act as a protective factor for vulnerable Queer
youth. High family support levels for Queer adolescents were linked to better mental health over
a 5-year period, healthy development of identity, and less likelihood for considering suicide
(Jordan, 2020). Resiliency was also shown to be a protective in factor as Queer youth of color
were found to “mature quickly, learn to advocate for themselves in their school systems,
developed complex identities, and found social support in online communities” (Harvey & Fish,
2015, p. 398). Harvey and Fish (2015) argued that resiliency is a core factor needed for Queer
youth, as their developmental task of identity development is challenged due to their identity
falling outside of cultural norms. They outlined that Queer youth have hidden resilience, which

CREATING A NEW YOU

24

includes maladaptive behaviors that emerge to functionally protect and grow Queer youth
identities in unsupportive environments (Harvey & Fish, 2015).
Avatar Usage for Identity Development with Queer Youth
A study conducted by Zomerplaag and Bakkes (2024) examined gender dysphoria and
the how character customization may be used to address gender dysphoria and identity
expression in Transgender adolescents between the ages of 16 to 23. Their research focused
on the flexibility of character customization, allowing for experimentation in gender presentation
and physical characteristics that allow for safe exploration of identity (Zomepplaag & Bakkes,
2024). The act of character customization also allowed for exploration and insight into how the
user may customize their character closer to their actual self or ideal self. In this study,
participants valued customization options like ability to toggle gender, clothing, abilities, and
being able to change one’s name in the game, often preferring higher levels of customization of
avatars (Zomerplaag & Bakkes, 2024). Most participants reported a decrease in presence of
gender dysphoria while playing video games, though this relief was described as temporary.
A study conducted by Morgan et al. (2020) examined the use of avatars and video
games in transgender and gender-diverse young people. Video games were found to be used
for mood improvement from negative moods as well as self-expression. Video games have
been used for interventions within the therapeutic space, including increasing social functioning
in individuals with autism, reduction of symptoms in adolescents with depression, and reduction
of auditory hallucinations in individuals with schizophrenia (Morgan et al., 2020). The focus
group for Transgender and Gender-diverse youth has responses showing the impact of avatars
and video games on their experience, including seeing representation of their experience, safe
private expression of gender identity before coming out, a safe environment to test out
identities, and identity consolidation in early stages of experimentation with their gender identity.

CREATING A NEW YOU

25

Witnessing, or having others see their avatar as an expression of their self-experience, was also
seen as an impactful use of video games and avatars with this population (Morgan et al., 2020).
Neurodivergence and Autism
Neurodiversity is an umbrella term often referring to individuals who have various
neurological or developmental conditions including autism spectrum disorder (ASD), attention
deficit hyperactivity disorder (ADHD), or learning abilities (Baumer & Frueh, 2021; CapannaHodge, 2025). This term was coined by an Australian Sociologist to help promote equity and
inclusion of neurological minorities as a social justice movement to encourage self-advocacy,
increase knowledge about conditions, and increase awareness within research and education
about these conditions (Baumer & Frueh, 2021). The neurodivergent community, with the
variety of diagnoses comprising the community, are united by the overall variants in functioning
and processing by their brains, which can include sensory processing, attention, social
communication, and cognitive processing, where individuals may fluctuate in abilities in these
various categories (Capanna-Hodge, 2025). Neurodivergence and ASD can also be associated
with hyperfixations or special interests. Hyperfixations are often associated with ADHD and
include short term, intense focus on interests, with focus so strong it can impact basic needs
and functioning due to time consumed on said interest (Wakeman, 2022). A special interest,
often associated with ASD, is similar but often lasts longer than hyperfixations and can vary in
the number an individual has as well as intensity (Wakeman, 2022). Individuals with ASD vastly
differ in presentation of communication skills, learning, and behavior. Individuals with ASD vary
in levels of IQ, communication skills, and level of functioning within society, leading to barriers
like social exclusion and inequity (Baumer & Frueh, 2021).
Co-morbidity of additional conditions is common in individuals with ASD, often including
diagnoses like ADHD, anxiety, depression, and epilepsy (Lord et al., 2020). Adolescents with
ASD have difficulty in routine changes, transitions, or stress which can lead to issues with

CREATING A NEW YOU

26

behavior like aggression, withdrawal, self-stimulation, and self-harm (Oshima et al., 2023).
Research into autistic identity among adolescents showed that most were unaware of their
diagnosis and lacked knowledge about their condition, and that lack of disclosure could
contribute to self-stigma and negatively impact their sense of self (Riccio et al., 2021).
Intersectionality of Queer and Neurodivergent Populations
Gaps in research regarding intersectionality of minority groups still exist in literature.
Research examining individuals with ASD who also are part of another minority group face
additional challenges including diagnosis delay, difficulties accessing healthcare, and issues
with receiving specialty services, and challenges with health care providers dismissing concerns
(Wallisch et al., 2023). Identifying as Queer or having ASD or other neurodivergent conditions
already poses greater risk to individuals, so identifying within both marginalized communities
may increase these risks further. (Wallisch et al., 2023). Transgender individuals with ASD show
elevated risk for anxiety, depression, and suicidality (Wallisch et al., 2023). The study
conducted by Wallisch et al. (2023) created a survey examining healthcare access for disabled
Queer individuals, finding that intersecting identities may correlate with unmet healthcare needs
and disparities in physical and mental health. Queer individuals were more likely to report “cooccurring disabilities, especially co-occurring mental health conditions” (Wallisch et al., 2023, p.
171).
A study conducted by Warrier et al. (2020) investigated the overlap between Queer
individuals and neurodivergent individuals through a metanalysis of studies. Their findings
indicated that transgender and gender-nonconforming individuals were three to six times more
likely to be autistic compared to their cisgender peers, reporting higher levels of autistic traits,
sensory sensitivity, and lower lates of empathy (Warrier et al., 2020). The Trevor Project (2023)
investigated the mental health of queer individuals with disabilities, finding that 29% of their
sample of queer young people identified as having a disability, with 48% stating they had ADHD

CREATING A NEW YOU

27

and 32% stating they had a developmental disorder like ASD, with 37% reporting they had two
diagnoses and 32% reporting they had three or more diagnoses. Their findings also found
elevated reports of identifying with a disability in multisexual (those attracted to more than one
gender) and transgender or nonbinary individuals compared to cisgender and monosexual
peers (The Trevor Project, 2023). Disability rates were highest in queer, asexual, and gender
diverse individuals who were assigned female at birth (AFAB;The Trevor Project, 2023).
Elevated reports of disability were also linked to higher reports of symptoms commonly seen in
this population, like depression, anxiety, suicidality, and suicidal attempts (The Trevor Project,
2023). A study conducted in the United Kingdom using five sets of data examined gender
identity in 641,860 people between 5 data sets, with all sets of data reflecting significantly higher
rates of autism diagnoses in gender-diverse individuals (Warrier et al., 2020).
Discrimination
Individuals with ASD or other neurodevelopmental disorders who identify as Queer face
overlap in discrimination due to dual identities. This can lead to experiencing a “cumulative
discriminatory impact” which can differ from prejudice related to each individual identity
separately (Hillier et al., 2020, p. 101). Individuals with ASD or neurodevelopmental disorders
already report marginalization related to health and social services, special education, and
advocacy related to disability rights (Hillier et al., 2020). Study participants noted their
experiences with their dual identities causing confusion from family, friends or providers, with
many providers lacking appropriate knowledge on ASD and queer identities (Hillier et al., 2020).
Several participants also stated that the lack of labels related to their diagnosis or sexuality led
to harm to their self-esteem (Hillier et al., 2020).
The overall lack of knowledge by individuals who should have been supports for Queer
and neurodivergent youth about their identity formation have led to harmful discrimination.
Discrimination can even occur from their own identity groups, where one participant mentioned

CREATING A NEW YOU

28

feeling excluded from both communities due to their ASD or Queer identity, stating they felt
“tolerated versus accepted”, pressured to conform to norms, forced to be in an “education
mode” to inform others about their dual identity experiences, and also being treated as
“inspiration porn” due to their status as a high-functioning individual with ASD (Hillier et al.,
2020, p. 103). Many participants disclosed instances where their dual identities and lack of
knowledge about these identities sparked negative reactions and confusion from others (Hillier
et al., 2020). A common experience involved ableism related to ASD, with several mentioning
others commenting on how they did not know themselves well enough to know they were queer
or how others took their Queer identity less seriously due to their ASD (Hillier et al., 2020).
Parents were identified as a challenge, as they were often reported to accept one identity but
not the other, leading to limited disclosure by the individual about their gender or sexuality, with
the presence of strict religious views making discussions with them harder (Hiller et al., 2020).
Depending on parents’ acceptance and religious views, some participants noted how their
parents asked them to move out or pressured them to conform into one category or identity due
to their identity as Queer (Hillier et al., 2020). Queer individuals with ASD also reported barriers
related to accessing healthcare, citing how medical and mental health providers lacked
knowledge on gender identity, with one participant noting how they went through six providers
before finding one who understood their dual identity experience (Hillier et al., 2020).
Neurodivergent Queer individuals have also faced challenges involving social and
recreational activities in indoor and outdoor settings due to issues with stigma, exclusion, feeling
unsafe, policies, discrimination and biases (Loy-Ashe, 2023). Queer individuals are also
frequently targeted for hate or violence, which may make involvement outdoors or in public
spaces difficult due to safety concerns (Bell & Perry, 2015). Neurodivergent individuals face
additional challenges in outdoor spaces, including sensory difficulties, change in routine by

CREATING A NEW YOU

29

navigating unfamiliar places, which can overlap with fear of safety due to identifying as Queer
(Loy-Ashe, 2023).
Research reflects how parents, social supports, and social services lack knowledge
surrounding both Queer and neurodivergent topics, which creates barriers and harm toward
individuals seeking support and services (Hillier et al., 2020). Current sexual education focuses
on heteronormative and cis-normative perspectives, which limits access to knowledge and
resources related to Queer health. Appropriate access to sexual health education is further
complicated by ableist barriers like speaking to the parents of the youth without them present or
not disclosing the neurodivergent diagnosis to the youth (Hillier et al., 2020). Lack of knowledge
and poor treatment by healthcare professionals creates barriers like fewer referrals to
community support and decline in mental health (Dhejne et al., 2016) which can impact overall
physical and mental health (Moagi et al., 2021).
Treatment
Current treatments for individuals with autism include “developmental, behavioral, and
psychosocial therapies, including applied behavioral analysis (ABA), cognitive behavioral
therapy (CBT), and early intensive behavioral intervention EIBI)” (DeFilippis & Wagner, 2016;
Lord et al., 2020, as cited in Vogel et al., 2024, p.1). Medication can be used to alleviate some
symptoms related to ASD, including reduction of self-injury of aggression, some antipsychotics
used to treat irritability, with common medications being used including selective serotonin reuptake inhibitors (SSRIs), tricyclics, psychoactive or anti-psychotic medications, stimulants, antianxiety medications, and anticonvulsants (Lamoreux, 2021). Medication intervention is not a
cure for ASD but can help alleviate behavioral issues that may impact daily functioning;
however, some individuals report negative side effects (Brodino et al., 2015). Additional
approaches include complementary therapies which are paired with other treatment

CREATING A NEW YOU

30

interventions, adding supportive treatments like natural supplements, yoga, acupuncture,
traditional medicine, and naturopathy (Hyman et al., 2020).
Art therapy may serve as a beneficial treatment modality for children with ASD. Vogel et
al. (2024) conducted a study examining a systematic review of art therapy literature to see
effectiveness on symptoms related to social, motor, and behavioral symptoms. Length of
interventions varied, but the method of group art therapy qualities may benefit this population.
Group art therapy allows for social interaction and practice of social and behavioral skills within
a controlled setting and may encourage safety and comfort to encourage self-expression and
connection within group members (Vogel et al., 2024). All outcomes measured within Vogel et
al.’s (2024) study reflected improvement of ASD symptoms with some improvement in
subdomains of social outcomes and behavioral skills within most studies examined. Use of
abstract art in individual sessions and drawing or utilizing multi-modality artmaking also showed
improvement in social outcomes and behavioral outcomes respectively (Vogel et al., 2024). Art
therapy has also seen applications in school settings to improve anxiety and self-concept, as
well as improve emotional behavioral difficulties and problem-solving skills (Moula, 2020).
Creative Interventions for Queer Neurodivergent Adolescents
Youth with identities within the Queer or neurodivergent community, due to these
identities, already face challenges related to cultural norms being shaped by heterosexual and
neurotypical thoughts, behaviors, and needs. Creative interventions can draw on hyper-fixations
and special interests from neurodivergent individuals which may encourage communication and
involvement in services. These interests can also be used to help address Queer individuals’
need for representation in relation to identifying with fandoms (pop culture fan communities)
they may resonate with and draw on strengths and interests to make therapy more accessible
and enjoyable. Utilizing therapy and treatment in non-direct ways like expressive therapies,
virtual environments, and game therapies may help decrease barriers to treatment due to

CREATING A NEW YOU

31

stigma and discrimination because of identity. Creating a safe environment, non-judgmental
space for Queer neurodivergent individuals to share their authentic experience is crucial to help
make mental health services accessible. Safe spaces and informed clinicians focused on Queer
and neurodivergent issues may encourage individuals to seek out and participate in mental
health treatment without the fear of stigma, prejudice, and discrimination. Making mental
healthcare more accessible and providing safe Queer and neurodivergent spaces can help
encourage more social support to help curb the effects of rejection and stigma these youth may
face in their communities.
Art Therapy
Art therapy is psychotherapy that uses the art process and/or the product as means for
healing (Hogan, 2010; Malchiodi, 2003; McNiff, 2009). This method has seen applications
across a variety of age groups and populations (Kelly, 2010). The therapeutic use of art may
particularly benefit where communication or conveying experiences may be difficult using words
alone (Moschini, 2005; Rubin, 2009). Art was used by Jung as a therapeutic process that
helped inform his interest and exploration surrounding symbolism and dreams (Hayman, 2002;
Jung, 1961). The use of art activates the brain and body and taps into neuroplasticity (Doidge,
2008). Art therapy focuses on the use of images to tap into the internal and external worlds and
memory (Kelly, 2010). Art therapy is regulated within the United States on the state level to
determine qualifications to practice if the title is protected. Art therapy in the United States is
also overseen by the Art Therapy Credentials Board who outlines specific ethical, educational,
and practice guides to assure there is regulation in who gain the title of “registered art therapist”
(ATR) or board certification after an exam (ATR-BC). Art therapy has seen wide clinical
applications and has helped address emotional and behavioral difficulties; anxiety; self-concept;
and problem-solving skills in school settings (Moula, 2020). Art therapy has helped to improve
anxiety, depression, and cognitive impairment in adults with Alzheimer's (Schweizer et al.,

CREATING A NEW YOU

32

2020), as well as addressing PTSD and trauma in veterans in a group setting (Smith, 2016). Art
therapy helps develop communication skills, social skills, and interpersonal relationships in
adults with ASD (Harris, 2015).
Art therapy provides a safe environment for identity exploration and processing of stress
and experiences individuals face (Holder, 2022; Pelton-Sweet & Sherry, 2008). Art therapy
interventions can be built upon pre-existing interventions, utilizing art as an additional method to
explore inter- and intrapersonal experiences, and tapping into the unconscious through artistic
means (Zascririnkis, et al., 2023). Art therapy can provide unique opportunities to participants
and help supply positive appraisal, pivot to an internal locus of control, emotional expression,
and increase growth related to queer identities after disclosing their identity (“coming out”) to
others (Antebi-Gruszcka et al., 2021). Art therapy has joined the growth of alternative
treatments (animal therapy, music therapy, dance therapy, and drama therapy) to address
symptoms related to autism (Brodino et al., 2015). Both one-on-one and group art therapy has
been conducted with individuals with ASD, with both formats reducing social, behavioral, and
motor symptoms (Vogel et al., 2024). Group art therapy was seen to help improve social
interaction and address deficits in social and behavior skills related to ASD, as groups require
different skills than individual work (Vogel et al., 2024). Drawing and artmaking involves
activating multiple senses which can help individuals reprocess fragmented memories of trauma
and illness into a more whole iteration through creative use of imagination, metaphors, and
similes (Venkatesan & Peter, 2018). Through autobiographical graphic medicine comics,
individuals were able to show how art and drawing helped them actualize their true self,
increase self-understanding and resolve issues related to grief, trauma, and psychological
conflict (Venkatesan & Peter, 2018).
Art Therapy with Queer Individuals

CREATING A NEW YOU

33

Esterline, an undergraduate art therapy student at the University of Wisconsin, proposed
an art therapy intervention to help individuals explore their Queer identity across different
contexts through a heuristic study. They proposed that art allows for exploration of gender and
sexual identity within a safe environment, allowing for symbolism and metaphor to aid in
expression through a non-threatening approach (Esterline, 2021). Their prompt revolved around
identity collages, encouraging participants to explore their queer identity within the context of
being part of a family, a partner, a friend. Overall, Esterline (2021) identified how these collage
prompts encouraged them to explore their relationship between their body and identity across
different integrations with others, related to the level of disclosure of their identity and their
overall physical presentation of their gender identity.
Van der Berg (2023) proposes a similar concept of creating artwork related to the Queer
community's history and cultural artifacts. Engaging with media related to their identity can help
encourage deconstruction and challenging of stereotypes and negative representations of
media (Austin et al., 2023), as both Queer and neurodivergent individuals face stigma,
prejudice, and public lack of knowledge about their identities (Mehus et al., 2017; Fish, 2021;
Jordan, 2020; Wallisch et al., 2023; Warrier et al., 2020). Participants within Van der Berg’s
(2023) study reported common experiences of the population, including isolation, rejection from
support, micro- and macro-aggressions, harassment, and overall lack of community. Working
within a supportive group experience, as well as engaging in symbolic work, can help
encourage participants to engage with their own personal narratives in relation to their overall
identity communities, helping encourage self-exploration and fostering empowerment (Van der
Berg, 2023).
Narrative Therapy
Narrative therapy involves the methods of processing thoughts, feelings, and
experiences through outlets like creative writing, poetry, or autobiographical work (Dodd, 2019).

CREATING A NEW YOU

34

Creative writing involves taking a story and adding elements of imagination, characterization,
and metaphor that can help with reprocessing and integration of life stories that may be
fragmented like trauma (Dodd, 2019). Individuals are given the opportunity to change and
reauthor their lives to externalize their experiences, reassess views related to past experiences,
and change the story to positively reintegrate it into their identity (Dodd, 2019; White & Epston,
1990). Writing, like art therapy, allows for distance and externalization of problems, providing
opportunities to explore experiences that may be too emotionally intense otherwise (Dodd,
2019). Creative writing also provides the unique opportunity to use fictional characters and
stories, allowing for distance during processing as participants may be reluctant to address
certain topics autobiographically due to trauma (Dodd, 2019).
Per Freytag (1895), narrative writing involves various elements of the story which include
the protagonist, antagonist, inciting incident, rising action, characterization, and resolution. The
protagonist is the main character of the story, the antagonist is what threatens the main
character (a person, force, or struggle). An inciting incident is something that occurs to motivate
the character toward change. The rising action are obstacles the protagonist faces for plot.
Characterization involves qualities of the main character to overcome the rising actions and
build a strong protagonist. Finally, resolution is an ending where change has occurred.
The use of fictional characters within narrative therapy, much like the use of avatars,
allows for individuals to explore aspects of the self through that character, fantasize, and
experiment with different qualities and behaviors within a safe setting (Dodd, 2019). The added
use of fiction allows for more use of imagination and freedom, which can encourage participants
to be more performative through their work during group settings where members share their
creations (Dodd, 2019). Fiction also allows participants to fill in gaps related to their life stories
(Dodd, 2019), as well as enter their stories and reclaim them (White & Epston,1990). The

CREATING A NEW YOU

35

flexibility of fiction and created characters can lead to personal change, strength through
example, and familiarity with emotional constancy (Detrixhe, 2010).
Research has shown that writing can be therapeutic. Expressive writing is an activity that
involves cognitive, social, emotional, and biological processing (Pennebaker, 1997) Writing
about traumatic experiences may lead to increases in physical health and better immune
functioning (Esterling, et al., 1999; McArdle & Byrt, 2001) and can lead to long term
improvements in health and mood (Pennebaker, 1997). Emotional writing can also impact
physical wellbeing, leading to less physician visits, better immune functioning, improvements in
stress hormones, blood pressure, and other aspects of wellness like social, academic, and
cognitive (Campbell & Pennebaker, 2003; Pennebaker & Graybeal., 2001). Expressive writing
can help with pain management and mood when used with individuals with chronic pain
(Graham et al., 2008) and help with meaning-making related to experiences of abuse
(Grossman et al., 2006). Journaling as an outlet can help with creativity and exploration of the
self (Cameron & Monroe, 2024; Rainer, 1998) and provide opportunities to use fiction to “go
inside” and “be characters”, where you can create and fantasize through characters within a
safe space (Grossman et al., 2006, p. 438). Writing has shown some benefit for queer
individuals, creating a safe space for talking about their experiences and providing social
support and motivation (Shobe, 2024). Queer writing and publishing has recently faced
censorship, so providing queer-oriented space can help give voices back to queer individuals
(Shobe, 2024).
Comics and Graphic Medicine
Comics are a sequential art format that combines the use of images and sometimes
words to tell a story or provide information (Dilworth, 2024). Comics originated as single-panel
images but grew into sequential pieces that were eventually published in newspapers as early
as 1774 (Dilworth, 2024). The newspaper comic strips commonly known today have been a pop

CREATING A NEW YOU

36

culture staple, with some titles like Peanuts still seeing publication to this day (Dilworth, 2024).
Due to their versatile nature, they have iterations across many genres, age groups, and
cultures. World War II and after launched comics into popularity. Some comics began pushing
what content they could cover, like romance, horror, violence, crime, drugs, and sexual themes,
which resulted in some mixed reactions from the public and worries related to corrupting youth
(Dilworth, 2024). Physical publication has declined and the growing popularity of manga
(Japanese comics) and webcomics, as well as easy access via internet, has caused a change
in the market for American comics (Dilworth, 2024). Comics integration may see benefit from
therapeutic incorporation due to their prevalence in pop culture, discussion of common issues
like “facing fear,” “losing a loved one,” or “being different,” and making therapy more enjoyable,
though more research is needed (Suskind, 2024).
Comics have seen some clinical applications in the realm of art therapy and CBT. The
comic format allows a unique experience where participants can explore their experiences in a
sequential matter using imagery, narrative, and dialogue to process thoughts and feelings
(Fernandez & Lina, 2020). Comics, due to their narrative format, allow participants to create
alternate preferred stories and externalize problems (Phang, 2024). Comics, like other art
therapy techniques, involve multiple senses that can help express trauma or memories through
creative means like metaphors and symbols (Venkatesan & Peter, 2018). Comic usage, like the
implementation of narrative therapy, often follows three distinct steps: externalizing the problem,
deconstructing the narrative surrounding the problem, and reauthorizing alternative narratives
and perspectives (Phang, 2024).
Art therapy builds off the strength of narrative therapy by offering unique methods to
externalize problems in a tangible method through a variety of mediums (Phang, 2024). A study
by Phang (2024) compared the usage of comics to single images for externalization and
processing of problems. Findings indicated that the comic format was more helpful than the

CREATING A NEW YOU

37

single by allowing participants to include more context and convey the whole problem but did
take longer and required more cognitive demands than the single image (Phang, 2024). Most
participants had prior exposure to comics aimed at children/adolescents, and even those
without prior knowledge and exposure were still able to successfully complete the comic
intervention without additional support (Phang, 2024).
Graphic medicine is a growing approach that uses comics as a format within clinical
contexts (Venkatesan & Peter, 2018). This approach draws from ideas related to art therapy,
using creative media like drawing, painting, or writing to help externalize experiences that
“cannot be spoken as they are felt” (Hirsch, 2004, p.1211). Graphic medicine uses comics to
focus on autobiographical stories from authors related to illness experiences (Venkatesan,
2016). The format not only allows authors to use art and comics to express their experiences
but also show through their work how art has aided in their healing and given them voice. Katie,
a narrative avatar of the author, is used to explore her challenges related to anorexia and sexual
violence, using scribbles over her head to depict these feelings (Venkatesan & Peter, 2018).
Both David and Katie within the respective graphic medicine novels are shown in the text
engaging with art and the restorative qualities it has, as well as how mastery leads to a sense of
control (Venkatesan & Peter, 2018). The authors’ work showcased in Venkatesan and Peter’s
(2018) article highlights how art can be used to create their own world of imagination where
authors can use fictional characters to have respite from reality. Creating graphic medicine
comics helps provide containment (Franklin, 1992), externally process grief, trauma, and
psychological conflicts (Venkatesan & Peter, 2018), imagine the world outside of their reality
(Czerwiec et al., 2015), and create representations of trials and failures, whether fictional or real
(Mulholland, 2004).
Fictional Characters Usage and Creation

CREATING A NEW YOU

38

Fictional characters are a common interest with neurodivergent individuals, though
academic research into this area is lacking (NeuroLaunch editorial team, 2024). Fictional
characters may appeal to neurodivergent individuals due to being a source of attachment,
comfort, friendship, and realness they may provide an individual, as well as clear rule-based
behavior or emotional cues (NeuroLaunch editorial team, 2024). Anecdotal discussion on the
social media website Reddit inquiries about the interest of fictional characters by neurodivergent
individuals identifies some common themes that may make fictional characters appeal to this
population. Common themes in responses include the struggles with social cues, as fiction often
has descriptive context to help infer the thoughts and feelings of the characters, identifiable
traits and motivations, and disliking the unpredictability of real people (AverageStarWarsFan,
2024). Additionally, Queer individuals reflecting on their character creation had the common
theme of seeking representation for the sexuality or gender identity through their created
characters (KTLYN, 2024).
Research has been done on character customization and avatar usage across various
contexts, as well as how narrative therapy can be used to reauthor life experiences. Little to no
research has examined how these methods can be combined and used therapeutically. To help
address this topic, I created an informal study to help examine trends in identity and original
character (OC) usage by individuals online. The survey was created using Survey Planet with
sixteen questions focusing on Queer identity, neurodivergent identity, character likeness and
character usage. Most questions were multiple choice questions with an option for ‘other’ where
individuals could specify if a desired response was not listed. Fifty-nine responses were
recorded by late April 2025.
Of the 59 responses, most responses fell between ages 18 to 29, with 55 identifying as
queer and 47 identifying as neurodivergent. This corroborates research highlighting the overlap
of queer and neurodivergent identities (Warrier et al., 2020). Out of the responses, a majority of

CREATING A NEW YOU

39

individuals identified as bisexual, nonbinary, or asexual, with over half of the participants stating
2 or more identities. The most identified neurodivergent diagnoses included autism spectrum
disorder (ASD), attention deficit hyperactivity disorder (ADHD), and social anxiety disorder, with
over half of the participants identifying with at least 2 different disorders. A majority of the
responses identified that most participants created their first OC between the ages of
elementary and middle school, with most participants identifying adolescence as a peak time for
creating their first OC with an elaborated background or personality.
Character usage varied, mostly using creative outlets like writing, drawing, role-playing
with other individuals, or in tabletop role playing games. OC creation included themes of
creative design, role-playing or interaction with others, a therapeutic outlet, telling stories, and
using them for exploration or externalization of qualities. OC personalities varied and most
reported them as being other, outside the categories of similar, idealized, or opposite to the
creator's qualities. Interestingly, for physical qualities, 39 responded as designing opposite to
their actual looks, though some noted through responses they amplified characteristics they
had. The prompt “my OCs help me...” created interesting responses with OCs assisting in
sparking creativity, exploring ideas, escaping reality, processing past experiences, comforting
the creator, acting as desired representation in media, and connect with others. A few
responses included notable quotes like their OC being “a vessel shaped by love”, another
respondent noting their OC used as a way to explore what you would say to a friend in your
shoes to externally process things, using OCs to imagine how other people feel in certain
situations, and using them to explore negative qualities as they are “not allowed to show a
single negative trait”.
Research corroborates anecdotal accounts that character creation can be used for
avatar and narrative therapy to explore personality qualities and behaviors within a safe
environment (Jen_the_Creator7, 2023; KTYLN, 2024). OCs give creators flexibility to explore

CREATING A NEW YOU

40

outside what they may not be able to experience, see desired representation, connect with
others, and look at themselves from a different perspective to gain insight (Jen_the_Creator7,
2023; KTYLN, 2024). The survey questions may have flaws in how they were worded or
limitations of the question format but was still able to yield important themes that show how
character creation can be used therapeutically. The overall difference between creative outlets
and avatar usage warrants more investigation on how individuals create characters and choose
to represent themselves, as well as their overall versatile functions.
Character Creation and Avatar in Clinical Applications
The term avatar originates from Hinduism as a deity embodied into the world through a
human or animal representation, with the term being used to describe digital representations of
the self in 1992 in the science fiction novel Snow Crash (Bailenson & Blascovich, 2004).
Avatars are a representation of the self used to interact with environments like a virtual, game,
or social space. Overall, avatars help users interact with a world or environment and their
respective culture, norms, and rules within that world. This can also expand to immersive uses
like Tabletop Role Playing Games (TTRPGs), Live Action Role Playing (LARP), and cosplay
which involve acting, movement, and costumes within the real world.
Avatars and Character Customization
Avatars are a vessel used within virtual, or game settings controlled by the user to
interact with the environment. Avatars can also be used broadly to indicate a created character
used for interaction within a virtual space, narrative world, or game world as a vessel to interact
with those respective environments. Closed avatars include pre-generated characters that are
not modified by the user, whereas open avatars are customized by the user. Users can
customize physical aspects of their avatar like gender, race, physical characteristics, height,
weight equipment, and sex or gender, as well as additional character qualities like name,

CREATING A NEW YOU

41

language, personality, moral alignment, and background history (Barbera & Haselager, 2020).
Flexibility in character creation allows users to create characters like their actual self and
explore their ideal self or alternate selves. Studies conducted on avatars across various online
video game genres have shown that avatars may be used for escape, to fulfill needs, or
compensate for deficiencies within the user’s current life (Fraser et al., 2023). The study
examined avatars across several video game genres and satisfaction within the user’s offline
life, finding that users who were satisfied with their offline life and played non-competitive games
preferred avatars similar to their current personality and self, whereas users dissatisfied with
their offline life preferred dissimilar avatars to their current self (Fraser et al., 2023).
Two theories that impact avatar creation and how users represent themselves are the
theory of impression management and the theory of self-discrepancy. Impression management
theory indicates that when representing themselves, people tend to idealize themselves and
show themselves as more positive (Mummendy, as cited in Zimmermann et al., 2023). Selfdiscrepancy theory involves the representation of the actual self and the ideal self, with
discrepancy between the two leading to negative emotions (Higgins, 1987). Idealized virtual
identity hypothesis emerged from these two studies, concluding that people tend to portray
themselves as an idealized representation of their actual, offline self (Manago et al., 2008).
Zimmermann et al., (2023) concluded that there was a high correlation between characteristics
of the avatar, actual self, and ideal self. They also noted that physical characteristics tended to
be enhanced from the actual self and that most maintained personality traits across various
online contexts (Zimmermann et al., 2023).
Video Games and Avatars
Most research on character creation is focused on avatar usage within virtual
environments like virtual reality and video games, both online and offline (Barbera & Haselager,
2020; Fraser et al., 2023; Gualeni et al., 2017; Kalyvaki et al., 2023; Venkatesan & Peter, 2018;

CREATING A NEW YOU

42

Zimmermann et al., 2023). The internet created unique opportunities for connections with others
worldwide via an avatar in virtual space. Users may be physically distant but be able to interact
with each other within a virtual space as if they were in the same room via text chat, voice chat,
video chat, and more immersive methods like the use of movement tracking, virtual reality
headsets, and haptic feedback devices.
Video Games. Video games are a unique format that allow for an escape to a more
predictable, controllable world through an avatar (Fraser et al., 2023). Studies have shown that
user can grow attached to the avatars used within video games, potentially forming strong
bonds with them (Mancini et al., 2019), fusion of the player’s self-concept with the avatar (Li et
al., 2020), and even develop the feeling of self-presence within the avatar (Burleigh et al.,
2017). Several studies have examined the avatar usage in Massively Multiplayer Online RolePlaying Games (MMORPGs) related to self-perception (Barbera & Haselager, 2020; Fraser et
al., 2023). MMORPGS, unlike other game formats, offers a highly social experience and
continual gameplay (Barbera & Haselager, 2020; Ng & Wiemer-Hastings, 2005) The social
nature of the MMORPG format creates unique opportunities for character customization where
users can create characters similar to themselves or explore new identities without inhibition or
consequences in a safe, controlled environment (Chappell et al., 2006; Wang, 2012). Studies
have shown that individuals are more likely to represent a character that is a projection of their
own personality (Park & Henley, 2007). One participant disclosed how his avatar is more
outgoing and flirtier, allowing him to test different characteristics he may then integrate into his
behavior offline (Barbera & Haselager, 2020). Another participant disclosed her character as
“more sensual and sexual” compared to her shy self, as the game format has less
consequences than real life (Bessière et al., 2007). She elaborates that this avatar allowed her
to express elegance and sensuality “even in a time when those were all things that were denied
to me in real life”, elaborating how important the escape element was for her (Bessière et al.,

CREATING A NEW YOU

43

2007). Users may experience unique shifts in perspective and identity during play, which can
lead to strong identification with the character/alter ego they have created (Barbera &
Haselager, 2020).
Avatar usage can lead to perspective shifting within the user (Müsseler et al., 2022).
Avatar-self merging occurs when some users “develop the feeling that they are integrating the
avatar into their selves”, potentially evening feeling they are “becoming one with it” (Böffel,
2021; Müsseler et al., 2022). This integration is not like the use of prosthetics with amputees,
where some have reported it has become part of themselves over time, but more like the
appearance and actions of the avatar affect the user (Bekrater-Bodmann, 2020; Müsseler et al.,
2022). Self-avatar overlap can fluctuate based on the user’s characteristics, which then impacts
their choice in avatar representation and overall behavior and interactivity (Hefner et al., 2007;
Müsseler et al., 2022). Self-avatar merging involves both the user and avatar influencing each
other on a continuum of intensity rather than total merging (Müsseler et al., 2022). The avatar is
essentially a tool for the user that “increases the user’s action space and possibilities, but
beyond that an avatar can be seen as a human(-like) being with its own appearance and
character” (Müsseler et al., 2022, p 3). Müsseler et al., (2022) examined how perspective and
view of the avatar impacts the user’s ability to complete the task and how this impacts
perspective taking of the user. Their findings concluded that overlap between avatar and self is
needed for avatar-self merging due to transfer of motor activities corresponding with the avatar.
Their experiment involved different situations that required perspective taking and found that
“users often overrode their own response tendencies and acted as if they were the avatar”
(Müsseler et al., 2022, p. 9). The environment and perspective of the view within the virtual
space can also impact the level of avatar-self merging, as more immersive environments were
more likely to engage the senses and encourage merging (Müsseler et al., 2022).

CREATING A NEW YOU

44

Tabletop Role Playing Games (TTRPGs) and Live Action Role Play (LARP). There
is a growing interest in additional, immersive methods that use avatars or Playable Characters
(PCs) without the assistance of technology or virtual environments (Bartenstein, 2024). Tabletop
Role Playing Games (TTRPGs) and Live Action Role Play (LARP) both involve the user of the
character/avatar more directly than playing a character (Bartenstein, 2024). These experiences
involve the creation of a character within the confines of the world. Instead of this character
interacting with a virtual environment, TTRPGs and LARP align more with drama therapy
(Bartenstein, 2024). Gameplay often involves verbal storytelling to progress the story and
character development, controlled by the game master (GM) who has an overview of the entire
playable campaign. Players announce their avatar’s actions, often rolling dice while referencing
their character statistics to determine the pass, fail, or other circumstances surrounding their
declared actions (Bartenstein, 2024; San Antonio Library, 2025). While TTRPGs can be
immersive, often involving dramatic elements like costumes, voices for the characters, or
physical actions outside of the game, LARP is more directive as it involves physically
embodying your avatar through outward dress and behavior (Bartenstein, 2024).
TTRPG mechanics like character creation have seen recent therapeutic use as Rick
Hudson, a clinician who uses Dungeons and Dragons (DnD) character creation with clients as
they enter services (HeySummit, 2022). He has individuals outline statistics regarding the client
as a character within the DnD world. They create two sheets to represent their actual and ideal
self. Utilizing both these sheets helps encourage discussion on changes and interventions like
role-playing (HeySummit, 2022). Both TTRPGs and LARP create unique opportunities for
participants where they can try out new behavior without consequences within their daily lives
(Staddon & Cerutti, 2003). Both formats allow participants to try out and reinforce behaviors
within a safe environment (Varrette et al., 2022), while encouraging perspective-taking
(Goegherty & Puntes, 2024). More immersive methods like TTRPG and LARP often include

CREATING A NEW YOU

45

rituals or closing activities connected to “de-roling”, or transitioning out of their role, of their
character. De-roling traditions allow for processing the LARP experience into memories,
reflection, and learning (Fatland, 2013). It allows participants to process emotions related to
their experiences and provide feedback (Fatland, 2013). It helps those involved say “goodbye”
to the character or help shift perspectives from their character back to the real world (Stark,
2013).
Common Themes in Avatar Usage and Character Creation
Self-representation. Though the format of avatar usage may vary, common themes
and benefits emerge from the research and data. Customizable avatars allow for individuals to
express themselves and fulfill needs within that environment, which may lead to projection of
the user onto the avatar (Zimmermann et al., 2023). Research shows that often individuals
project some level of their self onto the avatar (Barbera & Haselager, 2020; Fraser et al., 2023;
Rehm et al., 2016) where they may enhance some characteristics (Higgins, 1987; Zimmermann
et al. YEAR ). Individuals tend to see their avatars as extension of themselves (Back et al.,
2010), which can lead to idealization (Manago et al., 2008; Zimmermann et al., 2023).
Identity Exploration. Users, with the aid of highly customizable avatars, are allotted the
experience to create avatars that may be similar or different to their actual self (Barbera &
Haselager, 2020). Dissimilar avatars can help users increase self-understanding . Avatars allow
for identity exploration within a safe space (Barbera & Haselager, 2020; Kalyvaki et al., 2023;
Zimmermann et al., 2023) and can encourage perspective-taking and in turn increase selfinsight (Kim & Sundar, 2012). Avatar usage allows for self-extension, enhancement, and
diversification of experience that can translate into outcomes within the real world within the
user (Rehm et al., 2016). Immersive methods also allow users to practice shifting perspective,
being able to temporarily suspend the identity of the self and immerse into the perspective of the
avatar/playable character (Gualeni et al., 2017; Kim & Sundar, 2012; Müsseler et al., 2022).

CREATING A NEW YOU

46

Conclusion
Adolescents face the developmental task of identity development which can be
complicated by identifying as Queer or neurodivergent due to stigma, discrimination, and lack of
support and resources. Identity resolution occurs in early adulthood, but insufficient exploration
and commitment can lead to mental health concerns and maladaptive behaviors in adulthood.
Art therapy and narrative therapy have been shown to have an impact on physical and mental
health. These creative interventions allow for externalization of the problem and processing
within tangible means that can help empower and reauthor the participant’s life experiences.
Incorporation of created fictional characters may resonate with Queer and neurodivergent
individuals as it is common for them to create them during adolescence. Incorporating these
interests within a comic format can help combine the benefits of art and narrative therapy and
help support Queer neurodivergent adolescents through identity exploration. There has been an
increase in the use of geek interests like video games, role-playing like table-top games and
LARP, or other virtual environments in therapeutic applications. The use of avatars can
encourage exploration of the actual and ideal self within a low risk, controlled environment. The
creation and embodiment of a character offers unique benefits like allowing the creator to
physically embody these characters and explore related archetypes and identities. More
research into geek culture in therapeutic applications and the use of original characters (OCs)
with Queer neurodivergent youth is needed. The following section will outline a curriculum
combining the topics aligned above into a resource to help Queer neurodivergent youth explore
identity and connect with other peers within a group art therapy setting.

CREATING A NEW YOU

47

Section III: Methodology
This research will culminate in a comprehensive curriculum presented in workbook
format, including worksheets, templates, and guided activities for use within a group setting. A
curriculum format was selected due to the recommended facilitation and guidance from an art
therapist rather than individual work without assistance from a professional. The complex
experiences of queer neurodivergent youth and the high likelihood of lack of support or high
rates of discrimination and stigma calls for guidance and support from an art therapist trained in
issues related to these populations. Queer and neurodivergent youth have already reported
stigma and discrimination related to physical and mental health services, so to protect these
marginalized groups, a curriculum was selected.
Purpose Statement
The purpose of this research is to create a curriculum for use by an art therapist within a
group setting to address the unique needs of queer neurodivergent adolescents. This resource
is designed to help create a safe environment to guide these youth through identity exploration
and development through art and narrative interventions. The integration of geek culture and
artistic interventions creates distance between the content, allowing youth to explore topics
which may be too intense to discuss in an autobiographical way through settings like fantasy
and fiction that may resonate more and expand opportunities for exploration and play.
Population and Setting
This curriculum is intended for use by art therapists given their training and sensitivity to
developmental concerns. Use without art therapy training is ill advised due to the complex
nature of identity development with queer neurodivergent youth who have a high likelihood for
mental health concerns and trauma related to stigma, discrimination and prejudice within
various settings. Art therapists have knowledge of various art materials, formats, and creative

CREATING A NEW YOU

48

approaches that can help support this population and provide physical, emotional, and material.
Thier training on creativity and symbolism can help clients approach topics that may be too
intense to approach from an autobiographical perspective or through traditional talk therapy
means.
This curriculum is to be used within a group setting. Operating within a group helps
address lack of community support for queer neurodivergent youth and helps create a safe
setting where individuals can develop interpersonal skills that may be lacking. The group format
also encourages collaboration and a supportive environment to share ideas. Finally, a group art
therapy setting creates the environment ideal for the powerful act of witnessing, where
individuals may share their stories and experiences and have other group members respond.
Intended Audience
The group format is selected to help address the social support needs of queer youth
who may not have access or connections to other queer youth or individuals in their life,
providing them with a safe space of peers who may be more likely to be accepting and
supportive of their identities (Fish, 2021; Mehus et al., 2017). Creating an environment where
youth possess both identities of queer and neurodivergent may also create a space where they
feel accepted and understood by each other, as individual communities may pose risk for
discrimination and feeling others due to their dual identities (Hiller et al., 2020). The group
format can also help address social challenges associated with neurodevelopmental disorders
like ASD (Hillier et al, 2020). Having accessible, in-person resources can help address isolation
(Wallisch et al., 2023), provide social support, and address the needs of queer neurodivergent
youth (Hillier et al., 2020). Pro-social interaction with peers who experience similar struggles
and interaction with supportive adults may also help foster resilience, which can be beneficial for
queer youth in unsupportive environments (Harvey & Fish, 2015). Sharing within a group also
allows for opportunity of bearing witness, where group members can respond to how the other

CREATING A NEW YOU

49

group member’s story affected them (Dodd, 2019). Providing a space tailored to their unique
population experiences can help give space to process stress in a positive way, build
community, build confidence, and motivate each other (Shobe, 2024).
Curriculum Structure
The curriculum structure will be delivered in a workbook format to help provide
organization and structure for templates and worksheets related to content intended for use by a
trained art therapist in the described setting above. Worksheet topics will include an introduction
to the theories underlying this resource delivered in a developmentally appropriate way,
character sheets including templates for outlining character statistics similar to Dungeons and
Dragons, a character background sheet, a template for character design, and worksheets to
address different comic elements like format, dialogue, and the process of creating comics. The
workbook is divided into 4 separate topics preceded by 2 chapters detailing important topics
related to group activities.
Curriculum Outline
The curriculum outline consists of the content included to supplement the group
curriculum, as well as outline for weekly activities. The format is designed for a 4-week closed
group format, with meetings 3 times a week. This
1. Title Page
2. Table of Contents
3. Chapter 1: Introduction
4. Chapter 2: Original Characters
5. Topic 1: Introductions
a. Day 1: Gender and Sexuality Galaxies
i. Warm up intervention: What does your galaxy look like?

CREATING A NEW YOU

b. Day 2: Just like Me
i. 16 Types Quiz
ii. My Personality qualities, physical qualities, etc... worksheet
iii. OC Intervention 1: Just like me
c. Day 3: My World
i. Comic Intervention 1: My World
6. Topic 2: Who do I want to be?
a. Day 1:
i. Warm Up Intervention: Past and Future Vision Board
ii. OC Intervention 2: Who do I want to be?
b. Day 2:
i. What makes a comic?
ii. Comic Intervention #2: 4 Panels
c. Day 3:
i. Comic Intervention #3: Working in Pairs
7. Topic 3: Working Together (Comic intervention #4)
a. Day 1: Group project Overview
i. Scripting the Comic. Determining story details. Planning designs.
b. Day 2: Sketching. Creating rough draft/thumbnail.
c. Day 3: Inking Comic Rough Draft.
8. Topic 4: Sharing your Work
a. Day 1: Finishing Touches for Comic Intervention #4.
i. Finishing Comic Intervention #4. Shading and/or coloring.
ii. Determining talking points and discussion for group presentation.
b. Day 2: Group Presentations

50

CREATING A NEW YOU

c. Day 3: Review of Work/Saying Goodbye
i. Warm up: reviewing work created during group.
ii. Group Discussion
iii. Ending Intervention: Artist trading cards
9. Additional Resources
10. Afterword
11. Additional Templates
12. References

51

CREATING A NEW YOU

52

Chapter 4: Curriculum
The curriculum workbook can be found at the following link:
https://www.canva.com/design/DAGnzsehByo/MT5rWPTF6hg56bosMPZRQ/edit?utm_content=DAGnzsehByo&utm_campaign=designshare&utm_medium=link2&utm_s
ource=sharebutton

CREATING A NEW YOU

53

Chapter 5: Discussion
This section examines the final curriculum resource -- what is included, limitations, and
future implications for research. The curriculum included two introduction sections detailing
background information on related topics like character creation and underlying theories. This
section was followed by four sections that detailed activities building on identity development
and exploration within a group. Activities were designed to include a warmup, a main character
creation activity, and a follow-up comic activity, with each week building on the previous week.
Limitations included current political climate involving Queer issues with youth, limitation of time
for topics like opposite selves, and overall limitations of current research on geek therapy
applications with Queer and neurodivergent individuals.
Summary of Research
This research sought to address the limitations in current clinical tools for Queer
neurodivergent adolescents. Adolescence is a developmental period where individuals already
face physical, emotional, social, and cognitive changes that can be further complicated by being
Queer and neurodivergent. Both Queer and neurodivergent youth already face limitations in
services, stigma, and discrimination, which can be exacerbated by the intersection of these
identities. Additionally, current treatment modalities often fail to integrate interests of youth in a
way that makes treatment more engaging or approachable by youth who may have already
been discouraged by stigma. The addition of geek culture, comics, and character creation
allows for a unique outlet where youth can explore different personalities, behaviors, and
physical appearances within a safe, controlled environment. This curriculum outlines a 4 topic
group plan where Queer neurodivergent individuals can create characters, participate in group
work, and learn social skills while exploring identities and experiences with peers.
Discussion on what you think it all means (level 2)

CREATING A NEW YOU

54

Comic and narrative applications with Queer neurodivergent youth facilitate opportunities
for individuals to process and rewrite their life stories within a safe environment. Using comics
and narratives allows youth to examine the stories and events they have experienced and to
reflect on and change the outcome if desired. They can use perspective-taking and group
feedback to see how their stories can be changed and experience personal growth as they
rewrite their stories for more positive outcomes. Both Queer and neurodivergent youth face
discrimination, prejudice, and stigma due to their identities. Providing a safe and controlled
environment where these youth can process their past negative experiences and rewrite the
outcomes allows for reflection, insight, and positive identity development. These rewritten
stories are then shared within a group setting where other members can provide feedback,
advice, and relate to each other’s experience while providing validation, support, and growth of
insight among peers.
The curriculum was designed for use with Queer neurodivergent youth to draw on
interests that can increase engagement in treatment. However, these interests span beyond
these specific populations. After discussion with another clinician with more clinical experience,
she suggested that this curriculum could see wider application, especially within a school
setting. She suggested using it within an afterschool or break within a middle or high school
setting. This setting combined with a broad approach of character and comic creation can
engage the wider population and see application in most populations within the adolescent
demographic. Broader application may also make it easier to implement as it does not focus
specifically on Queer or neurodivergent issues but can focus more on developmental tasks of
this demographic.
The same colleague who suggested broader application also noted that sensitivity is
important while using broad language due to restrictions and concerns about Queer topics in
youth spaces. The Trump administration has pushed for an increase in bills to directly threat

CREATING A NEW YOU

55

Queer individual’s rights and specifically Transgender Americans, including health care bans,
sports bans, bathroom bans, a military ban, and an increase in banning books with themes of
gender identity, sexual orientation, and race within schools (Czachor, 2025). The Substance
Abuse and Mental Health Services Administration (SAMHSA) has also announced termination
of the 988 Suicide and Crisis Lifeline for Queer Youth, a vital free resource for Queer youth who
have seen an increase in direct discrimination at the start of the Trump Administration. There is
some concern about whether a Queer focused support group would even be allowed as
restrictions and bans grow toward Queer topics within certain spaces, like schools. A more
broad application, with additional focus on Queer and neurodivergent topics may make it easier
to implement in a school or community setting.
Should I find some articles about recent restrictions?
•

Current applications of creative means like graphic development show comics and
character creation have the potential to allow individuals to create and rewrite their
own story within a safe, nonjudgemental space.

Limitations
Searching for research for the literature review indicated the gap that currently exists for
research of Queer and neurodivergent youth overlap, as well as geek therapy applications for
these populations. More research is needed to help address current limitations in research and
expand on how intersectionality impacts these populations and what interventions are effective
for treatment and support, especially for Queer neurodivergent adolescents.
An additional limitation is that existing research using character creation and avatars focused
heavily on avatars within video games or virtual reality. Most research looked at how individual’s
approach for character creation reflected on their satisfaction in life or similarity/difference
between their avatar and actual self. Little to no research focused on character creation and use

CREATING A NEW YOU

56

outside of video games or online world applications. Most information found outside avatar
applications included anecdotal information shared on online forums for how people created or
identified with their Original Characters (OCs). Some additional information was gathered
through an informal survey conducted by the researcher to gain additional insight into how,
when, and why people created OCs, as well as how they used them. Additional research is
needed outside the video game application to learn more about character creation and its
clinical applications.
Time was an additional limitation for the resource creation. An additional section on
exploration of the opposite self was planned when outlining the main concepts for the resource.
However, due to time constraints and length of the resource, this additional concept was not
included. Focus was shifted to include the actual and ideal self-exploration within a group
setting and activities. If revisited in the future, adding an additional section for the opposite self
could increase exploration of the self.
The original format of a 4-week curriculum was also a limitation that was fixed later into
production. After consulting with a colleague therapist with many years of experience, she noted
that meeting three times per week could be difficult for adolescents, especially with different
involvements in sports or other extracurricular activities. This format was then changed from 4
weeks to 4 topics, allowing for flexibility in how frequent meetings occur.
Geek topics included focused heavily on character creation and comics. While comics
are a notable feature of geek culture, broader geek interests could be integrated into later
interactions. This could include more immersive methods like Live Action Role Play (LARP) with
created characters, utilizing created characters within Table Top Role-Playing Games
(TTRPGs), or game creation. Incorporating more specific geek culture topics like manga may
help tailor the group experience to the group’s unique culture and interests, making it more
interesting and better reach the group members involved.

CREATING A NEW YOU

57

Finally, this resource may be too specific for use within certain settings or populations.
This resource was specifically designed to address the unique needs and provide support for
Queer neurodivergent youth during a crucial period of identity development. Certain topics like
Queer identity development and concerns, as stated above, may not be permitted in certain
settings or spaces due to the increase of direct discrimination and stigma. Changes or
adaptations may need to be made to remove or make certain Queer topics more subtle to allow
for use in schools if bans or restrictions on Queer topic discussions are present. It is important
to note that, while restrictions and discriminations increase toward Queer Americans, Queer
individuals and youth will continue to live and exist despite targeted discrimination and active
removal of rights to medical care, involvement in sports, military, or other spaces.
Suggestions for Future Research
Geek therapy interventions, like the clinical application of Dungeons and Dragons (DnD)
and other TTRPGs, have seen an increase within the last few years as therapists look for
unique ways to engage clients outside of traditional talk therapy. Research going forward should
continue to explore the clinical application of geek interests like sci-fi, fantasy, role-playing,
LARP, TTRPGs, video games, comics, and other unconventional means. The focus should also
be to explore how these methods can be used in a way to help engage youth and support their
identity development within a safe, controlled environment like a game or workshop.
Engagement with geek interests may make therapy more approachable and provide comfort
and familiarity, especially during dire cultural times where Queer neurodivergent youth face
more direct discrimination and stigma that is rapidly evolving.
Additional research should also be conducted to continue examining Original Characters
(OCs) and their potential in clinical application. OC creation often begins around early to midadolescence but continues to be an active element of certain activities or games like Dungeons
and Dragons. More research should examine the role and use of character creation outside of

CREATING A NEW YOU

58

video games and virtual spaces, where a majority of the research exists. OCs are a broad topic
that may have useful applications beyond adolescents, so more research is needed to see their
application across different populations, contexts, and applications.
Expansion can also be made to the curriculum created during this research project.
Additional exploration for broader application with adolescents in general or young adult
populations can be useful to continue to support identity development throughout early
adulthood. This can include expanding on the created art interventions, creating additional
interventions to promote deeper exploration and insight, and the inclusion of topics more
relevant to early adulthood like planning for the future.
Finally, sharing this curriculum and research within different spaces is important to not
only bring attention to this topic, but also encourage others to research and share their
experience and use of original characters. As the researcher, I would like to present this
curriculum as a workshop at the Buckeye Art Therapy Association Symposium in Ohio or the
American Art Therapy Association’s annual conference. Many of the topics there include media
and interventions, but this space continues to lack input for geek therapy interventions and their
use within the art therapy space. Formatting this as a presentation and workshop for character
creation could help encourage other art therapists and clinicians to consider character and
comic creation in their practice. Additionally, I think exploring this topic within geek spaces could
also help reach individuals in these spaces who may be interested in treatment but are unsure
of how or where to engage. Providing a presentation and workshop within geek spaces like an
anime or comic convention could help increase research into how geek interests have a place in
therapy and what their application looks like, as well as continue to research the use of
character creation with individuals more familiar with the topic of OCs.
Conclusion

CREATING A NEW YOU

59

Queer neurodivergent adolescents face additional challenges compared to their peers,
including stigma, prejudice, discrimination, and complex identity development during a crucial
period of human development. Queer neurodivergent youth work to integrate their additional
identities while facing different levels of acceptance, support, and community as they figure out
who they are. Due to barriers like discrimination and lack of knowledge from healthcare and
mental health providers, these individuals may be reluctant to engage in treatment. Integrating
geek culture and other unconventional means like art and narrative therapy may make
treatment easier to engage in and more enjoyable while creating a safe environment and
reducing stigma and discrimination. Using original characters (OCs) and comics within a group
setting can help support Queer neurodivergent youth in identity exploration and development
while providing social support and developing social skills with similar peers. Creating
characters and using them in comics allows for individuals to project and externally process
within a safe and controlled environment of comics. The curriculum created from this research
includes several core topics and introductory information to help participants explore who they
are and who they want to be through cumulative art interventions. The setup encourages group
involvement and working together culminating in a final group project. The creation of the
curriculum faced limitations like time, broader application, and potential restrictions due to the
current political climate within the United States. Research going forward should continue
focusing on geek interests and their clinical application. Adjustments may also be made for
applications with young adults as they continue to develop identity. Finally, presenting this
curriculum at both art therapy or clinical conferences and anime/comic/geek conventions can
help spread awareness and interests in character creation and comic use with individuals for
therapeutic use.

CREATING A NEW YOU

60

References
Antebi-Gruszka, Cain, N, D., Millar, B.M., Parsons, J.T, Rendina, H.J. (2022). Stress-related
growth among transgender women: Measurement, correlates, and insights for clinical
Interventions. Journal of Homosexuality, 69(10), pp. 1679- 1702,
10.1080/00918369.2021.1921511
Art Therapy Credentials Board. (n.d.). Code, governing standards of practice, eligibility for and
regulation of credentials and disciplinary procedures.
https://atcb.org/ethics-appeals-lp/code-of-ethics-conduct-and-disciplinary-procedures/
Austin, A., & Craig, S. L. (2013). Support, discrimination, and alcohol use among
racially/ethnically diverse sexual minority youths. Journal of Gay & Lesbian Social
Services: The Quarterly Journal of Community & Clinical Practice, 25(4), 420–442.
https://doi.org/10.1080/10538720.2013.833067
Austin, A., Dentato, M. P., Holzworth, J., Ast, R., Verdino, A. P., Alessi, E. J., Eaton, A. D., &
Craig, S. L. (2023). Artistic expression as a source of resilience for transgender and
gender diverse young people. Journal of LGBT Youth, 20(2), 301–325.
https://doi.org/10.1080/19361653.2021. 2009080
AverageStarWarsFan. (2023). Why do neurodivergent people like fictional characters so much?
[Thread on the online forum r/autism.] Reddit.
https://www.reddit.com/r/autism/comments/11aqae3/why_do_neurodivergent_people_lik
e_fictional/
Back, M. D., Stopfer, J. M., Vazire, S., Gaddis, S., Schmukle, S. C., Egloff, B., & Gosling, S. D.
(2010). Facebook profiles reflect actual personality, not self-idealization. Psychological
Science, 21(3), 372–374
Bailenson, J. N., & Blascovich, J. (2004). Avatars. Virtual Human Interaction Lab.
https://vhil.stanford.edu/publications/avatars-and-agents/avatars-0

CREATING A NEW YOU

61

Barbera, M. S., & Haselager, W. F. G. (2020) The habit of massively multiplayer online roleplaying games (MMORPGs): Aa phenomenological analysis of bodily self-perception in
gaming addiction (finish) Rivista Internazionale Di Filosofia e Psicologia, 11(2), 190–210.
https://doi.org/10.4453/rifp.2020.0012
Bartenstein, L. (2024). Live Action Role Playing (Larp) in Cognitive Behavioral Psychotherapy: A
Case Study. International Journal of Role-Playing, 15, 92–126.
https://doi.org/10.33063/ijrp.vi15.322
Baumer, N., & Frueh, J. (2021). What is neurodiversity? Harvard Health Publishing.
Bekrater-Bodmann R. (2020). Perceptual correlates of successful body-prosthesis interaction in
lower limb amputees: psychometric characterisation and development of the Prosthesis
Embodiment Scale. Scientific reports, 10(1), 14203. https://doi.org/10.1038/s41598-02070828-y
Bell, J. G., & Perry, B. (2014). Outside looking in: The community impacts of Anti-Lesbian, gay,
and bisexual hate crime. Journal of Homosexuality, 62(1), 98–120.
https://doi.org/10.1080/00918369.2014.957133
Bessière, K., Seay, A. F., & Kiesler, S. (2007). The ideal elf: identity exploration in World of
Warcraft. Cyberpsychology & behavior: the impact of the Internet, multimedia and virtual
reality on behavior and society, 10(4), 530–535. https://doi.org/10.1089/cpb.2007.9994
Blutner, R., & Hochnadel, E. (2010). Two qubits for C. G. Jung’s theory of personality. Cognitive
Systems Research, 11(3), 243-259. https://doi.org/10.1016/j.cogsys.2009.12.002.
Böffel, C. (2021). Avatar-induced compatibilities and the concept of avatar-self merging.
doctoral dissertation. RWTH Aachen University.
Brondino, N., Fusar-Poli, L., Rocchetti, M., Provenzani, U., Barale, F., & Politi, P. (2015).
Complementary and alternative therapies for autism spectrum disorder. Evidence Based

CREATING A NEW YOU

62

Complementary and Alternative Medicine, 2015, 1–31.
https://doi.org/10.1155/2015/258589
Burleigh, T. L., Stavropoulos, V., Liew, L. W., Adams, B. L., & Griffiths, M. D. (2017).
Depression, internet gaming disorder, and the moderating effect of the gamer-avatar
relationship: An exploratory longitudinal study. International Journal of Mental Health and
Addiction, 16(1), 102–124. https://doi.org/10.1007/s11469-017-9806-3
Cameron, J., & Monroe, J. (2024). The artist’s way. Loudly.
Campbell, R. S., & Pennebaker, J. W. (2003). The secret life of pronouns: flexibility in writing
style and physical health. Psychological science, 14(1), 60–65.
https://doi.org/10.1111/1467-9280.01419
Capanna-Hodge, R. (2025, February 27). The Neurodivergent Umbrella: A guide to
understanding and supporting neurodiversity. Dr. Roseann. https://drroseann.com/theneurodivergent-umbrella/
Chappell, D., Eatough, V., Davies, M. N. O., & Griffiths, M. D. (2006). EverQuest—It’s Just a
Computer Game Right? An Interpretative Phenomenological Analysis of Online Gaming
Addiction. International Journal of Mental Health and Addiction, 4, 205-216.
http://dx.doi.org/10.1007/s11469-006-9028-6
Crocetti, E., Rubini, M., Luyckx, K., & Meeus, W. (2008). Identity formation in early and middle
adolescents from various ethnic groups: From three dimensions to five statuses. Journal
of Youth and Adolescence, 37(8), 983–996. https://doi.org/10.1007/s10964-007-9222-2
Czachor, E. M. (2025). The Trump administration’s “divide and conquer” approach to LGBTQ
rights. CBS News. https://www.cbsnews.com/news/trump-administration-lgbtq-rightsdivide-conquer-approach/

CREATING A NEW YOU

63

Czerwiec, M. K., Williams, I., Squier, S. M., Green, M. J., Myers, K. R., & Smith, S. T. (2015).
Graphic medicine manifesto. University Park, PN: The Pennsylvania State University
Press.
Dagorhir Battle Games Association. (n.d.). What is Dagorhir?. Dagorhir Battle Games.
https://dagorhir.com/wordpress/about/
D’amico, E., Julien, D., Tremblay, N., & Chartrand, E. (2015). Gay, Lesbian, and Bisexual
Youths Coming Out to Their Parents: Parental Reactions and Youths’ Outcomes.
Journal of GLBT Family Studies, 11(5), 411–437.
https://doi.org/10.1080/1550428X.2014.981627
DeFilippis, M., & Wagner, K. D. (2016). Treatment of Autism Spectrum Disorder in Children and
Adolescents. Psychopharmacology bulletin, 46(2), 18–41.
Detrixhe, J. J. (2010). Souls in jeopardy: Questions and innovations for bibliotherapy with fiction.
The Journal of Humanistic Counseling, Education and Development, 49(1), 58–72.
https://doi.org/10.1002/j.2161-1939.2010.tb00087.x
Dhejne, C., Van Vlerken, R., Heylens, G., Arcelus, J. (2016). Mental health and gender
dysphoria: a review of the literature. Int. Rev. Psychiatry, 28, 44–57.
http://doi.org/10.3109/09540261.2015.1115753.
Dilworth. (2024, April 22). Exploring the history of comics Library Blog Indiana University East.
https://east.iu.edu/blogs/library/2024/04/22/exploring-the-history-of-comics/
Dodd, L. (2019) Re-storying lives using creative writing a client-oriented approach to
overcoming the health impacts of domestic and family violence. Storytelling, Self,
Society, 15(1), 130-140.
Doidge, N. (2008). The Brain That Changes Itself. Melbourne: Scribe.

CREATING A NEW YOU

64

Ekstrom, S. R. (2004). The mind beyond our immediate awareness: Freudian, Jungian, and
cognitive models of the unconscious. The Journal of analytical psychology, 49(5), 657–
682. https://doi.org/10.1111/j.0021-8774.2004.00494.x
Erikson, E. H. (1980). Identity and the life cycle. W W Norton & Co.
Esterline, D. (2021). Finding your True Colors: Utilizing art therapy as a tool for Queer and
transgender youth identity exploration. The Macksey journal, 2.
Esterling, B. A., L'Abate, L., Murray, E. J., & Pennebaker, J. W. (1999). Empirical foundations
for writing in prevention and psychotherapy: mental and physical health outcomes.
Clinical psychology review, 19(1), 79–96. https://doi.org/10.1016/s0272-7358(98)000154
Fasick, F. A. (1994). On the "invention" of adolescence. The Journal of Early Adolescence,
14(1), 6–23. https://doi.org/10.1177/0272431694014001002
Fatland, E. (2013, July 23rd). Debriefing intense Larps 101 [Blog post]. Retrieved from
http://larpwright.efatland.com/?p=384
Fernandez, K. T. G., & Lina, S. G. A. (2020). Draw me your thoughts: The use of comic strips as
a cognitive behavioral therapy intervention. Journal of Creativity in Mental Health, 15(1),
17–29. https://doi.org/10.1080/15401383.2019.1638861
Fish, J. N. (2020). Future Directions in Understanding and Addressing Mental Health among
LGBTQ Youth. Journal of clinical child and adolescent psychology: the official journal for
the Society of Clinical Child and Adolescent Psychology, American Psychological
Association, Division 53, 49(6), 943–956.
https://doi.org/10.1080/15374416.2020.1815207
Franklin, M. (1992). Art therapy and self-esteem. Art Therapy: Journal of the American Art
Therapy Association, 9(2), 78–84.

CREATING A NEW YOU

65

Fraser, R., Slattery, J., & Yakovenko, I. (2023). Escaping through video games: Using your
avatar to find meaning in life. Computers in Human Behavior, 144, 107756-.
https://doi.org/10.1016/j.chb.2023.107756
Freytag, G. (1895). Freytag’s Technique of the drama, an exposition of dramatic composition
and art, by Dr. Gustav Freytag. An authorized translation from the 6th German ed. by
Elias J. MacEwan. S.C. Griggs & Company, 1895.
Ge, X., Brody, G. H., Conger, R. D., Simons, R. L., & Murry, V. M. (2002). Contextual
amplification of pubertal transition effects on deviant peer affiliation and externalizing
behavior among African American children. Developmental Psychology, 38(1), 42–54.
https://doi.org/10.1037/0012-1649.38.1.42
Gillon, E. (2007). A person-centered theory of personality and individual difference. In EDITOR
(Ed.), Person-centered counselling psychology: An introduction (pp. 26–42). SAGE
Publications Ltd. https://doi.org/10.4135/9781446279915.n3
Goegherty & Puntes, 2024
Graham, J. E., Lobel, M., Glass, P., & Lokshina, I. (2008). Effects of written anger expression in
chronic pain patients: making meaning from pain. Journal of behavioral medicine, 31(3),
201–212. https://doi.org/10.1007/s10865-008-9149-4
Grossman, F. K., Sorsoli, L., & Kia-Keating, M. (2006). A gale force wind: meaning making by
male survivors of childhood sexual abuse. The American journal of orthopsychiatry,
76(4), 434–443. https://doi.org/10.1037/0002-9432.76.4.434
Gualeni, S., Vella, D., & Harrington, J. (2017). De-Roling from Experiences and Identities in
Virtual Worlds. Journal For Virtual Worlds Research, 10(2).
https://doi.org/10.4101/jvwr.v10i2.7268
Harris, C. (2015). Portrait drawing: An art therapy intervention for adults with autism spectrum
disorder. ProQuest Dissertations Publishing.

CREATING A NEW YOU

66

Harris-Ray, N. (n.d.). What to Know About Identity Foreclosure. WebMD.
https://www.webmd.com/parenting/what-to-know-about-identity-foreclosure
Harvey, G. R., & Fish, L., S., (2015). Queer Youth in Family Therapy. Family Process, 54(3)
Hayman, R. (2002). A Life of Jung. London: Bloomsbury Press.
Heck, N.C., (2015), ‘The potential to promote resilience: Piloting a minority stress informed,
GSA-based, mental health promotion program for LGBTQ youth’, Psychology of Sexual
Orientation and Gender Diversity 2(3), 225–231. https://doi. Org/10.1037/sgd0000110
Hefner, D., Klimmt, C., and Vorderer, P. (2007). “Identification with the player character as
determinant of video game enjoyment,” in Entertainment Computing – ICEC 2007.
Lecture Notes in Computer Science, Vol. 4740. eds. L. Ma, M. Rauterberg and R.
Nakatsu (Berlin, Heidelberg: Springer)
HeySummit. (2022). Therapeutic + Applied Geek + Gaming Summit. Therapeutic + Applied
Geek + Gaming Summit.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Review,
94(3), 319–340.
Hillier, A., Gallop, N., Mendes, E., Tellez, D., Buckingham, A., Nizami, A., & Otoole, D. (2020).
LGBTQ+ and autism spectrum disorder: Experiences and challenges. International
Journal of Transgender Health, 21(1), 98-110.
https://doi.org/10/1080/15532739.2019.1594484
Hirsch, M. (2004). Editor’s column: Collateral damage. PMLA, 119(5), 1209–1215.
Hogan, S. (2001). Healing arts. Jessica Kingsley Publishers.
Holder, J. (2022). Creating an online arts journaling group for trans clients. International Journal
of Artelor Therapy, 27(2), 82–90. https://doi.org/10.1080/ 17454832.2021.1991966

CREATING A NEW YOU

67

Hong, C. & Skiba, B., (2025). Mental health outcomes, associated factors, and coping strategies
among LGBTQ adolescent and young adults during the COVID-19 pandemic: A
systematic review. Journal of Psychiatric Research. 182, 132-141.
Human Development Teaching and Learning Group. (2021). Human development. Portland
State University Library.
Hyman, S. L., Levy, S. E., Myers, S. M., & COUNCIL ON CHILDREN WITH DISABILITIES,
SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS. (2020).
Identification, evaluation, and management of children with autism spectrum disorder.
Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447
Jackson, S., & Bosma, H. A. (1992). Developmental research on adolescence: European
perspectives for the 1990s and beyond. British Journal of Developmental Psychology,
10(4), 319–337. https://doi.org/10.1111/j.2044-835x.1992.tb00581.x
Jakobsen, K., & Fischer, P. (2023). Developmental Theories. In Child and Adolescent
Development: A Topical Approach. essay, Pressbooks. Retrieved April 12, 2025, from
https://pressbooks.lib.jmu.edu/topicalchilddev/chapter/contextual-approach/.
Jen_the_Creator-7. (2023). Why do you make ocs? [Thread on the online forum
r/OriginalCharacter.] Reddit.
https://www.reddit.com/r/OriginalCharacter/comments/16g57dg/why_do_you_make_ocs
Johns, E. M. (2009). The challenges and approaches to working with lesbian, gay, bisexual, and
transgender youth. Hohonu – A Journal of Academic Writing, 7, 27-33.
Jones, R. A. (2013). Jung's "Psychology with the Psyche" and the Behavioral Slciences.
Behavioral sciences (Basel, Switzerland), 3(3), 408–417.
https://doi.org/10.3390/bs3030408

CREATING A NEW YOU

68

Jordan, F. (2020). Changing the narrative for LGBTQ adolescents: Aa literature review and call
for research into narrative therapy to improve family acceptance of LGBTQ teens.
Counseling and Family Therapy Scholarship Review, 3(1).
Jung, C. G. (1961). Memories, Dream, Reflections. Vintage Books.
Kalyvaki, M., McIntosh, H., & Nash, K. (2023). Virtual Selfhood and consumer behavior:
Exploring avatar attachment and consumption patterns in Second Life’s metaverse.
Computers in Human Behavior: Artificial Humans, 1(2), 100016.
https://doi.org/10.1016/j.chbah.2023.100016
Kelly, J. (2010). What is Art Therapy and how do we know it Works? An Australian Perspective
on the need for more Research. International Journal of Interdisciplinary Social Sciences,
5(5), 255–259. https://doi.org/10.18848/1833-1882/CGP/v05i05/51685
Kim, Y., & Sundar, S. S. (2012). Visualizing ideal self vs. actual self through avatars: Impact on
preventive health outcomes. Computers in Human Behavior, 28(4), 1356–1364.
https://doi.org/10.1016/j.chb.2012.02.021
KTYLN. (2024). Queer OC creators, has being part of the LGBTQ+ community affected the type
of characters you make? [Thread posted to the online forum f/OriginalCharacter.] Reddit.
Ladkin, D., Spiller, C., & Craze, G. (2018). The journey of individuation: A Jungian alternative to
the theory and practice of leading authentically. Leadership, 14(4), 415–434.
https://doi.org/10.1177/1742715016681942
Lamoreux, K. (2021, June 29). Medications for autism. Psych Central.
https://psychcentral.com/autism/medications-for-autism#anti-anxiety-medicationsre
LaSala, M. C. (2013). Out of the darkness; Three waves of family research and the emergence
of family therapy for lesbian and gay people. Clinical Social Work Journal, 41(3), 267276.

CREATING A NEW YOU

69

Li, Y., Li, Y., & Casta˜no, G. (2020). The mechanism underlying the effect of actual-ideal selfdiscrepancy on internet gaming addiction: A moderated mediation model. International
Journal of Mental Health and Addiction, 19(1), 283–301. https://doi.org/ 10.1007/s11469020-00273-5
Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones,
R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020).
Autism spectrum disorder. Nature reviews. Disease primers, 6(1), 5.
https://doi.org/10.1038/s41572-019-0138-4https://doi.org/10.1038/s41572-019-0138-4
Loy-Ashe, T. (2023). Neurodivergence is also an LGBTQ+ topic: Making space for
“neuroqueering” in the outdoors. Parks Stewardship Forum, 39(2), 297–301.
https://www.jstor.org/stable/48799226
Luyckx, K., Goossens, L., Soenens, B. et al. Identity Statuses Based on 4 Rather Than 2
Identity Dimensions: Extending and Refining Marcia's Paradigm. J Youth Adolescence
34, 605–618 (2005). https://doi.org/10.1007/s10964-005-8949-x
Luyckx, K., Schwartz, S. J., Berzonsky, M. D., Soenens, B., Vansteenkiste, M., Smits, I., &
Goossens, L. (2008). Capturing ruminative exploration: Extending the four-dimensional
model of identity formation in late adolescence. Journal of Research in Personality,
42(1), 58–82. https://doi.org/10.1016/j.jrp.2007.04.004
Malchiodi, C. (Ed.). (2003). Handbook of Art Therapy. New York, Guilford: Guilford Press.
Manago, A. M., Graham, M. B., Greenfield, P. M., & Salimkhan, G. (2008). Self-presentation
and gender on MySpace. Journal of Applied Developmental Psychology, 29(6), 446–
458. https://doi.org/10.1016/j.appdev.2008.07.001
Mancini, T., Imperato, C., & Sibilla, F. (2019). Does avatar’s character and emotional bond
expose to gaming addiction? Two studies on virtual self-discrepancy, avatar
identification and gaming addiction in massively multiplayer online role-playing game

CREATING A NEW YOU

70

players. Computers in Human Behavior, 92, 297–305. https://doi.org/10.1016/
j.chb.2018.11.007
Marcia, J. (2010). Life transitions and stress in the context of psychosocial development. In T.W.
Miller (Ed.), Handbook of stressful transitions across the lifespan (Part 1, pp. 19-34).
Springer Science & Business Media.
McArdle, S., & Byrt, R. (2001). Fiction, poetry and mental health: expressive and therapeutic
uses of literature. Journal of psychiatric and mental health nursing, 8(6), 517–524.
https://doi.org/10.1046/j.1351-0126.2001.00428.x
McNiff, S. (2009). Art-Based Research. London and Philadelphia: Jessica Kingsley Publishers.
Meeus, W. (1996). Studies on identity development in adolescence: An overview of research
and some new data. Journal of Youth and Adolescence, 25(5), 569–598.
https://doi.org/10.1007/BF01537355
Meeus, W., van de Schoot, R., Keijsers, L., & Branje, S. (2012). Identity statuses as
developmental trajectories: a five-wave longitudinal study in early-to-middle and middleto-late adolescents. J Youth Adolesc., 41(8):1008-21. http://doi.org/10.1007/s10964-0119730-y
Mehus, C. J., Watson, R. J., Eisenberg, M. E., Corliss, H. L., & Porta, C. M., (2017) Living as an
LGBTQ adolescent and a parent’s child: overlapping and separate experiences. J Fam.
Nurs. 23(2). 175-200.
The Mayo Clinic. (2025, January 1). Gender dysphoria. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/symptomscauses/syc-20475255
Moagi, M. M., van Der Wath, A. E., Jiyane, P. M., & Rikhotso, R. S. (2021). Mental health
challenges of lesbian, gay, bisexual and transgender people: An integrated literature
review. Health SA = SA Gesondheid, 26, 1487. https://doi.org/10.4102/hsag.v26i0.1487

CREATING A NEW YOU

71

Mongelli, F., Perrone, D., Balducci, J., Sacchetti, A., Ferrari, S., Mattei, G. et al., (2019).
‘Minority stress and mental health among LGBT populations: an update on the
evidence’, Minerva Psichiatrica 60(1), 27–50. https://doi.org/10.23736/S03911772.18.01995-7
Moula, Z. (2020). A systematic review of the effectiveness of art therapy delivered in schoolbased settings to children aged 5–12 years. International Journal of Art Therapy, 25(2),
88–99. https://doi.org/10.1080/17454832.2020.1751219
Mulholland, M. J. (2004). Comics as art therapy. Art Therapy: Journal of the American Art
Therapy Association, 21(1), 42–43.
Müsseler, J., von Salm-Hoogstraeten, S., & Böffel, C. (2022). Perspective Taking and AvatarSelf Merging. Frontiers in psychology, 13, 714464.
https://doi.org/10.3389/fpsyg.2022.714464
Needham, B. L., & Austin, E. L. (2010). Sexual orientation, parental support, and health during
the transition to young adulthood. Journal of Youth and Adolescence, 39(10), 11891198.
NeuroLaunch editorial team. (2024, August 11). Autism and attachment to fictional characters:
Exploring the connection. NeuroLaunch.com. https://neurolaunch.com/autism-attachmentto-fictional-characters/
Ng & Wiemer-Hastings, 2005
Niaz, A., Stanikzai, S. M., & Sahibzada, J. (2019). Review of Freud’s Psychoanalysis Approach
to Literary Studies. 4(2), 35–44. https://doi.org/10.46281/AIJSSR.V4I2.339
Oshima, F., Mandy, W., Seto, M. et al. (2023). Cognitive behavior therapy for autistic
adolescents, awareness and care for my autistic traits program: a multicenter
randomized controlled trial. BMC Psychiatry 23, 661. https://doi.org/10.1186/s12888023-05075-2

CREATING A NEW YOU

72

Park, A. E., & Henley, T. B. (2007). Personality and fantasy game character preferences.
Imagination, Cognition and Personality, 27(1), 37 - 46. https://doi.org/10.2190/IC.27.1.d
Pelton-Sweet, L. M., & Sherry, A. (2008). Coming out through art: A review of art therapy with
LGBT clients. Artelor Therapy: Journal of the American Artelor Therapy Association, 25,
170–176. https://doi.org/10.1080/07421656.2008.10129546
Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process.
Psychological Science, 8(3), 162–166. https://doi.org/10.1111/j.14679280.1997.tb00403.x
Pennebaker, J. W., & Graybeal, A. (2001). Patterns of Natural Language Use: Disclosure,
Personality, and Social Integration. Current Directions in Psychological Science, 10(3),
90–93. http://www.jstor.org/stable/20182707
Phang, C. (2024) Individual versus sequential: the potential of comic creation in art therapy.
International Journal of Art Therapy, 29(3), 154-164.
Piaget, J. (1971). The theory of stages in cognitive development. In D. R. Green, M. P. Ford, &
G. B. Flamer, Measurement and Piaget. McGraw-Hill.
Pledge, D. S. (2004). Counseling adolescents and children: Developing your clinical style.
Thomson/Wadsworth: Brooks/Cole.
Rainer, T. (1998). Your life as story: Discovering the “New autobiography” and Writing Memoir
as Literature. Jeremy P. Tarcher/Putnam.
Rehm, I. C., Foenander, E., Wallace, K., Abbott, J. M., Kyrios, M., & Thomas, N. (2016). What
Role Can Avatars Play in e-Mental Health Interventions? Exploring New Models of
Client-Therapist Interaction. Frontiers in Psychiatry, 7, 186.
https://doi.org/10.3389/fpsyt.2016.00186

CREATING A NEW YOU

73

Riccio, A., Kapp, S. K., Jordan, A., Dorelien, A. M., Gillespie-Lynch, K. (2021). How is autistic
identity in adolescence influenced by parental disclosure decisions and perceptions of
autism? Autism, 25, 374–88. https://doi.org/10.1177/1362361320958214.
Robb, M. A. (2022). Group art therapy: practice and research. Routledge.
https://doi.org/10.4324/9781003058335
Rubin, 2009
San Antonio Public Library. (2025, January 30). Libguides: Tabletop roleplaying games: What is
a TTRPG?. What is a TTRPG? - Tabletop Roleplaying Games - LibGuides at San Antonio
Public Library. https://guides.mysapl.org/c.php?g=1095451&p=10644241
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton G. C. (2018). The age of
adolescence. Lancet Child Adolesc Health. 2018 Mar;2(3):223-228. http://doi.org/:
10.1016/S2352-4642(18)30022-1.
Schweizer, C., Knorth, E. J., van Yperen, T. A., & Spreen, M. (2020). Evaluation of ‘images of
self,’ an art therapy program for children diagnosed with autism spectrum disorders
(ASD). Children and Youth Services Review, 116, 105207.
https://doi.org/10.1016/j.childyouth.2020.105207
Shobe, L. (2024, January 27). Queer creative writing space enables LGBTQ+ writers to express
themselves freely. Daily Bruin. https://dailybruin.com/2024/01/27/queer-creative-writingspace-enables-lgbtq-writers-to-express-themselves-freely
Smith, A. (2016). A literature review of the therapeutic mechanisms of art therapy for veterans
with post-traumatic stress disorder. International Journal of Art Therapy, 21(2), 66–74.
https://doi.org/10.1080/17454832.2016.1170055
Staddon, J. E. R, & Cerutti, D. T. (2003). Operant conditioning. Annual Review of Psychology,
54, (1), 115-144. https://doi.org/10.1146/annurev.psych.54.101601.145124

CREATING A NEW YOU

74

Stark, L. (2013, December 1). How to Run a Post-Larp debrief. Leaving Mundania: Inside the
World of Larp. May 1, 2025, https://leavingmundania.com/2013/12/01/run-post-larpdebrief/
Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: a
review of current literature. American Journal of Public Health (1971), 100(2), 254–263.
https://doi.org/10.2105/AJPH.2008.156497
Suskind, A. (2024, September 17). The rise of superhero therapy: Comic books as
psychological treatment. The Daily Beast. https://www.thedailybeast.com/the-rise-ofsuperhero-therapy-comic-books-as-psychological-treatment/
Sweezy, M., & Ziskind, E. L. (2013). An Introduction to IFS. In Internal Family Systems Therapy
(pp. xvii–xxvii). Taylor & Francis Group.
Tarzian, M., Ndrio, M., & Fakoya, A. O. (2023). An introduction and brief overview of
psychoanalysis. Cureus, 15(9), e45171. https://doi.org/10.7759/cureus.45171
The Trevor Project. (2023). The mental health of LGBTQ+ young people with disabilities.
The Trevor Project. (2024). Adult LGBTQ+ role models in the lives of LGBTQ+ young people.
Van der Berg, Z. D., (2023). Proposing an ar(t)chive of queer forms with sexual, gender, and
relationship diverse clients. Journal of the American Art Therapy Association 41(1). 4450.
Varrette, M., Berkenstock, J., Greenwood-Ericksen, A., Ortega, A., Michaels, F., Pietrobon, V.,
& Schodorf, M. (2022). Exploring the efficacy of cognitive behavioral therapy and roleplaying games as an intervention for adults with social anxiety. Social Work with Groups,
46(2), 140–156. https://doi.org/10.1080/01609513.2022.2146029
Venkatesan S. (2016). Graphic medicine manifesto, by MK Czerwiec, Ian Williams, Susan
Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith. Journal of
Graphic Novels and Comics, 7(1), 93–94.

CREATING A NEW YOU

75

Venkatesan, S., & Peter, A. M. (2018). “I want to live, I want to draw”: the poetics of drawing and
graphic medicine. Journal of Creative Communications, 13(2), 104-116.
Vogel, S. W., Mullins, K. L., & Kumar, S. (2024). Art therapy for children and adolescents with
autism: A systematic review. International Journal of Art Therapy. Advance online
publication. https://doi.org/10.1080/17454832.2024.2343373
Wakeman, C. (2022, June 28). Hyperfixations and special interests. Neurodiversity in
Engineering. https://neurodiversity.engineering.uconn.edu/2022/06/28/hyperfixationsand-special-interests/
Wallisch, A., Boyd, B. A., Hall, J. P., Kurth, N. K., Streed, C. G., Jr, Mulcahy, A., McMaughan, D.
J., & Batza, K. (2023). Health care disparities among autistic LGBTQ+ people. Autism in
adulthood: challenges and management, 5(2), 165–174.
https://doi.org/10.1089/aut.2022.0006
Wang, S. T., Yang, J. C., Chen, S. Y., & Kuo, W. C. (2012). The clusters of gaming behavior in
MMORPG: A case study in taiwan. In Proceedings of the 2012 IIAI International
Conference on Advanced Applied Informatics, IIAIAAI 2012 (pp. 263-266). Article
6337200 (Proceedings of the 2012 IIAI International Conference on Advanced Applied
Informatics, IIAIAAI 2012). https://doi.org/10.1109/IIAI-AAI.2012.60
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison. C., &
Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and
psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals.
Nat Commun.,11(1):3959. http://doi.org/10.1038/s41467-020-17794-1.
Waterman, A. S. (1982). Identity development from adolescence to adulthood: An extension of
theory and a review of research. Developmental Psychology, 18, 341–358.
10.1037/0012-1649.18.3.341

CREATING A NEW YOU

76

Watson, R., J., Wheldon, C., W., Russell, S., T. umbrell(2015). How does sexual identity
disclosure impact school experiences? Journal of LGBT Youth. 12(4):385–396.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W. W. Norton.
Wiesner, M., & Ittel, A. (2002). Relations of pubertal timing and depressive symptoms to
substance use in early adolescence. The Journal of Early Adolescence, 22(1), 5–23.
https://doi.org/10.1177/0272431602022001001
Zascririnkis, R. H., Pepper, B. I., & Tischler, A. E. (2023). An exploratory study of the coming out
road drawing: a novel growth promoting intervention for sexual and gender minority
individuals. The Arts in Psychotherapy, 82.
Zimmermann, D., Wehler, A., & Kaspar, K. (2023). Self-representation through avatars in digital
environments. Current Psychology, 42(25), 21775–21789.
https://doi.org/10.1007/s12144-022-03232-6
Zomerplaag, S., & Bakkes, S. (2024). An exploratory study on gender dysphoria & character
customisation. FDG, May 21-24, Worchester, MA, USA