ABSTRACT Background This paper addresses the need for critical reflection on how art therapists position themselves and represent their work in the context of diverse frameworks for understanding young people’s adverse life experiences, particularly in relation to the prevalence of trauma discourses. Aims The study examined how art therapists have represented in the literature their practice and research with young people (12-18 years old) experiencing adversity, from 2000 to 2019. Methods Employing Critical Interpretive Synthesis (Dixon-Woods et al., 2006), 26 theoretically-sampled articles were systematically reviewed through an interpretive, inductive and recursive process. Results Art therapists commonly use trauma as a lens to conceptualise young people’s diverse adverse life experiences, with variations based on their theoretical and philosophical orientations. These variations influence how they perceive young people’s needs and art therapy aims. The study also highlights varying levels of creativity and self-agency that young people express in art therapy, emphasising the importance of art therapists’ flexible and tailored approaches. Conclusions The importance of art therapists’ critical awareness when framing and working with young people’s complex life experiences and presentations to avoid stigmatisation and disempowerment is underscored. Implications for practice/policy/future research The study suggests that art therapists’ critical awareness that can enable collaborative practice and researchwith young people with adverse life experiences. It encourages more research into and cultivating art therapists’ conscious awareness of their choice of theoretical alignment and its implications. Additionally, it encourages future research to understand young people’s own conceptualisations of their lived experiences and their perspectives on the ongoing relevance and meaning of art therapy. Plain-language summary This study sought to present the key findings of a critical review of art therapy literature. The main focus of the review was to examine how art therapists represented their work and if there were dominant understandings of trauma influencing art therapists. Using a Critical Interpretive Synthesis method developed by Dixon-Woods et al. (2006), 26 peer-reviewed journal articles published between 2000-2019 were selected based on their relevance to this study. The selected articles described art therapy practice and research with young people (12-18 years old) who had various adverse life experiences. These articles were thoroughly reviewed and analysed through a cyclic process of re-examination and interpretation. Findings indicated that while young people’s diverse adverse life experiences were often labelled as trauma, art therapists’ conceptualisations of trauma varied depending on their theoretical and philosophical orientations. Intriguingly, how art therapists perceived the meaning of adverse life experiences influenced how they formulated young people’s needs and the aims of art therapy. Findings also highlighted young people’s creativity and expression of self-agency in their art therapy programmes and the importance of art therapists’ flexible and tailored approaches. Overall, this study highlights the importance of art therapists’ critical awareness when framing and working with young people’s complex life experiences and presentations to avoid stigmatisation and disempowerment. It recommends further exploring and cultivating art therapists’ conscious awareness of what theoretical concepts they align with and the implications of their choice. Additionally, future art therapy practice and research should actively explore the perspectives of young people with adverse life experiences to inform the ongoing relevance and meaning of art therapy.