Multicultural competence is an important component of effective art therapy. Today, the term multicultural no longer refers only to race and ethnicity but also to gender identity and sexua orientation. Presently only a small amount of professional art therapy literature has been published regarding how art therapy may benefit sexual minority youth and alliance organizations. This systematic literature review was intended to raise multicultural awareness in the field of art therapy and to inform the development of a pilot participatory action research (PAR) study aimed at exploring and evaluating the effectiveness of zine making as a creative needs assessment for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) youth. The desired outcome of this study is to identify the most current issues and needs in order to provide helpful information for LGBTQ alliance organizations and helping professionals.