This article examines how altered books can be used in art therapy with adolescents. An altered book is a published book that has been changed into a new work of visual art through various art processes such as painting, drawing, collage, writing, and embellishment. Books are discussed as an art canvas on which to provide stimulation, structure, portability, and increased opportunities for reflection. Altered book making is an option for art therapists who are looking for a means to provide containment while promoting creativity. Case examples of using altered books in art therapy groups with adolescents are featured. (Contains 4 figures.)