Excoriation (skin-picking) disorder is a body-focused repetitive behaviour frequently associated with depression, anxiety, and obsessive-compulsive and related disorders. Although art therapy is used as a complementary approach in mental health care, reports describing its therapeutic process in patients with comorbid major depressive disorder and excoriation disorder remain limited. This case report describes the therapeutic process of a 47-year-old woman with major depressive disorder and excoriation disorder who attended nine art therapy sessions. Weekly 90-min sessions included introduction, warm-up, art-making, sharing, and closure phases. Before and after each session, the patient completed the Emotion Identification Form, a routine clinical reflection tool used to document subjective emotional experiences. The patient’s artworks, narratives, form responses, and clinical observations were considered together. The patient’s artworks and narratives reflected family conflict, loss, self-worth, fear, hope, and identity. Visual expression facilitated discussion of experiences that were difficult to verbalize. Across the sessions, the patient demonstrated greater emotional awareness, self-expression, recognition of personal needs, and therapeutic engagement. Observable changes in skin-picking behaviour were limited, and behavioural change was not assessed using a standardized measure. This case suggests that brief art therapy may support emotional expression, self-reflection, and therapeutic engagement in individuals with complex psychiatric comorbidity. Further studies using larger samples, standardized outcome measures, and longer follow-up periods are needed.