For those in or getting out of a romantic relationship with a self-absorbed individual, the silent treatment can feel like a punishment worse than death.

Why Narcissistic People Use the Silent Treatment

The silent treatment is a form of emotional abuse typically employed by people with narcissistic tendencies. It is designed to (1) place the abuser in a position of control; (2) silence the target’s attempts at assertion; (3) avoid conflict resolution/personal responsibility/compromise; or (4) punish the target for a perceived ego slight. Often, the result of the silent treatment is exactly what the person with narcissism wishes to create: a reaction from the target and a sense of control.

The target, who may possess high emotional intelligence, empathy, conflict-resolution skills, and the ability to compromise, may work diligently to respond to the deafening silence. He or she may frequently reach out to the narcissistic person via email, phone, or text to resolve greatly inflated misunderstandings, and is typically met with continued disdain, contempt, and silence. Essentially, the narcissistic person’s message is one of extreme disapproval to the degree that the silence renders the target so insignificant that he or she is ignored and becomes more or less nonexistent in the eyes of the narcissistic person.

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Emotional Maturity of a Typical Narcissistic Person

The emotional maturity of a typical narcissistic person is akin to a 5-year-old child who pouts and refuses to play with a friend in the sandbox because the friend wants to share the pail and shovel. The 5-year-old refuses to talk with the friend and angrily storms off to play on the jungle gym with someone else. The bewildered child with the pail and shovel may feel confused, rejected, and may not understand why they can’t share. He or she just wanted to build a sand castle together.

Because no further communication can ensue unless and until the narcissistic person decides to give the target another chance, a false sense of control is nurtured. Often, the narcissistic person will demand that the target apologizes for whatever inflated transgression the target may have committed (the target may have set a limit or asserted a boundary against emotional abuse, for example). Sometimes, a person with narcissistic qualities will decide to abandon and discard the relationship when his or her partner presents an ultimatum or attempts resolution requiring compromise. The person with narcissism may prefer to end the relationship and start over rather than be in a position of potential abandonment. The 5-year-old storms off and plays with a new, innocent target on the swing set. It is too much work to share the pail and shovel.

How to Deal With the Silent Treatment

So how does one deal with the silent treatment from a person with narcissism? For those leaving a toxic relationship with such an individual, many therapists suggest that the survivor understands that the person with narcissism has not developed the ability to express a high level of empathy, reciprocity, and compromise. The silent treatment is a form of emotional abuse that no one deserves nor should tolerate. If an individual experiences this absence of communication, it is a sure sign that he or she needs to move on and heal.

The healing process can feel like mourning the loss of a relationship that did not really exist and was one-way in favor of the ego-massaging person with narcissism. The minute the partner disagrees with the narcissistic person or asserts his or her healthy boundaries, the narcissistic person deploys an arsenal of abuse tactics. The silent treatment is a favorite weapon.

Do not accept emotional abuse. Know that you are worthy of a healthy relationship with someone who can communicate in a mature, emotionally healthy manner. Play with someone who has the ability to share the shovel and pail. You deserve no less.

People who are healing from toxic love relationships do well to educate themselves on the nature of the emotional abuse sustained so that they can move through their pain to a place of healing.

In my individual work with people who have uncovered that they were involved in a romantic relationship with a person with narcissistic qualities, one of the first things we do in psychotherapy is to work together to understand the psychology behind narcissistic abuse recovery. Putting together the pieces of the puzzle and empowering the person to narrate their story is essential in the reality testing and support of a survivor of narcissistic abuse.

What Is Cognitive Dissonance in Toxic Relationships?

As mentioned in my previous articles on this subject, it is not my practice to label people with “conditions” or “disorders.” I am a strengths-focused therapist, and very solution-focused in my practice with people in therapy. However, when I work with people who are leaving toxic relationships, it helps to understand the nature of the emotional abuse in order to fully conceptualize and process their reality of the experience. Narcissistic abuse is an insidious, covert form of emotional abuse that can happen to unsuspecting individuals who are entangled in a relationship with a person with narcissistic qualities.

One of the key methods of emotional abuse employed by people with narcissistic tendencies is the generalized concept called cognitive dissonance. What this abuse tactic does is create in the target a sense of unreality, confusion, and a mind-set of not trusting their own perception of the situation. Leon Festinger (1957) was one researcher who studied the theory of cognitive dissonance. Essentially, cognitive dissonance occurs when humans experience a state of holding two or more contradictory thoughts or beliefs in their cognition at one time. The result is a state of anxious confusion and a desire to reduce the resultant overwhelm and unbalanced perception.

Cognitive Dissonance in Narcissistic Abuse: A Snapshot

A simplistic, condensed example in a toxic relationship: an abuser professes love and divines a marriage date with their partner. The partner is courted, romanced, and ultimately falls in love with the abuser, not knowing that the abuser has ulterior motives (i.e., not staying in the relationship). The partner envisions wedding details and enjoys the courtship, flowers, and being placed on a pedestal. The abuser then suddenly makes a comment denying they said anything about getting married. They go on to say the partner is “crazy” for thinking that. Blame is then projected upon the partner, and the partner is dizzy with confusion, recalling that, indeed, their significant other did discuss wedding bells and a future together.

The partner then experiences a state of cognitive dissonance—a hazy unreality of confusion. Such emotional abuse renders the target confused and reeling with heartache that the pace of the relationship has slammed to an abrupt halt, in addition to feelings of betrayal and being blamed.

Gaslighting: Another Insidious Form of Narcissistic Cognitive Dissonance

Another common tactic of emotional abuse employed by individuals with narcissistic issues is “gaslighting.” This term was coined after a movie titled Gaslight (1944) in which a form of psychological abuse resulting in cognitive dissonance occurred for the main character, played by Ingrid Bergman. The result of gaslighting is that the target of abuse doubts their own reality of the situation because the abuser is trying to confuse and disorient the target in order to maintain power and control, all at the cost of the emotional well-being of the target.

Another example of gaslighting in the movies would be the Julia Roberts character as the target of abuse in Sleeping with the Enemy (1991). In her situation, her abuser would appear as a stalker in her house by straightening out the bath towels. Roberts’ character knew that her partner was particular about cleanliness and order, so when she thought she was alone in the house, she found out she was not by seeing straightened bath towels arranged eerily in order. This gaslighting resulted in Roberts’ character doubting her reality and feeling a state of psychological terror. In circumstances where emotional abuse occurs outside of Hollywood films, often the “gaslighting” is verbal or emotional, placing the target of abuse in a state of perpetual confusion.

Using Validation to Diffuse Cognitive Dissonance

Cognitive dissonance is diffused and reduced when the survivor of narcissistic abuse is able to receive validation and confirmation of the reality of their circumstances. Narrating the story can take place verbally in psychotherapy sessions and/or via the use of journaling exercises. Although this is just the beginning of the healing process, mastering the trauma associated with narcissistic abuse ensues when the target has unconditional, positive regard, validation for their experience, psychoeducation about the nature of narcissistic abuse recovery, and empowerment as they move through the emotions associated with grief/trauma recovery.

Being able to vocalize or write about the particulars of the experience releases the trauma and enables the survivor to reduce cognitive dissonance and continue with the healing work. Talking to a licensed, compassionate therapist can be one helpful step in moving toward healing.

There are many more steps in the healing process, but working through cognitive dissonance is a key, initial component in reducing trauma and anxiety in survivors of emotional abuse.

The relationship cycle typical of extreme narcissistic abuse generally follows a pattern. Individuals in emotionally abusive relationships experience a dizzying whirlwind that includes three stages: idealization, devaluing, and discarding. This cycle can repeat numerous times, spinning a merry-go-round of emotional vertigo for those caught in such relationships.

In the beginning of a romantic relationship with a person affected by narcissism, an individual may describe the initial infatuation stage as “otherworldly.” The emotional high can feel like a drug cocktail as potent as cocaine, heroin, and ecstasy, all rolled into one noxious dose that lasts a few weeks, months, or in some cases a year or slightly more. Targets of narcissistic abuse report feeling as if they have found their soulmate and can’t believe their good fortune that this seductive courtesan has elevated them to soaring heights upon a pedestal. “Love bombing” is a phrase describing this stage, in which the narcissistic person may smother the target with praise, courting, intense sex, vacations, promises of a future together, and designation, essentially, as the most special person ever.

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Soon the relationship proceeds into a more comfortable rhythm. Perhaps the sex continues at a high intensity or it may begin to wane a bit. Gradually, the target begins to see bright red flags that indicate a problem in this fantastical paradise. The person with narcissism often may begin—subtly, insidiously, and covertly—to devalue his or her significant other. This may happen via putdowns, gaslighting, intermittently lacking emotional or physical intimacy, withdrawing affection, seductive withholding, inexplicably disappearing from contact, or blaming the target for the narcissistic person’s issues (projection).

Ultimately, the person with narcissism discards his or her dating partner, who served as a source of narcissistic supply to fuel the ego of the individual with narcissistic issues. When the target asks for compromise, reciprocity, empathy, integrity, honesty, and boundaries (all healthy and valid requests that people with extreme narcissistic qualities generally do not engage in), the person with narcissism may decide that the target has lost his or her luster and is tarnished—no longer the “perfect partner” to fluff the ego feathers. Inevitably, the discarding occurs when the person with narcissism either disappears or orchestrates his or her own abandonment by engaging in some form of egregious emotional abuse. The outcome is often shocking for the survivor, unclear as to how someone that he or she fell so deeply in love with could throw it all away.

In most cases, survivors of narcissism were able to offer empathy, compassion, authenticity, honesty, reciprocity, and compromise during the relationship. People with narcissistic tendencies are drawn to such empathic, deeply feeling people and know that, on some level, they personally are lacking in emotional depth and substance. By being in a relationship with such a nurturing, loving person, the person with narcissism is able to consume that person’s authentic love and extract narcissistic supply. Once fed over the course of days, weeks, or months, the person with narcissism is satiated and may grow bored with his or her partner. He or she must secure the supply of another target, usually in short order.

Survivors can heal and move forward with the help of psychotherapy and support in narrating their story and resolving the trauma of emotional abuse. Understanding the dynamics of abuse empowers survivors to lessen any cognitive dissonance remaining as a result of gaslighting and other emotional abuse. Armed with knowledge, survivors understand the relationship cycle they endured and can move forward with enough protective armor such that they can jump off the merry-go-round of emotional abuse and be just fine.

People encounter those with narcissism in love, work, and family relationships. When I provide psychotherapy for survivors of narcissistic abuse, one of the first steps in the healing process is psychoeducation about narcissism and emotional abuse. Survivors are often beset with myriad complex posttraumatic stress symptoms, including panic attacks, intrusive thoughts, depression, and the shellshock of cognitive dissonance.

By understanding the tactics employed upon the target of abuse, survivors empower themselves to reduce the impact of the emotional abuse aftermath. Given the delicate and subtle nuances involved in the psychology of healing, working with a trained clinician skilled in trauma recovery specific to narcissistic abuse is essential.

The literature on the subject of narcissistic abuse recovery is replete with pseudonyms for various circumstances involving a person with narcissism. One such concept is “hoovering” by the emotionally abusive person. When the cycle of “idealize, devalue, discard” is complete, a person with narcissistic qualities will often return to prior sources of narcissistic supply to see if he or she can tap such individuals for more ego-fueling attention, emotional reaction, sex, money, business advantages, a place to live, or other affirmations of his or her existence. “Hoover maneuver” was coined after the name of a popular vacuum cleaner, alluding to the fact abusers often attempt to suction up narcissistic supply from prior sources (people).

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Individuals who have narcissistic tendencies typically lack solid, healthy self-concepts and must extract narcissistic supply from lovers, friends, colleagues, and/or family members to feel affirmed, adored, admired, attended to, nurtured, feared, or despised. Positive or negative, the reaction doesn’t matter, as long as the abusive person can excise a response from a target’s reservoir of emotional sustenance, thus rendering the abusive person “alive” by virtue of having his or her false self acknowledged.

When a survivor has gone no-contact—in other words, the survivor has chosen to disengage completely from the abusive person—often the person with narcissism will attempt to see if the door is still open for more narcissistic supply. He or she may “hoover” prior survivors by emailing, texting, phoning, or showing up at a survivor’s workplace or residence under the pretext of apologizing for transgressions, delivering flowers, hitting the reset button, or feigning illness or a need for assistance (money, return of belongings, etc.).

This cycle is akin to the Power and Control Wheel often referred to in the domestic violence recovery community. The hoover maneuver is an attempt to see if a prior target of abuse can be conned into another cycle of abuse, resulting in the abusive person reclaiming a sense of power and control by causing pain (emotional and sometimes physical) to a target.

Survivors of narcissistic abuse should not be fooled by the hoover maneuver. Such an action is not a sign that the abusive person loves the survivor or that he/she can change and suddenly develop reciprocity, authentically own responsibility for mistakes, and consistently show emotional maturity. The analogy of a vampire sinking fangs into the jugular vein works here. The abusive person may home in on the target’s vulnerabilities (wanting to be accepted, loved, attractive, etc.) and try to hook that person back into another abuse cycle, solely for the benefit of soothing the abusive person’s ego—no more, no less.

It’s advisable for a survivor to continue with no contact and block the abusive person from email, text, phone, and any other form of communication. In most circumstances, assuming the survivor does not reengage, eventually the “hoovering” will stop. However, if the abusive person harasses or stalks the target, the survivor may want to consider seeking legal action and/or getting the police involved, including but not limited to filing a restraining/protective order.

Awareness of the emotional abuse tactics deployed by a person with narcissism, and going no-contact, is the beginning of empowerment and healing for survivors of narcissistic abuse.

In my work with people who have survived narcissistic abuse, I find that many have endured a devastating form of emotional abuse called gaslighting.

The film Gaslight (1944), starring Ingrid Bergman and Charles Boyer, is based on a 1938 play from which the term originates. In the movie, Bergman’s character falls head-over-heels in love with her significant other, played by Boyer, a dapper gentleman with classic signs of narcissism. Boyer’s character rushes Ingrid into marriage after a whirlwind romance, before she has any time to process the speed and savvy with which her suitor has wooed her.

Swiftly, the couple is married and moves into a London brownstone, whereby Boyer slowly inflicts an insidious form of emotional abuse that leads Bergman to question if she has lost her sanity, believing her captor as having omnipotent power.

Boyer literally dims the gaslights in their flat every evening, without Bergman knowing that her partner is playing mind games with her. Boyer slips away to the upstairs attic every night to create a climate of unease and brainwashing. When Bergman questions if Boyer has witnessed the flickering lights, he denies having any knowledge of such incidents, and gradually implies and insinuates that Bergman must be “going crazy” or “seeing things.” With time, Bergman believes she is losing her mind because she depends on Boyer as her window to reality.

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The film is an excellent example of how emotional abuse can slowly creep up upon an otherwise healthy, innocent target, only to overwhelm and devour the abused person’s sense of reality, self-confidence, and personal power over time.

Gaslighting in this day and age can exist simply by an abuser denying the confirmation of reality to a target. The abused individual could be a love object, family member, or colleague. Typically, such a lack of validation or confirmation of reality is a slow or insidious process wherein the targeted person gradually comes to doubt his or her sense of what is. Initially, the abused person may question if he or she misunderstood the situation, and often believes that the abuser knows better and has superior comprehension of the circumstances. With time, self-esteem is also stripped of the abused person until he or she realizes he/she has been denied trust and honesty with a loved one.

In my practice, I see many individuals who have endured such abuse either in their families, love, or work relationships. Psychotherapy can be helpful in healing from this form of trauma. Often, healing involves allowing the abused person to narrate his or her story in as much detail as possible, such that the person can in effect master his or her trauma and become empowered to lower the cognitive dissonance that rises oppressively in such an abusive relationship. As mentioned in my prior article on cognitive dissonance, this confusing state of mind occurs when an individual holds two diametrically opposed ideas, and the result is tremendous anxiety, which can include obsessive thoughts, panic attacks, and depression.

Cognitive dissonance can be one of the results of the emotional abuse tactic of gaslighting. Bergman’s character held in her mind that her lover, Boyer, had the best of intentions for Bergman and was protecting her from her own unraveling mind. Doubts slowly crept up in her mind that her lover may have ulterior motives. The horror of fathoming that Boyer’s character could be sociopathic/narcissistic created a suspended state of denial for Bergman, who then further suppressed her own reality of the situation, sinking into utter despair and apparent anxiety and depression.

With the help of a skilled therapist who knows how to support survivors of narcissistic abuse, people can thrive and restore their confidence in themselves. Mastering the trauma by narrating a story helps to synthesize facts, even contradictory and confusing facts/emotions caused by gaslighting and cognitive dissonance. With a compassionate, nonjudging psychotherapist, the abused person then learns or relearns how to trust his or her perception of the abuse history, thereby strengthening the individual to release the trauma and any associated anxiety. Increasing coping skills in moving through anxiety and depression is also essential, in addition to mourning the loss of the abusive relationship.

I recently had the honor and privilege of attending a workshop with renowned art therapists Cathy Malchiodi and Kate Webb in San Diego, CA, entitled Trauma-Informed Art Therapy and Positive Psychology. To say I was inspired, confirmed, validated, and energized by the experience is truly an understatement.

As a licensed clinical social worker, I often have drawn from the expressive arts as a means of helping my clients work through grief, loss, and trauma in psychotherapy. Art making, whether via collage, painting, drawing, sculpting, dancing, making music, and drama, has the potential to help individuals heal through very traumatic circumstances. The workshop focused on the evidence-based use of art making interventions and the intersection with neurobiology and somatic experiencing to help clients work through trying life challenges.

In my 20+ years of psychotherapy practice, I have called upon art intervention with the following populations: child witnesses of domestic violence, abuse survivors, hospice patients and their families, preschool children who witnessed L.A. riots, bereavement support groups, students struggling in academic settings, children of incarcerated parents, and mothers experiencing perinatal depression.

Art allowed clients to transcend their emotional pain, create a narrative through image of their trauma/loss, and subsequently “master” the trauma, thereby releasing the painful memory from its grip in the brain. Art continues to be transformative in my practice with clients and also in my own personal life.

[fat_widget_trauma_ptsd_right]As Malchiodi and Webb stated in their conference, we as humans all experience traumas across the lifespan. These incidents can be as “minor” as a traffic jam to as life-changing as the death of a family member. All traumas, no matter how seemingly big or small, are encoded in the brain’s amygdala where they are registered as potential alarm bells. The hippocampus then takes on the role of organizing these traumatic images, but struggles to encode them in such a way that makes sense to the cognitive (higher thinking/verbal) areas of the brain.

Art making taps into the lower-level (somatic/limbic) areas of the brain and also allows the client to release trauma in a somatic (physically manifested/preverbal) manner. Some individuals are rendered speechless in moments of trauma. As researchers have indicated, Broca’s Area in the brain has the potential to shut down verbalization of trauma, as an individual is in a hyper-alert state of fight or flight.

Art making accesses the somatic elements of the brain, enabling a client to express emotion which at times cannot be verbalized initially. Art making creates containment, safety, encouragement, validation, and an opportunity to narrate the traumatic experience in such a way that the trauma is then organized in the brain so that the individual’s somatic experiencing of the trauma is reduced.

Relaxation exercises coupled with art making bring about great relief for many clients. Playing music that matches a resting heartbeat has been proven to induce a state of calmness in many trauma survivors. Some clients are compelled to also engage in other forms of expression, such as drum playing and dancing. Discharging the trauma physically (exercise, music making, etc.) and through the use of creativity in art allows the client to move through the experience with a sense of self-compassion, mastery of the trauma, and a restored sense of trust in one’s surroundings.

To summarize the workshop I attended in a small article would not lend justice to all the incredible learning experienced. Suffice it to say my education of expressive arts is ongoing, and continues to be a driving force in the work I am honored to provide along the people who come to see me for therapy. Truly, belief that the client has the power of self-determination and the awareness and knowledge within to interpret their own art making is essential in nonjudgmentally supporting the client.

Ongoing training in the cutting edge juxtaposition of art and science in expressive arts and neurobiology is incredibly exciting and groundbreaking. Mindfulness and positive psychology also weave their way into the expressive arts as a form of healing which empowers clients to transcend trauma and loss and evolve to a place of healing and wellness.

The following is a list of titles I have found to be inspiring and helpful for psychotherapists wishing to learn more on the path of incorporating expressive arts in their work with clients:

1. Malchiodi, Cathy. (2002)The Soul’s Pallete: Drawing on Art’s Transformative Powers, Shambhala Publications
2. Malchiodi, Cathy. (2006)The Art Therapy Sourcebook, McGraw-Hill
3. Allen, Pat . (1995) Art is a Way of Knowing,Shambala Publications
4. McNiff, Shaun (2004). Art Heals: How Creativity Cures the Soul, Shambhala Publications
5. McNiff, Shaun (1992). Art as Medicine: Creating a Therapy of the Imagination, Shambhala Publications

In my previous article, I touched on the subject of narcissistic abuse recovery. I decided to write a second article as a follow-up for individuals who wish to explore further how to move forward through this specific healing process.

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As mentioned previously, recovery from this form of abuse can take a fair amount of months (or even years in some cases), given the insidious and covert nature of the emotional abuse (Sokol and Carter). Individuals who exhibit malignantly narcissistic behaviors are predatory in nature and seek to “conquer” targets to fuel their narcissistic supply (NS), which is the emotional sustenance which drives and fills them. These people thrive on attention (negative or positive) and will do anything in their power to ensure that their primary and secondary sources of NS are working in concert to feed the insecure ego of a broken psyche. Although by no means exhaustive of the complexity describing the individual suffering from narcissism, the DSM-IV states that people with narcissism exhibit the following traits: inflated sense of superiority, grandiosity, attention-seeking, self-absorption, arrogance, entitlement, and limited capacity to empathize and reciprocate in relationships.

Trapping a Target

It would make sense that individuals pulling away from someone like this would experience tremendous loss and trauma (Brown). Initially the person with narcissism presents as a knight in shining armor, completely in sync with the target’s emotions and dreams. The target is unaware that the individual then hones in on the target, studying the desired love object so that he or she can then act as the target’s soulmate, in essence.

This “hunting” can occur on dating websites or in the initial stages of dating (Brown). The target, who generally has the capacity for true, mature intimacy and love, is intelligent, attractive, and successful, then falls head over heels in love with the person with narcissistic tendencies. Subsequently, that individual then feigns love for the target. And the moment the target is hooked, distancing maneuvers ensue, which serve to disorient and confuse the target.

The target then becomes incredibly confused and experiences what is called cognitive dissonance, or a state of confusion. The person with narcissism had expressed love, but is now exhibiting distancing and detaching behaviors, which are not in alignment with the initial honeymoon stage (Carter and Sokol). Eventually, the individual is fully satiated on NS and then becomes bored and tired with it, because the target is merely an object or a vessel to obtain NS.

The target is devalued and discarded when the individual exhibiting narcissism no longer feels the need to court the individual who is a source of NS (Carter and Sokol). Ultimately, the target is left wondering what happened, and how someone who seemed so perfect as a soulmate completely undid everything that the target worked so hard to build. It was the target who fell in love with that individual, not the other way around. The person with narcissism purely was “feeding” on the NS, and as soon as his/her ego was full, the target was no longer considered useful (Payson).

Motivations of Narcissism

At that point, the individual with narcissism will either vanish completely or will say and do certain cruel and emotionally abusive things designed to injure the psyche of the target. He or she actually seeks to cause harm, and straddles the line of sociopathy (Brown). Ultimately, the target has no way of understanding what happened and is left with confusion, shock, disbelief, and betrayal.

Because people who tend toward narcissism always needs newer and fresher sources of supply, they have a habit of devaluing and discarding targets (Hotchkiss). They may be incapable of true love, empathy, reciprocity, kindness, and compassion. In essence, they may have broken psyches, much like a broken appliance (Hotchkiss).

Studies show that there is very limited effectiveness in treating narcissism in psychotherapy, as it can be firmly hardwired to someone’s personality due to largely environmental circumstances that occurred in his or her early childhood (Martinez-Lewi), including parental abandonment and severe abuse. It could be that they had inconsistent sources of love as children, if any at all, and to survive childhood, they had to create an outward mask to the world of the perfect individual. Underneath, these children could be empty and lacking a core sense of self, prone to depression and anxiety without NS to fill a void. Adults who are narcissistic are often referred to as developmentally stuck at age 5, when their emotional maturity ceased (Hotchkiss).

So what is a person to do if they have been crossed by this kind of toxic personality? First, I would say that though the pain is initially intense, you are blessed that the person with narcissism left. And no contact with this person will result in any form of healthy exchange.

The No-Contact Rule

Experts on narcissistic abuse recovery all agree that contact with someone like this always results in pain (Payson). Maintaining zero contact is essential for you to be able to heal and cognitively and emotionally process the mental hurricane that hit. Some clients have likened the experience to like coming off a drug; it is so painful to go through the traumatic grief work in being abandoned that these feelings are akin to withdrawals. However, as you heal, you can be empowered, stronger, wiser, and more discerning and reclaiming of your own self-worth.

The target is capable of empathy, reciprocity, true and mature love, and growing in a relationship. People with narcissistic behaviors are generally not. They are only capable of deceptively seducing preselected targets to fill a psychological void. The same cycle may repeat every time. It is so imperative that the target understand the process of grieving the loss of the fantasy of the person who narcissistically manipulated him or her.

Those with narcissistic behaviors are usually hard-pressed to find a healthy connection in any relationship. When the masks are pulled off, they realize they cannot manipulate and seduce as they are accustomed to. Too many people have caught on and discovered who they really are.

Luckily, for those whose lives have been touched (or slightly marred), there is a path to healing. This process takes place through no contact, a compassionate and understanding psychotherapist, and a support forum (whether online or in person). Those who have been targets heal and move on to love others in healthy, mature relationships.

Resources:

1. Saferelationshipsmagazine.com:  Sandra A. Brown, MA’s website and resources related to abuse recovery from unhealthy relationships
2. Help! I am in Love with a Narcissist by Steven Carter and Julia Sokol
3. Women Who Love Psychopaths: Inside the Relationships of Inevitable Harm with Psychopaths, Sociopaths and Narcissists by Sandra L. Brown
4. Why is it Always About You? The Seven Deadly Sins of Narcissism by Sandy HotchKiss, LCSW
5. The Wizard of Oz and Other Narcissists: Coping with the One-Way Relationship in Work, Love and Family by Eleanor Payson, MSW

We often hear the term “narcissist,” but what does it mean? From my vantage point as a psychotherapist, I work with many individuals who are leaving and healing from relationships, especially romantic ones, with people who are narcissists. When I first heard the term narcissist as a graduate student, I had a hard time labeling someone with such a label. I pride myself on being a strengths-focused therapist, in direct opposition of any of such disempowering diagnostic nomenclature.

However, as time progressed, I found in my own therapy practice that, indeed, there exist some individuals on this planet with narcissistic challenges. My clients educated me about the aftermath of what it is to heal from narcissistic abuse. I feel I owe it to the people I work with in therapy, and others who may be in similar circumstances, to assist with educating the public about narcissistic abuse, so that people can be informed and aware of how to protect themselves in the event they encounter people with narcissistic traits.

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The following is an attempt at a primer on such individuals. For further study, please refer to the resources listed at the end of the article, as the subject is quite vast.

Identifying Individuals with Narcissism

So just what traits does someone with narcissism have, and what does that person look like in the early stages of dating? Studies suggest that 1% of the general population (2-16% of psychiatric population) has narcissistic personality, while an even greater number exhibit typical traits of narcissism (Brown, 2013). In addition, although 75% of people with narcissism are found to be male, women can also be narcissists.

Narcissism is defined as: excessive sense of self-importance over and above the needs of others; grandiosity; arrogance; absence of ability to empathize and experience reciprocity in relationships; intense need for admiration/attention to fill very low self-esteem; impaired relationships resulting in parasitic/predatory behaviors designed to fill one’s self-esteem in the form of narcissistic supply (DSM-IV).

One could wonder, then, how someone would find such an individual, someone who embodies these characteristics, attractive. Well, studies show (Brown, 2013) that people with narcissism market themselves in attractive, deceptive packages. They may present with a swagger, intense eye contact, false bravado/charm, knock-your-socks-off seduction (often learned by neurolinguistic programming (NLP) programs or online seduction programs), swift pacing of rushing the relationship into commitment/cohabitation/marriage/business partnership, promising a future together (which is later discovered to be a lie), intense sexual chemistry, love-bombing (repetitive texting, emailing, phone calls), or romancing the target excessively (flowers, etc).

People with narcissistic traits are known for targeting intelligent, self-sufficient, empathic individuals as partners. They tend to lack core identity (Brown, 2013), and need narcissistic supply to fill their empty psyches. Narcissistic supply comes mostly in the form of adulation, adoration, and attention, but any sort of feedback allows the individual with narcissistic qualities to feel alive (including negative attention). These individuals feel a sense of challenge in targeting highly successful, attractive individuals who may already be in other relationships and/or who express a sense of vulnerability (i.e. having grief or depression, or recently getting out of a relationship).

Characteristics of the Relationship

The literature on malignant narcissism is extensive, yet many are not informed about the dangers of being involved with someone whose character or actions tend toward narcissism. I find that clients who were entangled in relationships with such individuals have more healing to do from breaks in these relationships than if they had been in relationships with healthy individuals, because often these clients are manifesting symptoms of posttraumatic stress.

Not only are they grieving the loss of the relationship, but they are also processing the unreality of a “fake relationship.” Furthermore, often psychological abuse (and sometimes physical and sexual abuse) has permeated the relationship. In order to heal, psychotherapy must focus on grief work and trauma recovery, in addition to understanding the elements of the toxic relationship, so that patterns are not repeated in the future.

Once the initial honeymoon wears off, partners of people with narcissistic traits go from feeling high on a pedestal (much like being on cocaine) to feeling devalued, discarded, and figuratively knocked off the pedestal. Their partners have successfully seduced and hooked them into relationships.

But suddenly, the individual with narcissism begins to reveal traits of lying, future-faking, and Dr. Jekyl /Mr. Hyde Personality. He or she may vanish for hours or days on end, or gaslight (confuses the reality of) a partner. This person becomes emotionally abusive and detaches from the partner, extracting narcissistic supply in the process.

The partner, then, is dropped/discarded, coming to the sudden and shocking realization that the other, the partner to has narcissistic qualities, is not capable of true intimacy/love, and really exhibits a limited capacity for emotional connectedness/bonding (Brown, 2013). The partner who has exhibited narcissistic personality traits, who was once a knight in shining armor, is now a mere fantasy, because he or she acted through mind control and brainwashing (Brown, 2013).

To Protect Yourself

So how does one avoid encountering someone with narcissism? I would suggest being particularly cautious with the pacing of dating. If you’re using a dating website, exercise extreme caution when meeting up with a dating partner for the first several dates until you feel you know the individual (i.e. meet in a public place).
If the dating partner attempts to rush the relationship, that is a red flag. An individual who respects your boundaries will work with you to slowly progress the relationship at a pace that is mutually agreed upon. Just because initially there is a highly seductive “zing” quality to the attraction does not mean that the dating partner is healthy. To protect yourself from someone who may end up behaving out of narcissism, it is best to allow the connection to unfold slowly and observe to see if actions and words are matching up.

Sexual chemistry is not the same thing as healthy bonding and attachment. A healthy person will want to get to know your personality, dreams, and interests, and slowly evolve the relationship. An individual with narcissistic tendencies may also want to know all about you, but then may fake being your soul mate by rushing you into consenting to a relationship/marriage/cohabitation/business arrangement (Hotchkiss, 2010).

If you have encountered an individual who seems to display these qualities, or are considering leaving a relationship with a similar person, it is in your best interests to get yourself out of the relationship as quickly as possible. People with narcissistic characteristics may be prone to causing harm by invading personal boundaries, lying about future possibilities in relationships, engaging in abuse, and exhibiting no empathy or remorse for emotional harm they have done.

Consult a licensed psychotherapist who is trained in narcissistic abuse recovery in addition to locating a qualified support group to help you through this time. You will recover. You will heal. But, it will take time and the assistance of qualified professionals who understand what you have endured and how to help you to reclaim your self-esteem.

Resources:

1. Saferelationshipsmagazine.com:  Sandra A. Brown, MA’s website and resources related to abuse recovery from unhealthy relationships
2. Lisaescott.com: The Path Forward online forum and support network for survivors of narcissistic abuse
3. Baggagereclaim.com: A website dedicated to individuals healing from relationships with emotionally-unavailable people (including narcissists)
4. Outofthefog.com: A website with support and resources for people moving forward from abusive relationships
5. Help! I am in Love with a Narcissist by Steven Carter and Julia Sokol
6. Women Who Love Psychopaths: Inside the Relationships of Inevitable Harm with Psychopaths, Sociopaths and Narcissists by Sandra L. Brown
7. Without Conscience: The Disturbing World of Psychopaths Among Us by Robert D. Hare
8. Emotional Vampires: Dealing With People Who Drain You Dry by Albert J. Bernstein, PhD
9. Emotional Blackmail: When People in Your Life use Fear, Obligation and Guilt to Manipulate You by Susan Forward
10. Why is it Always About You? The Seven Deadly Sins of Narcissism by Sandy HotchKiss, LCSW
11. The Wizard of Oz and Other Narcissists: Coping with the One-Way Relationship in Work, Love and Family by Eleanor Payson, MSW
12. Narcissistic Lovers: How to Cope, Recover, and Move On by Cythnia Zayn and Kevin Dibble
13. Splitting: Protecting Yourself While Divorcing Someone with Borderline or Narcissistic Personality Disorder by Bill Eddy, LCSW
14. Stop Walking On Eggshells: Taking Your Life Back When Someone You Love Has Borderline Personality Disorder by Paul Mason, MS
15. Malignant Self-Love: Narcissism Revisited by Sam Vaknin
16. Freeing Yourself from the Narcissist in Your Life: At Home, At Work, With Friends by Linda Martinez-Lewi, PhD

With the magnitude of demands placed on special needs families, siblings of special needs children can often feel overlooked and in need of emotional support. A “special needs child” is defined as having a medical, developmental, or neurological challenges, or another type of disability which impacts the entire family system, thereby requiring special supports (i.e. medical, educational, etc.). In many families where such challenges are present, it’s inevitable that the added stress impacts not only parents and the child in question, but also typically developing siblings. In fact, rates of depression, anxiety, and chronic stress are higher for the special needs family. But with adequate supports, such impediments can be reduced. Special needs disabilities can run the gamut from severely disabling conditions, such as cerebral palsy, in which a child is wheelchair bound and cannot speak, to a high-functioning child with an “invisible” disability, such as attention deficit (ADHD) or dyslexia.

Special needs siblings may feel the following:

• guilt about being a “typically” developing youngster;
• embarrassment about a sibling’s behavior in front of friends;
• frustration that the sibling may not be able to relate or play at the same level;
• worries about the health and survival of the sibling, and the impact of responsibility placed upon the sibling once parents become elderly;
• resentment that attention/services are diverted to the special needs sibling;
• loneliness, or a feeling that peers may not understand what they are going through;
• parentification in caretaking role of sibling, should parents not have adequate support/resources or emotional attunement to the sibling. It would make sense that special needs siblings might be at higher risk for depression and anxiety if they do not have support and resources available.

Your child may benefit from a referral to a competent and compassionate psychotherapist who specializes in special needs family therapy. It is of vital importance to special needs parents is to look for the following symptoms in siblings of special needs children:

• feelings of hopelessness, marked depressed or anxious mood for more days than not, isolation and withdrawal from peers, or a drop in grades or absence from school;
• marked increase in irritability;
• insomnia, appetite changes, panic attacks, and any clear behavioral/mood change that is in sharp contrast to the child’s typical baseline mood/behavior.

Likewise, if any parent/caregiver exhibits the above symptoms, I recommend seeing a family psychotherapist as soon as possible.

There are also many benefits and unique experiences for siblings of special needs children, however. They have the opportunity to learn caregiving and sensitivity that many of their peers may not experience.

Special needs siblings may also feel the following:

• higher level of maturity than peers, given the opportunities to practice empathy and patience with the special needs sibling;
• ability to embrace cultural diversity as relates to special needs and families that are not “typical”;
• protectiveness of the sibling, should he or she be in a position of bullying;
• pride in milestones accomplished by the special needs sibling;
• tolerance of people’s differences;
• increased emotional intelligence and insight to the human condition;
• opportunities to be involved in a strong family unit that focuses time and attention on all family members;
• loyalty to and cohesiveness with the family unit;
• gratitude for health and vitality;
• appreciation for siblings’ gifts/strengths, in light of any challenges;
• social adeptness: the sibling often is quite gifted in reading social cues and relating to people, having had much practice “translating” the world to the special needs sibling;
• resilience: they have also had much practice in managing adversity; they are often well-prepared for the real world, having had to problem-solve and endure challenge as a young person;
• creativity and resourcefulness: Siblings often must creatively problem solve strategies to help special needs families work around the special needs child (i.e. researching wheelchair friendly restaurants, creating a music CD for a blind sibling, etc.)
• mindfulness, focus, and gratitude: many siblings have found a peaceful emotional state as they accept the challenges and advantages that accompany a special needs family.

It is true that there are an equal or greater number of positives and opportunities for the special needs sibling, when given the appropriate support and resources. Several websites and references are listed at the end of this article to support the special needs sibling in acquiring appropriate support to thrive and embrace being a special needs family member. The following objectives are also of great importance for special needs parents, in an effort to ameliorate the stress involved with being a member of a special needs family:

• Provide ample one-on-one attention to all children in the family, not just the special needs child.
• Maintain high standards and expectations for all children, and, as much as possible, an expectation for all children in the household to abide by the same rules, consequences, and privileges.
• Be able to describe the special needs child’s disability to your “typical” child in a developmentally sensitive manner. Allow your child to ask questions about medical/educational/etc. interventions, course of treatment, what to expect long-term, etc. Be aware that preschool-age and younger may have a difficult time understanding and may need play/art therapy with a trained professional to assist in understanding the disability and answering any questions the child has. Older children (school-age) may wonder if the disability is contagious, and may need reassurance that they can’t “catch” the disability. Teens may need help with their mixed feelings of loyalty and embarrassment, as peer relationships become increasingly more important. Children of all ages may wrestle with guilt that they do not struggle with the same challenge as their siblings, and may even feel a pressure to achieve greater accomplishments to compensate for any “deficits” in their sibling.
• Reassure your typically developing child that his/her sibling is receiving the services he/she needs to develop optimally, that it is not their fault that their sibling has a disability, and that it is paramount to be a unique individual with her/his own unique dreams and gifts. Take the pressure off siblings and practice stress management activities like deep breathing, journaling, family discussions, and family fun.
• Family fun is really important. Find ways the entire family can bond together and laugh, whether you do something like swimming, hiking, singing, Pictionary, or whatever common-ground activity brings smiles, laughter, and family unity.
• Connect your typically developing child with a support group for special needs siblings to reduce isolation, increase validation, and reduce stress (see #5 in Resources, below).
• Acknowledge any concerns siblings may feel or demonstrate in behavior, and do not hesitate to enroll your child/family in a supportive psychotherapy program for the entire family.
• Model self-care as a parent; get your own psychotherapy, self-care regimen, and support, engage in stress-reduction activities, and include your family or designate a quiet time where everyone practices meditation, deep breathing, yoga, listening to music, etc.
• Allow typically developing siblings to have their own activities, which are specific to their talents and interests. Help them to flourish by attending sporting events, cheering them on, and encouraging friends and family to do the same. Honor each family member with rewards for unique gifts and talents (winning a spelling bee, scoring a goal in soccer, etc.). Pay attention to each family member and celebrate everyone’s successes and triumphs.

Most importantly, keep communication open with regular family meetings to problem solve about communication issues, chores, etc. Then take the opportunity to play a family game, laugh, dance, sing, and bond. As parents, keep a positive spin on being a special needs family; your situation does not have to be one of drudgery.
On the contrary, with the right resources and supports in place, life can be deeply meaningful, full of purpose, and imbued with unconditional love. Gifts and talents not detected before are discovered and embraced. Life can actually be beautiful. It is up to the parent to set the tone, to take the “emotional read” on the family, and link the family up with resources and supports, which make a world of difference in supporting the emotional health of the special needs family.

Resources for special needs siblings:

1. Siblingsupport.org: for a listing of support groups for special needs siblings and how to get a group up and running in your community
2. Thearc.org: sibling support network
3. med.umich.edu/yourchild/topics/specneed.htm: University of Michigan link for special needs families
4. friendshipcircle.org/blog/2013/04/25/the-importance-of-parental-support-and-guidance-for-special-needs-siblings/: Article with resources for sibling support The Friendship Circle website
5. nytimes.com/2001/03/06/health/06SIBL.html: Article from New York Times (2001) in support of special needs siblings
6. Meyer, Donald and Vadasy, Patricia. (2008). Sibshops: Workshops for Siblings of Children with Special Needs (Revised Edition), Brookes Publishing Co.
7. Meyer Donald. (1997). Views from Our Shoes: Growing Up with a Brother or Sister with Special Needs, Woodbine House.
8. Meyer, Donald. (2005). The Sibling Slam Book: What it’s Really Like to have a Brother or Sister with Special Needs, Woodbine House.
9. Bleach, Fiona. (2002). Everybody is Different: A Book for Young People Who Have Brothers or Sisters with Autism
10. Gordon, Michael. (1992). My Brother is a World-Class Pain: A Sibling’s Guide to ADHD-Hyperactivity
11. Stuve-Bodeen, Stephanie and Devito, Pam. (1998). We’ll Paint the Octopus Red
12. Choldenko, Gennifer. (2004). Al Capone Does My Shirts
13. The Sibling Information Network Newsletter: for quarterly support for special needs families

“Art washes away from the soul the dust of everyday life.” —Pablo Picasso

I am privileged to work with new moms in my private practice. It is tremendously gratifying to help women and their families move through what can be one of the most challenging life transitions—that of parenthood. In my work with mothers, I see many women who experience perinatal mood/anxiety issues (PMADs), perinatal loss (miscarriage), fertility challenges, and traumatic birth situations (see prior articles on these subjects on my GoodTherapy.org profile page). Most often, interventions with moms are a combination of evidence-based cognitive behavioral work and interpersonal approach to assist the client in full recovery.  I have also found great benefit in the use of expressive arts to assist this population in healing.

Expressive arts therapies are defined as the use of creative arts (art, dance, music, writing, drama) as a form of psychotherapy. The process of art making is emphasized versus the final product. In my practice, I employ the use of visual arts and crafts as a powerful intervention with clients of all ages. Although I am not an art therapist, I believe the use of art intervention is incredibly meaningful and assists in recovery from PMADs.

The American Art Therapy Association defines art therapy as a practice as “the therapeutic use of art making, within a professional relationship, by people who experience illness, trauma, or challenges in living, and by people who seek personal development.” Art therapy itself is considered a specific subspecialty in the field of psychology/counseling and requires an intensive registration and education process. With either expressive arts intervention or art therapy, the client does not need to have prior art training and need not feel pressured to produce a masterpiece. Again, the focus of the intervention is the process, not necessarily the product outcome.

I was initially exposed to the power of art to heal trauma in the drawings of child survivors of domestic violence in a San Diego shelter when I first began my career in clinical social work 20 years ago. In graduate school, I worked with a registered art therapist in a hospice setting, counseling children and families who experienced the loss of a loved one due to terminal illness. Art intervention was the primary modality in individual, group, and family work.

Moving forward through my career, most every setting I have been employed in involved the use of art as an intervention and source of healing. School and clinic-based settings provided ample opportunity to continue to bring art and creativity to the therapy process for children and adults managing depression, anxiety, trauma recovery, loss, life transitions, divorce, social skills issues, and medical traumas.

Art intervention is incredibly helpful for trauma survivors and those recovering from life challenges (including for clients feeling a sense of PTSD from perinatal depression). Art allows the right brain to be balanced and integrated with the rational, logical left brain. The bilateral movement of the hand moving across the page (mimicking the back-and-forth motion of EMDR) in turn assists in releasing trauma and integrating the experience in the brain.

Typically I will invite my client to participate in an art intervention at a point in her healing process in which she is beginning to feel the first glimpses of recovery. Sleep is beginning to be restored, mood is lifting, and anxiety is starting containment. Prior to art intervention, I will have helped to stabilize any crisis, link my client with other helping professionals and extended support networks (psychiatrists, lactation consultants, doulas, support groups, family support), and work with her to attain a level of recovery in which her focus and concentration are improving, along with her mood health. She may begin an exercise regimen; she may have hired a doula (caregiver) or enlisted the assistance of her extended family with baby care. She is beginning to feel biochemical relief, perhaps with the assistance of an SSRI, improving her nutrition with omega-3 fish oils, and she is sleeping for at least five consecutive hours (a full sleep cycle which restores serotonin).

Art interventions which I find particularly helpful for new moms contending with PMADs (which can also be adapted to other populations) can be created in individual or group modalities. Significant others of new moms may also participate in a couple/family session. The following are suggestions for use with new moms recovering from PMADs:

• Treasure Map; A Compass to Guide Me

Materials needed: colored pencils/markers, large poster paper.

Have client draw images of symbols which represent the wishes she hopes to manifest (for example, “good health/vitality” may be a sunshine image); encourage client to add powerful affirmation to the page (“I am reclaiming the best of my health and vitality”) and label each image. Invite client to post “treasure map” in a prominent location in her house to be reminded of the goals she is setting for herself in active manifestation.

Purpose: a visual guide to affirm client’s goals and provide reassurance.

• Magazine Photo Collage; A Lantern to Light the Way

Materials needed: magazines with a variety of images, large butcher/poster paper.

Have client select images from magazines which represent her new identity transformation as a mother, or use theme in intervention above to guide client in goal attainment for self-care and balance as a new mom. Discuss images and invite client to verbalize how the images are important and meaningful to her.

Purpose: validation and support with role transition to new motherhood.

• Masks; Outside/Inside Worlds

Materials needed: preformed paper/cardboard face masks (available in craft supply stores), feathers, colored markers, beads, yarn.

Ask client to create one mask which demonstrates how she presents to the “outside world.” The second mask will reflect how she feels “inside” as a new mom. Discuss how masks are similar and different and why. What is the purpose of each emotional mask?

Purpose: identifying how feelings inside often do not match what we show to the outside world.

• Sculpy Figurines; Talismans of Strength and Courage

Materials needed: sculpy clay, paint, paintbrushes.

Invite client to create image out of sculpy clay (that which can be baked and hardened at a later time, then painted). The image can be a symbol of new motherhood, an image of mother/baby, or an object representing courage and healing (perhaps a bead for a charm bracelet or necklace). Once completed, client gets to keep the object in a special place as a reminder of her strength and courage in her healing process.

Purpose: a transitional object/symbol of the work the client is doing in psychotherapy and a tangible representation of her inner strength and courage.

• Journals; Drawing Out My Feelings

Materials needed: art journal, colored pencils/markers/paint/paintbrushes.

Many clients prefer to draw feelings in lieu of writing about feelings. Invite client to create image of her birth experience using vibrant color of her choice, and to narrate her story of the experience. This exercise is especially helpful in working with survivors of birth trauma. It is also helpful to add second exercise of an image in which client creates a symbol on paper representing healing and recovery.

Purpose: Recording emotions (written or drawn/painted) allows a container for the client to “place” her feelings so she is less overwhelmed. She is able to “master” any traumas by telling her story and her experience.

• Beaded Jewelry (Bracelet, Necklace); Embrace Motherhood Beads

Materials needed: array of bead supplies (beads, bracelet/necklace wires, etc.).

Invite client to create jewelry representing her new identity as a mother, her connection with her child.

Purpose: affirmation of new role and connection/attachment to new baby.

• New Mom Memory Box/Book; The New Me

Materials needed: shoebox, construction paper, markers/pens/paints, any supply to decorate a box or album.

Assist client with decorating a special box to hold keepsakes (photos, poems, cards, etc.) as she becomes a new mother. A scrapbook can be a similar project. Discuss her identity transformation and the joys/positives of this new life role.

Purpose: recording the most transformational journey a woman can ever go through and celebrating it.

• Mandala Drawing; Drawing the Soul

Materials needed: paper, pastels, paints, pencils/pens.

Mandalas are circular images from ancient cultures and religions which represent the power of one’s healing process (see Mandala book). Invite client to create a mandala with the materials of her choice.

Purpose: for client to enjoy process (versus product) of art making and generating an image which represents healing and recovery; practicing self-care through creativity flow.

• Dream Catcher; Rest for the Weary

Materials needed: paper plate, yarn, beads, feather, single-hole punch, scotch tape.

Assist client in constructing a native American dreamcatcher, which can symbolically protect her from nightmares and scary, intrusive thoughts at night. Discuss the dreamcatcher as symbol of nighttime inner peace and tranquility.

Purpose: Most moms with PMADs have horrible sleep initially and need comfort at night. This craft is a great visual to calm the nerves and assuage the soul. Add some lavender- and vanilla-scented oil to the dreamcatcher, and invite client to place above her bed.

• Worry Dolls; A Place to Leave My Worry

Materials needed: clothespin, yarn, tongue depressors, colored pens, fabric scraps.

Invite client to create a Guatemalan worry doll which can hold her worries before she goes to sleep at night or when she begins her day (see The Kid’s Multicultural Art Book).

Purpose: Women with PMADs are anxious. They need a “container” in which to place their worries and fears; worry doll may represent transitional object of the therapist in between sessions.

“The aim of art is not to represent the outward appearance of things, but their inner significance.” —Aristotle, 384-322 B.C.

The following are books and websites which have been, and continue to be, a source of inspiration and enlightenment:

1. Allen, Pat (1995). Art Is a Way of Knowing, Shambala.
2. England, Pam (1998). Birthing from Within: The Extraordinary Guide to Childbirth Preparation,Partera Press.
3. Fincher, Susanne (2009). The Mandala Workbook: A Creative Guide for Self-Exploration, Balance, and Well-Being.
4. Malchiodi, Cathy (2006). The Art Therapy Sourcebook, McGraw-Hill.
5. Malchiodi, Cathy (2006). The Soul’s Palette: Drawing on Art’s Transformative Power,Shambala.
6. McNiff, Shaun (1992). Art as Medicine,Shambala.
7. Terzian, Alexandria (1993). The Kid’s Multicultural Art Book: Art and Craft Experiences from Around the World,Williamson Publishing Company.
8. Arttherapy.org:  American Art Therapy Association.
9. Atwb.org : Art Therapy Without Borders: Promoting international art therapy initiatives in mental health, health care, and education worldwide.