Cults A Natural Disaster
International Journal of Cultic Studies, Vol. 5, 2014, 12-29.
Cults: A Natural Disaster— Looking at Cult Involvement Through a Trauma Lens
Trauma Studies Center
Institute for Contemporary Psychotherapy
Recent advances in neuroscience, anthropology, psychology, and economics have highlighted the importance of social networks in human behavior. The author argues that the propensity for individuals to be drawn to nonkin groups is hard-wired and epigenetic. Narcissistic cult leaders are adept at creating cohesive groups attractive to those who are most drawn to nonkin groups—the altruists, idealists, and transcendence seekers. The slow process of indoctrination and social submission perpetrated by both narcissistic leaders and the cultic group dynamic is highly traumatizing to members and their children. Those drawn to cultic groups in adulthood are at risk for symptoms of post-traumatic stress disorder (PTSD). People who are born and raised in these groups are likely also to experience lags in the development of or dissociation from their own agency, identity, and core self-attributes, characteristic of complex post-traumatic stress disorder (C-PTSD). Longtime members who leave groups suffer the trauma of immigration. In addition, cult involvement is an under-recognized phenomena, and members are often labeled as pathological, which increases their shame, guilt, and isolation. The author contends that seeking group involvement with a charismatic leader is natural and human, and that cult involvement has the potential to induce profoundly painful and traumatic stress reactions. Rather than label cult involvement as aberrant, it is more humane to label it a natural disaster. Thus, cult involvement is akin to a hurricane or earthquake in its ubiquity in human history and its ability to shake people’s nervous systems in profound ways. Finally, because of the betrayal trauma induced by the leader, cult involvement may be more traumatic than surviving what we traditionally label mass disasters.
Working with former members involves understanding the severity of the trauma and the power of group dynamics. This paper highlights the special considerations necessary for professionals who work with former cult members. Best practices include stage-oriented treatment that emphasizes stabilization and psychoeducation.
Trauma Is in the Body, Not in the Event
On September 11th, 2001, Peter was working in tower seven at the World Trade Center. He looked out the window and saw what was happening at tower one just as his brother John stumbled into his office. Peter screamed, “John, don’t look—we have got to go—the collapse area of a building like this is huge!” Peter knew this because he is a volunteer firefighter in Yonkers. His coworkers stood frozen around him, staring out the window. He dragged his brother out of the building and they ran all the way to Canal Street, where he aggressively cornered a cab and sped home. Peter presented as a client later that week. He was upbeat and grateful, and he began working in a new Manhattan office where he still works today. He was somewhat nervous during his commute to the city the first few weeks following 9/11, but he had no symptoms of traumatic stress.
Another client, Michael, was between semesters at graduate school when Linda, the girl he was dating, brought him to an all-day workshop that combined his interests in politics and psychotherapy. The charismatic speaker at the workshop reached Michael, who was soon working long hours distributing leaflets and examining his “selfish” capitalistic motives in small-group sessions led by the speaker. Michael later learned that the speaker was the leader of a tight-knit and isolated group. Michael was eased into fraudulent activities to further the group’s aims, activities that months before would have made his skin crawl. One day, he dropped by his girlfriend’s apartment. Her bedroom door was open, and he could hear that she was in bed with the leader, laughing about how easy it was to recruit him. Michael froze in the doorway, utterly shocked. Soon after this experience, he left the group. Michael had trouble sleeping for the next 5 years, and he was alternately wary and angry in relationships. He had seemingly random auditory flashbacks of Linda’s laughter, and he was haunted by the way he deceived others, as instructed, while he was a part of the group. The few people he had told about his months in this group didn’t seem to grasp the gravity of what he had gone through. They also kept looking for “why he got taken so easily.”
Many think of trauma as a big event: war, earthquakes, or hurricanes. But Peter and Michael’s stories underscore that trauma is in the body, not in the event (Levine, 1997; Levine, 2010). I am defining psychological trauma as “the result of a frightening or shocking experience or ongoing experiences that overwhelm a person’s nervous system, causing ongoing emotional dysregulation and faulty memory integration of the thoughts, feelings, behaviors, and body sensations of the event.”
Although Peter witnessed a horrible disaster, as a volunteer firefighter he was prepared for catastrophic situations. Peter’s strong connection to his family served to help him in a split second take care of himself and his brother and flee toward home. He mobilized his energy to take charge and consciously protect himself from the frightening sights and sounds. At home, he received immediate support and respect for his actions.
Peter saw a disaster coming. He used his energy, protected himself, and triumphed. He tells his story with sadness and gratitude, and he remembers the details in the order they occurred. When we are not traumatized, the sensory, imaginal, narrative, behavioral, and emotional aspects of memory remain interconnected. The memory survives with a positive view of the self, and we are able to learn from the experience (Shapiro, 2001).
Michael, in contrast, was traumatized. He was unprepared and shocked by what he heard in the doorway. The world was not as he thought it was. The nervous-system shock was involuntary, and it blocked or immobilized his survival reactions to flee or fight.
This involuntary shut down, a common antecedent for post-traumatic stress disorder (PTSD), is out of awareness and out of conscious control. It is an ancient mammalian, last-ditch reaction to danger (Levine, 2010; Porges, 2011). The organism shuts down, freezes, and cannot move. It is in a state often referred to as “tonic immobility” (Abrams, Carleton, Taylor, & Asmundson, 2009; Bados, Toribio, & Garcia-Grau, 2008; Brand, Lanius, Vermetten, Lowenstein, & Spiegel, 2012 [p. 18]; Volchan et al., 2011). We see this response on PBS nature programs when we watch predators about to pounce on their prey. Just before the lion pounces, the gazelle, with no time to run and no match for this fight, collapses, still energized but immobile. Michael was also shocked by the betrayal. He suddenly saw and felt the connection to Linda for what it was—dangerous. Under these circumstances of frozen high energy, neurobiological systems become detached and unintegrated (Lanius, Lanius, Fisher, & Ogden, 2006; Nijenhuis & den Boer, 2009; Van der Hart, Nijenhuis, & Steele, 2006). It’s as if the gas and the brake are on at the same time and it’s too much for the system to bear (Napier, 2008). In some ways, the situation is like a fuse that blows—too much disorganized energy to hold, and there is a resulting blankness, a felt absence or forgetting. In other ways, it’s like a bomb that explodes, scattering the experiential elements of the event to disparate parts of the body and mind (Pain, Bluhm, & Lanius, 2009). We call all of these experiences dissociation, and these parts or elements “get stuck.” A striking physical example of this “stuckness” is phantom-limb pain (Amano, Seiyama, & Toichi, 2013; Ramachandran & Hirstein, 1998). These parts—anxiety reactions, flashbacks, body pain, involuntary movements, intermittent or persistent numbness or spaciness, and other sensory experiences—will remain sensitive to internal and external cues as long as they are unintegrated (Lanius, Bluhm, Lanius, & Pain, 2006; Sartory et al., 2013). They will reverberate in our associative memory networks (Hebb, 1949) with thematically similar events, which triggers a set of neural connections that in turn leads to what we often refer to as “symptoms” (Shapiro, 2001).
These cues, and the experiences they trigger, resemble the original overwhelming scene. At first, Michael reported that Linda’s mocking voice would “come out of nowhere.” This experience was an auditory flashback, a hallmark of PTSD. But we soon discovered the trigger. The aural flashback occurred whenever Michael entered a doorway in a quiet area. The set of connections was quiet→door→Linda’s voice→betrayal→shaky body sensations→
feelings of fear. Michael would also become irritable after one or two dates with women he was seeing. This was a stuck “fight” response triggered when he was out with a woman. As Michael was frozen at the door during the betrayal trauma, his shocked nervous system had blocked his ability to fight. These responses are the unfinished behavioral strivings that keep repeating, looking for completion and mastery. In psychoanalytic thinking, this pattern is labeled repetition compulsion.
Michael shared that, at that moment at the door, energy raced through his body but he couldn’t move. The energy “had nowhere to go.” Michael couldn’t remember how he confronted Linda and the leader, or how he left the building. He was spaced out. He also reported feeling ashamed and guilty, as if this betrayal was his fault—a meaning distortion typical in traumatic stress reactions. Later, Michael’s friends’ attitudes and comments about his being taken so easily resonated with and confirmed this distortion, which deepened his shame and guilt. Michael presented with PTSD symptoms.
Clinicians and researchers who work with trauma survivors understand traumatic reactions from a neuroscientific perspective, which includes varied types of dissociation, reexperiencing, and problems in integrative brain functions that impact memory consolidation, actions, and personality organization (Courtois & Ford, 2009; Dell & O’Neil, 2009; Sartory et al., 2013; Van der Hart, Nijenhuis, & Steele, 2006), For the purpose of this paper, I am referring to symptoms of the two most widely accepted trauma categories, PTSD as delineated in the DSM5 manual, and C-PTSD, to denote the psychological sequelae of prolonged, repeated trauma. Although the DSM does not currently list C-PTSD as a diagnosis, it is poised to become one in the ICD11 in 2015 (Singh, 2012). The C-PTSD category is widely used in psychological and neurobiological research. C-PTSD is also defined and highlighted by the U.S. Department of Veterans Affairs (available at http://www.ptsd.va.gov/professional/pages/complex-ptsd.asp).
Not all people who experience overwhelming or life-threatening events develop PTSD. The National Comorbidity Survey Replication (NCS-R) conducted interviews of a nationally representative sample of American adults and found that lifetime prevalence of PTSD among adult Americans is 6.8% (Kessler et al., 2005). The survey also found the lifetime prevalence of PTSD among men to be 3.6% and among women, 9.7% (National Comorbidity Survey, 2005). Prevalence rates for a more high-risk population—in this case, military personnel, post-deployment—fall between 10% and 25% (Hoge et al., 2004; Thomas et al., 2010). Results of research on former cult members reported rates of PTSD in a sample of former members in Spain at 27.9% (males) to 43.6% (females). In the United States, a study listed PTSD in former members at 61.4% for males and 71.3% for females (Almendros, C., 2006; Carrobles, J. A., Almendros, C., Rodriguez-Carballeira, A., & Gámez-Guadix, M. (2010).
The Power of Relational Trauma
Shock, timing, and the ability to move distinguish the stress reactions of Michael and Peter, but it’s likely that an important difference in their experience is that Michael’s trauma was interpersonal. Numerous studies indicate that relational trauma is likely more traumatizing than many physical events (Briere, Hodges, & Godbout, 2010; Butaney, Pelcovitz, & Kaplan, 2011; Freyd, 1998).
In a study by Briere and colleagues (2010) of adults who were abused as children, familial emotional abuse was more highly correlated with adult nervous-system dysregulation and avoidant behavioral symptoms than was physical abuse within the family or sexual abuse by a nonfamily member. Professionals who work with traumatized clients often recognize that, even when a client develops PTSD as a result of a powerful physical event, the individual’s reactions to the event bear an interpersonal marker. When a therapist asks a client, “What was the worst part of the experience?,” the therapist will invariably get a relational answer. Whether the event was a physical assault, a mass disaster, or a war experience, clients say things like “I was alone”; “I felt attacked and betrayed”; “My brother couldn’t get to the hospital on time”; “My partner was unhelpful”; and so on.
In small ways, our individual survival responses (to fight or to flee) can be immobilized by group survival responses, the social self. This is what we call stress. If, after an individual has worked long hours on a difficult job, a boss gives a poor evaluation, the individual can’t run out of the room or physically attack the boss. Doing this would likely cause more trouble for the individual on the job, and the response may feel immoral to him. As humans, we are challenged daily by threats of real or imagined hurts and abandonments by the people around us, which mobilize both our need to connect and at the same time our need to protect ourselves. The stress reaction is the tension caused by the conflict between the fight-or-flight survival reaction and the need for connection, another example of the gas and the brake engaging at the same time. This is an alternate conceptualization of Freud’s hypothesis that symptoms are a result of conflicts between the ego (social selves) and the id (animal selves) (Freud, 1961). This conflict is why individuals seek exercise, meditation, television viewing, dancing at a club, or a glass of wine at the end of the day. These are activities that can reregulate our nervous systems after a day of managing these conflicts at home and at work.
In cultic groups, this social pressure is constant. The verbal abuse, physical abuse, and neglect can be severe in high-demand groups. There is often limited or no ability for one to physically leave the stifling other(s). And once a person is indoctrinated, it’s often impossible to leave the demands that have become part of one’s own way of thinking. This is not stress that can be worked out at the end of the day. This is traumatic stress that overwhelms and gets stuck as a result of social and emotional captivity. Judith Lewis Herman, a pioneer in trauma theory and treatment, explains that captivity conditions in cults can be like those in slave camps or concentration camps (1992b). Cult leaders and group members often behave erratically, sometimes criticizing and punishing, sometimes loving and supporting. This pattern is described in studies regarding Stockholm syndrome wherein those who are captive become traumatically attached to their captors, sometimes within days (Ochberg, 2005). There is some evidence that this phenomenon of traumatic attachment has its origins in primate evolution (Cantor & Price, 2007).
Overwhelming interpersonal abuse and manipulation coupled with being trapped or immobilized by internalized fears and traumatic attachments are factors that can lead to the most serious trauma reactions. Thus, cult involvement has the potential to be one of the most highly traumatizing of human experiences. The adored leader, the traumatizing narcissist, perpetrates trauma using guilt and shame to dominate members and fulfill her needs (Shaw, 2013). Guilt and shame are painful but necessary emotions that may have evolved to help socialize developing children to belong, fit in, and be a part of the larger group. These emotions likely augment group cohesion and survival (Norenzayan & Shariff, 2008). Because humans all carry guilt, shame, and altruism, those who are not sociopathic have the potential to be manipulated (Cialdini, 1984). Cult leaders, who are narcissistic and often sociopathic, manipulate with aplomb.
For second-generation cult members (those born and raised in cultic groups), this dynamic is magnified. They have been raised in an encompassing community whose culture is defined by the needs and abusive practices of the leader during times of critical social and emotional development for them. In addition, their own parents will likely transmit some of the traumatizing and immobilizing aspects of the group in their own efforts to be good soldiers.
Thus, many people born and raised in high-demand groups, or adults who have spent many years in groups that are isolated and controlling suffer from C-PTSD. C-PTSD is marked by significant problems in nervous-system regulation, identity confusion, avoidant addictive behaviors, and more severe depression than those with PTSD (Briere et al., 2010; Courtois & Ford, 2009; Herman, 1992b; Thomaes et al., 2011; Van der Hart et al., 2006).
This reality then raises the question: If high-demand groups are so traumatizing, how and why do so many people get drawn in?
The Epigenetics of Group Affinity
In The Social Conquest of Earth (2012), E. O. Wilson argues that there have been only a few animal species in natural history that have evolutionary “group selection,” and that humans are one of those species. Wilson and others have long wondered about this hypothesis first proposed by Darwin (1871); but with recent advances in behavioral genetics and applied mathematics, Wilson set out to prove it. In 2010, he worked with mathematicians Martin A. Nowak and Corina Tarnita to run mathematical models to support the theory. Natural selection is Darwin’s theory, which postulates that individuals compete for life-sustaining resources, and that the fittest survive and pass on their genes (1871). The strongest individuals survive and move the species’ evolution in adaptive directions. But Wilson argues that humans also may have evolved through selection of groups of unrelated (nonkin) or distantly related individuals. That is, in the evolutionary record, groups of humans who worked together in a cooperative manner would advance the gene pool of that group. In this vein, altruism for the group and its strivings may be a genetic advantage for humans in the same way that selfishness and individual competition are viewed as an advantage.
Wilson argues that survival modes are epigenetic and flexible. That is, when individuals are in situations in which group survival is needed, the gene will express itself as strong altruism and group cooperation. When environmental needs favor individual competition, the gene will express itself as relative selfishness. The more flexible the gene, the more flexible the organism. Humans can thus adapt to a variety of habitats and circumstances.
If people are predisposed to be both morally altruistic to favor group survival and self-protective as individuals, then humans live with conflict at all times: When and how much do we strive to survive and protect ourselves, and when and how much do we cooperate and submit our personal needs for the group? This conflict is evident in the case of 9/11 survivor Peter. He actively protected himself and his brother and survived, but he also left many colleagues frozen and staring out the window. He did briefly call out to his colleagues to get out of danger, but that was the extent of his efforts toward his coworkers. His coworkers at the window did all survive; but, unlike Peter, they had lasting stress reactions. If he had spent a few minutes urging his colleagues to leave and had ushered them out of the building, Peter would have been seen as a hero, reflecting human group/altruistic traits. But then he might not have survived.
Everything Is Multidetermined
If we accept Wilson’s premise that group seeking is epigenetic, then environmental factors by definition can shape the expression of these genes, which impact affiliation and cooperation. Environmental possibilities may influence whether the expression in human behavior goes one way or the other. I propose that the factors that impact the genetic expression of altruism and group cooperation are necessary but not sufficient to cause or predict cult involvement, and that contextual issues will be part of the multidetermined mix. In addition, as is the case with so many other hereditable traits (Segal, 2012), it is possible that affiliation leanings are genetically wired so that an individual is predisposed to express the affiliation in one way or another.
Parental misatunement is ubiquitous. All parents are flawed, and they inadvertently affect the ways in which their children will dissociate or deny their own needs, proclivities, and self-protection (Fosha, in press). Some other-oriented behavior likely develops in the context of the family.
Other possible factors that may influence the propensity for altruism and cult involvement are
having grown up in an altruistic/idealistic family or community. Individuals are often affected by the cultural norms of the families and peer groups they grow up in (Harris, 1998).
having had early experiences of hurt and vulnerability that lead one to project vulnerability and innocence on others. This factor can also make it hard to read narcissists and sociopaths (Rosen, 2006).
having anxiety about competition (Rosen, 2006).
having giftedness, defined as having unique intelligence and sensitivities (Rosen, 2006).
biological/environmental factors that influence systemic levels of oxytocin, testosterone, and serotonin (Zak, 2012).
having a genetic predisposition for religiosity (Segal, 2012).
Some of the contextual factors for more likely cult involvement are
going through a transition or experiencing a recent loss or disappointment.
being raised in an isolating environment.
not being taught to recognize manipulation.
embarking on adulthood without being given the skills to be successful/powerful in work and love (Rosen, 2006).
being at a moment in development when the drive for transcendence/group is strong.
The Draw of the Narcissistic Leader
There exist two key factors in the evolution of group affiliation: Humans naturally organize into us-versus-them configurations (Berreby, 2005; Haidt, 2012; Harris, 1998; & Sherif, Harvey, White, Hood, & Sherif, 1961), and the best groups survive. If the individual’s group is better, stronger, more cohesive, then the individual will be more likely to gather resources, survive, and reproduce. If individuals are group seeking, they are thus more likely to be drawn to groups and leaders who appear to be strong and sure of themselves, and who promote superior ideals. In this context, being drawn to narcissistic leaders is likely more the norm. The group process of indoctrination is both sophisticated and slow (Lalich, 2004; Lifton, 1989). Very smart and able people do not know they are being manipulated; it’s an almost invisible affair. Thus, when group affiliation and altruism are viewed as natural human traits, and with the acknowledgement that narcissists can be attractive, seductive, and interpersonally powerful as leaders, there exists a potential recipe for disaster: a painful combination of human strivings and a leader who will invariably use blame, shame, and group pressure to cement the cohesion of the group to fulfill his narcissistic needs. This dynamic results in repeated betrayal traumas, which trigger potent destabilizing nervous-system arousal and harm the psyches and souls of members. It is more humane and more accurate to think of this scenario not as pathology, but as tragedy and trauma—a natural disaster.
Phase-Oriented Therapy with Former Members: Best Practices
If the trauma from cult involvement is about loss, dissociation, boundary ruptures, and betrayal, then healing impacts growth in connection, integration, self-recovery, self-respect, and trust. Healing is also about learning how to live in a world of ambiguity and multiple relationships, including group involvement. It involves understanding layers of cultural identity and the sense of otherness that comes with a stigmatized experience. The most comprehensive approach to addressing these issues is the standard of care in the trauma field, the phase-oriented model Pierre Janet first proposed (1919), and that various other trauma theorists and clinicians have most recently embraced (Courtois & Ford, 2009; Herman, 1992b; Ogden et al., 2006; Van der Hart et al., 2006). I have labeled these phases as Assessment, Stabilization, Trauma Processing, and Reintegration.
As in all psychotherapies, the therapist needs to assess the trauma client in terms of the client’s situation, history, culture, and current troubles.
Safety and Stabilization
The factors within this treatment phase include the following relative to the client:
Ensuring one’s personal and interpersonal safety.
Increasing one’s ability to manage extreme arousal.
Building one’s capacity to manage bodily/affective states, including numbing, flashbacks, dissociation, and so on.
Awareness of one’s sense of self and one’s relationship capacities.
Working through one’s fears of the therapy relationship.
Working through one’s fears of warded-off or dissociated trauma-related memories.
This phase includes providing the space for the client’s safe self-disclosure and exposure to traumatic memories.
During this phase, the focus with the client is on the following:
Building a narrative while integrating thoughts, feelings body sensations, and images.
Mourning and grief.
Increasing one’s level of functioning in the world (throughout therapy). Doing this necessitates
moving back and forth from stabilization to processing throughout the therapy.
increasing social functioning with friends, family, groups, and possible romantic partners.
increasing work possibilities.
ensuring that psychotherapy does not become a primary social connection over time (specific to former members).
strengthening boundaries—learning how to be intimate while maintaining a sense of self and self-priorities.
I will now review these stages of trauma therapy in more detail, with important considerations for both first- and second-generation former members.
The therapist should have or seek knowledge of how high-demand groups function, how harmful the experience can be, and the range of cultures, beliefs, and behaviors of such groups. If the therapist does not understand the cult experience—i.e., does not “get it,” the client may feel alone and untrusting (Brown 2008). Cult involvement is a unique cultural phenomenon. The International Cultic Studies Association (ICSA) website (icsahome.com) provides useful information about cults and includes a bookstore. There you can find “everything you ever wanted to learn about cults.”
At the same time, although high-demand groups have similar processes and attributes, each individual has a unique relationship to the group that individual was involved with, and every group is different. I recommend that the clinician approach each client and his situation like an anthropologist would, by assessing and understanding how the client experienced the group, how the client came to judge whether or not the group was harmful to him, and how the client integrated the experience. For the therapist, rather than to research the group on one’s own, it is most useful to follow the client’s exploration of books, websites, and forums relating to cultic groups and to the client’s group in particular. This approach reduces countertransference issues that may be countertherapeutic.
It is important to distinguish the experience of individuals born and raised in a group from that of those who joined as adults. For those born into a high-demand group, every aspect of their development is affected by the narcissistic leader, the group process, and the ways in which that process affected their parents, their siblings, and their community (Lalich & Tobias, 2006). Understanding C-PTSD is helpful when one is working with all clients, but it is vital when one is working with those born and raised in groups. Adults (and children) in cultic groups may perpetrate both subtle and shocking boundary violations and disruptions in primary caretaking during the critical development of those children and youth (Lalich & Tobias, 2006), which are common antecedents to C-PTSD.
The influence of having been born and raised within a cultic group is evident in a former client, Mary. Mary was raised in a fundamentalist Christian group in which she was shamed every time she expressed an opinion or preference. She was also aware that the male leader had sexual relations with the adolescent females, often with their parents’ knowledge. After leaving the group, Mary chose to dress in a manner that made it impossible for others to identify whether she was male or female, and she had other behaviors that protected her from being “seen” and “desired.” Mary also reported having trouble making decisions about even the smallest issue. Mary’s experience highlights the powerful and lasting influences of being raised in a cultic group. As a young child, Mary learned to protect herself in a highly adaptive manner. She had the felt sense that making her own choices could be quite dangerous if those choices were at odds with the group’s ideology and practice. Further, she learned that appearing sexually desirable may have increased her odds of being sexually abused. Her protective strategies developed during a critical developmental period and became an integral part of her identity. This scenario is quite different from that of Michael’s experience. By the time he joined the group, his tastes, interests, and gender identity had enough freedom and safety to form.
Family practices and configurations can vary greatly from group to group, and they may differ greatly from those of Western culture. A particular group’s interactions with the greater world may be far more isolating and foreign than one can imagine. Mary’s group was located in a remote area in West Virginia. She was homeschooled, and the leader and his followers vilified all media, newspapers, television, and the Internet. A careful interview revealed that, until she left the group as a teenager, she did not know there was a state called West Virginia or that there was a United States of America. She knew only that she was in a “good” group and there were “evil and fallen people on the outside” whom she could not trust. If someone at the age of 18 doesn’t know what a state is, imagine what else they don’t know about mainstream culture. For this reason, both first- and second-generation former cult members may look and behave in ways that seem strange. Often, these personality quirks fall away or become integrated as the former member finds his own place and tastes in the greater culture.
Because the shame of being different is so profound for human beings, it is imperative when therapists are working with former members not to make the mistake of calling other family organizations or cultures abnormal. The primacy of the two-parent, nuclear family is a recent development in human history and is in fact not the only paradigm for clan living in the modern world. The problem with one’s being born and raised in a cult is not that the members are not raised in nuclear families; one could argue that living with many people who support the parent-child bond is a better way to ensure secure attachment (Perry, 2009). Rather, the problem is that the leader and the group process perpetrate boundary violations on the group’s members; often separate spouses from each other, and parents from their children; and isolate their members from the greater world (Lalich & Tobias, 2006). This environment creates abandonment fear and stunts the process of sharing one’s particular proclivities with a variety of others, both of which greatly hinder development. A nuclear family with a narcissistic, isolating parent can be as problematic as a nonkin group with a narcissistic leader. The narcissism and the resulting lack of support, as well as the isolation from the greater human world, create the problem.
Trauma is perpetrated by the way the leader uses the group process and group ideology to manipulate and dominate the members. The unfamiliar or possibly “weird” ideology of the group is not necessarily a problem and may in fact be integrated into the belief system of the former member during recovery. Keep in mind that many American Christians think that Mormon beliefs are strange, and many atheists think the Christian belief in the resurrection of Christ is absurd. It is likely that if we inquire carefully, all humans have some beliefs in relation to helplessness and the unknowable. Weirdness is in the eye of the beholder.
During the assessment phase, it’s useful to identify clients’ secrets—experiences and ideas that were at odds with the cult group’s ideology and practices. These are the seeds of the self seeking resonance in the outside world. That resonance is the nourishment for the growth of the individual’s identity, which can be expanded in the therapeutic interaction (Fosha, in press) and with one’s friends. Michael, the client who left the political group, continued to go to Yankee games in the summer, an activity that he hid from other group members. Although he felt guilty and frightened when he went to the games, it was the one activity he continued with old friends; and it connected him to his precult self and community. Even in an isolated and severely controlling setting, a member may have hidden objects or ideas. In Mary’s West Virginia group, pets were banned because animals were considered “low creatures.” Even so, Mary would often sneak scraps from the cult dining hall and spend hours in the nearby woods feeding and petting stray dogs and cats. After she left the group, and with the help of her therapist and the support of her new friends, she pursued a career as a veterinary technician.
First-generation members have had a childhood outside a group and are impacted by the group sometime during adulthood. Here again, someone who joined at 19 and stayed for 25 years will have a vastly different experience from someone who joined at 19 and left a year later. The earlier and the longer the involvement, the more impact there is on the developing self and the possibility of one having C-PTSD symptoms. The degree of group isolation will invariably have more impact on a member’s development, as well. If a therapist is working with someone born and raised in an isolated group, I strongly recommend that the therapist read the many books and articles about C-PTSD (e.g., Courtois & Ford, 2009; Herman, 1992b; Van der Hart et al., 2006). The dilemmas in living for those with C-PTSD can be complicated and painful, and they should be met with informed care.
Assessment should include clarifying dissociative and avoidant aspects of the clients’ lives: the flashbacks, fear responses, and nervous-system dysregulation that we often label anger, anxiety, and depression. Because of the severity of the interpersonal abuse in cults, former members’ dissociation can be profound. Former members will often experience derealization, depersonalization, and fugue states. A cult self may exist along with a noncult self. Former members’ shame and guilt about pleasure, self-promotion, and self-expression can be persistent, particularly for those raised in high-demand groups, despite the therapist’s reassurances. We can view all these responses as normal, protective defenses against overwhelming internal conflict, or as remnants of the cultic group process that lead to PTSD or C-PTSD. These separate selves, parts, or self-states can integrate, and the dissociative experiences can melt away during the stabilization and trauma-processing phases of therapy.
Therapists can explore dissociative experiences by interview or with the aid of a structured scale. Many trauma therapists use the long and short forms of the Dissociative Experiences Scale (DES or DES-T; Bernstein & Putnam, 1986). They should administer these assessments routinely to clients being prepared for EMDR, and they also are recommended during EMDR training (Shapiro, 2001). Therapists can use other structured interview instruments such as the Cognitive Distortions Scale (CDS), the Tension Reduction Activities (TRA) and Tension Reduction Behavior (TRB) scales, and the Traumatic Attachment Belief Scale (TABS) to assess symptoms (Courtois & Ford, 2009).
Many former members experience a sense of “years lost” and stigma from the experience. In addition, many first-generation former members feel deep pain and guilt regarding the suffering their family and friends endured while the former members were in the group. And many second-generation former members have lost all connection with their families if they left the group and their families remained in it. As is often the case, the leader dictates that family members shun and vilify the person who has left.
The client and therapist can then cocreate goals for therapy. In most cases, there will be agreement in all areas except in the areas of avoidance. Avoidance and tension reduction through addictions, isolation, or the so-called self-destructive behaviors (e.g., excessive drinking, eating, sexual encounters; self-cutting; trichotillomania [a compulsion to pull out one's hair]) may be efforts to self-regulate and ward off terrifying memories. It behooves the therapist to develop both concern and patience with these issues. It is usual for a client either to be in a rush to rid herself of these painful symptoms, or to have a blind spot about them. It is important to pace therapy so that the client does not experience retraumatization by being exposed to frightening memories and overwhelming nervous-system dysregulation. Motivational interviewing (Lundahl & Burke, 2009; Miller & Rollnick, 2013) is an effective and respectful approach to help a former member to find the best model for reduction or abstinence at a pace that increases her stabilization.
At The Trauma Studies Center of The Institute of Contemporary Psychotherapy, where I teach, faculty is trained in two, three, and sometimes four trauma-processing techniques, in addition to receiving cognitive-behavioral and/or psychodynamic training. There has been a gradual move within the training toward an emphasis on stabilization, with an entire semester now devoted to the theory and practice of stabilization. Although trauma processing can be enormously effective with former members, working with them on the aspects of stabilization, along with providing the psychoeducation to enable them to understand and mourn the group experience, goes a long way. Engaging the concrete issues of addressing immigration (discussed in the following paragraph), increasing nervous-system regulation, strengthening boundaries, and developing relationships are necessary components of healing. Without attention to stabilization, exploring the specific group experiences can prove unsafe for clients. Recent studies regarding mass-disaster victims have clarified that the survivors’ trauma symptoms worsened if they were prompted to talk about the event before their home, community, and work contexts were stabilized (Miller, 2011; Tramontin & Halpern, 2007).
We can view all former cult members as invisible immigrants. They may continue to live in the same country and speak the same language, but their experience of dislocation, loss, and confusion can be as strong as that of an émigré from a third-world country. Livia Bardin, a long-time, valued member of ICSA, recently published a Web book called Starting Out in Mainstream America, which has a link on the ICSA website. This book contains information for former members about everything from outlining how to get a driver’s license to defining boundaries and explaining various aspects of social communication. This material can be particularly helpful and stabilizing for second-generation former members.
There are a variety of techniques for increasing nervous-system regulation. Those who feel comfortable with body-based therapy can use Somatic Experiencing and Sensorimotor Psychotherapy techniques, which can quickly bring the person into what is sometimes called the “window of tolerance” (Ogden et al., 2006). This is the nervous-system state that is more or less balanced, so that the client can be mindful enough to use the therapy process. If a client is in an agitated (sympathetically aroused) state, he cannot “think straight,” and the therapy sessions will be ineffective or, in some cases, frightening. If the client is in a dissociated or a depressive-type shutdown (parasympathetically aroused state), he also cannot concentrate fully and participate in therapy. I used Somatic Experiencing interventions in most sessions with Michael, which gradually calmed his nervous system. This approach brought him into the window of tolerance, which allowed him a greater capacity to face or hear things we were discussing in therapy.
Mindful meditation is a popular practice that trauma therapists often introduce to patients to help them stabilize and increase their window of tolerance. Indeed, many neuroimaging studies demonstrate that mindfulness practice can build cognitive and affective control (Lutz, Slagter, Dunne, & Davidson, 2008; Prakash, De Leon, Klatt, Malarkey, & Patterson, 2012; Teper & Inzlicht, 2012). However, therapists should be cautious about recommending meditation to former members. Many cultic groups practice meditation, and this practice can be a PTSD trigger for former members. In addition, clients who have the spacey or numb forms of dissociation, as well as other specific issues, can become distressed during meditation (Britton & Sydnor, in press). Lola, a former client, would discipline herself to meditate; but once she was relaxed, violent images would emerge. With some encouragement, she let go of this inner dictate about meditation; and when she was stressed or triggered, she would go on a bike ride, or look at beautiful art instead, which effectively calmed her nervous system and brought her a peaceful, centered feeling.
As with all other psychotherapy patients, it is sometimes useful for former cult members to consider and be evaluated for psychotropic medication for stabilization. Medication can be helpful for sleep and mood problems. It is also important to remember that not all symptoms are from traumatic experiences such as cult involvement. Many people come into the world with genetic predispositions for mood, and behavioral leanings that cause problems in living (Segal, 2012). Each former member has a history, biology, and uniqueness.
For former members (and for all clients), it is useful to educate, educate, educate. Psychoeducation can be the most stabilizing of all interventions. First and foremost, it is important to educate about the therapeutic process to counterbalance the magical ideas clients have learned in their groups. When it is fitting, the therapist can educate clients about the nervous system, neuroscience, psychoanalytic thinking, the power of negative cognitions, dissociative phenomena, self states, social and cultural realities, and so on. The therapist can educate clients about the varied natural reactions their minds and bodies are having to past and present overwhelming events. It is wise to educate clients that dissociative experiences are adaptive and can be ameliorated in therapy. In particular, clients who hear internal voices or experience visual hallucinations, abreactions, derealization, and depersonalization may be afraid that they are psychotic; they may be unaware that these are not uncommon experiences for people suffering from PTSD and C-PTSD (Dell & O’Neil, 2009).
It is beneficial to educate former members about the personalities of cult leaders and the potentially harmful group process within cults. Jennifer Freyd’s research on betrayal trauma can function as a useful tool in therapy for educating clients about the loyalty/attachment/dependency conflict, and the fact that self-protection can result in dissociation from the ongoing abuses that often occur in cultic groups (Freyd, 1998; Freyd & Birrell, 2013). It is also helpful to introduce ICSA to clients and encourage them to try the local monthly meetings and other ICSA-based groups that may be helpful to former members.
It is important to respect clients’ readiness for information and education. Some clients read everything they can get their hands on. Some are suspicious of interventions, so it is important to talk about what the therapist is doing and with what purpose. Some take longer than others to take in the reality that the leader is harmful. Some people do not like to read about high-demand groups. And still others may not want to attend support groups because attending a group is a trigger. Michael did not want to read about cults, attend a group, or talk about the leader’s character. He did not want to look at the ICSA website or join the online chat group for members of his former group. But he recovered. In contrast, Mary said it was life changing for her to meet other second-generation members, and to be involved with ICSA. Each client is different.
The standard of care for all clients should be a collaborative stance that is authoritative, not authoritarian (Rosen, 2006). Attention to language is crucial. Language should be nonpathologizing (Najavits, 2002; Rosen, 2013) and cocreated by therapist and client (Rosen, 2013).
The pacing of therapy with psychologically traumatized clients is different from the pacing with those experiencing ongoing or situational anxiety and depression. My client Adam, who was not a former member of a cultic group and did not have a traumatic stress reaction, came to therapy because of “panicky feelings” in his chest, and frantic worry about his former boyfriend ,who was devastated about losing his relationship with Adam. Adam reported that he had always been a worrier but his worries were increasing, and he was obsessing about his former boyfriend throughout the day. In efforts to lessen his anxiety, he was eager to examine his past, his current feelings, the sensations in his chest, and any thoughts that came to mind. We quickly established rapport, and I used all the tools in my therapeutic toolbox. Adam stayed present and engaged throughout the sessions; he did not experience dissociative symptoms.
Clients with C-PTSD, in contrast, have trauma-related phobias of their internal experience (Dell and O’Neil, 2009; van der Hart et al., 2006). Mary, a client born and raised in the West Virginia cult, required months of psychoeducation and discussions about our relationship to establish trust in me and the therapy process. I had to pick and choose carefully which areas to explore. If I mentioned or inquired about her parents in the early stages of therapy, Mary would report a frightening experience of having “sick, squeamish” feelings in her belly, and then she would become spacey. She would be unable to engage in talk therapy for the remainder of the hour because she “couldn’t think straight.” Following sessions like these, Mary would invariably spend a few days binging and purging, or drinking heavily, or both. For her first 2 years of therapy, I learned the “land mines” that were psychologically overwhelming for her, and I paced my interventions carefully in response. During this phase, we did not explore her personal history or talk about her parents. I recommended that she present “headlines” or mutually understood “tags” of past experiences that related to what we were discussing. By working in this carefully titrated manner, we forestalled triggering the spacey, dissociative state in sessions as well the “addictive avoidant behaviors” that followed those sessions.
During the stabilization phase, Mary willingly tried Somatic Experiencing (SE) and Sensorimotor Psychotherapy (SPI) techniques. In particular, I used the SE practice of “pendulation,” repeatedly guiding her awareness from areas of the body where there was relative calm to the areas where she felt activated, and then back to the clam areas. This approach greatly enhanced her ability to stay with body sensations and emotions, and to be less afraid of them. She realized that these sensations were just sensations and did not indicate present danger. She also utilized the “parts work” developed by Richard Schwartz (Schwartz, 1997). Mary identified the parts, or aspects, of her internal system that prompted the “spacing out” to protect her from becoming emotionally overwhelmed in the session. Once she was able to respect this numbing defense, she was able to identify what she wanted to avoid for the moment, and what she was able to face. Like the somatically focused work Mary practiced in session, this parts work helped her feel in control and expand her “window of tolerance.” In time, Mary’s capacity to stay with her “sick squeamish” feelings grew. Her addictive behaviors stopped. Relevant meaning and memories emerged safely. She was able to talk about her parents and eventually reestablished contact with them as we moved into the trauma-processing phase.
I recommend using caution when you are looking for why someone joined a group or why someone didn’t leave, particularly in the early stages of treatment. Those of us who have not had an experience of emotional captivity would like to think that we would be strong enough not to succumb, but the research shows that many others similar to us do get involved (Halperin, 1983; Herman, 1992; Symonds, 1982). I contend that in Western culture the act of questioning “Why?” regarding human behavior can imply personal responsibility, which can stimulate negative beliefs about oneself. Therapists use similar caution when they are working with women who have been in domestic-violence relationships. If therapists explore the question of why, which insinuates a sense of personal responsibility, too early in treatment, they risk increasing the clients’ experiences of self-blame. The question “Why?” may also stimulate the trauma-related phobias of internal experience. This outcome will delay stabilization, the possibility of the clients being able to process the traumatic memories. In the course of treatment, particularly during the trauma-processing phase, clients often discover that some of their habituated reactions from childhood, including attachment styles, interpersonal patterns, and freeze responses, may have contributed to their vulnerability to cult recruitment and involvement. We can see these patterns, like holograms and fractals, in varied aspects of clients’ experience: the therapy relationship, the clients’ self-referential beliefs, their physical movements, and other behaviors (Levenson, 1975; Marks-Tarlow, 2008; Ogden et al., 2006). During this phase, the therapist may also introduce possible connections or meaning regarding these patterns (interpretations).
But these realizations may not be necessary for healing. Cults invariably put too much personal responsibility on members. If something is painful or goes wrong, the member wasn’t good enough, or was not praying or meditating or recruiting enough. Former members make good psychotherapy patients—they are experts at looking at “their part in things.” In this realm, former members of high-demand groups may benefit more by gaining an understanding of social contexts and the nuances of social dynamics. The goals of trauma-informed treatment are to reduce PTSD and C-PTSD symptoms, and to create therapeutic conditions that allow clients to find their own inner strength and community, and possibly most importantly, to develop positive meaning about themselves and their experience (Prati & Pietrantoni, 2008).
The importance of friendship for stabilization is not emphasized enough in trauma and therapy literature. Having friends to call when one is down, to enjoy activities with, and to seek advice from impacts every other aspect of one’s life. This issue is important to keep front and center when you are working with former cult members, particularly those who become dependent on the advice of the therapist and fear connecting with others. Friendship also takes enormous pressure off of romantic relationships, which are complicated at best and cannot provide all of an individual’s need for support. In addition, having friends to confer with is enormously nourishing for cognitive problem-solving abilities eroded by the cult’s simple doctrine of “follow, don’t think.” Learning to hear many opinions and to digest or reject those opinions can be enormously centering. Former members can find the self that listens, reacts, and sifts the input.
In many ways, all psychotherapy is exposure therapy. In good therapy, clients are supported and stabilized by a cooperative relationship while they look at or integrate previously warded off, unattended to, or dissociated elements of their experience. These elements can be, among others, memories, body sensations, meaning, conflicts, images, feelings, and negative and positive views of themselves. The best outcomes include the clients bringing in these previously unintegrated elements of experience and gaining a positive view of the self in the present. Many of the quite varied trauma-processing models all work well because they are similar in a critical way: Each contains powerful elements of both exposure and support. And because each model is so distinct, the therapist can choose a model or combination of models that suits both therapist and client.
There is a burgeoning of processing methods in the trauma field. I recommend cautious use of exposure therapies and eye movement desensitization reprocessing (EMDR) with former members, particularly second-generation members who may have both developmental and adult trauma. An experienced trauma therapist should employ these approaches only if the client has achieved relative stability, and if the therapist is adept at working with dissociation and pacing interventions. Exposure therapy and EMDR include bold and steady exposure. EMDR has a lower dropout rate than exposure therapy (Power et al., 2002), perhaps because it includes supportive bilateral stimulation— tapping, eye movements, or music. However, during EMDR therapy, associative networks get stimulated quickly, and it is easy for a former member to suddenly remember something frightening during processing. With these and other modalities, there is always the risk that the emotions and body sensations associated with facing something squarely without a break or without enough distance can be too much. The client may become flooded with sympathetic arousal and reexperience all the implicit feelings of terror, helplessness, or humiliation of the original traumatic moment. Trauma researchers and therapists call this retraumatizing. Accelerated Experiential Dynamic Psychotherapy (AEDP); the somatic therapies—SE; Sensorimotor Psychotherapy, SPI; and Internal Family Systems (IFS) have built-in stabilizing elements that help the client stay emotionally regulated and present during trauma processing. If a therapist has training in EMDR or exposure therapies only and is not yet savvy about dissociation and pacing, it is better to stick with stabilization, slow exploration, and “working through.” Although the trauma-based therapies are efficient and powerful, reaching both verbally and somatically stored trauma, it is also important to remember that talk therapy works. Much of what works in therapy is understanding, respect, and the therapeutic alliance (Norcross & Lambert, 2011).
When second-generation former members are processing trauma, themes and incidents from childhood will likely stir the most potent body sensations and emotional charges. For first-generation former members, the opposite is most often true—the experiences with the leader and other group members were likely more abusive than any they had as children. Thus, processing the worst experiences rather than the earliest can bring great relief to first-generation members. It is also very important not to assume that the negative cognitions of adult members were learned in their families of origin. They are often the result of brainwashing: well-ingrained group beliefs that at the time seemed benign but were used to blame, punish, and control members (Lalich, 2004; Lalich & Tobias, 2006). The process of working through the issues and negative cognitions from the cult experience will also stimulate and enable clients to work through early childhood trauma with resonant themes.
Although they are highly effective and gaining in popularity, some of the aforementioned models have been developed only over the past twenty years or so. Consequently, they may seem strange to any psychotherapy patient and should be presented as “something to try” and be well described before the therapist uses them. Because some processing models have procedural elements, it is important to ensure that the relational, talking aspects of the therapy stay a strong part of the sessions. Otherwise, clients can feel alone, abandoned, or that something is being done to them, rather than with them. This result could prove to be a trigger for trauma born in the cult.
Integration and Healing
Recent discoveries in affective neuroscience and interpersonal neurobiology have influenced how we reconceptualize mental health. Neuroscientists and trauma therapists talk about flexibility, resonance, coherence, integration, and mindfulness (Siegel, 2010). It is my perspective that this is a positive shift in the trauma field away from a metapsychology of sickness and health, and toward a strength-based model of plasticity, nervous-system regulation, and relatedness.
In keeping with this model, we as humans are all striving to freely experience when to use our boundaries to say yes or no, to come close or go away. We want to find those with whom we resonate, to be able to cooperate with those we must, and to eschew those we wish to avoid. We want to live lives of relative calmness, and to have the ability to stay curious and flexible. We want to engage in meaningful work and activities. We want to have growing intimacy with our loved ones, and feel safe and engaged in communities. From Wilson’s evolutionary perspective (2012), we may deduce that humans all want to be thought of as valued members of the pack, the clan, and our human tribe (Perry, 2009). Francine Shapiro (2001) speaks about the possible shame and survival terror that may be a result of feeling left out of the herd. After all, vulnerable or marginalized animals in a herd are easier prey. Labeling former cult members as pathological or sick is highly traumatizing in and of itself and is reflective of the us-versus-them thinking we dislike in cultic groups. It is humane to see survivors of high-demand groups as “us,” fellow humans who have survived a natural disaster.
Providing strength-based trauma therapy can be enormously healing. After I had worked with Michael for months on stabilization, we began using EMDR to help process his memories and concomitant negative beliefs about himself. EMDR is an integrative, comprehensive psychotherapy model that incorporates many other psychotherapeutic modalities (Shapiro, 2001). There are assessment and preparation phases, and these phases can be extended for as long as necessary for work with patients with complex trauma. The EMDR trauma-processing phase includes components of cognitive behavioral therapy (CBT), the somatic psychotherapies, and emotionally focused therapy (EFT). After the elements of experience related to a particular traumatic incident are identified and stimulated, psychoanalytic processing is encouraged via free association while the client is experiencing some type of bilateral stimulation (BLS). The BLS is usually eye movement. Clients move their eyes, with the aid of a light bar or pendulum, from one side of their visual field to the other. The BLS can also be achieved by the clients’ rhythmic tapping of each side of the body or their listening to headphones that play tones that alternate from one ear to the other. The clients are reassured that with the support of the therapist and the EMDR steps, their own minds will find a more accurate memory of the traumatic event, with the fear and helplessness ameliorated, and a positive view of themselves.
In keeping with the EMDR protocol, Michael was free-associating during the trauma processing. He was processing a frightening memory of the leader criticizing him for being a “selfish capitalist.” The trauma was coupled with Michael’s negative belief, “I am defective,” which was still present 5 years after he had left the group.
In the last of a series of Michael’s EMDR sessions, I asked him to return to the image of the leader berating him. He responded, “Wooooooooow—now the leader just looks small and bad and crazy… There’s nothing wrong with me! I just joined the wrong group.”
Abrams, M. P., Carleton, R. N., Taylor, S., & Asmundson, G. J. (2009). Human tonic immobility: Measurement and correlates. Depression and Anxiety, 26(6), 550–556.
Almendros, C. (2006). Abuso psicológico en contextos grupales (Unpublished doctoral thesis). Universidad Autónoma de Madrid, Spain.
Amano, T., Seiyama, A., & Toichi, M. (2013). Brain activity measured with near-infrared spectroscopy during EMDR treatment of phantom limb pain. Journal of EMDR Practice and Research, 7(3), 144–153.
Bados, A., Toribio, L., Garcia-Gau, E. (2008). Traumatic events and tonic immobility. Spanish Journal of Psychology, 11(2), 516–521.
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.
Berreby, D. (2005). Us and them: Understanding your tribal mind. New York, NY: Little, Brown.
Brand, B., Lanius, R. A., Vermetten, E., Lowenstein, R. J., & Spiegel, D. (2012). Where are we going? An update on assessment, treatment, and neurobiological research in Dissociative Disorders as we move toward the DSM5. The Journal of Trauma and Dissociation, 13(1), 9–31. doi:10.1080/15299732.2011.620687
Briere, J., Hodges, M., & Godbout, N. (2010). Traumatic stress, affect dysregulation, and dysfunctional avoidance: A structural equation model. Journal of Traumatic Stress, 23(6), 767–774.
Britton, W. B., & Sydnor, A. (in press). Neurobiological models of meditation practices: Implications for applications with youth. In C. Willard (Ed.), Mindfulness with youth: From the classroom to the clinic. New York, NY: Guilford Press.
Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback (pp. 49–59). Washington, DC: American Psychological Association, viii (291 pp.). doi:10.1037/11752-002
Butaney, B., Pelcovitz, D., & Kaplan, S. (2011). Psychological maltreatment as a moderator for physical abuse and adolescent maladjustment: Implications for treatment and intervention. Journal of Infant, Child, & Adolescent Psychotherapy, 10(4), 442–454.
Cantor, C., & Price, J. (2007). Traumatic entrapment, appeasement and complex post-traumatic stress disorder: Evolutionary perspectives of hostage reactions, domestic abuse and the Stockholm syndrome. Australian and New Zealand Journal of Psychiatry, 41(5), 377–384.
Cialdini, R. B. (1984). Influence: How and why people agree to things. Minneapolis, MN: Quill.
Carrobles, J. A., Almendros, C., Rodriguez-Carballeira, A., & Gámez-Guadix, M. (2010, September). Psychological distress and personality profiles in former members of abusive groups. Poster presented at the International Conference of the European Health Psychology Society (EHPS): 24th European Health Psychology Conference, Cluj-Napoca, Romania.
Courtois, C. A., & Ford, J. D. (2009). Treating complex traumatic stress disorders (adults): An evidence-based guide. New York, NY: Guilford Press.
Darwin, C. (1871). The descent of man, and selection in relation to sex (1st ed.). London, England: John Murray.
Dell, P. F., & O’Neil, J. A. (2009). Dissociation and the dissociative disorders: DSM-V and beyond. New York, NY: Taylor & Francis.
Fosha, D. (in press). A heaven in a wild flower: Reflections on self, dissociation, and treatment in the context of the neurobiological core self. Psychoanalytic Inquiry, Special Issue on Dissociation.
Freud, S. (1923/1961). The ego and the id. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud, 19, 3–66. London, England: Hogarth Press.
Freyd, J. J. (1998). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.
Freyd, J. J., & Birrell, P. J. (2013). Blind to Betrayal. Hoboken, NJ: John Wiley & Sons.
Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. New York, NY: Vintage.
Halperin, D. A. (1983). Group processes in cult affiliation and recruitment. In Psychodynamic Perspectives on Religion, Sect, and Cult, Boston, MA: John Wright.
Harris, J. R. (1998). The nurture assumption. New York, NY: Free Press.
Hebb, D. O. (1949). The organization of behavior. New York, NY: Wiley & Sons.
Herman, J. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377- 390.
Herman, J. (1992b). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. New York, NY: BasicBooks.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 13–22.
Janet, P. (1919). Les medicaions psychologiques (Vol. 3). Paris, France : Felix Alcan. (Reprint: 1984. Paris, France: Societe Pierre Janet). English edition: Principles of psychotherapy (Vol. 2). New York, NY: Macmillan.
Kessler, R. C., Berglund, P., Delmer, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
Lalich, J. (2004). Bounded choice: True believers and charismatic cults. Los Angeles, CA: University of California Press.
Lalich, J., & Tobias, M. (2006). Take back your life: Recovering from cults and abusive relationships. Berkeley, CA: Bay Tree Publishing.
Lanius, R. A., Bluhm, R., Lanius, U., & Pain, C. (2006). A review of neuroimaging studies in PTSD: Heterogeneity of response to symptom provocation. Journal of Psychiatric Research, 40(8), 709–729.
Lanius, R., Lanius, U., Fisher J., & Ogden P. (2006). Psychological trauma and the brain: Toward a neurobiological treatment model. In P. Ogden, K. Minton, and C. Pain (Eds.), Trauma and the body (141–163). New York, NY: W.W. Norton & Company.
Levenson, E. A. (1975). A holographic model of psychoanalytic change. Contemporary Psychoanalysis, 12(1), 1–20.
Levine, P. A. (1997). Walking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books.
Lifton, R. J. (1989). Thought reform and the psychology of totalism: A study of brainwashing in China. Chapel Hill, NC: University of North Carolina Press.
Lundahl, B., & Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: A practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65(11), 1232–1245.
Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Sciences, 12(4), 163–169.
Marks-Tarlow, T. (2008). Psyche’s veil: Psychotherapy, fractals, and complexity. New York, NY: Taylor & Francis.
Miller, L. (2011). Psychological interventions for terroristic trauma: Prevention, crisis management, and clinical treatment strategies. International Journal of Emergency Mental Health, 13(2), 95–120.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Publications.
Napier, N. (2008). Somatic Experiencing professional training: An integrative approach to the prevention and resolution of trauma. Beginning Level: Module I. Lecture conducted from the Somatic Experiencing Trauma Institute.
National Comorbidity Survey. (2005). NCS-R appendix tables: Table 1. Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Table 2. Twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Retrieved at http://www.hcp.med.harvard.edu/ncs/publications.php
Najavits, L. M. (2002). Safety seeking: A treatment manual for PTSD and substance abuse (p. 12). New York, NY: Guilford Press.
Nijenhuis, E. R. S., & den Boer, J. A. (2009). Psychobiology of traumatization and trauma-related structural dissociation of the personality. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 337–365). New York, NY: Taylor & Francis.
Norcross, J. C., & Lambert, M. J. (2011). Evidence-based therapy relationships. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Evidence-based responsiveness (2nd ed.) (pp. 3–21). New York, NY: Oxford University Press.
Norenzayan, A., & Shariff, A. (2008). The origin and evolution of religious prosociality. Science, 322(5898), 58–62.
Ochberg, F. M. (2005, April 8). The ties that bind captive to captor. LA Times. Retrieved from http://articles.latimes.com/2005/apr/08/opinion/oe-ochberg8
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W.W. Norton.
Pain, C., Bluhm, R. L., & Lanius, R. A. (2009). Dissociation in patients with chronic PTSD: Hyperactivation and hypoactivation patterns, clinical and neuroimaging perspectives. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 373–382). New York, NY: Taylor & Francis.
Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14, 240–255.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York, NY: W.W. Norton.
Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Sanson, V., & Karatzias, A. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-traumatic stress disorder. Clinical Psychology and Psychotherapy, 9(5), 299–318.
Prakash, R. S., De Leon, A. A., Klatt, M., Malarkey, W., & Patterson, B. (2012). Mindfulness disposition and default-mode network connectivity. Social Cognitive and Affective Neuroscience, 8(1), 112–117.
Prati, G., & Pietrantoni, L. (2008). Optimism, social support, and coping strategies as factors contributing to posttraumatic growth: A meta-analysis. Journal of Loss and Trauma: International Perspectives on Stress & Coping, 14(5), 364–388.
Ramachandran, V. S., & Hirstein, W. (1998). The perception of phantom limbs: The D. O. Hebb lecture. Brain, 121(9), 1603–1630.
Rosen, S. (2006). Therapeutic concerns. In J. Lalich & M. Tobias, Take back your life: Recovering from cults and abusive relationships (pp. 305–313). Berkeley, CA: Bay Tree Publishing.
Rosen, S. (2013). Difficult conversations: The use of language for stabilization for trauma patients. A presentation for the Trauma Studies Cooperative at the Institute for Contemporary Psychotherapy, May, 2013.
Sartory, G., Cwik, J., Knuppertz, H., Schurholt, B., Lebens, M., Seitz, R. J., & Sculze, R. (2013). In search of the trauma memory: A meta-analysis of functional neuroimaging studies of symptom provocation in posttraumatic stress disorder (PTSD). PLoS ONE, 8(3), e58150. doi:10.1371/journal.pone.0058150.
Schwartz, Richard G. (1997). Internal family systems therapy (the Guilford family therapy series). New York, NY: Guilford Press.
Segal, N. L. (2012). Born together—reared apart: The landmark Minnesota twin study. Cambridge, MA: Harvard University Press.
Shaw, D. (2013). Traumatic narcissism: Relational systems of subjugation. New York, NY: Routledge.
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). New York, NY: Guilford Press.
Sherif, M., Harvey, O. J., White, B. J., Hood, W., & Sherif, C. W. (1961). Intergroup conflict and cooperation: The Robbers Cave Experiment. Norman, OK: University Book Exchange.
Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York, NY: Random House.
Singh, K. S. (2012). Moving towards ICD-11 & DSM-V [PowerPoint slides]. Retrieved from http://www.slideworld.org/slideshow.aspx/Moving-Towards-ICD-11-and-DSM-5-ppt-2851162
Symonds, M. (1982). Victim responses to terror: Understanding and treatment. In F. M. Ochberg and D. A. Soskis (Eds.), Victims of terrorism (pp. 95–103). Boulder, CO: Westview Press.
Teper, R., & Inzlicht, M. (2012). Meditation, mindfulness and executive control: The importance of emotional acceptance and brain-based performance monitoring. Social Cognitive and Affective Neuroscience, 8(1), 85–92.
Thomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., Sjoerds, Z., … & Veltman, D. J. (2011). Increased anterior cingulated cortex and hippocampus activation in complex PTSD during encoding of negative words. Social Cognitive and Affective Neuroscience (pp. 190-200).
Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry [now JAMA Psychiatry], 67, 614–623.
Tramontin, M., & Halpern, J. (2007). The psychological aftermath of terrorism: The 2001 World Trade Center attack. In E. K. Carll (Ed.) , Trauma psychology: Issues in violence, disaster, health, and illness, Vol. 1: Violence and disaster (pp. 1–31). Westport, CT: Praeger Publishers/Greenwood Publishing.
Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). Structural dissociation and treatment of chronic traumatization. New York, NY: W.W. Norton.
Volchan, E., Souza G. G., Franklin, C. M., Norte, C. E., Rocha-Rego, V., Oliveira, J. M., … & Figueira, I. (2011). Is there tonic immobility in humans? Biological evidence from victims of traumatic stress. Biological Psychology, 88(1), 13–19.
Wilson, E. O. (2012). The social conquest of earth. New York, NY: W.W. Norton.
Zak, P. J. (2012). The moral molecule: The source of love and prosperity. New York, NY: Penguin Group.
About the Author
Shelly Rosen, LCSW, is a relational psychotherapist with 30 years of clinical experience. She teaches and supervises at the Trauma Studies Center at the Institute for Contemporary Psychotherapy in New York. She was a therapist, and later Coordinator of The Cult Hot Line and Clinic in Manhattan from 1983 to 1991. There she worked with individuals and families who were harmed by high-demand groups. She continues to see former cult members and families harmed by cultic groups in her practice. Ms. Rosen has had extensive training in trauma-processing therapies for PTSD and other symptoms of trauma. She has written for The Cultic Studies Journal and has a chapter in the book Take Back Your Life. She provides clinical consultation to psychotherapists and serves as an advisor to communities, universities, and governments regarding the dynamics of authoritarian groups.