International Journal of Cultic Studies ■ Vol. 10, 2019, 1-13
In private practice in Vermont
Abstract
Recovering from cultic groups encompasses many areas of healing and so can be a complicated process. No single treatment has been developed for working with cult survivors; therefore, clinicians need to be able to synthesize their interventions from multiple sources. This narrative synthesis review outlines the key psychological components of cultic abuse and recovery that counselors must take into account when working with survivors of totalistic, abusive, or controlling groups, including practical needs, developmental goals, emotional and relational issues, and trauma. The author draws from both literature about cults and survivors of cultic groups and from the broader field of trauma, relational violence, and displacement; it highlights the subtle yet important differences that may exist between first-generation survivors and second-generation survivors. She explores the potential application and risks of treatment approaches such as psychoeducation, EMDR, sandtray, mindfulness, creativity, and somatic interventions. Finally, she touches on important ethical considerations related to power dynamics and multicultural issues.
Keywords: cults, cultic groups, high demand groups, abusive systems, counseling competencies
There are a number of theories to explain how cultic groups recruit, change, and control their members (Hassan, 1990; Lalich & McLaren, 2018; Lifton, 1963; Singer, 2003); however, no single theory encapsulates everything a survivor needs for recovering and healing. Thus, counselors often must be able to synthesize appropriate interventions from a broad range of approaches (DeYoung, 2009). Counselors need to implement treatment with intention, using a psychoeducational approach that takes into account general knowledge about how cultic groups affect people and also the specific needs of individual clients, to incorporate a trauma-informed approach for survivors who have been traumatized. Although treatment often covers a range of issues such as practical skills and concerns; developmental, relational, and emotional processes; and trauma, two overarching goals for their clients can guide clinicians in making informed choices about what is likely to be most beneficial to survivors: empowering autonomy and establishing connection to the self (Hassan, 1990; Herman, 1997; Singer, 2003). In this article, I highlight how counselors can pursue those goals as they address some of the common recovery needs of survivors, based on a narrative synthesis review of the literature.
A comparison of how various theoretical approaches define and describe cultic groups is outside of the purview of this paper. However, most cult theory references and is built on Lifton’s (1963) eight criteria of thought reform within totalistic environments. These criteria are still frequently used to evaluate groups and help survivors (Nunes & Timoner, 2007); readers who wish to know more about cult theory are encouraged to start with Lifton’s (1963) seminal work. The International Cultic Studies Association (ICSA) notes that within professional circles cult often refers to groups that use abusive or manipulative tactics (ICSA, n.d.). For the purposes of this paper, cultic groups are considered those groups that attempt to control, manipulate, or abuse members in ways that are likely to cause harm. Not every person who exits a cultic group will have had the same experiences, nor does every person who experiences cultic abuse necessarily struggle with posttraumatic stress or have the same struggles in integrating and adapting to a postcult life (Kendall, 2016; Lalich & McLaren, 2018; McKibbon, Lynn, & Malinoski, 2002). Although this article focuses on the segment of the population that is likely to have experienced trauma and abuse, and to have recovery needs as a result, the various sections should not be misunderstood to apply universally to every person who has been in or come out of a cult. Therefore, I encourage readers not to get caught up in defining a client’s experience for the client at the expense of looking at the client’s therapeutic goals and needs.
Practical Issues
Survivors of cultic groups share similarities with other populations, such as domestic-violence survivors and immigrants, particularly regarding practical matters that the survivors may need to address with the aid of a counselor (Herman, 1997; Kendall, 2016; Rosen, 2014; Singer, 2003). Those who come out of cultic groups may have experienced an inordinate amount of control exercised over their everyday lives (Hassan, 1990; Herman, 1997; Lalich & McLaren, 2018; Singer, 2003). Leaving one’s group often means losing not just an ideology but a support network, a livelihood, and even a home (Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014; Singer, 2003). Consequently, helping stabilize a survivor by addressing immediate and practical needs is paramount (Rosen, 2014).
Moreover, for many individuals coming out of highly controlling or abusive situations, leaving is not a process that happens all at once (Brown et al., 2005; Eichel, 2016; Herman, 1997; Lalich & McLaren, 2018). Counselors may watch clients return to a group or get involved in another group multiple times (Eichel, 2016; Hassan, 1990). In instances of domestic violence, researchers have found that it can take multiple attempts for a person to leave before leaving becomes final (Brown et al., 2005). Intermittent therapy is by no means an indication of failure of treatment (Eichel, 2016). Rather, the cycle of leaving and returning may be a process of one gathering the necessary internal resources to make a permanent choice (Brown et al., 2005; Herman, 1997). Therefore, clinicians need to be able to allow clients the autonomy to come and go as needed, and to provide a space that promises respect for clients’ autonomy and support that contrasts with the control of the group (Eichel, 2016). To this end, Eichel (2016) recommends pairing treatment with motivational interviewing to ensure that interventions meet survivors wherever they are in their process.
Stabilizing a clients’ immediate needs as much as possible is often a primary step in therapy (Rosen, 2014). Certain basic necessities, such as clients finding a place to live and acquiring a job, may need to be addressed before other types of therapeutic work become an option (Rosen, 2014; Singer, 2003). In this context, it’s important for clinicians to be aware of how profound the culture shock may be for survivors of cultic groups (Kendall, 2016; Lifton, 1963; Rosen, 2014; Singer, 2003). Rosen (2014) dubs cult survivors “invisible immigrants” (p. 21) who often experience difficulties in transitioning similar to those acclimating to a new location from other countries (Kendall, 2016; Rosen, 2014; Singer, 2003). Many survivors may need to develop new skills to handle money, seek medical care, and engage in various other tasks and make other decisions that a clinician might take for granted (Goldberg, 2006; Kendall, 2016; Singer, 2003).
If a survivor comes from a group in which employment was strictly controlled or kept within the confines of the group, the survivor may need assistance with finding a job. Often in situations of emotional or physical dependence, finding employment and managing finances become key in empowering someone to break free (Brown et al., 2005); however, in such cases in which lack of employment is a barrier to one’s leaving a group, a survivor may also lack relevant work experience. Like survivors of intimate-partner violence, cult survivors can learn to reframe the skills they used for survival into marketable language on a resume (Goldberg, 2006; Kendall, 2016; Morris, Shoffner, & Newsome, 2009).
Developmental Concerns
Counselors must be aware of both the similar and unique developmental aspects of recovery for both first- and second-generation survivors Frequently, survivors may struggle with issues related to decision-making and may find themselves grappling with rigid, black-and-white thinking instilled by the group.
Decision-Making Dilemmas
For adults who entered a cultic situation later in life (first-generation survivors), the demands, control, and absolute power of the group over the individual can have a regressive effect, infantilizing those who find themselves dependent on the leader or group for making decisions they previously might have been able to make on their own (Ward, 2011). Healing requires that they regain a sense of autonomy around their decision-making and life choices (Hassan, 1990; Singer, 2003).
Those who were raised in a group or brought in at a young age (second-generation survivors) face even more challenges around developmental recovery (Goldberg, 2006; Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014; Singer, 2003). With no outside influence during their critical stages of development, their personalities were formed within the cult (Matthews & Salazar, 2014; Singer, 2003). As such, they have no former identity on which to draw (Goldberg, 2006; Kendall, 2016; Lalich & McLaren, 2018; Lifton, 1963; Matthews & Salazar, 2014; Singer, 2003). As a result, many second-generation survivors may find choices overwhelming because they have had no previous opportunities to make decisions on their own (Matthews & Salazar, 2014). In interviews with second-generation survivors, Matthews and Salazar (2014) found that the extreme black-and-white thinking of the cult makes decision-making a terrifying experience whereby survivors search for the “one right answer” (p. 194). The concept that there may be multiple good choices or nuance to choice seems foreign.
Although some clients may be eager to assume responsibility for their choices and decisions, others may look to the therapist as a surrogate authority (Matthews & Salazar, 2014). Counselors should resist making decisions for clients and encourage them to develop autonomy and competence around decision-making; at the same time, they need to be mindful of the developmental limitations clients may have. In such cases, clients may need scaffolding and guidance in making their own decisions, with the counselor walking clients through the process of thinking through a choice.
A Black-and-White World
Both first- and second-generation survivors must fight conditioning for absolute obedience (Matthews & Salazar, 2014; Singer, 2003; Ward, 2011); however, second-generation survivors also have to contend with the developmental effects of such a rigid environment. Just as the cult world is split into us versus them, good versus evil, and right versus wrong, a child growing up in a cultic environment may experience a similar internal splitting that associates the infantilized, obedient parts of the child with the “good” group, and the individuating parts that begin to develop as the child ages with the “bad” outside world (Goldberg, 2006). Many children have been taught that any type of questioning or individuality is rebellion or sin (Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014; Singer, 2003).
The splitting of the “good” and “bad” parts of self tends to lead to the development of a secret self (Lalich & McLaren, 2018; Lifton, 1963; Matthews & Salazar, 2014; Rosen, 2014). Because the secret self often holds the parts of the survivor that craved freedom and autonomy, the secret self is a valuable tool in the recovery process (Matthews & Salazar, 2014; Rosen, 2014). It is important for counselors to strive for the client to join with the secret self, destigmatizing the desire for individual expression and validating the authenticity of the secret self. However, counselors also need to be aware of the risk of continued splitting (Goldberg, 2006; Lalich & McLaren, 2018). A client who is unable to integrate the seemingly opposing aspects of character may switch to splitting off and denying the cultic experience in an attempt to distance from the emotional pain and turmoil. Rosen (2014) underscores the role that friendships can play in helping the client break out of rigid, black-and-white thinking, stating that “learning to hear many opinions and to digest or reject those opinions can be enormously centering” (p. 24).
While the freedom to decide what to accept and believe may be liberating in some respects, it can also be distressing. Cults, while rigid, offer the comfort of an absolute worldview. For those who have not yet developed the ability to tolerate ambiguity, breaking out of black-and-white thinking can be as much an existential issue as a developmental issue. Counselors must be prepared to help clients learn to sit with their discomfort and resist the urge to constrict critical thinking even as they develop meaningful worldviews (Beck, 2006; Perach & Wisman, 2016).
Relational Issues
A good portion of a cult’s damage lies in the arena of connection and trust (Herman, 1997; Rosen, 2014). Within a cultic environment, the boundaries between the self and the group are violated in multiple ways, both disrupting the connection a person has to the self and muddying the distinction between the self and others (Herman, 1997; Lifton, 1963). Survivors may emerge from a group with little ability to maintain boundaries in a healthy way. Survivors of relational trauma in which boundary violations were the norm may not recognize typical red flags in other relationships; as a result, some individuals run the risk of repeatedly entering into toxic relationships (Herman, 1997). For others, trust seems daunting, if not impossible (Rosen, 2014). Having been violated by those closest to them, survivors may see all people as a threat. In addition, many survivors have been taught to fear the outside world, especially professionals such as law enforcement, doctors, and counselors (Bardin, 2005; Kendall, 2016; Lalich & McLaren, 2018; Singer, 2003).
Counseling will often need to involve an exploration of boundaries as survivors struggle to figure out a balance between having connection and protecting the integrity of the self (Kendall, 2016; Matthews & Salazar, 2014; Rosen, 2014). Counselors will first need to build trust with survivors. Counselors can model boundaries by setting and adhering to their own boundaries while simultaneously respecting those of their clients. Counselors must also be conscious of the power structure created or implied within the therapy room, acknowledging its existence and taking steps to ensure that the clients feel safe and capable of asserting their needs and boundaries with their counselors (Matthews & Salazar, 2014). The counseling experience offers an opportunity for healing connection whereby clients experience intimacy with boundaries (Herman, 1997). In therapy, survivors can also explore and practice social skills that they can apply in other relationships with family or friends (Kendall, 2016; Matthews & Salazar, 2014).
As therapy progresses, counselors can assist survivors in building an outer support network (Rosen, 2014). Clients may need to learn basic social expectations and norms of appropriate behavior, especially if they have been physically isolated from mainstream society (Kendall, 2016; Singer, 2003). Clients may also struggle with finding an appropriate balance in boundaries with others (Herman, 1997). For many who survived controlling and abusive relationships, boundaries often need to be rigid before they can become flexible as survivors learn to trust their own ability to hold a boundary and respond to violations (Czerny, Lassiter, & Lim, 2018). Matthews and Salazar (2014) point out that cultic groups often limit all major social relationships to those within the group; therefore, survivors may benefit from developing a diverse body of connections with people from multiple social groups and settings.
Group-therapy situations have the potential to be healing for survivors by providing connections with others who have gone through similar circumstances (Durocher, 1999; Matthews & Salazar, 2014); however, just as clients may initially distrust an individual therapist, they may also find it hard to trust a group-therapy situation. Because group therapy can devolve into toxic practices, groups should be facilitated by someone who is knowledgeable about totalistic influence and who can monitor and intervene should the group begin demonstrating concerning signs (Lalich & McLaren, 2018). The presence of a cofacilitator can also be an important check on the power of the group leader.
In addition to building new connections, many survivors will need to take some time to grieve the connections they have lost in leaving a cultic group (Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014; Rosen, 2014). No matter how abusive or toxic the group was, it is important for clinicians to realize that one of the draws of cultic groups lies in the intensity and closeness of the relationships formed (Herman, 1997). Survivors will have happy memories in addition to negative ones and may find it hard to accept the existence of both simultaneously. They will often lose contact with loved ones. The losses need to be honored and grieved (Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014; Rosen, 2014). Particularly for second-generation survivors, leaving may mean losing every major connection they have (Kendall, 2016; Lalich & McLaren, 2018; Matthews & Salazar, 2014). Often, the loss of connection may be the result of shunning practices of the group that treats a member who leaves as a nonperson, as dead or nonexistent, or as a stranger (Hassan, 1990; Kendall, 2016; Lalich & McLaren, 2018; Lifton, 1963; Singer, 2003). However, there are times when individuals may find that they must make the choice to cut off former abusive connections for their own well-being or to maintain boundaries (Celani, 2016). Either way, counselors must be able to help survivors process and grieve their losses.
Emotional Issues
Cultic environments are saturated with pervasive guilt and fear (Hassan, 1990; Lifton, 1963; Perry, 2006). As mentioned previously, fear of the outside world and of authority figures such as law enforcement, counselors, or doctors often will have been deliberately fostered within the group (Barden, 2005; Casoni, Pacheco, & Kropveld, 2015; Singer, 2003; Ward, 2011). Additionally, members may have been told that leaving the group would result in their death, whether through direct retaliation from the group or through fated acts of divine will (Hassan, 1990; Kendall, 2016; Nunes & Timoner, 2007; Singer, 2003). Members frequently have been conditioned to feel worthless and guilty on an existential level (Hassan, 1990; Kendall, 2016; Lifton, 1963), and they may have been inured to accept responsibility for their abuse (Herman, 1997; Kendall, 2016; Ward, 2011). While it is somewhat normal for those who experience overwhelming, violent, or life-threatening events to struggle with a certain amount of fear, shame, and self-blame (Rothschild, 2000), cult survivors have the added layer of deliberately instilled guilt, shame, and fear. Survivors may have very specific phobias that need to be addressed for them to reclaim normative experiences such as sexuality or leisure (Hassan, 1990). Because most fears may be largely ungrounded in reality (Matthews & Salazar, 2014), survivors will benefit from learning how to question and dismantle their fear (Hassan, 1990; Matthews & Salazar, 2014). However, Matthews and Salazar (2014) discourage dismissing physical threats from the cult without careful consideration of whether those threats could be carried out; some groups can become particularly dangerous or violent when people try to leave (Lalich & McLaren, 2018; Singer, 2003).
Although it might be helpful for survivors to notice patterns of response that might put them in vulnerable positions, generally they will need to let go of a sense of over-responsibility for their abuse (Rosen, 2014). It is necessary to empower them to see opportunities for choice or change moving forward, while not blaming them for what they experienced in the past (Herman, 1997).
Leaving a cultic group or abusive relationship is complicated. Regardless of whether a survivor could have physically exited the abusive situation earlier, emotional readiness is equally important. Questions such as “Why didn’t you just leave?” or “Why did you stay/join?” are often far more stigmatizing than helpful (Rosen, 2014).
One particularly sensitive area of guilt with which survivors may contend is in regard to their own participation in unethical or abusive practices toward others. A totalistic system is designed to gain the compliance and participation of those within it (Lalich & McLaren, 2018; Lifton, 1963). Different groups have different ways of involving members. Some have members participate in scam-like activities that involve deception and exploitation of nonmembers (Hassan, 1990; Singer, 2003). However, even in the absence of con-like activity, most members will be pressured into participating in the abuse of fellow members, be it parents physically abusing their children according to doctrinal instruction or peers emotionally or physically abusing each other (Bardin, 2005; Casoni et al., 2015; Kendall, 2011, 2016; Lalich & McLaren, 2018; Lifton, 1963; Matthews & Salazar, 2014; Singer, 2003). Survivors may need assistance in coming to terms with how they have harmed others (Casoni et al., 2015; Matthews & Salazar, 2014). When possible, making amends may be healing; however, Matthews and Salazar (2014) emphasize that options of how to reconcile safely may be limited if those to whom a survivor wishes to make amends are still in the cult. In such instances, symbolic interactions, such as role playing and letter writing, may be beneficial for the survivor.
Processing and Making Meaning
For those coming out of cultic groups who have been traumatized, it is often difficult to pinpoint a single traumatizing event because they may have experienced continual psychological and emotional abuse (Hassan, 1990; Herman, 1997; Kendall, 2016; Lalich & McLaren, 2018; Lifton, 1963; Rosen, 2014; Singer, 2003). Many also contend with physical and sexual abuse (Herman, 1997; Kendall, 2011; Rosen, 2014). As a result, survivors may display a range of trauma symptoms, including but not limited to hypervigilance, somatic distress, flashbacks, nightmares, state-dependent emotional memories, phobias, and difficulties with emotional regulation (Herman, 1997; Kendall, 2016; Lalich & McLaren, 2018; Lifton, 1963; Singer, 2003). Those who grew up in the group may have additional markers of complex posttraumatic stress (C-PTSD) that manifests as splitting, relational turmoil, depression, anxiety, and self-harm (Herman, 1997; Kendall, 2016). Singer (2003) and Herman (1997) both warn about the possibility of misdiagnosis. Some clients may even exhibit symptoms of psychosis (Lifton, 1963; Rosen, 2014; Singer, 2003); however, clinicians should be wary of overlooking the severe effects of the trauma of an abusive system. Singer (2003) has actively discouraged the diagnosis of psychosis with cult survivors, indicating that hallucinations and paranoia are often a result of conditioning. Rosen (2014) has further clarified that symptoms which can resemble other diagnoses can be a misattributed aspect of C-PTSD.
As with many forms of relational trauma, those who are recovering from a cultic experience will need to process what has happened to them. Although processing can be done in a number of ways, these methods must provide a means for survivors to tell their own stories and create a sense of understanding and meaning around them (Herman, 1997; Rosen, 2014). Although recent developments in trauma treatment indicate that telling the trauma story is not always necessary for healing, when the trauma involves relational wounds, shame, and silencing, telling one’s story becomes an act of reclamation important to the healing process (van der Kolk, 2015). The very act of telling the trauma story is a healing intervention, particularly while in a relationship with a counselor who believes, validates, and empathizes with the pain of the trauma (Herman, 1997; van der Kolk, 2014).
Determining the most effective method to facilitate processing and making meaning will depend upon each survivor’s individual experience. Although evidence-based trauma treatments have grown over the years, no single trauma treatment has been found to work for all trauma (Brom et al., 2017). Van der Kolk (2014) encourages clinicians treating trauma to be open to finding what works for each individual as opposed to assuming one way is the right way. The need for individual considerations is especially important in the case of survivors of abusive groups. Because cultic groups can use a variety of tools and techniques to manipulate and influence members, including modalities that can also be used for therapeutic purposes, clinicians should take precautions to ensure that any intended therapeutic intervention does not inadvertently retraumatize a survivor (DeYoung, 2009; Herman, 1997). Treatments that may resemble techniques used to control or abuse can create distrust or distress; thus, informed consent and reinforced autonomy throughout the therapeutic process are essential (Aguado, 2015; DeYoung, 2009; Singer, 2003).
Psychoeducation
Psychoeducation about cultic groups is one of the interventions whose importance has been emphasized consistently throughout the development and understanding of cult theory (Hassan, 1990; Herman, 1997; Lalich & McLaren, 2018; Lifton, 1963; Nunes & Timoner, 2007; Rosen, 2014; Singer, 2003). Psychoeducation serves to empower survivors by helping them understand and develop a language to talk about their experiences. It also helps survivors realize they are not alone in going through the recovery process. Additionally, understanding how cults function contributes to survivors’ ability to recognize warning signs and avoid repeating their experiences with other relationships or groups. Survivors may also benefit from understanding common responses to existential terror and worldview threats (Hayes, Schimel, & Williams, 2008). For many trauma survivors, the healing process is painful and can be long and overwhelming (Herman, 1997). By giving survivors a framework within which to understand both their cultic experiences and their process in recovery, clinicians also give the survivors a sense of purpose in their pain. Many survivors, in turn, find that educating others about the cultic experience and participating in actions to help others is itself rewarding and healing (Lifton, 1963; Matthews & Salazar, 2014).
Eye Movement Desensitization and Reprocessing
Eye movement desensitization and reprocessing (EMDR) has been gaining popularity as a trauma treatment because of its high rates of success in resolving trauma in adults, along with growing indications of its successful application with children (Boukezzi et al., 2017; de Roos et al., 2017; van der Kolk, 2015; van der Kolk et al., 2007). EMDR involves a client tuning into a distressing memory while undergoing bilateral stimulation, the most common of which involves visually following the fingers of the clinician to stimulate a kind of rapid eye movement (EMDR Institute, n.d.). Recent neuroimaging research indicates that EMDR leads to increases in gray-matter density in the medial prefrontal cortex, an area of the brain that is often inhibited following a traumatic event but which is key to emotion regulation and higher-order processing (Boukezzi et al., 2017; van der Kolk, 2014). However, DeYoung (2009) has cautioned that “cult members frequently remain afraid of any type of procedure that hints of ‘mind control’ or hypnosis-like techniques” (p. 148) and recommends that clinicians help clients understand how the process works. Survivors may especially need to know that EMDR does not require them to lose their orientation to reality (EMDR Institute, n.d.). Rather, EMDR assists a client in encountering a traumatic memory in order to process and reintegrate it, using an associative process that seems to mimic the role of dreams (DeYoung, 2009; van der Kolk, 2014).
In a 2009 case study, DeYoung related how he used EMDR to successfully help a former cult member process and integrate certain aspects of her trauma, with a 3-year follow-up indicating that treatment remained successful for the specific targeted memories. However, DeYoung (2009) noted that EMDR was not sufficient on its own as a treatment and that other interventions were necessary to address other aspects of recovery. Van der Kolk and colleagues (2007) found similar results related to complex trauma in a study comparing EMDR to fluoxetine and placebo. Although EMDR was highly effective overall in the study, the researchers found that it was most effective for adult-onset PSTD, concluding that short-term EMDR may not be sufficient for complex and developmental trauma (van der Kolk et al., 2007). Although EMDR is designed to help a client remain engaged, Rosen (2014) has expressed concern that EMDR may lack pacing elements to prevent a client from becoming overwhelmed with dissociation; therefore, for clients who lack the capacity to moderate their dissociative responses, other interventions with built-in stabilizers may be more appropriate.
Sandtray
In working with survivors who experienced trauma, particularly developmental or relational trauma, methods of externalizing and symbolizing can be helpful in making the trauma feel safer to explore (Malchiodi, 2015). Sandtray offers a method of utilizing alternate states of consciousness that blends absorption with conscious engagement in ways similar to active imagination (Boik & Goodwin, 2000). Depending on the approach of the practitioner, sandtray therapy can involve an exploration of family and social roles or patterns, a method of safely reexperiencing the trauma and resolving it, a means of seeking meaning around the trauma, or a method of interacting with parts of the self or internalized representations of others (Eberts & Homeyer, 2015; Graham, 2016; Webber & Mascari, 2008). Because of the use of figures and symbolism, sandtray is particularly useful at helping clients create meaning around their experiences.
Meditation and Mindfulness
Like EMDR, mindfulness is currently in vogue as a means of therapy and boasts impressive evidence as to its effectiveness (Baer, 2015; Doll et al., 2016; Porges, 2017; Singleton et al., 2014; van der Kolk, 2014). Mindfulness can be used to treat anxiety and depression and also trauma (Baer, 2015; Desmond, 2016; Doll et al., 2016; Rothschild, 2000). It can also be effective at helping individuals learn new ways to relate interpersonally with others or to develop self-compassion toward themselves (Baer, 2015; Desmond, 2016). Like EMDR, mindfulness seems to have neurophysiological effects on brain structures affected by trauma (Doll et al., 2016; Porges, 2017; Singleton et al., 2014). Porges (2017) has highlighted how mindful breathing can stimulate the neurophysiological state associated with safety, healing, and growth, thus successfully combatting the neurophysiological states associated with mobilization or freezing. Neuroimaging studies show that mindfulness can help calm hyperactivity in the amygdala and increase prefrontal-cortex control, thus increasing emotional regulation (Doll et al., 2016).
However, although mindfulness may be effective with some survivors, mindfulness as a therapeutic intervention comes with a warning. There is a tendency for clinicians to view meditation as if it were a panacea, despite the fact that it is not appropriate for everyone and can create severe negative reactions in some (Rosen, 2014; Rothschild, 2000; Singer, 2003). This attitude may be particularly problematic with cult survivors since meditation has been heavily coopted by destructive groups as a means of control, disconnection, and dissociation (Lalich & McLaren, 2018; Rosen, 2014; Singer, 2003). For example, one of the therapeutic goals of mindfulness is often to help clients relax and engage the senses as a means of mitigating anxiety and dissociation. For the many cult survivors who have trauma related to meditation practices, however, mindfulness that resembles meditation can exacerbate rather than help symptoms of anxiety or dissociation (Rosen, 2014; Singer, 2003). In such cases, finding other ways of accomplishing that goal may be needed. Rothschild (2000) outlined several ways that clients can disperse anxiety and tension if mindfulness exercises create negative reactions. Exercising, progressive tensing, or body training, for instance, may be more relaxing for many survivors than sitting meditations. Yoga can also be an avenue through which a survivor can access the benefits of mindful breathing without the traditional meditative sitting (Porges, 2017).
Survivors who exit meditation-based cults may still be able to use meditation techniques as part of healing, with it perhaps offering an opportunity for them to reclaim the same techniques from a different standpoint. Whereas in the cult survivors may have had meditation used to disconnect them from their emotional responses, particularly anger or doubt (Hassan, 1990; Lalich & McLaren, 2018; Singer, 2003), they may still be able to use this technique as a means of connecting with alienated emotions and learning acceptance and self-compassion within their healing process (Desmond, 2016). With that being said, the ultimate decision of whether to engage with and reclaim mindfulness practices (or any practice formerly used within a cult) should reside with the individual.
Creativity
There is growing evidence that creativity is an important vehicle for healing from trauma (Forgeard, 2013; Malchiodi, 2015). The value of creativity in recovery and growth is perhaps higher for survivors of cultic abuse (Jenkinson, 2010). Art and music are often tightly controlled and used within a cult to discourage individuality and increase conformity. Creative therapies can offer survivors a means to reconnect with their core and express themselves in a safe, healing environment (Jenkinson, 2010). Music therapy, for instance, can help survivors access, express, and process emotions (Sammons, 2011). Vocal music can help stimulate the neurophysiological state associated with safety, effectively helping calm the hyperarousal associated with trauma and facilitating social engagement and emotional regulation (Porges, 2017). Exercises such as drumming or improvisation can also help survivors explore the concept of connection and boundaries (Wolfe, 2011). Although intrusive rumination is associated with negative outcomes, deliberate and creative interactions with trauma are correlated with posttraumatic growth, which suggests that survivors who engage in creative and expressive arts from a therapeutic standpoint may be better equipped to process their experiences and find purpose and meaning around them (Forgeard, 2013). However, because survivors are frequently encouraged to use thought-stopping techniques to distract from emotions, doubts, and memories not supported within the cult (Hassan, 1990), clinicians may need to assist survivors in destigmatizing the expression of those elements.
Somatic and Movement-Based Interventions
As growing evidence emerges that not only the mind, but also the body stores trauma (van der Kolk, 2014, 2015), the importance of bringing in bodily techniques is becoming more evident. Some somatically focused interventions use a bottom-up method, meaning treatment primarily focuses on the body (Rothschild, 2000). For instance, Somatic Experiencing (SE) is a form of treatment that can help a trauma survivor discharge the physical energy stored from trauma by completing emotional and physical responses that have been stored in the body (Brom et al., 2017; Foundation for Human Enrichment, 2016; Levine, 1997; Parker, Doctor, & Selvam, 2008; Rothschild, 2000). Rosen (2014) recommends SE as part of trauma treatment for cult survivors because, in addition to helping survivors move through trauma, it can also facilitate survivors’ learning to pace their own process by shifting their focus between trauma sensations and anchors or calmness. Although SE is a specific technique that requires extensive training, clinicians can incorporate somatic forms of processing in other ways that can also be beneficial in helping clients re-embody and heal (Levine, 1997; Rothschild, 2000). For clients who may not be able to tolerate body attunement, body mapping may provide a means of exploring the physicality of trauma by externalizing it onto paper and blending body awareness with creativity such as coloring or drawing (Santen, 2015). Other interventions, such as authentic movement, drama, or dance movement therapy, also use the body as a tool for a more creative process and offer opportunities for an internal healing by stimulating the social-engagement system through connection to the unconscious (Bacon, 2012; Gray, 2015; Haen, 2015; Stromsted, 2009; Tantia, 2012).
A Note About Alternate States of Consciousness
Some trauma-specific interventions may involve or facilitate an alternate state of consciousness as a means of stimulating healing and transformation (Bacon, 2012; Boik & Goodwin, 2000; Singer, 2003; Tantia, 2012). Given the type of trauma that many cult survivors have experienced, such as prolonged, induced states of altered consciousness or inescapable interpersonal stress and physical or relational abuse, survivors may be particularly susceptible to dissociative states (Herman, 1997; Kendall, 2016; Porges, 2017; Rosen, 2014; Singer, 2003). Although dissociation can cause significant difficulties, it is not, in itself, a completely negative phenomenon. Rather, dissociation is a protective function of the psyche in response to trauma or overwhelming threat to the self (Herman, 1997; Levine, 1997; Lifton, 1963).
Historically, dissociation has been seen as relatively negative. However, recent research investigating the positive effects of dissociative states indicates that dissociation in some instances can activate healing by stimulating social engagement with one’s self or with transpersonal images (Granqvist, Gewirtz, Mikulincer, & Shaver, 2012; Granqvist, Hagekull, & Ivarsson, 2012; Stromsted, 2009; Tantia, 2012). Thus, helping clients learn to use their dissociative states to reconnect with themselves or to foster a spiritual sense outside of the cult may ultimately be a more powerful form of healing than trying to end dissociation. With that being said, counselors should be especially careful with their use of alternate states. As with creativity, cults often use the capacity for absorption and alternate states of consciousness to further the influence over members when they are more vulnerable to suggestion and influence (Aguado, 2015; Jenkinson, 2010; Singer, 2003). It is especially important with cult survivors that counselors elicit meaning from the client rather than imposing meaning on the client (Boik & Goodwin, 2000). Moreover, clinicians should never use an alternate state of consciousness without first educating clients about the process, what the risks are, and how they can make informed choices to protect themselves. This holds true for everything from deeply trance-like processes such as authentic movement to seemingly normative activities such as music and dancing (Aguado, 2015; Nunes & Timoner, 2007; Tantia, 2012; Wolfe, 2011).
Ethical Issues
There are a number of ethical issues that counselors should keep in mind in working with survivors of cultic groups. Those associated with power dynamics and cultural sensitivity are particularly important.
Power and Control
Although multiple theoretical orientations can be adapted to work effectively with cult survivors (Eichel, 2016; Goldberg, 2006; Rosen, 2014), a client-centered approach is imperative. Because of the way power and authority are abused within cultic environments, counselors run the risk of repeating toxic power dynamics unless there is active intention directed toward deconstructing the power within the counselor-client relationship (Matthews & Salazar, 2014; Rosen, 2014). Counselors who assume a savior-like role run the risk of further inhibiting the empowerment of the client (Herman, 1997); additionally, treatments that take control away from the client, perhaps by fostering obedience or acquiescence to therapist instructions, may seem effective in changing behaviors or achieving goals, but ultimately may reinforce an unhealthy power structure that fails to foster either autonomy or critical thinking.
Survivors of cultic groups often come to counseling in vulnerable states, many leaving behind the very views with which they made sense of the world. In many ways, survivors may resemble children because the group has deliberately stunted or regressed their development (Singer, 2003; Ward, 2011). While counselors may need to foster the emotional growth of clients, they also must be conscious of the fact that many clients may be looking for a new anchor. Counselors need to be wary of clients developing dependency on the counselor as an authority figure to replace their lost leader or group (Matthews & Salazar, 2014; Rosen, 2014).
Multicultural Concerns
Counselors must also show a willingness to learn from their clients. A general knowledge of cultic techniques is beneficial, but it cannot replace the personal perspective and experience of the individual (Matthews & Salazar, 2014; Rosen, 2014). This principle is especially important when one considers the intersectionality of various identities. None of the literature I found for this paper examines the specific experiences and needs of survivors who fall under the Queer umbrella, or for survivors of color, two populations that may have to contend with discrimination or abuse in other arenas as well.
As “invisible immigrants” (Rosen, 2014), cult survivors often have a unique culture compared to the surrounding community in which the cult resides. Rosen (2014) emphasizes the importance of not pathologizing culturally different practices that may have been part of a cultic group’s beliefs or culture. When it comes to family types, religious beliefs, or alternative lifestyles, she reminds counselors to remember that it is not necessarily the practices or beliefs themselves that are toxic, but the abuse and control of the group. Not everything within the cultic group will have been toxic, and there may be ways in which survivors feel their experience was beneficial to them as well (Kendall, 2016; McKibbon et al., 2002). Survivors may want to reclaim some of the positive cultural aspects of the cult that still resonate with them, and to learn how to incorporate those values and practices in healthy ways (Rosen, 2014). Thus, for their work with nontraditional families, minority groups, and uncommon beliefs, counselors may need to further educate themselves on multicultural competencies.
Limitations to Application
Although I have attempted to present some of the potential applications of some treatment modalities in this article, it is limited largely because of a lack of clinical research on this particular population. Parallels can be drawn between other populations such as refugees or survivors of complex trauma and intimate partner violence, but clinicians must keep in mind that generalizations may be limited (Herman, 1997; Rosen, 2014; van der Kolk, 2014). Even within the field of trauma research, not much has been done to differentiate which types of trauma may respond best to different types of treatment (Brom et al., 2017; van der Kolk, 2014). More research needs to be conducted on the effectiveness of interventions for complex, relational, or developmental trauma versus single-incident trauma, and also on the application of treatment modalities in the case of comorbid diagnoses.
Conclusion
Cult survivors are a unique and often overlooked population within the mental health field. Working competently with a survivor to foster recovery and healing requires knowledge of how abusive systems can affect individuals. Although cult survivors share similarities shared with other types of populations, their experiences also embody unique features that must be understood and addressed (Singer, 2003). In this narrative synthesis review, I have identified no single treatment as the definitive way to work with survivors of cultic abuse; but a thorough knowledge of trauma and cult theory can guide a clinician in making informed choices about what kinds of interventions may work best with individual clients.
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About the Author
Rachel Oblak, MA, earned her Master’s in Clinical Mental Health Counseling from Antioch University New England and is a nationally certified counselor through the National Board for Certified Counselors. She is working toward licensure in Vermont, where she owns a private practice. She has experience working with depression, anxiety, sexuality and gender identity, hearing voices, trauma, cult survivors, transitioning adults, grief, and emerging young adults. She also works with individuals on job burnout and wellness issues.
She originally wrote this article as part of a supervised independent study while attending Antioch for her master’s degree. Correspondence concerning the article should be directed to Rachel Oblak, 8031 Williston Rd. Suite 2, Williston, VT 05495. Contact: roblak@antioch.edu