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Mental Health Interventions

Cultic Studies Journal, 1984, Volume 1, Number 2, pages 156-166


Mental Health Interventions in Cult-Related Cases: Preliminary Investigation of Outcomes

Steve K. Dubrow Eichel, M.S.

Linda Dubrow Eichel, M.A.

Roberta Cobrin Eisenberg, M.S.W



Abstract


Data from 19 cult-related mental health consultations were systematically examined using a modified repeated case study design. The sample consisted of, on the average, white, predominantly college-educated individuals in their late 20’s. Males outnumbered females 2 to 1. The groups represented were almost equally divided between pseudotherapy-oriented, Eastern/meditation oriented and miscellaneous categories. Perhaps due to an overrepresentation of mass therapy groups, this sample seemed older and better educated than other samples. Following a variety of interventions, positive outcomes were reported in 10 of 15 (67%) cases in which outcomes were determined. This study’s limitations include selection bias, investigator paradigm effect, lack of comparison groups, and multiple treatments.

Do our interventions work? This question is undoubtedly on the minds of many professional counselors and lay advisors engaged in clinical work with cultists, former cultists, and their families. Since October 1983, the associates of the Re-Entry Therapy, Information and Referral Network (RETIRN) have maintained a record of all face-to-face consultations and subsequent interventions with individuals and families who seek assistance with cult-related problems. Whenever possible, we have followed (and continue to follow) cases after interventions are made in order to determine outcome.

Between October 1983 and October 1984, RETIRN associates consulted in 19 cult-related cases. We were able to determine definite or probably outcomes in 15 of them (79%). It is important to note that RETIRN was not the primary intervention agent in every one of these cases. Two families received short-term counseling from RETIRN and, following these sessions, decided to contact an outside deprogrammer (prematurely, we believed, in one instance). In another case, family counseling again resulted in a decision to utilize deprogramming: a former cultist who consults to RETIRN participated in part of it, but the overall effort was organized and led by a specialist not associated with RETIRN. In a few cases, the RETIRN intervention consisted of an evaluation and subsequent referral to appropriate mental health resources. At other times, the RETIRN intervention consisted of short-term, goal-oriented individual counseling or long-term psychotherapy. The cases and interventions reported here are therefore quite varied.

Singer (1978, 1979), Galper (1982), Goldberg & Goldberg (1982) and Langone (1983) have documented and attempted to validate clinically the construct of post-cult syndromes arising from prolonged exposure to indoctrination (“mind control” according to some) and various forms of stress-induced consciousness-altering techniques. They have reported on their psychotherapeutic work with former cultists and have suggested guidelines and strategies for counselors. Our report attempts to describe the range of situations and interventions we have encountered, to relate these to outcomes, and to suggest ways of quantifying the degree to which these interventions are successful.
Limitations of the Study

As a form of exploratory clinical research, our study suffeers from certain expected shortcomings (Barber, 1976). The issue of applying an appropriate paradigm to the planning, conducting, and interpretation of cult-related research is an example of one of these shortcomings. Most of what is a present known about cults has been obtained without the benefit of studies that employed true experimental design. We have thus far been dependent on subjective personal accounts, investigative reports, sociological analyses, and the results of quasi-experimental studies for the construction/validation of a paradigm that accounts for cult existence and behavior. It is unlikely that cults will permit objective, scientific studies in the near future. It is equally unlikely that we will be able to duplicate cultic situations and environments for experimental purposes because to do so would probably require pronounced violations of established ethical guidelines for conducting research with human participants (Ad hoc Committee on Ethical Standards in Psychological Research, 1978). That leaves researchers in the uncomfortable position of having to rely on paradigms that, while useful in other academic pursuits, may not be appropriate for the study of radical politico-religious groups.

After thoughtfully considering the literature on the psychology of thought reform, the available information about cultism, and our own experiences as clinicians and onetime targets of cult indoctrination, we find ourselves agreeing with Langone and Clark (1983): the evidence, subjective as it is at times, strongly supports the contentions that thought reform exists as a fairly well-understood and discrete social-psychological process that is utilized destructively by cults. Thought reform and what Singer (1982) terms the “systematic manipulation of social influence” constitutes the paradigm RETIRN utilizes, and it is this paradigm that makes our clinical study vulnerable to what Barber (1976) has termed “investigative paradigm effect” (pp. 4-12).

Our study contains other pitfalls as well (Campbell and Stanley, 1963). We did not utilize a sampling strategy, comparison group, or any kind of pretest measure. We have attempted to take into account the effects of history and maturation by making careful appraisals of backgrouns, events leading up to and since cult involvement, family factors, and other past and present influences on behavior/personality. However, we did not control or account for the effects of selection, expectancy, or multiple treatments.

We are, then, reporting a series of case studies and not the results of an experimental study. Our findings may or may not be valid or generalizable to other cultists. These questions will only be answered in time as additional data are collected under more controlled conditions.
Measures

Our outcome measures were generally informal: they consisted of self-reports, the reports of families and friends, and ongoing clinical evaluations during treatment. We defined a “successful” outcome as either: (1) one in which the client decided to exit the group and re-evaluate his/her beliefs and lifestyle in a productive manner, or (2) one in which cult/group participation was determined to be secondary to a more primary destruction problem (e.g., chronic drug abuse or suicide potential) and the client took clear and sincere action to remedy this problem (e.g., voluntary assignment to a drug rehabilitation program). And “unsuccessful” outcome was one in which the client remained in the cult/group and/or there was no apparent movement toward resolution of an underlying, more primary problem. “Undetermined” outcomes were cases that fell somewhere in between the former two categories. Sometimes the outcome was mixed, as with one client who was diagnosed as emotionally disturbed but whom we were able to help through referral to a cult-aware psychiatrist. This client has become distant but (to our knowledge) not disassociated from his cult. Both of the situations in which a plan of action involving exit-counseling or voluntary deprogramming has been decided on, or is in the presence of formulation, but has not yet been implemented.

Results

Demographic data

Our clients were all white, almost all either in college (N=5) or college graduates (N=12), total N=27 (89%), and generally from middle-class to upper middle-class or urban or suburban socioeconomic backgrounds. A large proportion (N=11, 58%) were from Jewish families (this figure is more indicative of RETIRN’s referral sources than it is necessarily representative of cult membership). Three (16%) of our clients were from Catholic families, four (21%) were from Protestant families. Only one client came from a mixed/nonreligious background. In age, our clients ranged from 19 to 56; the mean age was 28.8 with a standard deviation of 8.43 years. This mean becomes 27.3 years (standard deviation of 5.6) if one factors out the 56-year-old client, who was 16 years older than the second oldest client, compared to an average distance between adjacent ages of only 2 years, not counting the 56-year-old.

The cult or groups represented in our case-loan can be divided into 3 “type,” with each containing roughly one-third of our clients. Table 1 details our clients’ affiliation.

Table 1

RETIRN Clients’ Involvement in Groups by Category


Category

Number of Clients

Percent of All Cases

Prior Group Affiliations (1)


Eastern/Meditation

7

37%


ISKCON (Hare Krishna)

4

21%

1


DLM

1

5%

1


Rajneesh

1

5%

1


Other

1 (TM)



Mass Thp./Therapy-Oriented

6

32%


Est

3

16%


Scientology

1

5%




Insight/MSIA

2

11%


Other

3 (LRT, Lifespring, Rebirthing)



Miscellaneous

5

26%


Bawa Muhaiyaddeen Fellowship

2

11%


Church of Immortal Consciousness

2

11%


Beth Yeshua (Messianic Jewish)

1

5%


Undetermined

1

5%

Refers to groups belonged to prior to most recent and primary group involvement, e.g., a client who belonged to Lifespring prior to becoming involved in ISKCON.
Outcomes

Because we were not able to determine outcomes in all cases, we computed the success/failure rate both as a percentage of the total number of cases (determined and undetermined outcomes) and as a percentage of the total number of determined cases alone. These results are summarized in Table 2.
Table 2

Number of Successful and Unsuccessful Outcomes for RETIRN Cases


Number

Percent of Determined Cases

Percent of all cases


All Cases

19

100%



Determined Cases (1)

15

79%


Successful

7


Probably Successful

3


Total Successful

10

65%

53%



Undetermined Cases (2)


Terminated

2


Ongoing

2


Total Undetermined

4

21%

Cases in which RETIRN was able to determine the outcome following intervention(s).
Cases in which RETIRN has not yet determined outcome.

Table 3 allows a somewhat more detailed examination of interventions and outcomes on an individual, case-by-case basis. In 3 cases, our clients reported a history of involvement in more than one cultic group. One woman had a lengthy history of such prior involvements. Before being deprogrammed from her most recent cult, she had been involved in 4 other groups.

Prior cult involvements and other factors made it difficult to determine accurately the length of involvement in cults in all cases. Length of involvement ranged from just under one year to just over 12 years; most of our clients had been involved in their cult(s) for 2 to 6 years.

Table 3

Summary of RETIRN Consultations

AGE/SEX REFERRAL SOURCE GROUP

-RETIRN INTERVENTION

-OUTCOME

27 F anticult activist Beth Yeshua

-Consultation with mother, with plan developing for voluntary exit-counseling. Case on hold for mother’s personal reasons.

-Ongoing

22 M CFF Philadelphia ISKCON

-RETIRN consultant participated in deprogramming. Client went to Unbound.

-Client left IKSCON, intermittently follows up with RETIRN consultant.

37 M Newspaper article Scientology

-Re-entry therapy followed by ongoing individual psychotherapy with RETIRN clinical associate.

-Client left Scientology. Continues in psychotherapy.

30 F Newspaper article est

-Exit-counseling with RETIRN clinical associate (3 sessions).

-Client no longer involved with est. Sessions terminated just prior to client moving from area: potential referral sources in new location suggested.

26 M Newspaper article Muktananda

-Evaluation and consultation session with mother. Based on history, likelihood of emotional distubance seemed high. Information given.

-Family was disorganized and could not take any action.

23 M Anticult activist ISKCON/Lifespring

-Evaluation with father and sister. Voluntary deprogramming in Israel was set up, but did not succeed. Family counseling was recommended prior to any other action, due to RETIRN perception that further action within present family context (i.e., conflict) would be prone to failure.

-Mother declined counseling and, against RETIRN recommendations, sought involuntary deprogramming. Deprogramming appeared successful, but client left rehab and returned to ISKCON.

27 M CFF Philadelphia ISKCON

-Client returned to individual re-entry therapy with RETIRN clinical associate after 2-year hiatus due to renewed floating experiences.

-Client withdrew from therapy prior to complete resolution of problem.

27 M JFCA and TV ISKCON

-Consulted with mother and client in consideration of deprogramming.

-Client determined to be severely disturbed emotionally. Deprogramming not advised. Client continues to live with mother.

25 F Northeast Synagogue Council est

21 M (brother/sister)

-Consultation with mother and telephone consultation with brother. Voluntary deprogramming with sister. Brother attempted suicide after est basic. Brother’s therapist contacted.

-Sister chose to remain in est after boyfriend in est gave her engagement ring immediately following deprogramming. Brother continues in traditional outpatient psychotherapy and to date no longer continues with est.

29 F Newspaper article Church of Immortal Consciousness (prior groups: LRT, TM, Rebirthing, DLM)

-Consulted with parents, who then chose involuntary deprogramming. Parents seen intermittently for supportive counseling. Daughter went to rehab following deprogramming.

-Client left group, went to Unbound, and is at present being seen in outpatient ongoing re-entry therapy by RETIRN associate. Also attends group therapy with other former cultists.

33 M Prior client Church of Immortal Consciousness

-Client was not deprogrammed, but managed to accompany fiancée (prior client) to rehab, then back to Philadelphia. Seen in individual re-entry therapy by RETIRN associate.

-Client left group, but is floating. Client terminated from therapy due to repeated violation of limits regarding no use of drugs prior to sessions (seen 5 times).

21 M Mother’s therapist DLM

-Three consultation sessions with family and close friends (sever psychopathology suspected).

-DLM member made a predicted suicidal gesture and was successfully referred to cult-aware psychiatrist. Client continues to see psychiatrist and is on medication. Is now distant from, but not completely broken from, DLM.

19 M Northeast Synagogue Council Undetermined

-Consultation with mother and father, followed by 5 sessions of couples’ therapy with RETIRN clinical associate. Goal of sessions was to assist parents to develop a plan to get son into therapy. Legal referral also made.

-this case was determined to be not primarily cult-related. Options were explored, but due to parents’ unresolved anger toward their son, no action was taken. Son remains a legal dependent of alternative family “group.”

40 F Newspaper article Insight/MSIA

-Exit counseling with RETIRN clinical associate.

-Client resigned minister status in MSIA and chose to remain involved to some degree.

31 F AFF Bawa Muhaiyaddeen Fellowship

-Exit-counseling and re-entry therapy with RETIRN clinical associate.

-Client left group

31 M Husband of above Bawa Muhaiyaddeen Fellowship

-Voluntary deprogramming is under consideration (no contact made as of yet). Initial “deprogramming” is being done by wife, with guidance.

-Ongoing

22 M Newspaper article Rajneesh (prior ISKCON)

-Consultation and evaluation with mother, with goal to help mother establish and reinforce generational boundaries. Son has had ongoing drug problem and likelihood of emotional disturbance seemed high.

-Son voluntarily checked into drug rehabilitation center and then sought outpatient psychotherapy in New Orleans.

Discussion

The average age of RETIRN’s client seems to have been about 5 to 10 years above that reported by others (Clark, Langone, Schecter, & Daly, 1981). Among our clients, males outnumbered females 2 to 1. Previous reports (Clark, et al., 1981) also found more males than females, although their ratio (about 3 to 2) was somewhat less lopsided than ours. Only 6 of RETIRN’s clients (32%) were involved with one of the “Big Five” cults; between October 1983 and October 1984, RETIRN did not work directly with any Moonies or Way members. The number of clients associated with a mass therapy seemed high (almost one-third of RETIRN’s clients). Although we did not keep figures on telephone contacts, we estimate that between one-third to one-half of our telephone consultations and inquiries were related to mass therapies. Our clients were highly similar to other samples on indices of race, socioeconomic background, and educational level (we may have seen more college graduates, however).

The demographic differences between our clients and other samples might be reflective of changes in the membership characteristics of cultic groups (e.g., cultists are getting older) or they may be due to selection bias, with the latter explanation seeming more likely. In a sample of small as ours, tow or three “unusual” clients can produce an exaggerated effect on the descriptive statistics for all clients. The high average age of RETIRN’s clients, for example, may be due in large part to the number of mass therapy participants we counseled; 4 out of these 6 individuals were 30 or older.

Of the 5 definitely or probably unsuccessful outcomes, only 1 involved a client we judged to be severely disturbed psychologically; 3 seemed to involve especially disorganized and/or disturbed family situations. One case, for example, involved a powerful mother-son symbiosis complicated still further by a lengthy history of both physical and emotional child abuse. The parents seemed more concerned with their feelings of having been personally rejected than with their son’s welfare. Their marriage was also in trouble, and their son’s predicament served the unconscious purpose of distracting them from their own problems. The parents were involved in brief therapy, but therapy did not seem to help them gain insight into the family situation or their marital issues. These findings appear to support the contention of several exit counselors that an organized, communicating, prepared, and cooperating family is a highly important factor in assisting an individual in the exiting process. Psychological disturbance, in our sample, did not seem to be a main factor in unsuccessful exit attempts. In certain situations, there may be a need for intensive or even long-term family counseling.

In 2 out of 3 (determined) cases, parent/family counseling, exit counseling, deprogramming, and/or traditional psychotherapy (or some combination of these) seems to have resulted in some form of positive outcome for our clients. On the whole, then, it would appear that interventions worked most of the time. It is commonly accepted that, for psychotherapy clients, about 67% experience some degree of improvement (Garfield, 1981), while Langone (1984) found that bout 63% of forcible deprogrammings were immediately successful. The success rate for the range of interventions reported by RETIRN, then, compares favorably with both psychotherapy and forcible deprogrammings.

References

Ad hoc committee on Ethical Standards in Psychological Research, (1973). Ethical principles in the conduct of research with human participants. Washington, D.C.: American Psychological Association.

Barber, T. (1976). Pitfalls in human research. New York: Pergamon Press.

Campbell, D., & Stanley, J. (1963). Experimental and quasi-experimental designs for research. Chicago: Rand McNally College Publishing Company.

Galper, M. (1982). The cult phenomenon: Behavioral science perspectives applied to therapy. In F. Kaslow & M. Sussman (Eds.), Cults and the family (pp. 141-149). New York: Haworth Press.

Goldberg, L., & Goldberg, W. (1982). Group work with former cultists. Social Work, 27, 165-170.

Langone, M. (1983). Treatment of individuals and families troubled by cult involvement. Update, 7, 27-38.

Langone, M. (1984). Deprogramming: An analysis of parental questionnaires. Cultic Studies Journal, 1, 63-78.

Langone, M., & Clark, J. (1983). New religions and public policy: Research implications for social and behavioral scientists. In B. Kilbourne (Ed.), Divergent perspectives on new religions. In press.

Singer, M. (1978). Therapy with ex-cult members. Journal of the National Association of Private Psychiatric Hospitals, 9, 13.

Singer, M. (1979, January). Coming out of the cults. Psychology Today, 72-82.

* * * * * * *

Linda Dubrow Eichel, M.A., is a Licensed Psychologist and a Clinical Associate with the Re-Entry Therapy, Information & Referral Network (RETIRN). She also serves as Assistant Clinical Director of Achievement through Counseling and Treatment, a drug rehabilitation center, and she is a Ph. D. candidate at the University of Pennsylvania.

Steve. K. Dubrow Eichel, M.S., is a Licensed Psychologist and a National Certified Counselor. He served as RETIRN’s first President from 1983-84. Mr. Eichel has been studying cults since 1975, when he underwent Moonist training in Barrytown, New York. He is presently completing his doctoral dissertation, which is on deprogramming strategies, at the University of Pennsylvania.

Roberta Cobrin Eisenberg, M.S.W., is a clinical social worker who served as Coordinator of the Cult Service for the Philadelphia Jewish Family & Children’s Agency from 1981 through 1984. She is currently President and Clinical Director of RETIRN. Ms. Eisenberg was formerly involved with Dianetics (Scientology).