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The Unique Characteristics of Postcult Post Traumatic Stress Disorder and Suggested Therapeutic Approaches.docx


International Journal of Cultic Studies, Vol. 8, 2017, pages 60-70

The Unique Characteristics of Postcult Post Traumatic Stress Disorder and Suggested Therapeutic Approaches

Dennis Patrick Healy

counselor and psychotherapist in private practice

 Abstract

In this paper, I assert that postcult post-traumatic stress disorder (PTSD) is a unique form of Complex PTSD. With this knowledge, and incorporating understandings in neuroscience, I make recommendations about appropriate therapeutic interventions. I present the characteristic symptoms of Complex PTSD as described by Herman (1997), such as hyperarousal, intrusion, and constriction, and I describe in detail the unique features of cult-induced PTSD. I also consider the effects of superstition and the association with a God or the truth in the cultic context. This discussion leads to the conclusion that postcult PTSD is a unique form of Complex PTSD. Alongside this content are developments in neuroscience that have identified different forms of memory (implicit and explicit memory) located in separate centers of the human brain. Against this neuroscience knowledge, I discuss the commonly occurring and highly distressing experience of triggers, a form of implicit memory frequently reported by victims of trauma, including former cult members, and observed by therapists working with these victims. I then discuss the implications for therapy of the considerations of a unique form of PTSD and neuroscience knowledge.

Prevalence of PTSD in Former Cult Members

At the outset, it is important to state that multiple studies have concluded that the prevalence of PTSD is greater for former cult members than for any other specific population. Rosen (2014), citing Kessler et al. (2005), lists the results of the National Comorbidity Survey Replication (NCS-R), which found “that the lifetime prevalence of PTSD among adult Americans is 6.8%” (p. 14). The survey also found the lifetime prevalence of PTSD among men to be 3.6% and among women, 9.7%
(p. 14). Further, citing Hoge et al. (2004) and Thomas et al. (2010), Rosen noted that, considering a more high-risk population—postdeployment military personnel—the prevalence of PTSD ranged between 10% and 25% (p. 14). In citing Almendros (2006) and Carrobles, Almendros, Rodríguez-Carballeira, & Gámez-Guadix (2010), Rosen (2014) has highlighted the much higher percentages of PTSD for former cult members and has reported results of research on former cult members that show rates of PTSD in a sample of
former members in Spain at 27.9% (males) to 43.6% (females) (p. 14). In the United States, a study listed PTSD in former members at 61.4% for males and 71.3% for females (p. 14).

Herman’s Definition of Complex PTSD Symptoms

Herman (1997) defined three distinct symptoms of Complex PTSD: hyperarousal, intrusion, and constriction. I describe each symptom in more detail in the sections that follow. It is important to highlight that each of these symptoms incorporates symptoms that are both psychologic (relating to the mind or mental phenomena) and somatoform (physical symptoms without physical cause).

Postcult Complex PTSD

Finally, the data regarding PTSD in former cult members, together with Herman’s work regarding Complex PTSD symptoms, and the relevance of superstition and the cultic approach to God and truth, which I discuss further in the following pages, support Whitsett’s (2010) assertion that a specific form of Complex PTSD, postcult Complex PTSD, is a direct result of members’ experiences in cults. In the context of this larger discussion, it is important to understand that cult members are often kept in either a state of hyperarousal (emotionally aroused, easily startled) or hypoarousal (flat, numb, lethargic, not fully present).

Hyperarousal occurs as a result of cultic practices such as the application of Bateson’s double-bind principle (“If you’re not getting this, it’s not because my [the cult leader’s] dogma is wrong; it’s because you [the cult member] are just not trying hard enough!”); public confessions; poorly defined and ever-changing boundaries; sleep and food deprivation; and many others. Hypoarousal occurs through extensive meditation, chanting, and hypnotic guided sessions (Jenkinson, 2011).

Hyperarousal

Generic PTSD hyperarousal. Pitman (1990, as cited in Herman, 1997, p. 36) describes hyperarousal as a combination of phobias and generalized anxiety that is experienced physiologically as an increased startle response to general stimuli and an intense response to stimuli related to the traumatic event. Hyperarousal includes hypervigilance, “an elevated baseline of arousal: Their bodies are always on the alert to danger” (McFall, Murburg, Roszell, & Veith 1989, p. 252).

Cult-induced, Complex PTSD hyperarousal. What distinguishes this form is that some of the former members’ phobias, to which they respond as presented above, have been deliberately installed by the cult/cult leader (Hassan, 2000, p. 233). Equally, as a consequence of their extended periods of hyperarousal in the cult, the former members have a significantly increased predisposition to physiologically recognize and respond to these installed phobias (Hassan, 2013, p. 155). One of the most common ways for cult leaders to install phobias is to make suggestions, use testimonials, or tell stories during psychologically vulnerable altered states such as extensive meditation, chanting, and guided hypnotic sessions. These phobias frequently relate to the world outside the cult and, for example, instill fear in members of dire circumstances relating to their physical and mental health, their social life, or their spiritual life (their “chance of redemption/ salvation”) if the members ever leave the cult (Hassan, 2000, p. 239). In addition, cult leaders often use information of individuals’ vulnerabilities obtained during public confession sessions as the basis for creating a phobia, which they then install.

Superstition. Similarly, cult leaders will utilize superstition to control their members. They do this first by deliberately maintaining this hyperaroused state of nervousness/high anxiety and thereby increasing the likelihood of facilitating a self-serving superstition. Second, they will take full advantage of unconnected events to create a superstitious belief—for instance, linking the death or misadventure of a former cult member directly to the member’s decision to leave the cult.

Superstition

As we consider the impact of superstition, Dictionary.com defines it as

…a belief or notion, not based on reason or knowledge, in or of the ominous significance of a particular thing, circumstance, occurrence, proceeding, or the like. … a system or collection of such beliefs … irrational fear of what is unknown or mysterious, especially in connection with religion … any blindly accepted belief or notion.

An important understanding about superstition is that, the more anxious and frightened we are, the more likely we are to make an irrational connection between factually unrelated events. For example, in a 1977 experiment, the experimenters were able to demonstrate that paratroopers, in an obvious state of apprehension about to jump from an aircraft, were shown a TV screen with no image other than noise and snow. They were more likely to see “a nonexistent embedded figure” in this situation than if they had been presented with the TV image earlier (Goldberg, 2013, pp.1–3).

Superstitions seem to be a desire for control or the illusion of control because we human beings generally don’t like to feel that things occur capriciously; rather, we want to believe that there is a reason for things happening, and we look for simple, causal relationships between complex events.

Intrusion

Generic Complex PTSD intrusion. Herman (1997, p. 37) depicted intrusion as “long after the danger is past, traumatized people relive the event as though it were continually recurring in the present.” As a result of triggers, which are “seemingly insignificant reminders” of the trauma, the traumatic moment instantaneously bursts into consciousness and the traumatized persons experience them either as flashbacks during waking states or as traumatic nightmares while they are asleep. What is significant about these flashbacks and nightmares is that, because they have become encrypted into a specific form of memory (implicit memory), where they are stored as graphic images and sensations without context and verbal narrative, they recur with “the emotional intensity of the original event,” (Herman, 1997, p. 42) and with a heightened reality. The consequence of this for the traumatized person is one of never feeling safe because triggers can occur in what are normally safe environments. (Brett & Ostroff, 1985, pp. 422–423).

Postcult PTSD intrusion. Several aspects distinguish postcult PTSD intrusion: the nature of the nightmares, the range of triggers to which the former cult member is vulnerable, and a phobic avoidance of triggers.

The nightmares of former cult members are different. They are distinctly “themes of death, dying, violence and/or loss, helplessness” (Whitsett, 2010, p. 3).

Former cult members experience a wide range of triggers, which reconnect the individuals with often-abhorrent cult experiences. For example, a tone of voice, a particular song or chant sung in the cult, a word or a phrase—in fact, any type of sight, sound, smell, taste, or sensation, can trigger former members, who frequently have many triggers.

Lalich and Tobias (2006) provided an extensive list of common postcult triggers:

Sensory triggers are probably the most common. Typical ones are:

  • Sights: special colors, flags, pictures of the leader, facial expressions, hand signals, group symbols, items used in group activities rituals, certain buildings or locations
  • Physical sensations: hunger, fatigue, touches, handshakes, a kiss or caress, massage
  • Sounds: songs, certain music, slogans, mantras, certain prayers, key words and phrases, a certain rhythm or tone of voice, yelling
  • Smells: incense, perfume or Cologne of the leader, certain food aromas, room odors, body odors
  • Tastes: certain foods or liquids, herbs or spices

In addition, certain emotions, such as feelings of guilt, fear, and shame, all of which were encouraged in the cult, may function as triggers. (Lalich & Tobias, 2006, p. 121)

Phobic avoidance of triggers. As a result both of their hyperarousal, including hypervigilance, and of the vividness and emotional force of the flashbacks, many former members are confronted with a double whammy: the trigger itself, and a panic, a phobic response to the whole idea of triggers—the fear of the fear (Whitsett, 2010, p. 3).

Constriction

Generic Complex PTSD constriction. Different authors use different terms to describe this phenomenon, and they all claim that it lies at the heart of trauma disorders: constriction and numbing (Herman, 1997); floating (Lalich & Tobias, 2006); dissociation (Lifton, 1989; Martin, Langone, Dole, & Wiltrout, 1992; Singer, 2003); and splitting (Lifton, 1989). All the authors were referring to the commonly observed PTSD reaction that has been likened to the freeze state in animals when they are attacked (Herman, 1997, p. 42). According to Herman,

These detached states of consciousness are similar to hypnotic trance states. They share the same features of surrender of voluntary action, suspension of initiative and critical judgment, subjective detachment or calm, enhanced perception of imagery, altered sensation, including numbness and analgesia, and distortion of reality including depersonalization [a sense of separation or detachment from your body], derealization [“the world seems unreal”], and change in the sense of time. (1997, p. 43)

Postcult PTSD constriction. Cardena & Spiegel (1993, p. 477) suggested that people who go into a dissociative state at the time of the traumatic incident are among those most likely to develop long-lasting PTSD; and, as mentioned above, cult members, as a result of extensive periods of hypoarousal (meditation, chanting, hypnotic guided sessions, fatigue accompanied by insufficient food and sleep), have a much greater predisposition to dissociation. In other words, they have an increased likelihood of developing long-lasting PTSD (Lalich & Tobias, 2006, p. 108).

Former cult members also experience a particular type of constriction. Once again, various authors use different terms to describe the phenomenon of the former member frequently floating between their precult, in-cult, and postcult identities/ personalities: doubling (Lifton, 2000, as cited in Jenkinson, 2008, p. 199); false self (Winnicott, 1965, as cited in Jenkinson, 2008, p. 199); pseudopersonality (West, 1992, as cited in Martin et al., 1992, p. 66); altered persona (Goldberg, 2006, p. 5); double self (Herman, 1997, p. 103); new identity (Singer, 2003, pp. 77–79), to “surrender their identity” (Curtis & Curtis, 1993, p. 458); and cult pseudopersonality (Jenkinson, 2008, pp. 199–224).

Traumatized people suffered damage to the basic structures of the self. They lose their trust in themselves, in other people, and in God [italics mine]. Their self-esteem is assaulted by experiences of humiliation, guilt, and helplessness. Their capacity for intimacy is compromised by intense and contradictory feelings of need and fear. The identity they have formed prior to the trauma is irrevocably destroyed. (Herman, 1997, p. 56)

God and the Truth

Many cult leaders claim to be God or to have unique connection with God, or to be the sole source of spiritual knowledge. For example, Applewhite of Heaven’s Gate claimed, “I am in the same position to today’s society as was the One that was in Jesus then” (Lalich, 2004, p. 55). As Lalich and Tobias (2006) noted, “in cults, the love of God or higher ideals, the desire for self-improvement or the wish to help mankind and society are twisted and used to influence, control or exploit devoted believers” (p. 13). And earlier, Hassan (1990) observed, “There is a cult pattern now in which a particular ‘chosen’ human being is seen as a savior or source of salvation… The leaders become mediators for God” (p. 202).

Cult leaders use a variety of techniques to establish this God connection/unique truth, including the following:

  • Mystical manipulation is the use of preplanned, supposedly spontaneous mystical experiences to demonstrate the enigmatic skills of the cult leader. Singer (2003) explains one example of this when she discusses hyperventilation (overbreathing and repetitive sighing) (128–131). Cult leaders will conduct group sessions in which members, in unison and frequently accompanied by chanting, will exhale rapidly, forcefully, and sharply. The effects of hyperventilation are light-headedness and a feeling of being on a high, accompanied by loss of judgment and an inability to think critically. In its extreme, the action can lead to a range of physical symptoms such as tingling in the extremities, ringing in the ears, racing of the heart, even fainting. Cult leaders exploit this experience and describe it as “bliss”—the experience of taking in the spirit, of “being on the path.”
  • Sacred science is reflected when the group leader positions himself as close to God, as God’s spokesperson, with the highest possible level of enlightenment and knowledge, accompanied by “unique insights into the science of the world and universe” (Dubrow-Marshall, 2010, p. 5). The approach is positioned so that no member would dare criticize this ultimate science. Its effect is to inhibit any search for knowledge and discourage independent thinking (Jenkinson, 2011).
  • A spiritual experience is artificially contrived by the leader. For example, the leader might gain private information about an individual from a close affiliate in the cult and, at the right moment, the leadership will reveal this secret information, thus leading the cult member to believe that the leader can either “read their mind” or that the leader has some special contact with the spirit world (Hassan, 1990, p. 70).

Developments in Neuroscience

Having established that there are unique characteristics of cult-induced, postcult Complex PTSD, I now explore developments in neuroscience that extend the knowledge of the symptoms and effects of postcult Complex PTSD. From there, I make recommendations for appropriate therapeutic interventions.

Neuroscience Background

Siegel (2011) has presented a simple model of the human brain (pp. 14–22) that comprises three separate components:

  1. the brain stem (reptilian brain), which is responsible for regulating basic processes—for example, eat, sleep, and sex;
  2. the limbic brain, which includes the amygdala and manages instantaneous survival responses (fight, flight, freeze), is the center of implicit memory, and is also responsible for emotional attachment, relationships, and habits (pp. 149–153). Habits are patterns of behavior repeated with little or any conscious awareness (e.g., cleaning our teeth); the suggestion is that it requires 1,000 repetitions (either verbal or imagined) to change or develop a new habit (Gordon, 2009); and
  3. the prefrontal cortex, which is a reflective system that performs an executive function. The center of explicit memory, the prefontal cortex is responsible for thinking, decision making, strategy, regulation of emotions, and establishment of routines (Siegel, 2011, pp. 153–155). Routines are regular courses of action that require some conscious awareness (e.g., learning a new dance step) and can be altered relatively easily. Routines are distinct from habits, and this contrast between habits and routines becomes important later, in the discussion of neurochemicals/neurotransmitters.

Hierarchical Organization

Conceptually, the brain is organized hierarchically for processing; in this model, the prefrontal cortex, in nontraumatic circumstances, dominates lower-level centers and exercises a veto power over limbic responses. However, in the context of complex trauma, emotions and sensory-motor reactions (in the limbic control center) can disorganize the cognitive capability of the prefrontal cortex and interfere with its top-down regulation. This process has been described as “bottom-up hijacking” (Ogden, Pain, & Fisher, 2006, p. 365).

Neurochemicals As Fuel

A possible analogy is the use of fuel to describe the function of some of the brain’s neurotransmitters. The limbic brain uses a range of these neurochemicals and, in particular, adrenaline (composed mainly of epinephrine— fast acting and short lasting, and Cortisol—slower to increase but remaining longer); whereas a major neurochemical for the prefrontal cortex is dopamine (Whitsett, 2006, p. 353). It is cortisol that reduces the effectiveness of dopamine and blocks prefrontal cortex functioning, as described previously in the bottom-up hijacking process (Ogden et al., 2006, p. 365). One important characteristic of dopamine is that it utilizes a lot of energy (burns a lot of fuel); and significantly, if the limbic brain is predominating, for example, in the extended periods of both hyper- and hypoarousal, the prefrontal cortex has a long recovery period; it takes a long time for it to kick in (Gordon, 2009), particularly as a result of the cortisol staying in the blood stream longer. This behavior exacerbates the situation for cult members and has the potential for them that operating in the limbic brain becomes their habitual response. As a consequence, this way of functioning, without the critical-thinking oversight of the prefrontal cortex, becomes very difficult to change. This finding is reinforced by Kunsman (2014), who has reported neurophysiological imaging results that demonstrate greater blood and metabolism shifting toward the brain areas responsible for survival, and “the mind loses smooth, healthy integration of separate brain functions” (p. 1) as a result.

Another highly detrimental effect of too much adrenaline-based cortisol in the bloodstream, as a consequence of the brain spending significant amounts of time in the limbic state, is that, if cortisol remains in the bloodstream for too long, it actually burns out synaptic connections (Whitsett, 2006, p. 3). Equally in this context, the brain has difficulty recalibrating autonomic arousal—the return to baseline—because the body’s adaptive response of metabolizing the neurotransmitters has not functioned effectively (Ogden et al., 2006, p. 366; Whitsett, 2006, p. 353). This limitation might have the effect of further reinforcing the brain habitually operating in the limbic state.

Neuroscience and Memory Systems

According to Siegel (2011, pp. 149–154; Applegate & Shapiro, 2005, as cited in Whitsett, 2006, p. 354) and mentioned previously, the limbic brain is the center of implicit memory, which is not conscious, does not require focused attention, involves no sensation of recollection from the past, and does not involve the prefrontal cortex. In contrast, the prefrontal cortex is the center of explicit memory, which is conscious, does require focused attention, and integrates the elements of our experience into factual autobiographical representations—in other words, it creates the narratives of our lives. This distinction is important in the context of trauma because recollections of past traumas, typically referred to as triggers, are a flooding of implicit-only memory activation.

So triggers do not involve the prefrontal cortex because cortisol is inhibiting its function. This means that top-down regulation is lost and meaning making is inhibited. This is why we experience traumatic incidents, not as memories of the past, but as events happening in the present, and with little, if any, explicit awareness of the original traumatic incidents.

Significantly, the limbic brain’s flooding of adrenaline in response to any trigger potentially reinforces the initial neural wiring laid down with the original traumatic incident—what fires together wires together. There are several consequences of this sequencing: first, there is a risk that this response becomes habitual and, as mentioned previously, the habits established via the limbic brain are far more difficult to change than the routines that are established via the prefrontal cortex; second, there is the potential for the former cult member to become increasingly more vulnerable to progressively “minor triggers” (Post, Weiss, & Smith, 1995, as cited in Ogden et al., 2006, p. 4); third, former members also lose somatic connection to current reality; and, fourth, this response reinforces the member’s phobic avoidance of triggers. As van der Kolk et al. (as cited in Ogden et al., 2006) described it, Operating in either hyper-aroused (too much activation) or hypo-aroused states (too little activation) means information cannot be effectively processed (p. 3).

Trauma and the Speech Center

Cozolino (2002, as cited in Whitsett, 2006, p. 355) discusses the fact that, during trauma, Broca’s area, the area of the brain responsible for speech, actually shuts down, a phenomenon described as speechless terror. The implication of this action is that, when former cult members are triggered by past traumas, their capacity for verbal communication is drastically reduced.

Implications for Practice

Thus far, I have reviewed the definition of Complex PTSD, identified some unique characteristics of cult-induced, postcult Complex PTSD, and presented some developments in neuroscience. I now discuss the implications of all this for former cult members in therapy, followed by various therapeutic interventions.

Presentation in Therapy

Former cult members often come to therapy with many of the following:

  • They feel a loss of the sense of safety.
  • They have been (one or a combination of) psychologically, physically, spiritually, or sexually abused by people in positions of power.
  • They might have lost trust in people, in God, and in themselves; they may have a predisposition to be influenced by authority figures.
  • They are highly reactive to a wide range of triggers; they may have developed a phobic avoidance of triggers.
  • They might readily dissociate.
  • They can float between their pre-, in-cult, and postcult personality.
  • They are likely to be hypervigilant; they probably feel disempowered.
  • They frequently demonstrate a lack of critical thinking, possibly having incorporated deliberately installed phobias and superstitions, and are unable to make simple decisions (the prefrontal cortex “muscle” has atrophied).
  • They are frequently operating in the limbic state, with the limbic “muscle” being constantly overstimulated, which can become an habitual way of operating.
  • They can display motor symptoms that include numbness, paralysis, and ataxia.

Distinctions for Therapy

Based on the above analysis, I review important distinctions between therapeutic approaches for generic PTSD and postcult Complex PTSD in the following subsections.

Hypnosis and Meditative Practices

The therapeutic use of hypnosis and meditative practices runs a high risk of triggering and retraumatizing former cult members because of their extensive negative experiences with hypnosis and meditation during their time in the cult (Whitsett, 2006, p. 358; Kunsman, 2014, p. 3). Rosen (2014, p. 22) has warned that, although mindful meditation is a popular practice in the treatment of trauma, caution is advisable when one is considering these practices for former cult members.

Diagnosing

The process of diagnosing, as in a medical model, is to be discouraged because it might result in the former cult member experiencing further feelings of disempowerment (White, 2004, p. 70). Citing Najavitas (2002) and Rosen (2013), Rosen (2014, p. 23) recommended that the client and the therapist together create and use nonpathologizing language.

Therapist-Client Relationship

Similarly, decision making by the therapist on the behalf of former members can contribute to the former members’ sense of disempowerment. Dubrow-Marshall (2015) relates the circumstances of former members having been in cultic groups and experiencing the initial “love bombing” in conjunction with feigned intimacy, wherein other members pretended to share similarities with the new members, to exert influence over them. As a consequence, these former members can find the counselling relationship “cold and uncaring.” And because of their previous experiences of a highly structured, rule-driven environment within the cult, former members have an expectation and may “pressure therapists to be directive” (p. 16). Similarly, the therapist acting as an authority figure can be distinctly counterproductive: This approach can provoke a trigger, potentially disempower the person seeking therapy, or reproduce the destructive cult leader-follower relationship (Herman, 1997, pp. 134–139). Rosen (2014) has recommended an authoritative and collaborative, rather than an authoritarian, approach (p. 23, my italics).

In the same sense, failure to take into consideration the power imbalance between the therapist and the former cult member runs the risk of retraumatizing the former cult member because he is placing himself in a vulnerable position and has previously been abused by power figures while he was vulnerable within in the cult (Herman, 1997, pp. 134–139).

Biblical/Religious Counsellors

Kunsman (2015) identified concerns for former members with nouthetic-style biblical counsellors, who are not trained in therapeutic techniques and who believe that the Bible is the sole basis for counselling (p. 10). Some nouthetic counsellors believe that sin/demonic causes are the basis of all health issues. Similarly, citing Dowhower (2013), Langone (2015) reported on a study of people seeking help from mainline religious organizations. In the study, 40% of respondents rated the services “not at all helpful” (p. 12). Langone (2015) has recommended that religious organizations provide education about the needs of spiritually abused persons.

Multiple Triggers

As mentioned previously, the range of possible triggers for former cult members is extensive. Consequently, it is important for the therapist to recognize the potential for multiple triggers in a situation that the therapist’s past experience might otherwise suggest is a very safe environment (Brett & Ostroff, 1985, pp. 422–423).

Risk of Retraumatization

Exposure therapy, in which the person seeking therapy is exposed to episodes of past trauma, can exacerbate the situation for former cult members by retraumatization, and can create a “renewed sense of alienation rather than resolve symptoms” (White, 2004, p. 70; see also Ogden et al., 2006, p. 364). Citing Miller (2011) and Tremontin and Halpern (2007), Rosen (2014) reported that recent studies have confirmed that trauma symptoms are worse for survivors if they talk about the traumatic event before their personal stabilizers of home and community have been put into effect (p. 21). Accomplishing this can be extremely difficult for former members, many of whom have, with encouragement, cut of relationships with family, friends, and community. The consequences of any retraumatization are that the former cult member is highly likely to drop out of this exposure therapy (Ogden et al., 2006, p. 2).

In her therapy program for former cult members, Jenkinson (2011) has presented the trauma-managing strategies of containment and centering for hyperarousal, and orienting and grounding for both hyper- and hypoarousal. She has recommended implementing these strategies during any therapeutic occurrences of retraumatization.

Critical Thinking

A return to critical thinking and the ability to make decisions are of paramount importance for former cult members. Whitsett (2006) suggested that therapists be alert for opportunities for “encouraging disagreement or seeking the client’s opinion” (p. 5).

Full Range of Emotions

Linked with redeveloping skills of critical thinking is the need to for former members to redevelop a tolerance for ambiguity and uncertainty, as contrasted with the simple, dogmatic solutions and explanations that are endemic within cults (Dubrow-Marshall, 2015, p. 16). Recognizing the effects for former members of extensive periods of hyper- and hypoarousal, Dubrow-Marshall also has encouraged therapists to seek opportunities for former members “to express and accept a full range of emotions, including existential angst, anger, and grief” (p. 16).

Psychoeducation

Dubrow-Marshall (2015) considers psychoeducation to be a “key element” for families, close relations, and the individuals themselves, so that people can understand “the experience and the principles behind undue influence” (p. 16). Rosen (2014) has made similar recommendations, describing psychoeducation as possibly “the most stabilizing of all interventions” (p. 22). Such education needs to support an understanding of the potentially damaging health practices within the cult, and also some understanding of the dysfunctional personalities of cult leaders.

Finding Words

Whitsett has cited Siegel’s (2002) recommendation that, “If, as some have suggested, the hippocampus and Broca’s areas do not work properly during trauma, clients may need help in finding words to attach to their experience (Cozolino, 2010; van der Kolk, 1996)” (Siegel, 2002, as cited in Whitsett, 2014, p. 5). And again, to cite Siegel, “If an event is not encoded in words, it cannot be retrieved in words, so that therapist must be careful not to blame the client for being resistant, that is, not talking” (Siegel, as cited in Whitsett, 2014, p. 5). In another example, Rosen (2014) recounted the case of a client, Mary, who “would be unable to engage in talk therapy for the remainder of the hour because she ‘couldn’t think straight’” (p. 23). Because of the extensive periods of hyperarousal and hypoarousal within the cult, former cult members, in particular, struggle with finding words.

Affect Regulation

Whitsett (2014) has stressed how important it is for clients to be able to express their feelings in a safe space. The implication of this is that therapists must feel confident that they themselves are capable of maintaining their own state of calmness, in case the client picks up on this and “goes back into her shell” (p. 5). At the same time, it also implies that therapists must have the skills of assisting their clients to remain calm; otherwise, there is a risk of the clients becoming disorganized.

Bearing Witness

Another aspect of the initial phase of recovery, in which the client is moving toward a place of safety, is the importance of the therapist bearing witness. As Whitsett (2014) has warned, “the therapist must watch his own tendency to dissociate because the material is too painful to hear” (p. 5).

Believing

Whitsett (2014) also has spoken of the risk that clients might have their cult-related experiences invalidated because, through lack of experience/understanding, the therapist does not believe that the practices and experiences the client has described about the cult could be perpetrated by one human being on another, and, as a consequence, sees the client as “paranoid or exaggerating” (p. 5).

Mind Science and Neurophysiological Imaging

Kunsman (2014) has reviewed a range of therapeutic options for trauma, including the following:

Eye Movement Desensitization and Reprocessing (EMDR) reports very favorable results but, significantly, reports “works rapidly in non-complex trauma” (p. 2; my italics). There is no indicative success of EMDR with Complex PTSD. Rosen (2014) has cautioned about the use of this method, indicating that, during EMDR therapy, rapid stimulation of “associative networks” (p. 25) occurs, and it is possible for the former member to recall something frightening (i.e., retraumatizing) during processing.

Kunsman (2014) has observed that Emotional Freedom Techniques (EFT) are “not harmful,” there is “no need of therapist,” and “early research results findings appear favorable” (p. 2) for the use of EFT in the treatment of PTSD. Kunsman (2014, p. 2) has emphasizes the rapid effect of EFT in treating noncomplex trauma. Ogden et al. (2006) identified studies “with patients who are relatively stable or have adult-onset, single-incident trauma” (p. 364). Neither Kunsman nor Ogden reported studies relating to complex trauma.

Internal Family Systems

Rosen (2014) has highlighted the “built-in stabilizing elements” within Internal Family Systems (IFS) therapy, which facilitate clients being both “present” and also “regulated” in their emotions during therapy (p. 25, my italics). Similarly, van der Kolk (2014, pp. 281–284) is supportive of this therapy for Complex PTSD and has suggested its suitability for postcult Complex PTSD (van der Kolk, personal interview, 2016).

Talk Therapy

Rosen (2014) has stated that “talk therapy works” (p. 25) and, citing Norcross & Lambert (2011), has reemphasized that the therapeutic alliance, combined with respect and understanding, constitute a large part of what is effective in therapy. In the absence of this alliance, the former member could experience a sense of abandonment, loneliness, and have the feeling that something is being “done to them, rather than with them” (p. 25)—in other words, running the risk of creating another situation in which the clients have little or no agency and, thereby, reproducing their experience in the cult.

Sensorimotor Therapy

Sensorimotor psychotherapy uses bodily experience as the primary entry point (Ogden et al., 2006), including working in the state of “optimal arousal” (p. 4)—the “window of tolerance” between the extreme physiological states of hyper- and hypoarousal (Siegel, 1999, as cited in Ogden et al., 2006, p. 364) “within which the individual can experience psychophysiological arousal as tolerable…” (Ogden et al., 2006, p. 4)

…by keeping the treatment focused on the patient's here-and-now somatic experience in the session, by mindfully noticing the trauma as it manifests in changes in heart rate, breathing and muscle tone, the individual is encouraged to experience being “here and now”, while acknowledging the “there and then” of traumatic experience. (Ogden et al., 2006, p. 366)

Sensorimotor psychotherapy is typically integrated with talking therapies. Whitsett (2006) argued that therapists “should take advantage of occurrences such as flashbacks, since it is at these times that implicit memories are most available for processing. Helping the client put words on the limbic experiences will bring down the autonomic arousal” (p. 358). This approach commences with a top-down approach, engaging the prefrontal cortex by incorporating psychoeducation and creating the narrative/
meaning making for the former cult member.

It is not clear that any particular talking-therapy modality is more effective than any other, but it is important that, whichever modality is employed, close attention be paid to the issues of caution mentioned above. Further research into the effectiveness of different modalities is warranted.

Conclusions

Cult-induced PTSD is a unique form of Complex PTSD. A key contributor to this outcome is the highly structured practice by cult leaders of maintaining cult members in extensive states of hyper- and hypoarousal. The uniqueness of their in-cult experiences predisposes many former members to a range of vulnerabilities that require both caution and knowledge when one is proposing therapy for such members. It is highly recommended that further studies be conducted into the effectiveness of therapeutic methods for working with the traumas of former cult members.

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About the Author

Denis Patrick Healy, BA, Grad Dip (Counselling), M (Counselling and Applied Psychotherapy), has specific expertise in working with senior executives individually, in “corporate couples,” and in teams, to get beyond the “noise” of current dysfunctional behaviors and illuminate their underlying causes. He brings a unique set of skills through his own career in senior-management roles, extensive coaching experience with senior executives, and formal qualifications in counselling, coaching, and psychotherapy. Over the past 25 years, Denis has become one of Australasia’s most experienced executive counsellors. His clients have included Federal cabinet ministers; chairmen and CEOs of publicly listed organizations; partners and managing partners of the Big 4 accounting firms; secretaries and deputy secretaries within both state and Australian public-service organizations; and a chief judge. He has more than 10,000 hours of one-on-one development sessions with senior executives. Denis’s other credentials include Fellow, Australian Human Resources Institute (FAHRI); member of CAPA; PACFA registered; accredited coach; and Fellow, Australian Institute of Management (FAIM). Website: www.the executivewhisperer.com.au Email: denis@theexecutivewhisperer.com.au Phone: (61) 41146-3534.

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