International Journal of Cultic Studies ■ Vol.10, 2019 41
Ritual Abuse and Developmental Trauma:
Application of the Triphasic Model of Trauma Treatment in the Case of
“Sarah”
By Cortny Stark
The University of New Mexico, Rio Rancho, NM
Abstract
Clients who have experienced ritual abuse (RA)
in childhood present to therapy with a variety of
complex symptoms. The case of “Sarah”
provides clinicians with an example of the
presenting problems experienced by adult
survivors of childhood cultic abuse. This case
conceptualization utilizes developmental trauma
disorder (DTD van der Kolk, 2009) as an
organizing framework for understanding the
client’s symptoms and psychological distress.
Sarah’s treatment and related counseling
interventions follow Herman’s (2015/1992)
triphasic model of trauma recovery, while
referencing the fragmentation of trauma memory
(van der Kolk, 1996) as a foundation for trauma
processing. I also discuss the role of alternative
internal identities, or “alters,” in the recovery
process.
Keywords: Ritual abuse, developmental trauma
disorder, triphasic model of trauma recovery,
trauma treatment
Theoretical and Research Basis for
Treatment
In this article, I review the background and
foundations for counseling treatment of client
“Sarah” while she was receiving mental health
services at a college resource center. Sarah’s
experience with adverse childhood events,
specifically cult-perpetrated ritual abuse of a
sadistic nature, explains the origins of her
symptoms and psychological distress. I use
developmental trauma disorder (DTD) as a
framework for understanding the complex nature
of her symptoms and fragmented identity.
Adverse Childhood Events and Ritual Abuse
Exposure to traumatic events and adverse
experiences in childhood increases the
likelihood that individuals will experience
additional exposure or victimization in
adolescence, and adulthood (Herman,
2015/1992). Children who experience traumatic
events are more likely to experience adverse
physical and mental health symptoms across
their lifespan. Upon entering adulthood, these
children are at greater risk of developing liver
disease, chronic obstructive pulmonary disease,
autoimmune disease, somatization (negative
somatic symptoms with no biomedical cause),
depression, suicide attempts, and efforts to self-
medicate through the use of substances (Felitti &
Anda, 2010). Ritual abuse is a distinct form of
child abuse that not only predisposes individuals
to an increased likelihood of developing the
aforementioned difficulties but it is also
correlated with an increased risk of dissociative
symptoms and disorders (Noblitt &Perskin,
2000). This form of abuse is frequently
associated with destructive cults of various
ideological backgrounds, organized crime
groups, or both (Noblitt &Noblitt, 2008).
The ritual abuse of a child is a unique form of
trauma that aims to break down the child’s
integrity of self and create dissociative states,
with the ultimate aim of contributing to the
individual’s (or when the abuse occurs within a
group, the group’s) perceived sense of power
(Noblitt &Perskin, 2000). Ritual abuse consists
of maltreatment that is perpetrated “in a
ceremonial or circumscribed manner and where
the abuse causes traumagenic dissociation and/or
establishes or reinforces control over dissociated
states” (Noblitt &Noblitt, 2008, p. 25). This
form of abuse often includes the use of
programming, a method that includes extreme
physical, emotional and/or psychological pain to
Ritual Abuse and Developmental Trauma:
Application of the Triphasic Model of Trauma Treatment in the Case of
“Sarah”
By Cortny Stark
The University of New Mexico, Rio Rancho, NM
Abstract
Clients who have experienced ritual abuse (RA)
in childhood present to therapy with a variety of
complex symptoms. The case of “Sarah”
provides clinicians with an example of the
presenting problems experienced by adult
survivors of childhood cultic abuse. This case
conceptualization utilizes developmental trauma
disorder (DTD van der Kolk, 2009) as an
organizing framework for understanding the
client’s symptoms and psychological distress.
Sarah’s treatment and related counseling
interventions follow Herman’s (2015/1992)
triphasic model of trauma recovery, while
referencing the fragmentation of trauma memory
(van der Kolk, 1996) as a foundation for trauma
processing. I also discuss the role of alternative
internal identities, or “alters,” in the recovery
process.
Keywords: Ritual abuse, developmental trauma
disorder, triphasic model of trauma recovery,
trauma treatment
Theoretical and Research Basis for
Treatment
In this article, I review the background and
foundations for counseling treatment of client
“Sarah” while she was receiving mental health
services at a college resource center. Sarah’s
experience with adverse childhood events,
specifically cult-perpetrated ritual abuse of a
sadistic nature, explains the origins of her
symptoms and psychological distress. I use
developmental trauma disorder (DTD) as a
framework for understanding the complex nature
of her symptoms and fragmented identity.
Adverse Childhood Events and Ritual Abuse
Exposure to traumatic events and adverse
experiences in childhood increases the
likelihood that individuals will experience
additional exposure or victimization in
adolescence, and adulthood (Herman,
2015/1992). Children who experience traumatic
events are more likely to experience adverse
physical and mental health symptoms across
their lifespan. Upon entering adulthood, these
children are at greater risk of developing liver
disease, chronic obstructive pulmonary disease,
autoimmune disease, somatization (negative
somatic symptoms with no biomedical cause),
depression, suicide attempts, and efforts to self-
medicate through the use of substances (Felitti &
Anda, 2010). Ritual abuse is a distinct form of
child abuse that not only predisposes individuals
to an increased likelihood of developing the
aforementioned difficulties but it is also
correlated with an increased risk of dissociative
symptoms and disorders (Noblitt &Perskin,
2000). This form of abuse is frequently
associated with destructive cults of various
ideological backgrounds, organized crime
groups, or both (Noblitt &Noblitt, 2008).
The ritual abuse of a child is a unique form of
trauma that aims to break down the child’s
integrity of self and create dissociative states,
with the ultimate aim of contributing to the
individual’s (or when the abuse occurs within a
group, the group’s) perceived sense of power
(Noblitt &Perskin, 2000). Ritual abuse consists
of maltreatment that is perpetrated “in a
ceremonial or circumscribed manner and where
the abuse causes traumagenic dissociation and/or
establishes or reinforces control over dissociated
states” (Noblitt &Noblitt, 2008, p. 25). This
form of abuse often includes the use of
programming, a method that includes extreme
physical, emotional and/or psychological pain to
