42 International Journal of Cultic Studies ■ Vol. 10, 2019
induce dissociative states and create new
internal, or “alter,” identities (Miller, 2012).
Abuse of children within cultic settings may
also follow a nonritualized course, with children
subjected to sexual, physical, and/or
psychological abuse that is not directly related to
ritualized programming. Although nonritualized
abuse may be perpetrated as a means of
asserting control through violence, such abuse is
not associated with prescribed rituals or
ceremonies. In my clinical experience, not all
cults practice ritual abuse, nor due all groups
who may be classified as cults necessarily
engage in ritual abuse of its members. For those
groups who engage in abuse of their members
(and/or members’ children), the level of sadism
exercised in ritual versus nonritualized abuse is
individualized and inconsistent thus, the “level
of sadism” of ritual abuse cannot be generally
stated. The case of “Sarah,” described in the
following text, illustrates that severely sadistic
abuse can occur as an isolated event or isolated
events with individual cult members or persons
not explicitly affiliated with the cult.
The instances of abuse I discuss in this
manuscript include both ritualized and
nonritualized sadistic abuse, and also incest.
Sadistic abuse is defined as “extreme adverse
experiences” wherein the perpetrator derives
pleasure from the suffering of the victim(s), and
it includes “acts of torture, overcontrol, and
terrorization, ...ritual involvements, and
malevolent emotional abuse” (Goodwin, 1993,
p. 181). The sadistic nature of the traumatic
content I describe in this manuscript may be
disturbing for some readers, particularly those
individuals who have survived abuse or
violence. I encourage readers to use discretion
should the material shared here elicit a strong
negative response.
The organized and systemic nature of ritualized
trauma includes multiple experiences of torture,
threats of death to self and loved ones, and
exposure to gruesome scenes. Children
subjected to ritual abuse are often brought into
the abuse by a trusted loved one or caregiver and
are subjected to repeated exposure throughout
childhood. This repeated victimization affects
development of emotional regulation and
interpersonal skills (Cloitre et al., 2009), and it
impairs the individual’s ability to master
developmental milestones. Dr. Bessel van der
Kolk (2005) labeled the disruption of victims’
lifespan development and resulting
symptomology as developmental trauma
disorder.
Developmental Trauma Disorder: Framework
for Presenting Problem
DTD accounts for the complex nature of
traumatic stress when the client has experienced
ongoing trauma at the hands of caregivers that
extends over multiple developmental periods
(Bremness &Polzin, 2014). Van der Kolk and
colleagues (2009) proposed the addition of DTD
to the fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-
5), but they were unsuccessful. The DSM-5
maintains posttraumatic stress disorder (PTSD)
as the only diagnosis that explains the
symptomology attributed to traumatic
experience. Although DTD is not officially
acknowledged as a diagnosis by the American
Psychiatric Association (APA), the symptoms
outlined in DTD consist of consensus criteria
developed by the National Child Traumatic
Stress Network (NCTSN). These criteria were
derived from numerous longitudinal studies that
utilized diagnostic interviews to explore the
experience of children who have been exposed
to complex trauma to include ritual and cult
abuse (Bremness &Polzin, 2014).
DTD provides practitioners with a
comprehensive outline for understanding the
spectrum of symptoms and altered perception
experienced by survivors of ritual abuse.
Individuals with DTD experienced multiple
traumatic exposures that incited “intense affects
such as rage, betrayal, fear resignation, defeat
and shame,” and caused the child/adult survivor
to engage in “efforts to ward off the recurrence
of those emotions” these efforts included
avoiding experiences that preceded the trauma
or “engaging in behaviors that convey a
subjective sense of control in the face of
potential threats” (van der Kolk et al., 2009, p.
10). Survivors with DTD experience somatic
problems, from headaches and stomach aches to

International Journal of Cultic Studies ■ Vol. 10, 2019 43
specific sensations associated with body
memories.
Miller (2012) has described body memories as
bodily sensations experienced in the present that
have no current biomedical cause, and that are
directly related to some aspect of trauma.
Persons with developmental trauma are also
more likely to experience an overall lack of
connection with their bodies and affective states
(Levine, 1997). They may struggle to read their
environment and interpret external cues that
indicate other’s intentions. The inability to
adequately interpret the intentions of others,
combined with stressful stimuli that remind
individuals of the trauma, cause those with DTD
to feel “constantly on guard, frightened and
over-reactive” (van der Kolk et al., 2009, p. 11).
DTD attends to the many unique concerns and
symptoms presented by persons who have
experienced ritual abuse. The case study that
follows uses DTD as an organizing framework
within which to understand how the client’s
presenting complaints harkened back to her
traumatic experiences. Following the case study,
an impact statement gives voice to the influence
“Sarah” has had on my professional practice as a
therapist, and on my personal experience.
The Triphasic Model of Recovery:
Organizing Framework for Treatment in
Counseling
As context for the case study, I organized the
client’s treatment using Herman’s (2015/1992)
triphasic model of trauma recovery. Per phase 1
of the model, initial counseling sessions focused
on gathering information and helping the client
build resources and internal resiliency. During
phase 2, the focus shifted toward the processing
of traumatic memory, with the client and me
working collaboratively to identify fragments of
memory and create a cohesive narrative of the
experience. The second portion of phase 2
consisted of exploring together the ways that the
client had derived meaning from her traumatic
experience, and the related aftereffects.
I further enhanced Herman’s (2015/1992)
organizing framework through the use of
additional counseling interventions. These other
interventions included psychoeducation
regarding the fragmentation of traumatic
memory (van der Kolk, 1996) and identification
of body memories using somatic experiencing
(Levine, 1997). Using cognitive behavioral
therapy strategies (Beck, 1995), I identified and
challenged the client’s core beliefs and thought
processes that had been altered by the traumatic
experiences.
The triphasic model provided a recursive means
for organizing therapy. When the client
experienced increased distress or overwhelming
feelings during trauma processing (phase 2), I
would realign interventions to focus solely on
building resources (phase 1). Returning to phase
1, sessions would focus on increasing client
access to both physical resources (i.e., food,
shelter, safety) and internal resources (i.e.,
ability to self-regulate strong affective states and
navigate interpersonal relationships). Once the
client reported a return to baseline homeostasis
and seemed to adequately regulate emotions and
symptoms, treatment would again focus on the
processing of memories and the dentification
and reframing of irrational beliefs.
Case Introduction and Presenting
Complaints: The Case of “Sarah”
The following case study describes the treatment
of “Sarah,” a 27-year-old Hispanic female with a
history of childhood incest perpetrated by her
mother, and ritual abuse perpetrated by members
of the cults in which her mother participated.
Sarah presented to counseling with recurring
panic attacks, and the inability to fall asleep and
stay asleep. Sarah also reported somatic distress
for which no biomedical cause could be
determined. She reported being diagnosed with
autism spectrum disorder (ASD) around age 7
and stated that she hoped counseling could help
her “learn to function.”
History
Sarah grew up in the Southwest United States,
within walking distance of the Mexican-
American border. She described her hometown
as riddled with violence, organized crime, and
corruption that spilled over from a neighboring
city in Mexico. At home, she lived with her
father, a civilian contractor for the military, and
her mother, who stayed at home to care for