44 International Journal of Cultic Studies ■ Vol. 10, 2019
Sarah. Sarah was an only child until the age of
13, when her younger brother was born.
Sarah’s earliest memories centered on her
mother’s involvement in cult activities in the
small town where she grew up. She described
her mother maintaining a variety of cover-up
activities to conceal her cult involvement. These
activities ranged from taking Sarah to visit
family in Mexico for periods of time, to stints of
homeschooling, intense involvement in
agricultural clubs, and organized beauty
pageants that required travel. Sarah stated that
her father was unaware of her mother’s
connection with local cults because he worked
anywhere from 60 hours to 80 hours a week.
Sarah believed her father did not notice her odd
behavior following episodes of abuse because he
was “autistic and couldn’t read me.”
Sarah described the cults in which her mother
was involved as consistently organized and
centered on gaining spiritual power or money
through the sadistic abuse of children and
animals. She identified the cults through pieces
of information and details she recalled during
the processing of traumatic memories. Sarah
described the cults as follows:
• an ideologically based cult founded in an
extreme subsect of the Christian faith,
wherein ceremonies mimicked Catholic
ceremonies but included ritualized sexual
abuse of children and infanticide
• a coven cult whose primary goal was
connection with the power of demonic
forces through the use of hedonistic
practices with children and animals, and of
animal sacrifices (specifically the use of
dogs and goats)
• cult activities disguised as meetings for a
children’s agricultural club
• sex trafficking of young children under the
guise of organized beauty pageants that
served pedophiles seeking sex with children
and
• organized crime that involved the
transportation of illicit substances and
undocumented persons by Sarah’s mother,
coordinated by what Sarah described as “the
Mexican cartel. “Sarah described the
aforementioned cults as the most prominent
and identifiable in her memory, but stated
that the nature of her memories prevented
her from recalling specific names or
locations.
Sarah stated that she remembered fragments of
childhood trauma that occurred between the ages
of 3 and 16. She described extended periods of
her childhood during which she was unable to
recall any memories. Sarah described her mother
being involved in a number of cults because her
mother seemed to consistently “mess things up”
and be “forced out,” to which her mother would
respond by seeking out a “new group of
fanatics.”
Sarah recalled instances during childhood and
early adolescence during which she would “just
start screaming ...because I would remember
some part of the abuse.” She said that her
mother explained these instances to witnesses
and to Sarah’s father by saying that she was
“retarded.” It was after one of these episodes
that Sarah’s mother took her to the doctor, who
diagnosed Sarah with autism.
At age 16, Sarah was sexually assaulted by her
mother. She described this experience as one
that she now recalled vividly, but that she had
“blocked the memory” immediately following
the assault. Sarah stated that it was shortly after
being assaulted by her mother that she met her
boyfriend, now husband. Upon graduating from
high school, Sarah said that she and her
boyfriend married and moved in together. Sarah
described feeling uncomfortable, and at times
terrified when around her mother, but that she
was unable to recall the ritual abuse or incest
until the birth of her first child, a daughter, when
she was 23.
Immediately after giving birth, Sarah began
experiencing floods of overwhelming emotion
accompanied by snippets of memory. She
described experiencing auditory hallucinations
at night that began during this timeframe and
consisted of the auditory portions of fragmented
memories.
Sarah reported continuing to have a relationship
with her mother, albeit distant, until her daughter

International Journal of Cultic Studies ■ Vol. 10, 2019 45
was 9 months old. At that time, Sarah and her
husband left the child with Sarah’s mother “for a
couple of hours ...so we could have a date
night.” Sarah said that when she went to pick up
her daughter from her mother’s house, she
walked in on her mother molesting her daughter.
She described feeling a rush of physical and
emotional numbness and derealization as she
grabbed her daughter and quickly left the house.
Sarah said that she reported the abuse to child
protective services and began meeting with a
counselor. Sarah and her husband then relocated
to another state and ceased all contact with
Sarah’s mother.
Since this experience 4 years ago, Sarah has
relocated multiple times and discontinued all
contact with her mother, father, brother, and all
other family members. She described herself and
her present family as “on the run” from cult
members and from her mother, who “want me
dead because I talked.” Sarah said that she had
been in counseling on and off since her mother
molested her daughter, and that new memories
seemed to be consistently surfacing. Sarah and
her husband had another child when their first
daughter was 2 years old.
After her family relocated so that Sarah could
attend the state university, she was referred to a
resource center on campus for counseling
services. Sarah began meeting with me over the
summer as she was settling her family into
campus housing and preparing for the fall
semester. She asked that counseling be used as
her “trauma therapy space,” because she felt that
“no one else will believe me ...just you and my
husband.”
Assessment
My initial assessment of Sarah consisted of a
biopsychosocial intake assessment. The
assessment included questions inquiring about
Sarah’s presenting problem and her history of
suicidal ideation, homicidal ideation, self-
injurious behavior, substance use and abuse,
prescription medication, previous diagnoses,
medical history, family of origin and their
medical and trauma histories, and her traumatic
experiences. Sarah indicated that her primary
presenting problem was panic attacks and
insomnia, which she attributed to extensive
childhood trauma. Sarah’s trauma history thus
became a point of consistent reassessment and
exploration in session.
Case Conceptualization: Course of
Treatment and Assessment of Progress
Sarah’s treatment in counseling initially focused
on achieving psychological stability and
improved access to resources. This included
Sarah accessing resources through the university
where she was a student, and also applying for
healthcare benefits and nutritional assistance.
Additionally, Sarah and I cultivated
psychological resources such as coping
strategies and improved distress tolerance. The
final portion of treatment focused on Sarah
processing traumatic memories and grieving the
loss of “alters” or fragmented portions of her
identity.
Phase 1: Pragmatic Interventions
During her intake assessment, Sarah reported a
previous diagnosis of autism spectrum disorder
(ASD) in childhood. She attributed a range of
current experiences to ASD, including her
struggle to read other’s social cues and her need
for a consistent schedule, and overwhelming
anxiety when she was faced with changes. She
described experiencing a sense of overwhelm
and panic when confronted with too many
auditory stimuli, and so she used headphones
and loud music “to cope.”
Sarah stated that she believed that the ASD
symptoms she had experienced since childhood
complicated the distressing symptoms she
experienced following episodes of ritual abuse.
Examples of the complicated interplay of
symptoms include Sarah’s tendency to
experience panic attacks on campus when any of
the following occurred: an unexpected change in
class schedule, group activities that required
conversing with classmates, and interacting with
anyone during days associated with the
anniversary of a trauma. Sarah and I worked
together to identify practical ways of insuring
her success as a student, while we also
developed ways for her to regulate
overwhelming affect and surf the somatic
sensations associated with anxiety attacks.