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.
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.
