46 International Journal of Cultic Studies ■ Vol. 10, 2019
During the first phase of treatment, Sarah’s
stability and access to resources was the priority.
Initially, attending to her basic needs was not
only the most pragmatic approach, but also one
that aligned with Herman’s (2015/1992)
triphasic model of trauma recovery. Following
the intake assessment, our first goal was to
obtain academic accommodations through the
university. Sarah met with a rehabilitation-
counseling case worker who assessed her
symptoms and provided her with a letter for her
course instructors that indicated Sarah was to
receive excused absences and extended time to
complete assignments and tests.
Once Sarah had obtained academic
accommodations, she met with a student
advocate who helped her to understand the
financial costs that were applied to her
university bursar’s account and the status of her
financial aid. The advocate set up a meeting
between Sarah and a financial-aid advisor, who
then helped her to obtain multiple scholarships
and a loan to cover the costs of attending
classes. After multiple meetings with advocates
and advisors, Sarah obtained enough financial
aid to be able to register for courses.
Sarah stated that both she and her husband were
struggling to find work. Sarah met with an
advocate through campus career services who
helped her to create a resume and apply for
multiple student jobs and work-study positions
on campus. Sarah also utilized this resource to
role play and further develop her interview
skills. To ensure that Sarah and her family’s
basic needs were met, I assisted Sarah in
completing the applications for Medicaid, the
Supplemental Nutrition Assistance Program
(SNAP), and Women, Infants, and Children
(WIC) benefits.
Phase 1: Psychological Resources
After the first four sessions, Sarah stated that she
felt she had the resources she needed to be
successful as a student, and that she wished to
begin addressing the panic attacks, nightmares,
and distress she experienced as a result of her
traumatic memories. At that point, her primary
focus in treatment shifted from building access
to resources needed for daily living to
developing both tolerance to distress and coping
skills.
I obtained Sarah’s permission to introduce her to
some of the models for understanding
posttrauma reactions. Sarah and I reviewed
Porges’s (2004) polyvagal theory, exploring
how Sarah was presently experiencing fight,
flight, and immobilization in response to trauma
reminders. Sarah and I discussed how her body
seemed to unconsciously detect whether an
individual or situation was safe or unsafe, with
the body perceiving the majority of stimuli as
threatening. We explored early signs that her
autonomic nervous system was beginning to
react, and also identified the related trauma
triggers (Levine, 1997). Identifying triggers
enabled me to begin inducing these reactions in
session, and for Sara to practice coping
strategies (e.g., mindful breathing coupled with
grounding exercises, leaning in to the somatic
and emotional experience).
Phase 2: Trauma Processing
Each of Sarah’s counseling sessions included a
review of the status of resources and current
needs before we engaged in any traumatic
material. Phase 2 consisted of processing
traumatic material while creating a “trauma
narrative” (Herman, 2015/1992) that brought
together multiple fragments to create a cohesive
chronology of events. During each session, I
asked Sarah whether she had had a distressing
memory surface over the previous week. She
usually reported three to five fragmented
memories that had caused particular distress,
either through adrenaline-inducing nightmares
or from newly identified trauma reminders.
Van der Kolk’s (1996) model of the
fragmentation of trauma memory provided Sarah
and me with a means for understanding how her
memories were stored and recalled. Each time
Sarah reexperienced a traumatic memory, she
would recall only a couple of pieces perceived
through touch, taste, smell, feel, or hearing. Van
der Kolk (1996) explained this phenomenon to
be the result of the fragmented nature of trauma
memories. During a traumatic experience, the
individual’s threshold for affect and distress are
surpassed, and the mind fragments the memories
and fails to process them into declarative

International Journal of Cultic Studies ■ Vol. 10, 2019 47
memory. The failure to maintain the integrity of
the memory leads to the reexperiencing of
fragments whenever one encounters trauma
reminders.
When she was reexperiencing a trauma memory,
Sarah would experience each fragment as
though it were occurring in real time. She most
frequently provided a sound that she recalled
during the early morning hours, or that
awakened her in the middle of the night. She
described these instances as moments when she
heard a voice or a scream in real time. Sarah said
that she was aware that these experiences were
not occurring in real time only because she had
become accustomed to pausing and grounding
herself in the room, recognizing that the
experience was not actively occurring but was in
fact a piece of the past.
When Sarah was processing these auditory
memories, I asked her to recall whether any
other fragments were attached to this portion of
the memory. I asked that she sit with the sound
for a moment and recall whether there was a
smell, sight, tactile sensation, or taste associated
with it. Sarah often recalled additional somatic
experience associated with the traumatic
experience, and we used these pieces of
information to construct a narrative of the event.
I would then record in writing the details Sarah
provided regarding the event, Sarah’s
approximate age at the time the event occurred,
and any contextual variables such as location
and persons involved. Recording remembered
events helped Sarah to create a larger timeline of
events, thus contributing to the trauma narrative
of her childhood and adolescence.
Phase 2: Honoring, Deriving Meaning From,
and Grieving the Voices of “Alters”
Herman’s (2015/1992) phase 2 of the triphasic
model aims to help the client grieve the losses
associated with the trauma and derive a sense of
meaning from their suffering. After the initial
five to six sessions focused on developing
resources, Sarah’s trauma processing began. It
was at this time that she informed me she had
“alters,” or alternate personalities. She
concurrently identified and acknowledged the
alters during the processing of her memories.
She described these alters as ranging from
“violently angry” to “incredibly sad,” and that
they each carried specific memories from
difficult traumatic experiences. Each alter was a
version of Sarah at a specific age, which was
created during a traumatic experience facilitated
by the programmers, whom Sarah identified as
members of her mother’s cults tasked with using
torture to create dissociative states in children to
ensure that they would not remember the abuse.
Sarah’s description of dissociative states seemed
to follow the course of psychological
decompensation associated with dissociative
identity disorder (DID) because her outward
expression of multiple identities seems to have
been triggered by her removal from the
traumatic situation. Sarah described a dramatic
increase in the experience of derealization and
depersonalization following her move from the
community and state in which her mother lived
to a new community in a new state, with all
connections to former family and friends
severed. Although Sarah had never been
formally diagnosed with DID, she had described
symptoms that meet the diagnostic criteria.
Sarah reported more than two distinct
personality states that she called “alters.” When
switching between personalities, Sarah described
having varying levels of awareness of the
transition from one personality to the next. She
said that when she switched to those alters with
whom her primary personality “is more merged”
(the primary or host personality being Sarah),
her host personality remained cognizant of the
alters’ actions. She described one current alter,
however, who had conversations with her
husband at night that were completely out of her
awareness. Following an evening episode with
this alter, whom Sarah called “Roe,” she brought
her husband to session to discuss his experiences
with Roe. It was during this session that Sarah
shared about gaps in memory, specifically in the
evenings, and she shared her distress and fear
about “not having control ...I don’t know what
I’m doing then.” Sarah’s symptoms did not
appear to be associated with any substance use,
medical condition, or religious or cultural
practice thus, the aforementioned symptoms
meet the diagnostic criteria for DID (APA,
2013). We discussed the symptoms and
diagnosis of DID during multiple sessions, but