International Journal of Cultic Studies ■ Vol. 10, 2019 49
torturing or killing her should she talk about her
past. Sharing her memories and allowing alters
to speak of the horrors they witnessed violated
the cult’s programming. Sarah stated that the
consequences for violating programming, for
disclosing abuse, were death. Each session
concluded with Sarah expressing extreme fear
that her programmers (also referenced as
“handlers”) or other cult members would find
her. We used cognitive behavioral therapy
exercises to explore her thoughts and feelings
associated with these beliefs, and to challenge
the rationale that supported them (Beck, 1995).
Each counseling session thus became a small
victory, as Sarah challenged her belief that
speaking about the trauma would result in her
being hunted down, tortured, and killed. Sarah
described deriving new meaning from her
experiences as she began writing a book about
those experiences in the cult and how they had
impacted her present life. Her hope was that
sharing her experience would help others to seek
professional help, and inspire them to connect
with others, rather than to remain isolated out of
fear.
Complicating Factors
While she was in treatment, Sarah was
incredibly skeptical of formalized interventions
and assessments. She declined to complete the
Dissociative Experiences Scale (Carlson &
Putnam, 1993) and the Post Traumatic Stress
Disorder Checklist (Weathers et al., 2013). She
also refused a referral for a psychiatric
evaluation, stating that she was unwilling to take
medication because when “drugged as a kid”
during cult-related abuse, she “seemed too
sensitive to medication.” Sarah described feeling
fearful and distrusting of doctors, and thus
would not seek outside evaluations or
intervention.
Sarah’s panic attacks seemed to worsen during
specific anniversary dates related to her
traumatic experiences in childhood. The worst of
these anniversary dates occurred during the 2
weeks prior to Halloween. During that time of
the year, Sarah experienced several worse-than-
usual panic attacks. She dealt with the
worsening symptoms by engaging in additional
counseling sessions with me and receiving crisis
counseling through the university’s student
health center. Although Sarah continued to
refuse a psychiatric evaluation, she met with a
doctor during the month of October for a
physical and to rule out any medical
complications.
Access and Barriers to Care
The resource center where I counseled Sarah
was located on campus and provided free
counseling services to students and community
members. Sarah’s status as a student placed in
her in direct contact with a multitude of resource
centers on campus, including our center. Only
two other counseling agencies in the local area
provided pro bono services, with one agency
located on campus and the other located several
miles away from the university.
Sarah and her spouse initially used their bicycles
to travel from campus housing to the university
and around town. Two weeks after we began our
sessions, Sarah’s spouse had his bike stolen
from the bike rack in front of university housing.
Three weeks later, Sarah’s bike was stolen from
a bike rack on campus. After that, she, her
husband, and their children either walked or
used the bus to travel. Sarah’s limited
transportation made it increasingly difficult for
both her and her husband to apply for
employment and obtain food from local food
banks.
The resource center that facilitated Sarah’s
counseling partnered with other organizations on
campus to bring resources such as food, hygiene
products, and clothing to the center. Sarah was
able to take advantage of these resources in
addition to the counseling. The center also
helped her to obtain a free student bus pass to
improve her access to transportation. Despite the
mobilization of resources to support Sarah, her
access to more intensive treatment continued to
be incredibly limited because of her financial
and geographic barriers.
Trauma Work: A Catalyst for Personal
and Professional Transformation
Over the course of our 10 months working
together, Sarah and I had met for more than
thirty weekly counseling sessions. During the
first 2 months of treatment, the duration of

50 International Journal of Cultic Studies ■ Vol. 10, 2019
sessions ranged from one to one and a half
hours. After those first 3 months, when the fall
semester began and Sarah had achieved a sense
of stability, we transitioned to one 1-hour
session each week, with the occasional
emergency session when Sarah experienced a
panic attack or crisis. While the goal of our
weekly sessions was to help Sarah process her
memories, gain important resources, and derive
meaning from her experience, these sessions
also acted as a catalyst for my own personal and
professional transformation.
My work with Sarah caused me to critically
reevaluate many of my beliefs I had previously
taken for granted, particularly my sense of safety
in my community. Sarah once compared her life
experience to the Upside Down, a parallel
universe described in a popular television show
as a darker version of our current world. She
said that she had lived the majority of her life in
the Upside Down, a space for her that paralleled
the world everyone else lived in and that for her
was inhabited by monsters and steeped in the
ever-present threat of death.
Confronted with the reality that my community
contains real monsters—people who use their
power to harm children and derive pleasure from
the abuse they perpetrate—my own reality was
transformed. I now view once-trusted others
with skepticism. I find myself hyperaware and
ever vigilant for signs of danger in the
environment, and in the body language of
strangers. Although I left organized religion
years before I worked with Sarah, I now find
myself concerned about the legitimacy of local
religious organizations, particularly those that
facilitate activities at my children’s school.
Although my experience with Sarah may have
restricted my sense of safety, I have also had the
honor of bearing witness to her healing journey.
Sarah’s resilience and drive are evidence that the
propensity to overcome human suffering is
immeasurable, and that the will to live and love
trumps even the most unthinkable cruelty.
Some of my colleagues may attribute the
changes in my worldview and identity to
vicarious trauma (McCann &Pearlman, 1990),
or as the result of countertransference because of
my own unresolved issues (Saakvitne &
Pearlman, 1996). Vicarious trauma and
countertransference speak to the potential
adverse effects of bearing witness to our client’s
suffering, but they fail to capture the positive
effects of expansions in worldview. While I
acknowledge the ugliness of the Upside Down
and am aware of my new hypersensitivity to
potential sources of danger, I now see and
appreciate the resilience of life and strength of
survivors. I find myself drawn to spending more
of my time in the present moment, appreciating
the comfort and beauty in simply being.
Treatment Implications and Follow-Up
The effects of cumulative childhood trauma,
perpetrated and facilitated by a trusted caregiver,
impacted Sarah’s ability to attend to activities of
daily living. The distress and panic Sarah
experienced when confronted with specific
trauma reminders helped her to recall the origins
of these triggers. Sarah pieced together
fragments of traumatic memories, discovering
cohesive recollections of events that related to
one another. The creation of a trauma narrative
gave Sarah a sense of awareness of and control
over her past, and an understanding of how those
prior adverse experiences influence her
experience in the present.
Sarah described living each day pendulating
between emotional flooding and utter numbness.
As noted, her symptoms seemed to align with
DTD. Although not formally assessed, Sarah’s
reported dissociation when confronted with
specific trauma reminders and the presence of
alternate identities may have warranted the
diagnosis of DID (APA, 2013).
The treatment model I have described in this text
utilizes basic counseling skills, coupled with a
framework for understanding complex
childhood trauma, to organize trauma
processing. Client and counselor work together
to identify and dissect moments of particular
distress, then they piece together related
fragments of traumatic memory. Rejoining
pieces of memory and exploring context and
affective states enables the client to create a
cohesive narrative and derive meaning from an
experience once characterized by chaos and fear.