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.

International Journal of Cultic Studies ■ Vol. 10, 2019 51
Recommendations to Clinicians and
Students
Clients who report complex childhood trauma,
particularly ritual and cultic abuse, often present
information in session that seems chaotic and
emotionally charged. Providing clients with a
rationale for both understanding their problem
and the necessary treatment is essential to
achieving positive outcomes. Informing Sarah of
the purpose behind each intervention, each phase
of treatment, and how it related to the
developmental trauma she experienced seemed
to help her tame the chaos that pervaded her
thoughts, feelings, and behaviors.
Sarah was successful in treatment because she
developed rapport with her counselor and
believed that the therapeutic process could help
her. Our sessions were collaborative, and she
was provided the opportunity to alter each
intervention to meet her needs. My experience
with Sarah renewed my belief in the importance
of honoring a client’s voice. As clinicians, we
honor the client by believing their story, and by
acknowledging that they are the expert of their
lives.
Understanding how clients came to experience
the distress and suffering they present in session
is only half of the battle. Clients must be willing
to reexperience difficult emotions and painful
memories in session. As clinicians, we must
provide a framework for helping these clients to
practice new skills and develop new
perspectives.
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About the Author
Cortny Stark, LPCC, LADAC, CRC, a 2013
graduate of New Mexico Highlands University’s
Masters of Community Mental Health
Counseling and Rehabilitation Counseling
program, is currently a doctoral candidate,
graduate assistant, and teaching assistant in the