to attend support groups because attending a
group is a trigger. Michael did not want to read
about cults, attend a group, or talk about the
leader’s character. He did not want to look at
the ICSA website or join the online chat group
for members of his former group. But he
recovered. In contrast, Mary said it was life
changing for her to meet other second-
generation members, and to be involved with
ICSA. Each client is different.
The standard of care for all clients should be a
collaborative stance that is authoritative, not
authoritarian (Rosen, 2006). Attention to
language is crucial. Language should be
nonpathologizing (Najavits, 2002 Rosen, 2013)
and cocreated by therapist and client (Rosen,
2013).
The pacing of therapy with psychologically
traumatized clients is different from the pacing
with those experiencing ongoing or situational
anxiety and depression. My client Adam, who
was not a former member of a cultic group and
did not have a traumatic stress reaction, came to
therapy because of “panicky feelings” in his
chest, and frantic worry about his former
boyfriend ,who was devastated about losing his
relationship with Adam. Adam reported that he
had always been a worrier but his worries were
increasing, and he was obsessing about his
former boyfriend throughout the day. In efforts
to lessen his anxiety, he was eager to examine
his past, his current feelings, the sensations in
his chest, and any thoughts that came to mind.
We quickly established rapport, and I used all
the tools in my therapeutic toolbox. Adam
stayed present and engaged throughout the
sessions he did not experience dissociative
symptoms.
Clients with C-PTSD, in contrast, have trauma-
related phobias of their internal experience (Dell
and O’Neil, 2009 van der Hart et al., 2006).
Mary, a client born and raised in the West
Virginia cult, required months of
psychoeducation and discussions about our
relationship to establish trust in me and the
therapy process. I had to pick and choose
carefully which areas to explore. If I mentioned
or inquired about her parents in the early stages
of therapy, Mary would report a frightening
experience of having “sick, squeamish” feelings
in her belly, and then she would become spacey.
She would be unable to engage in talk therapy
for the remainder of the hour because she
“couldn’t think straight.” Following sessions
like these, Mary would invariably spend a few
days binging and purging, or drinking heavily,
or both. For her first 2 years of therapy, I
learned the “land mines” that were
psychologically overwhelming for her, and I
paced my interventions carefully in response.
During this phase, we did not explore her
personal history or talk about her parents. I
recommended that she present “headlines” or
mutually understood “tags” of past experiences
that related to what we were discussing. By
working in this carefully titrated manner, we
forestalled triggering the spacey, dissociative
state in sessions as well the “addictive avoidant
behaviors” that followed those sessions.
During the stabilization phase, Mary willingly
tried Somatic Experiencing (SE) and
Sensorimotor Psychotherapy (SPI) techniques.
In particular, I used the SE practice of
“pendulation,” repeatedly guiding her awareness
from areas of the body where there was relative
calm to the areas where she felt activated, and
then back to the clam areas. This approach
greatly enhanced her ability to stay with body
sensations and emotions, and to be less afraid of
them. She realized that these sensations were
just sensations and did not indicate present
danger. She also utilized the “parts work”
developed by Richard Schwartz (Schwartz,
1997). Mary identified the parts, or aspects, of
her internal system that prompted the “spacing
out” to protect her from becoming emotionally
overwhelmed in the session. Once she was able
to respect this numbing defense, she was able to
identify what she wanted to avoid for the
moment, and what she was able to face. Like
the somatically focused work Mary practiced in
session, this parts work helped her feel in control
and expand her “window of tolerance.” In time,
Mary’s capacity to stay with her “sick
squeamish” feelings grew. Her addictive
behaviors stopped. Relevant meaning and
memories emerged safely. She was able to talk
about her parents and eventually reestablished
International Journal of Cultic Studies ■ Vol. 5, 2014 23
group is a trigger. Michael did not want to read
about cults, attend a group, or talk about the
leader’s character. He did not want to look at
the ICSA website or join the online chat group
for members of his former group. But he
recovered. In contrast, Mary said it was life
changing for her to meet other second-
generation members, and to be involved with
ICSA. Each client is different.
The standard of care for all clients should be a
collaborative stance that is authoritative, not
authoritarian (Rosen, 2006). Attention to
language is crucial. Language should be
nonpathologizing (Najavits, 2002 Rosen, 2013)
and cocreated by therapist and client (Rosen,
2013).
The pacing of therapy with psychologically
traumatized clients is different from the pacing
with those experiencing ongoing or situational
anxiety and depression. My client Adam, who
was not a former member of a cultic group and
did not have a traumatic stress reaction, came to
therapy because of “panicky feelings” in his
chest, and frantic worry about his former
boyfriend ,who was devastated about losing his
relationship with Adam. Adam reported that he
had always been a worrier but his worries were
increasing, and he was obsessing about his
former boyfriend throughout the day. In efforts
to lessen his anxiety, he was eager to examine
his past, his current feelings, the sensations in
his chest, and any thoughts that came to mind.
We quickly established rapport, and I used all
the tools in my therapeutic toolbox. Adam
stayed present and engaged throughout the
sessions he did not experience dissociative
symptoms.
Clients with C-PTSD, in contrast, have trauma-
related phobias of their internal experience (Dell
and O’Neil, 2009 van der Hart et al., 2006).
Mary, a client born and raised in the West
Virginia cult, required months of
psychoeducation and discussions about our
relationship to establish trust in me and the
therapy process. I had to pick and choose
carefully which areas to explore. If I mentioned
or inquired about her parents in the early stages
of therapy, Mary would report a frightening
experience of having “sick, squeamish” feelings
in her belly, and then she would become spacey.
She would be unable to engage in talk therapy
for the remainder of the hour because she
“couldn’t think straight.” Following sessions
like these, Mary would invariably spend a few
days binging and purging, or drinking heavily,
or both. For her first 2 years of therapy, I
learned the “land mines” that were
psychologically overwhelming for her, and I
paced my interventions carefully in response.
During this phase, we did not explore her
personal history or talk about her parents. I
recommended that she present “headlines” or
mutually understood “tags” of past experiences
that related to what we were discussing. By
working in this carefully titrated manner, we
forestalled triggering the spacey, dissociative
state in sessions as well the “addictive avoidant
behaviors” that followed those sessions.
During the stabilization phase, Mary willingly
tried Somatic Experiencing (SE) and
Sensorimotor Psychotherapy (SPI) techniques.
In particular, I used the SE practice of
“pendulation,” repeatedly guiding her awareness
from areas of the body where there was relative
calm to the areas where she felt activated, and
then back to the clam areas. This approach
greatly enhanced her ability to stay with body
sensations and emotions, and to be less afraid of
them. She realized that these sensations were
just sensations and did not indicate present
danger. She also utilized the “parts work”
developed by Richard Schwartz (Schwartz,
1997). Mary identified the parts, or aspects, of
her internal system that prompted the “spacing
out” to protect her from becoming emotionally
overwhelmed in the session. Once she was able
to respect this numbing defense, she was able to
identify what she wanted to avoid for the
moment, and what she was able to face. Like
the somatically focused work Mary practiced in
session, this parts work helped her feel in control
and expand her “window of tolerance.” In time,
Mary’s capacity to stay with her “sick
squeamish” feelings grew. Her addictive
behaviors stopped. Relevant meaning and
memories emerged safely. She was able to talk
about her parents and eventually reestablished
International Journal of Cultic Studies ■ Vol. 5, 2014 23
