Psychotherapy Cults - an Ethical Analysis
Cultic Studies Journal, Volume 9, Number 2, 1992, pages 137-162
Psychotherapy Cults: An Ethical Analysis
Lewis & Clark College
Gordon Lindbloom, Ph.D.
Lewis & Clark College
A disparate literature on groups characterized as psychotherapy cults was analyzed. The reported practices of these groups were examined as regards confidentiality and privacy, dual relationships, informed consent, autonomy and dependency, therapist competence and limitations, financial practices, professional education, and separation and termination. The contraventions of standards of ethical conduct reported by observers typically go far beyond commonly discussed violations of ethical standards. They appear to create a new gestalt of practice and belief that directly opposes the intended protections of privacy and autonomy that form the basis of ethical codes in the mental health professions. Potential benefits of more analyses of this kind are suggested.
Recent years have brought growing attention to issues of ethical conduct among mental health practitioners. Most of the resulting literature has focused on defining and clarifying consensus standards on salient problems in psychotherapy, such as the issues of sexual contact between therapist and client. However, little systematic attention has been given to more extreme situations where psychotherapy becomes a pretext for major intrusions in clients' lives, and violations of common ethical standards are extensive and persistent.
This investigation offers an analysis of conduct associated with groups that have been loosely characterized as psychotherapy cults. It summarizes practices that have been documented in a scattered literature, and places them within the framework of ethical standards and guidelines that are generally accepted in the mental health professions. This has been done in the hope that it will provide a basis for analyzing the practices of such groups and will stimulate more systematic inquiry. Descriptions of specific aspects of conduct in groups labeled as psychotherapy cults are collated and evaluated. This analysis does not classify any group, but does offer a firstlevel definition of criteria that might be used for defining the status of groups under scrutiny. The emphasis chosen for this study was a first definition of types of conduct and the extent to which they appear to contravene prevailing standards of ethical practice in counseling and psychotherapy.
What Is a Psychotherapy Cult?
The concept of a cult has been associated in the public media with tightly knit, deviant religious groups. Their practices have been analyzed in terms of Chinese thought-reform techniques (Lifton, 1961; Singer & Ofshe, 1990), the physical alteration of the central nervous system (Clark, 1979), the development of an "indoctrinee syndrome" (Barnes, 1978; Rambo, 1982; West & Singer, 1982), the effects of charisma (Newman, 1983), attachment to the leader (Deutsch, 1980), a socialization process (Long & Hadden, 1983), group dynamics and formation of group fantasies (Halperin, 1982), and mind control (Hassan, 1988). A spiritual ideology has been commonly seen as a powerful binding force for participants. Cults are described as using powerful and deceptive methods for bringing converts under their control, making them compliant servants, depriving them of independent judgment, separating them from family and friends, and exploiting them financially and otherwise. These practices challenge respect for individual autonomy which is a fundamental value in Western culture and, as such, is a touchstone of ethical codes in all professions.
The first analysis of a group termed a "psychotherapy cult" was provided by Bainbridge (1978). In Satan's Power: A Deviant Psychotherapy Cult, he chronicled the evolution of a group that began by providing lowcost mental health services and evolved over 12 years into a fringe religious movement. Temerlin and Temerlin (1982, 1986) provided the first critical analysis of the practices of several groups. Their synthesis of characteristic practices and ethos was based on their clinical work with former members of five different groups that they described as psychotherapy cults. Hochman (1984) outlined the theory, practices, and casualties of a group in California that he referred to as a "therapy cult." Ayella (1985) wrote a doctoral dissertation analyzing the practices of the same group and comparing them to other groups that she identified as psychotherapy cults.
The essential characteristics of these groups were described variously. Appel wrote that "therapeutic cults frame the salvation they offer in psychological terms, as personal liberation or cure" (1983, p. 19). The Temerlins summarized their analyses in the following way:
These cults were an iatrogenic perversion of therapy because the character problems their patients brought to therapy were not worked through, but were replaced in consciousness by a "true believing" acceptance of their therapists' theories, selfless devotion to their therapists' welfare, unrecognized depression, and paranoid attitudes toward nonbelieving professionals. (Temerlin & Temerlin, 1982, p. 132)
Based on the descriptions available, the central features of the groups whose practices are under scrutiny here can be defined in at least a minimal way. They include (a) the use of psychotherapy language and concepts to offer help; (b) a predominant emphasis on working in a group; (c) the appearance and claim of competent professional leadership; (d) the elevation of a leader to charismatic status and idealization by members; (e) selfsacrifice by members on behalf of the leader and group; (f) the development of a strong group identity that separates them from other associations, groups, and professionals; and (g) the development of strong pressures for conformity and submission to the norms and practices of the group.
Existing studies of groups described by their observers as psychotherapy cults vary from ethnographic analyses to journalistic accounts. Their lack of a common framework of analysis limits comparisons and generalizations. For this study, we used eight categories of conduct in mental health practice that are cited in ethical codes or derive from them (American Psychological Association, 1989; Association for Specialists in Group Work, 1983; Corey, Corey, & Callahan, 1988; KeithSpiegel & Koocher, 1985). These categories include confidentiality, dual relationships, informed consent, professional competency, dependency and autonomy, financial practices, professional development, and separation/termination. In each of these categories accepted standards of behavior are first compared with deviations frequently cited in the literature on individual and group therapy; then, practices reported in the literature on groups described as psychotherapy cults are identified and briefly discussed.
Evidence about the conduct of these groups in each area under scrutiny was drawn from information available in both popular and professional publications on three extinct groups that have been labeled as psychotherapy cults. They are Synanon, Center for Feeling Therapy, and Compulsions Analysis. In addition, written material on another group currently operating has been analyzed. The posthoc, secondhand analyses of five groups provided by Temerlin and Temerlin (1982, 1986) were used. Further evidence was drawn from observations and interviews conducted by the first author with members of another group (Boland, 1989). The evidence and comparisons across categories of behavior are then succinctly described. A summary of the information is presented in Table 1 at the end of the article.
Analyses by Category
Maintaining confidentiality of client disclosures and safeguarding the privacy of clients are fundamental standards of conduct across helping professions (APA, 1989; ASGW, 1983; National Association of Social Workers, 1990). Both are backed by social sanctions and legal protections. In group therapies, special problems of defining and maintaining confidentiality arise (Kottler, 1982; Lakin, 1986; Roberts, 1982). Common violations include disclosures of confidential information to outsiders by therapists and group members, discussions of confidential information among group members outside the group, unauthorized disclosures of client information to other social service workers and professionals, and "leaks" of confidential information from individual therapy sessions to group therapy sessions.
Related but distinct issues arise regarding the extent of personal disclosure encouraged or demanded in individual and group therapy. In group therapy the risks of embarrassment, rejection, and vulnerability to severe pressures are much greater though they can also exist in individual psychotherapy. An excessive emphasis on openness can increase this vulnerability. Therapists, especially those working with groups, are expected to maintain a balance between encouraging client selfdisclosure and providing protection against pressures or tendencies to engage in too much revelation of personal secrets (Lakin, 1986).
The evidence available indicates that groups labeled as psychotherapy cults violate these guidelines routinely and pervasively. Observers report that leaders and group members routinely discuss personal information gathered in both group and individual therapy sessions with each other and with noninvolved persons (Boland, 1989). These disclosures are reported to often include information about the leader's personal life as well as that of members (Ofshe, 1976; Temerlin & Temerlin, 1982). This freedom has been described by Ayella (1985) as attractive, but it has also been described as a source of surveillance (Conason & McGarrahan, 1986) and the basis for threats of blackmail against an alienated member (Black, 1975).
Group dynamics are utilized to ensure that the private is made public (Ayella, 1985). The leader and other group members expect total "openness" or access into all parts of clients' lives, and sometimes those of leaders as well (Boland, 1989; Ofshe, 1976; Temerlin & Temerlin, 1986). This openness then leads to efforts to exert wide areas of control over the attitudes and behavior of members. Behavior that is not compliant is often viewed as resistance or a sign of character flaws (Ayella, 1985; Ofshe, 1976; Temerlin & Temerlin, 1982). These behaviors are then targets of "therapy," with the goal being that the member would surrender the identified deviance and adhere to group norms (Ofshe, 1976).
Ethical codes in mental health professions urge that business, professional, social, or sexual relationships with clients be avoided (APA, 1989; ASGW, 1983). Clients are to be protected from having other aspects of their lives affected by the private knowledge gained by a therapist or therapy group. Therapists are to avoid such conditions so that they do not develop personal interests that would compromise their commitment to their clients' therapeutic welfare.
More complications arise in avoiding harmful dual relationships among group therapy clients than is characteristic among individual therapy clients. Outside contacts between group members that provide emotional and practical support can be very beneficial. They can also lead to coalitions, subgrouping, and romances that confound the privacy and central emphases of therapeutic involvement (Lakin, 1986). Therapists sometimes have clients in both individual and group therapy at the same time, raising questions of which information disclosed in each setting will be used in the other.
In the groups under study, by contrast, relationships with multiple dimensions are not only tolerated but sanctioned and pursued. The group is viewed as a new family, providing for all the clients' social and personal needs (Boland, 1989; Hart, 1972; Singer, 1979; Span, 1988; Temerlin & Temerlin, 1986). This intensified involvement is often perpetuated by ensuring that when clients finish therapy or "graduate," they are promoted into staff or therapist positions within the group (Conason & McGarrahan, 1986; Hassan, 1988; Mithers, 1988). In some groups, therapists and staff are not excluded from the requirement that they continue to receive therapy (Ayella, 1985; Boland, 1989; Conason & McGarrahan, 1986; Hennican, 1988).
In these environments, therapists take on numerous roles in their clients' lives including employer, business partner, financial advisor, spiritual leader, and lover (Temerlin & Temerlin, 1982, 1986). In particular, sexual involvement of the therapist with clients can create an incestuous dynamic in which the client feels a need to protect the therapist from exposure or scrutiny (Pope & Bouhoutsos, 1986; Schoener, Milgrom, Gonsiorek, Luepler, & Conroe, 1990; Temerlin & Temerlin, 1986). This intensifies the role reversal where the therapist is now depending on the client to meet personal needs.
In these groups, clients are typically encouraged to take on a new identity (Ayella, 1985; Hochman, 1984; Temerlin & Temerlin, 1982). Ayella (1985) describes the emphasis in one group on open expression of feelings that became taxing and disruptive of members' outside relationships. This commonly leads to what Bainbridge (1978) described as a transition to a "culture of narcissism" and a concomitant alienation from previous relationships. This collapse of the client's social network and outside relationships is facilitated indirectly by the intensity of the new relationships and the new standards clients are encouraged to impose on themselves and on all of their relationships.
Other authors have written of the ways that clients in these groups are encouraged to end other relationships (Boland, 1989; Conason & McGarrahan, 1986; Hochman, 1984; Ofshe, 1976). Several observers reported the imposition of periods of time in which clients have been prevented from communicating with outsiders (Ayella, 1985; Hochman, 1984; Mithers, 1988; Temerlin & Temerlin, 1986). This is different from therapeutic encouragement to terminate dysfunctional relationships because the only criterion that is utilized to determine who is or is not acceptable is whether they are or are not members of the group. This enmeshed quality in relationships within the group readily leads to social isolation, which potentiates the development of internal relationships characterized as "psychological incest" (Temerlin & Temerlin, 1986) and "group think" (Janis, 1982).
Therapists are now expected to provide prospective clients with accurate information about the goals, content, procedures, and risks of therapy so they can decide freely whether to become involved (APA, 1989; ASGW, 1983; NASW, 1990). Barriers that can impair the clarity and freedom of this judgment include the urgency clients normally feel to get on with doing something about their problems (Lakin, 1986) and the prevalence of psychotherapy jargon that clients do not understand (Temerlin & Temerlin, 1986). Careless or unethical group therapists can violate this standard by failing to provide adequate information and unbiased opportunities for clients to ask questions and weigh their alternatives. They can continue the violation by treating initial consent to involvement as consent to all future events and activities in the group and by pressuring members to participate in these regardless of their reservations (Corey, Corey, Callahan, & Russell, 1982).
In the groups under study here these violations are often taken to extremes. Clients are lured by false advertising offering lowcost treatment or quick cures (Ayella, 1985; Bainbridge, 1978; Boland, 1989; Mithers, 1988). Clients use social contacts to recruit new members into the group (Hochman, 1984; Ofshe, 1976). The goals of having new members commit to "the work" of longterm intensive therapy and even lifelong involvement are hidden (Ayella, 1985; Boland, 1989; Hochman, 1984; Ofshe, 1976). Risks and liabilities of participation are not discussed at all. Group pressure is used with increasing directness to overcome any reluctance to submit to the therapy process, its ideology, and the group's standards of conduct (Hochman, 1984). Threats of retaliation or physical violence to members who threaten to leave have been reported in some cases (Anson, 1978; Mithers, 1988; Ofshe, 1976; Span, 1988).
Mental health professionals are responsible under their codes of ethics to be cognizant of the limitations of their individual competence and of the therapeutic techniques they employ (APA, 1989; ASGW, 1983; NASW, 1990). Common violations of these assumptions involve accepting clients for which one is not prepared, using techniques in which one is not proficient, and not recognizing the extent to which some clients will benefit from a particular approach while others may not. In discussing the formation of groups, Yalom (1985) acknowledges the reality that the difficulty of finding enough participants often overrides considerations of appropriate fit. Safeguards intended to limit potential harm to clients in such situations include pregroup screening interviews, informed consent to the purposes and procedures of the group, therapist protection of clients from excessive group pressures, and protection of the freedom of the client to exit from the group at any time (Lakin, 1986).
Groups under study here are described as taking very different approaches to these questions. Accounts of their recruitment practices imply that they commonly take all comers. Their conduct suggests that they believe that their brand of treatment can be practiced without consideration of the individual characteristics and needs of clients. They appear to believe that the treatment itself is so powerful that any limitations are ignored (Ayella, 1985; Kottler, 1982). The therapy is standardized and applied to all clients, who are expected to fit into a very restrictive treatment framework (Ayella, 1985; Boland, 1989). Clients are encouraged to blame themselves for lack of progress. Such failure is cited as proof of the need for further therapy (Temerlin & Temerlin, 1986). This uniformity is reinforced by the reported common practice of promoting clients to positions as staff members or therapists based on their work in therapy (Boland, 1989; Ofshe, 1976), often without regard for their educational or professional qualifications (Ayella, 1985; Black, 1975; Conason & McGarrahan, 1986; Mithers, 1988).
In the context of this belief in the efficacy of the leaders and their approach to therapy, Ayella (1985) and Rubins (1974) have both noted a high degree of inconsistency and unpredictability in the interpretations cult leaders make about what is therapeutic or healthy. This unpredictability is combined with an "absolutist attitude" about what is right and wrong (Rubins, 1974). The effect of these shifting interpretations is to require clients to attend closely, to induce confusion, and to intensify the tendency to blame the unsuccessful patient (Temerlin & Temerlin, 1986).
Dependency and Autonomy
Fundamental to the protections of client welfare are the protection of freedom of choice and limitations on the extent to which clients can become vulnerable to exploitation by professionals (APA, 1989; ASGW, 1983; NASW, 1990). In group therapies, the desire to be accepted as a member and the power of group pressures to conform add risks that appear different from those associated with individual psychotherapies. Ethical group leaders are expected to take care to protect individuals from excessive pressures (Corey, Corey, Callahan, & Russell, 1982) and to promote the independence of participants (KeithSpiegel & Koocher, 1985; Lakin, 1986) by helping clients define and adhere to their own goals (ASGW, 1983).
Unethical therapists minimize individuals' competence to make decisions and encourage dependency on the therapy and the group (Temerlin & Temerlin, 1986). It is common for clients to idealize and inflate the wisdom and skills of the therapist. Unethical therapists reinforce this inaccurate transference (Corey, Corey, Callahan, & Russell, 1982). In the theoretical framework of the groups under study, the concepts of transference and countertransference appear to be ignored (Ayella, 1985). This positive transference is labeled and accepted as Adeserved and accurate@ (Temerlin & Temerlin, 1986).
Whereas ethical group counselors are expected to exercise control over inordinate peer pressure and client selfesteem (Corey, Corey, Callahan, & Russell, 1982; Lakin, 1986), reports from the groups under study indicate that they often foster feelings of humiliation (Ayella, 1985; Hochman, 1984), failure (Ayella, 1985), and punishment (Ayella, 1985; Ofshe, 1976). Ayella (1985) also noted a constant striving for a "perfect" standard of mental health as defined by the group. The result of these forces is that psychotherapy cults evolve into enmeshed groups of dependent clients who are rarely referred elsewhere for help (Temerlin & Temerlin, 1986).
In these groups independence is not a goal. Instead, the measure of success is more commonly whether the individual develops a new identity (Ayella, 1985; Hochman, 1984). This is verified by "true-believing" acceptance of the therapy and the therapist (Temerlin & Temerlin, 1986). In these groups, submission to the group is Acharacterized as the height of personal liberation and transcendence@ (Appel, 1983, p. 20). Retaining successful members as therapists perpetuates the dependency and reinforces pressures for conformity (Ayella, 1985; Bainbridge, 1978; Black, 1975; Conason & McGarrahan, 1986; Mithers, 1988).
Professional standards for dealing with financial arrangements include informed consent regarding financial obligations and consideration of the clients' financial abilities to pay (APA, 1989; NASW, 1990), as well as accuracy of billing and payment practices. Common violations include manipulating a diagnosis in order to qualify for insurance payment, billing for services not delivered, bartering for client services, or entering into other business relationships with clients.
Violations in group therapy contexts follow these themes with added variations, such as charging for membership in its club (Ofshe, 1976), soliciting donations from clients to the sponsoring agency, and pressuring clients to recruit new referrals or to proselytize them from other groups or to donate volunteer time to the sponsoring agency (Ayella, 1985; Mithers, 1988). In the groups under study, financial relationships appear to become more exploitative and coercive (Bainbridge, 1978; Lewin, 1988; Span, 1988). The catalog of documented practices includes (a) requiring prepayment for services (Ayella, 1985); (b) therapists providing investment advice (Ayella, 1985); (c) borrowing money from clients (Boland, 1989; Hennican, 1988); (d) using volunteer and lowsalaried labor by clients (Ayella, 1985; Mithers, 1988; Ofshe, 1976); (e) imposing fines for noncompliance (Lewin, 1988); (f) charging members fees for legal services provided to the group (Lewin, 1988); (g) asking members to donate their salaries with the exception of $50 per month (Ofshe, 1976); (h) soliciting clients to become Astockholders@ in the purchase of real estate (Span, 1988); and (i) sending billings to insurance companies that appeared to be deceptive or fraudulent (Boland, 1989).
Other documented abuses took corporate form. One group attempted to become legally defined as a church in order to qualify for taxexempt status (Ofshe, 1976), and an indictment charged that the group destroyed evidence that would have adversely affected the application (Shenon, 1985). Another group prescribed marriages for the sole purpose of gaining insurance reimbursement for counseling fees (Conason & McGarrahan, 1986; Span, 1988). Two other agencies that became the center of such practices expanded to include numerous businesses staffed by clients who were underpaid or not paid at all (Ayella, 1985; Mithers, 1988; Ofshe, 1976).
To remain cognizant of changing knowledge and to maintain or acquire new competencies, members of most professions are expected to engage in continuing learning (APA, 1989; NASW, 1990). In these groups, however, the open exchange of ideas and skills with the community of mental health professionals is largely cut off. Group leaders commonly claim that they have found "the way" to mental health and healing. They are likely to use hostility and condescension to minimize what other professionals have to offer, and they commonly cultivate a paranoia towards outside professionals (Temerlin & Temerlin, 1982, 1986).
Ayella (1985) found that the group she studied felt they had nothing to learn or gain from other theorists or therapies. Rubins (1974) found that members were not allowed to pursue information from other theorists. Temerlin and Temerlin (1986) observed that the leader was the appointed interpreter of other ideas and that the groups attempted to limit their members' access to outside books in the name of preventing confusion; they also observed a related pattern of minimizing the value of critical, analytical thinking. In the groups they studied, all learning was believed to take place through emotion and experiential processes.
Professional standards for psychotherapists assume that in nearly all cases clients will become independent of therapy and therapists and that competent practice includes moving clients to termination (APA, 1989; NASW, 1990). Incompetent or passively unethical practice involves the failure to encourage the development of insights, skills, and external supports that will foster clients' independence and selfconfidence. Practices that discourage independence and encourage continued dependence on group or individual therapy actively contradict established standards for mental health professionals.
Unethical therapists can fail to support these goals, interpret moves toward termination as resistance, fail to assist clients in deciding when termination is appropriate, and encourage fears about being without therapy. These practices may take on particular power in reinforcing dependency on a group. They are highlighted by faith in the group that is so strong that therapists do not recognize casualties within their groups (Liberman, Yalom, & Miles, 1973).
Again, the groups under review here are described as taking a very different approach to ending therapy. The concepts of achieving a healthy level of personal functioning or of graduation from a group are commonly replaced with the concept of a permanent therapeutic community. Separation and termination are not accepted. Therapy is considered a way of life (Ayella, 1985; Conason & McGarrahan, 1986; Hochman, 1984; Mithers, 1988; Ofshe, 1976). Persons who leave are viewed not as successes but as failures (Ayella, 1985; Ofshe, 1976). Members who attempt to leave have been threatened with mental illness and an inability to survive without the group (Anson, 1978; Ayella, 1985; Black, 1975; Hochman, 1984; Temerlin & Temerlin, 1986). Other potential departees have been threatened with personal ruin (Mithers, 1988) and even with physical attacks (Span, 1988).
When members have left these groups, they have been ostracized by rules forbidding contact with other members and in one case by attempts to ostracize the therapists of former members (Conason & McGarrahan, 1986). Persecution of former members has been reported, including the use of violence (Anson, 1978; Span, 1988). Some groups have also ejected members (Black, 1975; Conason & McGarrahan, 1986; Span, 1988) in a process that has been described as a purging, which induces greater fear in the remaining members.
After the intensive and allencompassing nature of such group participation, separation poses major adjustments for departing members. Members' identities, social support, sources of information, and personal identity all become dependent on the group (Black, 1975; Temerlin & Temerlin, 1986). Outside relationships and interests diminish. As a result, group members who leave experience major psychological and practical losses and typically experience significant adjustment problems (Singer & Ofshe, 1990).
The most evident generalization to be drawn from these data is that the violations of key elements of established ethical guidelines are of a different order from the violations usually discussed in texts, articles, and ethics committees. For example, in the matter of dual relationships, these groups do not simply permit these to occur more frequently; multiple relationships between therapists and clients are actively pursued and encouraged and are presented as a positive element in therapy. These and other practices that contradict consensual ethical guidelines appear to be systematic, intentional, and in opposition to the intent of most standards to protect client autonomy. They stand the content and purposes of ethical standards on their heads.
A second generalization involves the interlocking effects of these practices. Taken individually, they may develop from minor to more extensive deviations from established norms; but combined, they appear to create a new gestalt of influences and ties that contain much greater potential for harm to clients than is present in conventional individual and group therapy.
The data also suggest that there does not yet exist any concerted or systematic effort by scholars or professional groups to investigate and address the problems posed by such groups. While there are serious problems associated with conducting more thorough research, we believe that it is in the interests of the public and the profession to do so. In an era of pervasive loneliness and the deterioration of family, community, and social supports, it seems likely that such groups will continue to emerge in many places and under a variety of rubrics.
Extending the effort begun by this study would appear to be one profitable avenue of continued research. Further definition of specific practices and patterns of conduct that can be identified across groups would give at least a rough set of criteria by which interested professionals and laypersons could evaluate the characteristics of groups that come to their attention. In addition to refining the criteria used in this study, practices in recruitment, member involvement, leader behavior, content and application of therapy rationales, and relations with the community and other professionals might well be included in continued research.
While it may be notably difficult to secure such information, the results would be more and better generalizations about such groups. This would provide a much better basis for studying their impact on individuals during and after their involvement, and the processes by which they enter and eventually exit. This, we hope, might provide better guidance and supports for individuals who are at risk for being drawn into involvements that would be ultimately harmful for them. It might also raise more distant questions about how to distinguish between practices and communities in which clients benefit from substantial personal involvement, such as continuing participation in selfhelp groups, and those practices and communities from which the participants are clearly left less able to conduct satisfying and productive lives.
Table 1. Comparisons of Behavior across Categories of Conduct
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The authors wish to thank Jane Temerlin for her comments on an earlier draft of this paper. They also wish to thank the American Family Foundation for assistance in locating references and the Positive Action Center for assistance in securing information and contacts with professionals.
Kim Boland is a Washington Certified Mental Health counselor. She will receive her MA in Counseling Psychology in June 1993. She lives and works in Vancouver, Washington, where she also teaches ethics classes for counselors.
Gordon Lindbloom, Ph.D., is Associate Professor of Counseling Psychology, Graduate School of Professional Studies, Lewis and Clark College, Portland, Oregon. His professional interests include stress and anxiety disorders, interpersonal relations and collaboration, and professional ethics.