Psychotherapy of a Casualty from a Mass Therapy Encounter Group

Cultic Studies Journal, Volume 5, Number 2, 1988, pages 211-227

Psychotherapy of a Casualty From a Mass Therapy Encounter Group: A Case Study

Anita O. Solomon, Ph.D., A.B.P.P.

Abstract

A clinical psychologist utilizing the case study approach describes her cognitive and analytic therapy with a patient, Ms. B, who had been in a mass therapy encounter group. Ms. B had become psychotic and suicidal, apparently as a result of the group's practices. A clinical history of the patient did not reveal any psychopathology in childhood or young adulthood. As a result of her group involvement, Ms. B could no longer think for herself, feared that she could not make friends, was no longer able to study, became laden with guilt, and lost her sense of reality. She took on schizophrenic-like symptomatology, at times becoming catatonic and withdrawn. While permanent scars remain, six years of psychotherapy restored Ms. B to a relatively high-functioning state.

Background Information

Presenting Symptomatology as Described by the Parent

The therapist's first contact with Ms. B came through Ms. B's father, whose own therapist had attended a state psychological seminar presented by the author on the subject of "Psychotherapy of Destructive Cult Victims." He reported to the therapist that his 21-year-old daughter had returned voluntarily from a group which he believed might be destructive. She had been involved in this group for three years, leaving after becoming disillusioned with and discouraged by the group's practices.

The father said that prior to group involvement, she was employed, had completed three years of college with a major in Economics, and had been involved with her friends in many activities. She had kept up her communication with her parents and three older brothers.

The father related that since early childhood Ms. B had been a good student and had not needed therapy, hospitalization, or medication; in fact, there had been no background to expect any mental problem, much less a psychotic break.

The father further revealed that upon his daughter's return he found her physically and emotionally exhausted, malnourished, withdrawn, and at times talking and behaving irrationally. At times, she would sit with her legs drawn up and her head held down upon them.

The father added that after several years of involvement, his daughter had moved to the group's central headquarters in another state far away from home. A year prior to her return from the group, Ms. B seemed to have changed from being competent, cheerful, and productive to helpless, depressed, and anxious.

Patient's Presenting Symptomatology

When the patient, Ms. B, came to her first session, she did indeed exhibit the symptoms that her father had reported. Her problems seemed to have developed as a result of her involvement with destructive group processes, including intense attacks on Ms. B by group leaders using brainwashing techniques (Lifton, 1961).

Through this devastating process, she had become overwhelmed by the group and robbed of her individuality. She had gradually given way to a "snapping process," (Conway & Siegelman, 1978) and had an almost complete disintegration of self. She had feelings of inferiority, depersonalization, and worthlessness.

She described many degrading exercises, e.g., times when she was persuaded to sit in the dirt making mud pies, exercises requiring her to wear a mat covered with dog feces, long periods of time when group leaders screamed and yelled at her and forced her into making confessions, which they later used against her in blackmail fashion when she chose to leave.

Although officially having left the group, Ms. B found herself still influenced by its hypnotic-like practices, e.g., in one of the group training exercises, she had fallen unconscious after sitting many hours in a yoga-like position, repeatedly placing her hands in various positions. After this induction, she believed that when leaders wanted her to follow certain commands, they had only to show their hands in the same positions, as demonstrated in the training exercise, and she felt compelled to do as she was told.

A study of her background, conducted over several sessions, made clear that since her involvement in the group she had demonstrated changes identical to those described by Shapiro (1977): "distinct behavior and personality changes, had lost her sense of personal identity, had ceased scholastic activities, was for a long time estranged from family and friends, and seemed to be subservient to group leaders." Such personality change from cult involvement is described in more detail by Shapiro (1977) and Singer (1987).

The therapist's initial clinical interviews with Ms. B confirmed her father's concerns. These clinical observations, and subsequent psychological and medical tests, demonstrated that Ms. B suffered from severe emotional and physical disability. She seemed overwhelmed with grief and depression. She had nutritional difficulties, was unusually thin and malnourished, and needed to return to a well-rounded diet.

She described a "fuzziness of thinking" or confusion, complaining that she was unable to make even small decisions, such as when to brush her teeth or how to establish a routine eating schedule. These periods of confusion fluctuated. She also described severe aches and pains, which she related felt like "aches in her bones."

In the initial work of therapy, she described times when she felt as if she were "floating," a term used to describe periods of confusion and disorientation when cultists are half in and half out of the states associated with dissociative group processes. These floating states seemed accompanied by flashbacks, as she vividly recalled traumatic and emotionally laden events from her experiences in the group. Although these floating periods were prevalent in the early work of our therapy, they occurred less frequently later in therapy, even when she believed that she was in stressful situations. At the end of the therapy, these states disappeared.

Certain stimuli, such as sounds and sights, would trigger off a period of floating. At these moments, the patient seemed anxious, hyperactive, and exhibited tic-like eye movements, which resembled a trance-like state with REMs (rapid eye movements), usually observed in sleeping states. Appel (1983) described these rapid eye movements exhibited by others in trance-like states.

In Ms. B's therapy, characteristic precursors to these floating states were periods of staring, fluttering of her eyelids, and abrupt silence in the middle of sentences. On one occasion while floating, she ran out of the therapy session.

She experienced nightmares, frightening visual images of being hunted down. She felt guilty that she had wasted several years' time in this group, had possibly caused harm to other group members, and believed that through her group leadership capacity, she had taken on the role of the abuser as well as the abused. Her many thoughts and feelings seemed to focus on themes revolving around her participation in objectionable group and later leadership exercises.

After only several months of therapy, during an especially difficult time, she attempted suicide by overdosing on medications that had been prescribed to relieve her depression and anxiety. She was hospitalized. During her hospital stay, she related to the therapist that trainers and peer members had encouraged her to believe that life was not worth living unless she remained in the group.

There had been many group exercises focused on preventing people from leaving the group. She had also received harassing phone calls from fellow group members. As a leader in the group, she had trained others to go in posse-like fashion after participants who fled, and she was fearful that they would come after her in the same way.ÿÿSince she had voluntarily left, she had suffered guilt feelings about leaving the group. She had left many friends and believed that she was abandoning them. After recognizing that these beliefs were prime motivators for her suicide attempt, her suicidal ideation dissolved.

She believed that she had little control over her mental faculties. She felt inadequate and guilty because of these beliefs and she commented that she wished to be in control at all times, which she later learned was a worthy but unrealistic goal. At other times, she described that she felt like two different people, one with a brain and one without, and that she had "a split-off version of herself."

In the first few years of therapy, she was haunted by the musical themes used in the group program. These selections set moods and trance-like states which were programmed to allow her to mentally escape from painful thoughts brought up in the group exercises. She believed that she had been "a bad child," as she recalled normal childhood experiences negatively accentuated in these encounter-like activities.

Through this seemingly psychotic-like symptomatology, there appeared glimpses of an independent, rational young woman who gave an account of her early life history.

Childhood History: Earlier Life Events

Ms. B's early life history had been essentially normal. She was born a full-term, normal delivery to a healthy mother and father. There had been no serious illnesses or accidents. She was the youngest of four children from a Caucasian, middle-class background. Her parents were upwardly mobile and achievement-oriented, both successful in their professions.

Ms. B had the usual amount of sibling rivalry and teasing from her three older brothers, and she was competitive with them. Her older brothers had left home early and she had learned to emulate their early independence and achievement orientation. She seemed advanced for her age, perhaps because of these early models. Although she was intellectually precocious, her maturity was somewhat of a facade. On an emotional level, she was extremely shy and lacked confidence. She had been particularly suggestible and vulnerable at the time of her admission into the group.

Ms. B's parents had separated when she was a teenager, initially causing her mild depression. As the youngest child in the family and the only one at home at that time, she believed that her parents had frequently depended on her for their own emotional support. While this may have been burdensome at times, she had maintained a good relationship with them.

She seemed to understand that her parents were basically different types of individuals and respected their decision to separate. The parents had been caring toward her and although they expressed objections to her entering the group, they supported her endeavors.

She had experienced a broken teenage romance, and for a short time subsequent mild depression, but later adjusted fairly well by accepting this loss. She continued to be productive in schoolwork.

Ms. B stated to the therapist that the period just before group involvement, when she was 18, had been a particularly difficult time for her. Since she had been an early admission to college, entering at the age of 16, she had not had opportunities to improve her interpersonal relationships with her age peers. She had been looking for educational advancement through motivational and self-help courses to increase her self-esteem and to develop more confidence in communicating with others. She believed that she had not been sufficiently assertive in her approach to people and in solving problems. She was overly perfectionistic and self-critical.

Although successful in schoolwork and minor jobs, she was not working in a field appropriate to her intellectual level. She seemed to be at a transition point. She had not made a definite vocational choice and was looking for educational and vocational advancement.

She entered the group in large part because her supervisor, a group member, had pressured her to join. He seemed to convey to Ms. B that if she did not join, he would not consider her a good employee. She later found that the supervisor received extra acknowledgment for bringing in members in the same manner that she was later expected to do when she completed her own training. Feeling her supervisor's pressure to join when she saw the group's advertisement in the lobby of a local hotel, she readily signed up, thinking that this would offer an easy solution to her problems.

Ash (1985) and Long (1987) describe stressful periods of life when there is a sense of loss due to a separation from loved ones, pursuit of careers, development in jobs. During these periods, many young adults experience states of vulnerability. After her group involvement, Ms. B experienced a sense of helplessness that was extreme in comparison to these normal developmental difficulties. Only after group involvement did Ms. B have feelings of fear, anxiety, and deep depression.

Symptomatology During Therapy

During therapy, Ms. B described how she and other participants had become mesmerized by the music programmed in the group. This music created agony and distress and triggered vivid negative associations and trance-like states. The music led to feelings of helplessness and low self-esteem. Throughout therapy, she had to extinguish the painful memories associated with particular songs. On several occasions when she heard the music, she reacted hysterically, felt out of control, and had the urge to flee. On one occasion when she heard the stimulus music over the radio, she ran out of the room screaming.

On another occasion, when Ms. B heard a certain musical selection, she visualized a group of people holding and rocking her, an exhilarating experience but one that meant complete surrender and dependency on the group. The feeling that Ms. B could cradle others also gave her a false sense that she could be all-powerful with other people. When she gradually understood that this music, originally played at strategic moments after painful group exercises, acted as a conditioned stimulus to incite these painful memories and feelings, she stopped reacting inappropriately.

In addition to the music, she had become conditioned or hypnotized when hearing key words. When she was told that she "was grounded," she imagined that her head was coming off and that she was stepping on it, splitting off her mind from her body. In trance-like states she had been forced to do things that were embarrassing and objectionable to her.

Her fears, anxiety, and embarrassment surfaced in the form of stomach aches. She had also been programmed to have aches if she planned to leave the group and she continued at times to battle with her conflicts. As dictated in the group, she felt that she was a failure if she could not solve every problem. She expressed her frustration regarding what she realized later in therapy was an impossible standard.

After a year of therapy, she continued to be haunted by memories of the group. She enrolled in a local university. She was somewhat successful but had bouts of depression and physical illness and had to drop out. This once successful student struggled in therapy to fight feelings of failure and defeat.

Several years after therapy began, Ms. B continued to have anxiety attacks about her thoughts of self-unworthiness. Gradually, however, her paranoia and anxiety attacks receded.

The Therapeutic Process

Amount of Therapeutic Contact

Because of the negative psychological effects of this group, the nature of the therapeutic contact varied. The formal 50-minute hour was often insufficient time to achieve the goals necessary for restoring Ms. B's mental health. Therefore, therapy time varied from the formal 50-minute hour to many extended hourly sessions, taking place over a six-year period involving approximately 350 hours of psychological intervention, which included formal office visits, time when the therapist saw her at the hospital when she attempted suicide, numerous phone calls for psychological support to Ms. B before and after her hospitalization for this suicide attempt, and numerous psychological phone consultations on other problems.

The therapist arranged for a psychiatric nurse to assist her on the case. During the early months of therapy, during Ms. B's most difficult psychotic period, the nurse visited Ms. B at home. At that time, Ms. B needed medical and nutritional care and retraining in self-help health skills. The nurse, working closely with the therapist, provided nutritional and personal hygiene care to the patient and recorded observations to be reported to the therapist, all efforts leading to more effective psychotherapy.

In those early months of therapy, Ms. B experienced night terrors. The therapist and the nurse worked together in assisting and comforting the patient. The nurse, who took notes of the content of the dreams, reported to the therapist. The next day the therapist would help Ms. B to interpret and clarify what had happened during the night. The night terrors seemed to be related to the exercises experienced in the group.

In addition to the formal therapy process in office visits, the therapist discussed the patient's medical evaluations with her physicians, administered psychological tests, and, utilizing the evaluations of two other psychologists, planned and carried out the treatment program in therapy. The therapist also monitored the supportive satellite therapy provided by the psychiatric nurse.

Voluntary Deprogramming

In the early stages of therapy, Ms. B elected to go to a friend for intensive voluntary deprogramming. The friend had herself been involved in destructive techniques and assisted Ms. B in an intensive week of studying Chapter XXII of Robert Lifton's book, Thought Reform and the Psychology of Totalism: A Study of Brainwashing in China (1961), which described "mind controlling techniques" similar to those the group used on her.

The study of the processes Ms. B experienced was continued in her psychotherapy. In studying Lifton, she found that "thought reform has a psychological momentum of its own, a self-perpetuating energy." She applied Dr. Lifton's concept of "ideological totalism" and his eight themes of "brainwashing" to her own experiences. A combination of these themes tends to create an atmosphere which might temporarily energize or exhilarate individuals while at the same time threatening them. Ex-cult patients describe their experience of euphoria, at times accompanied by fear of loss of self. At other times while in the group they were unaware of the imminent danger to their individuality. The deprogramming process and the deconditioning that occur in psychotherapy work towards the identification and ultimate removal of these eight types of mind control methods found in differing forms and varying degrees in all cultic groups.

Ms. B learned how techniques of mind manipulation, isolation, nutritional deficiencies, fatigue, and complete subservience to a leader or leaders could take away the independent thought of the member and produce effects similar to those she was then experiencing. She thereby began the first step in eventually eliminating their effects. In a sense, the intensive study of this chapter helped Ms. B to "snap" out, much as she had "snapped" in (Conway & Siegelman, 1978).

In Dellinger (1980), Fr. William Kent Burtner, a Dominican priest and counselor to former cult victims, defines deprogramming as "a counseling process whereby a cult victim is given the opportunity to see a broad perspective on his/her group; to see more fully the implications of membership; to learn the rudiments of abusive behavior modification techniques and thought reform processes; to examine the values, tenets, and practices of the group: to examine his/her own thoughts and feelings so that the person reevaluates the affiliation and makes a free personal choice." In Ms. B's case, voluntary deprogramming was a necessary precursor to effective psychotherapy.

Ideally, voluntary deprogramming is performed by mental health professionals and former cult members. The latter have the advantage of bringing their former experiences into the counseling process, both from the standpoint of their particular cult indoctrinations and from their own previous deprogramming.

Test Results

Evaluation and testing began in the initial months of therapy. However, because of Ms. B's confusion and highly depressed state, she had difficulty concentrating and answering long lists of test questions. Also, because of her suicidal condition, psychotherapy's first goal was eliminating the obvious depression. Full batteries of psychological tests, therefore, took one year to complete. A second battery of tests was conducted two and one-half years after therapy, and a third battery given after three years. The first battery included the Minnesota Multiphasic Personality Inventory (MMPI), the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Bender Gestalt Test, and the Rorschach Inkblot Test.

Ms. B was again tested two and one-half years later by a second psychologist, who gave her the Holtzman Ink Blot Test, the Wechsler Adult Intelligence Scale-Revised, the Rorschach, the Thematic Apperceptionÿ• Test, the Bender Gestalt Test, and the Forer Structured Sentence Completion Tests.

These results indicated a "basically healthy personality, but a person who was very anxious and insecure...However, she is sufficiently self-assertive to cope with the demands made on her but there will be an overlay of anxiety and depression. She appears to be coping well and has a logical, methodical problem-solving approach...there are still unmet needs with which she must deal and a tendency to depression with which she needs help."

On a third testing, the MMPI was interpreted by an independent psychologist who indicated that Ms. B had made significant improvement, stating that Ms. B's MMPI "clinical profile was well within the normal range." However, the patient was still exhibiting her "overdependency with significant resentment and oversensitivity."

Testing I results indicated that Ms. B had superior intelligence and that she was verbally gifted. She demonstrated good perceptual skills. Her tests of emotional status revealed high paranoia. She felt guilty and angry about letting herself become involved in the group. She described the various ego-defacing exercises performed in the group and how these had worn her down, making her feel guilty about normal childhood experiences for which she had believed she deserved to be punished. She continued to suffer feelings of distrust toward others, and she worried that she was unusually paranoid. She realized in psychotherapy that she now should have a "healthy distrust" and that she had reason to be less than completely trusting of others.

After the first test, the tester, using the Diagnostic and Statistical Manual of Mental Disorders, DSM III, diagnosed the patient as having an Atypical Dissociative Disorder, a condition caused by "prolonged and intense coercive persuasion (brainwashing, thought reform, and indoctrination...of cultists)."

After the second testing, three years later, Ms. B was diagnosed as having an Adjustment Disorder with Mixed Emotional Features of Depression and Anxiety.

Status of the Problem

At formal termination of therapy the earlier category of DSM III 300.15, Atypical Dissociative Disorder, was no longer appropriate and symptoms of DSM III 309.28, Adjustment Disorder with Mild Emotional Features, had subsided. The patient had totally recovered from psychotic and neurotic symptomatology and no DSM III classification was given, although there was a mild degree of intermittent depression, obsessiveness, and sensations of pain in her back, fingers and toes, with no physical etiological correlates observable to her physician or the therapist.

These latter sensations subsided and gradually disappeared after therapeutic sessions that centered on helping her understand her feelings of guilt and helplessness and the triggered memories of excruciatingly painful exercises forced upon her in the group. As therapy was terminating, the unpleasant memories, unlike in the past, did not cause floating or periods of confusion, disorientation, or depression.

Goals in Therapy

Throughout the therapy, a warm, caring, and nurturing environment was planned and achieved to help the patient view herself in more appropriate ways and to develop her autonomy. The therapeutic setting created opportunities for expression and ventilation of her physical complaints and emotional strife, which occurred during particularly painful periods of "floating" (Appel, 1983).

Other specific goals in psychotherapy were to:

1. Help the patient set objectives for herself, i.e., scheduling, personal, hygiene and nutritional care.

2. Interpret the patient's somatic complaints, which were frequently precursors to her "floating states," thus alleviating her somatization.

3. Help the patient become aware of these "floating" states and clear up these confused periods.

4. Understand that a negative conditioning process created body aches associated with the induced suggestions of helplessness, that the idea of sinfulness was associated with leaving the group, that the group's music selections were cued to the alleviation of pain that they themselves had inflicted, and that these illogical associations and behavior led her to criticize herself and to feel guilty.

5. Remove her guilt and recognize the difference between guilt and responsibility.

6. Be alert to and change inappropriate behavior, i.e., fleeing from her therapy sessions and/or everyday life situations when anxious or depressed.

7. Work through her suicidal ideation by understanding the destructive group programming.

8. Develop alternate solutions to problems other than the withdrawal, flight, and self-destruction taught by the group. Suicidal ideation terminated after she understood that it was group-induced.

9. Study the brainwashing techniques used by the group.

10. Support her in working through macabre-like night terrors.

11. Help her to develop realistic viewpoints concerning trust in relationships.

12. Understand that her illogical beliefs were reinforced by group doctrine, e.g., the doctrine that in order to have self-esteem and to feel worthy she had to have "complete" pseudo-control over everything even though there were times when control was impossible.

13. Help her to deal with her anger after she fully realized that she had been deceived as well as emotionally and physically abused.

In summary, psychotherapeutic goals were directed toward the development of a greater sense of self and better synchronicity with reality, and toward distinguishing her own values, beliefs, and desires from those that were group-related.

Rationale for Procedures and Techniques

The therapist organized a comprehensive total rehabilitation program which included psychological and medical evaluations. In the early part of therapy, around-the-clock psychiatric nursing care was necessary. Direct counseling on nutrition and personal hygiene care was required. Some therapy to the parents was also provided, particularly at the time of the stressful suicide attempt.

The purpose of psychotherapy was to offset the intensive programming, hypnotic involvement, and conditioning processes that had been applied to the patient while she was involved in the group. As described by Sargant (1975), "former cult victims usually have lost contact with reality and do not have sufficient ego strength so necessary for psychotherapy to take place...to offset the brainwashing period."

The rationale for psychotherapeutic techniques used in this case was based upon the therapist's background and training in psychoanalytic and cognitive psychotherapy and conditioning processes, and techniques described by John Clark (1981) and his colleagues, and Margaret Singer (1978; 1979).

In addition to the typical psychotherapeutic concerns of psychoanalytic psychotherapy, the therapist worked on specific problem areas caused by the cult group's negative training processes. For example, the therapist helped the patient become aware of negative responses associated with certain stimuli. The therapist also extinguished these negative responses, and taught new responses to these stimuli.

Essential and critical to therapy was the identification and treatment of the patient's "floating" states. As noted earlier, precursors to these states were frequent staring into space and the fluttering of the patient's eyelids. She would stop talking in the middle of a sentence, followed sometimes by running out of the therapy session. The therapist helped her to stay with these frightening feelings and images, to talk about the visual imagery, mantras, and key words she experienced and perceived in fantasy, and to realize that these were conditioned in the cult.

Her physiological symptoms were identified as precursors to her floating stages. When, for example, she would start to blink her eyes or feel pain in her body, she would be alerted by the therapist to think through some traumatic experience in the group. After eight months of therapy, floating was significantly diminished.

The therapist also helped her to adjust to her feelings of emptiness, the considerable loss of time that had been spent in the cult, and the guilt caused by leaving close friends behind in the group, including some whom she had brought in and trained. She was also encouraged to distinguish those values which were her own from those which belonged to the group.

Her group training had been so intense that fantasy had blended into reality. Therapy helped her distinguish between the two. Contrary to what was taught to her in the group, she was relieved that she was not required "to handle everything," e.g., bring in more recruits, or feel guilty when she was not successful in doing so. She was encouraged to be less self-critical and to be patient and kinder to herself when she felt that she had failed.

In responding to Ms. B's need to build self-confidence, the therapist brought out Ms. B's strengths and reinforced them. The patient had come out of the group on her own, a task that took courage. Before the cult indoctrination she had gone to college as an early admission student. She had achieved honors during three years of college. She had resisted pot and heroin despite the fact that her friends had succumbed. The therapist pointed out these achievements to the patient.

To a less dramatic degree, the therapist discussed difficulties with current relationships, and the problems that occur in normal development when separated from parents and friends. Autonomy had to be relearned in therapy as if Ms. B were an early toddler separating in the Mahlerian-rapprochement stage (Mahler, 1975). The therapist brought into conscious awareness those steps of early learning which the patient was experiencing. She encouraged the patient to be tolerant with herself as she emerged from the regressed state encouraged in the group and moved to the former emotional maturity of her pre-group days.

As the heavy emotional layers of group-induced psychosis were lifted, the patient began to talk more about her life problems before joining the group. She talked about her parents' leaning on her for emotional support after their divorce, a common problem in families that have separated. Although she had earlier felt troubled by this, she learned (without feeling embarrassed) how to assert herself more appropriately.

Even though she had to have courage to leave the group, she felt under the control of group leaders and had not been able to speak up to them. Speaking her thoughts had frequently been a problem for her. During psychotherapy, practice in sharing her feelings and ideas helped her to speak up when she felt she was being imposed upon.

Using cognitive techniques, the therapist encouraged Ms. B. to make introspective obervations regarding her thoughts, feelings, and wishes and to report them. Ms. B was encouraged "to delineate her emotional reactions and maladaptive overbehavior" and also to "ascertain meaningful relationships between her life events and her psychological reactions" in the style of Beck (1976; 1986) and Freeman and Greenwood (1987). Both analytic and cognitive therapies were directed toward uncovering the meanings of her thoughts, feelings, and actions.

Psychoanalytic techniques included an explanation of the patient's unconscious, the analysis of transference and countertransference, analysis of the patient's ego defenses, appropriate interpretation, and encouragment to understand the causes of her regression.

The cognitive approach involved studying and rekindling Ms. B's thinking skills, thereby reversing the regressive processes. For example, the therapist found in the early stages of her work that a pervasive, pessimistic vision dominated Ms. B's thoughts. As she looked into her past, as reinforced in the group, she could only remember moments of depression and tragic suffering.

Ms. B had learned in the group to distort her memories of the past. She had pushed out of her mind all satisfying memories and had concluded that she had always been miserable. Her only consolation was to listen in an addictive fashion to music that had been piped in to group sessions. She became regressed in a mind-altering and hypnotic state. Work in therapy was educative and cognitive in that she was retrained to see how illogical these thoughts were. She needed to develop the rational and logical thinking skills herself since they had been removed from her.

Behavior modification and learning theory were also utilized to promote extinction of negative responses to stimuli. The patient relearned more adaptive modes of thought and perception and more appropriate attitudes toward reality.

As a result of this work, the patient improved her concept of herself, related more appropriately to her peers, and developed a realistic viewpoint. She became conscious of the guilt to which the group trainers had conditioned her. She felt less guilty about the training that she herself had inflicted on others and learned to accept her normal human weaknesses.

Psychotherapy gave her hope and support and enabled her to achieve greater sense of self and return to reality.

References

Appel, W. (1983). Cults in America: Programmed for paradise. New York: Holt, Rinehart, and Winston.

Ash, S. M. (1985). Cult-induced psychopathology, part I: Clinical picture. Cultic Studies Journal, 2, 31-90.

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: New American Library.

Beck, A. T. (1976). Depression: Causes and treatments. Philadelphia: University of Pennsylvania Press.

Clark, J. G., Langone, M. D., Schecter, R. E., & Daley, R. C. B. (1981). Destructive cult conversion: Theory, research, and treatment. Weston, MA: American Family Foundation.

Conway, F., & Siegelman, J. (1978). Snapping: America's epidemic of sudden personality change. New York: Dell Publishing.

Dellinger, R. W. (1979). Cults and kids: A study of coercion. Boys Town, NE: The Boys Town Center.

Freeman, A., & Greenwood, V. (1987). Cognitive therapy: Applications in psychological and medical settings. New York: Human Science Press.

Lifton, R. J. (1961). Thought reform and the psychology of totalism: A study of brainwashing in China. New York: W. W. Norton.ÿ

Long, M. K. (1987). The cult appeal: Susceptibilities of the missionary kid. Cultic Studies Journal, 4, 38-60.

Mahler, M. (1975). The psychological birth of the human infant. The Library of Congress: Basic Publishing Company.

Sargant, W. (1975). The mind possessed. New York: Penguin Press.

Shapiro, E. (1977, February). Destructive cultism. American Family Physician, 15, 80-83.

Singer, M. T. (1978). Therapy with ex-cult members. Journal of the National Association of Private Psychiatric Hospitals, 9, 13.

Singer, M. T. (1979, January). Coming out of the cults. Psychology Today, 72-82.

Singer, M. T. (1987). Group psychodynamics. The Merck manual of diagnosis and therapy, fifteenth edition. Rahway, NJ: Merck, Sharp & Dohme Research Laboratories.

******************************

Acknowledgments

Appreciation and thanks go to Dr. Michael Langone, Dr. Carole Rayburn, Jeanne Downs, RNBA, and Marcia Miller for assistance.

Anita O. Solomon, Ph.D., A.B.P.P., is a Diplomate Clinical Psychologist licensed to practice in Washington, D.C. and Maryland. Dr. Solomon conducts psychodiagnostic tests and psychotherapy with children and adults. She is a member of the American Family Foundation's Victim Assistance Committee and Chairwoman of its Educators' Committee. She is also President-Elect of the Association of Practicing Psychologists, Montgomery-Prince George's Counties, Inc., Maryland.