Residential Treatment: The Potential for Cultic Evolution

Cultic Studies Journal, Volume 8, Number 1, 1991, pages 46-60

Residential Treatment: The Potential for Cultic Evolution

David A. Halperin, M.D.

Mount Sinai School of Medicine, New York

Arnold Markowitz, M.S.W.

Cult Hotline and Clinic, New York


Residential treatment centers give residents an opportunity to develop psychologically within a close-knit, structured community. Certain psychological and political processes, however, can on occasion lead residential treatment centers to a cult-like culture of indoctrination and self-suppression rather than a culture of self-awareness and education. Lifton's (1961) analysis of totalistic systems is helpful in understanding how such an evolution can take place. Specific examples of cultic residential treatment centers are discussed to illustrate the processes under study.

The residential treatment center provides an invaluable holding environment where the severely impaired are helped to develop intrapersonal awareness, interpersonal skills, and the ability to function autonomously. In real and symbolic terms, the residential treatment setting serves as a second-chance family. Here residents are given the opportunity to experience and grow within a close-knit community with a goal of enhancing the sense of self. As with all psychotherapeutic efforts, the individual's ultimate growth is the product of an initial period of dependency and regression. In this context, responsible mental health professionals have questioned whether or not the development of intense dependency bonds may render individuals incapable of functioning outside of this "protective" setting. This concern is especially acute when working with individuals so lacking in ego strength that their primary mode of relating to the outside world often entails repeated abuse of several substances.

The residential treatment center sponsored and staffed by mental health professionals is not the only facility that attempts to work with the severely dysfunctional. A plethora of "treatment" facilities have been created under the auspices of cult-like groups. Within these rigidly structured environments, group processes are used in ways that lead to a diminution of the individual's sense of self. Here indoctrination replaces education, and regression is valued over independence or autonomy. This article examines the political and psychological processes that encourage regression and the group processes within the residential treatment center that sponsor the development of a culture of indoctrination rather than a culture of self-awareness and education. It examines the group dynamics that may lead to the transformation of a respected residential treatment center into a cult-like organization.

The Cult Group

Cults and cult-like groups function in ways that destroy the member's emotional autonomy. Their modus operandi is reflected in their organization. The destructive cult group is organizationally characterized by the following (Halperin, 1983a):

  1. A current living leader who is venerated by his or her followers and claims to have been chosen by God or some other supranatural force. In some cases, the leader may claim access to knowledge of a psychological or political nature.

  2. The cult leader often lives a very lavish lifestyle, whereas cult members are encouraged to live a life of privation and austerity.

  3. Deception is often used in recruitment and fund-raising. The use of deception is sanctioned by a double standard.

  4. All doubts are considered "evil." Public confession of beliefs, questions, and thoughts of the most private nature is encouraged. Members are censured and shamed for any deviation -- no matter how trivial -- from the group's philosophy.

The continuing indoctrination processes within the destructive cult group simulate the psychological climate described by Lifton in his Thought Reform and the Psychology of Totalism (1961). In this significant work, Lifton comments that the potential for totalism is ubiquitous, but he qualifies this by noting that

. . .this is most likely to occur with those ideologies which are most sweeping in their content and most ambitious -- or messianic -- in their claims, whether religious, political or scientific. And where totalism exists, a religion, a political movement, or even a scientific organization becomes little more than an exclusive cult. (p. 419)

Lifton enumerates eight conditions that potentiate effective totalistic control of the individual. Lifton's analysis of these requisite conditions enables us to appreciate both the recruitment processes used by destructive cult groups within the "treatment" facilities under their control and the potential for cultic evolution within the residential treatment center. The conditions that most directly affect cultic evolution in residential treatment centers are discussed below.

Environmental Control

The most basic prerequisite for totalistic control of the individual is the domination of all personal communications. Cults and cult-like groups completely control the individual's communication with the noncult or outside world. This type of control facilitates the cult's penetration of the individual's inner life and enables the group to dominate the individual's communication with the self. Cults control all sources of information: radio, television, and newspapers are either not available or their use is proscribed.

In addition, groups control when members eat, use the toilet, and when/if they sleep. Sleep deprivation is a common practice. Most cult groups control the sexual activity of members by demanding abstinence and/or selecting when and with whom the members can be sexually active. Even with arranged marriages, partners are often separated and/or pressured into extramarital affairs. By severing ties to family and friends and by encouraging the individual to change schools and career choices, the destructive cult increases the individual's sense of isolation and severs his or her access to reliable and objective sources of information.

In a superficially analogous fashion, the residential treatment center may initially regulate contact between the individual resident and the outside (often pathological) environment that he or she came from. The residential treatment center, however, uses these controls in a highly selective manner. No control is exercised over the individual's sources of information (except when the source is clearly suspect, for example, a drug dealer). Indeed, the focus is always on increasing the individual's meaningful contacts with the outside world. Residents are usually encouraged to find employment outside the center. If possible, they are enrolled in community schools; participation in cultural and sports events outside the center is facilitated. Home visits are allowed whenever appropriate.

When the residential treatment center is in an isolated setting, environmental controls can develop to cult-like proportions if precautions are not taken. While the residential treatment center may briefly discourage contact between the new resident and the pathological external environment, the center's very isolation may discourage any contact between the individual and the outside community or family. Severing ties to the extent that the individual is totally isolated fosters regression and may impede the resident's ability to leave the center. The underlying premise at the "cultic" residential treatment center is that parents should be totally excluded from any participation in the treatment process. In this context, parental objections toward any treatment decisions are deflected and dismissed. As a result, the individual is denied contact with his or her biological family and the residential treatment center becomes more than a "second-chance family"; it becomes a primary support system necessary to the individual's continuing survival.

Directors of residential treatment centers monitor the boundaries between the treatment center and the external environment. Their activities alter the permeability of this boundary. Ideally, directors should encourage the staff to obtain additional extramural training. Inappropriate directors, however, may establish a climate in which the search for extramural training is seen as a betrayal of the center's ethos. In this context, inappropriate directors may create a collusive atmosphere between themselves and the staff, an atmosphere in which they bond together against an ostensibly hostile outside world. Directors may encourage staff members to change records (presumably to obtain funds from recalcitrant sources or to "protect" residents). They may propagate the myth that only they have sufficient ability and cunning to maneuver the staff and residents through the impending shoals of financial or therapeutic disaster. These actions inevitably lead to the director's self-aggrandizement and the formation of an increasingly isolated residential treatment community with cultic overtones.

Mystical Manipulation

Cult groups may often claim to be imbued with a higher sense of purpose. They portray themselves as members of an elite -- the vanguard of a social or spiritual movement with a mystical imperative, "the pursuit of which must supersede all considerations of decency or of immediate human welfare" (Lifton, 1961, p. 422).

The goal of residential treatment is limited -- the enhancement of personal autonomy. Yet, both cults and residential treatment centers share a belief in the use of structure designed to alter the human condition. They share a common discomfort with the dysfunctional present and, by extension, a common vision of human perfectability. Hence, skillful manipulators justify their rigid control over residents or followers and their cruel and/or bizarre practices in the name of faith or of "therapeutic necessity." Similarly, both residents and followers are led to refocus their lives from a "pathological" past (or as some cults may reframe it, a "satanic world").

Isolation, sensory deprivation, and solitary confinement as forms of limit-setting, or the reliance on self-revelation and public confession, are all rationalized as necessary sacrifices along the road to Oz. These practices create a dramatic atmosphere that encourages residents and staff to view the world in polarized terms. Polarization provides the incentive for residents to forge increasingly symbiotic bonds between themselves and the director. Indeed, in one case a group began to pray for the painful death of a recently departed member. In such a polarized atmosphere, it is not surprising that other groups forestall departures or stifle criticism by resorting to beatings and solitary confinement. (In Synanon, for example, a rattlesnake was placed in a lawyer's mailbox to stifle his opposition.)

Demand for Purity

Cults portray a world divided into absolute good and absolute evil. Goodness is defined as those ideas, feelings, and behavior consistent with the cult's totalist ideology (which may reduce itself to the leader's whims of the moment). Anything done in the cult's name is perceived as good and is therefore given moral validation. On the other hand, any thoughts or actions that deviate from the group leader's wishes are viewed as inherently impure or sinful. The individual who voices doubts about the group's ideology or actions is viewed as a traitor to be ostracized and humiliated. Doubters are publicly shamed to enforce conformity. Reasoning and rational discourse are replaced with an atmosphere dominated by shame and guilt. This process of public humiliation and the substitution of shame for doubt should be alien to the residential treatment center whose only goal is to enhance the individual's personal autonomy. Inappropriate actions cannot be justified by reference to a mystical ÿ…quaÿ• therapeutic imperative.

The residential treatment center is a place of moral (in the broadest sense of the word) education. It is a forum in which to present the resident with alternate belief systems and an enhanced sense that there is a good way of being in the world (Lothane, 1978). Residents gain a sense of awareness of alternate paths in the world when staff members are encouraged to voice their contradictory opinions and examine "arbitrary" treatment decisions.

While the residential treatment center is a place where residents are presented with precepts for actions (indeed, they may require detailed guidelines), it should not be an environment where they are presented with arbitrary and punitive prescriptions. Reeducation requires an appreciation of the values underlying choices, not the arbitrary elimination of choice. Reeducation, unlike indoctrination, requires the creation of a holding environment with boundaries defined by a permeable membrane not by an Iron Curtain. When indoctrination is the goal of the "educational" process, the external world is inevitably presented as a threat to the purity of the group's ideology. External sources of information are treated with suspicion because they are judged primarily according to their potential for diluting "the truth" rather than being judged objectively. Similarly, the resident's growth and development may be regarded with suspicion, seen as a step in the direction of "heresy." Even acquiring personal skills or educational credentials may be discouraged. In this world, growth is possible only at the expense of pure belief.

The Cult of Confession

An obsession with personal confession beyond any legal, religious, or therapeutic boundaries is closely linked to the demand for purity. Cults create a milieu in which the individual experiences intensified feelings of shame and guilt and is ultimately led toward relief from pain by surrendering his or her individuality. Within this process, the alternation of self-condemnation and purgation through confession leads to the creation of a false self whereby individuals experience "pleasure" during self-degradation and ultimately attain a sense of "oneness" by identifying with their persecutors and fellow confessors. The indoctrination is complete when there is a final erosion of ego boundaries and a loss of sense of self. This happens when the individual finally discards all previous belief systems, replacing them with the ideology of the cult.

Staff may also be subject to the cult of confession. The supervisory process in the residential treatment center requires sensitivity within the supervisor-supervisee relationship. Narcissistic supervisors can manipulate staff meetings and supervisory sessions into becoming arenas for public confession. In this context they may use personal material to undermine the staff's self-confidence, thus creating a cultic atmosphere. Supervision may be confused with "therapy" to obtain this material as the supervisor becomes a hybrid of therapist cum administrator.

Treatment centers may require staff as well as residents to keep a personal diary of thoughts, ideas, and feelings, in addition to reporting on their activities. Diaries may be scrutinized by the directors and this private information may be shared with others in the "therapeutic" community meetings. Because many of the staff of drug treatment centers are themselves rehabilitated drug users it is particularly difficult for them to deal with this abusive intrusiveness. For example, a staff member of a "therapeutic community" was required to work 20-22 hours daily for $1.00/hr. Grateful for the help he had received from the facility, he was unable to confront the program director's constant demands on him for additional time, even though he had graduated from the program some years previously and ostensibly was now a staff member. Any objections voiced to this exploitation were routinely interpreted as manifesting his desire to return to drug use. In a very real sense, this vignette illustrates the manner in which cults exploit individuals through their adherence to a sacred dogma, load the language with reductionistic and simplistic phrases, and require members to shape their identities and lives in accordance with the group's demands. The group thus attempts to take on the role of ultimate dispenser of members' existence by making it impossible for them to live outside the group.

Psychotherapy Cults

The isolation of the residential treatment center with its population of severely damaged individuals may lead staff and residents alike to seek dramatic solutions to therapeutic problems through undue reliance upon a charismatic leader. This may foster a cultic evolution. Temerlin and Temerlin (1982) noted that outpatient psychotherapy may also be exploited to produce a cultic context. In such cases, therapists fail to maintain professional boundaries between their patients and themselves. Thus, patients will be converted into lovers, business partners, artistic patrons, and even therapists in training. Mental health professionals usually appreciate that patients' idealization of the therapist represents a positive transference phenomenon. Unfortunately, some mental health professionals fail to recognize that transference may be very intense and instead they proceed to act out their countertransference by encouraging patient submission and obedience to the therapist. The idealizing transference is thus transformed into a cultic relationship. The end product is a "therapeutic" cult in which interpretations are used exclusively to reinforce a closed system of dependence on the therapist who controls his or her patients' personal lives with dictatorial authority.

The Center for Feeling Therapy of southern California which flourished from 1971-81 is an illustrative example. In this group, the "psychotherapists" selected their patients' sexual partners, controlled how often they would have sex, regulated diets, and demanded that pregnant patients have abortions. Indeed, during the group's 10 years of existence, no children were born within the 350-member community. Dissolution of marriages and severing of family ties were common. The group saw itself as an elite of psychologically superior beings devoted to having feelings and expressing their feelings freely. The central thesis of the Center was that in an "insane" world, mental health could come about only by living within a "therapeutic" community where the individual could overcome sexual "problems" such as monogamous marriage (Hochman, 1984).

The following example demonstrates the destructive activity of the Center for Feeling Therapy:

Kathy K. initially went to the Center for a three-week intensive program for marital problems. Her husband followed her to California when after three weeks she failed to return either to her home or job. When he arrived in California he was not allowed to live with her. Despite the Center's claims that its treatment approaches enhanced intimacy and saved relationships, Kathy and her husband were forced to live separately and to take other partners. Kathy's reluctance to have extramarital affairs was labeled as a "clinging dependency" on her husband. Eventually, she became severely depressed. On her return to New York she was suicidal and sought treatment at the Cult Hotline and Clinic because she hoped that it might help her to reestablish contact with her family.

Kathy K.'s experience is, of course, not unique. Synanon presents another example of the transformation of a "therapeutic community" into a cultic organization (Ofshe, 1980). Synanon was started in the 1950s as a therapeutic community for the rehabilitation of alcoholics and other substance abusers. Under the leadership of Charles Diederich, a charismatic former substance abuser, Synanon developed into a highly controlled, tightly organized authoritarian community. With the intention of expanding, Synanon members began recruiting among disaffected middle class dropouts who were seeking to form a utopian community. Many members sold their homes and businesses, turning the proceeds over to the "Synanon Church." These new members -- "lifestylers" -- subjected themselves to abortions or vasectomies to abide by the group's dictate and to show a sign of identification with their leader.

Children of members were subjected to extraordinary brutalization. J., a former member who was enrolled at age 11 when her parents joined, eventually sought treatment at the Cult Hotline and Clinic. She described how she was separated from her parents and received no education. After enrollment, she was repeatedly raped by groups of men who were "in charge" of the children. She described having been severely beaten when she attempted to run away from Synanon. Isolation and degradation in confrontational stripping-down group encounter sessions -- the "Synanon Game" -- also followed her attempts to escape. During her initial consultation at the Cult Clinic, she reported anxiety-laden nightmares reflecting her entrapment in the group. J.'s fears and anxieties are similar to those reported by many members and former members of other destructive cults. Like Kathy in the earlier example, J.'s story is not unique. Histories replete with descriptions of isolation, separation, and degrading confrontation sessions have been reported by former members of other cult-like groups, such as the Sullivanian Institute, another utopian "therapeutic" community (Lewin, June 3, 1988).

Residents and Cult Members: Clinical Considerations

Cult members and residents of residential treatment centers share many clinical characteristics, even though cult members are usually older and may appear to be more sophisticated. Both cult members and residents often employ similar immature defense mechanisms, such as splitting and projection. Both groups often show poor frustration tolerance and faulty reality testing; both employ magical thinking in dealing with their problems. While the resident of a center may be attracted to grandiose pop cultural heroes such as Michael Jackson, Prince, and so on, the cult member will be attracted to grandiose gurus and/or pop ideology with its promise of becoming part of a new governing elite. Residents and members alike frequently demonstrate severe problems with separation. Both often have internalized unrealistic expectations of their families and/or society. Indeed, in both cults and cult-like residential treatment centers, members are encouraged to establish a symbiotic bond with the leader.

Initially, the residential treatment center may function as a leader-centered group where both staff and residents feel compelled to adopt a regressive dependent posture toward the group leader. This focus on the group leader may encourage the vulnerable director to see himself as possessing a unique access to the arcana of therapy. Thus, the group may transform its leader into a magus whose therapeutic wisdom will allow the staff and residents to participate in a therapeutic endeavor with a goal that has been redefined from the prosaic one of integration into society to the more magical one of rebirth.

Residential treatment centers often appear to work best when they are organized around charismatic leaders who are able to lend some part of their enthusiasm, dynamism, and therapeutic optimism to the staff and residents. However, the recent revelations about the Orthogenic School and the activities of Bruno Bettelheim underscore the risks inherent in entrusting an enterprise to the beneficence of a single gifted, charismatic leader. Bettelheim's former staff have characterized him as a

. . .cult leader who would enter into a therapeutic relationship with staff members to solidify his hold on them. "It's a story of how someone who's a very smart self-promoter can con the media into thinking they're [sic] someone else and build a reputation on it. . .But this is a tragedy based on people's lives, and everyone I've talked to is still carrying around this burden." (Baldacchi, Sept. 16, 1990, p. 5)

In the example of the Orthogenic School, the individuals labeled as "autistic" conformed to the paradigm of being so narcissistically deprived that, like the followers of the Guru Maharaj Ji, they are

. . .persons who have suffered such trauma (as adolescents and adults) that they are forever attempting to achieve a union with the idealized object. . .Their narcissistic equilibrium is safeguarded only through the interest, the responses, and the approval of present-day (i.e., currently active) replicas of the traumatically lost selfobject. (Kriegman & Solomon, 1985, p. 139)

This study by Kriegman and Solomon on followers of the Guru Maharaj Ji confirms the work of others (Halperin, 1990; Markowitz, 1983) highlighting the extent to which cult affiliation may be part of a reparative process. The relationship between the cult leader and the cult member parallels the development of an intense dependency relationship between the leader/director of the residential treatment center and the residents and/or staff. The extent to which charismatic leadership lends itself to being utilized as part of a reparative process should not blind us to the possibility that this same creative resource may also lend itself to a species of malignant degeneration and regression. This malignant process, which has the capacity to transform a treatment center such as the Orthogenic School into a cult-like setting, is accelerated when the director begins to accept uncritically the overvaluation of him or her by either staff or residents (Halperin, 1983b).

The Director of the Residential Treatment Center:

Organizational Considerations

The director of the residential treatment center exercises a multiplicity of roles. On one level, he or she mediates between the conflicting hierarchies that comprise a residence. And, in the role of preeminent definer of boundaries, the director creates a climate that encourages the exploration of both positive and negative transferential and countertransferential distortion (Kernberg, 1973). In this context, a significant aspect of limit-setting is to restrict the duration of a resident's stay at the center. Residents should be encouraged to leave the residence and to live independently after discharge. Termination is a complex decision (Halperin, 1986). Unfortunately, relatively few residents reach a point where further treatment after discharge is unnecessary. The development of a "floating" therapeutic community of former residents dropping in to socialize with current residents and staff preserves a diluted therapeutic relationship with the center and is characteristic. However, when the center begins to postpone discharge, presenting to residents the implicit message that discharge and termination are fearful, destructive experiences, the conditions described by Temerlin and Temerlin (1982) are approximated:

Patients also dreaded the consequences of termination without approval of the therapist because of fantasies -- which the therapist often provided -- of personal or professional destruction should they leave the group, which bears a remarkable resemblance to some of the techniques of thought reform and brainwashing. . .Cult membership converted psychotherapy from an ego-building process of individuation into an infantilizing and destructive religion, which these people could no more leave than most people can leave the religion of their youth. (p. 139)

In a residential treatment setting, both staff and residents often face monumental demands for change and growth. At the time of termination, the staff's need for magic to achieve overwhelming goals is exacerbated. The director may respond to the needs of staff and residents by overvaluing his ability to "treat the untreatable." Under the pressure of this group fantasy, especially when it conforms to their own narcissistic needs, directors may gradually begin to exclude from the decision-making process those staff members who do not share their pretensions. They may accuse dissenters of being unnecessarily competitive when their sole "flaw" is their independence, integrity, and/or desire to retain respect for their past training. In the Orthogenic School, for example, the director advanced to the use of brutality to treat those individuals who were essentially organically impaired and would maintain his public image by defining as autistic those who were otherwise treatable, hailing their recovery as an example of his ability to treat autism.

In the cult-like residential treatment setting, directors promote individuals without training because of their need to surround themselves with sycophants. Directors rationalize such capricious promotions as examples of their willingness to promote the "specially gifted" or the "innately talented" and of their refusal to be bound by "archaic" and/or "bureaucratic" credentialing requirements. Thus, the head of the Sullivanian Institute was formerly the registrar in an analytic training institute (not a student), and the training analysts in the Sullivanian Institute are often individuals without formal training in mental health sciences or in psychoanalysis. In such an environment, the director may adopt the more subtly destructive policy of alluding to any criticism as an example of the staff member's "unresolved problems." If a staff member questions the absence of appropriate boundaries between the director and a resident (which may include financial and/or sexual exploitation), the director will interpret this as an example of the staff member's competitiveness stemming from his unresolved "Oedipal conflicts."

Staff members may be subjected to confrontational sessions characterized by humiliating and intrusive scrutiny to help them "work through" their "transference." Ultimately, the staff members who remain within this setting do so on the basis of shame rather than conviction. They may even be encouraged to enter into "psychoanalysis" with the director or senior members of the center's hierarchy to "resolve" their "problems." The presence of an internal climate indicates the growing encapsulation of the center from the outside world and the heightened potential for or the presence of a cultic evolution. Although a wide variety of financial and quasitherapeutic rationalizations may be advanced in support of this growing isolation, the end product is an increasingly incestuous treatment setting in which both staff and residents are deprived of meaningful opportunities for growth.

The director is responsible for setting the tone for the enforcement of discipline within the residential treatment center. Striker (1984), for example, reported that cases in Arkansas and Florida questioned the state's right to regulate discipline within child-care facilities. In both states, residential centers were maintained by fundamentalist religious groups that had resorted to corporal punishment. When, in Arkansas, the state rescinded a rule that permitted spanking in child-care facilities, these groups opposed the state's action. As one group leader said, "We believe that we are mandated by our spank" (Streiker, 1984, p. 96). A more dramatic case is that of the Rebehak Home operated by Lester Roloff. According to the charges, residents were paddled and whipped for misbehavior. Roloff claimed that "such discipline was meant to save their souls. . .There's nothing wrong with handcuffing a girl to keep her from going to hell" (Striker, 1984, p. 98).

More recently, the Ecclesia case in Oregon demonstrates the potential for death in facilities where the leader's need to impose discipline for trivial offenses overrode any sense of paternity or compassion (Thompson, June 1, 1990). And, as the Orthogenic School illustrates, the desire to abuse physically is not limited to fundamentalists. One can only fear for children in facilities that operate under religious and/or therapeutic auspices without appropriate supervision.

Discussion and Recommendations

Certain measures may prevent the development of a cult-like atmosphere within the residential treatment center. These include:

  1. Encourage directors and other appropriate professional staff to take vacations and include a provision for sabbaticals. During these interim periods, associates should be given administrative responsibility. This may inhibit the growth of a cult of personality.

  2. Form an active advisory board independent of the actual agency administration.

  3. Foster an atmosphere in which staff are encouraged to seek outside training.

  4. Foster an atmosphere in which staff are encouraged to examine and deal with the profound emotional drain that comes from constantly responding to the demands of residents.

  5. Relate to organizations such as the American Association of Children's Residential Centers, the American Society of Adolescent Psychiatry, and so on. These organizations should also foster the development of consultation services with ombudsmen available to residents and staff.

The residential treatment center is an enterprise whose task is to reach the previously unreachable. This article discusses the climate that fosters abuses. It must be recognized, however, that despite occasional and notorious abuses, the remarkable reality is that they occur infrequently.


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Thompson, C. (June 1, 1990). 7-year term set for Ecclesia member. The Oregonian.


David A. Halperin, M.D. is Associate Clinical Professor of Psychiatry at Mount Sinai School of Medicine. Dr. Halperin has lectured extensively and published numerous articles and books on cults, including the edited volume Psychodynamic Perspectives on Religion, Sect and Cult.

Arnold Markowitz, M.S.W. is Director of the Cult Hotline and Clinic of the Jewish Board of Family and Children's Services of New York City. He is chair of the American Family Foundation Family Guidelines Committee.