The following is based on a presentation made at the 8th Annual U.S. Psychiatric & Mental Health Congress in New York City, November 16-19, 1995. The author is Executive Director of AFF, publisher of The Cult Observer, and Editor of AFF's Cultic Studies Journal.

Research indicates that although a large majority of cult members eventually leave their groups, many, perhaps most, experience high levels of psychological distress after leaving and frequently seek mental health counseling.

A factor analytic study of former cult members' experiences has led to the development of a "Group Psychological Abuse Scale," which in turn has found four factors which characterize cultic environments of all types compliance, expolitation, mind control, and anxious dependency which determine whether and to what extent an individual may be harmed by the experience.

Theories of Involvement

Why people join cults, why they leave, why they often experience distress upon leaving, how they can be helped are questions that have not been extensively researched, although three general models of cult conversion and departure can be identified, with the answers to these questions varying among the models.

First is the psychodynamic model, which presumes that cultic groups fulfill unconscious needs of its members. Second is the deliberative model (popular among theologians and sociologists), which presumes that people join and leave cultic groups because of their cognitive evaluations, however faulty, of the group. Third is the thought reform model, which presumes that cultic environments lure and hold on to members through high levels of psychological manipulation. An integrative model proposes that the degree of deliberation in a group involvement is a function of the psychological neediness of the individual and manipulativeness of the environment. When neediness and manipulativeness are low, deliberation will be highest. Those harmed by a cultic involvement are most likely to come from highly manipulative groups. About one-third appear to have had psychological disorders before joining the cult, but most appear to have been relatively normal psychologically.

"Cult-sensitive assessment"

Treatment of former cult members should include a cult-sensitive assessment. The clinician should appreciate the degree to which negative emotional reactions can be a function psychological trauma experienced in the cult, and should not rush to a psychodynamic interpretation that focuses on preexisting disorders. However, even though the cult environment is potent, the psychological, family, and social/vocational history of the individual should be investigated thoroughly. It is also important to assess the psycho-educational needs of patients, that is, the degree to which they understand cultic manipulations, as well as academic and vocational skills (cultic isolation can put many ex-members years behind their peers in educational and vocational development.)

Elements of treatment
Treatment should also include the following:(1) education about psychological manipulation and an application of this knowledge to the patient's cult experience; (2) active management of day-to-day crises, which are especially common in recently exited person; (3) a reconnecting to the pre-cult past; (4) support in the resolution of grief and guilt related to lost time, lost friendships, and lost innocence; (5) education and mobilization of the patient's social support network; and (6) ultimately, a cognitive integration of the positive and negative aspects of the cult experience into the patient's emerging post-cult identity. Pharmocotherapy can often help former cultists, especially those experiencing severe depression, but psychiatrists should be more cautious in making the decision to prescribe and more vigilant in follow-up when a cult involvement is evident. Former cult members' symptoms are often much more a function of psychological trauma than of long-standing psychopathology.

Family members

Family members who consult mental health professionals because of a loved one's cult involvement should not be dismissed as overprotective, enmeshed, or otherwise dysfunctional. Most family members seeking help are relatively normal, although many experience considerable anxiety and anguish in response to the cult involvement. Family members typically need information about cults, communication skills training, add assistance in dividing a strategy to help their loved one make an informed reevaluation of the cult involvement. Such persons should be referred to cult experts.

Satanism

Treatment of youth involved in Satanism, or ritual abuse survivors, though similar in some ways to the treatment of cult victims, is different in others. Satanically involved youth tend to be disturbed psychologically and often are solitary in their satanic dabbling. These youth appear to gain a compensatory, though illusory, feeling of power through Satanism. Treatment should focus on helping them build a more reality-based self-esteem. The treatment of ritualistic abuse survivors (children and adults) is fraught with controversy, especially where recovered memories are involved. Based on current lack of research data, the recommendations of the American Psychiatric Association's Statement on Memories of Sexual Abuse appears to be the most balanced approach to dealing with ritual abuse cases.

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