Working With Patients From High Control Groups, Part 2

While working with patients who have been in cults, one treatment method is psychodynamic therapy.

This theory is especially useful when dealing with Jehovah’s Witnesses’ patients (Friedson, 2015). The role of the therapist within the psychodynamic approach is to reach out to the client’s unconsciousness and promote exploration. By doing so,  individuals’ inner world, where dreams, fantasies, fears, and wishes as well as personal relationships exist provides the opportunity to begin work towards recovery.

Other important tactics that contribute to successful psychodynamic treatment are mirroring, validating patient’s feelings in addition to assisting members to recreate a narrative of their lives which may otherwise be too overwhelming to achieve on their own (Friedson, 2015).

Building a Therapeutic Relationship is Crucial

Being in this therapeutic relationship with clients and showing consistency is something new, unknown and different from what they have been accustomed to in their cult lives. Hence, building a therapeutic relationship is of utmost importance in addition to validating the clients’ experiences.

Although many psychodynamic therapists would prefer to focus on the cause rather than the symptoms, this does not suggest that they are unconcerned with the current difficulties that a patient may be experiencing.

Often, clients are unaware of what lies underneath. Treating patients from high control groups with the methods of psychodynamic theory implies that professionals look for the broader picture and context along with any underlying issues.

Exit counseling is the preferred choice of treatment according to Sirkin (1990). In order to successfully treat a cult member, counselors must be able to take an in-depth, effective assessment.

“Unlike most other difficulties for which psychotherapy is sought, the cult-involved individual usually feels that they have no problems; rather, the family members and others who object to the involvement are in need of assistance” (Sirkin, 1990).

Therapists Assess Pre-Cult Identity

There’s a lot of work to be done prior to the actual individual session with the person involved in a cult. An ideal option would include counseling sessions with both the involved individual and his/her family. Loved ones who have already been indoctrinated and living in the cult for years are often perceived by their family as having bizarre behavior.

Therapists’ roles are to educate the family that blaming statements and judgmental behaviors are not beneficial. On the contrary, they will surely reinforce the cult mentality that indeed, family members do act as opposers.

Family therapy sessions are helpful because they assist to open lines of communication with cult members. If parents haven’t heard from their loved ones then a counselor or a therapist could suggest that they write letters, send emails, and pictures to remind the cult member that people still deeply love and care about them.

Once communication with the family is restored and the relationship between members is consistent, then individual therapy may begin. Therapists are encouraged to assess the person’s pre-cult identity. By asking questions of who they were and what they enjoyed doing prior to joining the cult, members are reminded of long forgotten activities, of a different life.

What is often found during therapy is that cult members have limited or absolutely no knowledge of the cult’s history and leadership practices (Sirkin, 1990). The actual individual exit counseling process may take anywhere from several hours to several days.

Individual and family therapy as modalities complement one another and are used to build a consistent and stable rapport not only between a therapist and client, but also between each member in the family unit.

There has not been a lot of research done with second and third generation cult members. When working with this population, researchers suggest to utilize a constructivist, social justice, grounded theory approach in order to examine how clients have built the world they now live in (Matthews and Salazar, 2014).

Initially, counselors are to educate themselves about cult and cult recovery. The next step would be to assess the client’s personal cult experiences and to help him critically evaluate the nature of the cult along with its power dynamics.

As the therapeutic process progresses, clients are encouraged to review the effects of growing up in a cult. New skills are taught such as deep breathing techniques, relaxation, and visualization. By the end of therapy, patients are empowered to take control of their lives as well as to advocate and empower others (Matthews & Salazar, 2014).

Implications for Therapists

Counselors working with former and current cult members need to be educated when working with this population. Being informed and well-trained with the skills and techniques needed in order to assist these clients is imperative. Many struggle treating individuals coming from Bible-based as well as non-religious high control groups.

For a number of years, some scholars have argued that religious and spiritual matters are reserved territory for pastors and spiritual leaders and should be treated separately from psychotherapy (Rosenberg, 2010). However, mental illness is closely connected with clients’ spiritual life.

More and more therapists now consider an individual’s spiritual beliefs as a piece of the puzzle, in order to achieve client’s overall well-being. Discussing religion and spirituality during sessions could be used as a building block. To separate them from the therapeutic process could be detrimental for clients.

There is a growing awareness of cults and their practices because more ex-cult members are going public and sharing their personal stories and experiences. This trend allows mental health counselors the ability to gather a lot of information in a relatively short time. However, more studies need to be conducted in order for researchers to develop a deeper understanding when treating these clients. Generally, cult members are not very open in participating in studies because of feeling afraid and of being ridiculed (Coates, 2010).

Lastly, therapists need to be mindful when working with families prior to meeting their loved ones. They may feel tempted to ally with the family, especially knowing that high control groups use unethical practices.

Parting Thoughts to Remember

The interventions discussed in this article followed psychodynamic theory, client-centered therapy, interventions based on cognitive-behavioral therapy and constructivist grounded theory.

When using these theories and interventions, psychologists and therapists must remember that even if the intervention is not initially effective and the individual remains in the cult, the seed has been planted potentially making it easier to leave at a later time.

Although this situation can be heartbreaking for family members, sometimes the timing is just as important as the intervention itself. Overall, building rapport and psychoeducation has shown to be most effective when dealing with this population.

As destructive as high control groups can be, individuals need to be aware that there is hope and that they can overcome a cult experience. On the other hand, counselors and therapists must not be weary and afraid of addressing people’s spiritual and religious experiences especially if it’s detrimental to their patients.

More information about Ekaterina Musok, LCSW can be found at



Aronoff, J., Lynn, S. J., & Malinoski, P. (2000). Are cultic environments psychologically harmful?. Clinical Psychology Review, 2091-111. doi:10.1016/S0272-7358(98)00093-2

Burke, B., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.

Gibney, A. (2015). Going Clear: Scientology and the Prison of Belief. Retrieved from

Coates, D. D. (2010). Post-Involvement Difficulties Experienced by Former Members of Charismatic Groups. Journal of Religion and Health, (3). 296.

Friedson, M. L. (2015). Psychotherapy and the Fundamentalist client: The aims and challenges of treating Jehovah’s Witnesses. Journal Of Religion And Health, 54(2), 693-712. doi:10.1007/s10943-014-9946-8

Matthews, C., & Salazar, C. (2014). Second-Generation Adult Former Cult Group Members’ Recovery Experiences: Implications for Counseling. International Journal For The Advancement Of Counselling, 36(2), 188. doi:10.1007/s10447-013-9201-0

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing (2nd ed.). New York, NY: Guilford Press

Sirkin, M. I. (1990). Cult involvement: A systems approach to assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 27(1), 116-123. doi:10.1037/0033-3204.27.1.116

Rosenfeld, G. W. (2010). Identifying and integrating helpful and harmful religious beliefs into psychotherapy. Psychotherapy Theory, Research, Practice, Training, 47(4), 512–526.

Walsh, Y. (2001). Deconstructing ‘brainwashing’ within cults as an aid to counselling psychologists. Counselling Psychology Quarterly, 14(2), 119-128. doi:10.1080/09515070110058558

Ward, D. (2000). “Where do I start?”: Assessment and intervention with ex-cult members. Australian Social Work, 53(2), 37. doi:10.1080/03124070008414147




Working With Patients From High Control Groups, Part 2

Ekaterina Musok LCSW

Ekaterina Musok is an experienced, licensed Mental Health Professional based in Tampa, FL. She specializes in anxiety, depression, and relationship issues.


APA Reference
, . (2019). Working With Patients From High Control Groups, Part 2. Psych Central. Retrieved on October 27, 2020, from


Scientifically Reviewed
Last updated: 23 Sep 2019
Last reviewed: By John M. Grohol, Psy.D. on 23 Sep 2019
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