Clinical Update on Cults

Psychiatric TimesPsychiatric Times Vol 13 No 7
Volume 13
Issue 7

Historically, cult refers to a system of worship and more specifically to an innovative religious system, as opposed to a sect, which is a breakaway group from an established religion. During the past 30 years, however, cult has taken on a pejorative connotation arising from disasters such as Jonestown and Waco, and hundreds of media reports of individuals and families devastated by involvement in cults.

Historically, cult refers to a system of worship and more specifically to an innovative religious system, as opposed to a sect, which is a breakaway group from an established religion. During the past 30 years, however, cult has taken on a pejorative connotation arising from disasters such as Jonestown and Waco, and hundreds of media reports of individuals and families devastated by involvement in cults.

Although some scholars of religion now favor the term new religious movement over cult, many mental health professionals, perhaps because they are more likely to see the casualties of new groups, feel comfortable using the term cult (Langone; Singer and Lalich; Tobias and Lalich). They see cults as highly manipulative groups that exploit and otherwise abuse their members. Although most groups accused of being cults are religious, some claim to be psychological (Singer and colleagues; Temerlin and Temerlin) or political (Lalich).

A factor-analytic study of 308 former members of 101 groups resulted in the development of the Group Psychological Abuse Scale (Chambers and others). This scale identified four factors associated with cultic environments: compliance, exploitation, mind control and anxious dependency. The following definition emerged from this study:

"Cults are groups that often exploit members psychologically and/or financially, typically by making members comply with leadership's demands through certain types of psychological manipulation, popularly called mind control, and through the inculcation of deep-seated anxious dependency on the group and its leaders."

According to this perspective (and that of this author) cults can be distinguished from new religious and other new groups in that the latter are not characterized by high levels of exploitation, compliance, mind control and anxious dependency. Of course, a spectrum of groups exists along each of these dimensions. As the Group Psychological Abuse Scale is given to large numbers of people from a variety of groups (mainstream and nonmainstream), group profiles and empirically based classification systems will probably emerge and thereby reduce the definitional ambiguity that currently surrounds the word cult.


In 1984 the Cult Awareness Network (a grassroots organization founded by parents of cult members) compiled a list of more than 2,000 groups about which it had received inquiries (Virginia Hulet, unpublished manuscript, 1984). Based on the frequency with which this and other organizations receive inquiries about groups not on this original list, I believe it is reasonable to estimate that at least 3,000 to 5,000 potentially cultic groups exist.

A survey of primary care physicians in Pennsylvania (Lottick) found that 2.2 percent reported they or a member of their family had been involved in a cult (clearly defined as a noxious, not merely unorthodox, group), that 21 percent had personal, professional, or both personal and professional experience with cults, and 64 percent felt they had inadequate information (which was later supplied through a tear-out booklet for patients and physicians, published by the Pennsylvania Medical Society [1995]). Other surveys (Bird and Reimer; ICR Survey Research Group, unpublished, 1993; Zimbardo and Hartley) also indicate that at least 1 percent of the population has had a cult involvement.

Who Joins Cults?

No particular psychopathology profile is associated with cult involvement, in part because cults, like many effective sales organizations, adjust their pitch to the personality and needs of their prospects. Although cult members appear to have a somewhat higher rate of psychological distress than nonmembers, the majority seems to lie within the normal range. Nevertheless, clinical experience strongly suggests that certain situational or developmental features (singly or in combination) appear to make people more receptive to cult sales pitches, including:

  • a high level of stress or dissatisfaction

  • lack of self-confidence

  • unassertiveness

  • gullibility

  • esire to belong to a group

  • low tolerance for ambiguity

  • naive idealism

  • cultural disillusionment

  • frustrated spiritual searching

  • susceptibility to trance-like states

Why Do People Join?

The definitional ambiguity surrounding the term cult has fueled much controversy regarding why people join cults and other unorthodox groups. Three apparently conflicting models attempt to account for conversion to unorthodox groups. The deliberative model, favored by most sociologists and religious scholars, says that people join because of what they think about the group. The psychodynamic model, favored by many mental health professionals with little direct experience with cultists, says that people join because of what the group does for them-namely, fulfill unconscious psychological needs. The thought reform model, favored by many mental health professionals who have worked with large numbers of cultists, says that people join because of what the group does to them- that is, because of a systematic program of psychological manipulation that exploits, rather than fulfills, needs.

In professional talks, I have proposed an integrative model. This model treats deliberation as a dependent variable and manipulativeness and psychological neediness as independent variables. Neediness, rather than psychopathology, is preferred because, as noted, the factors that render some people susceptible to cult pitches are developmental or situational in nature. Breaking manipulation and neediness into "low" and "high" results in a four-cell table.

When manipulation and neediness are low, rational deliberation is high, and the deliberative model is most applicable. Unpressured conversions by relatively mature and stable individuals would be examples of this type of conversion.

When manipulation is low but neediness is high, deliberation is distorted by emotional needs (i.e., an overdriven striving that reflects unconscious conflict), and the psychodynamic model is most applicable. A sexually conflicted young man's joining a nonmanipulative celibate religious group could be an example of such emotionalized deliberation.

When neediness is low but manipulation is high, deliberation is distorted by environmental pressures, and the thought reform model is most applicable. Because converts' attention, as well as their behavior, is manipulated by the environment, I refer to their deliberation as dissociated: the environment manipulates recruits' "searchlight of awareness" (West) causing them to uncritically accept pivotal presuppositions (e.g., "I must destroy the mind to find God"; "Guru is God incarnate"; "Only with Guru's help can I overcome my worldly attachments"), which will lead to certain corollaries through a process of rational deliberation ("Guru must want to sleep with me to help me overcome my attachments to sexuality").

Of course, there will be cases in which individuals accept such presuppositions in a nonmanipulative environment, which makes the differential diagnosis task more difficult. Thus, converts make "choices" and "deliberate," but without a full awareness of how their deliberations and choices are manipulated at certain key points.

When manipulation and neediness are high, deliberation will be emotionalized and dissociated, and the psychodynamic and thought reform models will both apply. Because little has been written about cases that would fall within this cell, more investigation is needed.


The manipulativeness of cults is similar to the debility-dependency-dread (DDD) syndrome explanation of how the Chinese communists were able to gain a high degree of control over American POWs during the Korean conflict (Farber and colleagues). Contemporary cults, which operate in an open society and do not have the power of the state at their disposal, cannot forcibly restrain prospects and run them through a debilitating regimen. Instead, they must fool them. They must persuade prospects that the group is beneficial in some way that appeals to the targeted individuals. As a result of this deception and the systematic use of highly manipulative techniques of influence (see Cialdini for an overview of social-psychological manipulation), recruits come to commit themselves to the group's prescribed ways of thinking, feeling and acting. By gradually isolating members from outside influences, establishing unrealistically high, guilt-inducing expectations, punishing any expressions of "negativity," and denigrating independent critical thinking, the group causes members to become extremely dependent on its compliance-oriented expressions of love and support. Once a state of dependency is firmly established, the group's control over members' thoughts, feelings and behavior is strengthened by the members' growing dread of losing the group's psychological support (physical threat also occurs in some groups), however much that support may aim at ensuring their compliance with leadership's often debilitating demands. Thus, the new DDD syndrome is one of deception, dependency and dread.

What Happens to Cult Members?

The limited research and clinical data concerning cult members seems at first to be perplexing and contradictory. On the one hand, clinicians tell us that cult environments attempt to surreptitiously reshape their members' personalities (Clark; Singer; West and Martin), a process that on its face should be fraught with tension. On the other hand, some studies indicate that cult members score in the normal range on personality tests, despite some evidence of attempts to "look good" (Ross; Ungerleider and Wellisch). Other research (Galanter and others; Galanter) indicates that joining a cult may reduce perceived distress. Research on cult departure (Skonovd; Wright), however, suggests that members feel extreme pressure to remain in the cult, and research on postcult effects (Galanter; Martin and others) indicates that those who leave experience considerable distress after their return to the mainstream world. Langone (1993) comments:

If they [ex-cult members] were unhappy before they joined, became happier after they joined, were pressured to remain, left anyway, and were more distressed than ever after leaving, what could have impelled them to leave and to remain apart from the group? The inescapable conclusion seems to be that the cult experience is not what it appears to be. Clinical observers, beginning with Clark (1979) and Singer (1979), appear to be correct in their contention that dissociative defenses help cultists adapt to the contradictory and intense demands of the cult environment.

The dissociation-mediated tension between benign appearance and abusive reality tends to destabilize members' commitment to the group. The majority (90 percent or more) of cult members eventually leave their groups (Barker; Galanter). However, individuals' psychological distress when they leave their groups is substantial and typically misunderstood by themselves, their families and helping professionals. Therefore, clinicians should not dismiss families seeking help for cult-involved loved ones because the odds say that they will probably eventually leave. There is no way to predict in the individual case whether a particular person will be among the 90 percent who leave, how long "eventually" will take, or how distressed the person will be when he or she leaves the group.

Psychotherapist's Role

Former cult members, families of currently or formerly involved cult members, and occasionally current cult members may contact psychotherapists for assistance.

Helping former cult members. Former cult members who seek treatment tend to describe their cult experience as abusive or traumatic (Langone and Chambers). Frequently, however, their understanding of their experience is limited, if not faulty. As with many other victims of abuse, they continue to blame themselves inappropriately for distress resulting from the psychological assault of the cult. It is usually advisable, therefore, that therapists take an active stance with ex-cult members and not rely too much on reflection and paraphrase; otherwise, patients may project their failure onto the therapist's "blank screen" and leave treatment prematurely.

Clinicians should make a cult-sensitive assessment. They should not rush to a diagnosis, for much of the emotional turmoil of former cult members is a direct result of psychological assault, not long-standing personality patterns or conflicts. Clinicians should evaluate the positive as well as the negative influences of the cult environment and patients' psychosocial histories in order to identify those factors that may have rendered them susceptible to cultic manipulations and those precult psychological problems that may reemerge after the cult experience.

Clinicians should also assess patients' understanding of how cults manipulate and the patients' educational and job-skill levels (many cult members, especially those raised in cults, are educationally and vocationally deprived). Standard psychiatric medications can sometimes be helpful, but because these patients tend to appear to be more disturbed than they actually are, a conservative and watchful medication stance is called for. Psychotherapy with former cult members includes five overlapping goals:


  • Help patients understand the psychological manipulation and abuse to which they were subjected;
  • Help them manage the day-to-day crises (e.g., how to deal with skeptical Aunt Carol's visit) that often seem out of proportion to patients' level of intellectual functioning and psychological history (and that often cause therapists to overestimate the degree of psychopathology in ex-member patients);
  • Help patients reconnect to and repair their pasts (personal relationships, goals, interests), grieve over lost time, friendships, and sense of purpose (however illusory it may have been), and compare and contrast their cult and mainstream lives;
  • To the extent possible, mobilize patients' social support network and other resources (e.g., educational or vocational resources);
  • Help patients integrate their cult experience into the rest of their life experience and deal with residual psychological problems.

Helping families. Clinical work with families is usually through consultation, though sometimes treatment (Singer 1986). Consultation involves educational interventions designed to help families respond effectively to a loved one's cult involvement. Treatment aims at helping family members cope with their emotional reactions to the cult involvement. However, even treatment requires some educational work because the troubled family member needs to better understand the cult phenomenon in order to reduce the confusion, fear and despair that results from the family's unsuccessful attempts to help their involved loved one. Other than this educational component, treatment of family members' emotional reactions can include standard clinical procedures.

Counseling Families

Consultation with families addresses three areas: assessment, education and training (Langone; Ross and Langone).

Assessment should include an exploration of the family's history, strengths, weaknesses, current functioning and knowledge about the loved one's involvement (frequently families become alarmed, though not necessarily inappropriately, even though they have minimal information about the group in question). I use the following question to help focus the family: "If your child (spouse) were not in a cult, what if anything would bother you about his or her behavior?"

If there are no troublesome behaviors, it is likely that the family is overreacting. If troublesome behaviors are identified, then the consultant tries to help the family determine whether there is reason to believe that these behaviors are linked to the group's practices.

During the assessment process the consultant should begin to teach the family about cults and psychological manipulation (many useful resources can be obtained from the American Family Foundation, P.O. Box 2265, Bonita Springs, FL 33959, [212] 249-7693). It is important, however, not to let the unavoidable generalizations of books, articles, and audiovisual materials obscure the uniqueness of the individual case.

The training component has three goals: (1) to improve communication; (2) to identify a strategy to help the involved person; and (3) to implement the strategy. Standard communication and negotiation skills training can contribute much to the first goal. In addressing the second, the consultant and family will usually choose from one of the following options: (a) postpone a decision about strategy and focus on collecting more information to complete the assessment properly; (b) acknowledge the family's limited influence, devise a strategy for making the best out of a bad situation and carefully look for reasons to hope that the situation may someday change for the better; and (c) develop a strategy for intervention, which may include family counseling with the involved person or exit counseling.

Exit Counseling

Exit counseling (Giambalvo) is a voluntary, intensive, time-limited contractual educational process that emphasizes the respectful sharing of information with members of exploitatively manipulative groups. Exit counselors ideally should have intimate knowledge about the group in question. Exit counseling is distinguished from deprogramming, which received much media coverage in the late 1970s and 1980s, in that the former is a voluntary process, whereas the latter is currently associated with a temporary restraint of the cult member. If the implementation strategy focuses on family counseling, the clinician may nonetheless consider bringing in an exit counselor consultant at some point in order to help the involved person better understand details about the group's manipulations.

Helping current cult members. Because cults tend to be elitist and distrustful of the outside world, members will rarely consult a mental health professional, so my suggestions are based more on reasoning than experience. If a cult member consults a clinician at the urging of family members concerned about a possible cult involvement, then the clinician can explore the cult issue in depth and, if indicated, bring in the family. If, however, the cult member comes in voluntarily (e.g., to deal with depression that may or may not be causally connected to the group's practices), clinicians should be even more sensitive to the ethical implications of their actions. Even if the destructiveness of the group involvement is obvious to the clinician, the cult member may not be willing even to consider this issue. Does the clinician force the issue? Keep a hidden agenda? Do what is possible within the boundaries established by the patient? Refer the person elsewhere? The answer to these questions will depend upon the patient's situation (e.g., is he or she suicidal?) and the clinician's ethical analysis of the situation.

If clinicians address the cult issue when working with a cult member, they may find it helpful to take a careful chronological history in order to try to help the patient see how his or her behavior and psychological state may have been influenced by the group's practices. Sometimes it may be appropriate to bring in an exit counselor, with the patient's permission, of course.

Working with cult victims and their families demands a special understanding and appreciation of the potential power of highly manipulative environments. It is a field full of uncertainty, ambiguity, frustration and complexity. But it is also a field in which success brings the special gratification of having helped to liberate both a body and a mind.



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