A Demystified, Pragmatic Approach to the Treatment of Patients with a History of Organized Sadistic Abuse

This presentation describes a pragmatic clinical approach to patients reporting a history of organized sadistic abuse (OSA). It is helpful to begin with a brief overview of the history of OSA in the dissociative disorders (DD) field, and the controversies generated about them within the DD field and outside it. These patients do not qualitatively differ from other dissociative identity disorder (DID) or Complex PTSD (CPTSD) patients, although generally they are at the most extreme end of the severity spectrum. They require rigorous application of basic principles of the evidence based, phasic trauma treatment model that prioritizes safety and stabilization, and the patient’s responsibility for all behavior. Relatively limited attention is paid to patients’ reports of occultist or “government mind control” experiences, being respectful of the importance of these to some patients. Victims are terrorized to conceal the underlying purpose of OSA: highly profitable trafficking of children and adults. The patient is educated that all perpetrators use domination, power and control, primarily fueled by humiliation, to develop control of the patient’s thoughts, feelings and behavior. 

It is essential to consistently and rigorously focus on the dynamics of shame and humiliation in OSA. In OSA, patients usually describe systematic torture to generate specific, conditioned responses to create automatic responding, quasidelusional/ delusional beliefs and subjective slavery. Patients learn to demystify perpetrators’ reported statements and behavior; and demystify perpetrator threats and rationalizations, e.g., “programming” is actually systematic torture. Reports of current revictimization need to be separated from actual events; OSA patients’ difficulties separating outside from subjective reality, including flashbacks experienced as current events; dissociative self states engaging in subjective behaviors experienced as real “outside” events; or combinations of these. In general, it is best to maintain empathic neutrality to patients’ reports of specific trauma events, as these may change as patients become better stabilized and less dissociative. Patients may report memory contamination by perpetrator-induced illusion and “created reality” in which fear states, drugs, sleep-deprivation, coercive hypnosis and the dissociativity of the child, among others, are used to create the subjective experience of events that that are partial or full illusions. Continual attention to traumatic transference, particularly “mind control” transference, can help tease out these issues. Attention to the process of the transference/countertransference can be helpful in elucidating the patient’s subjective experience of perpetration. Often, the attempt by the patient to focus on occultism and/or “government mind control” to the exclusion of all else, is a form of defensive avoidance of much more devastating, but more prosaic betrayals by attachment figures in the context of childhood abuse, organized or not.

This session was originally presented as a live webinar in October 2020.

Target Audience


Learning Objectives

Upon completion of this webinar participants will be able to:

  • Summarize the basic principles of the pragmatic phase-oriented conceptualization of the treatment of individuals reporting organized sadistic abuse (OSA).
  • Evaluate the relevance of this model to the listeners’ current clinical practice.
  • Identify clinical situations where this model can help identify whether OSA patients are currently being revictimized
  • Classify the major themes of shame/humiliation that occur in the psychotherapy of OSA patients
  • Differentiate the impact on the patient of OSA itself from betrayal by early attachment figures
Course summary
Available credit: 
  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.
Course opens: 
Course expires: 
ISSTD Member cost:
Your Price:

Presenter: Richard J Loewenstein, MD
Presenter Biography: Richard J. Loewenstein M.D. is the founder and was the Medical Director of The Trauma Disorders Program at Sheppard Pratt, Baltimore, MD, from 1987-2020. He is rated by U.S. News and World Report as among America’s top 1 % of psychiatrists. He is Clinical Professor of Psychiatry at the University of Maryland School of Medicine. Founded in 1992, the Sheppard Pratt Trauma Disorders Program includes a 22-bed inpatient unit, an outpatient program, a fellowship program, and research, consultation and teaching components. Dr. Loewenstein did a research fellowship at the National Institute of Mental Health in Bethesda, MD. He is the author of over 100 papers and book chapters on delirium, dementia, consultation-liaison psychiatry, dissociation, dissociative disorders and trauma disorders. He is the Section Editor, Dissociative Disorders, DSM-5 Text Revision, and Co-editor of the 4th revision of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for Treatment of Dissociative Identity Disorder, both currently in development. He is a distinguished life fellow of the American Psychiatric Association and has received the Lifetime Achievement Award of the ISSTD

Available Credit

  • 1.50 ISSTD Certificate Program
    This program is eligible for 1.50 credits in the ISSTD Certificate Program.


ISSTD Member cost:
Your Price:
Please login or register to take this course.

"Your Price" above reflects your final price based on your membership status and career level. 

  • ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. 
  • ISSTD defines an emerging professional as mental health professionals who have completed an advanced degree and are in the first three years of their career (or first three years after graduation for researchers).
  • If you do not fall into one of the above categories please register as Professional/Retired. 

These prices are for Tier I countries. For a list of countries by Tier click here. If you are located in a country that falls into Tier II-VI please contact ISSTD at cfas@isst-d.org to receive the appropriate discount code.