Abstract
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.