Introduction

In the past, the issue of satanic ritual abuse (SRA) has led only to heated controversy and media attention, in the Netherlands as well as elsewhere in the world. This has not contributed to a better understanding of clients who report such trauma histories. Clinicians in the Netherlands (myself included) were portrayed as half-wits who were deceiving their clients into believing that they had been subject to this kind of abuse, or who were foolish or over-involved enough to accept the validity of their clients' reports unquestioningly. Indeed, in their editorial in the Dutch Journal of Psychotherapy, Van Daele and Lauteslager (2010) supported Canadian philosopher Ian Hacking's proposition that a therapist should only take the fears of a client seriously provided there is compelling legal evidence to support the client's reports of sexual or ritual abuse. Without such evidence, the therapist would be engaging in the harmful and outrageous encouragement of fears that are not actually based on facts. Since such a proposition is untenable and quite incompatible with psychotherapy, this does not exactly encourage (more) public reflection on these complex treatments. On the other hand, the treatment of clients who report abuse by organised networks is still a topical issue, particularly at mental health care centres that have specialised in the treatment of severely traumatised clients with a Complex Post-Traumatic Stress Disorder (CPTSD) or dissociative disorders. The dilemmas encountered in the course of such treatments, as explained in more detail in this article, are not solved by silence but by sharing experiences with colleagues and by continuing to seek ways to assist these clients to the best of our ability.

This article will not discuss detailed content of the reported events and cruelties, as I do not find such details relevant to proper treatment. As a matter of fact, losing oneself in too many grisly details may even be a pitfall to clinicians. The whole point is that clinicians must be able to keep sight of the larger picture during treatment and not become bound up in such details or allow themselves to be distracted by them. I will also refrain from making any attempt at establishing a "truth" or proving that "it really does exist": those are matters for the judicial authorities. I sincerely doubt whether surveys based on detailed questionnaires administered to clinicians and clients will contribute to a better treatment of this problem (Marinkelle, 2013 Rutz et al, 2008). Such surveys offer a lot of (very) detailed information on trauma, but they do not suggest ways for the therapist to deal with that kind of trauma. 

This article will explain how and when I first encountered the phenomenon of organised abuse, followed by a description of the clients reporting this type of abuse, the networks, the treatment and any pitfall involved.

 

Background

It was in the mid-eighties that we, staff members of a social psychiatry department at a mental health centre, were first confronted with the phenomenon of "ritual abuse." This happened during a workshop by an American colleague on the diagnosis and treatment of DSM-III dissociative disorders; in themselves already diagnostic categories that were considered controversial, particularly where it concerned the Dissociative Identity Disorder (DID). We presented case histories of clients with symptoms and behaviour of which we had little understanding. The clients concerned were all being treated for severe psychiatric symptoms, including chronic dissociative symptoms and post-traumatic stress symptoms. In addition, they suffered from problems such as serious eating problems, chronic suicidality and often severe forms of self-mutilation. Beforehand, our questions mainly concerned the meaning of drawings, apparently made by dissociative (child) parts, of bizarre-looking abuse involving much symbolism such as reversed crosses, the pentagram and people with robes and hoods, as well as texts that were frequently written in inverted print. These materials were given to us by clients in the course of their treatment. The clients, as a rule, insisted that they had no memory of drawing or writing that which they presented to us and were very avoidant and anxious. Once they realised that they must have created these materials themselves, they voiced opinions about themselves in no uncertain terms: they had to be stark raving mad and their fantasies and thoughts must be utterly bizarre. That American colleague then told us that some of the symptoms our clients exhibited, including these drawings, may be an indication that the clients had experienced some form of ritual abuse. Similar materials had also been presented during treatments in the United States and a number of European countries, including Germany and England (Huber, 1995; Sinason, 1994, Tate, 1991). Incidentally, according to some, such materials are precisely the reason for the emergence of a global pandemic of 'ritual abuse', with clinicians from various continents influencing each other and subsequently influencing vulnerable clients (who would then produce such materials in order to please their therapists or to receive attention).

In the years thereafter, the issue of ritual abuse gained increasing media attention, first and foremost in the United States and England, in particular as a result of high-profile court cases and studies of large groups of young children in nurseries or at schools of whom it was suspected that they suffered organised ritual abuse. This suspicion was based on the many consistent stories and drawings by these (often very young) children. This resulted in a fierce polarisation between so-called believers and non-believers. The non-believers, remaining unreservedly convinced of being right, spoke of mass hysteria involving parents, researchers and care providers who had led the children to believe these cruelties through over-involvement and unprofessional conduct. Colleagues from the United States who had fallen prey to this mass hysteria would then delude suggestible clinicians around the world, such as ourselves, into accepting this nonsense. The Netherlands was not spared from intense controversy about the issue either.

In the United States, a new syndrome was introduced: the so-called false memory syndrome (Pedzek & Banks, 1996). Partly influenced by the existing "suing culture", this resulted in a long string of court cases in which (mostly) adult clients accused their therapists of talking them into believing false memories. They demanded (and often - but not always - received) enormous damages. The court cases concerned supposed ritual abuse, but were certainly not limited to such extreme testimonies from clients. False memory claims were also made in cases involving sexual abuse by a single perpetrator, such as the father. The introduction of the so-called  false memory syndrome and all of the subsequent court cases involving false memories  had a major impact on psychiatrists and psychotherapists in the United States who were treating clients of this sort. Some of them stopped treating these clients altogether. Others decided never again to speak about the issue in public - not even at scientific conferences.

Reports of organised abuse kept emerging, however, (also in the Netherlands) and sometimes these reports were so convincing that they could not simply be dismissed as fabrications by suggestible children or adults and their over-involved therapists. In 1993, a current affairs programme on Dutch national television (entitled "NOVA") devoted two extensive episodes to the phenomenon following 11 reports to the Dutch Inspectorate for Youth Care of suspected organised ritual abuse. I was invited to contribute to the programme, I felt like I was definitely "risking my neck’ by doing so, since it was clear that such a programme would add fuel to the fire of disbelief for those who thought that the existence of such abuse was nonsense by definition or simply the fruit of the deranged minds of certain therapists and their clients. Moreover, it seemed highly questionable whether this media attention would ultimately be beneficial to the clients concerned and their therapists. The programme led to parliamentary questions and the creation of a committee, chaired by Mr Hulsenbek LL M, that thoroughly investigated the issue and questioned many people involved with regard to their experiences and ideas, ranging from clinicians (myself included) and clients to members of the police, judicial authorities and critics. The conclusion of the committee's final report was that there was (and, incidentally, there still is) no firm evidence for the existence of such organised networks in the Netherlands. Consequently, and understandably, the credibility of the witnesses is questioned to this day - over and over again. It is often already difficult enough for the Public Prosecution Service to establish "simple" sexual abuse, let alone proving the extreme stories about organised networks (see also Nierop & Van den Langeshof, 2010). I know that some of the vice squad detectives in Amsterdam with whom I sometimes had contact at the time thoroughly investigated a number of cases and found evidence that some statements were indeed accurate. They were therefore convinced that not all stories were fabrications. Nevertheless, they were never able to find sufficient legal evidence to prosecute the perpetrators. In fact, none of my own clients, and none of the clients of therapists whom I have supervised, has ever filed a criminal complaint against the perpetrators. Personally, I hold the opinion that therapists must maintain a strict boundary between their role as a clinician and the responsibilities of the police and the Public Prosecution Service. Therefore, I believe that it is not a task of therapists to encourage their clients to report the crimes to which they have been subjected to the police.

Even if the Hulsenbek committee concluded that there was no firm evidence for the existence of organised networks in the Netherlands, it did not completely rule out that the testimonies that were given could - at least in part - be true. The report therefore included recommendations for further research and increased support for care providers. At the same time, however, it was evident that conducting such research would hardly be feasible. After all, time and again the testimonies are given by clients who often suffer from serious psychiatric problems. The vast majority of them is unable or unwilling to file a criminal complaint, while the stories they tell are often (still) inconsistent as a result of their fears and inner division.

I never participated in any work groups dedicated to this issue, but continued to focus on treating clients and supervising colleagues who approached me with questions about this problem. I did, however, co-write a chapter for a book that was edited by G. Fraser and published by the American Psychiatric Press (Van der Hart, Boon, & Janssen Heijtmajer, 1997). The primary goal of this book, with contributions from many clinicians who often already had years of experience with clients who reported organised (ritual) abuse in the course of their treatment, was to provide guidelines for the treatment of such clients.

 

The clients

Since 1986, I have personally treated (and still treat) a significant number of clients who reported histories of (frequently still ongoing) organised abuse in the course of their treatment. Some of them were in treatment for a short while, others for a very long time. In addition, I acted as a supervisor to colleagues who encountered such testimonies and met with many of their clients during consultations. At the moment, I am working at a Top Referent Trauma Centre (TRTC). Of the 119  DID clients currently undergoing individual treatment at this TRTC, nearly a quarter of them (28) report histories of organised abuse, and a number of them still seem to be in contact with the perpetrator system or network. Many, but not all, reports concern ritual abuse. Some of the perpetrator networks are primarily engaged in other criminal activities, such as the systematic exploitation of children and adults for the purpose of the porn industry.

The clients concerned differ greatly in the degree to which they are able to function in their daily lives. Some of them are attending university or hold jobs; others have been undergoing psychiatric treatment for an extensive period of time and are functioning much less well. All of them were diagnosed with a severe dissociative disorder and suffer from chronic post-traumatic stress symptoms. In addition, most of them meet the criteria for a cluster C personality disorder, showing symptoms of extreme avoidance. On the other hand, there is certainly also a group of clients with a cluster B personality disorder. In most cases, testimonies about organised abuse emerged only in the course of treatment.

These clients are (often, but not always) different from other clients with a dissociative disorder in that they more often suffer from the following symptoms: (pseudo) epileptic seizures; severe eating problems, severe forms of self-mutilation, extreme anxieties, specific phobias, severe sleeping problems, flashbacks with bizarre contents, paranoia, a recurring increase in symptoms, suicidality and self-harmful behaviour during certain periods of the year. These periods coincide(d) with the reported gatherings of the network. Some of these clients dissociate so severely during treatment that the therapist is unable to make contact withthem. Also, they often have a great fear of, and resistance to, using medication - or demonstrate an adverse response to it. The reason for this can be found in their reports of the perpetrator networks' wide use of drugs and medication, which increases their fear of losing control. Finally, these clients all have similar, rigid and inflexible beliefs about themselves, others and the world. A remarkable element of this are their grandiose ideas about the power and superiority of "their world" (the network), reaching far beyond the world of "us ordinary souls". They have a great fear of the almost supernatural power of the network over them. On the other hand, they hold consistent ideas about never being able to belong to "our world" as they are "bad to the core" because of the things they did (or are still doing) within the network or group.

 

The perpetrator networks

Most clients report that, as a child, they were taken to the groups where the abuse took place by one or both parents, or a family member. A few were entrusted to neighbours or friends so frequently that it was possible for the child to be taken to the network of perpetrators quite regularly. We do not know of any adults who report that they experienced this form of abuse at school only. The networks that are being reported on differ in size, goals and motives, the degree of possible contact with other - even international - networks, and the way in which children and adults are exploited and indoctrinated. The rituals that have been reported to take place within some of these networks at times seem likely to be a sort of cover used to bind those involved to the network and to force them to engage in criminal activities, such as activities related to the porn industry, prostitution, child trafficking, arms and drug trafficking, and other matters that enable criminal organisations to earn a lot of money (see also Van der Hart et all., 1997). The networks are similar in the following ways: the abuse is systematic and there are multiple perpetrators; both men, women and children are involved; the group or organisation knows a strict hierarchy; children are systematically trained to be obedient. All clients report forms of sadistic torture aimed at teaching them to be obedient and loyal to the group. Clients who (also) report ritual abuse, in particular, all have experiences of becoming perpetrators themselves at a young age, committing acts of abuse and torture on other children, adults or animals. The systematic indoctrination of the beliefs and ideas of the group are an important part of the so-called training. And perhaps most importantly: early attachment relationships are systematically manipulated and exploited as the children are neglected, abused and isolated by their primary caregivers, only to be lovingly received and praised again when they have demonstrated "good" behaviour within the group. Siblings are also systematically played off against one another to prevent them from forming an alliance or confirming each other's testimonies later in life. Subsequently, children (and later: adults) are continually intimidated with threats to their own lives or the lives of loved ones and with the possibility of having movies and photographs distributed of the acts in which they have engaged. Moreover, wide use seems to be made of deception and trickery in these "trainings", including the use of drugs and medication that induce hallucinations. Memories seem to be systematically manipulated. Reality is manipulated and distorted to such an extent that any testimonies given about the network and its activities will seem to be inaccurate and therefore not pose a threat to the network.

 

The treatment

Together with some of my colleagues, I have published extensively on the treatment of complex dissociative disorders (Boon, 1997; Boon & Van der Hart, 1995; Boon, Steele, & Van der Hart, 2011; Van der Hart & Boon, 1997). During the intake phase, the client is subjected to a comprehensive diagnostic examination. At this time, minimal attention is paid to the trauma history of the client. It is certainly never explored. What is important, is the nature and severity of the symptoms at that time. Also, hypnosis is never used in order to recover memories. Clients that are eligible for treatment at our TRTC meet the criteria for a Complex Post-Traumatic Stress Disorder (CPTSD) or a Complex Dissociative Disorder (DID or DSNAO). The treatment consists of three phases (1) stabilisation, symptom reduction, (2) treatment of traumatic memories, and (3) further integration of the personality and rehabilitation (see also the guidelines developed by the International Society for the Study of Trauma and Dissociation (ISSTD, 2011).

Phase 1 of the treatment focuses entirely on the present as clients learn to cope with their symptoms. Traumatic memories are not at all explored during this phase. In addition to individual treatment, many clients also participate in structured group programs during phase 1. One of the rules of such groups is that the past is not discussed (Boon et al., 2011; Dorrepaal, Thomaes, & Draijer, 2008).

If the abuse has taken place within an organised network in the past, and provided that there is no evidence that the client is still in contact with the perpetrators at the present time, traumatic memories will be discussed only once a client is stable enough to proceed to the next treatment phase. Treatments such as these can be complex and long lasting. Also, there is more risk of increasing self-destructiveness and the undermining of the therapeutic relationship (Boon, 1997; Kluft, 1997; Van der Hart et al., 1997, 2006/10). The main reason for this is that old network messages are re-activated, which will at first intensify the feeling of internal chaos and internal conflict experienced by these clients. Examples of such messages include: you are not allowed to talk, you are not allowed to have treatment, you must end your life if you start talking about the secrets, your therapist will send you away or run you into the ground if he or she finds out all the things you have done and who you really are. Extremely serious attachment problems mean that it sometimes takes years before a stable working relationship with the therapist can be established and the client is sufficiently stabilised to start focussing on the integration of traumatic experiences. Daily life is complicated by many intrusive memories of awful events as well as extremely negative convictions about the self. Another aspect of these treatments is that it takes a lot of time to build up a working relationship with those parts of the personality that are loyal to the network and that exert a great deal of influence within the system of dissociative parts. For example, they can give orders to engage in self-destructive acts or to undermine the therapeutic relationship. In general, the dissociative organisation of the personality is much more complex and much more layered (i.e., divided into several distinct systems of dissociative parts of the personality) than in clients who report other forms of abuse. Also, various (systems of) dissociative parts of the personality seem to be systematically pit or played off against one another internally. Some dissociative parts report that they are praised, considered "good", and have been given a status within the network that comes with certain privileges (such as not being tortured or abused anymore). These parts consider it their duty to keep an eye on the other parts within the person, to report on their behaviour and to punish them in case of resistance. By sustaining the illusion of “separateness”, they remain unaware that they are actually punishing and endangering themselves. The reluctance to face reality is often quite extensive, however, as is the way in which the perpetrators have misled them.

When the abuse appears to be ongoing

As mentioned above, a number of these clients reports in the course of the treatment that their contact with the perpetrators has not yet been severed. Essentially, they are travelling back and forth between therapy and the perpetrators. Usually, the person entering into treatment has amnesia for this fact. It is shocking to realise that the abuse is still continuing and this may result in persistent disbelief or avoidance when this information is shared by another dissociative part (or parts) of the personality. In any event where the client is still subject to (continuing) abuse, regardless of whether this involves abuse repetition by a sadistic partner or parent, or ongoing abuse by a network of perpetrators, the primary goal of the treatment must be to help the client end the abuse and sever any contact with the perpetrators.

To do so, a combination of the treatment phases 1 and 2 may be necessary in order to break some of the fears that make people return to the perpetrator network over and over again. It is essential for the therapist to stay grounded and not to be swept up by the vortex of intense stories and the strong emotions that they invoke within both the client and the therapist. Clients can only save themselves, but to do so they will need very consistent support. As soon as there are indications in the treatment that contact with the perpetrators still exists, it is important to carefully and gradually explore how exactly that contact is established. Many clients have dissociative parts that must telephone in to report on the content of the therapy at the end of each treatment session. The focus of the treatment must be to determine which dissociative parts are still returning to the network (or perpetrators) and what fears and/or rigid beliefs play a role in this. Usually, it is a result of a fear of death - both one's own death and (especially) the death of loved ones. In addition, once clients have become more attached to their therapist, they report that the perpetrators are making threats to the therapist and his or her family as well. The clients nearly always assign (irrational) supernatural powers and excessive influence to the group. The process of detachment may take years because clients are constantly returning to the perpetrators, only to have their convictions and fears confirmed through rituals or brutal abuse. It is important that the therapist puts the alleged omnipotence of the network or group into perspective and that he or she helps the client to critically examine and correct these magical thoughts and associated fears. This can only be done step by step and may lead to anger issues within the transference relationship, particularly on the part of the dissociative parts that are still loyal to the network. A narcissistic collusion between these parts of the personality and the perpetrators is often found, brought about at a young age as a way of surviving. To give up this collusion means to become painfully aware of the extreme deception, pain and helplessness. These dissociative parts in particular are often "storing" the most awful experiences and intense feelings of guilt and shame to which the person as a whole is so resistant. The process of detachment from the network is by definition accompanied by intense guilt, shame and mourning as the client must usually let go of people with whom there is an intense, albeit ambivalent, connection (such as immediate family members). Detachment is only possible if the client is at the same time entering into new meaningful relationships with other people, or strengthening ties with people outside of the network. Messages like "if you leave us, you will remain alone forever", "there is no life for you outside of the group", "if we turn you away, you will die a miserable painful death", and "if people would really know who you are and what you have done, you would be locked up forever" are constantly repeated internally and often stand in the way of new, meaningful attachment relationships.

Prognosis

A lot has been written already about the prognosis of clients with a Complex Dissociative Disorder (Boon, 1997; Boon & Van der Hart, 1995; Kluft 1997a, 1997b; Van der Hart et al., 2006). The treatment of clients with a dissociative disorder who continue to be abused is complicated and lengthy. The prognosis is determined in part by the extent to which the client is able to form a proper working relationship with a therapist and treatment team, has good cognitive skills and a reasonable ego strength, is capable of creating new meaningful relationships or strengthening existing (healthy) ties, and is able to develop a good daily structure that includes activities that are meaningful as well as activities that are fun. Very severe comorbidity on Axis II, particularly cluster B, and severe comorbid addiction problems, are factors that adversely affect the prognosis.

Pitfalls and dilemmas during treatment

Obviously, the treatment of problems such as these knows many pitfalls. The most common dilemmas encountered regularly by clinicians or treatment teams are listed below. All of these dilemmas require a lot of attention, care and reflection:

• Therapists may lose themselves in all kinds of details and thereby fail to keep sight of the larger picture. 
• The tremendous appeal made to the therapist may lead to a lack of boundaries. In other words: therapists may start feeling that they should meet with this client more often and for a longer time than they would in any other treatment.
• Therapists may become anxious or paranoid themselves as a result of the stories told to them by the client and be inclined to take literally everything the client tells them. This may cause a collusion of fears, which is not beneficial to the therapeutic process.
• A reverse reaction could be that therapists suddenly dismiss everything the client tells them as a fanciful narrative that must be rejected or ignored as much as possible.
• Therapists (even entire treatment teams) may be so swept up by a case that they run the risk of losing all ability for sound reflection.
• Therapists may become so overwhelmed that secondary traumatisation or a burnout can occur. 
• There may be confusion about the role of the therapist. Therapists may be tempted to take on the role of the Public Prosecution Service and want to investigate or prove what is actually happening or identify the perpetrators and report them to the police.
• There may be disagreement and confusion about the need to file a criminal complaint against the perpetrators, especially when the client reports that minors are currently still being abused.
• Therapists may become isolated; no longer daring to discuss the case with their colleagues for fear of ridicule, disbelief or encountering rigid convictions with regard to the proper course of treatment for their clients.

Finally, it is very important to avoid a split in the team and to keep an eye out for the parallel processes that may occur in teams where such serious and violent problems are being treated. It is therefore essential for the therapist to be embedded in a team of colleagues who understand the complexity of such treatments and can support the therapist, but are also able to ask critical questions or help guard boundaries if necessary. 

In conclusion

I completely disagree with the proposition that the fears of clients related to reported abuse should only be taken seriously once sufficient legal evidence has been provided. I do think, however, that reports of such severe abuse require careful handling. Intervision is a prerequisite for the therapist and should take place within a multidisciplinary team that will always leave room to seriously consider alternative explanations for a particular report of abuse or for certain "facts". Such explanations could include: (1) delusions or a psychotic episode, (2) pseudologic fantastica, or (3) pseudo-memories that are functional because they are covering up other (emotional) pain, such as severe emotional neglect or the feeling of being unseen as a child/adult. In the past 30 years, I have encountered several clients to whom explanation 2 or 3 applied. In the cases of all other clients, I and the colleagues with whom I work are convinced that they were indeed abused by a perpetrator network (and sometimes still are). That does not mean, however, that all of their memories are factually accurate. As mentioned earlier, the general impression is that the perpetrators use drugs and deception to intentionally distort memories and induce pseudo-memories.

The aim of this short article was to describe my personal experience, as well as the experiences of many of my colleagues, in treating clients who have reported organised (ritual) abuse by perpetrator networks. Especially in centres that specialise in the treatment of long-term consequences of severe early childhood trauma, therapists are regularly confronted with this problem. Discussions about whether trauma histories should be considered fact or fiction (like those taking place in the Dutch media in the nineties, as well as those among professionals) are quite pointless in my opinion and thus make little sense. They have only resulted in a polarisation of views. What does make sense, is informing a new generation of clinicians about the problems, treatment dilemmas and pitfalls in order to arrive at a consistent, balanced approach towards this group of clients. I hope that this will ultimately contribute to the further development of appropriate treatment services for this client group.

 

Literature

Boon, S. (1997). The treatment of traumatic memories in DID: Indications and contraindications. Dissociation, 10, 65-79.

Boon, S., & Van der Hart, O. (1995). De behandeling van de multiple persoonlijkheidsstoornis [The treatment of the multiple personality disorder]. In O. van der Hart (red.), Trauma, dissociatie en hypnose [Trauma, dissociation and hypnosis] (3rd edition) (pp. 187-232). Lisse (the Netherlands): Swets & Zeitlinger.

Boon, S., Steele, K., & Van der Hart, O. (2011). Coping with trauma-related dissociation: Skills training for patients and therapists. New York/London: W. W. Norton & Co. (Dutch edition: Omgaan met traumagerelateerde dissociatie: Vaardigheidstraining voor patiënten en hun therapeuten. Amsterdam: Pearson, 2012.)

Van Daele, E., & Lauteslager, M. (2010). Editorial. Tijdschrift voor Psychotherapie [Dutch Journal of Psychotherapy], 36, 145.

Dorrepaal, E., Thomaes, K., & Draijer, N. (2008). Vroeger en verder: Cursus na een geschiedenis van misbruik of mishandeling. [The past and beyond: training course following a history of sexual of physical abuse] Amsterdam: Pearson.

Van der Hart, O., & Boon, S. (1997). Treatment strategies for complex dissociative disorders: Two Dutch case examples. Dissociation, 9, 157-165.

Van der Hart, O., Boon, S., & Heijtmajer Jansen, O. (1997). Ritual abuse in European countries: A clinician's perspective. In G.A. Fraser (Ed.), The dilemma of ritual abuse: Cautions and guides for therapists (pp. 137-163). Washington, DC: American Psychiatric Press.

Van der Hart, O., Nijenhuis, E.R.S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. New York/London: Norton & Co. (Dutch edition: Het belaagde zelf: Structurele dissociatie en de behandeling van chronische traumatisering. Amsterdam: Boom, 2010.)

Huber, M. (1995). Mültiple Persönlichkeiten: Uberlebenden extremer Gewalt. [Multiple personalities: survivors of extreme violence] Frankfurt: Fisher Taschenbuch Verlag.

International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity disorder in adults (3rd rev.). Journal of Trauma & Dissociation, 12, 115-187.

Kluft, R.P. (1997a). On the treatment of the traumatic memories of DID patients: Always? Never? Now? Later? Dissociation, 10, 80-90.

 Kluft, R.P. (1997b). Overview of the treatment of patients alleging that they have suffered ritualized or sadistic abuse. In G.A. Fraser (Ed.), The dilemma of ritual abuse: Cautions and guides for therapists (pp. 31-63). Washington, DC: American Psychiatric Press.

Marinkelle, A.B (2013). Ritueel misbruik: per definitie fantasie of fictie? [Ritual abuse: fantasy or fiction by definition?] Tijdschrift voor Psychotherapie, 39, 425-433. [Dutch Journal of Psychotherapy].

Nierop, N. & Van den Eshof, P. (2010). Herinneringen: Continu, sluimerend, hervonden of gelogen? Ervaringen van de Landelijke Expertisegroep Bijzondere Zedenzaken [Memories: Constant, dormant, refound or untrue? Experiences of the Dutch National Expert Group for Special Sexual Offenses]. Tijdschrift voor Psychotherapie [Dutch Journal of Psychotherapy], 36, 148-170. Pezdek, K. & Banks, W.P. (Eds.) (1996). The recovered memory/false memory debate. San Diego, CA: Academic Press.

Rutz, C., Becker, T., Overkamp, B., & Karriker, W. (2008). Exploring commonalities reported by adult survivors of extreme abuse: Preliminary empirical findings. In R. Noblit & P. Perskin Noblit (Eds.), Ritual abuse in the twenty-first century (pp. 31-85). Bandon: Reeds publishers.

Sinason, V. (Ed). (1994). Treating survivors of satanist abuse. London/New York: Routledge.

Tate, T. (1991). Children for the devil: Ritual abuse and satanic crime. Londen: Methuen.