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Steven Hassan’s new book Freedom of Mind provides the knowledge and awareness needed to help yourself and loved ones avoid or escape from such dangerous people and situations. Available on Amazon.com and other online booksellers as paperback and e-book.Learn More

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Ex Member Case Evaluation and Background Form
Counseling for Ex-Cult Members and Escapees from a Destructive Mind Control Relationship

If you feel like you are still experiencing negative after effects, there are now more options for recovery. If you grew up in a destructive cult or family system, or have been physically away for some time, you probably could really benefit from specialized counseling.

Steven Hassan M.Ed. LMHC offers reasonably priced, short term counseling for ex-members who need assistance with their recovery. As a former member of a destructive group himself, he understands that many mental health practitioners have no training or experience with mind control related issues.

You many call Debra at (617) 628-9918 for more details or to set up an appointment. The best time to call is between 11am and 5pm (Eastern Time) on Monday, Tuesday, Thursday or Friday. Note that telephone appointments are available for those who are unable to travel to our Somerville office.

Discounted week long or two week long packages at our Somerville office are now available. Recovery workshops are now being planned in Boston and Los Angeles.

Please provide the following confidential background information before your first appointment via this secure form.

Attention: filling out this form can take some time.

In case of browser or transmission problems you may have to retype all information.

We therefore suggest filling out the down-loadable Case Evaluation Form (PDF) or Word Format (doc) form in order to email it as an attachment.

Right-click on either link and choose Save as…. Save the document to a place where you can easily find it back.

In addition to cult cases, Steven Hassan has been helping people involved in destructive one-on-one relationships, mini-cults and other unusual situations. All involve radical personality changes, often resulting in dropping out of school, work, alienation and loss of contact. Some involve covert uses of hypnosis and sexual abuse.

Filling out this form might take a while. You may decide to answer all of these questions in form of an email and while you are not online. Filling out this form will send the information directly to Steven Hassan. Please note that Steven charges a $100 fee for reviewing your case evaluation form and conducting a thirty-minute follow-up phone consultation. All information is strictly confidential and will be handled as such.

Once you have sent the form to us, please call within two business days to set up your initial phone appointment.

Comments or questions are welcome.
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How did you find Steven Hassan and FoM?
Name(s) of Group
Leader's Name
Date Involved With Group
Briefly Describe Your Relevant Personal History:
Do you have any family or friends still involved? Who?
Do you still go to group functions? Do any practices you learned in group?
Have you worked, or are you currently working with any other therapist or support group? Please give details.
Have you read any books about cult mind control issues? List the best ones:
Have you watched any good videos/television specials that were helpful to you?
List the issues/problems that you are dealing with. Some of most common are: 1. Extreme identity confusion 2. Dissociative states - "floating"(getting triggered back into cult mode) 3. Panic and anxiety attacks 4. Depression 5. Post-Traumatic Stress Disorder (P.T.S.D.) 6. Psychosomatic symptoms (headaches, backaches, asthma, skin problems) 7. Problems with decision-making dependency 8. Retarded psychological development- loss of psychological power 9. Guilt 10. Fear 11. Sleep disorders/ nightmares 12. Eating disorders 13. Sexual problems / Sexuality Issues 14. Lack of trust / fear of intimacy and commitment - people/work 15. Harassment and threats 16. Grieving loss of friends, family 17. Spiritual "rape" of the soul
Is there anything else that we should know?
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