PICT is an ideal therapeutic model for clients who have experienced SRA for the very same reasons that it works so well for abuse in general; namely that PICT is compassionate with little need of uncomfortable disclosure unless the client wishes to do so. However, there are additional dynamics and complicating features with SRA, which must be considered to bring about a successful resolution. In the same way as a counsellor lacking specialist knowledge about Childhood Sexual Abuse (CSA) can cause harm to their clients, (See 'Adults Abused As Children ~ Experiences of Counselling & Psychotherapy' by Peter Dale, Sage Publishers, 1999 ~ for many examples) a lack of knowledge about SRA may do the same. PICT therapists are given sources of knowledge that are required for work with such clients.

One thing to remember, people who have survived ritual abuse will have great stamina and strength. The fact that they have come forward for help testifies to that because most have been programmed to never tell what they know and, in some cases, instructed by subliminal suggestions to kill themselves if they do tell. As a child they will have been drugged and hypnotised and so the 'facts' they recall may sound, and actually be, impossible, more like hallucinations. That is exactly why hallucinatory drugs and hypnosis were used in the first place - to make the stories sound so unbelievable they would be discounted as having been purely manufactured. There will be things described that are not actual facts and there will be actual facts that are too bizarre to be believed. A PICT therapist will take everything as if it were true because it is the client's truth and that truth is what needs resolution. The client may also be confused about what is true and what isn't, it is explained that those feelings are normal and that the PICT therapist will work with the information 'as if' it were true, accepting that some distortions will be there as a result of the drugs/hypnosis.

There are PICT techniques used to quickly bring clients back to the here and now during times when clients may access a severe traumatic experience and associate into it (re-experience it as though it were happening now). This technique is also taught to clients so they can use it should flashbacks happen out of session time.

A longer period of overall therapy time will be needed with these clients because of the volume of material they will be working with and because of the extreme trauma they will have experienced.

It may surprise some people, but it is unlikely that all individuals will be aware that they are victims of SRA. Like all victims of abuse, they will have normalised their experiences to survive but, during work with them, a number of indicators may start to be disclosed that should lead the therapist to consider this possibility. As with most clients, they are likely to present with their 'here and now' problems. They may be aware that they have been abused, even sexually abused, but are unlikely to be consciously aware of the serious extent or degree.

It is likely that people with these experiences will be very strong individuals, most will have become lifelong silent prisoners, or are wholly self sabotaging - of course, some will have committed suicide. Any or all of this is the intentional strategy of the perpetrator/s, so anyone who makes it to engage as a client is already a very resourceful survivor, they are likely to have normalised their experiences and will have developed many other ingenious coping strategies.

The following list of indicators is not exhaustive by any means. Many of the indicators are also true for victims of any kind of abuse, or no abuse at all. A PICT therapist will be looking for a larger than normal number of them coupled with extreme examples; and an emotional connection that is different to the interest or excitement that some find in these topics. It is also the case that often there will be a theme to the events being recounted, themes could be religious, involve rituals, could be to do with death, pornography, specific groups/clubs, torture or mutilation etc. The following list of indicators is based on information from: 'Breaking the Circle of Satanic Ritual Abuse' by Daniel Ryder:

• Dreams with reoccurring images of blood, body parts, killing and torture; involving animals and/or children. Also robed figures, demons, satan, animal skulls, candles and fire etc
• Vague or almost nonexistent childhood memories
• Powerful abreactions to violence and/or instruments of violence whether real or fictional
• Dangerous, even life threatening, self harming
• Being extremely quiet, passive or self effacing
• Being very uncomfortable when at the centre of attention or when being photographed
• A dislike of any situations involving human circles or ceremonies
• Unusual sexual likes, dislikes and fantasies often involving ritual, pain and torture
• Extreme fear or panic reactions and startle reactions to sudden or loud noises, certain sounds, unexpected touch or to seeing certain items. These are frequently very ordinary: dolls, rings, watches and clocks, certain colours such as black, red or pink. One client became fearful at the sound of others talking just out of earshot
• Fearful and or exaggerated reactions to certain smells such as blood, urine, faeces, incense, burning flesh and hair
• Extreme hypervigilance
• Extreme co-dependency issues, a whole section is devoted to this in the book mentioned above
• Fascination with or extreme fear of the occult, witchcraft, the macabre, gothic culture etc
• Fascination or fear of certain signs and symbols, scars and marks
• Unusual marks and scars, missing fingers or toes
• Many phobic reactions; sometimes to very ordinary everyday experiences such as being hungry, thirsty, hot, cold and wanting to go to the toilet and also including fears of counsellors or a dread of disclosing
• Sleep disorders ~ night terrors
• High tolerance of pain
• Chronic pain
• Psychosomatic disorders
• An ability to describe horrific experiences or incidents in a very straightforward and even casual way
• Outrageous and hard to believe memories and accounts of incidents; even memories of events which are impossible
• Difficulty in accepting very simple and obvious logical concepts and truths which run contrary to the information programmed into them during the abuse. This can be quite startling when it occurs. For example, one female SRA victim ran her own very successful business. She was well educated and intelligent, but as a child victim she had been shown a photograph of herself with red eyes. She had been told that it meant that she was possessed by the devil. She knew all about the 'red eye' phenomena in flash photography; but she insisted on believing the programming she had been told as a child. It took many hours of work before she would accept that she had been deceived. The effect on her was very similar to the hypnotist's trick of causing someone to forget a number, say 7. The person would then count to ten and miss out 7; or not recognise the number if written in a sequence.
• Memory flooding. As fast as one does the work, more traumatic memories can continue to surface and instead of almost automatically resolving, as with most CSA clients, they are usually highly charged, traumatic and disorientating. They often have unusual characteristics such as strange visual content or involving taste and smell, cold or heat, thirst and hunger or to do with passing or not being allowed to pass urine and faeces. Just the process of continually recovering these memories is traumatising.
• Clients with Dissociative Identity Disorder
• Stuck clients, or clients that just don't seem to get it or clients that appeared to make good progress and then slide back.