Understanding High-Control Groups: What Clinicians Need to Know
Recently, I had the privilege of presenting to the Mental Health Nurse Practitioner Special Interest Group on a topic that is rarely discussed openly, yet affects far more people than we often realise: high-control groups — how they recruit, how they retain, and how we can support people who are trying to leave.
High-control groups are deeply misunderstood. The word “cult” conjures images of isolated communities or extreme belief systems, but in reality these dynamics often hide in plain sight. They can emerge in:
wellness or spiritual communities
coaching programs or “containers”
religious or ideological groups
multi-level marketing structures
intimate relationships with increasing control
workplaces or family systems
What unites them is not the content of the belief, but the degree of control exercised over a person’s autonomy.
Common Dynamics of High-Control Systems
Across different settings, similar patterns tend to emerge:
Restriction of freedom — limiting choices, movement, or independent decision-making
Erosion of critical thinking — discouraging questions or dissent
Shame-based compliance — using guilt, fear, or moral purity to enforce behaviour
Control of language, relationships, time, money, or belief — shaping a person’s entire framework for understanding themselves and the world
These dynamics can slowly dismantle a person’s sense of self, leaving them vulnerable, isolated, or dependent on the group or individual exerting control.
Clinical Implications: Assessment, Risk, Consent, and Recovery
For Mental Health Nurse Practitioners and other clinicians, these situations raise complex questions:
How do we assess someone who is still embedded in a high-control system?
How do we work with consent when autonomy is compromised?
How do we differentiate between belief, coercion, trauma response, and identity?
How do we support recovery without imposing our own agenda or replicating controlling dynamics?
People who are exiting high-control groups often arrive with a combination of trauma, identity confusion, attachment injuries, and practical barriers such as housing, finances, or social isolation.
They need autonomy-building, trauma-informed care — not rescuing, moralising, or pathologising.
Our role is to help them rediscover their own agency, rebuild critical thinking, reclaim relationships, and reconnect with personal meaning outside of the system they left.
A Growing Area of Clinical Need
I’m grateful to the SIG for the invitation and the rich, thoughtful discussion. It’s encouraging to see how many clinicians are ready to deepen their understanding of high-control groups, coercive influence, and post-exit recovery.
This is an area where stigma and misconception have kept people silent for far too long.
If you work clinically in mental health, this topic is worth your attention — not only for your clients, but for the broader conversation around safety, autonomy, and informed care.
