est and the Landmark Forum

1. Introduction

Version followed: the Landmark Forum and its follow-on curriculum as Landmark Worldwide LLC publishes it (current), and est (Erhard Seminars Training, 1971-1984) as journalists and historians describe it. This guide is written for the psychotherapist, not for a trainer. It does not teach anyone to run a training.

est and the Landmark Forum are commercial large-group awareness trainings (LGATs): intensive, multi-day group programmes, led by one central facilitator before an audience of dozens to hundreds, that promise a rapid, self-directed change in how a person sees their life [source: Finkelstein, Wenegrat & Yalom 1982; LGAT review]. The core idea of change is not insight accumulated slowly but a sudden cognitive-emotional reframe - in est's language "getting it," in Landmark's a "breakthrough" - in which the participant is led to see that the meaning they have assigned to past events is a story they authored and can author differently, and so take "responsibility" for their experience [source: Pressman 1993; Wikipedia overviews of LGATs and Landmark, uncertain: secondary, unverified]. est delivered this through a confrontational marathon format over roughly 60 hours across two weekends; Landmark presents a gentler, more business-oriented facilitated "inquiry" over three days [source: Pressman 1993; Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].

A training like this is neither therapy nor a clinician's tool. The therapist's job, set out in this guide, is to help a client decide whether to attend, give informed consent, prepare, and recover - and to recognise and manage the adverse reactions that intensive group formats can precipitate. The therapist does not deliver, co-facilitate, endorse, attend on the client's behalf, or assist a training [synthesis].

2. Framework

The published course ladder (describe to clients as the organisation presents it). Landmark markets a sequence of courses, mostly by word of mouth rather than advertising, recruiting through existing participants and guest events [source: Wikipedia, Landmark Worldwide, citing CSIndy 2019; uncertain: secondary, unverified].

Introduction to the Landmark Forum - an introductory evening event at which current participants share results and bring guests; reporting describes it as the main recruitment point [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].
The Landmark Forum - three consecutive days plus a following evening session: a facilitated large-group dialogue in which participants are urged to be "coachable" and to attend every part, ending with an evening to which participants bring guests [source: Wikipedia, Landmark Worldwide, citing Time; uncertain: secondary, unverified]. Price varies by year and country; the client should check Landmark's current published price and refund terms.
The Forum in Action - a follow-on evening seminar series to sustain and apply the material [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].
Advanced Course - a further multi-day course building on the Forum [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].
Self-Expression and Leadership Program (SELP) - a longer programme in which participants design and complete a community project [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].
Seminar series and an "assisting"/volunteer programme - Landmark reports a large volunteer corps (described in reporting as "assistants" who staff phones, enrolment and logistics). The company disputes high volunteer counts; US Department of Labor reviews of its volunteer use reportedly closed without required changes [source: Wikipedia citing New York Magazine 2001, CSIndy 2019; uncertain: secondary, unverified].

est history (describe as historians report it). Werner Erhard (born Jack Rosenberg) founded Erhard Seminars Training in 1971, drawing on Mind Dynamics, Dale Carnegie, Napoleon Hill, Maxwell Maltz's Psycho-Cybernetics and Scientology among other influences [source: Pressman 1993]. In 1985 Erhard retired est and replaced it with The Forum, presented as gentler and more business-oriented; in 1991 he sold the intellectual property to employees (his brother Harry Rosenberg became CEO), and the company became Landmark Education and later (2013) Landmark Worldwide LLC [source: Wikipedia citing a 1994 US Court of Appeals (Fourth Circuit) ruling, New York Magazine 2001, Pressman 1993; uncertain: secondary, unverified]. Landmark describes itself as a for-profit, employee-owned educational company and denies being a religious movement [source: Wikipedia; uncertain: secondary, unverified].

The therapist's framework: phases of supporting a client around a training. This is the clinician's working structure, not the training's. Format is ordinary individual psychotherapy sessions; the "phases" are organised around the training event, not a fixed session count [synthesis].

Assessment and screening (before any decision). Goal: establish whether an intensive, confrontational, sleep-shortening large-group format is safe for this client now. Move on only when risk factors have been evaluated.
Informed decision and consent. Goal: the client understands what the training is and is not, the cost ladder, the right to leave, and that participants are largely unscreened with no mental-health staff on hand [source: Wikipedia citing Time 2011; uncertain: secondary, unverified]. Move on when the client can state these in their own words.
Preparation. Goal: a concrete plan - medication continuity, sleep and food, a support contact, an exit plan, limits on what to disclose in the room. Move on when the plan is written and the client holds crisis numbers.
During the training (contact and boundaries). Goal: the client knows they may leave, and has a check-in and crisis plan; the therapist stays in the therapist role.
Debrief and integration. Goal: metabolise a "breakthrough" or distress without reinforcing grandiosity or self-blame; distinguish durable gains from a transient high.
Aftercare and crisis. Goal: detect and manage dissociation, derealisation, manic or psychotic emergence, or suicidality; escalate when indicated.
Follow-on pressure and disengagement. Goal: support decisions about further courses, recruiting others, assisting, debt, and - where wanted - leaving and recovering.

3. Guiding principles

Stay the therapist, never the trainer or recruiter. Do not run exercises, quote the training's confrontational moves, or evangelise for or against it [synthesis].
Client-led and non-pathologising. Explore what attending means in the client's own words; intense interest in self-change is not in itself disorder [source: DSM-5-TR Cultural Formulation Interview framing, uncertain: not verified; synthesis].
Informed consent is continuous. The client may decide not to attend, to leave mid-course, or to stop the ladder at any point, without losing your support [source: APA Ethics Code, consent principles; synthesis].
Screen before you support attendance. Known high-risk states change the calculation; name them explicitly [source: Finkelstein et al. 1982, as summarised secondarily, advise that borderline or psychotic patients not participate; uncertain: secondary, unverified].
Format carries the risk. Long hours, shortened sleep, high arousal, public confrontation and group pressure are the active ingredients to plan around, whatever the stated content [source: McWilliams 1994; Singer & Lalich 1995; uncertain: secondary, unverified].
A "breakthrough" is a hypothesis, not a cure. Treat post-training highs as material to integrate and test over weeks, not as proof of change [source: Coon 2003 on placebo-like effects, uncertain: secondary, unverified; synthesis].
Protect reality testing. Watch for the training's responsibility rhetoric hardening into self-blame, or euphoria into grandiosity or loosened reality testing [source: Haaken & Adams 1983 on impaired reality testing in an LGAT].
Money is a clinical variable. The upsell ladder, pressure to enrol others, and debt are legitimate therapy content [source: Wikipedia citing New York Magazine 2001, Time; uncertain: secondary, unverified].
Family fallout is foreseeable. Trainings encourage participants to "clean up" relationships; plan for ruptures and estrangement [source: Pressman 1993; synthesis].
Attribute claims; don't adjudicate the method. Present the training's claims as its claims, and the contested evidence as contested, rather than ruling it true or fraudulent [synthesis].
Keep crisis routing ready. Have 988 (US Suicide & Crisis Lifeline) and Samaritans 116 123 (UK/IE) to hand whenever distress rises [synthesis].
Mind dual relationships. If you have personally done the training, keep that separate from the client's decision and disclose minimally and purposefully [source: APA Ethics Code, Standard 3.05 (Multiple Relationships); synthesis].

4. Intervention inventory

These are the psychotherapist's interventions for supporting a client before, during and after a large-group awareness training. No training content, confrontation wording or exercise steps are reproduced. Example language is illustrative unless quoted and cited.

4.1 Risk screening for suitability

Purpose / when: Before supporting any decision to attend. Intensive LGAT formats have been linked to decompensation in vulnerable people; the LGAT review itself advised that borderline or psychotic patients not participate [source: Finkelstein et al. 1982; uncertain: secondary, unverified].
Steps: Screen for, and document: current or past psychosis or schizophrenia-spectrum illness; bipolar disorder (risk of manic switch with sleep loss and high arousal); PTSD or significant unprocessed trauma; recent bereavement or major loss; current suicidality or self-harm; eating disorders; dissociative disorders; pregnancy; acute situational crisis; and heavy reliance on continuity of medication, meals and sleep. Weigh the client's stability now, not in general.
Example language (illustrative): "Before we weigh this up, I want to understand your mental-health history, because a three-day, high-intensity group with short nights affects some conditions more than others."
Watch for: Minimisation ("I'm fine, I just need a push"); a hypomanic client drawn to the intensity; a recently bereaved client seeking catharsis. Any active high-risk state is a reason to advise delay.

4.2 Reality-testing and mental-status baseline

Purpose / when: During screening and again at debrief, so you can tell a post-training change from the client's baseline.
Steps: Record a brief mental-state baseline: mood range, sleep, any perceptual anomalies, magical or grandiose thinking, dissociative tendencies, insight. Keep it for comparison afterwards.
Example language (illustrative): "I'm noting how things are for you right now so that if anything shifts after the weekend, we both have something to compare it to."
Watch for: Pre-existing loosening of reality testing; a baseline that itself warrants care before any training is considered.

4.3 Exploring the meaning of attending

Purpose / when: Early, to understand what the client hopes the training will do and what need it answers.
Steps: Ask, in the client's own words, what drew them, who invited them, what they want to be different, and what they fear. The DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions offer a non-pathologising structure for this [source: DSM-5-TR CFI, uncertain: not verified in primary]. Do not pathologise the wish for change.
Example language (illustrative): "What would need to happen that weekend for you to feel it was worth it?"
Watch for: Attendance as a flight from grief or crisis; a decision driven mainly by a recruiter's pressure rather than the client's own goal.

4.4 Informed-consent conversation

Purpose / when: Before the client commits, and revisited if they enrol in further courses.
Steps: Make sure the client understands, in their own words: the format (long days, large group, facilitated confrontation/inquiry, guest evening); that participation is self-directed and they may leave at any time; that participants are largely unscreened and mental-health professionals are not routinely present [source: Wikipedia citing Time 2011; uncertain: secondary, unverified]; the full cost ladder and refund terms; and that strong emotional reactions are common and usually transient. Document the discussion.
Example language (illustrative): "You can stand up and leave the room at any point - no one there has the authority to keep you. Let's agree now that leaving is always allowed."
Watch for: A client who believes they have signed away the right to leave; consent given under enrolment-deadline pressure.

4.5 Decision support and values clarification

Purpose / when: When the client is undecided or ambivalent.
Steps: Lay out pros, cons, alternatives (ordinary therapy, a less intensive course, no course) and a decision timeline that outlasts the enrolment deadline. Separate the client's own goals from the recruiter's enthusiasm. The decision is the client's; your role is clarity, not approval.
Example language (illustrative): "Let's park the sign-up deadline for now and look at what you actually want. A real decision shouldn't need to be made tonight."
Watch for: Requests that you decide for them, or that you bless the decision so they can tell the recruiter their therapist approves.

4.6 Financial-risk review

Purpose / when: Before enrolment and whenever upsell pressure appears.
Steps: Map the cost ladder (Forum, seminar series, Advanced Course, SELP, and the time cost of assisting) against the client's actual budget; name debt and sunk-cost dynamics; agree a spending limit the client sets in advance [source: Wikipedia citing New York Magazine 2001; uncertain: secondary, unverified].
Example language (illustrative): "What would you be comfortable spending in total on this over the next year - and shall we write that number down before the next course is offered to you?"
Watch for: Borrowing to attend; "I've already paid for the Forum, so I may as well do the Advanced"; pressure applied in the room to enrol on the spot.

4.7 Preparation plan

Purpose / when: In the week(s) before the training.
Steps: Agree a concrete plan: continue prescribed medication as usual and do not change it for the training; protect sleep and meals as far as the schedule allows; nominate one trusted support contact; set limits on what personal/traumatic material the client will disclose in a large public room; and write a simple exit plan (how to leave, where to go, who to call). Put crisis numbers in the client's phone.
Example language (illustrative): "Let's decide now what you will not put on display in front of 150 strangers, so the room can't talk you into it."
Watch for: Any plan to stop medication or 'detox' before the course; a client with no support contact; disclosure boundaries that are vague.

4.8 Clarifying the therapist's role and boundaries

Purpose / when: Before the training, and whenever the client asks you to participate.
Steps: State plainly that you will not attend, co-lead, assist, or endorse the training, and will not change that even if asked by the client or the organisation; you remain their therapist throughout. If you have personally taken the training, keep that separate and disclose only briefly and for the client's benefit [source: APA Ethics Code, Standard 3.05 (Multiple Relationships); synthesis].
Example language (illustrative): "I won't be coming or signing anything for them, but I'll be here before and after - that's the most useful thing I can be for you."
Watch for: Requests to write a letter of approval; the client framing your refusal as rejection.

4.9 Rehearsing the right to leave

Purpose / when: Before the training, especially for anxious or compliant clients.
Steps: Normalise leaving; rehearse a simple internal script and a physical plan for exiting a room where leaving is socially discouraged. Agree that leaving is a success of self-protection, not a failure.
Example language (illustrative): "If your body says 'I need to stop,' the plan is: pick up your bag, walk out, step outside, call your contact. You don't owe anyone an explanation."
Watch for: Beliefs that leaving will 'ruin the breakthrough' or let the group down.

4.10 During-training check-in and crisis plan

Purpose / when: For the days of the training.
Steps: Agree a light-touch check-in (e.g. an evening text to the support contact), the signs that mean 'leave and call,' and the crisis numbers. You are not on call as a trainer; you are a safety net.
Example language (illustrative): "Text your contact each night with one word for how you are. If it's ever 'unsafe,' that's the signal to leave and call the line."
Watch for: Escalating distress reported in check-ins; sleeplessness; a client who goes silent.

4.11 Debriefing a "breakthrough" or peak

Purpose / when: The first sessions after the training, when the client often arrives elated and certain.
Steps: Welcome the material without amplifying it. Ask what specifically felt different and what concrete change they want to keep; help translate slogans into testable, modest commitments; agree to review in a few weeks whether the change held. Treat the high as data, not proof [source: Coon 2003 on placebo-like effects, uncertain: secondary, unverified; synthesis].
Example language (illustrative): "Let's hold onto this and also give it time. In three weeks we'll look at what's still true when the glow has faded."
Watch for: Grandiosity, pressure to overhaul life overnight, or sweeping promises; euphoria that looks hypomanic rather than happy.

4.12 Containing self-blame from "total responsibility"

Purpose / when: When the training's rhetoric that one is responsible for everything in one's life hardens into blaming oneself for abuse, loss or illness.
Steps: Separate agency (what the client can influence now) from fault (causing past harm done to them). Name that responsibility for one's response is not responsibility for others' actions. Re-anchor to the client's lived reality.
Example language (illustrative): "Choosing how you respond now is yours. What was done to you was not something you created."
Watch for: A client concluding they 'attracted' or 'caused' a trauma; forgiveness pressed before it is wanted.

4.13 Grounding after emotional catharsis

Purpose / when: When the client is flooded, raw or tearful after intense group work.
Steps: Use brief, consent-based grounding and orientation (slowed breathing within comfort, sensory orienting, naming the present), paced to the client. Re-establish safety and routine. Avoid re-opening the catharsis; focus on settling.
Example language (illustrative): "Let's just bring you back into this room for a minute - feet on the floor, notice three things you can see."
Watch for: Re-flooding; a client who cannot settle between sessions - a sign to increase support and reassess.

4.14 Managing dissociation, derealisation and depersonalisation

Purpose / when: When the client reports feeling unreal, detached, foggy or 'outside' themselves after the intensive.
Steps: Normalise that intense group formats can transiently produce these states; use grounding and sleep/meal restoration; track duration. Persistent or distressing symptoms warrant fuller assessment. These states are documented after intensive practice and in LGAT research [source: Haaken & Adams 1983].
Example language (illustrative): "Feeling a step removed from things can happen after an intense weekend. Let's help it settle, and keep an eye on whether it lifts over the next days."
Watch for: Dissociation that persists beyond a few days, worsens, or comes with distress or risk.

4.15 Differentiating a manic or psychotic emergence

Purpose / when: When post-training presentation includes elevated mood, little need for sleep, racing thought, grandiosity, or new perceptual changes.
Steps: Assess against the client's baseline (4.2). Distinguish a transient spiritual/transformational crisis from an emerging manic or psychotic episode: Lukoff's signs favour a self-limiting crisis when there is good prior functioning, acute onset, a clear precipitant, and an exploratory (not terrified) stance, and no conceptual disorganisation [source: Lukoff via spiritualcompetency.com]. Where mania or psychosis is likely, or risk is present, refer urgently for psychiatric assessment. An LGAT case series and a controlled study both record at least transient psychotic reactions after such trainings [source: Kirsch & Glass 1977; Lieberman 1987].
Example language (illustrative): "Some of what you're describing I want a psychiatrist to see quickly, just to be safe - that's not a judgement on the course."
Watch for: Sleeplessness with elevated mood; thought disorder; command experiences or safety concerns - escalate.

4.16 Using the Religious or Spiritual Problem frame

Purpose / when: When a client's post-training crisis is spiritual/existential rather than a mental disorder, to avoid over-pathologising.
Steps: Consider the non-disorder code for a religious or spiritual problem (ICD-10-CM Z65.8; the DSM-5-TR category wording [uncertain: not verified]) when the picture is an intense but self-limiting crisis of meaning without disorder [source: Lukoff category work via spiritualcompetency.com; ICD-10-CM Z65.8]. Hold it alongside, not instead of, a careful psychiatric differential.
Example language (illustrative): "What you're going through may be more a crisis of meaning than an illness - but I'll keep checking both, so we don't miss anything."
Watch for: Using a spiritual framing to rationalise away genuine mania, psychosis or suicidality.

4.17 Supporting disclosure and privacy decisions

Purpose / when: Around guest evenings and 'sharing' pressure, where participants are urged to disclose publicly and to invite others.
Steps: Help the client decide in advance what is theirs to keep private, and that declining to share or to bring a guest is allowed. Protect their autonomy over their own story.
Example language (illustrative): "You get to choose what stays yours. 'I'd rather not share that' is a complete sentence, even there."
Watch for: Regret after public disclosure; coercion to name or bring specific people.

4.18 Working with recruitment and enrolment pressure

Purpose / when: When the client feels pushed to enrol friends and family, or to keep climbing the ladder.
Steps: Distinguish genuine enthusiasm from obligation; rehearse declining without guilt; examine what the client fears will happen if they say no. Name that enrolment pressure is a feature of the model, reported by multiple sources [source: Wikipedia citing New York Magazine 2001, Time, CSIndy 2019; uncertain: secondary, unverified].
Example language (illustrative): "You can value what you got and still not become their salesperson. Let's practise how you'd decline a friend who's pushing you."
Watch for: Strained relationships from repeated recruiting; the client's self-worth tied to enrolling others or assisting.

4.19 Repairing or protecting family relationships

Purpose / when: When the training prompts the client to confront relatives, 'clean up' old grievances, or distance those who disapprove.
Steps: Slow down big relational moves; help the client weigh timing and the other person's readiness; support measured, non-scripted communication; prepare for the possibility of rupture. Keep the client's existing supports in view.
Example language (illustrative): "A conversation you've waited years for can wait another week while we think about how to have it well."
Watch for: Sudden estrangements framed as growth; a client cutting off supports because they 'don't get it.'

4.20 Supporting a former participant's disengagement and recovery

Purpose / when: When a client wants to step back or leave the ladder, or is distressed by their involvement.
Steps: Validate ambivalence; address loss of community and identity; rebuild outside supports and structure; process any shame, debt or ruptured relationships; treat trauma symptoms where present. Frame leaving as a reasonable choice, not a betrayal [synthesis].
Example language (illustrative): "It makes sense that stepping back feels like a loss as well as a relief. Let's rebuild what you're stepping back toward."
Watch for: Isolation after leaving; a punitive inner voice echoing the training; unresolved debt or family fallout.

4.21 Documentation, coordination and crisis routing

Purpose / when: Throughout, and urgently in any crisis.
Steps: Document screening, consent and risk decisions; coordinate with the client's prescriber or GP with consent; and in any acute crisis provide and use crisis resources - 988 Suicide & Crisis Lifeline (US), Samaritans 116 123 (UK/IE) - and arrange urgent assessment. This is standard safe practice [synthesis].
Example language (illustrative): "With your okay, I'd like to let your prescriber know you're doing this, so we're all pulling the same way."
Watch for: Gaps in the care network; a client who wants the training kept secret from other clinicians.

5. Handling problems

The client who wants you to approve or attend. Hold the boundary warmly: you support their autonomy and will not endorse, attend or assist. Explore what approval would mean to them. Reframe your constancy before and after as the useful thing [synthesis].
The 'true believer' who won't hear any caution. Do not argue the method's validity; you will lose the alliance. Stay curious, anchor to the client's own stated goals, and keep the door open for when integration proves harder than promised [synthesis].
Rupture when you voice concern. If the client feels judged, name it directly, affirm the relationship, and separate your care for their safety from any verdict on the training. Repair the alliance before returning to content [synthesis].
Overwhelm or flooding after the intensive. Prioritise stabilisation over processing: grounding (4.13), sleep and meal restoration, reduced stimulation, more frequent brief contact. Reassess risk at each contact [synthesis].
A crisis that emerges days or weeks later. Keep screening live after the event, not only immediately. Delayed dissociation, a manic switch, or deepening self-blame can appear once the high fades; treat late presentation as expected, not anomalous [synthesis].
Suicidality. Use current standard risk assessment and safety planning, lethal-means counselling (storage and removal, not method detail), and crisis routing: 988 (US), Samaritans 116 123 (UK/IE). Escalate to urgent assessment when indicated [synthesis].
Non-adherence to the safety plan. If the client drops medication, skips sleep, or discloses everything publicly against plan, revisit the rationale without shaming, renegotiate what is realistic, and raise your support level rather than withdrawing it [synthesis].
Debt and sunk-cost spirals. Treat money as clinical material (4.6): name the sunk-cost trap, set a pre-agreed spending ceiling, and involve financial support or the client's partner with consent where appropriate [synthesis].
Family splitting and estrangement. Slow sudden cut-offs (4.19); where safe relationships are being severed as 'growth,' help the client test that against their own longer-term values and keep supports intact [synthesis].
Pressure on you to recommend or refer clients to the training. Decline referral; keep your professional recommendations within evidence-based care. If a client or colleague presses, state your boundary plainly [source: APA Ethics Code; synthesis].
When you have attended yourself. Guard against both over-identifying and over-correcting. Disclose minimally, keep the focus on the client's needs, and seek supervision if your own view is colouring the work [synthesis].
Uncertainty about whether it 'worked.' The evidence is genuinely mixed - some controlled work finds few lasting casualties while case series report serious reactions. Tell clients honestly that effects vary and durable change is tested over time, not declared on Sunday night [source: Lieberman 1987; Kirsch & Glass 1977; Coon 2003, uncertain: secondary, unverified].

Harm account

This account concerns the est era and the large-group awareness training format generally. It is included because clinicians still meet its after-effects and its rebranded descendants. Evidence is contested: controlled studies and case series reach different conclusions, and allegations are stated as allegations. Only Werner Erhard, the public founder, and figures named by courts or major news are named; no participants are named. Verbatim exercise scripts and timings are deliberately omitted.

What was actually done

est (Erhard Seminars Training), founded by Werner Erhard in 1971, was delivered to large groups over two long weekends by a single trainer, in a tightly controlled room with long days and limited breaks, combining lectures, emotionally arousing group exercises and direct confrontation of participants by the trainer [source: Finkelstein, Wenegrat and Yalom 1982, Annual Review of Psychology, uncertain: secondary, unverified; Glass, Kirsch and Parris 1977, American Journal of Psychiatry, uncertain: full text not verified]. Participants were pressed to accept the training's premise that they alone were responsible for their experience. Recruitment of friends and family and progression to further courses were built into the model, as major news outlets later reported of its successor [source: Wikipedia, Landmark Worldwide, citing Time and New York Magazine 2001; uncertain: secondary, unverified]. A peer-reviewed participant-observation study of Lifespring, a training of the same era and format, described a staged process that worked against participants' existing defences [source: Haaken & Adams 1983, Psychiatry]. The successor Forum (1985) and the current Landmark Forum are presented by the organisation as shorter and less confrontational; reporting describes the large-group format and the enrolment of guests as continuing [source: Wikipedia, Landmark Worldwide, citing Time 2011 and CSIndy 2019; uncertain: secondary, unverified]. Exercise content, wording and timings are not described here.

How it caused harm

Two case reports in the American Journal of Psychiatry described people who developed psychiatric disturbances after est: Glass, Kirsch and Parris (1977) and Kirsch and Glass (1977, 'II. Additional cases and theoretical considerations'). The second tabulates seven patients; the disturbances reported included psychotic and paranoid reactions, severe mood disturbance and impaired reality testing [source: Kirsch & Glass 1977 correction notice, PsychiatryOnline; further detail uncertain: full texts not verified]. The peer-reviewed participant-observation study of Lifespring concluded that the training could weaken ego functioning and impair reality testing even while participants reported feeling well [source: Haaken & Adams 1983]. A later controlled study (Lieberman 1987, American Journal of Psychiatry) of more than 289 participants identified a small number of stress reactions, including one transitory psychotic episode, and no lasting psychiatric casualties, a finding often set against the case reports; it is reported to have been partly funded by Lifespring [source: Lieberman 1987 abstract; funding detail uncertain: secondary, unverified]. Clinicians reading these reports point to the format's own ingredients: shortened sleep, prolonged high arousal, public confrontation, group conformity pressure, and a challenge to a person's existing defences without the screening, pacing or aftercare of clinical treatment [synthesis]. The 1982 review is reported to have advised that people with borderline or psychotic conditions should not take part [source: Finkelstein et al. 1982; uncertain: secondary, unverified]. Major news reporting, as summarised secondarily, describes financial pressure through the course ladder, pressure to recruit, unpaid 'assisting' and strain on family relationships; Landmark disputes high volunteer counts, and US Department of Labor reviews of its volunteer use reportedly closed without required changes [source: Wikipedia, Landmark Worldwide, citing New York Magazine 2001, Time and CSIndy 2019; uncertain: secondary, unverified]. Lawsuits against the organisation have included a claim alleging a psychotic episode after a seminar; this is an allegation, and its outcome is not stated here [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified]. A 1995 French parliamentary commission report included the organisation in its list of "sectes" (groups the commission regarded as high-demand or harmful movements), and later French reporting discussed that listing [source: Wikipedia, Landmark Worldwide, citing Palmer 2011 and Le Parisien 2004; uncertain: secondary, unverified]. Landmark's published position is that it is a for-profit, employee-owned educational company and not a religious movement [source: Wikipedia, Landmark Worldwide; uncertain: secondary, unverified].

Recognising it today

Elements of the est format, as the sources below describe them, continue in Landmark and in many other large-group awareness and 'transformational' trainings, corporate 'breakthrough' intensives, and some coaching and online programmes. Recognisable features: a multi-day, long-hours intensive with a single charismatic leader before a large group; a self-responsibility doctrine extended to 'you create your whole reality'; emotionally arousing confrontation or catharsis exercises; strong pressure to enrol friends and family and to buy the next course; unpaid volunteering framed as service; a guest/graduation evening; participants largely unscreened with no mental-health staff present; and testimonials of a sudden 'breakthrough' [source: Wikipedia, Landmark Worldwide, citing Time 2011; Finkelstein et al. 1982; both uncertain: secondary, unverified]. Red flags in a colleague's or a service's practice: running unscreened high-intensity group catharsis, discouraging participants from leaving, equating a post-course high with cure, or recommending such a programme to vulnerable clients. How legitimate practice differs: evidence-based group therapy screens participants, obtains informed consent, paces arousal, has clinicians present, allows free exit, and provides aftercare - and does not sell a ladder of further courses or depend on recruiting others [synthesis].

What to do instead and how to help those harmed

For the goals people seek from these trainings - confidence, direction, relief from stuckness - offer screened, consented, evidence-based care: individual psychotherapy, properly facilitated group therapy, and structured approaches to the presenting problem. For a client harmed by a training: stabilise first (grounding, sleep and routine restoration, risk assessment); obtain urgent psychiatric assessment for manic or psychotic emergence; treat dissociation and trauma symptoms with trauma-informed care; address self-blame installed by 'total responsibility' doctrine; and work on debt, ruptured relationships and loss of community during disengagement (4.12, 4.14, 4.15, 4.19, 4.20). Use crisis resources where risk is present: 988 Suicide & Crisis Lifeline (US), Samaritans 116 123 (UK/IE). Ethical and legal duties: practise within competence, keep clear records of risk decisions, coordinate with the client's other clinicians with consent, and follow local duties on risk to self or others and on safeguarding where children or dependent adults are affected [source: APA Ethics Code for competence/consent points; synthesis for the rest].

Sources

Web sources

Cited by author, year, title

Finkelstein, P., Wenegrat, B., & Yalom, I. (1982). Large Group Awareness Training. Annual Review of Psychology, 33, 515-539. [uncertain: secondary, unverified]
Glass, L. L., Kirsch, M. A., & Parris, F. N. (1977). Psychiatric disturbances associated with Erhard Seminars Training: I. American Journal of Psychiatry. [uncertain: full text not verified]
Kirsch, M. A., & Glass, L. L. (1977). Psychiatric disturbances associated with Erhard Seminars Training: II. Additional cases and theoretical considerations. American Journal of Psychiatry. [uncertain: full text not verified]
Haaken, J., & Adams, R. (1983). Pathology as 'Personal Growth': A Participant-Observation Study of Lifespring Training. Psychiatry, 46(3), 270-280.
Cushman, P. (1989). Iron Fists/Velvet Gloves. Psychotherapy, 26. [uncertain: secondary, unverified]
Singer, M. T., & Lalich, J. (1995). Cults in Our Midst. [uncertain: secondary, unverified]
McWilliams, P. (1994), on the pressure/release cycle in LGATs. [uncertain: secondary, unverified]
Coon, D. (2003). Psychology (textbook), on placebo-like effects of LGATs. [uncertain: secondary, unverified]
Pressman, S. (1993). Outrageous Betrayal: The Dark Journey of Werner Erhard from est to Exile. St. Martin's Press (2nd ed. Random House, 1995).

Reference frameworks

DSM-5-TR Cultural Formulation Interview and its spirituality/religion module [uncertain: not verified in primary].
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), Unbound Medicine; DSM-5-TR category wording [uncertain: not verified].
APA Ethical Principles of Psychologists and Code of Conduct, https://www.apa.org/ethics/code (cited for Standard 3.05, Multiple Relationships, and for general competence and informed-consent points; other practice points marked [synthesis]).

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