After the world's worst therapist, here's how I actually recovered from PTSD.

A practical guide — and my latest for Slate.

Every few months I get a furtive text from a friend: their acquaintance has PTSD and needs help but doesn't know where to start. Could they put us in touch? 

I always say yes, largely because when I sought treatment in 2018 I had one of the worst therapists in the world. Short of violating any actual laws she did just about everything wrong. Today, Slate published my essay about my experience.

I was desperate and that desperation made it nearly impossible for me to think clearly about what I needed. And honestly I never would have guessed. The PTSD treatments with the most evidence behind them are probably not things you've heard of. Some of my friends know that I went through a very bizarre sounding treatment that totally worked. Go read the article and then come back and I'll tell you about how I got treatment for PTSD. 

(Content note: the Slate piece includes details of sexual assault. This guide includes references but no details. If your PTSD was anything like mine, now you will feel your body is going up in flames from seeing the word sexual assault)

Inciting Incident #1

1992-2010 My bad childhood as detailed in my memoir, Acceptance.

Inciting Incident #2

2010: Sexual assault while traveling abroad - the details of which my book editor once called in a margin note, “chilling beyond belief.”

Inciting Incident #3

2018 : “Me Too” happened and I had to report a mentor for sexual harassment linked to the Google article. I completely fell apart.

Steps taken to remedy the situation

2010-2015 I tried and failed to get therapy during my gap year and then at Harvard.

2017: I saw a very nice woman through the employer resource program to talk about something else. I felt much worse before I got better. Promise myself that if I ever went back to therapy I would see a specialist.

Early 2018: I searched Yelp, therapist recommendation spreadsheets, and company mental health servers looking for “sexual assaults therapist” or “rape therapist” (I had the wrong keyword. The keyword was “trauma,” a word I personally hate and that is so vague as to be meaningless) 

March of 2018, a friend says she's working for a psychologist. I asked to get in touch somehow. I managed to tell her what the problem was. She told me luckily trauma is one of my specialties. The next 8 months went horribly. She may have been a specialist in something but it was not what I needed. 

All therapy is not the same

Drawing on my deep knowledge of 12th grade AP psychology, there are two main schools of therapy: colin psychodynamic and cognitive behavioral (many people practice a blend).

My therapist was firmly on the psychodynamic side. That means she was interested in Freud and other thinkers descending from Freud. She went to a school where everyone is like that and that was the model that she used. There is very little evidence to support how well that model works, and it’s very hard to study. But this way of thinking also lends itself well to very long-term therapy including probing, delving into childhood etc etc. I, on the other hand, needed immediate relief. 

The other type of therapy - cognitive behavioral - descends from B.F. Skinner and the other  “behaviorists.” If you've ever heard about a dog salivating after a bell rings, that is behaviorism. The premise is that certain behaviors are enforced with rewards. In this model, post-traumatic stress disorder is essentially an anxiety disorder. Certain memories cause you stress so you try your hardest to avoid them - but because you keep avoiding them, you never learn that memories cannot hurt you. 

The cure for this then is exposure. 

The most popular example of exposure therapy is someone with a phobia of spiders having to be in the same room with them and having to touch them until they're no longer afraid. Now, how can you expose yourself to a memory? You can talk about it again and again. Perhaps in first person present tense, leaving no detail spared. And then you can listen to tape recordings of yourself talking about it every single day.

When I told people I was doing this, many warned that I couldn’t do this exposure therapy for the sexual assault if it was completely impossible to go into great detail about what happened. As if it would break a cosmic rule and the Earth would implode. 

But readers, it is possible. And I did it. 

It did not make me perfect - but it did get me to a place where I could benefit from more traditional therapy without worrying that I would off myself to escape the misery. 

Does this therapy work?

Yes, at least if you believe the many trials and the military. Prolonged exposure therapy, as it's called, is the gold standard treatment for PTSD. If you are a veteran and you walk into the VA, you will probably be offered exposure therapy. If you are interested in learning about treatments for PTSD, you would do well to look at the military's research. There are millions of service members with PTSD and the government has a responsibility to treat them, so they have invested enormous amounts of money into figuring out how to do so quickly and for minimal cost. (Of course that has its own problems.) People assume that all veterans have PTSD from combat, but many veterans with PTSD have it from “military sexual trauma.”

Are there other treatments that work?

Yes, check out this guide.

Caveat: My current therapist researches what therapy works and why. She would tell you that the most important part of therapy is not actually what treatment is done but the relationship between therapist and client. That's great, but it's very hard to control what that relationship is. And even she would admit that exposure therapy is great for handling symptoms. 

“I’m sold. How do I get this amazing life-changing treatment?”

The short answer: you can't. (Except at the VA.) 

The longer answer: exposure therapy, and other specialized treatments, are rarely offered in private practice. (This doesn’t just affect sufferers of PTSD, but also OCD, phobias, social anxiety and other anxiety disorders.) Therapists shy away from it for many reasons, including money. One course of exposure therapy is 10-14 sessions. That it is not a sustainable economic model for a business, especially in a city like New York where just renting a room can cost $50 an hour. 

I learned this after tons of frustration and googling. But you can find a therapist who is familiar with short-term PTSD therapies — and therapy more generally. 

The key is to identify your area’s “major [insert issue here] research center.” 

Once you have done that, you can either: 

1. Try to become a research subject. (What I did. Time consuming, inconvenient, free.)

2. Find someone who interned at that group or worked for it. (Also what I did.)

In NYC, that group happens to be the World Trade Center Health Program. (Warning: your PTSD treatment may come with copious 9/11 metaphors.) In Philadelphia, that is the Center for The Treatment and Study of Anxiety — the mecca. But I’ve helped people in a lot of regions — most have something similar.

If you are seeking help for sexual trauma, RAINN can connect you to a local rape crisis center. I always thought these places were for people who had just been attacked (and who felt comfortable calling it the r-word), but nope! This would’ve saved me so much time and energy. (For NYC folks, CVTC is the place to go. I guarantee they do not bite.) 

If you still can’t find help — EMDR is in many ways very similar to exposure therapy but is more common. (Many theorize that it is merely exposure therapy in disguise.) I myself have never done it since the people who recommended it to me were creepy; that’s my personal bias but many say they were helped by it. 

If you have a friend with PTSD, an anxiety disorder, or another ailment who needs help, I hope you pass this on! It is SO frustrating, alienating and demoralizing to be ready to get better and not be able to.

EXCITING NEWS: Farah Faye, the managing editor of this newsletter, is taking new clients! She has CHANGED MY LIFE. I was really struggling getting ready for mat leave and she made it possible. She edited all of the guest posts, totally ran the newsletter and my social media, and made it easy for me to step away during maternity leave. She has great taste, incredible organizational and marketing skills and I trust her completely. Hire her to help with your book launch, startup, podcast, or developmental edit — JUST DON'T STEAL HER FROM ME!

Reach out to Farah directly and I'm happy to give a reference!