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Prolonged Exposure (PE)


In trauma work, we must sometimes tell the stories that bother us most.

PE is well-suited for patients who hold memories that seem "untouchable." Perhaps when the memory arises, one's first instinct is to push it back down. However, memories such as these influence how we move through the world (or how we don't ). When trauma-related avoidance has limited your options, PE may be one method for you to learn how to co-exist with your most frightening lived experiences. 

Sessions are highly structured, generally span 10-to-12 meetings, and involve experiential homework that is reviewed in the subsequent session. In-session work includes constructing an exposure hierarchy of feared but necessary activities (e.g., entering public spaces, sitting with your back to others) and repetitions of the trauma narrative. Sessions may extend beyond the typical therapy hour (up to 90 minutes) to allow sufficient time for patients to repeat their trauma narrative, experience habituation (i.e., allowing the mind to calm from initial anxiety), and processing of emergent themes. This process, while often intense, facilitates emotional healing and symptom reductions as you learn you can voice your trauma and move toward value-aligned actions. 

Typical outcomes of this treatment include decreases in posttraumatic stress symptoms and higher engagement in previously avoided activities. Following this brief protocol, most patients elect to continue in psychotherapy to address remaining symptoms and barriers to wellbeing.

Given the intensity of this protocol, I generally ask that patients participate in preparatory sessions to ensure readiness and willingness to complete all sessions in sequence. Patients who choose not to complete homework and those who prematurely withdraw from PE are at a higher risk of symptom increases. Thus, it is advised that interested patients undertake PE with high willingness and understanding that things may feel "worse" before they feel better. Typical session rates apply for 50-minute sessions of PE. When 90-minute sessions are required in the middle phase, patients are charged an adjusted rate of $220.00 to account for the enhanced duration.

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