I Sought Treatment for a Terrible Sexual Assault. It Made Me Worse Off Than I Was Before.
Reading Time: 6 minutesFor many problems, endless talk therapy isn’t the answer., Sexual assault treatment: Endless talk therapy made things worse for me.
I met my new psychologist in Manhattan’s ugliest office building. ‘Hello,’ she said, opening her door with a big smile. She introduced herself as ‘Doctor’ followed by her last initial. Let’s call her Dr. M. Dr. M was beautiful—blond blow-out, charmingly snarled teeth—and I was desperate. I’d put off seeking help for years, scarred by bad experiences as an adolescent that involved too many drugs, punitive treatments, and clueless counselors. Finally, at 25, I was here, doing the thing we are all supposed to do to be healthy, high-functioning humans: I was going to therapy.
I’d had a crappy childhood, with enough drama and betrayal to fill a 384-page memoir. I’d walked into Dr. M’s office for help with something very specific, though: At 17, I’d been sexually assaulted. Now, I was haunted by the memory of a middle-aged man calling me a bitch and yelling at me to swallow his dick. I’d never shared the details with anyone; over time, the memories tormented me more instead of less. I told myself it didn’t bother me, but really I’d just contorted my life to avoid any reminders. Simply seeing the word ‘rape’ made me feel like flames had engulfed my limbs. Only exercise could purge the horror, but my two or three hours of daily workouts aggravated my back until my doctor prescribed opioid painkillers. The cozy comfort of tramadol terrified me: I could easily see a future in which I succumbed to addiction. Other days, I fantasized about jumping off my office’s 14th-floor terrace.
‘Trauma is one of my specialties,’ Dr. M. assured me, smiling, when I told her I’d been assaulted.
So, I began recalling everything. I told her about staying in a hostel in Budapest. I was traveling by myself and, surprisingly, there were no other guests, just two employees who made small talk and offered me alcohol that I declined and coffee that I accepted. Then, one man left to get cigarettes. The other man talked to me for a long time, and asked me to kiss him. Then, he stood up and unbuckled his belt.
When I got to that point, Dr. M announced that our time had run out. She explained her fee was $220 a session and suggested I come twice a week. My high-deductible insurance plan meant that would cost more than my rent—but I figured I wouldn’t need that many sessions. I Venmoed Dr. M, assuming that the next time we’d pick up where we left off. When I walked into the warm evening, I felt buoyed by the promise of imminent relief.
At the next appointment, I sat down, ready to begin. ‘So the man,’ I started.
Dr. M flinched. ‘What about your family?’ she asked, interrupting me. ‘You haven’t told me at all about your childhood.’
My childhood? I wondered. I wasn’t here to talk about that. But Dr. M was persistent. And she was a professional, with a Ph.D. and research papers in her name. She must have known what she was doing, I told myself. So, I told her about my childhood. And every Tuesday and Thursday evening, I obediently returned to her futon.
In the weeks that followed, I tried to contort the conversation back to the assault. Each time I mentioned it though, she gasped, recoiled, and changed the topic. Often, she monologued. Since I was attacked in Hungary, she shared her experience growing up in Eastern Europe. ‘That’s just the way it is there: You walk in a room and’—she clapped her hands—’someone rapes you.’ Instead of helping me work through the shame, these conversations added to it.
Five thousand dollars’ worth of sessions later, I finally brought up the problem directly: ‘I feel like you don’t want me to tell you what happened.’
‘Well,’ Dr. M replied, ‘we don’t have the alliance.’ She explained that sharing details would only ‘retraumatize’ me—unless I could voice them without being upset. How, I wondered, could I ever describe crying while a man ejaculated on my cardigan without being upset?
I asked how long it would take to build said alliance.
‘Maybe 10 years,’ Dr. M said.
‘I don’t have 10 years,’ I responded.
I wasn’t even sure I had 10 months before it became unbearable. I thought, longingly, about diving into traffic on the West Side Highway. But what Dr. M had told me fit a dominant narrative around therapy—that we should all be in it, forever. Real relief takes time, the story goes: There are no quick fixes or simple cures. If you don’t feel better, it’s because you aren’t doing the work. Peace only comes from plumbing our inner depths.
I believed this, despite having had plenty of bad therapy experiences as a kid. My mom was a hoarder who, instead of dealing with her own issues, took me to doctors who prescribed increasingly intense drugs until I was on antipsychotics at 13. I spent time in a locked facility and in foster care. ‘Treatment’ felt like punishment, focused on coercing my obedience while ignoring my emotions.
What shocked me about Dr. M was that, even as an adult with incredible privilege, my therapy experience could still be so bad. I was a software engineer at Google, earning six figures. I lived in New York City, a hotbed of psychology. In college, at Harvard, I minored in statistics and was mentored by a preeminent historian of psychiatry, equipping me to comb through hundreds of peer-reviewed papers to read about what might actually help me (though in the meantime, I kept seeing Dr. M—I had to do something).
It was clear that I had Post-Traumatic Stress Disorder. Despite the rhetoric about amorphous ‘trauma’ living in the body forever and leading to unnamable malaise, my own dive into the research told me that PTSD was imminently treatable—quickly.
Several short-term treatments often provided relief to patients in 10 to 14 sessions. One, called prolonged exposure therapy, seemed to work particularly well. Premised on the idea that PTSD is caused by avoiding upsetting thoughts, patients expose themselves to trauma triggers in a highly structured setting. You talk about the moments that you can’t get over, again and again, until they lose their power. The sessions are longer than typical talk-therapy sessions, and there’s daily homework—the process is intense. The approach makes intuitive sense, summed up by the adage ‘face your fears.’ But it also flies in the face of the warm fuzzies offered by many talk therapists. Part of the point of prolonged exposure is to become as upset as possible, so that you learn that memories cannot actually hurt you. This is essentially the opposite of Dr. M’s claim that I would be ‘retraumatized’ by speaking about the assault too much.
Like many short-term, evidence-based therapies, it was almost impossible to access. While prolonged exposure is the go-to treatment for veterans seeking care at the VA, I’d searched extensively for someone in private practice who offered it and came up blank. Part of this was surely economics, since a short course of treatment was far less lucrative than billing private insurance indefinitely.
In the meantime, it’s not just that my sessions with Dr. M kept me in a holding pattern. I actually started to feel worse. I could no longer sleep through the night. I went on a starvation-level diet. I almost called off my wedding. I fantasized about tumbling into a freezing lake, my limp body finally finding peace at the bottom. Dr. M didn’t know what was going on, because she never asked; like most therapists, she didn’t track or even really ask about my symptoms. She probably thought I was doing great and that she was, too, since research shows that therapists overestimate their skills and their patient’s progress. Even the patient who inspired the so-called ‘talking cure’ wasn’t cured by it: Contrary to Freud’s claims in a famous case study, historical records show that ‘Anna O.’ got progressively worse until she wound up institutionalized. She only got better after quitting analysis and taking up activism, a transformation that took a while to occur.
But studies suggest that short-term treatments can be hugely beneficial, fast. It’s not just for PTSD—phobias, OCD, and social anxiety all respond well to exposure. Experiments show reductions in symptoms from a single session—or as little as two hours with a primary care provider. According to one analysis, after a 10-to-14-week course of prolonged exposure, two-thirds of sufferers no longer meet the diagnostic criteria for PTSD. In another, 83 percent no longer met the criteria six years later. The trouble is that these therapies can be difficult for patients to find.
I redoubled my search for exposure therapy, and learned that I could access it if I became a clinical research subject. In screening phone calls, young research assistants asked me questions like, ‘Can you tell me about what happened?’ I would choke out my answer, only to have to them ask dozens more questions, about my sleep, my social life, and whether or not I could go to the grocery store or ride public transportation. These screening calls were exhausting, but when I hung up, I always felt better—in a way I absolutely had not after a session with my own therapist.
After several months, I was accepted into a study where I could receive prolonged exposure treatment—treatment that would change my life the way I’d once hoped talk therapy would. Having secured a new source of help, I finally broke up with Dr. M. In our last session, she informed me, ‘You are mad at the world and the people who hurt you. But I don’t see you trying to change.’ I knew what she meant: I’d only gotten acupuncture once, despite her promise that bodywork could ‘unstick’ the trauma; I refused to let Dr. M hypnotize me. I hadn’t upended my schedule to practice yoga or quit my job to attend silent meditation retreats. It wasn’t just Dr. M: It seemed like an entire culture told me that long-term therapy was morally good, no matter how much of an expensive slog it was. But I didn’t want to sacrifice my future to the pursuit of mental wellness. I wanted to heal. I wanted to get treatment, and then, to move on.
If you need to talk, or if you or someone you know is experiencing suicidal thoughts, call the suicide lifeline at 988 or text the Crisis Text Line at 741-741.
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