Prolonged Exposure Therapy: Session 3
this session was downright painful. it was painful because I had to face the pain I'd been running from for years. it was the pain that marked a cross-roads in my life, or could have, had I been in a position to make decisions for myself.
it was twelve years ago, and a simple mistake was blown out of proportion when I embarrassed "The Ministry". that's what we called it. that's how we thought of it, with a capital T and M, as significant in our lock-stepped, cult-conditioned minds as the difference between a sculpted god of the pantheon and the "One True God".
the puppet-master in my tragedy was a region coordinator. those words should also be capitalized, yet I'm averse to giving them more significance than the people holding the positions deserve. they are the coordinators of a region of states for a cult that in reality is very small and insignificant. it's just at that time, it was the only world I knew. being on the inside was Righteous. being on the outside was Lost. worse, for someone like me to be on the outside, my mind would have to be seared with a hot iron, my heart would have to be hardened against God.
by the time the magnitude of my simple mistake had been amplified as it made its way up the chain of command, it was so grave that I doubted my own sanity as the region assistant's pronouncement resonated in the small part of my brain that could still register sound or movement from outside. I was nearly in full autistic shut-down as she spoke the words:
You are a dangerous person. Your mind is full of holes. I can't see a reason why you should be trusted with anything.
that was it. I was worthless. from that moment on, I doubted my judgment and my memories. my self-doubt became so deep that if my recollection of an event or conversation differed from another person's, my mind would alter my memories to match what I was told.
my self was erased, and I was helpless to protect myself from the cult and from the man I was married to.
in Prolonged Exposure Therapy, the subject (me) chooses several traumatic experiences to explore for the Imaginal Exposure portion of the treatment. that day may not have been the most traumatic thing I've ever experienced, but it was among the most traumatic as well as being one of the most clear.
one of the reasons it was so deeply traumatic is that I never processed the event or the impact it had on me. at first when I would think about it, I was ashamed because I was worthless. over time, I avoided it because the very people I was supposed to trust with my life and who had the responsibility for making decisions that were for my benefit were the same people who sat with me in that room and agreed with the region coordinator's assessment of my worth. I became withdrawn because I didn't trust them. I put on fake smiles and tried to fulfill their commandments so that I wouldn't have to endure another closed-door session. I didn't think I could survive that pain again, so I tried not to think about it. I could not leave the cult, so I pretended to be someone I wasn't. I pretended to be happy when I was dead inside.
I chose that event for my first Imaginal Exposure session because I felt if I can strip away the pain and fear from that event, perhaps I can free myself of the trap that was implanted in my mind that day.
the handout for Session Three has a section on the rationale behind Imaginal Exposure:
The trauma was a very frightening and upsetting experience, so you tend to push away or avoid the painful memories. You tell yourself not to think about it or that you just have to forget it. Other people often advise you to do the same... But, as you have already discovered, no matter how hard you try to push away thoughts about the trauma, the experience comes back to haunt you through distressing thoughts and feelings, nightmares, and flashbacks.
so, what does one do, instead of push the memories away and avoid them? when one is exposed to ongoing abuse and trauma so that there is never a moment to process what's happened, or to trauma so profound it's impossible to find context for it, it becomes almost impossible to change the way one copes, even when the trauma is long past. it seems counter-intuitive to then purposefully immerse oneself in the traumatic memory and subject oneself to re-experiencing the pain of it.
yet that's what Imaginal Exposure seeks to do.
I closed my eyes, and I haltingly recounted, out loud and in present tense, what led up to the event, the event itself, and what I remembered of what happened afterward. at certain points, my sobs wracked my body so badly that I could not speak and felt in danger of becoming trapped in that moment. it was at these times my therapist asked me "what's your SUDs level right now?" SUD, if you remember from my last post, stands for subjective units of discomfort, and my therapist and I had previously populated it with situations ranging from zero (comfortable) to completely distressing (100). to my surprise, my SUDs level never reached 100, although at the time I experienced the trauma it certainly was a 100 on my as-yet-unbuilt scale.
I finished recounting the event. my therapist allowed me to take several breaths, then asked me to start over and recount the entire thing again. it wasn't as bad, although I struggled and shed some tears. at its most severe, my SUDs level was 20 points lower. after I was done, she asked me to do it again.
afterward, I felt wrung out and my face hurt from crying, but I didn't feel avoidant. I didn't feel the urge to hide in a bowl of ice cream or a bottle of wine or a shopping expedition.
I listened to the recording of that session each day until my next appointment. the first time, I cried over a particularly cruel moment. I practiced my relaxation breathing. when I was done listening, I had learned some things about myself. things like: I sometimes stop speaking in the middle of a sentence. it sounds like I'm trying to make something up on the spot, or that I've forgotten that I was talking at all. in reality, I've paused to organize my thoughts because the anxiety makes it hard to stay focused. I also learned that I profoundly desire to be trusted and for other people to recognize that I am trustworthy. I also learned that I was victimized over things that should not have mattered at all, because they are inconsequential.
the second time I listened to the recording, I didn't cry. I got mad. really, really mad. the anger itself was high on my SUDs scale, but it indicated something important: that I no longer blame myself for what happened.