682: Ten Sessions

Ira Glass

From WBEZ Chicago, it's This American Life. I'm Ira Glass. There's this kind of therapy for trauma, victims of sexual assault, soldiers with PTSD, where instead of taking years and talking, and talking, and talking on some couch to a therapist with no end in sight, you basically knock it out, all the treatment in just 10 or 12 sessions.

Two weeks-- you can do it in two weeks. And it's effective. Studies have shown that. This therapy's been around since the '80s, but I think lots of people who might find it useful don't even know it's an option for them. Like, for instance, Jaime Lowe, who's a writer and reporter and a good candidate for this treatment.

Jaime Lowe

I was sexually assaulted when I was 13, almost 30 years ago. And for most of those 30 years, I didn't really talk about it. Not because I didn't want to or need to, but because I didn't know how. And no one asked.

Ira Glass

Jaime Lowe decided to do a story where she would go through this therapy herself and record all of the sessions, which never happens. Like most therapy, usually this treatment is in private, not on the radio.

And hearing how it works, it really is kind of remarkable. My mom was a therapist. I've been in therapy. This is so different from what I have ever heard. And that's going to be our show today. We're going to hear it step by step, this sometimes life-changing process, and how that can happen so quickly.

A quick warning to listeners before we start about content. This story does mention the sexual assault of a teenager. Here's Jaime Lowe.

Jaime Lowe

I thought because I didn't talk about the assault or even think about it much, everything was as resolved as it could be. But then after Donald Trump, and "grab them by the pussy," and Harvey Weinstein, and all of them, it's not that specific memories of the assault would pop up, I just felt immobilized, anxious, protective of my body. And I realized my sexual assault wasn't resolved at all.

Around this time, I heard about a therapy for sexual assault survivors, called Cognitive Processing Therapy, or CPT. A researcher described it to me as short-term inexpensive, practical, like learning a skill. The typical way to deal with trauma in therapy is to talk about the incident over and over, until it's less radioactive.

CPT does the same thing, but in a systematized way. It's all laid out in advance, and the same for everyone-- what you'll do in the first session, and the second, and the third, and so on. Each session is based on learning a skill and practicing that skill on a worksheet. You go over each element of the trauma, piece by piece, and try to see it differently. The goal is to change the story you've been telling yourself about what happened.

I got in touch with Dr. Debra Kaysen, a psychologist with a specialty in trauma therapy at the University of Washington School of Medicine. She and I started talking and e-mailing about CPT. It all seemed so different than the therapy I was used to-- my weekly talk sessions-- and I realized I wanted to try it.

I've done a lot of therapy. After the assault, I had two manic episodes and was diagnosed bipolar. I've always been very open about mental illness. I wrote a book about being bipolar a couple of years ago. But even though that book is partly about my adolescence, I barely mention the assault. I've never dealt with it, I never wanted to-- in the book, in treatment.

But now I was feeling the trauma more. I thought CPT might help me. I also thought, what if this could help lots of people? I asked Dr. Kaysen if I could record the sessions and play them on the radio. She checked in with colleagues-- a psychologist with an expertise in journalism, a journalism ethics professor-- to make sure we'd be able to have a therapeutic relationship while I was simultaneously doing a story about the therapy.

After a lot of back and forth and establishing some basic ground rules, we set up our CPT boot camp-- 10 hour-long sessions over two weeks in Seattle. Usually CPT is one session a week for 12 weeks, but we decided to condense it. And early studies show this approach is effective. Last October, I flew out to Seattle.

Jaime Lowe

I'm sitting with Dr. Kaysen in a generic room at the university clinic. I fail at setting up the recording equipment a few times, before getting it semi-right. I'm not a radio person.

Dr. Kaysen has a kindergarten teacher presence that makes me feel ready and OK. She starts the first session with me the way she would with anyone, by talking about sexual assault and PTSD. 50% of women who are sexually assaulted develop PTSD. That could mean symptoms like depression, anxiety, flashbacks-- some of the things I've actually been feeling when I hear the news.

Dr. Kaysen hands me a photocopied worksheet. Everything we're going to do, this entire therapy, is structured around these worksheets. I'll do them at my Airbnb. And when Dr. Kaysen and I meet, we'll go over them. Each set of worksheets will cover a new skill, and I'll master that before moving on to the next skill, which Dr. Kaysen will introduce at the end of each session.

The idea is, by the time we're done, I'll be able to do this on my own with any issue in my life. Dr. Kaysen explains my first assignment. Most of the worksheets have all sorts of boxes to fill in with answers. They look like badly designed forms you'd get at the DMV, but this first one is just a sheet of paper.

Jaime Lowe

The phrase "caused the event" makes me uneasy, because as much as I intellectually believe that nothing specific really caused the event, there are things I still question. It's embarrassing that, after 30 years, I still might think it's my fault, but I do.

Jaime Lowe

But of course, I'm worried. The thought of reliving the assault is terrifying. Even reading the one-sentence description of the assault during the audio recording of my book left me in tears. I rarely articulated the details out loud. I just don't know what will come up. I don't know what it's going to be like to dig in for the next two weeks.

Jaime Lowe

Dr. Kaysen says we'll start all the sessions like this-- going over my PTSD symptoms and rating their intensity. How frequently have I been thinking of the trauma? Have I been dreaming about it? Reliving it? In the past 24 hours, how much have I been distressed by repeated disturbing and unwanted memories of the traumatic event? Each question gets a numerical value on a scale of 0 to 4, and Dr. Kaysen adds them up.

Jaime Lowe

I'm not sure how to answer these questions with a number, but I have the same problem when physicians ask me to rate pain on a scale of 1 to 10. After we go over my PTSD symptoms, Dr. Kaysen will ask me about my mood. Then we'll move on to the homework, what she calls the practice.

Jaime Lowe

The impact statement-- the one-page worksheet on why I think the assault happened. I wrote it before sunrise this morning, and it was, not surprisingly, really hard to write.

I break down, but I keep reading. Even though I'd followed Dr. Kaysen's instructions not to write down specific details of the event just yet, they were all coming back to me anyway.

Jaime Lowe

Dr. Kaysen hands me a Kleenex box.

I tell Dr. Kaysen more about my mom's rule and how I broke it. She wonders if this might be a stuck point. Stuck points are the first skill introduced in CPT, and they might be the most important skill of all. In a sense, the entire project of CPT is finding stuck points, and then learning how to unstick them.

A stuck point is basically something you hold to be true, but might in fact not be true. A stuck point is a belief or a thought that's keeping you stuck in the PTSD, stuck in thinking that it's your fault, or that there's something you could have done to avoid it, or stuck in any number of upsetting or inaccurate or harmful ways of remembering what happened. They're so central to this process that Dr. Kaysen hands me a worksheet titled, Stuck Point Log.

Jaime Lowe

We'll keep track of all my stuck points here, adding to the list as we identify new ones each session, and crossing them off as I work through them.

Jaime Lowe

Dr. Kaysen asked me what feelings are coming up.

I bristle at the word "shame." I always have. There's no room for shame. It sounds weak to me. Like, if you have shame, you have something to feel shameful about. With shame comes softness, and vulnerability, and fragility.

Jaime Lowe

It's the end of the session, and ABC is the new skill. I'm supposed to fill in the A column with the activating event-- in my case, the sexual assault-- B with my belief or stuck point about the event, C with the consequence of that belief or stuck point. It's kind of clunky, but the idea seems to be to get you to see that your stuck points are not rational and that hanging on to these irrational stuck points has real emotional consequences, that continuing to tell yourself this stuff as fact makes you feel bad.

I'm sitting with Dr. Kaysen going over the checklist of my PTSD symptoms. Did I have memories about the assault? Was I dreaming about it? Reliving it?

We finish the checklist and take out the worksheets. I'd done seven the night before. Because I'm doing a crash course in CPT, each session each day covers a week's worth of treatment. It feels like I'm cramming, but Dr. Kaysen tells me she has patients who are still doing worksheets in the waiting room before sessions. That makes me feel a little better.

We pick up with the stuck point we started on yesterday. If I hadn't said hi, he wouldn't have assaulted me.

Dr. Kaysen has clearly heard similar stuck points. She pokes holes in my logic until it's obvious that there's another way to see it.

I associate the words "little girl" with a kind of unformed, helpless pink thing covered in ruffles. I didn't relate. At 13, I was babysitting. I had crushes and fantasies. I happily went to the movies or thrifting by myself.

We move on to another one of the stuck points, which was covering something I hadn't thought about for a long time-- what I was wearing on the day of the assault. I wore floral boxers from The Gap and a matching solid colored T-shirt. While doing the worksheets this morning, I realized that some part of me still thought the assault was my fault for wearing men's boxers as shorts. And I tell Dr. Kaysen about this.

She assumes that there was some kind of sexiness attached to the outfit for me, but that wasn't it.

Jaime Lowe

The outfit wasn't sexy. These were baggy clothes that masked my body. But even as the assault was happening, I remember standing there and thinking it was somehow because of the boxers.

Jaime Lowe

I remember picking out the outfit at The Gap. And I remember putting it in the giveaway pile months later and being asked why I was giving it away since it looked brand new. By the end of the worksheet, my thinking shifts. I articulate my new thought about the boxers-- a more balanced thought, Dr. Kaysen calls it.

Jaime Lowe

I'm starting to understand Dr. Kaysen's technique with these stuck points. She asks questions so I can arrive at answers myself. My previous belief shifts because I've concluded that it's inaccurate. She's my guide, but I have to come to the conclusion myself.

At the end of the session, Dr. Kaysen introduces a skill.

Finding evidence for whether your stuck point is true. She hands me something called the Challenging Questions Worksheet. The questions are like the ones she asked me during the session, like am I looking at this in an exaggerated way? Am I looking at the whole picture? Am I basing things on facts or feelings? My homework tonight is to do seven more worksheets.

I'm not used to the gray, damp fog of Seattle. I understand the moodiness of "Twin Peaks" better and why cardigans were so essential for Kurt Cobain. It doesn't help that the majority of my time is spent alone, holed up making spaghetti and doing homework, piles and piles of homework.

I take out the worksheets, and we loop back to my stuck point about the boxers. I wondered if it would have been harder for him to assault me if I was wearing jeans.

I'm not used to speaking out loud about what happened, but I knew that at some point it would come up. It would all come up-- the details, how I felt, what exactly happened in that moment, and what exactly changed.

We're nearing the end of our first week together, and I feel like Dr. Kaysen, on purpose or not, has waited until we both felt comfortable. There was trust, the skills of CPT had been discussed, and then this, this story-- the main reason I was here in this room, in this city. It was time for it to come out.

We lived in a very middle class area in West Los Angeles. Our apartment was near two big streets, Santa Monica Boulevard and Beverly Glen. There were office buildings nearby and a big mall with a massive food court.

My mom's greatest fear in life was that our landlord would sell the duplex, forcing us to leave. It was a place where I knew most of our neighbors. There were always people hanging out in front of their houses. Our across-the-street-neighbors were mechanics with a pitbull named Bumper. It was a tree-lined, sun-kissed, America dream neighborhood.

That morning, I walked past an alley between an office building and an apartment building, and the guy was there.

I wish the word vagina didn't feel so clinical. It was more than that. It was like he found a way into my personal sexuality, like a portal into parts of me I hadn't explored or known, because I was so young.

Eighth grade-- before it happened, I would daydream about having a first kiss. And then after it happened, I thought I'd never be able to. Like, I'd never be able to experience romantic interactions or understand them. Sex, sexual bodies, that shit is hard enough for a 13-year-old.

Because it wasn't worse, I should be functioning better. I add this to the stuck point log. My experience, by the way, was an outlier in that I was assaulted by a stranger. Sexual assault is usually perpetrated by an acquaintance or family member. Only 7% of juvenile victims who report sexual assault are assaulted by strangers.

At the end of the session, Dr. Kaysen introduces the new skill-- patterns of problematic thinking, which include things like mind reading, and emotional reasoning, and exaggerating, or minimizing. I'm put off by the language. It's oddly formal. I came in thinking CPT was supposed to be accessible, but it's hard to get a handle on. They use real English words, but not in the dictionary definition way. The phrases have a separate CPT meaning.

Jaime Lowe

Dr. Kaysen explains that this is part of a process we are in the process of learning, that it will make sense. But I don't see how it's adding up yet. It's just painful and hard.

It's Session five. I've made it to Friday of my first week. It feels like a small victory. I'm thinking of the assault constantly. I'm staying in the gentrified industrial neighborhood of Ballard. It's quiet. There are lots of car repair and tire shops, and warehouses, and expensive microbreweries.

Crossing the street, I'm reminded of the alley. Locking the doors at night to the Airbnb, I worry about security. I don't know anyone around me, and I feel alone. I don't want to take risks. I don't want to explore Seattle. I won't go for a run.

Jaime Lowe

Today, after the PTSD checklist, Dr. Kaysen reveals the worksheet that all the worksheets were leading up to this whole time. It has many boxes, and tables, and questions, 26 in all. It's the mother of all worksheets. It includes all the things I've learned on the worksheets til now. It's intimidating and complicated, but Dr. Kaysen reminds me that I know how to do each step. She says now that I have all the skills I need to do CPT, the therapy will shift.

We practice a couple stuck points on the big mama worksheet. One of them is about how I'm feeling uncomfortable in Seattle. I mention that the Dodgers are playing in the World Series, and I'm hesitant to walk the few blocks to the bar at the end of my street. But I really want to watch the game.

Dr. Kaysen says that I should consider trying to go to the bar to watch the game, that it's actually not risky behavior. She's not a big baseball fan, so I almost feel like the assignment is for both of us.

Jaime Lowe

As hard as this week has been, it helps that I trust Dr. Kaysen. She's a good guide.

Ira Glass

Jaime Lowe. Coming up, if you learn something important about yourself from a worksheet, is it OK to feel resentful that you learned it from a worksheet? That's in a minute, from Chicago Public Radio, when our program continues.

Ira Glass

It's This American Life. I'm Ira Glass. Today's program, Ten Sessions. What can you do with trauma from long ago that's never healed? If you're just tuning in, writer Jaime Lowe heard about a kind of therapy called CPT, Cognitive Processing Therapy, that helps people deal with unhealed trauma from sexual assault or combat PTSD, incredibly, in just 10 or 12 sessions. And she decided to try it herself. We pick up halfway through the therapy.

Jaime Lowe

Session six.

Jaime Lowe

It's Monday, and I've self-cared my way through the weekend, which is another way to say that I went to a handful of vintage clothing stores. I bought a poncho the colors of Mardi Gras. I did not buy the T-shirt that said "Rain, and Coffee, and Salmon, and Weed." The Dodgers lost the series, but I went to the bar to watch the game, and it was fine. It was actually nice.

We check the audio levels. I still have no idea if I'm doing it right. I tell myself, worst case scenario, I won't be able to share the most traumatic moments of my life with millions of people. And that seems like an OK outcome.

I take out the big mama worksheets I did over the weekend. Each sheet took a lot longer than I expected. Dr. Kaysen picks out a worksheet with the stuck point, I can't protect myself.

Jaime Lowe

Dr. Kaysen pauses. It seems like she's seeing a stuck point in the stuck point, which happens a lot-- Russian dolls of stuck points.

There's a song from Stephen Sondheim's musical, Into the Woods, that I used to listen to over and over after the attack. The wolf beckons Little Red Riding Hood. She strays from the path, and then she sings, "He drew me close and he swallowed me down, down a dark slimy path where life's secrets that I never want to know and when everything familiar seemed to disappear forever." I mean, those lyrics described how I felt in the aftermath of the assault to a tee, that everything familiar seemed to disappear forever.

Dr. Kaysen and I walk through the worksheet, step by step, through all the prompts and questions CPT relies on-- whether there's evidence for my stuck point, whether I'm making an all or nothing statement, whether I'm jumping to conclusions, what I'm leaving out. I realize that I still feel angry with myself for freezing, that I didn't scream sooner, hit him, run, or defend myself. Dr. Kaysen reminds me that he had a knife.

Jaime Lowe

Or the only response. We continue going through it. And eventually, I reach a more balanced thought.

Jaime Lowe

The big mama worksheets ask for percentages related to how much you feel things and to how much you believe certain thoughts. At the beginning of this worksheet, I believed I can't protect myself 70%. By the end, I'm in a different place.

Jaime Lowe

Suddenly, I'm getting the worksheets. They're still difficult, because thinking is difficult. But that night, I find that doing them is calming and clear. The next day, in session seven, I tell Dr. Kaysen that there's something about the writing that's really key.

Jaime Lowe

I like that the goal of CPT is to have the tools to be your own therapist. Several CPT experts told me their role as clinicians was to put themselves out of business. I'm not sure that's true of talk therapy-- for me, anyway.

I don't set an end goal. With CPT, I have. I know exactly what I want to work on, and I'm drilling down on that one thing. I'm dealing with the after effects of sexual assault. And I have a list of stuck points to show for it-- 31 different sentences written sloppily on a piece of paper, like a list of groceries. Dr. Kaysen asks me if I've crossed any off.

If I hadn't said hi, he wouldn't have assaulted me-- done with that. I can't trust my judgment-- crossed off. Because it wasn't worse, I should be functioning better-- gone. I've been working so hard to learn the process of CPT that I didn't realize how much I'd resolved along the way.

I leave the session feeling a sense of accomplishment. I love making lists. I love crossing things off my lists. This is starting to feel satisfying.

Jaime Lowe

It's session eight, and Dr. Kaysen and I are making levels jokes. I'll check the level of her volume, and she'll check the levels of my PTSD symptoms.

Dr. Kaysen and I are starting to get into a nice, comfortable rhythm. And of course, there's only three sessions left, including this one.

It's Halloween, and she's got on themed earrings and spider web tights. In another setting, I might find this kind of ridiculous, but I know her enough to know it's genuine and wonderful. And I feel sad I'm not dressed up, too.

We go through my big mama worksheets. Just as Dr. Kaysen said we would, we've been using the big worksheets to explore big themes. We've gone through safety and esteem. Today is control. And one of my stuck points is, when I'm not in control, bad things will happen, which I believe 80%.

Jaime Lowe

When Dr. Kaysen asks about mania, I pause, just sit there for a while. Then I nod without saying anything. Control is a big thing for me. It's a big thing in mania. You're not in control, but you think you are. Dr. Kaysen and I keep going through this sheet. My statement, when I'm not in control, bad things will happen-- is there evidence it might not be true?

We go over my answers to each of the little boxes on the worksheet. By the end, I have a new thought. Giving up control does not always mean bad things will happen. Dr. Kaysen asks, what feelings come up when I'm thinking about giving up control? Fear is the first one. And then--

Jaime Lowe

We're joking, but there's something there. I'm realizing that, for me, shame is related to mental illness. After mania, it's hard not to want to be buried for a decade, until everyone forgets that you tried to start a hippie cult in a tutu covered in glitter and war paint.

Today, at the end of the session, my homework is a little different.

Jaime Lowe

This is the point of the exercise. Dr. Kaysen is preparing me for life post-treatment by encouraging me to interact with people. She explains that social isolation often follows PTSD.

Session nine.

Jaime Lowe

Yesterday when Dr. Kaysen gave me the compliment assignment, it seemed difficult and silly. It felt like I entered Mr. Roger's land. And even though I know he was a good soul, I was always a Muppets Show person.

I wasn't entirely sure how to conjure up compliments. As I anticipated, giving compliments was pretty easy. I told Dr. Kaysen that I told my Airbnb guy I liked his record collection and his illustrations.

Jaime Lowe

I pause. I'm choking up.

About my book, Mental, the memoir I wrote about being bipolar. The email was from a young woman who is also bipolar.

Jaime Lowe

We'd been talking in a previous session about my feelings of being a failure, of not doing well at my work. Dr. Kaysen wants me to remember this email.

Jaime Lowe

This is the next to last session, and I can feel we're coming to the end. The way Dr. Kaysen is talking and the way I'm feeling, it just feels close to over. And then my last homework assignment is revealed.

It makes sense. If one purpose of this therapy is to change the story you're telling yourself, it would be a good gauge to write a before and after, to see how the narrative shifts-- the perfect book ends.

Session ten.

It's the day of my last session, and it's like Seattle knows it. This morning, I rode the ferry and saw a double rainbow. I walked around Bainbridge Island with a friend and saw sun, real sun through trees and abandoned mills, sun shining against the sound, and against graffiti, and against soaring seagulls, sun that reflected on the sign for Bernie's Automotive Service that read, "Welcome to the team, Charlie." It all looked shining and miraculous. I could feel the excitement of being done. And the Pacific Northwest felt it with me.

Writing the second impact statement was easier than writing the first one. I didn't feel pent up emotions spilling over. I didn't feel out of control.

I keep going. And when I get to the end, Dr. Kaysen reads back what I wrote after our first session, my original impact statement.

Jaime Lowe

Dr. Kaysen keeps reading, and I can hear how my story has changed.

Acceptance that it wasn't me, that it wasn't my fault. Dr. Kaysen hands me a print-out of the PTSD check-ins that we did at the beginning of each session. By the end, my number has dropped from the initial total by about 12 points. She says 10 points indicates meaningful change. The number doesn't mean that much to me, but I do feel better. I know that. She wonders how I feel about the therapy, overall.

The process of CPT surprised me. Its effectiveness surprised me. I could see in just those two statements how the ten sessions in between shifted my thinking. This is like ninja therapy. They distract you with the weird language, and then progress creeps up on you from behind. As always, Dr. Kaysen is huggable, gracious, warm. I'm going to miss her. I'm sad to leave, even though I know it's time, and I know I can.

It's been 10 months since I did CPT. I still have my folder stuffed with more than 100 worksheets. The spine is reinforced with neon orange duct tape, because the folder is falling apart, but I'm not. I feel like I did, in fact, get something I wanted out of this, more than what I expected.

I don't feel as hopeless and incapacitated when I hear about other assaults. The news doesn't dictate my emotional state in the same way. When Jeffrey Epstein was found dead, I was angry on behalf of his victims. I shouted a few expletives and threw my phone on the ground, but I could still function. And really, that's a very rational reaction.

Before CPT, I had a lot of anxiety and overwhelming feelings. I was experiencing PTSD symptoms, which I didn't even realize. I had my suspicions that these intense emotions were related to the assault, but it was never named for me. Now, my symptoms are mostly gone. And when problems come up, I can work them through in my head, or I pull out a blank worksheet.

There's a surge of women seeking help right now. A National Sexual Assault hotline saw a 200% increase over normal volume after the Kavanaugh hearing. There was a 20% increase in calls after the R. Kelly doc aired. After the sentencing hearing of Larry Nassar, calls to the same hotline increased by 46%. Of course, so many survivors of sexual assault don't get any treatment at all-- not talk therapy, not CPT, nothing.

When I started CPT, it was hard to say I'd been sexually assaulted out loud. I think I carried a lot of shame-- the word I was most offended by. But now I can say it, and I can say it without crying. I was sexually assaulted when I was 13.

Ira Glass

Jaime Lowe, she's the author of a memoir called Mental. In the month since she saw Dr. Debra Kaysen, Dr. Kaysen has moved from the University of Washington to Stanford.

[MUSIC - MARY J. BLIGE, "THERAPY"]

Ira Glass

Our program was produced today by Susan Burton. People who put together today's show includes Bim Adewunmi, Elna Baker, Ben Calhoun, Zoe Chace, Dana Chivvis, Sean Cole, Whitney Dangerfield, Neil Drumming, Damien Grave, Michelle Harris, Jessica Lussenhopp, Stowe Nelson, Catherine Raimondo, Alissa Shipp, Lilly Sullivan, Christopher Svetala, and Matt Tierney. Our managing editor is Diane Wu. Our executive editor is David Kestenbaum.

Special thanks to Emily Dworkin, Patricia Resick, Henry Schwartz, and Shawn Bishop. Original music for today's show by Daniel Hart. Our website, thisamericanlife.org, where you can stream our archive of over 680 episodes for absolutely free. Also there's videos and tons of other stuff there, too. Or get our app, which has all that stuff and also lets you download as many episodes as you want. Again, thisamericanlife.org.

This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Thanks, as always, to our program's co-founder, Mr. Torey Malatia. He took some ayahuasca before painting his own apartment-- not a good idea. He was getting the primer ready, and he said one of the walls started talking to him that said--

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.

[MUSIC - MARY J. BLIGE, "THERAPY"]