"He grabs two glasses and breaks them," the patient said. "He's screaming and calling me all kinds of things. The next thing I know I'm bleeding. . . . I see all this blood coming out of my neck."
Edna Foa, one of the world's experts on treating PTSD, watched intently with 12 of her staff members at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.
This meeting, held weekly, was less about the patients than about ensuring that therapists were making the most of the treatment Foa developed: prolonged exposure. It has earned her international acclaim and made her a sought-after speaker as the nation's long involvement in Afghanistan and Iraq has produced a new generation of emotionally wounded soldiers. But prolonged exposure is emotionally demanding for both patients and therapists. Foa, an intense woman who rarely sees patients now herself, takes this supervision meeting very seriously.
She already had chided one therapist for being too skeptical with a difficult patient and confirmed another's suspicions that her patient's real problem was obsessive-compulsive disorder, not PTSD. Now Foa, a fan of positive reinforcement, suggested more praise for the slashing victim.
"You probably could say once, 'You're doing great,' " Foa told Carmen McLean, a relatively new staffer.
Other therapists jumped in to gush about the patient. He had had the strength to tell his story to McLean several times in their first "imaginal" session, during which he tried to reexperience the trauma. The theory is that this repeated exposure would make the attack lose its power to frighten, much as repeated viewing makes a terrifying movie grow dull.
