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Visit better help. Dotcom LongTail. Chicago, is this American Life? I'm IRA Glass. This is kind of therapy for trauma victims of sexual assault soldiers with PTSD.

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, just 10 or 12 sessions, two weeks. You can do it in two weeks. And it's effective. Studies have shown that. This therapy has 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, Jamie Lowe is a writer and reporter and a good candidate for this treatment.

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.

Jamie decided to do a story where she would go through this therapy herself and record all 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 started about content, this story does mention the sexual assault of a teenager.

Here's Jameela. 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 and expensive, practical, like learning a skill, the typical way to deal with trauma therapy is to talk about the incident over and over until it's less radioactive. 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. Deborah Cason, a psychologist with a specialty in trauma therapy at the University of Washington School of Medicine. She and I started talking and emailing about CPT. It all seems 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 CBT might help me. I also thought, what if this could help lots of people?

I asked Dr. Carson 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 CBT is one session a week for 12 weeks, but we decided to condense it.

An early studies show this approach is effective. I flew out to Seattle session one October.

Twenty second. Excellent. Yeah, OK.

I'm sitting with Dr. Carson in a generic room at the university clinic. I feel at setting up the recording equipment a few times before getting at some irate. I'm not a radio person. So let me tell you a little bit about what we're going to do today.

OK, so usually today is a little more heavy on the cycle and it's going to be a little different than a lot of our other sessions. I'm going to be talking a lot. OK, OK. Which takes a little bit of the pressure off of you maybe.

OK, Dr. Carson 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.

Fifty percent of women who are sexually assaulted develop PTSD.

That can mean symptoms like depression, anxiety, flashbacks. Some of the things I've actually been feeling when I hear the news of Dr. Carson 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 urban B, and when Dr. Carson and I meet, we'll go over them each set of worksheets. We'll cover a new skill and I'll master that before moving on to the next school, which Dr.

Kasim 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 lectures, Dr. Carson explains. My first assignment, most of the worksheets have all sorts of boxes to fill in with the answers. They look like badly designed forms you'd get at the DMV. But this first one is just a sheet of paper.

What I want you to do is write at least one page on why you think that the sexual assault occurred. I do not want you to use this as an opportunity to write specific details about the event. OK, this is more of what you think caused the event.

The phrase caused the event makes me uneasy because as much as I intellectually believe that nothing specifically 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.

I can tell you that the cause is going to be very hard for me.

Yeah, we talked earlier about what are the stories we tell ourselves.

You know, it was this, right? The event happened because I. I took a shortcut. Right. The event happened because I had a drink. The event happened because I was wearing a short skirt. And sometimes people know that that's not why it happened. But sometimes those thoughts still haunt them. There aren't any right or wrong answers. I want you to just vomit the ideas on the page. That's my specialty. Also, I love to ask.

That's what I want. All right. So. OK, any worries that you have about doing this? 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 over and Lee 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.

Session two, so what are you actually doing right now? Yeah, I'm totaling it. Can you describe the worksheet actually?

Yeah, so happy to. So this is called the PTSD checklist, OK. OK. And all it is, is a measure of how intense the symptoms of PTSD are.

Dr. Carson says we'll start all the sessions like this going over my PTSD symptoms and reading their intensity. How frequently have I been thinking of the trauma? Have I been dreaming about it, reliving it, what we're 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 the scale of zero to four. And Dr. Carson adds them up.

And so what I'll do is I'll actually start graphing these and keeping track of them.

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 one to 10.

After we go over my PTSD symptoms, Dr. Carson will ask me about my mood. Then we'll move on to the homework, what she calls the practice.

Most of each session we're going to spend actually reviewing the practice that you did over the day.

OK, so for today we're going to do is we're going to actually start by going through the impact statement that you wrote, the impact statement, the one page worksheet on why I think the assault happened. I wrote up before sunrise this morning and it was, not surprisingly, really hard to write.

So I'm going to have you read to me what you wrote. OK.

OK, uh, I was young 13 and I don't think I know I knew much about actual human nature, friendliness, strangers. It's funny to think that I was not cautious about the very thing. Kids are always warned of strangers. I walked to my bus stop alone every morning.

It was always early. You're doing great, Jimmy, to stay with. There were many people, but it was Los Angeles and no one walks, I used to pass an alley and wave at a man who was young, maybe late teens, early 20s.

Every morning I'd wake, but he would walk up the alley, I would cross the alley, or some mornings I would walk down the alley against my mom's instructions, but we'd pass and I'd always wave or smile, which is how I greeted everyone in the neighborhood.

It didn't seem like he should be any different. And in some ways, in retrospect, I feel like I overcompensated and was extra friendly and maybe invited him in. My way somehow signaled to him that this was something I wanted, that my friendliness was misinterpreted as desire, but I should have avoided.

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

You did an incredible job with that. You did an incredible job. Dr. Carson, hands me a Kleenex box. It's OK, I don't encourage her. Yeah, I'm really into this. It's not I was going to say leaves work fine for me. OK, is it OK with you if I take a look at of course. All right, so one of the things was a piece there on your mom's instructions is that I noticed that those emotions got a little more intense when you got to that.

That was something they didn't actually remember until I was writing it this morning.

We were never really supposed to walk down the alley, even though it was closer to get to the bus stop.

I tell Dr. Casemore about my mom's rule and how I broke it. She wonders if this might be a stuck point, stuck points of the first skill introduced in CBT, and they might be the most important skill of all. In a sense, the entire project of CBT 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 there.

So central to this process that Dr. Carson hands me a worksheet titled Stuck Point Log, OK, this is going to be a living document that you and I are going to share.

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

So I may I may be here in a little bit of a start point, maybe around like I should have listened to my mom, or if I hadn't gone that way, it wouldn't have happened. I think it's more like if I hadn't waved, they wouldn't have a perfect like that actually feels more like Yeah. Oh so write that down, we're going to start keeping track of these as we find them. OK, so if I hadn't waved, it wouldn't have happened, OK?

All right. Dr. Carson asked me what feelings are coming up.

I mean, I hear the word shame associated a lot with things like those, and I feel like that would apply. But it doesn't feel like the right word. Like it feels more just like I want to just shelter myself and I want to just cocoon.

OK, I think I also just don't like that word, like I think that there's something shameful about shame, like it's like I don't know.

So I think that's going to be an important one for us to sort out, actually, because feelings aren't good or bad. Right? Right. Isn't there another word, though?

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

So you will see these lovely worksheets. These are called A.B.C. sheets. OK, it's the end of the session. And ABC is the new skell.

I'm supposed to fill in the A column with the activating event. In my case, the sexual assault be with my belief or stuck point about the event. See 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 you're 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.

Last thoughts.

Questions. How did this work for you today? Good.

It was intense, I mean, I was like, that is definitely I feel weirdly better because I feel like we've started. We've started. All right, I'm going to make a copy of the impact statements. OK, got that. All right. Thanks, dudes. Until then, we're done.

Session three, so this is hard for me, the answer is the unwanted I'm sitting with Dr. Carson going over the checklist of my PTSD symptoms. Did I have memories about the assault?

Was I dreaming about it, reliving it to feel like I was reliving a little, oh, we finish the checklist and take out the worksheets.

I'd done seven the night before because I'm doing a crash course and CPT each session, each day covers a week's worth of treatment. It feels like I'm cramming, but Dr. Carson 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 at the stuck point we started on yesterday. If I hadn't said hi, he wouldn't have assaulted me.

Had you interacted with this guy beforehand? It had been several weeks probably of saying hi, OK.

And did anything happen on those other days where you said hi?

No, Dr. Carson has clearly heard similar STUC points. She pokes holes in my logic until it's obvious that there's another way to see it.

Could he have assaulted you if you had never said? I guess the likelihood that that was the cause is very small to know you were a little girl, right?

Right. You were a little girl going to school. Right.

But still, I wouldn't have said I was a little girl.

Like, I felt like I was someone who was able to operate in the world and have conversations and interactions with adults and have responsibility.

And 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, everything by myself.

Still, we move on to another one of the stock 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 color 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. When I tell Dr. Carson about this, I mean, I liked thinking about what I was wearing and trying to wear cute things.

And she assumes that there was some kind of sexiness attached to the outfit for me. But that wasn't it. Or I didn't wear sexy. I like I have never really worn makeup or can go to that kind of thing.

It's just like not my body. Not your thing. Yeah, OK.

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.

I remember being very like associating the exact outfit exactly with what was happening. I remember that it was because it was an elastic waistband that seemed like it was like there was more access to me or that like there was something about the article of clothing and the choice of that felt like that maybe in some way caused it, even if it wasn't the sexy factor.

Right.

OK, so it might not be the sexy factor, but it might be an access factor, like an appropriate like maybe inappropriate clothing. Interesting. OK, all right.

I remember picking out the outfit at The Gap and I remember putting it in the giveaway pile. Months later, I'm 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. Carson calls it.

You know, you came up with this really lovely balance thought, which is it doesn't matter what you wear. How much do you believe that?

I believe that I think it can happen to anyone. I mean, I think it's not. It has nothing to do with what you're wearing.

I think I'm starting to understand Dr. Carson'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.

So when you have that thought, no matter what I wear, what happens to that feeling of shame? I think it shifts to helplessness in some ways more interesting. So if it's what I wear, if I change what I wear, I can be safe. It doesn't matter.

Then there's nothing I can do. If someone wants to sexually assault you, I think there's very little you can do at the end of the session, Dr. Carson introduces a skill.

All right. So I'm going to teach you something new. OK. Finding evidence for whether you're 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? My basing things on facts or feelings. My homework tonight is to do seven more worksheets.

All right. I'm going to go make you a bunch of copies, OK?

And I'm going to push stuff. Excellent.

Session for so first of all, how was your mood? You know, I don't know how people live in Seattle. It's very gray and rainy, like all morning. I really wanted to take a walk.

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.

And it doesn't help that the majority of my time is spent alone, hold up making spaghetti and doing homework piles and piles of homework as well.

How is the practice? It was harder than the other practice. I think it's also I'm just so used to knowing what therapy is and like really tough. Like it's super different. It is super different. And so I guess I feel like a straight-A student in English who's taking a chemistry class, like I'm in someone else's clothes and they they aren't quite fit. You're in a different major right now. Yeah.

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

And from what you know about perpetration, more difficult, does that mean not possible? No, it's still possible. Yeah. And he had a knife, right? Yeah. Yeah.

OK, and we're going to be working on a scale tomorrow. It's like you're having some strong feelings working on this one. What's coming up for you right now?

Stay with it. I think just thinking about the naval speech, really?

Yeah.

So I want you to not try and shut the emotions down.

OK, walk me through how it unfolded.

Um, I was walking to school. I walked past the alley.

I'm not used to speaking out loud about what happened, but I knew that at some point it would come up to know when it would all come up, the details, how I felt, what exactly happened in that moment and what exactly changed. And we're nearing the end of our first week together. And I feel like Dr. Carson, on purpose or not, has waited until we both felt comfortable.

There was trust the skills of CPT had been discussed. And then there's the story. The main reason I was here in this room in this city, it was time for it to come out. And he was kind of in this like kind of cold, I guess, behind the bush.

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. Yeah, it was a place where I knew most of our neighbors. There were always people hanging out in front of their houses all across the street. Neighbors were mechanics with a pit bull named Bumper because it wasn't it was a tree lined Sunkist America dream neighborhood. That morning, I walked past an alley between an office building and an apartment building, and the guy was there and he kind of he like like I smiled or waved and then he beckoned me over.

I didn't know why. And then I walked over and he held a knife to my side and then he put his hands down my boxers and felt my vagina. And then I think I said something about like protesting. And he said that my father owed him money. And I was like, you know, there's no way that's true.

And then he kept saying, let me just guess and put his mouth on my vagina.

And then I like I scream. But it was a scream. I was just kind of a vocal articulator and it wasn't particularly loud. And then he ran up the alley the other way. 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.

And so in that moment where he had a knife up to you, what did you think was going to happen to you? Remember? I have no idea. I didn't know you were just super scared. No. Yeah, I mean, I think part of the reason that I haven't dealt with a lot of it is like the outcome was a I don't know, I've heard those before from other people who have been assaulted is that the outcome wasn't like that, that I wasn't raped.

I wasn't, like even cut.

Like, nothing was physically wrong. Nothing was like particularly. But damaged, I guess, except for like psychologically everything was right. And so it's in some ways, I think even harder because I felt like it wasn't so bad or I was supposed to think it wasn't so bad.

So I'm hearing a stuck point around. I shouldn't be distressed or like this wasn't there's almost a little bit of a minimizing kind of stuck point. Yeah. What how would you put it? What would the belief be around that the because I wasn't raped or because I wasn't cut. I shouldn't have I shouldn't have these reactions. I'm not sure exactly what the point is. I think because it wasn't worse, 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 seven percent of juvenile victims who report sexual assault are assaulted by strangers.

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

The phrases have a separate meaning to these makes sense for the most part, for you kind of wonder where do you have questions? I guess what are we doing this for? Mm hmm.

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

All right. But I'm going to make you another copy of the actual PARADICE form.

OK, cool. It's Section 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 they feel alone.

I don't want to take risks. I don't want to explore Seattle.

I won't go for a run taking too many risks or doing things that could cause you harm. They're OK being super alert or watchful or on guard to today.

After the PTSD checklist, Dr. Carson reveals the worksheet that all the worksheets were leading up to this whole time. It is many boxes and tables and questions. Twenty six and all. All right. It's the mother of all worksheets. It includes all the things I've learned on the worksheets till now. It's intimidating and complicated. But Dr. Kasim reminds me that I know how to do each step. She says now that I have all the skills I need to do CBT, the therapy will shift.

But what we're going to be doing from this session on out is we're going to start working with different themes.

The first one we're going to focus in on is around safety. OK, so how this event may have affected your ideas about safety?

We practice a couple stuck points on the Big Mama Workshy. One of them is about how I'm feeling uncomfortable in Seattle. I mentioned 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. Carson 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. So I'm going to you know, I'm going to ask you on Monday whether you saw the get into it.

Yes. Yes. OK, all right. So in terms of and I'll ask you if you know what the score was. Oh, there are.

But I really I was excited to actually, I hate to tell you this, but I'm really treatment resistant.

This sounds like a stuck point. It could be a stuck point.

We could get through the baseball stuff we can work together on.

Absolutely. We'll set it as a long term treatment goal. Yeah. All right.

So in terms of as patients, as hard as this week has been, it helps that I trust Dr. Kay said she's a good guide.

Jamie, well, coming up, if you're going to something important about yourself from a worksheet, is it OK to feel resentful that you're going to it from a worksheet?

That's in a minute from Chicago Public Radio when our program continues. Support for this American life comes from ETSI, you can find truly special holiday gifts on Etsy, the perfect housewares, personalized jewelry, custom made toys and more, both made by hand and handpicked by vintage experts.

Giving a gift from Etsy is a way to show the people you love, that you're really thinking about who they are and what they care about.

Go to Etsy, dotcom gifts to shop the thoughtful gifts you need for the people you love this holiday season. This American Life Miracle has today's program, 10 sessions, what can you do with trauma from long ago that's never healed? It was just tuning in.

Writer Jamie Low heard about a kind of therapy called CBT cognitive processing therapy that helps people deal with unhealed trauma from sexual assault to combat PTSD.

Incredibly, in just 10 or 12 sessions, she decided to try it herself. We pick up halfway through therapy session sex.

All right.

So so in general, since I last saw you on Friday, how's your mood been?

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.

All right. So do you want to check levels and then we will delve in? Yeah.

Why don't you speak a tiny bit? 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. I think Dr. Kasem picks out a worksheet with the stuck point. I can't protect myself.

I can't protect myself. Oh, good. This is a great one to do also with you going out to the bar, too. Yeah, really relevant.

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

Let me ask you a question also. There's another piece here. Are you different now than you were then? Yeah. How so? I'm older and no more. I've learned from that experience. Um, this reminds me of that song and Into the Woods, the musical, uh, the Little Red Riding Hood song.

Yep. Which is basically all about sexual trauma. 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 my 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. Carson and I walk through the worksheet step by step through all the prompts and question, CPT relies on whether there's evidence for my point, whether I'm making an all or nothing statement, whether I'm jumping to conclusions, what I'm leaving out.

And I realize that I still feel angry with myself for freezing, that it didn't scream sooner, hit home, run or defend myself. And Dr. Kasim reminds me that he had a knife if somebody's got a weapon.

Sometimes freezing is the best response in that moment or the only response, we continue going through it and eventually I reach a more balanced thought.

Good, I did what I could to protect myself from physical harm. Absolutely.

That's beautiful that you came up with that the Big Momma worksheets ask for percentages related to how much you feel things and how much you believe certain thoughts most.

At the beginning of this worksheet, I believed I can't protect myself 70 percent by the end, I'm in a different place.

And so you managed to get that from 70 percent to 20 percent. That's a really nice movement around that.

Yeah, I don't fully understand the percentages, but I do. I did feel better after working through it.

Nice and fair came down, anger came down and frustration came down. Nice. That's lovely. And you've also got some other balanced thoughts in here too. Like. Right. I can protect myself most of the time. Yeah, you can think about how does that feel? Empresses. I can't protect myself at all. Right. Beautiful job with that.

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

And so when I'm writing it down, I'm just seeing that even just subtle shifts are really different when you write it. That's right. I can see the beginning point and then I see the end. I'm just like I like it's like your forehead slapping. You're just like, oh, yeah.

That starting point was really off. Like, that's not a rational way to think. Right.

But I love what I'm hearing you say is also you're really seeing some cognitive shifts with doing these. So it's hard work, but you're also seeing some pay out. Yeah, I think I'm also a little resentful that it's just coming from a worksheet.

I'm sorry. It's like there's something like this. It's like it's like I can't describe it, but it's sort of like, OK, I think I can describe it. It's I think that in like talk therapy or traditional analysis, it's so individualized, it's so cool and it's so specified to your relationship with one person and that space and that time. Yeah. And it's it's very much like a special thing, whereas a workshy it's an equation and so it's more generic, which actually makes it way better in a lot of ways, but also hard because it feels less special.

Right. But also kind of like not this precious thing. You're special and your problems are special. It's interesting.

I like that the goal of CBT 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 CBT. 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.

OK, thirty one different sentences written sloppily on a piece of paper, like a list of groceries. Dr. Carson asks me if I've crossed any off.

I cross over ones that I just didn't think for. That points in the first place. And then I crossed off some that I felt like we worked through. That's fantastic.

If I hadn't said hi, he wouldn't have assaulted me down 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 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.

You check my level and I tell you my love. Yeah, OK, it's seven, eight, and Dr. Carson and I are making levels jokes. I'll check the level of her volume and she'll check the levels of my PTSD symptoms.

So since yesterday, how much have you been distressed by repeated, disturbing and unwanted memories of the traumatic event to one?

Probably one.

Dr. Carson 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 to. We go through my big mama worksheets, just as Dr. Carson said we would, we've been using the big worksheets to explore big themes. We've gone through safety and the steam today is control. And one of my stock points is when I'm not in control, bad things will happen, which I believe 80 percent.

What evidence do you have that if you are not in control, bad things will happen? Um, bad things have happened when I haven't been in control.

OK, so. So you can say things in the past. OK, OK. So I'm assuming with the sexual assault events that happened when you were manic, ok.

OK, when Dr. Carson asks about Manea, 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 and mania, you're not in control, but you think you are right, you're relaxing.

Dr. Carson and I keep going through this shit. My statement, when I'm not in control, bad things will happen. Is there evidence that might not be true?

So bad things can happen when I'm in control. When you are in control. Yeah, absolutely.

And have you ever been out of control and not had something bad happen?

Yeah. 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. Hasan asks, what feelings come up when I'm thinking about giving up control to be fears the first one.

And then there's definitely a lot of guilt and shame. Yeah. So I really come around to the same concept. Yeah. You've really been really embracing it. Yeah, you have. That's true. That is true.

We're joking. But there's something there. What are the stuff.

I'm realizing that for me shamers 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 more pain. Today, at the end of the session, my homework is a little different.

And then I want you to practice giving one compliment and receiving one compliment. I don't really speak to people that I know I know.

So it would mean you'd have to speak to people, give one compliment and receive one. How do I make someone compliment me?

So that's tough because you're in a strange city. Yeah.

So what it's going to mean as a couple of things, either you need to listen for compliments. You're getting naturally without filtering them, OK? Or sometimes if you're interacting with people, then you may be more likely to get compliments.

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

Section nine. All right, well, let's dig in to have a practice one before we go into worksheets. How did the giving and receiving compliments go yesterday when Dr. Carson gave me the compliment assignment?

It seemed difficult and silly. The one thing it felt like I entered Mr. Rogers land.

And even though I know it was a good soul, I was always a Muppet Show person. It took on.

I wasn't entirely sure how to conjure up compliments. Probably as I anticipated. Giving compliments was pretty easy. I tell Dr. Carson that I told my Airbnb guy I liked his record collection and his illustrations.

Yeah, nice. Did you get any compliments? I did. It was really funny, actually.

I got a very a really, really, really big compliment to me. Yeah.

I pause. I'm choking up. Someone wrote me an email. My book about my book, Mantel, the memoir I wrote about being bipolar, the email is from a young woman who is also bipolar.

She had to leave college and go home and kind of really shift her plans. And she said that she really felt like this story that I told was something that she had never read but could really relate to. It was really that's powerful.

We'd been talking in a previous session about my feelings of being a failure of not doing well at my work. Dr. Carson wants me to remember this email. I can try and remember it. It's hard.

It's really hard for me to remember the positive responses to anything. Yeah. And so this is one for you to practice, right? This is so we're starting to move into, like, LifeSkills, right. This is one that's going to be a life skill for you. What am I leaving out? That's been a really helpful question for you, right? It it forces you to get out of that negative space and look for things that don't fit with the stuck point.

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

I want you to write at least one page on what you think now about why the traumatic event occurred. OK, 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 bookends. Session 10, how was it writing the second impact statement? It was good. They felt like it was less fraught, like it's the day of my last session and it's like Seattle knows it.

This morning I rode the ferry and saw 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 Burnie's automotive service that read Welcome to the team, Charlie. It all it's shining and miraculous. I could feel the excitement of being done and the Pacific Northwest felt it with me. Is writing the second impact statement was easier than writing the first one.

I didn't feel pent up emotion spilling over. I didn't feel out of control.

So I'm going to have you read it to me, OK? OK.

The attack happened because who knows why it happened. I don't know why he molested me. I don't know what motivated him. I know that it didn't happen because I was there. Or wearing boxers or friendly are willing it upon myself. I was young and walking to school, not looking for a sexual assault. That's pretty improbable. Why would anyone look for that? I think it happened because I just really can't explain why he was in control. He had a knife.

I did everything I could to protect myself and to get away. My feelings after it happened were natural. My response was as good as I could be. Good is the wrong word. But I think I did OK, considering all of the circumstances. Other people, I keep going.

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

So let me read back to you what you wrote the first time, OK? I was young 13, and I don't think I knew much about actual human nature, friendliness, strangers. It's funny to think that I was not cautious about the very thing. Kids are always warned of strangers. I walked to my bus stop alone every morning.

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

So what dangers do you hear? Well, I think there's a huge shift of focus. Now it feels like there's just a different way of seeing it, right, like that attack just doesn't feel as potent. I think yeah.

Yeah, that's what I heard, too. And and also really an acceptance that you may never know. In fact, you probably will never know exactly why it happened, but you can be really confident that it didn't have anything to do with you. Right. Which is something that I do think I intellectually understood. But it wasn't something I accepted. I don't think and I think that in the difference between the first statement of the last, there was acceptance and acceptance that it wasn't me, that it wasn't my fault.

Dr. Carson hands me a printout of the PTSD check ends that we did at the beginning of each session. By the end, my number has dropped from the initial total by about 12 points. Since she says 10 points indicates meaningful change. The number doesn't mean that much to me, but I do feel better. I know that. So first of all, she wonders how I feel about the therapy overall.

What did you notice in the process? What was helpful for you? What was not helpful? How have you seen shifts?

Well, I've definitely seen I mean, I think working through all of the stuff about the assault was incredibly helpful because I felt like there was a lot of unresolved assumptions, but I didn't really even recognize were there and that it was, frankly, kind of a relief to not really have that there is much they get just kind of feels better. Mm hmm.

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. Carson 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 let it. That's it. That's all right. 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 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 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 percent increase over normal volume after the cabinet hearing. There was a 20 percent increase in calls after the R. Kelly dog aired after the sentencing hearing of Larry Nassar, calls to the same hotline increased by forty six percent. Of course, so many survivors of sexual assault don't get any treatment at all, not talk therapy, not CBT, 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. Jamie Lowe, she's the author of a memoir called Mental, just a month after she saw Dr Deborah case on Dr Case and moved from the University of Washington to Stanford, it's now been a couple of years since Jamie did those 10 sessions. She did them back in twenty eighteen.

She has this last year she got covid. She experienced relationship ups and downs and one point had bedbugs. But she said the CBT worksheets made everything a little easier to deal with.

Ms. Hmmm, why would I spend the rest of my days unhappy? Why would I spend the rest of this year alone when I got therapy, when I got therapy, when I got therapy two times a day. My program was produced today by Susan Burton.

People who put together today's show includes them out, me and the Baker, Ben Calhoun, Zoe Chace, Dana Shivashankar with the Dangerfield's Neil Drumming, Damien Grave, Michelle Harris, Jessica Larson, HOP, Don Nelson, Catherine Raimondo ship, Lilly Sullivan, Christopher Switzler and Matt Tierney.

Managing editor for today's show is Diane Will. Our executive editor for Today Show is David Kestenbaum. Additional production for this rerun from Nergal special thanks to Emily Dworkin, Patricia Rezac, Henry Schwartz and Sean Bishop.

Original music for today's show by Daniel Hart, our website, This American Life Dog, where you can stream our archive of over 700 episodes for absolutely free.

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Thanks as always, for our program's cofounder, Mr Malatya.

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.

It said, I hate to tell you this, but I'm really treatment resistant.

I'm IRA Glass, back next week with more stories of this American life. Why would I spend. Part of our listening is making you bids up to do nothing, but everything went I and down that road means we're knocking off. Roughly two times a day.