It’s a Tuesday at 3 pm, which means it’s time for my therapist to remind me that I am a victim of a violent crime. Each time she says this it’s in a way that’s meant to bring solace, a gentle reminder that it’s okay to feel the way I do. She reminds me that the bad dreams and inability to feel safe around most men and the occasional crying before, during, and after intimacy are symptomatic of post-traumatic stress disorder. She recommends a type of therapy called eye movement desensitization and reprocessing. She informs me that she unfortunately does not specialize in that particular treatment and instead suggests a visit to a rape therapist. At the end of the session, she gently suggests that I ask my doctor to up my dosage of Zoloft to 100 milligrams.
It’s a Tuesday at 3:58, which means it’s time to poke my head in through the threshold of my roommates bedroom. Sometimes she is napping, small and c-shaped against the windowsill full of plants and charging crystals. On days after particularly hard sessions, she examines my puffy eyes and flushed face and asks if I’m okay. I dissolve into her floor in shame. Ashamed that after more than a year and a half from the night I became the “victim of a violent crime,” it still manages to take so much from me. She patiently listens to diatribes about how angry and puny I feel and talks me down, encourages me to be kind to myself. On Tuesdays when my roommate isn’t home at 3:58, a scream into the void normally does the trick.
I’ve started referring to the assault-inflicted PTSD as Rape Feelings, an improperly proper noun that envelops all of the pain and confusion and anger I experience on a daily basis. It has made explaining the incapacitating mental trap of PTSD easier, like instead I just have a cold or a migraine.
Sorry I couldn’t make your birthday dinner – Rape Feelings.
Sorry I can’t have sex tonight – Rape Feelings.
Sorry I have to clock out early – Rape Feelings.
My therapist reminds me weekly that I am the victim of a violent crime, but I try to convince myself I don’t feel like one. But as any therapist will remind a client, feelings are not fact. A friend once asked me why the label of victim made me feel so deeply uncomfortable and I could only answer back with the obvious: it feels uncomfortable because it’s a label I never chose in the first place. I wasn’t, and then I was.
My victimhood, unlike the Rape Feelings, does not come and go like an unwelcome house guest. She attaches herself to me like a little sister. If I want to experience any kind of freedom, I have to bring her along with me. She’s not that much of a bother. She’s quiet until we’re alone and you touch me or I notice your eyes narrowing as they examine my body. Victimhood has a really good memory; she doesn’t forget pain and keeps track of the thumb-shaped bruises.
My therapist reminds me weekly that I am the victim of a violent crime. She does not let me forget about my PTSD. She recommends a treatment she does not specialize in. She encourages me to reach out to a rape counselor.
Eye movement desensitization and reprocessing, more commonly referred to as EMDR, is a form of psychotherapy developed in 1988 by Francine Shapiro of the Mental Research Institute in Palo Alto. EMDR is most commonly used to treat PTSD and does so by focusing directly on the cognitive, affective, and somatic components of memory. The goal of treatment is to create new cognitive connections with existing memories in hopes that resolution is achieved. Resolution, defined by Shapiro in the Encyclopedia of Psychotherapy, is “the desentization of triggers, elimination of emotional distress, elicitation of insight, reformulation of associated beliefs, relief of accompanying physiological arousal, and enhancement of personal growth and functional behaviors.”
Like every other system in our body, memory is a machine. The same way our bodies digest food and absorb nutrients, we digest and absorb memories. In college, I learned about synaptic pruning: our evolutionary ability to reject what does not serve us anymore by no longer tending to the dendrites that transmit the information to our brains. We process to learn, we build associations, and we store those in our memory if they serve us.
That is, unless there are strong negative associations induced by traumatic events, in which case information processing is affected, and the memory becomes “dysfunctionally stored with negative emotion and physical sensations intact.” As a result of this, the memories are not being recalled as historical events and are instead re-experienced. Based on Shapiro’s research, this presents itself in the form of “intrusive thoughts, emotional disturbance, and negative self-referencing cognitions of post-traumatic stress disorder.” Check, check, and check. EMDR seeks to turn the dysfunctional reexperiencing of memory into new associations through external stimulants like eye movements, hand-tapping, or bilateral tones, all aiming to ensure that past, present, and future aspects of the “problem” are “thoroughly addressed.”
The eight phases of EMDR according to Francine Shapiro are as follows:
Phase One, Client History and Treatment Planning:
“The therapist takes a full history, assesses the client’s readiness for EMDR, and develops a treatment plan. The therapist evaluates aspects such as diagnosis, comorbidity, suicidality, dissociation, existing support system, life stability, presence of current stressors, physical health, secondary gain issues, and substance use.” I imagine Francine Shapiro to be a short Italian woman. She has dark hair and hollow eyes. Maybe she wears a lab coat with her name embroidered into it and is holding one of those clear clipboards with the pen attached so that you can’t steal it. She sits and stares with her clipboard, asks you to empty yourself, to tell the doctor your trauma. Who hurt you and how did they do it and what was the weather like the night that you were violated? Did you get a rape kit? Did you have a pap smear? Were you already feeling like you wanted to die? How often do you feel outside of your body? Do you hate your job? Have you ever smoked marijuana? Do you drink to forget someone hurt you? Targets are then chosen based on theories about information processing. “Targets include recent distressing events, current situations that stimulate emotional disturbance, historical incidents, and the developments of specific skills and behaviors.” Did you hit a dog with your car recently? Were you fired from your job? Are your parents divorced? Did your mother forget to pick you up from school when you were six? “When appropriate, events are selected for processing in chronological order, beginning with the earliest.” Starting from the beginning of your memory, recount for me all of the times you felt as though something was taken from you.
Phase Two, Preparation:
This step involves “establishing the therapeutic relationship, setting reasonable levels of expectation, educating the client about his or her symptoms and about EMDR, and ensuring that the client demonstrates adequate stabilization.” This treatment is meant to help. Your therapist said she referred you. Lots of rape victims benefit from EMDR. “Client strengths are developed by combining relaxation, imagery, and EMDR in interventions that assist the client in acquiring new skills and resources.” Imaginary Francine reenters the room with her clear clipboard. This time, she has on thick glasses. Imagine the place you feel the most safe. Is it a classroom? Is it your grandmother’s house? Is it a forest? Let me put on this CD of calming river noises. He can’t hurt you here, you’re safe. The babbling brook will protect you. “The client receives supportive statements from the clinician in a safe context, fostering positive counterconditioning.” You’re doing great. You are so brave. You are not damaged goods. We can’t undo the victimhood you did not choose but we can try to heal you.
Phase Three, Assessment:
Imaginary Francine asks you to select a particular memory to address during the session and “identify the mental image, beliefs, emotions and physical sensation, taking baseline response measures.” No glasses today, but she is wearing a fun top you recognize from Ann Taylor Loft underneath her lab coat. Tell me about the mental picture that’s burned into your brain, the one where he is kneeling above you, prying at your closed knees. Can you still feel the way his skin was rough against your unshaved legs? How red is the blood that stained his sheets? Tell me everything you remember. Imaginary Francine pushes you to name the negative belief about yourself related to the memory. Does it make you feel powerless? Does it make you feel like a commodity? Does it make you feel like a man will never be kind to you ever again? She asks you to phrase these answers in the present tense, to “activate the disturbing information and to assist clients in recognizing the impact of the past event on current self-concept.” Say it with me. “I am powerless. I am a commodity. I will never be worth a man’s kindness ever again.” After this, Imaginary Francine tells you to identify a “desired positive belief,” she encourages you to express empowerment or value in relation to the hurt and violation. Try this: “I am worthy. I am brave. I am strong.” You say the words, and then through her thick-rimmed glasses, she asks you to rate how accurate the positive affirmation feels on the Validity of Cognition Scale, where 1 is “completely false” and 7 is “completely true.” Just to get a baseline, we’ll eventually use it to measure your progress. It’ll be a great way to measure how far you’ve come at the end of treatment. She reminds you of the proverbial light at the end of the tunnel.
Phase four, Desensitization:
Learning begins to take place. Imaginary Francine asks you to focus on the visual image, your negative belief of choice, and the external sensations of your body. Whatever happens, happens. She asks you to move your eyes from side to side for 20 seconds minimum, you follow her chubby fingers back and forth. You’ve never noticed her wedding band before. As she moves her finger, you begin to wonder what Imaginary Francine’s husband looks like. Is he jacked? Is he also a shrink moving his finger back and forth in front of another traumatized schmuck’s face on a Monday afternoon? After the 20 seconds has lapsed, she asks you to let go of the image. Let your brain go blank. Let go. Breathe deep. Good. She asks you, “What do you get now?” And repeat. More eye movement. More focus. More “what do you get now?”
Phase Five, Cognitive Installation:
As treatment progresses, negative imagery and associated emotions and beliefs diffuse and become less real-feeling. The positive ones become stronger and more valid. Imaginary Francine tells you she’s proud of you for edging closer to the truest version of yourself. She tells you your brain is shifting how the memory is being stored and that new associations are forming. The work is hard, but it’s good. She’s not wearing the glasses today, but you notice she trimmed her bangs. She asks you if your self-concept has changed. Do you still feel worthless? Do you still feel like you have to rush into sex with men because the sooner you just give it to them the less time can go by scared that they will eventually take it from you? Are you better yet? Imaginary Francine asks you to focus on incorporating and increasing the strength of the positive thought until it feels real. On a scale from 1 to 7, how much does the thought “I am healing.” feel like an absolute lie? Imaginary Francine reminds you that this treatment is helpful for rape victims because they enter therapy knowing they are not to blame, but phase five is not complete until you actually believe it wasn’t your fault. How about now? Say it again, “It wasn’t my fault.” 1 to 7, does it feel like bullshit as the words fall out of your mouth?
Phase Six, Body Scan:
Imaginary Francine asks you to notice any tension in your body as you focus on the mental image and positive thoughts. “Because dysfunctionally stored information is experienced physiologically, processing is not considered complete until the client can bring the previously disturbing memory into consciousness without feeling any significant body tension.” Imagine him kneeling over you trying to separate your knees again. Do you still grind your teeth at the thought of it? Does it still make your stomach bubble with diarrhea? Do you still want to puke? The more physical discomfort you experience, the more eye movements until the physiological symptoms are gone. Back and forth, you follow Imaginary Francine’s chubby fingers until you stop grinding your teeth. And your stomach stops churning. And the bile settles back into your stomach. Scale of 1 to 7, how true does the phrase “I am worthy,” feel? What about “It wasn’t my fault?” Okay, now try “I did nothing wrong.” 1 to 7.
Phase Seven, Closure:
Imaginary Francine does her assessment. She decides whether or not you’ve accurately processed the trauma. The good news is that you graduate Trauma School. But if the Rape Feelings keep persisting, keep a journal. It’ll be good for the nightmares about being trapped in an enclosed space with your rapist. Or for you to document how it felt after you cried after sex last week. She reminds you that recognizing and recording patterns extends treatment effects to real-life events and encourages self-mastery and awareness. This is called stabilization.
Phase Eight, Reevaluation:
Imaginary Francine measures whether the treatment gains from the previous session have been maintained by reminding you of the previously processed target and assessing your responses. She reads your journal. Make sure you mention the post-sex crying to your therapist next Tuesday. That’ll be important. You pass the assessment almost as easily as you renew your driver’s license. You’re free. Nothing can haunt you anymore. Imaginary Francine fades back into obscurity. You forget what her Ann Taylor blouses look like and can’t remember what the inside of her index finger looks like as it moves back and forth before your eyes.
Last Tuesday, I skipped therapy. Andrea did not tell me that I was a victim of the violent crime because I did not let her. I didn’t have to tell her that I hadn’t found a rape counselor yet. She didn’t tell me how helpful it would be to let someone like Imaginary Francine move their hand from one end of my face to the other while they asked me to tell myself lies until I felt that they were the truth. Instead, I let the Rape Feelings into my home again. I let them bellow about how much simpler life used to be. I crawled into bed and didn’t move for at least twelve hours. I left the house only once, at 10 pm for McDonald’s fries. While sitting in my car waiting for the drive thru line to move, I screamed into the void. It did not do the trick. But I did it again anyway.