Controlled and Random

This morning I got into an argument with a man who insisted that posting potentially triggering content without a warning was simply the best treatment method for PTSD. His profound misunderstanding of exposure therapy and how to not be a jerk to people with mental illness is sadly common. Exposure therapy was developed in the 1950s and has changed substantially over time. Among other things, it has become gentler and more specifically tailored to the individual therapy patient.

Exposure therapy is controlled exposure in a safe environment with a trained professional the patient trusts. Each of those elements is vital to effective therapy that does not retraumatize the patient. The therapeutic office is designed to be calming and safe. Over my years in therapy I’ve noticed some decorating trends that reflect this design. The furniture tends to be comfortable. The lights are often low. There are plants growing and there is pastoral or still life art work on the wall. There may be a white noise machine in a shared practice, to better protect privacy. The best therapists have fidget toys for you to handle when you can’t bear to look someone in the eye. The setting is meant to create a sense of intimate safety.

Image shows a drop oil timer, one of the therapy fidgets I most prefer. It is blue with blue oil against a white background.

Exposure therapy is performed by trained professionals. A licensed therapist has gone through years of schooling on best practices for mental health. They’ve also been supervised by other licensed professionals. They know how to recognize signs of distress like vocal pitch and body posture, and they know how to bring a distressed patient back to a place of calm. Since therapists tend to specialize, someone providing exposure therapy probably spends a significant portion of their time doing just that.

What’s more, exposure therapy doesn’t happen at the first session. It’s something the patient and therapist work up to together as they build a working relationship that lets the patient feel safe. For some patients this will mean asking their therapist a lot of personal questions and getting to know them as an individual. For others it will mean talking only about themselves and intentionally keeping an emotional distance from the therapist’s private life. Rapport is part of the safe environment necessary for safe exposure therapy.

Once exposure therapy is about to begin, the therapist will most often provide the patient with something tantamount to a trigger warning – a brief note about what traumatic memories or phobias will be addressed in the session and how that may make the patient feel. Exposure is controlled. It is done in a decidedly safe way that minimizes potential risks. Continuous consent is part of the process and a patient who cries “uncle” is given a minute to regain themselves or the rest of the session to recover.

Exposure therapy is controlled exposure in a controlled environment with a trained professional. Refusing to post a content warning is a personal choice that has nothing whatsoever to do with exposure therapy or best practices for the treatment of PTSD. It’s a choice that can come from desire for convenience, extreme ignorance of mental health and therapeutic technique, or malice. I would urge people to show their friends and loved ones the courtesy a content warning provides, but at the very least if you will not, please do not pretend it is some kindness you are doing for me.