BLUF: Veterans Day is when people ask veterans for their story. It happens at work, at school assemblies, and around the dinner table. A lot of veterans who could use treatment stay away from it for the same reason they dread those questions. They assume therapy means telling the whole story, out loud and in order, starting in the first session. It doesn't.
I understand why people think that. It’s one of the most common worries I hear, and it keeps people out of care. When Silvestrini and Chen (2023) interviewed male veterans starting PTSD treatment, many said they held off because of stigma and because they didn’t want to relive what happened. Avoidance is also a core symptom of PTSD, so the dread of retelling is often the condition itself talking.
What the first few sessions look like
Mostly we talk about the present. How you’re sleeping. What’s going on at work and at home. What you want to be different. We’ll touch on your history, but only at a high level. The details come later, a little at a time, and only when the treatment calls for it.
How the memory work actually happens
The main trauma treatments use memories in ways most people don’t expect.
With EMDR, you don’t have to describe the event out loud in detail. You bring parts of it to mind for short stretches while I keep track of how you’re responding.
Cognitive processing therapy focuses on what the event left behind, meaning the beliefs about blame, safety, and trust that stuck with you. You don’t have to give a minute-by-minute account.
Written exposure therapy has you write briefly about the event during sessions instead of telling it aloud. In a study of 178 veterans at three VA medical centers, Sloan and colleagues (2023) found it worked as well as prolonged exposure, and far fewer veterans dropped out. The dropout rate was 12.5 percent for written exposure and 35.6 percent for prolonged exposure.
That last number matters to me. Treatment only works if you stay long enough to finish it. How we do the work and how fast we go are real clinical choices, and they make a difference.
It’s your story
Nobody is owed your story, this week or any week. If you speak at an event tomorrow or answer questions from family, you decide what you share. Therapy works the same way. You set the pace. You can tell me something isn’t ready to be talked about yet, and I’ll plan around it. A good trauma therapist expects that conversation.
If this is what’s been keeping you from getting help, reach out. We’ll start wherever you are.
Key Takeaways
Fear of retelling the trauma is a documented reason veterans put off PTSD treatment (Silvestrini and Chen, 2023).
Early sessions focus on sleep, current symptoms, and your goals. Details come later, in small doses.
EMDR doesn’t require a detailed spoken account, and cognitive processing therapy focuses on the beliefs the event left behind.
Written exposure therapy worked as well as prolonged exposure for veterans, with far fewer dropouts (Sloan et al., 2023).
You control the pace, including what stays off the table for now.
Graham Sterling, PhD, is the founder of The Sterling Practice. He offers individual therapy and adjunctive EMDR by secure telehealth across Massachusetts and Maine, working mostly with veterans, first responders, and other adults dealing with trauma, PTSD, and burnout. Book at tspractice.com or call (617) 299-1296.
References
Silvestrini, M., & Chen, J. A. (2023). “It’s a sign of weakness”: Masculinity and help-seeking behaviors among male veterans accessing posttraumatic stress disorder care. Psychological Trauma: Theory, Research, Practice, and Policy, 15(4), 665-671. https://doi.org/10.1037/tra0001382
Sloan, D. M., et al. (2023). Written exposure therapy vs prolonged exposure therapy in the treatment of posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 80(11), 1093-1100. https://doi.org/10.1001/jamapsychiatry.2023.2810