In video 7, I want to give you an example of an imaginal exposure transcript.
This is the case of an adult female sexual assault survivor
that I treated a number of
years ago.
When she presented for treatment, she was 31 years old, married,
Caucasian.
She had a master’s degree.
She presented for treatment about 1 year after
a rape in her townhouse.
Her complaints were of nightmares, fear of being alone, avoidance of sex with her
husband, hypervigilance, jumpiness, checking locks,
decreased concentration, which
was causing difficulties in school, and she was avoiding
taking her dogs for walks after
dark, being downstairs alone, or discussing the assault with anyone.
So, this is a transcript of her imaginal exposure narrative.
I should warn you, it does
have some upsetting material in it.
I see this person in the doorway of the stairwell and
he seems to be rushing at me.
And my
heart’s pounding.
I’m really surprised and I know I’m really in trouble.
He has this thing at my
head and he says if I scream—which I don’t because I’ve got
fingers practically down my
throat—that he’ll shoot me.
He says, “Where did your husband go?” And I say, “Just out to do
something very quickly.
He’ll be right back.” And he says, “I’ve got my buddy waiting for
him.” And that really scares me because it seems like now this
is some type of horror story or
something that we’re both going to be hurt.
He says, “Get on the bed,” which again scares
me.
I didn’t expect that.
It’s the first time I suspect rape.
So, I get on the bed.
I don’t see any
choice, any way to escape.
I think there’s somebody downstairs.
He whacks me across the
face and he says, “Don’t scream anymore.” I think this man is really dangerous.
He can really
hurt me and I have to be careful.
So, I have to figure out how much anything I try to do is
going to provoke him and not let it get that far.
He’s pushing too low and I feel burning, sharp
cutting, and then it goes in.
And I don’t really feel it after that.
Just like movement.
He says,
“When I’m done with you, my buddy is coming up.” That’s
just another terrifying moment.
I
want to get out.
I can’t have that, another person going to hit me.
I’m saying, “No, no.
Please
don’t hurt me.
No, no.” And I hate it.
I hate whining.
I hate myself, hearing myself say it.
I
wish I would stop.
It’s like I can’t make myself stop.
He comes off of me and says, “Kiss it,”
which I don’t want to do.
My mouth’s bleeding and it hurts.
It just looks evil and I think it’s
dirty.
And I don’t want to do it.
But he pushes me down and I’m afraid I’m going to be hurt.
So, I just do it.
I’m shaking now.
It’s cold and I’m embarrassed.
It’s very peculiar.
It’s like I’m
again suspended and I’m new to my bedroom with someone I don’t know.
It’s like the same
feeling when you dream you’re at work but you’re not dressed
correctly like you wore your
pajamas to work or something, sort of a little panic and
embarrassed, and you don’t want
anyone to see you.
Those were excerpts from her imaginal exposure.
And you can hear that it’s got a lot of the
information we want included.
We want information about the stimuli and she includes that.
You want information
about responses and she includes that.
I think she says, “my heart’s pounding” at one
point.
And you want information about the meaning.
And she has a lot of information
about the meaning.
“Now, I think it’s really dangerous.” “There’s someone
downstairs.” “They’re going to attack my husband, too.” “We’re both going to be
hurt.” And again, in therapy, we’re going to repeat this over
and over again every session.
These were just excerpts from her narrative and we’re going
to repeat it session after
session.
Some key points from this video.
In this example of an imaginal exposure narrative,
the patient included information about the stimuli.
“It looked dirty.” “It looked evil.”
“I could hear myself screaming.” And the meaning: “Now, I think this
is really dangerous.” She speaks in the present tense to help engagement.
She
describes many points that will be important to discuss in the processing.