For many people living with the aftermath of trauma, avoidance becomes a way of life. You stop going to certain places. You push memories away. You stay busy so you don't have to feel. And for a while, it works — until it doesn't.

Prolonged Exposure (PE) therapy is one of the most extensively studied treatments for post-traumatic stress disorder. Developed by the late Dr. Edna Foa at the University of Pennsylvania, it has been shown to significantly reduce PTSD symptoms in the majority of people who complete it. I had the privilege of training in PE and participating in Dr. Foa's research at Penn — and I saw firsthand how transformative this approach can be. Her passing in March 2026 was a profound loss to the field, but her legacy lives on in every clinician she trained and every patient whose life was changed by her work.

So how does it actually work?

PE is built on a straightforward idea: avoidance keeps trauma alive. When we avoid reminders of what happened — whether those are places, people, memories, or feelings — we never get the chance to learn that those things are no longer dangerous. The fear stays frozen in time.

PE involves two core components. The first is imaginal exposure, where you recount the traumatic memory aloud in a safe therapeutic setting, repeatedly, until the memory loses its overwhelming emotional charge. The second is in vivo exposure, where you gradually re-engage with real-world situations you've been avoiding — not dangerous situations, but safe ones that trauma has made feel threatening.

What PE is not

PE is not about "reliving" your trauma for the sake of it. It's not about being re-traumatized. It's a structured, guided process where your therapist helps you approach difficult material at a pace that's manageable. You're always in control.

It's also not a quick fix. PE typically involves 8 to 15 sessions, and the work between sessions matters. But the research consistently shows that people who engage in PE experience meaningful, lasting reduction in PTSD symptoms — including people with complex trauma histories.

Who is PE right for?

PE has been used successfully with survivors of sexual assault, combat veterans, survivors of childhood abuse, accident survivors, and people who've experienced domestic violence. It works across ages, genders, and cultural backgrounds. In 2007, the Department of Veterans Affairs adopted PE as a first-line treatment for PTSD — a testament to the strength of the evidence behind it.

My own published research with Dr. Foa examined trauma exposure and PTSD rates in Philadelphia's community mental health system, and found that the need for evidence-based trauma treatment far exceeds what most people realize.

If you've been struggling with nightmares, flashbacks, hypervigilance, or emotional numbness — and if avoidance has become your primary coping strategy — PE may be worth exploring.

The hardest part is starting

Most people who seek trauma therapy have been living with their symptoms for years. The idea of talking about what happened can feel impossible. That's completely understandable. A good therapist will never push you faster than you're ready to go.

How I work with trauma

Intensive PE protocol is demanding — for both client and therapist — and delivering it well requires a clinical infrastructure that goes beyond what a solo practice can provide. I take that standard seriously because I helped build it.

In my practice, I provide evidence-based trauma therapy grounded in CBT, exposure principles, and emotional processing theory — the same body of knowledge that underpins PE. For clients who would benefit from the full intensive PE protocol, I offer thorough assessment and direct referrals to specialized providers, including colleagues at the University of Pennsylvania's Center for the Treatment and Study of Anxiety — the center Dr. Foa founded.

If you're curious about what approach might be right for you, a consultation is a good first step. You don't need to have the right words — just reaching out is enough.

You wake up exhausted. Not the kind of tired that sleep fixes — the kind that sits in your bones. You go through the motions: care for the kids, check on your aging parent, show up for work, hold it together for everyone who needs you. And at the end of the day, there's nothing left.

This is caregiver burnout. And it's not a weakness — it's what happens when a deeply caring person gives more than they have, for longer than anyone should.

What caregiver burnout actually looks like

Burnout doesn't always look dramatic. Sometimes it shows up as irritability that surprises you — snapping at someone you love over something small. Sometimes it's a creeping numbness, a feeling of going through the motions without being present. Sometimes it's resentment toward the very people you're caring for, followed immediately by guilt for feeling that way.

Other signs include difficulty sleeping even when you're exhausted, withdrawing from friends and activities you used to enjoy, feeling like nothing you do is ever enough, and physical symptoms like headaches, muscle tension, or getting sick more often than usual.

Why caregivers resist getting help

If you're a caregiver, chances are you've internalized a belief that your needs come last. You might tell yourself that other people have it worse. That you should be able to handle this. That taking time for yourself is selfish.

These beliefs are understandable — they often come from a lifetime of being the responsible one, the strong one, the person others turn to. But they're also the beliefs that keep you stuck.

Here's the truth: you cannot pour from an empty cup, and that's not a motivational poster — it's a clinical reality. Chronic stress without recovery leads to emotional depletion, compassion fatigue, and eventually, a breakdown in your ability to care for anyone, including yourself.

What therapy for burnout looks like

Therapy for caregiver burnout isn't about adding one more thing to your list. It's about creating a space — maybe the only space in your life — where someone is focused entirely on you.

In therapy, we work on identifying the patterns that got you here. We challenge the beliefs that tell you your needs don't matter. We build practical strategies for setting boundaries, asking for help, and reconnecting with the parts of yourself that got lost in the caregiving.

Cognitive Behavioral Therapy can help you recognize and restructure the thought patterns that keep you trapped in the cycle of over-giving. A trauma-informed approach can address any underlying experiences that shaped your relationship with caregiving in the first place.

You don't need to earn the right to get help

If any of this resonates, I want you to know something: you don't need to be in crisis to deserve support. You don't need to justify it. You just need to reach out.

A brief consultation — 15 minutes, no pressure — is a good first step. It's a chance to talk about what's going on and see if therapy feels like the right next move.

When people first consider therapy, one of the first questions is usually: "Does my insurance cover this?" It's a reasonable question. Therapy is a financial commitment, and insurance exists to help with healthcare costs.

But there's something most people don't realize about how insurance works with mental health care — and understanding it can change how you think about the investment.

What insurance requires

To use insurance for therapy, your therapist has to give you a mental health diagnosis. That diagnosis goes on your permanent medical record. Insurance companies then dictate how many sessions you're approved for, what kind of treatment is covered, and when you need to stop.

Your therapist also has to submit notes and treatment plans to the insurance company, which means a third party has access to details about your care. For many people, that level of outside involvement doesn't feel compatible with the kind of open, private space therapy is supposed to be.

What private pay offers

Private pay — also called out-of-pocket or self-pay — means you pay your therapist directly. There's no diagnosis requirement, no session limits, and no insurance company reviewing your treatment.

This creates several meaningful advantages. Your therapist can tailor your treatment entirely to your needs, not to what an insurance company will approve. There are no arbitrary limits on how many sessions you can have. Your therapy stays completely private — no diagnosis on your record, no notes sent to a third party. And you have the freedom to choose the therapist who's the best fit for you, not just whoever is in your network.

The cost question

Private pay therapy in Pennsylvania typically ranges from $125 to $200+ per session for a licensed therapist. That's real money, and it's worth being honest about that. But consider what you're getting: an hour each week with a highly trained professional, focused entirely on helping you live a better life.

The superbill option

Even with private pay, you may be able to get partial reimbursement from your insurance company. Many therapists provide what's called a superbill — a detailed receipt you can submit to your insurer for out-of-network reimbursement. Depending on your plan, you may get back 40-80% of the session cost.

It's worth calling your insurance company and asking about your out-of-network mental health benefits before ruling out private pay. Under the No Surprises Act, you also have the right to receive a Good Faith Estimate of costs before starting treatment.

The bottom line

Insurance-based therapy works well for some people. But if you value privacy, flexibility, and a therapeutic relationship that isn't shaped by a corporation's coverage policies, private pay is worth serious consideration.

The best way to figure out what's right for you is to talk to a therapist directly. A brief phone or video consultation can help you understand your options and decide what feels right.

On March 24, 2026, the field of psychology lost one of its most important figures. Dr. Edna Foa, the founder of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, died in Philadelphia at age 88. She was, quite simply, the person who made effective treatment for PTSD possible.

I'm writing this not just as a clinician who uses her methods, but as someone who had the privilege of working alongside her. Early in my career, while counseling survivors of sexual violence at WOAR (Philadelphia Center Against Sexual Violence), I served as a coordinating therapist in a Prolonged Exposure Therapy study at the University of Pennsylvania — Dr. Foa's study. That experience changed the trajectory of my career and fundamentally shaped the therapist I became.

What she changed

Before Dr. Foa's work, the prevailing approach to treating trauma was cautious and indirect. Many clinicians believed that asking patients to confront their traumatic memories directly would make things worse. The dominant methods moved slowly, often too slowly, and many people with severe PTSD never got meaningfully better.

Dr. Foa challenged that assumption. She developed Prolonged Exposure (PE) therapy, a structured treatment that asks patients to face their traumatic memories rather than avoid them — not recklessly, but systematically, in a safe therapeutic environment. The idea was that avoidance was the engine keeping PTSD alive, and that confronting what happened, with support, was the path through.

The results were striking. Study after study showed that PE significantly reduced PTSD symptoms in the majority of patients who completed it. By 2007, the Department of Veterans Affairs adopted PE as a first-line treatment, training over a thousand therapists nationwide. In 2010, Time magazine named Dr. Foa one of the 100 most influential people in the world.

What she taught me

Working in Dr. Foa's research environment taught me things I couldn't have learned from a textbook. Three lessons stand out.

The first was trust the evidence. Dr. Foa didn't just believe her treatment worked — she tested it rigorously, published the results, and invited scrutiny. She insisted that the treatments we offer to vulnerable people should be backed by the strongest possible evidence, not just clinical intuition. That commitment shaped my entire career, from my clinical work to the decade I spent directing evidence-based practice initiatives for Philadelphia's public behavioral health system.

The second was people are more resilient than we think. One of the most counterintuitive aspects of PE is that it asks patients to approach what they've been desperately avoiding. Many clinicians resist this — they worry about causing harm. Dr. Foa's work showed, over and over, that people can face extraordinarily difficult material and come through it stronger. That belief in people's capacity to heal is something I carry into every session.

The third was access matters. Dr. Foa didn't develop her treatment just for university settings. She fought to make PE available in community mental health, in VA hospitals, in under-resourced systems where the need was greatest. My own published research with Dr. Foa examined PTSD rates in Philadelphia's community mental health system, and what we found was sobering: the rate of potential PTSD among people in community mental health was roughly seven times the national average. The need for effective, accessible treatment is enormous — and it drove much of the work I did in the years that followed.

Her legacy in my practice

Today, when I sit with a client who has been carrying trauma for years — someone who has been avoiding, numbing, pushing through — I hear Dr. Foa's voice in the back of my mind. Not literally, but in the approach. The conviction that avoidance is not protection. The trust in the evidence. The belief that this person, sitting across from me, has the strength to face what happened and come out the other side.

That's what I offer my clients at Restore Resilience: treatment that is grounded in research, shaped by mentorship from one of the field's great minds, and delivered with the belief that healing is possible — even when it doesn't feel that way yet.

Dr. Foa was 88. She was still training therapists and conducting research in the weeks before she died. Her work will continue to save lives for generations. I am grateful to have been, in a small way, part of her story.

Resources

If you're interested in learning more about Prolonged Exposure Therapy and Dr. Foa's work:

• Center for the Treatment and Study of Anxiety, University of Pennsylvania
• APA Clinical Practice Guideline: Prolonged Exposure
• National Center for PTSD: About Prolonged Exposure
• NIMH: Post-Traumatic Stress Disorder