If the thought of telling the whole story is what keeps you from contacting a therapist, it helps to know that treatments differ on exactly this point.
This article does not ask you to recall anything. It describes what the main studied treatments ask of a person, mostly in the words of the VA's National Center for PTSD, and what research says about the options.
Does trauma therapy always mean retelling the event?
No. It depends on the treatment. Of the three therapies with the strongest recommendation in the 2023 guideline from the Departments of Veterans Affairs and Defense (VA/DoD), one involves a detailed spoken account, one makes a written account optional, and one asks you to hold the memory in mind without describing it in detail. Another studied therapy does not focus on the event at all.
So a trauma-focused therapy is not always one in which you tell the story aloud. The sections below take each treatment in turn. How their evidence compares is covered in types of trauma therapy and what the research says.
Which treatments involve a detailed account?
Prolonged exposure and written exposure therapy.
Prolonged exposure. The VA answers the question "Will I talk about my trauma?" directly: "Yes, around your 3rd session, you will start talking in detail about your trauma each session. Your provider will guide you through it, keep track of your anxiety level as you talk, and make sure you take things at your own pace." You also listen to a recording of that part of the session at home. The VA describes the risks as "mild to moderate discomfort when engaging in new activities and when talking about trauma-related memories. These feelings are usually brief and people tend to feel better as they keep doing PE."
Written exposure therapy. Here the account is written, not spoken. The VA says: "You will not need to talk about your trauma. You will write in detail about your trauma. Your clinician will read your writing between sessions." It lasts for 5 sessions.
Which treatments work with the memory without a detailed spoken account?
Cognitive processing therapy and EMDR.
Cognitive processing therapy (CPT). The VA describes CPT as a therapy in which you learn ways to evaluate and change upsetting thoughts about the trauma. At the start, it says, "you will not need to go into great detail right away." You write and talk about your thoughts as to why the trauma happened and how it has affected you. Around the third session you have the option, working with your therapist, of writing the story of the trauma in detail. That written account is a choice, not a requirement. A 2008 trial took CPT apart to test this. It randomized 150 women with PTSD after interpersonal violence to full CPT, CPT without the written account, or the written account alone. Women in all three improved substantially, and during treatment the version without the account showed greater improvement in PTSD than the written account alone. It is one trial, in women only.
EMDR. For eye movement desensitization and reprocessing, the VA says: "No, in most cases you will not be asked to talk about the details of your trauma. But you will be asked to think about your trauma in session." You call the memory to mind while paying attention to a back-and-forth movement or sound.
Is there a studied treatment that does not focus on the event?
Yes: present-centered therapy (PCT). The VA describes it this way: "PCT is not a trauma-focused psychotherapy, which means the therapy does not focus on your traumatic event. You will have the opportunity to talk about your trauma in the first session if you want to, but this is not required." Sessions deal with current life problems that may be related to PTSD.
Guidelines rate it differently. VA/DoD suggests PCT, a weak recommendation, one level below the strong recommendation it gives CPT, EMDR and prolonged exposure. The American Psychological Association's 2025 guideline finds insufficient evidence to recommend for or against it. Written exposure therapy has a similar split: VA/DoD suggests it, while the American Psychological Association lists it under insufficient evidence against no treatment and found "no difference in effect" between it and CPT or prolonged exposure, with no recommendation either way.
A 2019 Cochrane review covered 12 studies with 1,837 participants. PCT was more effective than the control conditions in reducing PTSD symptom severity, on moderate-quality evidence from 3 studies with 290 participants. Compared with trauma-focused CBT at the end of treatment, the results did not support the claim that PCT is no worse, although the reviewers wrote that the differences "may attenuate over time." PCT had approximately 14% lower treatment dropout rates. The reviewers caution that all the included studies were primarily designed to test trauma-focused CBT.
One practical limit: the VA says PCT "is not likely to be widely available in the community," and that a therapist who uses elements of a present-centered approach is not offering exactly the same thing.
Why do guidelines still favor working with the memory?
Because that is where the strongest recommendations are. The VA/DoD guideline's "Strong for" rating goes to three trauma-focused therapies, and the American Psychological Association's goes to CPT, prolonged exposure and trauma-focused CBT. The VA also describes the cost of the alternative: "Using avoidance as your main way of coping with traumatic memories can make PTSD symptoms worse and make it harder to move on with your life." It names the fear behind avoidance too: "You may be afraid that if you let yourself feel difficult emotions, they might overwhelm you."
One study speaks to that fear. In 2016, researchers looked at 192 women in two randomized trials of prolonged exposure, CPT and CPT without the written account. A minority, between 14.7% and 28.6% depending on the therapy, had a rise in PTSD symptoms during treatment. They still showed clinically significant improvement by the end, and the rise was not related to leaving treatment. These were women in research trials, and those who had a rise ended with higher symptom scores and were more likely to still have a PTSD diagnosis, both small effects according to the study.
None of this means you must choose a treatment built around a detailed account. It means the choice has trade-offs that are worth talking through with a clinician. If you have thoughts of suicide at any point, call or text 988, or call 911 in an emergency.
What does Dr. Rabin's trauma page say?
Her trauma therapy page answers the question "Will I have to relive the trauma in therapy?" in these words: "No. We move only as fast as feels safe for you, and you always control what we discuss."
Her approach is psychodynamic, attachment-based, trauma-informed and mindfulness-based, guided by safety, pacing and the therapeutic relationship. The work builds trust and stability before approaching painful material.
Two honest points belong here. Psychodynamic therapy has been studied much less for PTSD than the trauma-focused therapies above, and the VA/DoD guideline lists it under insufficient evidence to recommend for or against. And none of the official pages used for this guide describes how much of the trauma is discussed in psychodynamic therapy, so this article relies on her own page for that.
This guide makes no claim about whether she offers prolonged exposure, CPT, EMDR or any other named protocol. You can ask on a free consultation of about 15 minutes, requested through the contact page, whether she offers one or would refer you. What to expect in trauma therapy describes how the work begins.
Keep reading
Sources
- VA National Center for PTSD, Prolonged Exposure (PE) for PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Cognitive Processing Therapy (CPT) for PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Eye Movement Desensitization and Reprocessing (EMDR) for PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Written Exposure Therapy (WET) for PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Present-Centered Therapy for PTSD (last updated September 25, 2026)
- VA National Center for PTSD, Avoidance (last updated September 25, 2026)
- U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
- American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)
- Belsher BE, Beech E, Evatt D et al., Present-centered therapy (PCT) for post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev (2019)
- Larsen SE, Wiltsey Stirman S, Smith BN et al., Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behav Res Ther (2016)
- Resick PA, Galovski TE, Uhlmansiek MO et al., A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. J Consult Clin Psychol (2008)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.
