The handsome man on the videotape was reliving a very bad memory, and he was doing it amazingly well. His eyes were closed. He was speaking in present tense. His voice was shaking, and he was sniffling. His whole body looked wired.
He wanted to cure his post-traumatic stress disorder (PTSD), and he was doing exactly what his new therapist had told him to do. He was mentally putting himself back in the night that most terrified him, one that had haunted him with flashbacks and nightmares for nine years.
His ex-boyfriend had been testy all night, so weirdly edgy that the patient was frightened and wanted to leave. But he didn't. The argument started again. His ex began yelling .
"He grabs two glasses and breaks them," the patient said. "He's screaming and calling me all kinds of things. The next thing I know I'm bleeding. . . . I see all this blood coming out of my neck."
Edna Foa, one of the world's experts on treating PTSD, watched intently with 12 of her staff members at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania.
This meeting, held weekly, was less about the patients than about ensuring that therapists were making the most of the treatment Foa developed: prolonged exposure. It has earned her international acclaim and made her a sought-after speaker as the nation's long involvement in Afghanistan and Iraq has produced a new generation of emotionally wounded soldiers. But prolonged exposure is emotionally demanding for both patients and therapists. Foa, an intense woman who rarely sees patients now herself, takes this supervision meeting very seriously.
She already had chided one therapist for being too skeptical with a difficult patient and confirmed another's suspicions that her patient's real problem was obsessive-compulsive disorder, not PTSD. Now Foa, a fan of positive reinforcement, suggested more praise for the slashing victim.
"You probably could say once, 'You're doing great,' " Foa told Carmen McLean, a relatively new staffer.
Other therapists jumped in to gush about the patient. He had had the strength to tell his story to McLean several times in their first "imaginal" session, during which he tried to reexperience the trauma. The theory is that this repeated exposure would make the attack lose its power to frighten, much as repeated viewing makes a terrifying movie grow dull.
McLean restarted the tape. "He has some gems in processing I want you guys to hear," she said. Processing was next. Foa thinks it's not enough to reactivate a bad memory. You need to change how you think about it.
"I think what I got from it was there was nothing I could have done different," the patient said. "He's the bad person, not me."
"My reaction would be, 'Good for you,' " Foa said.
"I think this guy in five sessions will say goodbye."
In the vanguard, on the go
Promptly at 4 p.m., the meeting disbanded, and Foa rushed to another with Philadelphia officials to discuss teaching her protocols to employees of nine city agencies. The next week, she and her staff would teach therapists from around the country.
"She's the premier expert in the field," said one of them, Cindy Haines of East Brunswick, N.J. "We studied her at school. She's Edna Foa. She's it, and there's everybody else."
Foa is a rare fusion of scientist, therapist, and teacher. She was among the first women to rise to the top ranks of research in psychology, and she did it, for a while, as a divorced mother raising three children. She was at the forefront of scientifically developing and testing mental-health treatments, and is much respected for honing effective counseling regimens. The Institute of Medicine has deemed exposure the only treatment for PTSD proven to work.
Foa has received awards from the American Psychological Association in recognition of both her scientific and clinical work. She helped shape the definitions of obsessive-compulsive disorder (OCD) and post-traumatic stress disorder in the DSM-IV, the bible of psychological maladies. She has systematically taught her methods to counselors who work with soldiers in Israel as well as to therapists in Veterans Affairs and the Army.
Last year, Time magazine called her one of the 100 most influential people in the world.
Yet her step-by-step, science-tested treatment - in contrast to traditional talk therapies that leave more room for creativity and meandering conversation - remains a tough sell in many mental-health quarters. She is devoting much of her life now to spreading her approach to worry gone wild.
The week after her center's seminar here in October, she flew to Los Angeles to conduct more training, then returned to serve as a trauma expert for lawyers representing people who had been involved in the BP explosion.
In 2009, she was invited to give 28 lectures, many of them in four-day workshops. She was in San Diego and Las Vegas in January; Miami and Minneapolis in February; Zurich and Copenhagen in March; Israel in June; San Juan in September; Jerusalem and Paris in October; Atlanta, San Diego, and New York in November; and Istanbul in December.
This for a woman in her 70s. Friends decades younger say they can't keep up with her. Tales abound of her formidable ability to combine hard work and world travel with dinner parties, the opera, art-house movies, museums, and shopping.
Yet she is neither jumpy nor nervous nor constantly in motion. She is engaged, curious, and focused, in what appears to be a calm, comfortable, stable way. The Edna Foa who pours wine at holidays doesn't seem much different from the Edna Foa who leads a seminar or answers questions during an interview.