What Happens in a PRT Session?

Okay, but what do we actually do for 50 minutes?

This is a fair question. Pain Reprocessing Therapy sounds relatively straightforward when I explain it on my website: we work on helping the brain stop interpreting safe sensations as dangerous. Great. But then you book an appointment and realize that still leaves quite a bit unanswered. Are you going to spend 50 minutes meditating? Am I going to make you stare at your pain? Are we going to talk about your childhood? Is there homework? Do you need to show up already convinced that your symptoms are neuroplastic?

No, no, maybe, sometimes, and definitely not.

I went back through some of my actual PRT session transcripts while writing this because I wanted this to describe what a session with me looks like, rather than giving you a generic description of what PRT is supposed to look like on paper. And one thing became very obvious very quickly: my sessions do not all look the same. That is partly because PRT itself includes several different kinds of work, but mostly because the person sitting across from me is not the same person I met with an hour ago. Someone whose biggest problem is fear every time they stand up needs something different from someone who understands the science completely but checks their body forty times a day. Someone who is terrified of a migraine needs something different from someone who has stopped going to restaurants because sitting hurts.

So there isn’t a script that says minute one is pain education, minute twenty is somatic tracking, minute forty-seven is homework.

Thank goodness, because I wouldn’t like working that way.

We usually start with what has actually been happening

Especially after the first session, I generally don’t start with, “Today we’re going to learn about graded exposure.” I start with you.

How was your week? What happened with your symptoms? Was there a moment that surprised you? Did you try something we talked about last time? Did it help? Did it make you more anxious? Did you completely forget to do it? Did you have a wonderful three-day stretch followed by one terrible day that convinced you none of the wonderful days counted?

All of that is useful information.

A lot of PRT happens in conversations that, on the surface, don’t look particularly therapeutic. You tell me that you can walk around a grocery store by yourself but feel nervous taking your kids to the zoo, even though the amount of walking is similar. We slow down there. Interesting. So maybe walking itself isn’t the entire problem. What feels different at the zoo? What is your brain anticipating? In one actual session, that difference led us into a conversation about which situations were creating a stronger sense of danger despite requiring similar physical activity. 

Or you tell me that you wake up without noticing pain, think I wonder how my neck feels today, and within seconds the sensations seem to arrive. That is worth looking at—not because it proves anything from one experience, but because it gives us information about attention, expectation, fear, and the way your particular symptom pattern works. One client described almost exactly that sequence, and we used it to explore how quickly repeated attention and emotional intensity can become part of the symptom loop. 

Those are some of my favorite moments in sessions because we are not trying to force your experience into PRT. We’re letting your own life show us where PRT might fit.

The first session has a little more detective work

The first session is usually different because I need to understand the story before we start changing it.

You’ve already filled out an intake, so I don’t need you to spend 50 minutes reciting your medical history from birth. I will have read it. Instead, I’m usually asking about the parts that stood out to me. When did this symptom begin? What else was happening around that time? What have doctors found? What have they ruled out? Are there activities you can do sometimes but not others? What makes symptoms better or worse? What are you afraid would happen if you ignored the sensation and kept going?

I also want to know how you feel about the whole neuroplastic explanation in the first place.

Some people come in essentially saying, I have read The Way Out twice, listened to twelve podcasts, and I am 95% convinced. Please tell me how to actually do this.

Others are more like, I understand what you’re saying, but I have an MRI and a body that hurts, so I’m going to need a little more here.

Both are welcome.

I don’t think it is useful to pretend away doubt. In fact, sometimes we make an evidence list specifically because the brain keeps returning to the scariest piece of information while conveniently forgetting the other twenty things that point in a different direction. The purpose isn’t to force yourself to believe your symptoms are neuroplastic. It is to look honestly at the evidence on both sides and notice what the full story shows. In sessions, I’ve had clients list structural evidence right alongside things that may point toward a neuroplastic contribution rather than being told they have to choose one explanation before we can work together.

Some of the first session is also education, but I try not to turn it into a college lecture. If you already understand predictive processing, I am not going to spend half the hour explaining it to you because it appears on my imaginary PRT syllabus. If the pain-fear cycle is brand new to you, we’ll spend more time there. If one diagram makes something click, we’ll stay with it. If I explain something and you look at me like I have just started speaking gibberish, I will explain it differently.

The goal is for you to understand what we’re doing well enough that it makes sense—not for me to successfully get through all of my material.

Sometimes we work with a sensation in the session

This is the part people are usually picturing when they hear PRT.

Somatic tracking is one of the core tools I use, and yes, we may do it together during a session. But it is much less dramatic than it sounds. I might ask you to close your eyes if that feels comfortable, notice a sensation that is already present, and describe what it actually feels like. Is it pressure? Burning? Tightness? Pulsing? Is it in one small area or more widespread? Does it stay still? Shift? Intensify? Fade?

Then we practice observing it without immediately jumping to What does this mean? How do I fix it? Is it worse? Is it gone yet?

That last part is harder than it sounds.

I’ve had clients start monitoring whether the pain is decreasing while we’re in the middle of somatic tracking, which is very understandable because obviously they would like it to decrease. Then we work with that. Can we notice the urge to check without turning the whole exercise into a pain-removal test?

I also individualize how I guide these practices. Sometimes we stay with the uncomfortable sensation. Sometimes we shift attention to something pleasant or neutral in the body and let the brain experience that sense of safety more fully. Sometimes an image or metaphor helps. In one session I compared fatigue sensations to falling snow: sometimes a light dusting, sometimes a blizzard, but the work was in changing the way the sensations were being experienced rather than fighting the weather every second it was there. 

And sometimes we don’t do somatic tracking at all.

PRT is much bigger than one exercise.

We might practice the thing your brain has learned to fear

This can be physical, or it can happen entirely in your imagination at first.

If standing up has become scary because your brain expects pain, I may have you imagine yourself standing up and notice what happens inside your body. If eating a particular food has become associated with symptoms, we may talk about a very gradual exposure plan rather than going from avoidance to eating an enormous plate of it while repeating I AM SAFE through clenched teeth. If typing, driving, walking, exercising, bending, sitting, or being in a particular environment has become loaded with danger, we look for ways to begin creating different experiences around that trigger.

The word graded matters here.

I am generally not interested in throwing someone into the deep end to prove that they can swim. There may be times when a bigger exposure makes sense, but often we are looking for something challenging enough to create new learning without making your nervous system feel like we’ve declared war on it.

And we pay attention to what actually happens instead of only what was predicted to happen.

Maybe you expected ten-out-of-ten pain and got a four. Maybe the pain happened, but you weren’t nearly as afraid of it. Maybe you did the activity longer than you thought you could. Maybe the symptom showed up and disappeared much faster than usual. Maybe absolutely nothing changed physically, but you noticed you didn’t spend the next three hours panicking about it.

Those all give us information.

Sometimes the most important thing that happens in a PRT session is not that a symptom disappears. It is that something you’ve been treating like an unquestionable fact suddenly becomes a question.

Wait. Why can I do this here but not there?

Why did that hurt yesterday and not today?

Why did the symptom start before I even moved?

Why did I feel better when I stopped paying attention to it?

Now we have something to work with.

And yes, sometimes we talk about emotions

This part varies a lot from person to person.

PRT includes looking at stress and emotional patterns because the brain’s danger system does not only respond to physical threats. For some people, symptoms are very clearly connected to pressure, conflict, perfectionism, fear, anger, grief, or other emotional experiences. For others, that connection is much less obvious, and we don’t need to go hunting for a traumatic memory because apparently every PRT session is legally required to contain one.

Sometimes emotional work is as simple as noticing, Every time I feel like I’m disappointing someone, my symptoms spike.

Sometimes we work with self-compassion or an inner critic. Sometimes we notice that you spend your entire day overriding what you want and then wonder why your nervous system seems slightly displeased with the arrangement.

And, when appropriate and when a client wants to do this kind of work, I may incorporate techniques from Emotional Awareness and Expression Therapy (EAET) alongside PRT. That can involve going more directly into emotions that have felt unsafe to experience or express. But it isn’t automatically part of every session, and I don’t believe everyone needs to dig through their entire childhood in order to recover from neuroplastic symptoms.

Sometimes we need to work on anger.

Sometimes we need to work on walking around Target without checking your sensation every thirty seconds.

Both can be nervous system work.

You won’t spend the whole session being “worked on”

This is important to me.

Sessions are collaborative. I will teach, point out patterns, guide exercises, challenge things occasionally, and make suggestions, but I also want to know when something doesn’t fit.

Actually, one of the things I say fairly often is some version of: give it a real try, take what helps, and leave what doesn’t.

PRT can become its own weird form of perfectionism if we’re not careful. Am I somatic tracking correctly? Am I reassuring myself enough? Should I be ignoring the pain? Wait, am I ignoring it too much? Was that fear? Was THAT fear?

We have now made recovery another full-time job.

I don’t want that.

Part of our work is usually figuring out which tools actually help your brain experience less danger and which ones make you monitor yourself even more. A tool can be excellent and still not be the right tool for you at this particular moment. We change course.

There is room to laugh in my sessions. There is room to tell me that something sounds weird. There is room to say, “I tried that and hated it.” There is room to have no idea how to answer a question. There is room to spend twenty minutes on something I had absolutely no intention of talking about when the session began because it turns out to be the thing that matters.

That probably describes my coaching style more accurately than any official PRT diagram could.

What happens after the 50 minutes?

I don’t want you to leave a session thinking, Well, that made sense while Amberleigh was saying it, and then forget everything by dinner.

After our sessions, I send you a concise visit summary with the main things I want you to be able to come back to. I generally organize those around Key Insights, Celebrations, and Gentle Experiments—not a transcript of everything we said and not an enormous list of assignments.

The “celebrations” piece matters. Our brains are very good at remembering that Tuesday was awful and strangely bad at remembering that Monday, Wednesday, Thursday, and Friday were noticeably better. So if you did something you had been avoiding, responded to a symptom differently, noticed a new pattern, or had even a small moment where your brain seemed less afraid, I want that recorded somewhere.

And I call the between-session work Gentle Experiments for a reason.

You may practice somatic tracking. Add to an evidence list. Try responding differently when you notice yourself checking. Experiment with a feared movement. Listen to an audio. Notice what was happening immediately before symptoms increased. Practice doing something while allowing the sensation to be there instead of waiting until you feel perfect first.

But I’m not grading it.

There will be no final exam.

So what does a PRT session with me actually feel like?

Probably less clinical than you’re imagining.

We talk. We get curious. I teach you what I think will be useful and skip what you already know. We look closely at the strange things your symptoms do instead of dismissing them as strange. Sometimes I share my screen and show you a diagram. Sometimes you close your eyes and I guide you through a sensation. Sometimes we practice something in real time. Sometimes we realize the thing we thought we were going to work on is not actually the thing that needs our attention that day.

And throughout all of it, I’m trying to help you move from: What if this means I’m in danger? toward: What if my body is safer than my brain currently believes?

You don’t need to arrive at the first session convinced.

You don’t need to be good at somatic tracking.

You don’t need to stop being afraid of your symptoms before we begin.

That’s the work.

If you’re wondering whether Pain Reprocessing Therapy might be a good fit for your chronic pain or other symptoms, I offer a free 15-minute connect call. We can talk about what you’ve been experiencing, whether there are signs that a neuroplastic process may be involved, and what working together could actually look like for you.