PTSD and Trauma Treatment in Manhattan

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If you are in crisis right now: call or text 988 (Suicide and Crisis Lifeline) or go to your nearest emergency department. This page describes outpatient treatment, and outpatient treatment starts after you're safe.

An estimated 3.6% of US adults had PTSD in the past year, based on National Comorbidity Survey Replication data collected 2001–2003, with rates higher in women (5.2%) than men (1.8%); lifetime prevalence was 6.8%. Most people exposed to trauma never develop PTSD, and most who do develop it can expect meaningful improvement with treatments that have been tested repeatedly.

This page covers what PTSD is, how I evaluate it, which treatments the evidence supports and how strongly, what makes trauma treatment fail, and what care costs at this practice.

What PTSD is

Four symptom clusters following exposure to actual or threatened death, serious injury, or sexual violence — experienced directly, witnessed, learned about happening to someone close, or through repeated exposure to aversive details, which is why first responders and certain professions carry elevated rates.

• Intrusion — memories, nightmares, flashbacks, intense reactivity to reminders
• Avoidance — of memories, thoughts, feelings, or external reminders
• Negative alterations in cognition and mood — persistent negative beliefs, distorted blame, detachment, inability to feel positive emotion
• Alterations in arousal — irritability, recklessness, hypervigilance, startle, concentration and sleep problems

At least one month. Symptoms in the first month are acute stress disorder, which frequently resolves without treatment.

Complex PTSD

ICD-11 recognizes complex PTSD: the core PTSD features plus persistent difficulties in emotion regulation, a damaged self-concept, and difficulty sustaining relationships. It typically follows prolonged or repeated trauma, often developmental: chronic abuse, neglect, captivity.

This matters practically. Complex PTSD needs a longer stabilization phase before trauma processing begins, and starting exposure work too early destabilizes people. It is also frequently misdiagnosed as borderline personality disorder, which changes how someone is treated by every clinician who reads the chart afterward.

What gets missed

• ADHD — hypervigilance and concentration failure read as inattention. They co-occur often.
• Depression — comorbid in roughly half of PTSD cases.
• Panic disorder — trauma-triggered panic attacks misread as primary panic.
• Substance use — alcohol and cannabis are extremely common self-medication for hyperarousal and nightmares, and they work in the short term. See addiction.
• Traumatic brain injury — frequently co-occurs with the events that cause PTSD and produces overlapping symptoms.

How I evaluate PTSD

The initial evaluation runs 60 to 90 minutes, and it does not require you to narrate the trauma in detail. I need to know what kind of event occurred and when; the details can wait until treatment, and in some treatments they're never required at length.

What the evaluation covers:

• The four symptom clusters, systematically, including the ones people don't volunteer: emotional numbing, detachment, and the recklessness that belongs to the arousal cluster.
• Dissociation. Depersonalization, derealization, and lost time change both the diagnosis and the treatment sequence, so I screen for them directly.
• The comorbidity map: depression, panic, substance use, ADHD, and prior psychiatric history that predates the trauma.
• Sleep and nightmares, in their own right, since they respond to specific interventions and drive much of the daytime symptom load.
• Safety, asked about plainly.
• Timeline and function: single-incident versus prolonged or developmental trauma, which determines whether stabilization work comes before processing.

You leave with a diagnosis, a treatment sequence, and an honest statement of what I can treat here and what belongs elsewhere.

Treatment

Trauma-focused psychotherapy is first-line. The 2023 VA/DoD Clinical Practice Guideline, which reviewed the evidence for each therapy individually rather than as a class, recommends three:

• EMDR — I provide this directly. Less verbal narration of the trauma required, which some people strongly prefer. Its efficacy is established across guidelines; its mechanism, specifically what the eye movements contribute beyond the exposure and reprocessing core, remains contested in the research literature. I treat that honestly with patients: the outcome data support the treatment, and the mechanism debate doesn't change them.
• Prolonged exposure (PE) — repeated imaginal and in-vivo exposure.
• Cognitive processing therapy (CPT) — targets the beliefs formed at the time of the trauma.

Head-to-head, they perform comparably. Choice comes down to fit, tolerance, and availability. The same 2023 guideline recommends psychotherapy over medication as the first choice, based on larger and more durable improvement, which is worth knowing if you've only ever been offered a prescription.

Medication. Sertraline and paroxetine are the two FDA-approved medications for PTSD; venlafaxine carries a recommendation in the 2023 VA/DoD guideline alongside them. Response takes 8–12 weeks, longer than in depression, which is a common source of premature discontinuation. Medication makes sense when trauma-focused therapy isn't available or tolerable yet, when depression rides along, or as a deliberate combination.

Prazosin for nightmares. Widely used, with genuinely mixed evidence. The largest trial, run across 13 VA medical centers in veterans with chronic PTSD, found prazosin no better than placebo for distressing dreams or sleep quality over 26 weeks (Raskind et al., New England Journal of Medicine, 2018), while earlier smaller trials were positive. My read: worth a time-limited trial in the right patient, worth stopping if it doesn't earn its place.

Benzodiazepines are contraindicated. They are associated with worse PTSD outcomes, they interfere with the extinction learning that trauma-focused therapy depends on, and this population carries elevated substance use risk. If you're on a standing benzodiazepine for PTSD, that's worth revisiting. See second opinions.

Stabilization before processing

The most common way trauma treatment goes wrong is processing too early. Someone arrives in acute distress, the clinician begins exposure work, and the person destabilizes and drops out having concluded that treatment made things worse.

It did. The failure was in the sequencing rather than in the treatment itself. Stabilization — sleep, substance use, safety, distress tolerance skills — comes first, and with complex trauma it can legitimately take months. DBT skills are useful here.

What treatment can look like: a composite example

This is a composite drawn from multiple patients, with identifying details changed. It is illustrative, and no outcome is guaranteed.

A man in his early forties is assaulted on his block walking home. Eight months later he's rerouting his commute to avoid the corner, sleeping four broken hours with recurring nightmares, scanning every restaurant for exits, and drinking three or four beers nightly to get to sleep. His internist offered a benzodiazepine; he came for a second opinion instead.

The evaluation confirms PTSD with prominent nightmares and early-stage alcohol self-medication. We sequence it: sleep and alcohol first, because processing work fails on four hours of sleep and nightly drinking. Sertraline is started and titrated; the drinking contracts to weekends with tracking and a plan. At week six, EMDR begins, and he's clear that not having to narrate the assault repeatedly is what makes it tolerable. Over roughly ten processing sessions the nightmares thin out, then the rerouting drops away because the corner has stopped organizing his day. He keeps the sertraline for now and knows exactly what he'd taper later, and why.

Who this practice fits, and when to go elsewhere

A good fit: adults and adolescents with single-incident or repeated trauma; PTSD tangled with depression, panic, ADHD, or early-stage substance use; nightmare-dominant presentations; people who want EMDR and medication managed together by one clinician; people on a benzodiazepine regimen that deserves a second look.

When another setting is right, I'll say so and help arrange it:

• Complex dissociative presentations. Dissociative identity disorder and severe dissociative symptoms need a clinician who specializes in that work and a longer treatment frame than this practice provides. I refer to those specialists.
• Active substance withdrawal. Medically supervised withdrawal management comes first; trauma processing on an unstable withdrawal course does harm.
• Acute safety crises. Active suicidality or acute destabilization belongs in emergency or intensive settings: 988, an emergency department, or a higher level of care. Outpatient trauma work resumes afterward.

Cost and how to start

The practice is out-of-network with all insurers. You pay directly and receive a superbill, an itemized receipt with the codes your insurer needs, to submit for reimbursement. Many PPO plans reimburse a portion of out-of-network psychiatric care once the deductible is met, so it's worth checking your out-of-network benefits before the first visit; the full fee structure is on the fees and insurance page.

The initial evaluation runs 60 to 90 minutes and ends with a diagnosis and a sequenced plan: stabilization if it's needed, then trauma-focused treatment, with medication where it earns its place. PTSD responds to specific treatment, and the next step is scheduling the evaluation: schedule a consultation.

Related

EMDR · Anxiety · Depression · DBT · Addiction · Medication management

Frequently Asked Questions

What is the best treatment for PTSD?

Trauma-focused psychotherapy — EMDR, prolonged exposure, or cognitive processing therapy. All three carry strong guideline support and perform comparably head-to-head. Medication, principally sertraline or paroxetine, is effective and often combined.

Do I need to talk about what happened in detail?

Not necessarily. Prolonged exposure involves detailed narration; EMDR requires substantially less. If detailed retelling is a barrier, EMDR is often the better starting point.

Are benzodiazepines used for PTSD?

They shouldn't be. Benzodiazepines are associated with worse PTSD outcomes and interfere with the extinction learning trauma-focused therapy depends on. A standing benzodiazepine prescription for PTSD is worth reviewing.

What is complex PTSD?

An ICD-11 diagnosis involving core PTSD symptoms plus persistent difficulties with emotion regulation, self-concept, and relationships, typically following prolonged or repeated trauma. It requires a longer stabilization phase and is frequently misdiagnosed as borderline personality disorder.

How long does PTSD treatment take?

Session counts differ by protocol. For single-incident trauma, EMDR commonly runs 6 to 12 sessions, prolonged exposure 8 to 15, and cognitive processing therapy 12. Complex or developmental trauma takes considerably longer in every protocol, with much of that time spent on stabilization before processing begins.

Can PTSD develop years after the event?

Yes. Delayed-onset PTSD, where full criteria are met at least six months after the trauma, is recognized. Symptoms also commonly re-emerge after a period of remission when triggered by a later stressor.

Is EMDR as effective as prolonged exposure?

The 2023 VA/DoD guideline recommends EMDR, prolonged exposure, and cognitive processing therapy as first-line treatments, and head-to-head they perform comparably. EMDR's efficacy is established while its mechanism, specifically what the eye movements add, remains contested. The outcome evidence supports the treatment either way, so the choice comes down to fit, including how much detailed retelling you can tolerate.

What should I do in a mental health crisis?

Call or text 988, the Suicide and Crisis Lifeline, or go to your nearest emergency department. This is an outpatient office and can't provide emergency response. Once the crisis has stabilized, outpatient trauma treatment can begin or resume.