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Brief eclectic psychotherapy for PTSD

Life is full of ups and downs or “bumps in the road” – obstacles of varying degrees that we all strive to overcome.  However, life isn’t always fair and some individuals experience intensely painful, life-altering events in addition to the normal bumps in the road that everyone experiences.  These traumatizing events come in many forms such as a life-threatening accident or natural disaster, physical or sexual abuse, combat, rape or another form of violent assault, or witnessing the violent death of a loved one.

While some people do recover from trauma without the need for professional help, many aren’t so fortunate.  Unresolved trauma can result in the development of posttraumatic stress disorder (PTSD).  The challenging symptoms of this often complex psychiatric condition cause significant distress.  In severe cases they can be completely debilitating.

Millions of people in the U.S. suffer from PTSD. Without effective treatment their odds of truly overcoming it are slim.  Although time is often said to heal all wounds, time often does little in the way of healing PTSD.  Symptoms can and often do last for years, decades, and even a lifetime.  Not only does PTSD have a tremendous negative effect on those who experienced the trauma, it also adversely impacts the lives of those closest to them – spouses, children, family members, and even close friends.

Fortunately, PTSD can be treated effectively and the deep, persistent wounds of unresolved trauma can be healed.  One of the most effective treatments for PTSD is a form of psychotherapy known as Brief Eclectic Psychotherapy for PTSD, or BEPP for short.  Originally developed in the Netherlands back in the 1980s and 1990s, BEPP is a unique but powerful trauma-focused therapy. It has helped countless individuals finally resolve the lingering impact of whatever trauma touched their lives.

Symptoms of PTSD

In order to understand the components of BEPP and why it’s so effective, a brief review of the symptoms of PTSD may be helpful.

Individuals diagnosed with PTSD experience a variety of symptoms from each of the following four categories:

  • Re-experiencing or reliving the trauma symptoms – This category includes things like vivid dreams and nightmares, flashbacks, intrusive memories, and significant distress when reminded of the traumatic event.
  • Avoidance symptoms – This category includes attempts to avoid people, places, and activities associated with the event or that trigger memories of the event, and / or attempts to avoid thinking about it or experiencing painful feelings related to it.
  • Cognitive and mood symptoms – This category includes having a distorted view of oneself, others, or the world, persistent negative feelings, feelings detached from others, loss of interest in things that were once enjoyed, a persistent negative mood, or being unable to remember key aspects of the trauma.
  • Arousal and reactivity symptoms – This category of symptoms may include feeling constantly “on guard” from danger, insomnia and other sleep problems, self-destructive behavior, and anger outbursts.

(It should be noted that the symptoms listed above in each category don’t include every potential symptom of PTSD.)

One of the main goals of BEPP is help therapy clients reach a place where they’re no longer experiencing any symptoms of PTSD.

What is BEPP?

Brief eclectic psychotherapy for PTSD was originally created to treat police officers suffering from symptoms of PTSD.  It’s currently used to treat adults with PTSD that stems from all types of trauma.  It’s an evidence-based treatment with a clearly structured protocol that therapists use as a guide to help their clients through the healing process.

Brief eclectic psychotherapy for PTSD is a highly effective treatment.  Research has found it to be at least as effective as other popular trauma-focused therapies, such as EMDR (eye movement desensitization and reprocessing) and trauma-focused cognitive behavioral therapy.  However, one of the advantages and unique elements of BEPP is that it’s a very comprehensive approach to treatment.

As the name clearly suggests, BEPP is designed to be a relatively short-term treatment.  The standard protocol consists of just 16 weekly sessions, although some therapy clients may need a few additional sessions in some cases.  Each session has a specific purpose that follows a natural progression.

The eclectic nature of BEPP stems from the fact that it combines elements of several different types of psychotherapy, including hypnotherapy, psychodynamic psychotherapy, cognitive behavioral therapy, and directive therapy.  These elements are used in a specific order that ensures a natural flow and maximizes the effectiveness of treatment.

BEPP therapists are licensed psychologists or psychiatrists who’ve received proper training and supervision.  Therapy clients are adults who have been properly assessed and diagnosed with PTSD, and who don’t have any contraindications for this particular treatment.

Goals of BEPP

Brief eclectic psychotherapy for PTSD is designed to accomplish four things:

  • Eliminate the client’s PTSD symptoms
  • Have the client experience every emotion associated with the trauma (emotions that aren’t experienced and addressed will continue to cause problems)
  • Help the client find meaning in the trauma, understand how it has impacted the way the client looks at the world, others, and his or her self
  • Help the client trust again, based on these new perceptions

How BEPP Works

The effectiveness of BEPP is based largely on the way the sessions are carefully structured, the specific techniques used, and the way in which they flow.  The overlapping is due to the fact that more than one activity often occurs within the same session.

  • Session 1: Psychoeducation (with a spouse, partner, or close friend present)
  • Sessions 2 – 6: Imaginal exposure (relaxation exercises are always done first to prepare the client for the exposure process)
  • Sessions 3 – 6: Letter writing
  • Session 7: Intermediate progress assessment (at the halfway point)
  • Sessions 7 – 15: Meaning and integration
  • Sessions 13 – 16: Farewell ritual and end of treatment

Following is a closer look at each of these components of the therapy process.

Psychoeducation

The first session in BEPP is focused on psychoeducation.  Your and your partner (or spouse, loved one, or close, supportive friend) learn about the nature of PTSD, how it’s triggered by trauma, and how your troubling symptoms are directly related to it.  The treatment process will also be reviewed in some detail.  During this session you’ll also briefly talk about the trauma you experienced.

This psychoeducation session serves several purposes:

  • It requires the therapist to review PTSD and the effects of trauma with you and your partner, rather than assume that you already have that knowledge
  • It shows you that the therapist has understands trauma, which helps you trust that he or she knows what they’re doing (trust can be very difficult for someone with PTSD, as trauma often significantly damages trust)
  • It helps you understand that you are not your symptoms; that PTSD is a disorder and not an indicator of a character flaw or weakness on your part
  • Knowing how the process works and what’s ahead removes the “mystery” that often accompanies less structured types of therapy
  • It shows you that the therapist can handle the awful details of what you’ve been through

Every future session will begin with a quick review of the last session, a discussion regarding your current symptoms (are they getting better, getting worse, any new symptoms, etc.), and an overview of what will happen (and why) in the current session.

Imaginal Exposure

Imaginal exposure (also called “imaginary exposure”) plays an important role in BEPP.  As the name suggests, imaginal exposure involves reliving or re-experiencing by picturing or imagining it in your mind.  Since this process elicits strong emotions, the therapist will have you do a relaxation exercise, such as progressive muscle relaxation, prior to starting.

The therapist will ask you to close your eyes and start talking about the trauma in vivid detail, as if you were experiencing it in the present moment.  This can be difficult for many people at first, because reliving the trauma is the last thing someone with PTSD wants to do.  However, most discover that it’s a very beneficial part of treatment.

If you’re having difficulty recalling aspects of the trauma or reliving it in your mind, bringing a memento – e.g. a piece of clothing you were wearing or a photo related to the event – can be helpful.  The therapist will guide you through the exposure process and help you identify and express the painful memories and feelings it triggers.

The goal of imaginal exposure is to eliminate the powerful emotions associated with the trauma.  Initially, you’ll likely experience sadness, grief, anger, intense anxiety, and even shame or guilt.  These emotions will gradually fade, and when the intensity is gone this part of therapy is complete.

The imaginal exposure part of BEPP typically requires about five sessions. Within each session, the exposure process usually takes 15 to 20 minutes.

Letter Writing

You may have had a time in your life (unrelated to the trauma) when you were really upset or angry at someone and wrote all your feelings out in a letter to the person – even though you had no intention of sending it. In BEPP, the therapist will have you start a letter as a homework assignment to work on between sessions.  The letter is to be written to whoever you blame for the trauma or its aftermath (e.g. the army, government, or enemy if you were in combat, the person who assaulted you, or the mechanic who failed to properly fix the brakes on your car, resulting in a near-fatal accident).

The letter – which should be hand-written- allows you to express all the anger, rage, hate, sadness, sorrow, etc. that you’re feeling as a result of the trauma.  You won’t be sending the letter so don’t worry about mistakes or editing your words; use it to say exactly what you feel – no matter how ugly.  Since trauma sometimes involves the loss of a loved one, the letter can also be used to express your grief and say goodbye.

The letter writing will be an ongoing process, something you’ll work on for a half hour or so each day.  The letter gives you the satisfaction or speaking your mind, while also helping you regain some degree of self-respect and a sense of power.  It will help you express and experience emotions that may have been pent-up ever since the traumatic event – ones that had been too frightening or painful to express before.

During this part of therapy, you’ll bring the letter to each session to read and discuss portions of it with your therapist.  Once all the rage and anger have been expressed, this part of therapy is complete.

Intermediate evaluation

Now that you’re approximately halfway through therapy, the therapist will have you and your partner come in together to discuss your progress.  This will include any change or improvement in symptoms, as well as any concerns you have (or your partner has), and the issues with which you’re still struggling.  This assessment gives the therapist valuable information, and he or she will make adjustments to your treatment if needed.   1961

Meaning and Integration

One of the primary goals in BEPP is to help people make meaning out of the trauma they’ve experienced.  Although PTSD symptoms can be resolved and healing can take place with treatment, the life-changing effect of trauma can’t be reversed.  BEPP addresses this important issue in a way that other therapies tend to miss.  It’s designed to help you acknowledge, process, and accept that your life will never be the same as it was prior to the trauma.

This unique part of BEPP is known as the “domain of meaning”.  It involves working through this realization that the trauma has forever changed you.  You’ll discuss how you’ve changed and how it’s impacted your attitude, expectations, and ability to trust.  You’ll also discuss what you’ve learned and how you look at yourself and the world differently.   You’ll learn how to integrate this new meaning into your life.  This part of treatment can be difficult.  It’s also less structured than other parts and usually takes several sessions.

Farewell Ritual

As therapy nears the end the farewell ritual begins.  The closure this part of treatment provides is also a very important part of treatment.  The farewell ritual should include your partner (or whoever came with you for the initial session and intermediate evaluation).  It may also include your children.  The farewell ritual stems from the work of Dr. Onno Van der Hart, a psychologist and psychotraumatologist from the Netherlands who has studied farewell rituals.

The farewell ritual acknowledges the fact that, although trauma has played a major role in your life for some time (perhaps even a very long time), that painful time is finally over.  It can now be left in the past.  You and your partner will bid it goodbye in with a ritual that is meaningful to you.  For example, you may choose to burn mementos of the trauma.  This, or some other similar ritual, represents letting go of the trauma and the negative impact it had on your life. The ritual isn’t just to say goodbye.  It’s also a way of welcoming and celebrating the happier future that lies ahead.

The farewell ritual also provides an opportunity to reflect upon what you’ve learned in therapy and celebrating the fact that you’ve come to the end of your treatment.  When we mourn and remember the loss of a loved one with a funeral or memorial service, we also acknowledge that life goes on.

Before therapy is officially terminated, the therapist will need to make sure that there are no lingering PTSD symptoms.  This is often done with a checklist or similar diagnostic tool.  If symptoms haven’t sufficiently diminished, one or more aspects of treatment may need to be repeated.  Most therapists will also meet with you for a follow-up session several months (6 months is typical) after treatment has ended.  This is to make sure that the positive results of treatment are still intact.

Finding a Qualified BEPP Therapist

If you are interested in working with a psychologist or psychiatrist who offers BEPP, you may have to do a little digging to locate one in your area.  Probably one of the best ways is to search for a trauma or PTSD therapist in your city.  (A search for “brief eclectic psychotherapy” will often bring up many “eclectic therapists”, which usually isn’t the same thing.)  Most psychologists and psychiatrists who specialize in trauma treatment should be familiar with this particular approach.  If they don’t offer it, they may be able to suggest someone they know who does.

Trauma is one of the worst things you can experience in life.  However, in spite of the tremendous pain it causes, it can also be an opportunity for growth.  Seeing it in that light is often very difficult, but BEPP can help you heal from and find meaning in the trauma that you never thought possible.

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