John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Treatment of Emotional Distress Following Spontaneous Miscarriage

RRP Treatment of Emotional Distress by Dr. Tkach


The experience of miscarriage results in tremendous emotional disturbance for many affected women. Depression, anxiety, grief, guilt, and post-traumatic stress symptoms are commonly experienced reactions. A lack of a grief reaction at the time of the event may lead to later depression. 7% of women experience post traumatic stress symptoms four months after miscarriage.

Commonly women post miscarriage are supported with care and compassion by family and friends. But this may not provide sufficient relief. With time, a woman may incorporate the event into her past and move on to her life and her future with the trauma stored somewhere in the back of her mind.

Caring, loving, compassionate support is very helpful. However, sometimes it is not enough to free a woman to get back to her life. Why is that not enough? Let's get back to that.

In my humble opinion, the worst approach is to tell a woman to keep a stiff upper lip. Another is to tell the woman that she should see her glass as half full instead of half empty. Why don't I like that?

When you lose a pregnancy, it is emotionally traumatic. It brings forth strong uncomfortable, unhappy feelings. Those are your feelings. Those are real feelings. You are justified in having those feelings. It's normal.

If someone says otherwise to you, he/she is implying that you somehow should not have those feelings, that there is something wrong with you to have those feelings. Even worse, there is the implication that you are not worthy of having those uncomfortable feelings. Such messages leave the woman confused and depressed. This, in my opinion, is someone else putting you down. Recognize it for what it is. It is a put down. Do not let anyone put you down.

Now, I realize that the person saying that is probably unaware of the implications, and is just trying to be helpful. But, let's be clear, those are your feelings, they are real, and you are entitled to them. You are important. You do deserve to have your feelings.

Consider this scenario. A woman thinks she is having a normal pregnancy and is making all sorts of plans for the near and distant future. Suddenly, something goes terribly wrong. She is given bad news in the emergency room, and the next thing she knows is she is on a procedure table getting a D&C and suffering from crushed hopes. If you have been through that, of course you deserve to feel unhappy. Of course those uncomfortable feelings may linger. You are entitled to those feelings, and you deserve help.

What is going on when these uncomfortable feelings linger? From the RRP point of view, what has happened is that a part of you is still back there experiencing the events of the miscarriage over and over. It is as tough you were locked in jail and unable to get out. What you and I need to do is to go back there and rescue her. She lost her smile. We need to help her get her smile back.

Miscarriage is a common problem. In 1996, it was felt that 12% to 24% of clinically recognized pregnancies ended in miscarriage within the first 12-13 weeks. A Norwegian study estimated the incidence at 38.6%. If we include those unnoticed miscarriages such as missing a menstrual period, the incidence may be up to 75%. The average age at miscarriage is 28.

Only 59% miscarriages were accompanied by symptoms. 61% of all miscarriages occur in the first 2 weeks of the pregnancy (The 2-Week Rule). It is common for some placenta to remain after the miscarriage. This occurs in 71% of miscarriages. That carries several risks. It may prolong bleeding and lead to serious infection. So, your doctor may want to do a dilatation and curettage after a miscarriage.

Recurrent Miscarriage

After the first miscarriage, the husband and wife are feeling understandably anxious about the experience of the second pregnancy. Recurrence of miscarriage occurs in 1-3% of such couples.

In a Scottish study, the risk of first miscarriage as 4.3%, second miscarriage was 0.5%; three or more was 0.08%. However, after 3 miscarriages, the risk levels off. A history of miscarriage also increases the risk of premature birth.

On the Horizon

A study of management of miscarriage in the Australian and Canadian health care systems concluded that the burden of emotional management for couple experiencing miscarriage falls on midwives since those health care systems have eliminated those services as of the year 2002.

The Case of R.

A 34-year-old lady had a spontaneous miscarriage at 12 weeks in her pregnancy. The fetus had probably died at 10 weeks. She had a D&C done. Normally a happy person, she became unhappy. Her distress worsened over the next three weeks. She became more and more fatigued and had trouble making it through the day.

I asked her to close eyes, to feel the uncomfortable feeling, and to let it carry her back to the first time she had had it. This step, Affect Bridge, carried her back to a traumatic event at age 4. I guided her to rescue that 4-year-old child, to resolve the conflict, to get her smile back, and to reintegrate that ego state into her mainstream personality. In this process, she did not relive the old trauma. She just identified it and resolved it.

Seven months after her first miscarriage, she had another miscarriage. However, she was much better able to cope with it emotionally. A third pregnancy produced a robust, healthy, bright baby boy, and her life changed forever.

How can it be that her symptoms were related to an event at age 4? Symptoms occur when events in the present occur that are reminiscent of traumatic events in the past. It is often a surprise finding those lost memories and the age at which they occurred.

Rapid Reintegration Procedure

Rapid Reintegration Procedure (RRP) is a profound new form of psychotherapy that is gentle, non-threatening, and effective. RRP offers you great hope for relief from symptoms (see symptom list).

RRP is symptom oriented. It runs on feelings. Buried within the symptom is the path to cure of that symptom. What I do is to guide you gently to uncover and resolve troublesome conflicts that arose at those past critical events. It was at that point that a part of you lost your smile. You will know RRP worked when you get your smile back.

Your experience with RRP is likely to be wonderful, profound and very beneficial.

  1. History of RRP

    Canadian medical doctor Edgar Barnett invented RRP in 2003. Dr. Barnett was born and raised in England. He went to Medical School in England. Initially a family doctor, he observed that many problems were not helped by medicines alone because they were also psychological. He has been doing psychotherapy for over 40 years. He has written two books on psychotherapy: 1. ANALYTICAL HYPNOTHERAPY 2. UNLOCK YOUR MIND. His RRP evolved after 40 years of his experiences treating patients with psychological problems. Dr. Barnett started training me in RRP in April 2004. We have written a book about RRP.

  2. What is RRP?

    At first we thought it was a type of hypnosis or "waking hypnosis," and it may very well be. Dr. Barnett thinks it is a special form of hypnosis. For me, the problem with that is that hypnosis traditionally requires a procedure called induction, induction of a hypnotic trance. To you, it will seem like daydreaming.

    The reason traditional psychotherapies sometimes fail is that they require people to reveal their innermost, private, personal, embarrassing, threatening, or frightening secrets and the details of those secrets. There is none of that with RRP. It is okay to tell me personal things, but I won't require it of you.

    The procedure is between you and yourself. I, as therapist, guide you, and I am there with you so you do not need to go through it alone. Where you are about to go in the RRP state, I have been many times. I know the way in. I know the way out. I will be there with you every step of the way.

  3. The Goal of the RRP Therapy Session

    The goal of your Rapid Reintegration Procedure (RRP) session with me is to free you up from some sort of unwanted symptom that pesters you. A symptom can be any one of a large number of problems such as overeating, phobias (fears of specific things), smoking, anxiety, stage fright, test anxiety, nightmares, panic, anorexia, and so on. (See the symptom list at the end.)

    The first step is for you to decide what symptom you want help with. What unwanted behavior or problem do you want to get rid of or get help for? There is a feeling that goes with that symptom. Try to identify what the feeling is that you experience when you have the urge to do the unwanted behavior or experience the symptom.

  4. What Will You Experience In RRP?

    You sit in a chair with your eyes close, and I guide you through recalling feelings and finding old memories. It is very simple, it occurs very easily. It is like daydreaming. If you can daydream, you can do RRP.

    You do not need to suffer in RRP. You do not need to relive traumatic events. You can recall them without reliving them. During RRP you will still be in control at all times. If something about RRP puzzles you, just ask me. If you want to stop, you will be able to do so easily. Your being in control makes RRP easy and non-threatening.

  5. Getting Results

    RRP is results oriented. You and I want to get results for you. We want to free you up from uncomfortable symptoms and feeling. When you have gotten results from RRP it will be obvious to you. There will be immediate relief.

    We will just keep working until you get results. That may take 26 minutes or it may take four sessions of two hours each. But it does not go for years.

    If RRP does not get results for you within 4-6 sessions, then you need a different form of treatment. In that case, you should work with a psychiatrist, clinical psychologist, or counselor.

    Your RRP work with me complements your work with your primary doctor or therapist. I am not taking over your case from your doctor. I am helping out. With your permission, I shall send a report to your doctor.

    For example, if you come to me for overeating, I can help you profoundly with RRP. But I am not going to tell you what to eat or how much. That's for you and your dietician to work on.

  6. After Your RRP Session
    1. Memories will come back to you, perhaps of things you have not thought about for a long time. This will go on for months and even years.
    2. Once you have experienced RRP, you can do a lot of this RRP work yourself. When you experience the symptom, instead of bemoaning it, say to yourself, "Hot dog. This is the symptom I want to get rid of. Here's my chance, and I know how to do it now."

    It used to be that you were imprisoned by your symptom. Now, RRP can set you free.

  7. Other Things to Consider about RRP

    What will your life be like once you have achieved freedom from your symptoms? If you have been suffering from your symptoms for years, you have built up a life style, and those around you have adjusted to it.

    Ideally, RRP results are immediate and dramatic. When you have achieved results in RRP therapy, there will be no question in your mind about it. Your whole attitude about your symptoms will change and surprise you and others. You will be delighted. As I have said before, it is like being released from jail and given all the respect, rights, and privileges of a normal citizen, a first class citizen.

    If your symptoms have made you shy about going out of the house and being around other people due to the stress, that will change. You will find yourself more outgoing. You will likely create new friendships. How will that affect your current friends? How will that affect your spouse? The two of you should talk about it before you start RRP.

    I am not saying these things to discourage you from RRP. I just want you to let those close to you know that you are working on a way to free yourself from your symptoms to protect your health. And they should know that when RRP does work for you, they might notice some nice changes in you.

    I videotape the sessions for Dr. Barnett to give me supervision. These videotapes are confidential.

  8. How To Get Started With RRP

    Dr. Barnett and I are doing clinical trials of RRP in the treatment of a wide variety of symptoms, especially when standard treatments have failed. We want to take it out for a spin and see what it can do.

    Because these are trial studies, there will be no fee. If RRP sounds interesting to you do this:

    1. Determine if you want me to help you. Make a commitment to work with me. That will be very easy. I won't ask you to do anything difficult. You will find it easy to work with me.
    2. Let's work in cooperation with your doctor or therapist. Obtain a letter of referral from him or her at your expense. The letter should state clearly that the doctor is referring you to me for RRP therapy as an adjunct to the other treatments, briefly state what the symptoms are, present medicines and what drugs and treatments have been tried. Your doctor must understand I am not an internist and I am NOT trying to take over your care or your medications management. Those things are up to you and your personal doctor.
    3. Understand that I videotape the sessions for Dr. Barnett to review, and I shall review them.
    4. Discuss with your family and friends how your life is about to change. Ask them to support you in this effort. Think it over for about a week before you go on to the next step.
    5. Call my secretary to schedule yourself for RRP. (406) 587-5442.
    6. Come to my home on a Saturday morning or several Saturdays. If you are not going to come, you must call my office two days in advance and cancel. I am doing this in my spare time, and I don't have much spare time. If you fail to show up for your session, you will be dropped from the study. I'd like you to bring a spouse, relative, or friend as a chaperone.
    7. Send me a letter at 6 months, one year, two years, and three years letting me know how you are doing.
    8. Sign the attached release of liability.
    9. To prepare for RRP, do this homework assignment. Every time you experience your symptoms, instead of bemoaning it, identify the feelings associated the symptoms.

Potential Risks of RRP

Dr. Barnett has treated over a thousand patients with RRP and has found no negative consequences. RRP is new, and there is no history of adverse outcomes. The main risk of RRP is failure to get results. But, Dr. Tkach and Dr. Barnett feel that RRP is highly likely to get results. When results are slow to achieve, it may require several sessions.

Uncovering forgotten old traumas can be distressing, but finding and working through such critical events is the whole point of therapy. You will not go through it alone. Dr. Tkach will be with you every step of the way. If you become too uncomfortable, just open your eyes and stop the session. Then talk about it with Dr. Tkach before resuming RRP. You will not be required to do anything you do not want to do.

If you are feeling suicidal, tell me, and your primary doctor or therapist and get help with that.

See the separate information sheet on the recovery of false memories.

You will have to read and sign a copy of this with the release form before being seen by Dr. Tkach for RRP.

Learn more about the Rapid Reintegration Procedure or buy a copy of Dr. Barnett and Dr Tkach's book.