GoodTherapy | How to Talk to a Therapist about DepressionBy the nature of how depression manifests itself, it’s often hard for those in its grip to seek any support, let alone therapy. 

And while it may seem like everyone else isn’t struggling, there’s a good chance that’s not the case. In fact, major depression is one of the common mental illnesses, affecting about 8% of all American adults every year.  

But it doesn’t have to remain that way. Though there are some tell-tale signs of depression, other indicators aren’t quite as obvious, and a mental health professional can offer an objective analysis of your situation, as well as a safe place to discuss some of the underlying factors contributing to one’s symptoms.  

If you think you may be struggling with depression, learn about the benefits of seeking therapy and how to discuss depression with a trusted professional.  

Differences between depression and anxiety 

Individuals experiencing depression may also have anxiety, and it can be difficult to decipher where one ends and the other begins. After all, it’s normal to feel sad or anxious throughout our lives, but depression and anxiety should be taken more seriously when it begins to interfere with daily functioning. A declining job performance resulting from depression, or retreating from activities with friends due to social anxiety is a sign to seek professional help. Because each condition requires different approaches, it’s important to understand the differences between each. 

Anxiety 

Anxiety is characterized by a jittery, apprehensive feeling, usually about something that could happen in either the near or long term. Virtually everyone experiences feelings of anxiety at some point in their lives, but it’s typically considered a disorder when such thought patterns are ongoing in nature. Those with such conditions often feel uneasy, with “what-if” thoughts that are more future-focused particularly prevalent. 

Depression 

Depression, on the other hand, typically carries a sensation of consistent exhaustion or fatigue, physically and/or emotionally. Many describe it as feeling like there is something weighing them down, as if performing the simplest of tasks – making one’s bed, running errands – feels, at times, extraordinarily difficult. While anxiety is typically associated with apprehension about current or future events, those with depression typically report feelings of hopelessness. 

Types of depression 

Stressful and life-altering situations can cause us to feel depressed throughout our lives. Grief from the loss of a loved one can trigger depressive symptoms, such as a loss of energy or intense feelings of sadness or despair. These grief-related emotions may remain for a long time, but many people are able to return to a more functional psychological state over several months, perhaps within a year in more extreme cases, in which they’re able to perform daily responsibilities, experience positive emotions, and maintain healthy relationships. 

But clinical depression occurs when symptoms occur over an extended period of time and interfere with daily functioning. There are various forms of depression, some of which arise out of particular circumstances: 

Seasonal affective disorder:

SAD tends to arise as days get shorter during the wintertime, in addition to, in many cases, colder weather. The combination of lower temperatures and less light can alter our moods and even routines.   

Perinatal:

This type of depression is seen during pregnancy or in the first year after giving birth, commonly known as postpartum depression. An abrupt life change, less sleep, and hormonal changes lead to emotional and psychological blues for many parents, but prolonged feelings of sadness or despair may point to something deeper.  

Bipolar disorder:

Manic episodes, characterized by high energy and, in many cases, delusions of grandeur, are part of bipolar disorder. But what tends to follow are periods of depression, leading to low energy, isolation, and less overall activity. Therapy is important for those with the condition, but it is also usually paired with medication treatment.  

Persistent depressive disorder:

Major depression is noted for its extreme symptoms, particularly ongoing changes in appetite, lack of social activity leading to self-isolation, and other symptoms that get in the way of daily functioning, like holding down a job. By contrast, however, persistent depressive disorder is characterized by slightly less intense symptoms that remain for around two years or more.  

Benefits of discussing depression with your therapist 

Maintaining a supportive network of loved ones, including friends and family, is a powerful way to stave off the most intense symptoms of depression. There are other ways to lessen the intensity of symptoms, such as staying physically active, eating healthy, and adhering to a routine most days.  

But therapists are experienced and objective professionals that can help contextualize feelings and symptoms. They help navigate underlying causes that are exacerbating one’s symptoms and help find ways to change, accept or adapt to external circumstances.   

Therapists can also identify thought patterns that are particularly damaging, or conversely, beneficial. They are well-equipped to help clients develop skills that combat insidious and counterproductive thoughts and behaviors, especially those that exacerbate depression. They can also help you set realistic treatment goals – such as a daily walk or social connection – and monitor your progress.  

While continuing to seek support for your social network is key, just like with a physical illness, it’s also important to talk to a trained professional who understands how to navigate and help treat such mental health conditions.  

How to talk to your therapist about depression 

Mental health professionals will often do an assessment as you begin treatment to understand why you are seeking therapy, what approaches may or may not work, and if and what symptoms are contributing to your decision to seek counseling. Think of it like a questionnaire that involves a range of inquiries into your personal life, background, medical history, and more. The point of such evaluations is not to interrogate you but to make sure your sessions are as impactful and tailored to your needs as possible.  

Remember, everything you say is confidential, so as difficult as it may be, it’s important to be honest about your emotional state.  

Types of therapy that may benefit someone with depression 

Cognitive behavioral therapy  

CBT teaches individuals to identify and track their thoughts and behavior patterns, particularly those that contribute to depression. These thought patterns are often decades old, meaning they seem so second nature and automatic that we don’t even recognize we have the power to change.  But CBT can help reverse unhelpful thoughts, which in turn, leads to more desirable behaviors.  

Interpersonal therapy  

Therapists employing this type of therapy help individuals improve relationships with others, in turn promoting their own mental health. During IPT, clients can deepen important connections, healthily resolve conflict, and set boundaries necessary for personal growth and fulfillment. This can prevent isolation and spur social engagement, a key barrier to long-term depression.  

Mindfulness-based cognitive therapy 

This therapeutic approach takes the benefits of CBT and combines it with mindfulness techniques, such as meditation. These types of practices help anchor us in the present moment, which helps combat feelings of anxiety or depression, often stemming from thoughts about the past or future.  

Seeking Help  

While depression may feel insurmountable, it is a very treatable mental health condition. With the right plan and professionals to guide you, studies have shown that anywhere from 80 – 90% of patients respond favorably to treatment. Research has also shown that psychological treatments like talk therapy can have comparable effects on depressive symptoms as antidepressants and even more powerful impacts than medication long term.  

Make sure you are using an online directory that helps filter therapists and mental health professionals with important characteristics or experience, as well as those who can take your insurance. Doing so through platforms like GoodTherapy can jumpstart your therapy journey to make it as easy as possible to start feeling more like yourself.  

Dealing with the Trauma of Giving Birth 

Newborn baby looking at mother

For many new mothers, giving birth is one of the most exciting times in life. After all, you’re bringing a new tiny human into the world — one that you love more than pretty much everyone else. You can’t wait to meet the little guy or gal. 

In the ideal world, giving birth would be a seamless, painless, uplifting experience. Everything would go according to your birth plan, and you’d meet your bundle of joy quickly, without any hiccups along the way. 

Unfortunately, that doesn’t always happen — quite the contrary. According to a recent study, as many as 45 percent of new mothers experience birth trauma.  

What Is a Traumatic Birth Experience? 

A traumatic birth experience occurs when a new mother experiences discomfort or distress during the process of giving birth. Since every woman is unique, each new mother may experience trauma differently. 

Contrary to what the term might suggest, a traumatic birth experience doesn’t necessarily stem from a physical birthing complication (e.g., a uterine inversion or an emergency C-section).  

In many cases, the trauma can be psychological (e.g., stressing out over giving birth in a hospital during COVID-19). After all, the birthing experience can be incredibly stressful and physically exhausting — even when everything goes to plan.  

The Physical and Emotional Effects of a Traumatic Birth 

After a traumatic birth, new mothers have to deal with physical and psychological pain. 

Physical trauma 

All new mothers are physically exhausted after giving birth. Since most muscles strain during contractions, it’s perfectly normal to be sore throughout the body after giving birth. Of course, there’s also vaginal bleeding and vaginal soreness to deal with. On top of this, hormones fluctuate considerably, making new mothers perhaps more emotional than normal.  

While every new mother is different, it generally takes between six and eight weeks for the body to recover after giving birth. 

Psychological trauma 

In addition to the physical trauma that new mothers have to deal with, many women also experience psychological issues after giving birth. 

Postpartum depression 

As many as one in seven new mothers develop postpartum depression after giving birth. When this happens, women can feel hopeless, sad, and isolated. These feelings often translate into a decreased appetite, loss of sex drive, and lack of appetite, among other negative outcomes. On top of this, women dealing with postpartum depression may also struggle to bond with their newborns. 

While exceedingly rare, some new mothers develop a condition called postpartum psychosis, which can lead to dangerous thoughts and behaviors. If you or someone you know who’s recently given birth is dealing with hallucinations, paranoia, or delusions, seek medical help immediately. 

Post-traumatic stress disorder (PTSD) 

Depending on how bad the birthing experience is, some mothers can develop PTSD. One study found that mothers who were less educated, had less prenatal healthcare, and gave birth prematurely were most likely to be diagnosed with PTSD. Additionally, research also suggests that new mothers who’ve suffered from depression and those who were victims of childhood sexual abuse and domestic violence are also more likely to develop PTSD. 

In addition to affecting a new mother’s well-being, PTSD can also damage romantic relationships. Women who’ve had a traumatic birth report a lack of sex and arguments with their significant other over the birth itself, among other things. 

Now that you have a better idea of what a traumatic birth is and what a new mother might experience in the aftermath of one, let’s turn our attention to the most important piece of the puzzle: what women can do to overcome these feelings and live their best lives. 

Postpartum Healing: How to Overcome a Traumatic Birth Experience 

From the outset, a traumatic birth experience can seem downright devastating. But there are some things you can do to overcome the trauma.  

It may take time, to be sure. But as long as you’re dedicated to improving your headspace and becoming the mom you’ve always been destined to be, you will get through this challenge before you know it. Here are some ways to make that happen.

1. Think about your experience

While you might be tempted to block your trauma out of your mind, that pain will always exist below the surface unless you confront it head-on. And that starts with being upfront with yourself. Spend time thinking about what you’ve been through and try to understand exactly why you feel the way you do. Whenever you get a moment, you might want to try journaling to really clear your mind. 

Once you’ve processed your thoughts, it’s time to share them with those closest to you — your partner, your family, and your friends. Don’t share anything more than you’re comfortable with. But the sooner you can connect with someone else about what you’re going through, the faster the weight will be off your shoulders.

2. Spend time with your new child

It’s not at all uncommon for new mothers to feel disconnected from their babies after a traumatic birth. While you might not be able to prevent those feelings from happening, you can proactively try to address the issue by making a point to spend more time with your newborn. Easing into skin-to-skin contact and breastfeeding when you’re comfortable can help you get through this difficult time. 

3. Talk with a professional about your traumatic birth

At the end of the day, you need to know that you don’t have to deal with this entire situation on your own. While talking with your friends, family, and partner about your emotions and what’s going through your mind can be helpful, you may be best off speaking to a neutral third party when the going gets really tough after giving birth. 

After all, emotional healing when you have a tiny new human in your life can be hard — even if you aren’t experiencing postpartum depression. Speaking with a professional therapist who specializes in treating new mothers can make all the difference in the world. 

If you’re struggling after a traumatic birth experience, reach out to a therapist today to get the help you need to adjust to this huge life change. 

Maternal Mental Health - GoodTherapy

Maternal mental health was not always on the radar of things to address for many behavioral health providers in our nation. In 2020, the world view has shifted, and the mental health of mothers (and parents in general) is increasingly important to the behavioral health community. More and more providers are exploring mental health disorders in women who are pregnant, are new mothers, or are experienced mothers and how their mental health impacts that of their children. According to the World Health Organization, roughly 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression, leading to an inability to properly function and impacting the growth and development of their children. Below are some of the common types and causes of Maternal Mental Health Disorders and how managing one or more of those disorders can impact a child.

Common Types of Maternal Mental Health Disorders

1) Depression /Postpartum Depression

Depression is the most common maternal mental health issue experienced by mothers across the globe. While many mothers experience varying types of depression in their lives, the number one most experienced form is postpartum depression. Up to 80% of women will experience postpartum depression to some degree after childbirth. Symptoms of this maternal mental health disorder include weepiness, impatience, irritability, restlessness, fatigue, insomnia, sadness, intrusive thoughts, or the inability to stay focused. 

2) Anxiety Disorder

Another common paternal and maternal mental health issue experienced by parents are anxiety disorders. This is often experienced as intense/excessive worry and fear about everyday situations. Some mothers experience this due to fear of harm coming to their children or for other reasons outside of motherhood. Regardless of the reason, increased anxiety can impact a parent’s decision-making and the ability to assess certain situations as well as other processes when raising a child.

3) Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is categorized as a pattern of unwanted thoughts, fears, and obsessions that lead an individual to experience certain compulsions that interfere with daily life and are often exacerbated by increased stress levels. For a parent that is now responsible for a helpless child, the obsessive-compulsive disorder can be experienced as a result and desire to keep harm away from the child. It could lead to incessant cleanliness habits, repetitive phrasing or actions, mental compulsions, and more.

4) PTSD

Anther maternal mental health disorder that is common in the United States is Post-traumatic Stress Disorder or PTSD. PTSD can be brought on from several experiences but is most commonly experienced by mothers who went through a traumatic child-birthing process. Otherwise known as birth-trauma, this form of PTSD is often a result of fear experienced during childbirth that harm is going to come to you or your child, or the realization of those fears (high-risk births).

 The Impact of Paternal and Maternal Mental Health on Children

During the formative years of a child’s life, the mental health of a mother or parent has a huge impact on the child’s behavioral and mental health. A parent who is managing some type of paternal or maternal mental health disorder can sometimes have a decreased ability to manage, respond, and react to their child in a way that promotes stability, growth, and development. Left unaddressed, paternal/maternal mental health disorders can become dangerous, impacting the child.

Untreated paternal or maternal mental health can have several significant impacts on the emotional and behavioral health of a child, such as:

Seeking treatment for your paternal or maternal mental health disorder(s) is essential to decreasing the risk that your child experiences any of these consequences. If you believe you are experiencing depression, anxiety, or any other form of mental health disorder, you should consult with a behavioral health provider. To learn more about a provider near you, click here to begin your search.

tired mother with childIf you are a mother, you have probably experienced at least one day (if not many) when you wondered if you were cut out for the job of parenting. Mothering is hard work. Even on our best days parenting our kids, there are difficult moments. Many days, it is the occasional joyful moment that makes it all worthwhile. Other times, it may not feel like the good justifies the bad.

You can find some blogs these days that describe parenthood more authentically and accurately than in the past, including the good, the bad, and the ugly. Moms are increasingly owning up to the fact being a mom is tough and sometimes thankless. But almost universally, these stories end with a phrase such as “It’s all worth it,” “I still wouldn’t trade being a mother for anything,” or even, “Being a mother is the best job in the world.”

But what if your experience of motherhood doesn’t include that last sentence? What if your true feeling is that, while you love your child/children, motherhood itself is not what you thought it would be and you just don’t enjoy it much?

For some mothers, these feelings arise out of depression, and once the depression lifts, joy enters into the parenting experience and all regrets about becoming a mom dissipate. But for others, even after recovery from depression, and despite loving their child and enjoying many moments with them, the bottom line is that motherhood is not a job they enjoy overall or would choose again.

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If it were any other job, it would be acceptable to acknowledge that it’s hard and maybe you’re not totally suited to it, but when you’re talking about motherhood, admitting you don’t love it is a huge taboo.

A recent study published in the journal Demography found that, on average, happiness decreased more in the two years following becoming a parent than following a job loss, divorce, or even the death of a spouse. Clearly, not every mother is happy with her new life, and yet those feelings are typically buried, not talked about, and the women who feel that way often experience shame and guilt.

So few mothers admit to having these feelings, but that doesn’t make them go away. Parenting is difficult, and of course it makes sense that not everyone is equally suited to it temperamentally. But the stigma of admitting that one doesn’t really enjoy being a parent is enormous, and the necessity of hiding those feelings can be a huge burden—which in itself is a contributor to depression and anxiety.

Acknowledging our ambivalence—the fact not every moment, nor even every stage, of motherhood is fun—allows mothers to accept themselves for who they are and what they feel, and be freer to find ways to make motherhood more authentically enjoyable.

There are those who would point out that enabling women to acknowledge their negative feelings about motherhood might adversely impact our children. How can our children feel loved and wanted if they knew the way Mom really feels about her job? But I would argue the opposite: By stuffing those negative feelings, by shaming mothers for their normal responses, normal emotions are more likely to be acted out in negative ways.

Acknowledging our ambivalence—the fact not every moment, nor even every stage, of motherhood is fun—allows mothers to accept themselves for who they are and what they feel, and be freer to find ways to make motherhood more authentically enjoyable. Being honest within ourselves and accepting all our feelings gives us permission to do motherhood differently—and perhaps allow more acceptance in our children of their own inevitable negative feelings as well.

Don’t look to social media for validation of your motherhood experience. Don’t compare your insides to other people’s outsides. If you don’t feel heard, understood, and validated by your partner, friends, or family, therapy can be an outlet to explore and accept your complicated and ever-changing emotions regarding parenthood and life.

Reference:

Myrskyla, M., & Margolis, R. (2014). Happiness: Before and after the kids. Demography, 1843-1866.

Mother kissing sleeping infantIn addition to adapting to the brand new experience of parenting, many new parents may also be managing preexisting mental health issues, like depression or bipolar. Others may experience postpartum depression (PPD) after the birth of a child. The American Psychological Association states that postpartum depression affects 9–16% of postpartum women, and women who experienced PPD after the birth of their first child are even more likely to experience PPD after a second pregnancy.

Online resources like GoodTherapy.org can be valuable in helping you understand issues like postpartum depression—you can find a selection of blog articles related to PPD on the GoodTherapy.org Blog—but finding others who can relate is also essential. That’s why we appreciate the many wonderful blogs by parents who have experience with postpartum or general depression. It’s comforting to find people who have documented their stories and shared their own inspiration for coping with mental health issues.

Below are some of our favorite blogs by and for parents who are experiencing or have experienced PPD or depression.

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Postpartum Progress

With a team of over 15 writers, Postpartum Progress discusses the experience of motherhood—for parents-to-be, those who have decades of parenting behind them, and everyone in between. Because so many authors are contributing, you can follow the stories of mothers who are in all stages of PPD and depression. Click on “Find Moms Like You” under the Get Hope tab to explore personal stories you can relate to and resources for moving forward.

All Work and No Play Makes Mommy Go Something Something

A wife and mother who has experienced PPD and been diagnosed with bipolar II, Kimberly has many published pieces to her name in addition to her popular blog. In her bio, she writes, “Together, my boys have guided me through the darkest times of my life and held onto my hope when I lost it. Their love saves me every single day.” The link above takes you to her posts specifically addressing PPD and recovery.

Beautiful Courageous You

Lauralee writes that her faith has been of the utmost importance to her success in dealing with mental health issues while raising her five children. “Most of what I write about is a real and raw journey through depression, anxiety, and grief, not to bring you down but to bring you UP and fill your heart to brimming over with Hope.” Many people search for a spiritual approach to overcoming hardships in life; if you’re looking for inspiration from a mother with a Christian perspective, Beautiful Courageous You is the account of a woman who has learned to embrace change and rejoice in life’s trials.

Ivy’s PPD Blog

After a failed pregnancy and an unsuccessful cycle of in vitro fertilization, Ivy gave birth to her daughter in December 2004 and experienced PPD six weeks later. Though she considers her experience with PPD over, she has continued to be an advocate for education about maternal mental health issues, perinatal mood issues, and infertility. Ivy’s blog is one of our favorites because of her dedication to reducing stigma about mental health issues that women and mothers face. She also shares insightful posts about bullying and the importance of staying wary of social media—both for kids and adults.

Farewell Stranger

Robin Farr named her blog not for the Supertramp song “Goodbye Stranger”—OK, maybe a little bit for that—but because, “In telling this story, I’m saying goodbye to a version of myself that I didn’t know and didn’t understand.” Robin has presented a TEDx talk, contributed to Huffington Post, and written for Postpartum Progress about her ongoing experience with depression and the recurrence of what she calls “blips”—those times that might make one hyperaware of mental health issues. Farewell Stranger has formed an online community around Robin, her life with her two sons, and maternal depression.

PPD to Joy

The author of PPD to Joy, Yael, had a traumatic introduction to postpartum depression: her mother committed suicide when Yael was 6. When Yael found herself having similar thoughts and motives after the births of her own children, she said the memory of her mother’s death “ignited a spark” under her. She began seeking help and finding strength through support networks and professionals. Years later, she continues her blog, hosts support groups in Ithaca, New York, and helps eliminate stigma and confusion about PPD.

While there tends to be an abundance of resources available for women with postpartum depression, the help for their partners is not as plentiful. Spouses should not only learn how to support a partner with depression; they should also be prepared for dealing with depression issues themselves. Studies have shown that fathers, too, may experience postpartum depression. We are still looking for blogs by fathers with PPD; please email inquiries@goodtherapy.org with suggestions.

Are there other blogs about depression and PPD that you read? Please let us know! Have your own blog that covers these issues? We want to find it! Leave your suggestions in the comments, so we can include them in future lists like this.

sad mother holding young childOne of the common themes I come across when working with mothers experiencing depression and anxiety is perfectionism and people-pleasing. Moms get worn out when they are trying to make everyone happy all the time.

There are often good reasons for a tendency to be over-responsible for the feelings of others. Many of us come from families where there was an unspoken expectation that a child must be “good,” because one or both parents were unable to tolerate the challenge of even normal childhood misbehavior. Or sometimes, children develop an unconscious habit of caretaking for others as a way to get their own needs met.

However this pattern develops, it likely served a valuable purpose, which is why it became second nature. Children learn to intuit the moods, thoughts, and feelings of others. They modify their own behavior in an attempt to manage the responses of others. Often, this behavior is rewarded. Who doesn’t appreciate the helpful child who asks her mom if she needs a hug when she seems sad, or goes and plays quietly in her room when there is tension between her parents?

People-pleasing behavior is rewarded by friends and family, at work, and at school. A people-pleaser is there for her friends when they need support and earns the love and trust of her partner. She knows what to say and when to say it, at least most of the time. The cost of this unconscious caretaking is a loss of connection to the self. When your thoughts are focused on intuiting what others want and need, and your actions are focused on pleasing others, there is little space to experience your own feelings, thoughts, and needs. You may not even notice when your needs go unmet or when emotions are pulling for your attention. Sometimes, these unmet needs and unfelt emotions cause physical symptoms—headaches, back or stomach problems, or other tension-related difficulties. These symptoms temporarily draw our attention back to ourselves, making it harder to attend to others and focusing more attention on ourselves and our discomfort.

Having children can push what is already a difficult emotional burden into overdrive, creating anxiety, depression, exhaustion, and even worse physical manifestations. While you may have been able to keep your friends, employer, partner, and family happy before, when a baby comes into the picture, a whole new level of exhaustion ensues. Now you’re sleep-deprived, have a baby whose needs are never-ending, a partner who is stressed out, and it is truly impossible to make everyone happy. This is when, for a lot of moms, things hit a crisis point. Anxiety becomes unmanageable, or exhaustion leads to crippling depression. However, it is also an opportunity to address a long-standing pattern of behavior that has prevented you from taking care of yourself. It is a necessity to learn to increase your attunement to yourself and to let go of unconscious patterns of caretaking.

Looking at how these patterns play out in everyday life can be illuminating. You may discover that ways in which you are caring for others are based on assumptions of what people want or need from you, and that these assumptions are often wrong. You may find that your unconscious perpetual caretaking actually makes you less available when others truly do want or need something from you. So often, people-pleasing behavior leaves us resentful and feeling less generous to those we love. Compulsive caretaking can actually make us less available to others in concrete ways.

One way to begin to address people-pleasing is to become aware of how much of your thinking takes the form of “I should.” It is important to examine all the thoughts about what you should be doing/saying/feeling. Who says you “should”? What will happen if you don’t? What do you really want to do? One way of improving self-care and reducing people-pleasing is to challenge the “shoulds” whenever you become aware of them. Another is to check in with people about what they really do want and need from you, and more carefully balance the stated needs of others with what you truly need to do to take care of yourself. And making conscious choices to do for others is emotionally quite different from unconscious caretaking. It is done in the spirit of generosity, not because it is what you are supposed to do.

Learning to tune into your own feelings and needs and becoming conscious of making choices to balance them against your sense of responsibility to others is one of the most powerful ways to regain a sense of personal power. Regaining a sense of power in your life helps make you a better, stronger, and healthier mom and partner.

Woman sits painting“Art washes away from the soul the dust of everyday life.” —Pablo Picasso

I am privileged to work with new moms in my private practice. It is tremendously gratifying to help women and their families move through what can be one of the most challenging life transitions—that of parenthood. In my work with mothers, I see many women who experience perinatal mood/anxiety issues (PMADs), perinatal loss (miscarriage), fertility challenges, and traumatic birth situations (see prior articles on these subjects on my GoodTherapy.org profile page). Most often, interventions with moms are a combination of evidence-based cognitive behavioral work and interpersonal approach to assist the client in full recovery.  I have also found great benefit in the use of expressive arts to assist this population in healing.

Expressive arts therapies are defined as the use of creative arts (art, dance, music, writing, drama) as a form of psychotherapy. The process of art making is emphasized versus the final product. In my practice, I employ the use of visual arts and crafts as a powerful intervention with clients of all ages. Although I am not an art therapist, I believe the use of art intervention is incredibly meaningful and assists in recovery from PMADs.

The American Art Therapy Association defines art therapy as a practice as “the therapeutic use of art making, within a professional relationship, by people who experience illness, trauma, or challenges in living, and by people who seek personal development.” Art therapy itself is considered a specific subspecialty in the field of psychology/counseling and requires an intensive registration and education process. With either expressive arts intervention or art therapy, the client does not need to have prior art training and need not feel pressured to produce a masterpiece. Again, the focus of the intervention is the process, not necessarily the product outcome.

I was initially exposed to the power of art to heal trauma in the drawings of child survivors of domestic violence in a San Diego shelter when I first began my career in clinical social work 20 years ago. In graduate school, I worked with a registered art therapist in a hospice setting, counseling children and families who experienced the loss of a loved one due to terminal illness. Art intervention was the primary modality in individual, group, and family work.

Moving forward through my career, most every setting I have been employed in involved the use of art as an intervention and source of healing. School and clinic-based settings provided ample opportunity to continue to bring art and creativity to the therapy process for children and adults managing depression, anxiety, trauma recovery, loss, life transitions, divorce, social skills issues, and medical traumas.

Art intervention is incredibly helpful for trauma survivors and those recovering from life challenges (including for clients feeling a sense of PTSD from perinatal depression). Art allows the right brain to be balanced and integrated with the rational, logical left brain. The bilateral movement of the hand moving across the page (mimicking the back-and-forth motion of EMDR) in turn assists in releasing trauma and integrating the experience in the brain.

Typically I will invite my client to participate in an art intervention at a point in her healing process in which she is beginning to feel the first glimpses of recovery. Sleep is beginning to be restored, mood is lifting, and anxiety is starting containment. Prior to art intervention, I will have helped to stabilize any crisis, link my client with other helping professionals and extended support networks (psychiatrists, lactation consultants, doulas, support groups, family support), and work with her to attain a level of recovery in which her focus and concentration are improving, along with her mood health. She may begin an exercise regimen; she may have hired a doula (caregiver) or enlisted the assistance of her extended family with baby care. She is beginning to feel biochemical relief, perhaps with the assistance of an SSRI, improving her nutrition with omega-3 fish oils, and she is sleeping for at least five consecutive hours (a full sleep cycle which restores serotonin).

Art interventions which I find particularly helpful for new moms contending with PMADs (which can also be adapted to other populations) can be created in individual or group modalities. Significant others of new moms may also participate in a couple/family session. The following are suggestions for use with new moms recovering from PMADs:

Materials needed: colored pencils/markers, large poster paper.

Have client draw images of symbols which represent the wishes she hopes to manifest (for example, “good health/vitality” may be a sunshine image); encourage client to add powerful affirmation to the page (“I am reclaiming the best of my health and vitality”) and label each image. Invite client to post “treasure map” in a prominent location in her house to be reminded of the goals she is setting for herself in active manifestation.

Purpose: a visual guide to affirm client’s goals and provide reassurance.

Materials needed: magazines with a variety of images, large butcher/poster paper.

Have client select images from magazines which represent her new identity transformation as a mother, or use theme in intervention above to guide client in goal attainment for self-care and balance as a new mom. Discuss images and invite client to verbalize how the images are important and meaningful to her.

Purpose: validation and support with role transition to new motherhood.

Materials needed: preformed paper/cardboard face masks (available in craft supply stores), feathers, colored markers, beads, yarn.

Ask client to create one mask which demonstrates how she presents to the “outside world.” The second mask will reflect how she feels “inside” as a new mom. Discuss how masks are similar and different and why. What is the purpose of each emotional mask?

Purpose: identifying how feelings inside often do not match what we show to the outside world.

Materials needed: sculpy clay, paint, paintbrushes.

Invite client to create image out of sculpy clay (that which can be baked and hardened at a later time, then painted). The image can be a symbol of new motherhood, an image of mother/baby, or an object representing courage and healing (perhaps a bead for a charm bracelet or necklace). Once completed, client gets to keep the object in a special place as a reminder of her strength and courage in her healing process.

Purpose: a transitional object/symbol of the work the client is doing in psychotherapy and a tangible representation of her inner strength and courage.

Materials needed: art journal, colored pencils/markers/paint/paintbrushes.

Many clients prefer to draw feelings in lieu of writing about feelings. Invite client to create image of her birth experience using vibrant color of her choice, and to narrate her story of the experience. This exercise is especially helpful in working with survivors of birth trauma. It is also helpful to add second exercise of an image in which client creates a symbol on paper representing healing and recovery.

Purpose: Recording emotions (written or drawn/painted) allows a container for the client to “place” her feelings so she is less overwhelmed. She is able to “master” any traumas by telling her story and her experience.

Materials needed: array of bead supplies (beads, bracelet/necklace wires, etc.).

Invite client to create jewelry representing her new identity as a mother, her connection with her child.

Purpose: affirmation of new role and connection/attachment to new baby.

Materials needed: shoebox, construction paper, markers/pens/paints, any supply to decorate a box or album.

Assist client with decorating a special box to hold keepsakes (photos, poems, cards, etc.) as she becomes a new mother. A scrapbook can be a similar project. Discuss her identity transformation and the joys/positives of this new life role.

Purpose: recording the most transformational journey a woman can ever go through and celebrating it.

Materials needed: paper, pastels, paints, pencils/pens.

Mandalas are circular images from ancient cultures and religions which represent the power of one’s healing process (see Mandala book). Invite client to create a mandala with the materials of her choice.

Purpose: for client to enjoy process (versus product) of art making and generating an image which represents healing and recovery; practicing self-care through creativity flow.

Materials needed: paper plate, yarn, beads, feather, single-hole punch, scotch tape.

Assist client in constructing a native American dreamcatcher, which can symbolically protect her from nightmares and scary, intrusive thoughts at night. Discuss the dreamcatcher as symbol of nighttime inner peace and tranquility.

Purpose: Most moms with PMADs have horrible sleep initially and need comfort at night. This craft is a great visual to calm the nerves and assuage the soul. Add some lavender- and vanilla-scented oil to the dreamcatcher, and invite client to place above her bed.

Materials needed: clothespin, yarn, tongue depressors, colored pens, fabric scraps.

Invite client to create a Guatemalan worry doll which can hold her worries before she goes to sleep at night or when she begins her day (see The Kid’s Multicultural Art Book).

Purpose: Women with PMADs are anxious. They need a “container” in which to place their worries and fears; worry doll may represent transitional object of the therapist in between sessions.

“The aim of art is not to represent the outward appearance of things, but their inner significance.” —Aristotle, 384-322 B.C.

The following are books and websites which have been, and continue to be, a source of inspiration and enlightenment:

  1. Allen, Pat (1995). Art Is a Way of Knowing, Shambala.
  2. England, Pam (1998). Birthing from Within: The Extraordinary Guide to Childbirth Preparation,Partera Press.
  3. Fincher, Susanne (2009). The Mandala Workbook: A Creative Guide for Self-Exploration, Balance, and Well-Being.
  4. Malchiodi, Cathy (2006). The Art Therapy Sourcebook, McGraw-Hill.
  5. Malchiodi, Cathy (2006). The Soul’s Palette: Drawing on Art’s Transformative Power,Shambala.
  6. McNiff, Shaun (1992). Art as Medicine,Shambala.
  7. Terzian, Alexandria (1993). The Kid’s Multicultural Art Book: Art and Craft Experiences from Around the World,Williamson Publishing Company.
  8. Arttherapy.org:  American Art Therapy Association.
  9. Atwb.org : Art Therapy Without Borders: Promoting international art therapy initiatives in mental health, health care, and education worldwide.

Father and son playing with paper airplaneLast week, I had the honor of attending and speaking at Postpartum Support International’s 25th Annual Conference in Seattle, WA. I was moved and inspired by the amazing work gestating and being born in the perinatal world by so many compassionate professionals. (Refresher: “perinatal” refers to the time from conception, through pregnancy, on through the first year after having a baby.)

My dear colleague Gabrielle Kaufman, BC-DMT, NCC and I presented a workshop on special needs parenting as relates to the family experiencing perinatal challenges. Both Gabrielle and I have found in our practices a large number of women and families who are impacted by the double whammy of a perinatal mood/anxiety disorder (PMAD), coupled with parenting a special needs child. We felt it was important to highlight this population of folks who are in great need of resources and support. Although this subject could be an entire week-long conference, we discussed the following highlights that are pertinent for special needs families and the people that support them.

It’s hard to define special needs, as we all are special and we all have challenges. We choose to define special needs as a child in a family system who is experiencing the challenge of a neurological, emotional, behavioral, developmental, or physical disability. This challenge affects the entire family system on several levels.

  1. One in 10 children have a disability (neurological, emotional, behavioral, developmental, physical)
  2. Parents of special needs children are more at risk for depression and anxiety
  3. Couples (parents) of special needs children benefit from support such as psychotherapy and regular date nights (50% or more of all special needs couples divorce)
  4. “Neurotypical” siblings benefit from support in the form of sibling support groups, one-on-one attention from parents, and open-ended discussion of feelings/solutions to concerns associated with being a special needs family (i.e., role-playing how to handle being in public with special needs sibling, preventing parentification, etc.)
  5. Stigma is real and exists, even in the 21st century. Therefore, family discussions need to happen to address this concern and to build social support networks.
  6. Family/couple/individual therapy and support groups were found to be helpful in buffering the effects of stress and lowering depression/anxiety in these family systems in several studies
  7. The special needs family is exposed to chronic stress and therefore requires an ongoing stress management program that will lower the effects of cortisol and adrenaline (the fight or flight response) that develop. For example, self-care, yoga, psychotherapy, respite care, support groups.

Below are some helpful resources we found to be beneficial.

Resources

Organizational Aids:

Books:

Parental Self-Care:

Other Materials:

This list of resources is far from comprehensive, as every day the Web has new sites on the special needs family. We chose to highlight a few websites and books which we found to be helpful for our clients and our practice, as perinatal psychotherapists.

Woman holding newbornMandy nuzzled her 3 month old baby happily as she warmed his bottle. It felt so good to breathe in his sweet baby smell and touch his soft delicate skin, his little body curled in a warm embrace into the curve of her neck. Mandy was starting to feel like she had her “sea-legs’ as a new mom and was particularly enamored of the fact that her new baby was sleeping through the night. The rough night-time awakenings were beginning to subside as baby Noah matured and slept for longer periods. She was looking forward to meeting a new mom friend in the park with their babies after she gave Noah a bottle.

Suddenly, in the wink of an eye, the tender moment vanished. Mandy watched the water warm Noah’s bottle on the stove. She  was blind-sided by a  horrific thought, flashing through her mind of the  water morphing into hot lava and scalding her baby boy. Mandy flinched, gasping and clenching tightly onto Noah, quickly backing away from the oven. The thought terrified her, and she could not believe such an image threatened to envelop her mind. Mandy’s entire body tensed as she began to pant, shallow breaths. She didn’t know it at the time, but, she was well on her way to her first panic attack after experiencing an intrusive thought…a hallmark symptom of perinatal depression and/or perinatal OCD.

Experiences like Mandy’s are common in some 20% of all child-bearing women who develop perinatal mood/anxiety disorders (the clinical term for depression/anxiety during pregnancy and up through the first year after having a baby). Some women develop symptoms of anxiety with intrusive thoughts while others may not experience these often debilitating and traumatic images. Others may have more depression symptoms with a smattering of anxiety, panic attacks, and sometimes intrusive thoughts.

PMADs (perinatal mood/anxiety disorders) are the clinical term for a myriad of symptoms under the umbrella of depression and anxiety from conception through the first year following childbirth.  In layman’s terms, perinatal challenges/neurobiochemical imbalances while pregnant and after having a baby often leave women completely stunned, horrified, and traumatized…because  women don’t know what hit them. And no one talks about it.

The reality is that PMADs are very common, and most likely under-reported due to the stigma connected to them. Mothers can be wracked with so much guilt about any of the symptoms, particularly if she has intrusive thoughts, that they are loathe to talk to a specialist to get help or to a family member. Many women report they feel like they are “going crazy” or afraid to be “like that woman on TV who killed her kids.”

I want to underscore the importance of supporting a woman who is experiencing intrusive thoughts to not delay in seeking help, to get help immediately with a trained specialist in perinatal challenges. The differential amongst these particular perinatal struggles is quite delicate. Furthermore, to receive the best care, she must have help from a skilled perinatal psychotherapist who can provide a comprehensive bio-psycho-social assessment and steer her in the appropriate direction for what is ideally a multidisciplinary approach to treatment.

This article is not intended to be a primer on the difference between perinatal intrusive thoughts and hallucinations since such is the subject of a workshop or conference. And, each set of circumstances requires a different course of treatment (both medically and in psychotherapy). Generally speaking, however, when a woman experiences intrusive thoughts, she is grounded in reality and horrified of the images that are occurring, feeling that her body is betraying her. She will often respond with disgust at the images and in turn demonstrate behaviors that lessen her anxiety and protect her baby (for example, Mandy avoided ovens for a time because such objects were a trigger for her). Intrusive thoughts can be part of perinatal depression and will remit with psychotherapy and in many cases, medication management (typically an SSRI), along with a good self-care plan and social supports in place.  Hallucinations, on the other hand, are considered a medical emergency and potentially part of a more rare PMAD, perinatal bipolar disorder or psychosis. In such a case, the woman is not grounded in reality, and hallucinations can cause her to do or say things that she would not normally do and have the potential to be life-threatening to her or the baby. If you suspect that you or a loved one are experiencing hallucinations, call 911 or go to your nearest emergency room immediately. Do not attempt to diagnose.

Fortunately for Mandy, she realized something was amiss in her brain biochemistry and immediately sought help with a trained perinatal psychotherapist. Upon consulting with a psychiatrist specializing in reproductive mental health, she agreed to try an antidepressant (Zoloft) to help her biochemistry restore itself. Mandy’s recovery was swift because she sought help immediately, she received support, non-judgment, validation, psycho-education, as well as cognitive behavioral strategies in psychotherapy to help her diminish the anxiety and intrusive thoughts. She worked with her therapist on a solid self-care plan and put in place the help of a doula (hired caregiver specifically for new parents). Mandy feels empowered now as a new mom, free of intrusive thoughts and filled with pride at the arrival of Noah in her life. She is now on to a full recovery, enjoying her 7 month old son. (Please note: swiftness of recovery times vary with each individual’s unique circumstances).

If you or someone you love appears to have intrusive thoughts after having a baby (or even while pregnant), do not attempt to diagnose her. Do find a trained perinatal specialist to help the woman you care about to get treatment. The good news is that PMADs are treatable and temporary, and with help, women recover fully.

Other useful resources:

Great book on intrusive thoughts:
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel (2010). –excellent book for new moms dealing with PMADs, also for perinatal professionals

Working mom with bottle.“The phrase ‘working mother’ is redundant.” Jane Sellman

 

“Making the decision to have a child-It’s momentous. It is to decide forever to have your heart go walking around outside your body.” Elizabeth Stone

I was inspired to write this article by many beautiful, courageous mothers, family, friends and clients.  I believe all moms are working moms, whether working at home and/or out of an office.  When I had my first son almost 10 years ago, I remember how difficult this transition was for me, as a mom who worked out of the home, and I needed all the support in the world. Having a baby for the first time is challenging enough. However, a second adjustment most definitely occurs when a mother returns to work after her baby is born. And if this mommy happens to also have other children, the transition can feel completely overwhelming.

I also want to add that for women who stay-at-home or who work part-time, they are working just as hard…doesn’t matter if work is at home, in an office, or both. Juggling it all can be tough, and all women need and deserve support. This article is geared mostly to the mom who is returning to an office job and/or a job that requires separating from baby. (more…)

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