10 Things to Know about Psychotherapy Treatment for PPD

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psychotherapy, posptartum depression treatmentEvery time a mom in distress calls me to schedule a new therapy appointment, I am reminded of the courage that this takes.  Society just doesn’t set us up for the reality of needing this type of support after having a baby.  Women are led to envision romantic moments around breastfeeding, moments cradling a swaddled baby who sleeps peacefully with a light smile on her lips, loving and contented embraces with partners, and sweet jaunts through the park with a baby carriage in which a baby lies peacefully.  Certainly these moments may happen, but more times than not, new parents find themselves in the company of moments that feel less ideal than these.  Very few women spend time envisioning themselves nestled into a therapist’s couch when they look forward to the first weeks and months of being a mother.  However, psychotherapy is known to be one of the most important pieces of perinatal mood and anxiety treatment for women with moderate to severe symptoms of depression and anxiety during pregnancy or postpartum.

And so with all of these brave calls to my office in mind, I share this list of ten things to keep in mind when you are moving towards the support of a trained psychotherapist:

1.  Sometimes making the first call is the hardest part.   Women tell me all the time that they have been holding onto my card for months.  Acknowledging that you cannot heal on your own, picking up the phone to ask for help, and disclosing your most intimate information for the first time to someone who you don’t know can be excruciatingly difficult.  But once you do take this step, you may find that you begin to feel better immediately.

2.  Therapists who are appropriately trained in treating postpartum mood and anxiety disorders like PPD won’t judge you.  Chances are, no matter how awful you believe that your symptoms, thoughts, or behaviors sound, a skilled therapist will have heard it already.  Many women will resist psychotherapy for fear that their therapist will think awful things about them, and this is unfortunate.  Give your therapist a chance to hear you out and understand.

3.  Yes, therapy is hard work, and it doesn’t always feel good.  One of the important pieces of healing from PPD involves talking openly about how you feel, what you are thinking, and parts of your environment that might be contributing to your distress.  And, often, it feels easiest (and less painful) to keep these things stored inside where no body can touch them.  However, the way past this kind of distress is through it, and an appropriately trained therapist will support you in a way that feels gradual and safe.  I often relate psychotherapy to physical therapy that is used to treat a physical injury, like a knee.  In order to heal a knee injury, you may need to go into a physical therapist’s office and move it in ways that feel painful in the moment.  And your knee may feel additionally sore for a time.  However, with work and treatment your knee begins to strengthen and heal.  Psychotherapy and the brain work the same way.

4.  The time and resources that you give to your individual therapy will serve your whole family.  Often, women talk about how “selfish” it feels to be spending money or time away from their baby in order to be at a therapy session.  And yet this does not take into account the impact that your own healing will have on those around you.  Through your own work at healing, your relationships with your partner (or family and friends) and your attachment with your baby will strengthen.   Sometimes it takes the realization that “I am going to therapy for my baby and family” to actually motivate women to pick up the phone.

5.  If you don’t gel with your therapist, it is entirely appropriate to seek out someone else who you feel more comfortable with.  For most of us, what matters is that you get the kind of support that you need to heal, not that it must be us who supports you in this healing.  It can be hard to have this conversation with a new therapist, but most of us will be more than willing to help you connect with someone different if the chemistry doesn’t feel like a fit for you.  With this said, it is also important to talk through your concerns with a new therapist before deciding that he/she won’t be able to support you. You may find that there was a misunderstanding somewhere (by you or your therapist) that can be easily worked out.

 6.  Often, your therapist may ask you to sign something that gives him/her permission to talk with other important people in your life (OBs, MDs, midwives, pediatricians, doulas, lactation consultants, psychiatrists, acupuncturists, other medical providers, and/or family).  If this request is made, please understand that it is to best serve you in your treatment- to enable the therapist to create a comprehensive team of support people so that things don’t fall between the cracks.  Sometimes this release of information can feel scary, but you will find that enabling the therapist to talk openly with select others about your care enhances the support that you will receive.

 7.  If medicine is a part of your treatment plan, please understand the value of psychotherapy support along with this.  Sometimes a medicine to treat postpartum depression or anxiety will work so well to decrease or eliminate symptoms that women will feel that there is no longer a need for therapy.  While brain chemistry imbalance is often a large “cause” of postpartum distress, not addressing the other physical, psychological and/or social contributions to a mom’s challenges is, in my opinion, a missed opportunity.  Medicine is often an important part of symptom relief, but the life-long change in mental health will almost always involve aspects that go beyond the medicine that you are taking.

 8.  What you learn in your therapy treatment about managing anxiety and depression will be a gift.  I know that it probably doesn’t feel like that now, but you will likely walk away from your therapy with tools that you can pass down to your kiddos that will help them to manage distress in their own lives.  Life can be stressful, and many of us don’t learn the skills to manage distress until we are well into adulthood.  Through you, your children can learn some of those skills early, and this will serve them immensely throughout their lifetime.

 9.  Your therapy support will probably include a combination of education around perinatal mood and anxiety disorders, talking through how you feel, coming up with a plan that involves physical, social, and emotional strategies for health, and valuable support while you negotiate the journey towards wellness.  And while you understandably would like to feel better immediately, this takes time.

10.  You will feel better with support.  When women reach out to an appropriately trained mental health provider, follow treatment recommendations, and stick with the treatment they get well.  All the time.

~ Kate Kripke, LCSW

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About Kate Kripke

Kate Kripke is a Licensed Clinical Social Worker (LCSW) specializing in the prevention and treatment of perinatal mood and anxiety disorders. She is also a Colorado state coordinator for Postpartum Support International. Kate lives in Boulder with her husband and two daughters and writes an eponymous blog.

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  1. Greg Marlow says:

    Have you considered the stress of lactation as a cause of postpartum depression? Research has shown how omega-3 fat supplementation is an effective treatment for psychiatric disorders. Omega-3 fats are an important component of milk. If a mother is not getting enough omega-3’s for herself and her baby she could end up with psychiatric symptoms.

    • Actually, my understanding from the research is that omega-3 supplementation is an effective complementary treatment for PPD — it’s not something that research has thus far show would be effective as the sole treatment for a mom with moderate to severe postpartum depression. If you’ve seen more recent research that shows it would work alone for moms with PPD, let us know.

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