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.

13 Things You Should Know About Grief After Miscarriage or Baby Loss

By Kate Kripke May 16, 2013 Comments

Trigger warning: The following post is one which discusses pre-term and neonatal loss and the process that many women and families go through when they have lost a baby. If you are feeling vulnerable at this time and this post does not speak to your experience, consider not reading it as it may cause you distress at a time when you are trying to regain strength.

Losing a baby though miscarriage, elective termination, stillbirth, childbirth, after a NICU stay, SIDS, or any other time is, without a doubt, one of the most difficult experiences that a parent will ever endure. There are no words to explain the depth of despair that a parent goes through when attempting to understand the shift that occurs when all hopes and expectations suddenly drop out from underneath anything stable. It is an experience that many will never need to make sense of and also one that many others will swim through unexpectedly. It is tragic and drastic and totally and completely unfair and yet thousands upon thousands of families find themselves in this position each year.

Here is what we know:

Approximately 15-20% of confirmed pregnancies end in miscarriage
In the US, the rate of stillbirth is documented as 1 in 160-200 pregnancies
In the US, the rates of SIDS affects between 5,000-7,000 infants every year
In the US, approximately 11,300 infants die within 24 hours of their birth each year

I give these statistics not to scare you, but because it is important for those mothers who have lost their children to know that they are not alone; to know that there are many others out there who are needing to navigate this loss too.

I have worked with countless women in my office as they try to manage the unfamiliar emotions that surround loss, and I have learned a great deal from these phenomenal moms. I also have a dear friend and colleague who lost her daughter hours after birth and she, too, has honored me with her insight, pain, and eventual healing. With the information gathered from both my clients and my dear friend (who is now a clinician in San Francisco specializing in perinatal loss), this post today is written for all of the moms out there who are trying to navigate the unfamiliar postpartum experience while also grieving the loss of a child that never made it home or past that first year mark. For these moms, postpartum distress is complicated by the process of grief, and sometimes it is hard to make sense of what goes where in this unimaginable puzzle.

So, if you are one of these women, here is what I want you to know:

Some women who lose babies through miscarriage are able to move through this loss freely, while others feel deep despair at this loss. There are no “shoulds” in this. No right way to feel. If you feel strong and grounded and ready to move forward after a miscarriage that is totally valid. If you feel deep loss and grief then that, too, is appropriate. No one gets to tell you how you feel except you.
Any time a body goes from being pregnant to not being pregnant, there is a significant shift in hormones that can affect brain chemistry. Postpartum depression, anxiety, and other mood disorders can affect a mom regardless of the point at which a baby is delivered. You are likely in a position where you need to process through grief while also having a vulnerable brain chemistry. This can make the experience of healing feel impossible for many.
Grief is a normal process and includes a shifting of emotions such as denial, anger, bargaining, depression, and acceptance. Grief felt after the loss of a baby is not necessarily depression and while there may be some overlap, it should not be treated as such. If you feel angry one day and dissociated from your loss the next, this is normal.
If you are not aware of a shifting through the stages of grief and continue to feel debilitated by your suffering, there may be an element of clinical depression or anxiety that needs to be addressed. “Healthy” grief moves, but sometimes it can develop into relentless depression that requires more specific treatment. Many moms will experience depression that includes feelings of guilt, shame, self-doubt and sometimes suicidal ideation. Regaining a sense of self, hope, and trust is important to one’s healing after a loss such as this. [Read more...]

May 16, 2013 10:00 am Filed Under: Miscarriage, Postpartum Depression

8 Types of Psychotherapy for Postpartum Depression Treatment

By Kate Kripke March 21, 2013 Comments

You may have heard it over and over before — one of the best ways to treat a postpartum mood and anxiety disorder like postpartum depression is through therapy. “Find a therapist” is probably the first suggestion that you will hear from people who specialize in these challenges. Symptoms of depression, anxiety, post traumatic stress, OCD, and adjustment can be understood, worked through, and alleviated though psychotherapy but what this treatment actually looks like can vary tremendously.

So, what is psychotherapy, exactly? While a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Marriage and Family Therapist (MFT), Psychologist (PsyD or PhD) can all provide psychotherapy support, what this support actually looks like may be different depending on that particular therapist’s approach to treatment. And so “I am seeing a therapist” can mean something very different for each person.

In light of providing clarity around this, I am going to briefly describe the different types of therapy that are most utilized in the treatment of a postpartum mood and anxiety disorder like postpartum depression:

Interpersonal Psychotherapy (IPT) is currently thought to be one of the most effective therapy models for treating PPD. IPT is a time-limited form of therapy (12-16 weeks) and the main goal is symptom relief. An IPT therapist tends to be fairly direct and active in the treatment, and he/she will help to make insights regarding the sources of a new mom’s distress. IPT is based on the premise that postpartum distress is rooted in four “problem areas”: 1. Grief (acknowledging the losses that occur to sense of self, changes in relationships, or more specific loss) 2. Role Transitions (life stage transitions and social transitions including loss of independence and changing social networks) 3. Interpersonal Disputes (ones that frequently occur after the birth of a child including unmet expectations and intimacy struggles within partnerships) 4. Interpersonal Deficits (looking at struggles with attachment in other relationships that may be causing distress.) A big part of IPT is the teaching of communication skills that assist in building relationships, stronger social support, and increased confidence. IPT is manual-based and follows a specific course of treatment.
Cognitive Behavioral Therapy (CBT) is best known for its efficacy in treating anxiety including OCD. CBT works with the understanding that the way we think affects the way that we feel, and so treatment is focused on helping mom have control over her thoughts so that she feels more able to change them. A CBT therapist will work with a mom to identify and acknowledge her automatic thoughts, evaluate these thoughts and become aware of when these thoughts are not helpful, explore and change underlying beliefs, differentiate between realistic and false threats, and develop new and more helpful perspectives. CBT helps a mom to develop coping strategies so that she feels better equipped to manage distress. CBT uses tools such as homework, relaxation, exposure therapy, thought stopping, mental imagery, and tools for changing catastrophic thoughts and irrational thinking. Mindfulness-Based Cognitive Therapy (MBCT) is a form of CBT that also incorporates significant component of mindfulness meditation.
Dialectical Behavioral Therapy (DBT) began as a treatment for Borderline Personality Disorder, but is now known to be effective in many instances where distress is prominent. Like CBT, DBT uses practice and homework as a part of its process. DBT teaches skills in the following categories: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. DBT is often supported through both group and individual therapy and follows a specific guideline for teaching skills to reduce symptoms related to distress.
Psychodynamic psychotherapy is one of the earliest types of psychotherapy and focuses on unconscious and past experiences in understanding current behavior. Psychodynamic psychotherapists believe that our earliest childhood experiences have a direct impact on our present distress, and that when moms are able to identify and accept these experiences as playing a role they are able to begin the process of healing and becoming less entangled in the past. This type of therapy looks into early experiences that play a role in forming beliefs about ourselves as adults, and identifies those beliefs that are no longer helpful. When working with a psychodynamic psychotherapist, a mom will be encouraged to talk about relationships with parents and other significant people in an effort to uncover the unconscious content of a mom’s way of thinking. This process reduces tension and distress. A psychodynamic approach to treatment is thought to be important because change requires awareness and understanding to occur. Often in this type of therapy, the “aha” moments allow for self-validation, empathy, and, ideally, freedom from self-judgment.
Eye Movement Desensitization and Reprocessing (EMDR) is currently thought to be one of the most effective types of therapy when working through a traumatic experience and is being used more in the treatment of postpartum PTSD. This specialized type of therapy requires specific training and credentialing. EMDR uses elements of both CBT and Psychodynamic therapy along with specific techniques that are used to reduce the sensory impact of traumatic memories. Because traumatic memories are often stored in EITHER the right (feeling-based and emotional) OR left (logical and intellectual) side of the brain, EMDR uses a bilateral stimulation of the brain (though eye movements, bilateral sound, or bilateral tactile stimulation) combined with beliefs, visualization, and attention to body awareness as a way to re-process memories more effectively. A significant piece of EMDR involves helping mom to access thoughts and feelings that are positive, grounding, and healing.
Solution-Focused Brief Psychotherapy focuses on a specific issue and works toward positive change. Unlike other therapies that identify early experiences as playing a role in current distress, solution-focused therapy stays away from past problems and highlights, and instead, on a mom’s strengths and skills. Much of this type of therapy is about setting goals and is solution-based rather than problem solving. This very short-term therapy often requires several sessions to be beneficial, however many other types of clinicians may feel that this type of therapy does not address the root cause of problems effectively enough to create lasting change.
Group Therapy uses the role of community in support. A true group therapy session is facilitated by one or more trained psychotherapists and uses the dynamics that occur between members of the group to help identify problem areas and interpersonal distress. A postpartum depression support group often combines psycho-education (teaching about maternal mental illnesses, causes, treatment options, life strategies for wellness, typical new mom stresses etc.) with the important role of validation from others in the group. The goal of a PPD support group is to help build community, give space for a mom to be heard by others and to learn that she is not alone in her struggles, and to talk about and share ideas regarding stress management, coping, and early mothering.
Couples Therapy provides a space for partners to be heard during a time of crises. In a couples therapy setting recurrent negative patterns within the relationship will be addressed and couples will learn communication and listening strategies necessary in working through these challenges. Often in postpartum work, couples therapy will address issues related to PMADs, changing dynamics in a relationship, intimacy challenges, individual needs that may be interfering in connection, and individual needs that are necessary in maintaining the health of a couple’s relationship.

When interviewing new therapists, it is absolutely appropriate to ask him/her what type of therapy he/she practices…. However in most cases you will find that therapists use pieces of many different types of therapy in their work. A therapist who has a specific training and therapeutic background may allow for other types of therapy in his/her work when working with a mom struggling with a PMAD. Specialists in the treatment of PMADs will be driven by what is known about important aspects in PMAD treatment (biological causes, symptom reduction, life change management, expectation, infant-attachment support etc) and will either incorporate therapeutic approach into this work or wait to begin that phase of treatment until a mom’s initial distress is managed.

I hope this helps.

~ Kate Kripke

For more on this topic, try:

5 Common Concerns About Therapy for Postpartum Depression

How Does Psychotherapy for Postpartum Depression Work Anyway

March 21, 2013 9:50 am Filed Under: Postpartum Depression Treatment

Is Someone Holding Your Postpartum Depression Against You?

By Kate Kripke February 11, 2013 Comments

Postpartum depression changes you. There is no doubt about it. It can also change your partners, children, extended family and friends. Thankfully and for the most part, these changes are positive ones; although it is certainly difficult to see this side of things when you are smack in the middle of your recovery. But I can say with complete honesty that when moms have received adequate support during their illness, more times than not, women and families leave behind their postpartum mood and anxiety disorders feeling a greater sense of self, more ability to communicate their needs, and more prepared to keep themselves healthy and teach their little ones to do the same. I know that it is hard to hear when you are amidst the suffering, but postpartum depression can create opportunities for growth that women never saw coming.

And then, unfortunately, there are also the times when this is not the case. There are, without doubt, times when a mom’s diagnosis of postpartum depression can be used against her in ways that can create the feeling of entrapment, disgrace, and continued shame. This is what I am writing about today.

Katherine has heard from these moms who are reading her blog, I have worked with these women in my office, and we have all heard about these moms in the media: these are the moms who can’t seem to shake the label of “postpartum depressed” whatever they do. They are judged by partners, family members, friends, and, at times, society as a whole no matter how distant their diagnosis may be. Courts try to use their diagnoses against them in custody battles. Partners at home assume for years that anytime they react emotionally to something they are doing so because they have or had postpartum depression. And family members and friends suddenly hold lesser expectations for success simply because these moms have at one time been unable to perform at their capacities. These women feel like they are taken less seriously. They feel less trusted. Their postpartum depression suddenly defines these moms in a way that does not allow them to be who they truly are outside of the illness that they suffered from. [Read more...]

February 11, 2013 12:01 pm Filed Under: Postpartum Depression

Should You Have A Baby If You Struggle with Serious Mental Illness?

By Kate Kripke February 7, 2013 Comments

Let’s say you are in the high-risk category for developing a postpartum mood or anxiety disorder like postpartum depression. You have battled depression, anxiety, OCD, or bipolar throughout your lifetime, and you have been told that the major hormonal and identity shifts that occur during pregnancy and childbirth are likely to push you out of remission, aggravate your symptoms, or lead to even more mental health challenges than you have already faced, like psychosis perhaps. Maybe you are currently taking medicine and maybe you are not. Maybe you are willing to continue your medication while pregnant, and maybe you are not. Maybe you have already had a child and suffered with severe postpartum mental illness including psychosis and maybe you have not. But one thing is for sure: you desperately want a baby and you are scared to death about what this might mean for you. And for your child.

These are tough questions, and anyone who identifies with the above snapshot can attest to how unbearably complicated all of this can feel. Struggling with a perinatal mood and anxiety disorder when you didn’t see it coming is like a blow to the head that knocks you flat for a while. Thinking ahead and knowing that you are likely to struggle gives a mom the chance to plan ahead for support, but can also be downright terrifying.

Perinatal mental illness awareness is increasing, but the fact is that there are many highly skilled medical professionals out there who still are not up to date, informed, and knowledgeable about the many elements to consider when it comes to perinatal mental health. Women are told to not even consider having children due to mental illness when there may be safe ways to do so. Women are told to stop taking their medication during pregnancy when this is neither necessary nor safe. Women are given wrong information all the time, and life-changing decisions are made without adequate information. And this is a problem.

This is what we know, in no particular order: [Read more...]

February 7, 2013 10:18 am Filed Under: Postpartum Depression