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.

    Understanding Vulnerability in Postpartum Depression

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    vulnerableWhat comes to mind when you hear the word “vulnerability?”  Really, what are the images, words, and reactions that invite themselves along with that word?  My guess is that it is something like this: weakness, fear, shame, powerlessness, and insecurity.  I imagine that, for most of you, the word vulnerability sends with it a warning sign and a very deafening message of “Be Tough!”  I imagine that all of you reading this know what it feels like to be vulnerable and that most of you are working very, very hard to run in the opposite direction.  To prove to others that you are anything but.

    My post today comes after being reminded, again, of Brene Brown’s phenomenal research on vulnerability.  Her message is that in order to feel strong, empowered, and connected we must face vulnerability head on.  Not run from it or resist it. Her decade of research tells us that the people who run from vulnerability are the ones who continue to feel shame, a lack of worthiness, and fear; that the people who embrace vulnerability are the ones who feel worthy, connected, and strong.  It is somewhat counter-intuitive, isn’t it?  This conclusion may confuse many of us who have been taught, from an early age, that admitting to vulnerability is failure.  But this conclusion may, when all is said and done, provide postpartum moms some freedom.

    For the majority of women who walk into my office, vulnerability is assumed to be a dirty word. For the first-time therapy client, the brand new mom, or the woman who exists in a place of shame and unworthiness, the idea of vulnerability is one to be avoided at all costs.  This idea is terrifying.  For many people, it equates failure.  It suggests lack of competence.  This resistance takes charge of the mom who is suffering in silence and is terrified to ask for help because she assumes this means that she is weak.  This gets expressed in my office as, “I feel so much shame for having to be here.  I feel like I should be able to do this without any help.”

    But yet that mom is there, in my office.  That mom is vulnerable.  Not because she is weak, but because she is a mom.  And she is human.

    Lets, just for a moment, name all of the times in early motherhood that we are vulnerable:

    When we try to get pregnant; when we learn that we are pregnant; during the first trimester; when we experience miscarriage; when we become pregnant again; when our bodies change before our eyes; when we give birth; when we adopt a child; when we attempt to breast feed our babies; when we choose to bottle feed our babies; when we wean; when we bring our babies home from the hospital, when our midwives leave, or when we bring our adopted babies home for the first time; when our babies cry; when we don’t have the answers; when we make mistakes; when we experience our partners’ struggle; when we are tired; when we are hungry; when we forget to change a diaper and our babies get a rash; when we lose our temper; when our feelings are hurt; when we realize we have hurt someone else’s feelings; when we are trying to cook dinner, tend to a newborn, and manage our toddler’s tantrums or endless chatter all at once; when we burn the toast; when we don’t recognize our bodies; when we have sex with our partners; when we are cold; when we are hot; when we are lonely; when we are sad; when our hormones are shifting; when we are surprised by something; when we are disappointed by something; when our expectations aren’t met…. Get it?

    WE FEEL VULNERABLE ALL THE TIME.

    What many of us do is this: Panic.  We assume that if we are vulnerable there must be something wrong with us.  And so we pretend to feel invincible when we aren’t.  We say that we are fine when we’re not.  We refuse help when we need it.  And we attempt to be who we aren’t in that moment- we pretend to be moms who are super-human and impenetrable.

    What would it mean if being “strong” meant knowing our limits and asking for help when we need it?  What if being worthy meant understanding our own individual challenges and working with them rather than against them?  What if being competent meant being super duper authentic with where we are emotionally, physically, and spiritually in each and every moment?  What if being okay meant being willing to not be okay?  What if the ability to acknowledge vulnerability was strength and not a weakness?

    Well, what Brene Brown’s research says is this:  We would be happier.  It says that we would feel more connected to others.  It says that we would report more feelings of worthiness and less shame.  It says that we would feel more competent, more capable, and more in control.  It says that by simply “leaning in” to discomfort we will be freed of the burden or it.  Imagine that!

    Postpartum mood and anxiety Disorders like PPD have many layers to them.  Moms who struggle with depression and anxiety often are dealing with a double whammy of vulnerability- they are both vulnerable because they are moms and because the symptoms associated with depression and anxiety are making it hard for them to think with clarity and confidence.  These moms may want nothing more than to wish their vulnerabilities away because they feel awful.  But the more they try to NOT be vulnerable, they more they feel that they are.  And they feel shame, and guilt, and worthlessness.    And they resist these feelings of vulnerability.  And around, and around, and around.

    If Brene Brown’s 10 years of research is accurate, we know with a fair amount of certainty that this resistance to vulnerability and this assumption that being vulnerable is a character flaw only causes more distress and creates a deeper sense of isolation and lack of needed connection.   And if we understand this, then we all may want to try something new: we may want to take a deep breath, find our inner courage and strength, and let someone in on our little secret.  Reach out for help. We may want to give ourselves permission to be vulnerable simply because we are.  And my guess is that by doing this, we actually get what we need to feel better.

    ~ Kate Kripke, LCSW

    Photo credit: © intheskies – Fotolia.com

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    Normal Postpartum Adjustment vs. Postpartum Mood Disorders

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    postpartum adjustmentI was recently asked to speak about the difference between normal postpartum adjustment and perinatal mental illness at a Maternal Wellness Summit in Denver. My first reaction was, “Sure. That is simple.  I know this like the back of my hand.” And then, upon my initial attempt to create a presentation for the audience, who were non mental-health providers working with perinatal women, I was reminded of how undeniably complicated this question really is.  It would be so much easier, so much clearer, if we always knew the difference between the two.  But even experts in the field of perinatal mental health aren’t always as clear about this as we would like to be.  And because of this, too often women get over or under diagnosed with PPD and other similar illnesses.

    What we do know is this:

    -       The image of the always happy, gracefully content, instinctively breast-feeding mom of an ever-peaceful baby is a myth.

    -       A “normal” or healthy postpartum adjustment includes plenty of anxiety-filled moments, plenty of time feeling isolated, plenty of overwhelm and a healthy dose of uncertainty.  Moms in this category will feel better with reassurance and community support.

    -       The Baby Blues, defined as a period of 2-3 weeks (and no longer) characterized by emotional vulnerability and mood swings, are a normal and expected part of a healthy postpartum adjustment.  The baby blues affect about 85% new moms and go away on their own.

    -       Almost all brand new moms will notice changes in appetite, some difficulty sleeping, and a decrease in sex drive.  Although these changes are also symptoms of depression, women who experience these are often not clinically depressed and are, instead, simply sharing a common (and transient) experience with other new moms.

    -       Approximately 1 in 7 women will struggle with a perinatal mood or anxiety disorder like PPD and, for these women, their symptoms will noticeably interfere with their ability to function as necessary, meaning that their symptoms related to depression or anxiety (or both) will intrude on their ability to sleep, eat, work, care for their children, engage in activities that were once pleasurable to them, or connect with others in social situations.

    Still, there is a vast group of women who get missed in the above “facts.” There are mamas out there who are really, truly struggling more than we might expect them to in a healthy adjustment to motherhood but who don’t necessarily fit the criteria for a major depressive illness or an anxiety disorder.  I’ve mentioned these moms before –  they are the mamas who hold it all together for those around them but, behind closed doors, fall into a heap on the bathroom floor, or in bed at night, or any place where no one is looking.  It’s these moms who I worry most about because they aren’t likely to reach out for the support that they need to thrive. [Read more...]

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    10 Things A Mom Learned in Therapy That Lead Her to Emotional Health

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    emotional healthMan, I love the work that I do.  Truly.  And recently a woman who I work with in my Boulder psychotherapy practice reminded me of this once again.  What this phenomenal woman reminded me of is this: Emotional pain is excruciating, but even depression that keeps someone in a place of deep despair for much of a lifetime can be shifted.  Not easily, of course, but with hard work, commitment, insight, and hope, heaviness can be lifted and emotional health recovered.

    I’d like to share her list with  you of the ten things that she has realized are important for her to feel well.  Ten things she says that she learned in my office, but ten things that, truthfully, she has discovered on her own.

    1.     Pay attention to physical health and symptom reduction. 

    Like so many others, Lisa* spent years in doctors offices seeking help for what she believed to by physical illness.  Emotional pain can be stored in the body and identified initially as physical ailments that seem ongoing.  When insomnia, body pain, and other physical distractions seem unexplainable and chronic, depression and/or anxiety may be the cause.  Lisa spent much of her life seeking help for these issues but now realizes that the cause of many of them was her emotional stress and depression.  What she has found is that when she takes care of herself physically (through sleep, nutrition, exercise, and breath) she feels better emotionally.  And, as she recovers from her depression she feels less physical pain and discomfort.

    2.     Acknowledge, defend, and obtain wants and needs.

    Lisa is not unlike so many others who have been motivated by the shoulds in life.  Lisa has been so accustomed to this that it took some time for her to recognize what her own wants and needs are outside of the shoulds placed on her by others.  When Lisa was able to listen carefully to her own internally driven wants and needs, she found that she not only accessed important instincts but she also was more likely to achieve her goals.   She has found that there is often a need to speak up for herself in this area and she has learned to be her own advocate regardless of the expectations of others.

    3.     Self-monitor and self-soothe.

    Lisa learned the importance of listening for changes in the way she feels.  What she found is that when she is able to notice shifts in body tension, her thought processes, and her reactions to things she is able to catch her rising stress early enough to stop it in its tracks.  Lisa has found deep breathing to be an especially helpful tool, along with other coping strategies for emotional health such as taking a break, exercise, and getting outdoors.

    4.     Accept emotional turbulence and understanding that suffering is temporary.

    As a child, Lisa was not allowed to feel anything other than happiness.  Struggle (especially fear, sadness, and anger) was not welcome in her household.  Because of this, Lisa had learned to dread the negative emotions that are experienced in life. Each time that she experienced even “normal” amounts of distress, she was catapulted into a deep dark hole that she felt she could not get out of.  Through our work together, Lisa learned that emotional turbulence is a normal part of being human, and that if she is able to let go of the need to change or deny it, her suffering is temporary.  This awareness has lifted the additional layer of stress and self-judgment that she often felt whenever she experienced anything other than happiness.  This has made the suffering that she does experience from time to time more tolerable.

    5.     Have self-compassion and non-judgment.

    Along with the above, Lisa has learned to understand the devastating impact that self-judgment has had on her well-being. As she learned to understand why she has felt the way she has with compassion and empathy for herself, her confidence and acceptance of herself has grown immensely. [Read more...]

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    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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