# #PPDChat Topic: Postpartum Therapy Q & A (And a Giveaway!) with @DrCHibbert

Tonight’s chat will cover a topic many of us have questions about – therapy.

Postpartum Mood & Anxiety disorders are complex to say the least. There is so much to consider when you’re facing diagnosis. One of the chief concerns is most definitely where to find help, how to tell if it’s good help, how to reach out for help, and how to talk with your family about finding good help.

I hope you’ll join me and Dr. Christina Hibbert, author of This is How We Grow and founder of the AZ Postpartum Wellness Coalition, as we discuss therapy and answer any questions you may have about it. Be sure to follow her on Twitter: @DrCHibbert

Also! We will be giving away a copy of Dr. Hibbert’s book to a lucky chat participant so you’ll want to be sure to join in! (No registration required and no money or product changed hands for this giveaway/chat.)

See you tonight on Twitter at 830pm ET, 530pm PT.

# What Does Kurt Gödel’s Incompleteness Theorem Have to Do With Mental Health?

In 1931, Kurt Gödel, a brilliant mathematician, gained quite a bit of fame with his “Incompleteness Theorem.” What Gödel stated was the following (in non-technical terms thanks to a Wikipedia article):

Any effectively generated theory capable of expressing elementary arithmetic cannot be both consistent and complete. In particular, for any consistent, effectively generated formal theory that proves certain basic arithmetic truths, there is an arithmetical statement that is true,[1] but not provable in the theory (Kleene 1967, p. 250).

Reading this, although directly applicable to mathematics, hit home as an analogy for mental health care and the quest for successful treatment of our conditions as patients.

The equation in our case, at its simplest expression is expressed as such: $\frac{P+D}{C}= T$

whereas P = patient, D = Doctor, C = condition, and T = treatment. But we know all too well that it is not this simple, don’t we? No treatments for mental health are fully consistent nor are they anywhere near complete.

There are too many factors involved to arrive at a simple treatment for the more complex mental health problems. Too many unknowns or additional variables. These variables come in the form of emotional/situational issues with the patient, education/knowledge of the presenting symptoms by the doctor, the symptoms presented by the patient, and the available known data regarding the various symptom sets related to the potential condition diagnoses which is again, limited by the presenting patient and comprehension of said presentation by the attending physician. Therefore, with this equation, we have an infinite amount of possibilities which is essentially what Gödel’s theorem states – that there is an infinite amount of true possible answers but none of them are absolutely provable.

If we take this theory, this Gödel theorem of Incompleteness, we significantly address the reasoning behind the continuing stigma of treatment for mental health in the world today. For instance, let’s address cancer. Most cancers respond to radiation and various forms of chemotherapy, right? Granted, we still lose people to cancer but there is an accepted manner of treatment and no one seems to question that course. It is assumed if one is diagnosed with cancer, he or she will receive some form of radiation or chemotherapy to combat the disease within.

If one is struggling mentally, we hear everything from “suck it up” to “take the natural approach” to “go exercise more” to “take a pill” to “every kind of therapy under the sun” to “eat more chocolate” to “happy light” to “color therapy” to “hospitalization” to…. you get my point. I could keep going for quite some time. There is a sea of possibilities to treat the many various forms of mental health issues which have plagued mankind since the dawn of time.

Even the ancient Greek scholars studied these disorders of the mind and out of these studies, they developed equations which helped them further gain insight into the functioning of the brain we have today. Now, they may have referred to mental imbalance as “black bile” but they were aware that when the mind and body were not connected and in balance, there was something very awry in the state of man. For the Greeks, mental well-being was very closely associated with the health of the body which is why good health was important. As a group of voracious scholars, to be off balance was to fail to be the essence of what their very society represented.

Back to the equation at hand, however. While scholars today struggle to continue to understand the inner workings of the human mind and thereby the issues which cause mental disharmony, we are left with this Incomplete Theorem of care to combat the imbalance inside us.

Gödel’s Theorem in the application of mental health may seem hopeless in the face of stigma because it does not narrow down the understanding of the range of issues so many of us face but there is a silver lining. With the infinite possibilities available for care and those possibilities increasing in effectiveness every day, we are able to fine-tune the available treatments for each patient, thereby increasing the potential for a successful outcome, even if it is just one case at a time.

I am reminded at this time of the story of the hare and the turtle. The hare zooms off past the great oak tree at the top of the hill the beginning of the race while the turtle meanders along the dusty road because well, that’s what turtles do. The hare, winded halfway through the race, stopped to nestle himself among some clover for a quick rest, only to discover the turtle crossed the finish line while he slept. As those around us continue to sleep through the reality that is the challenge of mental health issues, unaware of the battle we fight every second of the day, it is up to those of us who are awake and trudging forward to bring them to the finish line and show them that we are capable of getting there too.

An infinite but unprovable amount of solutions is not a bad thing for us – in fact, it is a rainbow of hope shining across an otherwise dark and stormy sky. Don’t let it go.

# Enriching postpartum therapy through at-home activities

In addition to the different types of therapy we discussed yesterday, there are some at home activities you can do (provided your therapist has approved them) to enrich your professional care and journey toward wellness.

First, start a gratitude journal. But I don’t journal. I hate writing! Don’t worry – this isn’t having to write an entire page every day. It’s a simple two entries a day. In the morning, when you first wake up, grab your pen and journal. Write down three things for which you are grateful, no matter how small that thing may be. As your day progresses, focus on what has made you laugh or smile. Once you have retired to bed each night (even if it’s for two hours), write down at least three things which made you smile or laugh during the day. At the beginning, even just barely cracking a smile counts. This activity is two-fold. First, it forces your brain to refocus on the positive things in your life. Second, it provides physical evidence of the positive influences in your life you can look through on the particularly tough days.

Second, write down all five senses on a sheet of paper. Taste, touch, smell, sounds, and sight. Write down five of your favorite things for each sense. Chocolate, silk, a favorite perfume, a cd or song that makes you smile, favorite color or flower or art. Post the list on the fridge. Treat yourself to at least one thing from EACH SENSE every week. Rotate them out. Putting the list on the fridge helps family members and friends to know what to help keep around the house as well. (Sneaky, I know)

Third, take time for yourself. Schedule it if you have to. One thing I love to do is to dress up my lunch. It’s my quiet time of day and I have been known to make a frozen pizza and a coke look like it belongs on a table prepped by Gordon Ramsey. Lean Cuisine never looked so haute. I’ll also treat myself to the routine of making tea. The key is finding one thing you love and making sure you do it at least once a day. Without interruption.

Some other moms will put positive post-its throughout the house and even in the car to help give them a boost when they need it most.

A successful recovery relies heavily on your active participation. If you’re not participating, you’re not getting better. YOU are the most important quotient in the equation when it comes to journeying toward mental health wellness!

How did you actively participate in your recovery? Have any tips for currently struggling moms? We’d love to hear them!

Be sure to stop back tomorrow for the triumphant return of the Friday Soother, my weekly gift to you!

# Therapy Choices for the Postpartum Woman

Once diagnosed with a Postpartum Mood Disorder, you are then faced with a literal bevy of choices regarding your path to wellness.

Some doctors may toss pills at you. If that happens, run. Run very fast and very far away from any physician who shoves anti-depressants your way before you’ve even finished describing what’s wrong. A good prescribing doctor will sit down with you and hear you out before grabbing for his pen and pad (or these days, keyboard and internet connection). A good physician should also run a couple of simple blood tests first to rule out thyroid disorders or anemia which need completely different types of medication to show improvement.

Some doctors may suggest psychotherapy. And that is where things start to get a little sticky. What kind of talk therapy? Will there be a couch? Will it be comfy? Will I have to talk about how my Great Aunt Edna used to kiss me on the cheeks and leave funny lipstick stains? Will I have to talk about things not related at all to my current state of mind? Will I be hypnotized? Or any other strange mumbo jumbo I’ve seen happen on TV or in the movies or from my best friend who found this website and…

Hold the phone there.

Cognitive Behavioral Therapy proved to be the best option out there for me. There was a couch but I didn’t lay down on it. I sat cross-legged on it as I drank coffee and chatted with my therapist. She sat in a really cool rocking chair with a foot stool. I got along fabulously with my therapist. That’s not to say we were bestest of buds but she knew what she was doing, just let me talk and work a lot of my issues out. I did occasionally talk about things in my past but it wasn’t at all like “So, you were born… let’s start there.” She met me where I was and let things fall where they fell. Or at least she seemed to. She did ask questions to get me to think about issues and how I was reacting to them. I had not planned on staying in therapy for long but once I became pregnant again, I made the decision to stay in through my pregnancy. Therapy gradually stopped at about 6 months postpartum of that pregnancy as we scaled our sessions back.

While I will not be covering every single last type of therapy out there, my goal is to provide some basic information for the most common therapies  used with Postpartum women.

At the top of the list is Cognitive Behavioral Therapy which is actually a blanket term for several types of therapies with similar traits. Primarily Cognitive Behavior Therapy (CBT) promotes that WE have power over our moods through our thoughts. You can read more about it by clicking here. A great resource now available for women and clinicians alike when it comes to treating Postpartum Depression is Karen Kleiman’s Therapy and the Postpartum Woman. You can read more about it by clicking here. (In the interest of full disclosure now required by the FTC, I have not been compensated at all for including this link. I sincerely believe it’s a good resource.)

EMDR or Eye movement desensitization and reprocessing is gaining popularity as an option. EMDR is most effective with Post Traumatic Stress Syndrome. You can read more about this approach by clicking here.

Peer Support/Group therapy is also an option. The primary benefit of this option is the realization it provides to women of not being alone. They really aren’t the only ones having a panic attack when they get in a car or experiencing frightening thoughts prancing through their mind at the most inopportune moments. Many times this option is a cost-effective option as well because many groups do not charge. A group led by a therapist may only charge a small fee such as \$10-15 for attending. While peer support should absolutely not replace professional medical care for Postpartum Mood Disorders, it is an important aspect to add to recovery. If your area does not have a local peer group, you can find help online. The Online PPD Support Page has a very active forum for postpartum women. You can also visit the iVillage Postpartum or the Pregnant & Depressed/Mental Illness Boards. (Shameless plug on the iVillage boards, I am the Community Leader for both.) Another bonus of peer support? It reduces the recovery time.

Pharmaceutical therapy is also an available option. Some women are against taking medication and that’s perfectly okay. No one should ever be forced to take medication. Typically, pharmaceutical therapy is paired with another type of therapy. In fact, combining pharmaceutical therapy with a type of Cognitive Behavioral Therapy has proven to be one of the most successful approaches for the Postpartum Woman. Sinead O’Connor really put it best during an appearance on Oprah in regards to the function of psychiatric medications. They are the scaffolding holding you up as you revamp yourself. There are risks involved with taking medications and you should absolutely educate yourself, talk with your doctor, and if you end up deciding to take medication, be sure to inform your child’s pediatrician if you are nursing so they can be involved in monitoring for any potential issues.You should also familiarize yourself with the symptoms of Serotonin Syndrome, a fast-acting reaction which occurs for some people when they do not metabolize medication quickly enough. The build up results in a severe toxic situation. You should also avoid stopping any pharmaceutical therapy without consulting with a physician. Stopping suddenly can cause very negative symptoms similar to Serotonin Syndrome. If you have any signs or symptoms of Serotonin Syndrome, get medical help immediately.

For more serious cases of Postpartum Depression that do not respond to medication, Electroconvulsive Therapy may be suggested. ECT has come a long way since the 50’s and is a viable choice for many women who do not respond to medication. Now, I am not saying that if you choose not to take medication, you’ll be given ECT. This is for women with severe depression who cannot metabolize or do not respond at all to medication. Choosing not to take medication does not buy you an ECT ticket at all.

For women who want to use a more natural approach, there are a lot of choices. Again though, I have to urge you to make sure you are seeing a professional during your recovery. Don’t take something because it worked well for Aunt Martha. Check with your doctor and make sure it’s applicable to your situation and okay for you to take in combination with any other medication you may already be taking. Be sure your naturalist or herbalist is licensed and trained. You’ll also want to make sure that any herbs/natural supplements you are taking are compatible with breastfeeding if you are doing so. You can visit the blog over at Rebuild from Depression for a food/diet based approach.

As you can see, there are a lot of options available if you are diagnosed with a Postpartum Mood Disorder. More and more practitioners are becoming familiar with these disorders. More help is available today than even 6 years ago when I was first diagnosed. Remember to ask questions when choosing a therapist, advocate for yourself and what best fits your personal lifestyle philosophy. Don’t settle just because you want to heal. You have the power to say no. It’s your body, your mind, your say.

# Just Talkin’ Tuesday 03.23.10: How did you find your therapist?

Original photo: "Everyday Use Items: a couch" by @foka_kytutr @ flickr.com

Congratulations!

You have broken through the fear to make the call for help.

But now what?

Unless you have a therapist tucked away with the burp cloths or shoved in a random diaper bag pocket, chances are you’ll be scrambling to find one after diagnosis with Postpartum Mood Disorder.

There are a lot of questions to be considered when searching for a therapist. Some are financial, some regarding training, and others regarding how experienced the therapist is with your specific diagnosis.

Just as you wouldn’t see an Oncologist for a Pulmonary Embolism, you wouldn’t visit a Substance abuse therapist for a Postpartum Mood Disorder.

But when you are in the throes of Postpartum Mood Disorder, you don’t necessarily have the wherewithal to be going down a checklist of requirements for a Therapist. (That is, unless you get lucky like me and develop Postpartum OCD. Then lists and keeping certain things in a very particular order becomes very very important to you.)

So how can you tell your therapist is going to be a good match or is trained in dealing with Postpartum Mood Disorders?

The first thing you need to know is what degrees to look for when ensuring the therapist you are considering is professionally and properly trained. A therapist will primarily hold a Masters level degree and be either a Licensed Social Worker or Counselor/Therapist depending on your state’s licensing office. A solid counselor should not hesitate to provide evidence of his/her training and current license status if requested. You may also see a Psychologist, who will hold either a Ph.D (research) or a Psy.D (Professional) for therapy.

The second thing to consider is specialized training in Postpartum Mood Disorders. If the therapist is truly focused/familiar with Postpartum Mood Disorder patients, he or she will be aware of Postpartum Support International, Karen Kleiman’s Clinician Training at the Postpartum Stress Center, or Pec Indman’s two day training via Postpartum Support International. If your therapist claims to be intimately involved with treating Postpartum Mood Disorder clients yet has no earthly idea who these people or organizations are, be wary. Ask what specialized training they have completed in the area of Postpartum Mood Disorders (if any) and how long they’ve been treating patients with similar diagnoses to yours.

Third, while your therapist is not meant to be your best friend, you should feel somewhat at ease during the appointment. If you feel uncomfortable or on edge during therapy, you’ll be less likely to disclose as much and therefore hinder your own journey toward wellness. It’s worth the search to find a therapist with philosophies similar to yours.

Do not be afraid to ask what their policy is on admitting to Intrusive thoughts. Many many women worry that if they admit they have thoughts of doing horrible things to their children, the children will be taken away from them. I faced this very same issue and asked my therapist this question before I admitted some pretty dark thoughts to her. Her response was that yes, she was required to report situations which indicated imminent harm to oneself or others but that she understood intrusive thoughts and their involvement in my particular diagnosis. This particular concern goes back to finding out what experience the therapist you are considering has with Postpartum Mood Disorders.

Dr. John Grohol over at PsychCentral has some good advice on how to tell a good therapist from a bad one. I would highly recommend you read it and keep these tips in mind.

Another great link to keep tucked away is “Tips for talking with your doctor” by Karen Kleiman over at the Postpartum Stress Center. She suggests starting with the doctor you feel most at ease with even if it’s your primary care physician. He or she can always refer you to specialists once a consensus is made that further help is indeed needed.

I now hand this post over to you, the reader.

What did you do to find your Postpartum Therapist? Any tips? Suggestions? What to look for? What to avoid?

Let’s get to just talking here!

(Tomorrow we’ll be discussing different types of therapy available for the Postpartum Woman. Stay tuned!)