Tag Archives: Cognitive Behavioral Therapy

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.

Note: I had a reader, Steve, from Noblu.org leave a comment regarding IPT or Interpersonal Therapy. You can click here to read his comment. Thanks, Steve, for stopping by and sharing your knowledge with us!

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.

Tomorrow we’ll be discussing some things you can do on your own to help your recovery along. Stay tuned!

Sharing the Journey with Pec Indman

Pec is one of the warmest people I have had the pleasure of emailing. Ever. She has been super supportive of all that I do and for me it’s amazing that in just four years, I’ve gone from an unsupportive OB to being able to email an expert like Pec and get a response in mere seconds. What a road! Pec is whole-heartedly dedicated to women and families struggling with Postpartum Mood Disorders and like me, I know she’ll never stop doing what she’s doing. Keep up the amazing work and thank you for sharing a bit of yourself with us!

Would you share a little bit about yourself with us?

I grew up in a very loving family. My parents were active in political movements that supported causes including civil rights and the women’s movement. I became a family practice trained Physician Assistant in the 70’s, and worked in Family Practice and women’s health. After deciding to go back to school, I completed a Master’s in Health Psychology, and then a Doctorate in Counseling. I had Megan, my first daughter just after I completed my doctoral coursework. Emily was born almost six years later, after treatment for fertility problems and a miscarriage.

How did you become focused on Postpartum Mood Disorders? What drew you in to the subject?

About 12 years ago, I was in an OB/GYN waiting room and happened to see a flier by Postpartum Support International (PSI) about Postpartum Depression. I realized that although I had years of training and experience in women’s health and mental health, and had delivered two children, I had been taught nothing about mood disorders related to childbearing. I was horrified and angry. I am still outraged that my Master’s program in Health Psychology never covered anything related to specific issues related to women’s reproductive mental health (for example, PMS, perinatal, or perimenopause/menopause). So, I joined PSI, read everything I could, and went to trainings and conferences. I began teaching for PSI and co-authored a book, Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression. We’ve updated it several times to reflect the latest information and research, and are proud to have it in Spanish, as well. I’ve been honored to be invited to participate and contribute in the creation of several federally funded projects on perinatal mood disorders. I feel very honored to do this work. It’s the most rewarding work I’ve done. It’s also the most fun; I work with nice moms, sometimes they bring their babies, and everyone gets better! What could be more fun?

I know different approaches work for different people. What have you found to be the most successful in your practice with Postpartum Women?

My clients describe me as “warm and fuzzy.” I like to think my office is a comfortable place where women and families can feel safe and free from judgments. One of the things I find that women and families thirst for is information. So often I hear, “why didn’t anyone tell me I was at risk?” I practice a model of therapy called cognitive-behavioral therapy. It is a very practical model that helps people learn how depression and anxiety distort thinking and teaches people how to think differently. My clients really appreciate the practical skills and tools.

As a mom, what have you found to be the most energizing about motherhood? The most challenging?

I feel enormous pride when I watch my girls achieve something they have worked hard to accomplish. The most difficult thing has been standing by while they have experienced life challenges, knowing I can’t take away the disappointment and pain.

What are some of the biggest challenges you have faced in balancing motherhood and work?

I think the idea of “work/life balance” is an impossible goal that sets women up for feeling not good enough. I see it as a juggling act. Sometimes one ball is on the floor-it might be the laundry or the dishes. Or, sometimes a kid gets sick or there is a client emergency. There is no “balance”. I think the key is to be flexible and have clear priorities. Laundry and dishes will always wait for you. I am extremely lucky in that I can arrange my work schedule around my “chauffeur” mom job.

We often encourage mothers to remember to take time for themselves. What is it that YOU do to recharge your batteries?

I am an avid scuba diver and tropical fish lover. My whole family dives, and we just had a delightful family vacation in Cozumel, Mexico. I enjoy taking underwater photos, and my husband takes underwater video. So, when I can’t be with the fish, I can still enjoy their beauty and the magnificent underwater world.

Postpartum Mood Disorder recognition and acceptance has come a LONG way but we still have miles to go. What do you see as some of the hurdles we still have to cross?

We have come a long way, but we have a lot more work to do. Ideally, all women should be informed about risk factors for perinatal mood disorders, before getting pregnant or at a diagnosis of pregnancy. Women should be screened for mood problems during pregnancy and throughout the first year. In order to do this, health care providers need have a better understanding of perinatal disorders and why it so important to take them seriously. And we need to train providers to treat women and families suffering. I am appalled that the most common complication of childbearing is still so misunderstood and poorly treated. I think we need to dispel the myths that still surround perinatal mood disorders. We need to educate women and families about the problem and to be good consumers in seeking treatment. We need to train health care providers to ask the questions and screen, and we need a trained therapist on every street corner.

I believe one of the biggest keys to positive recovery for women is full family involvement -i.e., a supportive and educated husband/partner and family. Of course, education prior to an episode is wonderful but how can we best aid in this process when the family is in the midst of a Postpartum Mood Disorder Crisis?

I agree that family involvement is critical. Whenever possible it is important to include the family in the process of treatment. Often the family is confused and unsure what to say or how to be supportive. Treatment should include family whenever possible.

What makes you smile?

Hanging out with my family, being in a clear turquoise tropical ocean (I did have to learn not to smile at the fish, because it would cause my face mask to leak!), and hearing a mom say “I got my self back”.

And last but not least, if you had a chance to give just one piece of advice to an expectant mother (new or experienced), what would you say?

I have a few words of wisdom:hug and kiss your kids as often as possible, notice the positive, and remember to be emotionally flexible. Know what is developmentally appropriate for your child and have realistic expectations of them. Lastly, if it’s not a health or safety issue, be able to let it go…… somethings aren’t important to make a big issue over.