psychotherapy, posptartum depression treatmentAsk any clinician who treats postpartum depression and related illnesses,  there are many times when a mom who is struggling and in desperate need of support reaches out for an initial therapy session and then does not return.  And while those of us who get the cancellation call or who wait in our offices at the time of her appointment until we register that she is not coming feel worried or disappointed that we will not see her again, we also get it.  This postpartum depression treatment stuff is hard.  And it can be scary.  And it can feel like another mountain to climb when moms are already worn out from the first several mountains that they have run into since giving birth to her baby.

Sometimes it may be that we simply weren’t the best fit for this particular mom who finally reached out for help with PPD and is now disheartened by the idea that no one can help her.   A mom cancels after a first session and we understand why.

Nonetheless, it still concerns us, because while some of these moms may reach out again or seek out someone better fitted to their personalities or needs, many will never attempt to get support after that first appointment.  These moms will walk away from that first session with a variety of concerns about therapy for postpartum depression. Among them are these five thoughts:

  1. “No way am I doing THAT again. If I go back and see her she will make me take medicine and I am not doing that.”
  2. I knew I shouldn’t have tried therapy. I knew he would just ask me about my own parents and I am so done talking about them.
  3. When I told her that I was thinking about wanting to hurt myself, the therapist said that I needed to let my husband/partner know how much I am struggling.  I knew that I couldn’t trust her to keep my secrets.
  4. He suggested that I need more time for myself?  What does he know?!  There isn’t more time for myself.  Clearly, he does not understand…
  5. It’s just too expensive.  I can’t afford her fee every week and so there is no way that I will ever be able to get support.

I, like many others, understand these concerns and more, but I am also concerned for those moms who, because of the frustrations that they walk away with, never receive adequate treatment and care.  What we know without a doubt is that moms who reach out for support from an appropriately trained expert in perinatal mental health and who follow treatment recommendations get well.

So, what to do about these very valid concerns if you find yourself cancelling after a first session?  Go back, at least one more time, and talk about them.  As hard as this might be.  You see, the truth is that the first session is not necessarily an adequate representation of the work because connections, trust, and assessments can take time.

If you don’t agree with your therapist’s suggestion to take medicine, ask her why she feels that medicine is important for you and help her to understand what concerns you about this option.  If you are frustrated by his questions about your own family, let him know that so that he can identify the reasons why this piece of history may be important in understanding your current struggles as a mom.  If you are angry that she isn’t willing to keep your suicidal thoughts a secret, tell her this and make space for a conversation regarding why this type of secret is harmful to you.  If you feel misunderstood, do your best to be open about who you are and what you are struggling with.  And if you still feel misunderstood, ask for another referral from that therapist or someone else. Many of us care more that you get the support you need than that you are seeing us for this support.  And, if you can not afford her fee, ask her about the option of a sliding scale; most of us will have a number of these spots in our practice if we do not accept insurance as direct payment.

You have been through so much already.  And postpartum depression is a lonely and often very long battle when you are in it alone.  Let us help you get to the support that will lead you toward wellness again.

~ Kate Kripke, LCSW

Editor’s Note: Karen Kleiman also wrote about therapy this week. So for another great story on this topic, read No Time For Therapy