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)
Interpersonal Psychotherapy 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)
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)
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)
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
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
10 Things to Know About Psychotherapy Treatment for PPD
And click this link to find a postpartum depression therapist near you.
Dialectic Behavioral Therapy (DBT) saved my life. I am thrilled to see it included on your list. I was fortunate to find a DBT intensive outpatient program (3X per week) and then a 1X DBT group as follow-up — both within a 30 minute drive from my home. I can’t speak highly enough of DBT and its effectiveness.
I find myself using my DBT skills every day. They help me to take care of myself, my marriage and my children.
One word on Eye Movement Desensitization and Reprocessing (EMDR) — it sounds a little scary, but it is NOT AT ALL so.
I have also done EMDR in conjunction with Cognitive Behavioral Therapy (CBT.) The “brain stimulation” is not electrodes stuck to your head or anything! 🙂 In my case (and my husband’s experience w/ EMDR–treatment for addiction), there were “clickers” that we held in each hand or put under each thigh.
These clickers do just that– click or vibrate at a steady and regular pace, alternating between the left and right. They don’t hurt at all. After awhile, you stop noticing them all together. The physical stimulation causes the brain to access both the left and right hemispheres, as the description above explains.
Thank you again for this wonderfully informative post.
Heidi- thanks for sharing your insight and for that VERY important addition to my information on EMDR… It can sound scary and so I appreciate your clarification…
Great article! Thanks, Kate, for making it so easy to understand the different types of therapy and when they might be most appropriate.
I concur with Heidi’s remarks about EMDR — sounds a little “out there” but has worked wonders for me with specific traumatic issues, including birth trauma. For years I had recurring unsettling dreams about a specific time in my life; after a few sessions of EMDR, I’ve NEVER had those same dreams again.
The good news is that there is an answer to each woman’s situation — it just takes some knowledge and research to find the right therapist and the right technique.
do not forget psychiatric nurses….
I encourage women and families to be good consumers when looking for a therapist to treat pregnancy and postpartum related mental health issues.
Here are the screening questions I list on my website that should be asked:
When searching for a therapist it important to find someone with the right training and experience. These questions will help you when you talk to a prospective therapist. Be a good consumer! Take your time and find someone that you feel comfortable with, who has the skills and training appropriate for your needs.
Ask these questions:
» Do you have any specific training in women’s reproductive mental health or the specific area of help I’m looking for? Most psychologists and psychotherapists are trained and work as generalists with no specific training in this area
» What model of therapy do you practice? Long term psychodynamic therapy is not appropriate for this population.
» Can you recommend any books on the topic? Many therapists are generalists, without a specific area of focus or advanced education. Any therapist who specializes or says they have expertise in areas such as neonatal loss, or postpartum depression/anxiety, should easily be able to name several books on the topic. If they cannot, they are not familiar with the topic.
» Do you belong to any professional organizations? Therapists involved in the field usually belong to Postpartum Support International, the North American Society for Psychosocial OB-GYN, or the Marce Society.
It’s often difficult to find a trained specialist. Regroup Therapy is helping expand the reach of therapists through the internet. We are offering therapist led support groups that can be accessed by women all over. We are also now offering individual on-line live therapy. Our goal is to have trained providers in each state that provide individual therapy to women.
To find an online support group go to http://regrouptherapy.com
If you are interested in becoming a regroup provider please contact firstname.lastname@example.org.
With the right treatment, you will be well!
Thank you for sharing this. It is hard to, when you are in the throes of PPD to know what kind of therapy to look for. I was seeing a psychodynamic therapist for 2 years before we parted ways. I treasure the help from my first therapist, but now I know that I need more of a CBT approach – more of a “practical applications” therapy.
This is all such good information. It’s so important to remember that not all therapists are created equal and that sometimes it takes a while and many “first dates” to find “the one”. I wish I had known that a few years ago. :-/
GReat article Kate!!! And thanks to Katherine Stone for wider dissemination – and to the many great comments and information shared here. A wealth of information and oh so important!!!
It’s great to see that there are so many options for help. Chances are you won’t have access to all these therapies locally, but it will give you an idea of where to start.
If one type of therapy doesn’t help, there will be another that will, so don’t give up!