[Editor’s Note: Whether you’re considering or getting therapy for postpartum depression or any other mental health issue, you’re going to love this clear explanation of how psychotherapy works and why it helps from Kate Kripke. -Katherine]
Lately in my office I have been having a very scientific and detailed conversation with folks about how psychotherapy works for women with antenatal or postpartum depression and anxiety. I mean how it REALLY works, inside the brain.
As many of you can relate, a large percentage of the new moms who come to my therapy practice have never been in therapy before. Although these women may have had symptoms of anxiety or depression in the past, they have been able to manage their symptoms through exercise, managing expectations, ensuring (apparent) control, and other coping behaviors. And now, with a baby in hand, these strategies no longer work and they find themselves in the last place they expected themselves to be after giving birth: my office.
Because this setting is so unexpected and never before experienced, many of these women enter our work together doubting the process. Does therapy really work? What is the point of talking about how I am feeling? Is it really going to get me somewhere?
Psychotherapy treatment for a postpartum illness, at least initially, is often different from therapy for more generalized disorders in that it is very focused on symptom relief. As Karen Kleiman notes so often in her many books on postpartum depression, women who come to therapy after having a baby are not seeking long-term psychodynamic support. They are in our offices, rather, because they want—no they NEED—to feel better. So our first goal is to work with them to reduce their symptoms. While that is sometimes less simple than it seems, the first part of PPD treatment is to assess brain chemistry, sleep, nutrition, support, hydration, and exercise so that a mom can do whatever is within her control to help herself to feel better.
Moms who are depressed or anxious also tend to engage in thought patterns that are destructive and that ultimately add to her feelings of distress. Because of this, therapy treatment for postpartum depression frequently involves a magnified look at self talk and the ways in which fortune telling, catastrophic thinking, discounting coping skills, all or nothing thinking, overestimating the threat, ‘what if’ statements, and ‘should’ statements (all known clinically as “cognitive distortions”) are interfering with a mom’s ability to feel good.
Finally, once a mom is feeling well enough to engage in more triggering discussions around her past that may be contributing to her current distress, therapeutic treatment for PPD often looks at beliefs and behaviors that are developed through earlier experiences.
Ahh, this last one: This is where the resistance, hesitation, uncertainty, and often anxiety come in. Is this talking part really helpful? How much good can talking about what is over and past and done with have in feeling better today?
So, for this question, let me explain in as basic a way I can how the brain works.
Our brains are made up of a number of different regions that control logical thinking and rational thought (the pre-frontal cortex), emotional processing (the mid brain or limbic system), and the autonomic nervous system or our fight/flight response (the brain stem). Our brains are also divided into two parts: the Right hemisphere (responsible for emotion, relational response and creativity) and the Left Hemisphere (responsible for abstract and practical thinking).
Experiences that we have, beginning in childhood, help to develop neural pathways, or well tread instincts, between parts of the brain. Sometimes these neural pathways serve us. For example, if we have been raised by consistent, present, and emotionally available parents, we may learn that others are to be trusted and enter into adult relationships with this assumption. In other words, we develop the instinct to trust.
Sometimes, however, our brains form neural pathways that get in the way of our emotional health. This is the case when, for example, a child is raised in an environment in which she is constantly ridiculed, laughed at, and invalidated. This child’s brain will, most likely, form neural pathways that lead her to believe as an adult that she should not express herself, that she does not have anything important to say, and that she is not good enough just as she is. For this mom, there may be the instinct to self doubt. We develop ways of thinking and doing that are the result of a sort of knee-jerk reaction in our brains.
So, to frame this very visually, imagine that you are exploring the deep jungle. The grasses are high and the vegetation thick. There is a path, however, that is well trodden; the grass has been walked on and a clear trail lies ahead. What will you do? You will take this path. It is “easiest” and most traveled and you know it well. Why on earth would you try to get to where you were going by bushwhacking though thick and intimidating vegetation?
The answer to THAT question is because, although the path is visible and well trodden, it no longer takes you to some place safe. It seems easier to take this path, but really where it takes you is to a place that doesn’t feel so great.
Yet the rest of the terrain looks impossible to pass though. What you learn in therapy is to form new neural pathways, or new trails, so that instincts and belief systems change for the better. What therapy does is help you to trod a new path in the vegetation, often step by step, little by little, until a new trail is formed; one that takes you to someplace that feels good. And what happens over time to that old path? As it is walked on less and less, the grasses return to where they once were and, over time, that trail no longer exists.
A well-trained psychotherapist helps with this process by working with you to explore these old patterns. Talking about this stuff allows for the information that is needed to understand why you think and behave the way that you do today. And once you understand the implications of early experiences, you are armed with the awareness—and hopefully the tools—to trail blaze some place new.
This is not always easy, of course. But physical strength (obtained through basic needs), unconditional support and encouragement (from your therapist, your spouse, or others close to you), and the prospect of a happier way of being make this all very, very possible.
Through therapy, you literally change the landscape and structure of your brain. So, yes, according to brain science, therapy does work.
~ Kate Kripke, LCSW
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Thank you for this! As a survivor mama with a biology degree, my anxiety and education led me to sometimes obsessive biological understanding of what was going on with me. Sometimes it helped me feel better to know how and why my body was fighting me on how I wanted to feel. I know therapy works because I've had some significant "aha" moments recently that have given me absolute freedom from thought patterns I developed as a child. I love reading the biology behind it as to why!
Hello Catherine and Kate
This is a REALLY excellent piece and describes the process so succinctly for clients – I love the bushwacking metaphor and with your permission would like to share this piece with New Zealand mums and dads. May I put it up on the website and in our newsletter credited to you both of course.
Counselling and psychotherapy are so often seen as either luxury activities for those who have enough cash to indulge in talking or for those who (they) think must be going mad/crazy/worst case scenario.
As those who have had the wisdom and courage to experience counselling /psychotherapy will testify, the experience is beneficial and can be life changing.
It is false economy to ignore therapy help in the early stages hoping the symptoms will go away. They probably will eventually but at what cost to enjoyment and good mental health in the present.
So all you mums and dads out there consider letting go of one or two other activities in favour of your mental well being and talk to a recognised perinatal therapist now.
Kia Kaha – be strong
Rosie from New Zealand Perinatal Mental Health Trust
Rosie is a counsellor working with perinatal mental health in NZ
I am glad that you have found this useful… and it sounds as though you are doing such important work in New Zealand. I will defer to Catherine on usage, as this is her site, but I am happy for you to use the metaphor whenever it feels useful!
Glad to know you are out there.
Do visit our website http://www.pmhnz.org.nz and email me with your contact details as we'd love to have you on our database
When I next visit the western deserts which is a beautiful spot shall make a note to contact you.