Expert Advice: Q+A With A Postpartum Therapist
Today we are speaking with Aga Grabowski, psychotherapist and co-founder of Wildflower Center for Emotional Health, a group of caring mental health professionals skilled in the practice of individual, couples, family, and group psychotherapy. Aga generously took the time to answer our most pressing questions about postpartum therapy so you can start feeling better, faster.
How is postpartum depression different from the baby blues?
This is a really important question as the two are often confused which may cause women to delay seeking help. It’s important to know that every new mother will feel overwhelmed by the demands of motherhood, but there is a clear distinction between transient negative emotions and thoughts that accompany this transition, and symptoms that require professional help.
Postpartum blues is a mild and temporary experience of emotional volatility that starts after giving birth and resolves by two weeks postpartum. Blues is experienced by the majority of women and is not a cause for concern. It’s marked by moments of irritability, tearfulness and feeling more reactive. Women are able to return to a contented baseline throughout the day and don’t experience impairment in their functioning.
If a woman had a baby and feels persistently distressed – sad, anxious, and/or irritable – and does not bounce back, this may suggest the presence of symptoms of postpartum mood or anxiety disorder. It is important not to blame yourself or self-diagnose. The best thing is schedule an appointment with a mental health professional who specializes in perinatal mental health.
What should I do if I need help right away?
If you are experiencing a mental health emergency, you need to go to the nearest emergency room for further evaluation without any delay. This is the step to take if you’re having suicidal thoughts, or fearing you might harm your baby, or have been extremely sleep-deprived due to your symptoms, or unable to function and take care of yourself and the baby. If you are not experiencing a crisis but are concerned about your mental health, your first step would be to schedule an evaluation appointment with a specialist in perinatal mental health. This can be a psychotherapist or a reproductive psychiatrist. If you live in the Chicagoland area, you can also reach out to a confidential perinatal mental health hotline called MOMS Line at 866.364.MOMS for further guidance and support.
What does perinatal mean?
Perinatal refers to the period encompassing the time from pregnancy through the first postpartum year.
What other perinatal symptoms or issues are there beyond postpartum depression?
The phrase postpartum depression is misleading if used as an umbrella term. The better, more comprehensive term is perinatal mood and anxiety disorders (PMADs). A lot of postpartum women experience anxiety marked by worry, rumination, and agitation rather than symptoms of depression. For many, both depressive and anxiety symptoms may be present. There are also other challenges women might experience. They include: obsessive compulsive symptoms, trauma, eating disorders, substance use. Whatever the constellation of symptoms, the key message we want all women to hear is one that is beautifully captured by Postpartum Support International, a leading education and advocacy organization: “You are not alone and you are not to blame. Help is available. You will get better.”
What causes perinatal mood and anxiety disorders?
If you are experiencing a mood or anxiety disorder during the perinatal period, you're likely wondering why. You might even be questioning whether you have done something to cause your struggles. I want to reiterate here that it is very important for you to know that you are not to blame. PMADs are legitimate medical conditions with complex etiology. The hopeful news is that these conditions are very treatable. Once you receive the help you need and deserve, you will start feeling better.
Researchers have identified biological, psychological, and social/environmental factors that place birthing people at an increased risk for developing a mood or anxiety disorder during pregnancy and postpartum. Notably, endorsing a certain risk factor, or even several of them, does not mean you will actually develop a mental health disorder. It simply means you are more vulnerable to it. PMADs are often caused by a perfect storm of circumstances having to do with your biology, identity shifts, relational challenges, sleep deprivation, and other dimensions of the transition to parenthood. Whatever your situation, attending to your mental health during the perinatal period is a wise decision given that it is a time of major change which makes stress -- and distress -- more likely.
What treatments are available and when do I need to speak with someone about how I’m feeling?
Psychotherapy has been shown to be very effective in addressing PMADs. Therapists use a variety of modalities to help women. These include Cognitive Behavioral Therapy, Interpersonal Psychotherapy, Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and others. Women whose symptoms are more severe may need to consider a combination of psychotherapy and medication. Additionally, social support is a key component of mental health, which is why groups like The Chicago New Moms Group where mothers can connect in a nonjudgmental setting are so powerful. All mothers need a village, and not just any village, but one that has their back, does not judge, and accepts them with all their strengths and struggles. There is nothing more painful than experiencing distress and feeling alone and ashamed of the difficulties you are having. I feel passionately about creating spaces for new parents – whether that is in psychotherapy, support groups, prenatal yoga, or elsewhere – that honor all of their experiences and where they can receive the support and guidance every new parent needs and deserves.
As far as when to speak with someone about how you’re feeling, the transition to parenthood is one of the most emotionally intense experiences an individual can face, which means that having a trusted someone you can talk to about the vast range of emotions that accompany this time, is always important. When it comes to working with a mental health professional, know that psychotherapy is not only reserved for times of struggle. It is also a powerful vehicle for self-discovery and self-growth, and can be an effective preventative measure to safeguard your emotional wellbeing. We’re living through such challenging times, none of us can take mental health for granted.
How long will it take for me to feel better?
We often hear from clients that they feel a bit better after their very first psychotherapy appointment. I believe this has to do with no longer feeling alone and isolated in their struggle, and an emergence of hope that there is light at the end of the tunnel. If you are willing to put in the effort, you will start feeling better. Depending on what is bringing you in, for some clients it will take a bit longer than others, and part of the initial process is figuring out what is likely to be helpful. Recommendations may include support groups, couples therapy, medication, mindfulness, specific self-care practices, etc. My point here is that therapists who specialize in perinatal mental health are very pragmatic in their approach – we want you to walk away from every appointment with a new tool, idea, or resource to help you start feeling better.
In what ways can a partner support someone struggling with postpartum depression?
The most important thing a partner can do is educate themselves on this condition and recognize that they can support recovery in meaningful ways. Criticism or demanding that the sufferer snap out of her symptoms is never helpful and will hinder progress. I encourage partners to ask directly: “What can I do to help? What is not helpful?” It is also key for partners to take care of themselves, seek support, and consider psychotherapy for themselves. Research shows that mental health struggles in one new parent make the other parent more vulnerable to experiencing them as well. Postpartum Support International has a variety of useful resources for partners.
How and in what ways does Wildflower support their clients?
We are a mental health practice so one of the primary means of supporting our clients is through the provision of attuned, effective, and culturally sensitive psychotherapy services. We also provide virtual support groups and are very focused in our approach on helping clients connect with useful and empowering resources in the community. In addition to these focus areas, a key dimension of our work at Wildflower has to do with education and advocacy.
Unfortunately, there are many ways in which our society fails to support the mental wellbeing of new parents. As mental health professionals, we believe we have an ethical and moral mandate to promote a more humane, just and equitable society. We are profoundly social beings which means that our capacity to thrive is constrained or supported by social and cultural forces that act on us daily. Our efforts to make a difference include writing and presenting on topics related to perinatal mental health as well as getting involved in meaningful community initiatives. This June you can find us at Chicago’s Climb Out of the Darkness event which raises funds and awareness for the mental health of new families. We are delighted to be one of its sponsors.
What are a few top tips for postpartum wellness?
Where to begin! I’ll name the ones that immediately came to my mind. Protect your sleep as much as possible. Ask for help, don’t feel bad about asking, and be clear about what you need as our loved ones really can’t read our minds (even when something seems obvious!). Recognize that you are in the midst of a major transition and it will take time to find your footing – so be kind to yourself and don’t try to do it all. And no flying solo, mama! Get a therapist, join a support group, spend time with people who truly see you and make you feel better.