As therapists, we are acutely aware of the complex interplay between mental health and life’s transitions. One of the most significant yet often overlooked transitions occurs during the perinatal period—encompassing pregnancy and the first year postpartum. Understanding perinatal mental health is essential for us to support our clients effectively during this transformative time.
The Importance of Perinatal Mental Health
Perinatal mental health includes a range of emotional and psychological issues that can arise during pregnancy and the postpartum period. Disorders such as perinatal depression, anxiety, OCD, Bipolar, and PTSD can profoundly impact a person’s well-being. Research indicates that up to 20% of women may experience some form of mental health challenge during this period, and around one in ten fathers develop postpartum depression or anxiety. As therapists, we must recognize that these challenges do not solely impact the individual but also affect the family system, including children’s development, the mother-baby relationship, and conflict level within the couple.
Recognizing Risk Factors
Understanding risk factors is critical in our work with patients in the perinatal period. Women with a history of mental health disorders, particularly anxiety and depression, are at an increased risk for perinatal mental health issues. There are a multitude of biological, psychological, and social stressors that can contribute to the likelihood of perinatal mental health struggles. Some of these factors include lack of strong support system, strain or conflict within primary interpersonal relationships, and having a history of trauma. Being aware of these risk factors can empower psychotherapists to provide effective screening and intervention with perinatal populations.
The Role of Therapists
As therapists, we have the opportunity to create a safe space for clients to authentically explore their often complex emotions about pregnancy, childbirth, and new motherhood. Many women may feel pressure to present an idealized version of motherhood, leading to feelings of shame or inadequacy when their experience doesn’t match societal expectations. Our role is to validate and normalize their experiences and help them navigate this developmentally significant period of the transition to motherhood, known as “matrescence.” Establishing a strong therapeutic alliance is essential, particularly given the stigma around perinatal mental health. Creating a non-judgmental space can help support patients in authenticity sharing about their experiences. Open-ended questions can guide them to express emotions they might not even recognize, such as anxiety about parenting or feelings of loss related to their previous identity.
Therapeutic Approaches
There are several evidence-based therapeutic approaches we can employ to support clients during this period. Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Dialectical Behavioral Therapy (DBT) can all effectively help treat perinatal mood and anxiety disorders. Mindfulness practices can be beneficial in helping clients stay grounded and reduce anxiety, and Interpersonal Therapy (IPT) focuses on improving interpersonal relationships and communication patterns, which can be particularly useful for clients dealing with relationship stress during the perinatal period.
Encouraging Support Systems
Encouraging clients to engage with their support systems is vital. This might include partners, family members, or friends. Involving partners in therapy sessions can be beneficial, as it can be a safe space for partners to learn about perinatal mental health and for patients to express their need for support. Educating families about perinatal mental health can also reduce stigma and enhance support. Discussing the importance of open communication within the family can empower clients to express their needs.
Screening and Referrals
As mental health professionals, we must advocate for routine screening for perinatal mental health disorders in our practice. Utilizing tools such as the Edinburgh Postnatal Depression Scale (EPDS), the PHQ-9, or GAD-7 can help identify those in need of additional support.
Furthermore, it’s critical to refer clients to additional resources, including support groups and psychiatric services, when necessary. Collaborating with obstetricians, doulas, and other professionals supporting the patient can create a more holistic and comprehensive support network for clients.
Conclusion
By understanding the complexities of the perinatal period and employing effective therapeutic strategies, we can provide meaningful support to women navigating these profound changes. As we work to destigmatize mental health challenges and promote open dialogue, we contribute to healthier mothers, families, and communities. Our role as therapists is not only to treat but also to empower women, helping them reclaim their narratives and thrive during one of life’s most transformative journeys.
For a more robust dive into working with perinatal populations in the psychotherapy space, Wildflower Center for Learning is thrilled to offer “Pregnancy and Postpartum Mental Health: What Psychotherapists Should Know.” This 90 minute training takes a more detailed look at the transition to parenthood, perinatal mood and anxiety disorders, and working effectively with this population in therapy. This training provides 1.5 CEU’s for LCSWs, LCPCs, and Psychologists and provides 1.5 hours towards obtaining or renewing your PMH-C through Postpartum Support International. This training and others can be found at Wildflower Center for Learning’s website: https://wildflowerllc.thinkific.com/.
References
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Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for Family Health. Journal of Advanced Nursing, 45(1), 26–35. https://doi.org/10.1046/j.1365-2648.2003.02857.x
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Margerison, C. E., Roberts, M. H., Gemmill, A., & Goldman-Mellor, S. (2022). Pregnancy-associated deaths due to drugs, suicide, and homicide in the United States, 2010-2019. Obstetrics and Gynecology, 139(2), 172–180. https://doi.org/10.1097/AOG.0000000000004649
United States Preventive Services Task Force. (2019). Perinatal Depression: Preventive Interventions. [Website]. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/perinatal-depression-preventive-interventions
Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490–498. https://doi.org/10.1001/jamapsychiatry.2013.87
