Postpartum Depression in New Moms

Cognitive Behavioral Therapy and Postpartum Depression
Introduction
Becoming a new mother can be a very overwhelming experience for some women and the symptoms of postpartum depression that follow birth can confuse and deject them. It is important that women receive the therapeutic help they need in these situations. This paper will discuss the symptoms and causes of postpartum depression, how a counselor can develop strategies to work with clients experiencing postpartum depression, how a counselor can build rapport, barriers to care, and psychological interventions the counselor can use to treat the client.
Symptoms and Causes
Symptoms of postpartum depression for new mothers include a range of signs that can go from mild to extreme. On the mild end of the scale one may experience mood swings, anxiety, sadness, irritability, feelings of being overwhelmed, crying, inability to concentrate, loss of appetite and trouble sleeping (Mayo Clinic, 2020). These symptoms can last anywhere from a few days to a few weeks—but one thing to remember is that a mother’s hormones are rebalancing now that the baby has been delivered, so post-pregnancy hormonal changes could contribute to these symptoms occurring (Baka et al., 2017). Therefore, it is not uncommon for symptoms of postpartum depression to go away on their own after a few days or weeks as the mother’s body achieves a more balanced hormonal state.
However, on the more severe scale of postpartum depression, a new mother can experience far worse symptoms that do not go away on their own. Postpartum depression can end up interfering with the new mother’s ability to care for the new baby and can consist of excessive crying, prolonged depressed mood, severe mood swings, difficulty bonding with the baby, withdrawal, loss of appetite, insomnia, loss of pleasure in old routine activities, intense anger, despair, self-harm or murderous or suicidal ideation (Ko, Rockhill, Tong, Morrow & Farr, 2017).
If these symptoms do not begin to fade after two weeks (at which point the body’s hormones should be more balanced out), one should see a doctor; if the symptoms worsen or impair the new mother’s ability to care for the baby, one should see a doctor (Mayo Clinic, 2020). However, in many cases the cause of postpartum depression will go away as the hormone levels rebalance and the new mother gets more used to the emotional and physical toll that caring for an infant brings. Physical changes and emotional changes are simply part of the process of becoming a new mother, and one way that counselors can help new mothers to overcome postpartum depression is by helping them to see that they are now on a new journey and that there are steps they can take to prepare themselves mentally, emotionally and physically for successfully navigating that next step in their lives. Lack of preparation and awareness of what to expect with being a new mother can contribute to the onset of postpartum depression, and it is important to have a strong support network in place if postpartum issues persist after two weeks so that the mother’s and the child’s life are not endangered and an intervention can be made.
How a Counselor Can Develop Strategies to Work with Individuals
Developing strategies to work with individuals is an important step for treating clients with postpartum depression. One strategy to use is to maintain a sense of one’s professional role at all times so that the counselor does not become personally involved in the client’s life. That professional distance has to be maintained both for the good of the client and the counselor (American Psychological Association, 2002). It also allows the counselor to maintain an objective focus on the client’s issues and not lose sight of them by falling prey to subjective experiences and feelings.
Another strategy is to stay connected to oneself and to block out beliefs that can get in the way of active and effective counseling (Firman, 2009). Counseling can be a grueling exercise that can cause one to question one’s own motives, one’s ability to counsel effectively, and one’s commitment to the calling. However, counseling is a vocation and one who is called to it must remember to stay connected to that place in one’s self that has heard and responded to that call. By staying connected to that place, a counselor will be better equipped to connect with clients and provide them with the support, insight and treatment they require (Firman, 2009).
Clients experiencing postpartum depression will likely need a great deal of reassurance and empathy: they are already likely to feel that they are bad mothers, that they are letting their family down, and that it is all their fault. A counselor must be secure enough to help the client address the real life issues and thought processes that are keeping the client in a cycle of guilt, despair and depression while simultaneously helping the client to build up her confidence so that she can reach the all-important stage of self-actualization recognized by Maslow (1943) as the pinnacle of human motivation.
How a Counselor Can Build Rapport
Building rapport with clients is another important step and the way to do that is to use active listening skills so as to understand the client and the issues that impacting the postpartum depression. The counselor should also maintain an even speed and neither proceed too quickly nor too slowly in attempting to reach an intimate place where there can be open sharing of information. Each client will have a unique cultural background and sensitivity level, and sensitivity can vary day to day depending on emotional states and perceptions, so the counselor should be careful to go at a speed the client feels comfortable with. Client body language and the content of what the client is sharing will be good indicators of how fast or slow the counselor needs to take things.
One of the biggest breakthroughs to celebrate is the first, small success because this allows the client to feel that the counseling is working and that it is all worth the effort. She will especially feel grateful to the counselor for aiding in the progress, so small successes should be celebrated especially in the beginning stages of the sessions.
Another way to build rapport quickly with the client is to match style for style. The counselor should always be a little more to center, however, than the client is because the point is to model behavior that the client can pick up on and mimic so that the client behavior becomes more directed to the center, i.e., to normalcy. Thus if the client is emotional, it will be fine for the counselor to be emotional as well so that the client feels that they are connecting—but the client should be a little on the rational side of emotional so that the two are being directed back towards reason where they can begin to get a handle on the situation (LoFrisco, 2012).
Finally, self-disclosure is always helpful in building rapport. However, too much personal disclosure upfront can turn the client off, so it should be just enough to help win the client’s confidence but it should stay about the client and not deviate into being about the counselor. The purpose of self-disclosure is to strengthen the relationship so disclosure can be done up to the point that it has the desired effect of getting the client to climb onboard with the counseling. The client-counselor relationship is more important than theory or intervention method, as LoFrisco (2012) points out so at the end of the day it is all about making sure that relationship is solid and inoffensive to the client.
Barriers
Some common barriers to counseling include negative attitudes towards and perceptions of counseling, negative expectations (i.e., failure), defensive posturing and a fear of disclosure (i.e., not wanting to share necessary details with the counselor), and a general feeling of discomfort with the sessions or with the counselor because of a failure to bond with the counselor (Tucker, 1981).
The way to remove barriers is to identify them and to work to modify the various attitudes and perceptions that support them (Tucker, 1981). Thus a counselor who is treating a patient who does not believe the counselor can help her can say something like, “You’re absolutely right—I cannot help you. Only you can help you, but if you adopt a negative attitude you will never learn to help yourself or get out of your own way. The only thing that I as a counselor can ultimately do is help you to see where you are getting in your own way, and then it is up to you to do something about it. You can listen and judge for yourself whether what I am saying is meaningless or worth your while—but since you’re here and I’m here and we’ve got an hour on the clock, what do you say we give it a go and see where it takes us. You’re free to walk out the door at any time, no questions asked.” It is this kind of approach in which the thoughts and feelings of the client are acknowledged but guided more towards a positive train of thought that can ultimately have the most impact in overcoming barriers.
Psychological Interventions
Two types of therapy that counselors can use to work with individuals experiencing postpartum depression are cognitive behavioral therapy and interpersonal therapy. Cognitive behavioral therapy is one of the most common and routine forms of counseling available today and has been in practice for decades. It is an approach in which the counselor and the client work together to identify and change the negative or triggering thoughts and behaviors that are harming the client’s mental health and preventing the person from living an active, engaged and positive life (Jones & Lyddon, 2000).
Interpersonal therapy is an approach in which the counselor helps the client to identify the problematic behaviors and thought processes that are keeping the person stuck in a state of depression. The counselor then advises the client on how to work through cognitive and emotional problems in a more effective manner. It differs from cognitive therapy in the sense that in the former, the client and the counselor are working more as a collaborative team while in interpersonal therapy the counselor is more of in a guide role and the client is more passive in terms of accepting guidance. Interpersonal therapy is likely going to be the better option for counselors and clients experiencing postpartum depression and showing an inability to critically think about their own problems or sort through their emotions and thoughts in an objective enough way to identify the problem areas. Cognitive behavioral therapy requires an ability on the client’s part to be able to take a good, hard, objective and honest look at oneself. Not every client is equipped with the tools to do that, so interpersonal therapy can be a way for the counselor to step in and guide the process of healing in a more hands-on and directorial way.
Animal assisted therapy is another psychological intervention that has been found to help people with depression and introducing an emotional support animal into an environment where a new mother is feeling overwhelmed by a new baby can be a way to help the new mother. Emotional support animals require no training but they can help to alter the brain chemistry of a woman going through postpartum depression. Spending time with an emotional support animal can increase levels of serotonin in the brain, as well as oxytocin and prolactin. Some animals can know when the new mother is feeling down and can try to engage with the person to get them feeling more active and engaged. These animals can also help the new mother to feel not so alone. A new baby can be very demanding and without another sympathetic creature in her life the new mother can feel isolated—but using animal assisted therapy can help to overcome those feelings (Badr & Zauszniewski, 2017).
Conclusion
In conclusion, new mothers may experience postpartum depression symptoms for up to two weeks before they begin to decline on their own just because of the newness of the emotional experience and the fact that the body’s hormone levels are rebalancing. However, for individuals who experience severe postpartum depression or whose symptoms increase and impair the mother’s ability to care for the infant or last longer than two weeks, an intervention may be needed. Cognitive behavioral therapy, interpersonal therapy and animal assisted therapy can all be useful interventions, but at the end of the day the best experience for the client is to have a strong relationship with the counselor so that a relationship of trust, support, empathy and encouragement can be developed.
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