Seeing A Therapist In The Postpartum Period

Seeing A Therapist In The Postpartum Period
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If you are one of the many women who is struggling in the post-partum period, seeing a therapist can be the key piece that can help you get back to thriving. However, there are many questions and concerns that might be preventing you from making that first appointment. Many of my clients who had some initial hesitation to make an appointment have shared with me the exact fears and concerns that prevented them from seeking care earlier. I have listed some of the common questions I’ve heard over my years in practice.

1. What is therapy and how can it help me?

...a patient who has struggled with fears that she might be inadequate as a new mother may need some a space to express her concerns

Therapy, also known as counseling, talk therapy or psychotherapy, is a highly effective therapeutic intervention that explores and manages serious issues such as depression, anxiety, self-esteem issues and anything else you may be struggling with. The therapy techniques used to reach these goals is dependent on the type of therapy, such as cognitive-behavioral, supportive, psychodynamic and DBT therapies. Therapy settings can be individual, couples, family or group.

Some of the common concerns I hear post partum are feelings of being overwhelmed by motherhood, marital strain, recurrent thoughts of inadequacy, negative views of oneself or one’s body post-delivery, irritation towards a fussy baby, anxiety around baby’s wellbeing, struggling to establish a routine, and feelings of sadness or guilt around issues surrounding health. These thoughts can support and worsen depression, anxiety or any other post partum mental illness, and therapy can be highly effective in such cases. For example, a patient who has struggled with fears that she might be inadequate as a new mother may need some a space to express her concerns, as well as some perspective that challenges these negative thoughts and replaces them with a healthy understanding of all that she has accomplished as a mother.

Each person who seeks therapy will have a unique situation, so how therapy can help each person varies based on those factors. A therapist will help you to assess your situation and goals, translate these into treatment objectives and come up with a treatment plan that can help you achieve those objectives.

2. How do I go about finding a therapist?

I know it may feel really intimidating but luckily there are many great ways of finding a therapist! A lot of times, friends, family and coworkers are great resources because they can tell you from first hand experience if they have found a great and trustworthy therapist. However, sometimes we don’t feel comfortable telling others that we are seeking therapy and that’s okay. One possible option is, if you have health insurance, your insurance company will have a list of therapists that accept your plan.

Another excellent way to search is through the internet, which is a really powerful tool to find a therapist that fits your needs. Websites like allow you to search for several therapists in your area with just a few clicks. In establishing a therapeutic relationship, a good fit is key.

How do you know if a therapist is a good fit for you? Looking online and reading about how a therapist approaches treatment can provide really good insight into whether it might be a good fit. When you read a therapist’s biography and treatment approach, it will frequently offer some other helpful information, such as whether the therapist has a special focus on women’s mental health or whether the therapist might be of a specific gender, culture or orientation that could make them feel more relatable to you.

3. When should I start seeing a therapist?

It’s always better to be proactive! In this case, that means it’s better to start therapy when the symptoms start instead of waiting for the symptoms to progress in severity. Sometimes when people ignore their symptoms of depression and anxiety, it can progress to the point that, by the time they see a therapist, there are experiencing very severe symptoms or may even be in an emotional crisis.

In fact, people who are experiencing mental health symptoms during their pregnancy or who have a history of mental health issues prior to the pregnancy could benefit from seeing a therapist during the pregnancy itself. This will be protective against worsening mental health issues during the post partum period and can lead to an easier transition into those early days of motherhood.

4. Once I start seeing a therapist, how often and for how long will I need to be in therapy?

Some people worry that being in therapy means you’ll be committed to going to therapy forever - that’s absolutely not the case!

The first appointment is typically spent sharing information, setting goals and determining a treatment plan. It’s also a chance for you and the therapist to get to know each other and start building trust. As part of the treatment plan, you and your therapist can decide how often to see each other. As a rule of thumb, if you’re struggling and need more support, it’s best to see your therapist with more frequency. Once you’re feeling better, usually you can decrease the frequency of your therapy sessions. Some people worry that being in therapy means you’ll be committed to going to therapy forever - that’s absolutely not the case! Therapy could be short term and last only for a few sessions, or it could be longer term. Sometimes a few therapy sessions can be sufficient for a patient to feel better. For many people, once the symptoms have substantially improved, you and your therapist may even plan to switch to an “as needed” basis, which means that you’d only return to therapy if any symptoms return or worsen.

5. If I see a therapist, will I need to go on medications?

Many people who seek therapy do not need to be on medications, since therapy by itself is an effective form of treatment in several conditions and situations. However, depending on the severity of symptoms or how rapidly those symptoms are responding to therapy, your therapist might recommend that you have an evaluation by a psychiatrist, who is a physician that is able to evaluate you and prescribe medications if needed. There are a lot of medications that are safe and non-addictive, and the medication that you and your doctor decide on will be based on your individual situation, medical history and preferences. For example, if you are breastfeeding, it’s important to let your doctor know so that she can tailor your medication plan to support that.

6. What will my therapist share with others?

Since people share very personal and private information with their therapists, it is natural to be concerned about confidentiality. Some people choose to involve their family or partners in their therapy, while others prefer to keep it a totally private experience. However, no matter what your preference is, therapists are ethically and legally bound to keep your information private. What that means is that we as cannot identify who our patients are or what they disclose to us. There are some exceptions, such as if a patient signs a release that consents us to speak with another person (like a partner, another doctor, or a family member) or if a patient is a danger to herself or others. As therapists, we understand that the most important part of creating a therapeutic environment is creating a safe, private space where you feel open to share your feelings and concerns.

7. I’m really worried that I won’t be able to afford therapy.

The good news is that therapy is typically a lot more affordable than most people think! Many therapists accept various health insurance plans. If you are uninsured or if your health insurance doesn’t offer mental health benefits, don’t worry! In these circumstances, many therapists will offer sliding scales, which means a reduced fee, for people who need it. In some areas, there are local agencies or funds set aside to aid postpartum women in receiving mental health care; searching on the internet for any postpartum support agencies can usually guide you on how to apply for these funds. Lastly, local hospitals often offer their own resources, such as free post partum and breastfeeding support groups.

Dr. Aparna Iyer is a board-certified psychiatrist in Frisco, TX and assistant professor at UT Southwestern in Dallas, TX. She has a special interest in women’s mental health, particularly during pregnant and in the postpartum period.

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