A common inquiry I receive from those searching for help for themselves or a loved one struggling with postpartum depression is "Who can help me?", "How do I find a provider?", "What should I look for and expect in therapy for postpartum depression?" Here are the different kinds of mental health professionals who may offer postpartum depression therapy, how you can find them and the approaches that may be used.
Clinical Social Workers who carry the advanced license (LCSW, licensed clinical social worker which is only offered at the post Master's level of completed education) deliver most of the individual mental health services sought by consumers today. The advanced license is conferred only after after rigorous exams and thousands of supervisory hours of clinical practice. The license is conferred by each state after the Social Work Examiners Board has verified passage of the clinical exam and maintained through additional annual educational requirements and continuing training in their chosen area of specialty.
Clinical social workers maintain group or independent private practices, are directly accepted by insurance companies, make diagnostic and treatment determinations, but do not prescribe medication. They are among the most respected mental health practitioners for women, families and children with a special appreciation for the biopsychosocial perspective.
Clinical Psychologists must have a Ph.D. and a state license in order to practice or offer mental health services independently outside an agency or hospital setting. Today, many psychologists are employed for their specialized skills in testing and evaluation. They also provide individual and group therapy, but are not able to prescribe medication. Licensed psychologists are directly accepted by insurance companies.
Nurse Practitioners - Are licensed to assessed, treat and in some cases prescribe medication for the clients they treat. A rapidly developing field of private practice, nurse practitioners are highly trained clinicians whose medical background and experience gives them great professional understanding of the perinatal period. They are also able to accept and submit to insurance companies.
Psychiatrist - Is an M.D. who has chosen to dedicate his practice to the field of mental health. Psychiatrists assess, evaluate and treat clients and may prescribe medication or admit clients to an inpatient programs at affiliated hospitals where they may remain under their care. Psychiatrists may offer therapy themselves or make therapy referrals to social workers, nurse practitioners or psychologists. Most psychiatrists participate in insurance programs.
Doulas and Midwives - Are excellent sources of support and information. They have "seen it all" and usually know who in your area can provide additional therapy services. Some insurance companies cover the services of Doulas and Midwives.
Always ask what specific training your provider has had in perinatal mood disorders to ensure the best possible match between your needs and his/her professional expertise. A mental health provider with this specialty should be able to see you within 48 hours of referral or sooner if there is an emergency.
You can find local resources including FREE support groups by visiting the website of Postpartum Support International www.postpartum.net . In addition, the MediSpin website (www.mededppd.org) has listings of providers who have taken some training in perinatal mood disorders. Therapist search sites like Psychology Today www.psychologytoday.com and Help Pro www.helppro.com verify licensing before listing a therapist and allow you to search using the term "postpartum depression". Of course, if you live in northern NJ, southern CT or the New York City area, you can contact the ppd therapy team at Blue Skye Consulting through www.perinatalpro.com
Postpartum Therapy Approaches
There are several treatment approaches to perinatal and postpartum mood disorders which have been found to be helpful; these include Interpersonal Psychotherapy, Cognitive Behavior Therapy, Dialectical Behavior Therapy, Psychodynamic Therapy, Family Therapy and others.
In addition, trained practitioners should also focus on nutrition, exercise, coping skills, stress reduction, infant-mother bonding, medical issues and other psychosocial influences. Social support is also a critical area and your therapist may recommend a support group for you to attend.
If you are not responding to one of the talk or group therapies, medication may be appropriate. If your symptoms of anxiety and depression are so severe that you cannot function, if you have not had adequate sleep for several days, a course of medication may be helpful to stabilize those symptoms. The kind of medication and duration of treatment depends on many factors. It is dangerous to compare yourself to others; your illness is a combination of biopsychosocial factors unique to you alone!
Your psychiatrist and therapist will discuss the pros and cons of medication with you. But remember, medication alone without therapy is not recommended. Equally important is receiving support, education, insight, developing new skills and awareness, modifying lifestyle and self care that will help prevent these disorders from coming back once you have recovered. Talk therapy and medication have consistently been found to be the "gold standard" of treatment for depression and anxiety.
Specifically, the cognitive, interpersonal and family approaches offer support, skills for managing emotions and relationships and important emphasis on wellness through nutrition, diet, exercise, sleep and social support.
If you are feeling suicidal, feel people are watching you, having strange sensory experiences or hearing voices commanding you to hurt yourself or your baby this represents a psychiatric emergency that requires immediate hospitalization and medication. With appropriate treatment, you WILL recover.
After an initial consultation, usually you will meet with your therapist weekly. Later, when you are feeling better, you may meet only once or twice a month. The goal of any good therapist should be obviously, to help you feel better as soon as possible, but also to support the healthy development of the maternal/child bond, encourage independence, symptom management, personal expowerment and self-reliance that will build confidence and joy in mothering.
Sometimes homework is given between sessions to practice new skills and begin to apply what you learn in session to your home environment. This is very important because only through practice and determination of the kinds of activities which soothe you, the setting of personal boundaries and establishment of reliable helping networks which support you, and application of newly learned skills to manage emotional upset, will you learn to master your own emotional life.
Some mothers bring their infants to sessions because they do not have help or the financial means to hire a sitter. If possible, it's better to reserve this time for yourself. You may want to bring your partner or family members to a session or two so they can become educated about these disorders and learn how to best support your recovery. A common complaint I often hear is that my partner, husband, mother, friend, colleague does not understand what I am going through! This can be very isolating and shaming to a struggling mother.
If you decide to pursue therapy, be sure your selected therapist has experience treating these kinds of disorders. You should discuss your treatment goals with your therapist and together, outline a plan of how you will get there. You may want to review the list of questions in the next article, so you can think about those that most apply to you. These questions are not diagnostic of an ante partum or postpartum mood disorder. Only a professional consult with a mental health professional can determine a definite diagnosis, but these questions may help you focus on areas of importance in treatment.
Finally, do not wait to seek treatment if you are not feeling like yourself. Recovery cannot start until treatment begins. If you've already gone through weeks of feeling badly, please know that you do not have to continue to suffer. These illnesses are highly treatable! Resolve to reach out and find help today!