Finding the right type of therapy can sometimes feel like you are stuck in a chose your own adventure book. Unless you have a particular interest in this area, you may not even know that there are different types of therapeutic modalities. And when you are in the depths of a postpartum mood disorder, there is nothing more discouraging than getting your hopes up when you book with a new therapist, only to discover that they aren’t the right fit for you.
I know this because it happened to me. Not only was it not the right type of therapy, this person didn’t offer evening or weekend appointments, didn’t allow babies in the session, and all of their advice overlooked the fact that I had an infant and a three-year-old at home (I would also like to get more sleep, but unfortunately I need to feed my baby several times a night).
If you had a bad first experience with therapy, I encourage you not to give up. The good news is that there are SO many different ways to do therapy and counseling! And there is absolutely no right or wrong way to get support for postpartum depression/anxiety (PPD/A). Below is a list of some of the types of therapies that I have found work best for parents with postpartum depression/anxiety, and I encourage you to experiment with all of them.
General Heads Up: Each of the therapeutic approaches listed below have been put into big, broad buckets. They are not organized with an exact preciseness, nor is this list exhaustive. Everything could use a way more in-depth description so it may be most helping to think of this as a map to help get you started in the right direction. See which ones spark an interest in you to learn more. Don’t get too hung up what you think therapy is supposed to be like or what others think therapy should be like for you. YOU get to decide what therapeutic interventions work for you.
Overview: Behavioral therapies focus on, well, your behavior. This type of therapy is totally the ‘it girl’ right now, with cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) being widely used with OHIP covered services and therapeutic clinics. They are most often used to support people living with depression, anxiety, anger, addiction, panic and intrusive thoughts. Behavioral therapies can be done in groups or one on one. During sessions, you will often spend your time exploring the link between thoughts, feelings and actions, as well as challenging ‘distorted’ thinking.
Why I like this therapy for PPD/A: There is a lot of evidence that suggests behavioral therapies are effective for improving your mood very quickly. They are tool and skill based modalities that are generally easy to understand and apply. They also address your most pressing current concerns and don’t require spending a lot of time talking about your past or early childhood.
Limitation of this therapy for PPD/A: Because they are tool and skill based, there is a lot of ‘teaching’ and ‘telling’ in therapeutic sessions, rather than letting you define your own experience. With language like ‘disorder’ and ‘distorted thinking’, some people find this approach overly pathologizing and clinical and it doesn’t always account for the many other complex realities of the postpartum experience, such as loss of identity. It is also rather process heavy. For example, you may be asked to fill out thought records or track your mood throughout the day, which can feel cumbersome to a parent who doesn’t even have time to pee alone.
Who might want to try it: Parents who are drawn to medical models to conceptualize their mood. Also, those who like to follow templates and processes.
Overview: These modalities are non-pathologizing and don’t require a medical diagnosis of a mood disorder. For client-centred/humanist therapies, challenges with mood are generally understood to be a response to feeling lost, going through a negative or stressful time, or when we have a major shift in our identity or relationships. Common modalities include narrative, gestalt, and emotionally-focussed therapies.
Why I like this therapy for PPD/A: These modalities tend to focus on you as a whole person and your therapist should seek to understand your unique circumstances, rather than just focus on your thoughts, moods, and behavior. They allow you to name and label your experience, as opposed to having a medical label applied to you. There is also an understanding that there are forces outside of your control, including issues related to social justice, that impact your day to day mood. In other words, client-centred/humanist therapists get that your mood is influenced by so much more than just brain chemicals and hormonal changes – the toxic mothering messages and impossible parenting standards you are subjected to absolutely impact your mood (clearly I am drawn to these modalities, as a lot of my research in this area).
Limitation of this therapy for PPD/A: There is an underlying assumption in many client-centred/humanist therapies that if you have a new awareness about yourself or your circumstance, you will be or feel different – which may or may not be true. Finding or deepening a new awareness can take time, and some parents feel as though new/deepened awareness is not enough to shift their mood or feel better about their circumstances. Client-centred/humanist therapists don’t always leave parents with a set of concrete tools/skills to help them with their mood in the same way that behavioral or mind/body therapies do.
Who might want to try it: Those who find it easy to talk about their feelings with others, and who find that this allows them to process their emotions and gain new perspectives. Those who don’t want to follow a rigid therapeutic process or who want to be able to set the agenda for their therapy sessions, rather than having it be somewhat predetermined.
Overview: Mind/body therapies take you out of your head and into your body. They allow you to explore the link between your feelings (i.e. emotional pain) and your bodies (i.e. physical discomfort). Popular approaches include breath therapy, mindfulness, emotional freedom technique (EFT) or have energetic connections such as reiki. These therapies are often strengthened when offered in combination with other modalities, such as mindfulness based cognitive therapy.
Why I like this therapy for PPD/A: Like behavioral therapies, mind/body therapies can be quite tool/skill based (i.e. breathing exercises) but often take less time than behavioral strategies and can be done anywhere, as you don’t need any tools outside of your body. They can be very effective for anxiety or panic, providing immediate relief. They allow you to explore the depth and range of the impact your PMAD has on your body. Unlike modalities that ask you to focus on positive thoughts, mind/body therapies often allow you to explore deeply negative feelings, and promote acceptance of the difficult moments, rather than trying to fight against them. Acceptance can take less emotional energy that fighting negative thoughts and feelings, and as energy is limited with a new baby, this can sometimes feel easier than behavioral therapies.
Limitation of this therapy for PPD/A: These therapies don’t tend to offer problem-solving or resolutions for the legitimate day to day demands that also impact your postpartum mood, nor do they touch on intrapersonal relationships. Also, it can be hard to remember the skills during a panicked moment, and some modalities require parents to try to build in a breath awareness or mindfulness practice into each day, which you may find overwhelming when you are already so time crunched.
Who might want to try it: Those struggling with high anxiety, panic attacks, or who have trouble giving up control (because it promotes acceptancing your circumstances). Those that are interested in non-western approaches to healing, or are drawn to meditation or yoga. Those who have a lot of physical pain in their body (whether related to mood or not).
Overview: These modalities often don’t feel like ‘therapy’ because they involve art activities, moving your body, and equipment. Depending on the practitioner you may be asked to engage in expressive arts, dance, or music therapy. There is no need to be a talented artist – it’s more about the process and finding meaning to you personally and can be for your eyes only.
Why I like this therapy for PPD/A: These approaches can help you access thoughts and feelings that you have trouble connecting to, and can be quite helpful in processing difficult emotions – particularly if you had a traumatic birth or are struggling with a loss of identity since becoming a parent. The associated activities can also inspire ongoing self-care activities, such adult colouring books or journaling.
Limitation of this therapy for PPD/A: Some of the activities can feel silly or childlike and our own resistance to the activity can limit its effectiveness. Also, if you are struggling with high levels of social anxiety it can feel too weird to perform creatively in front of others. Sometimes you may feel like you are forcing deep meaning onto an activity, or feel like you haven’t done it correctly if you don’t have an emotional shift from the process.
Who might want to try it: Creative, artistic types. Those who are impacted emotionally by the arts. Those who feel stuck in their heads and want to find new ways to explore their feelings.
There are a few other broad types of therapy worth mentioning. If you experience birth trauma, EMDR, exposure therapy or somatic experiencing can be helpful in ways that the above modalities may not be. If you are struggling in your relationship or with family dynamics, couples or family counselling may feel the most supportive. Additionally, group or peer to peer support can be deeply meaningful and impactful for PMAD recovery, because it reduces isolation and provides you with a community of others who ‘get it’. There is a reason they say the most powerful words in the English language are me too.
I am not a huge fan of psychoanalytic approaches for PMAD because they are often overly focussed on your past/early childhood and not on surviving the heavy demands of the day to day with a baby. Also, some people find that by fixating on the ways in which your own parent(s) failed you, it ramps up anxiety that you will permanently damage your young children/babies. For PMADs, I much prefer modalities that focus on coping tools, emotional processing, and that are forward facing.
It is important to know that many counselors, including myself, use an eclectic approach that uses a variety of strategies because we find that one therapeutic approach is too constraining, as each one has limitations. Also – and this is important – feeling connected to your therapist is MUCH more significant than what kind of modality you chose. Being respected, listened too, and having your feelings validated is critical to doing work with someone that requires you to be vulnerable.
For example, the first time I was matched with a CBT therapist, I had no connection with them, was given a few thoughts records, and sent on my way. Predictably, it didn’t do much for me. But later with a therapist that I felt connected to and who used a variety of other modalities, CBT had a deeply positive impact on my life.
My final suggestion is to shop around for a therapist. And if you can afford it – you can have more than one! Your healing process is you own. I encourage you to play and have some fun with it and try on some of the modalities that feel like a stretch.
As always, if you want help figuring out what kind of therapy might be best for you, I can help.
Olivia Scobie, MSW, M.A., ACC, MSP