Psychotherapy Options for Treating PPD

By Kate Kripke, LCSW

You may have heard it over and over before: One of the best ways to treat a postpartum mood and anxiety disorder like postpartum depression is through therapy. “Find a therapist” is probably the first suggestion that you will hear from people who specialize in these challenges. Symptoms of depression, anxiety, post traumatic stress, OCD, and adjustment can be understood, worked through, and alleviated though psychotherapy, but what this treatment actually looks like can vary tremendously.

So, what is psychotherapy, exactly?  While a Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Marriage and Family Therapist (MFT), Psychologist (PsyD or PhD) can all provide psychotherapy support, what this support actually looks like may be different depending on that particular therapist’s approach to treatment. And so “I am seeing a therapist” can mean something very different for each person.

In light of providing clarity around this, I am going to briefly describe the different types of therapy that are most utilized in the treatment of a postpartum mood and anxiety disorder like postpartum depression:

Interpersonal Psychotherapy (IPT)

Interpersonal Psychotherapy is currently thought to be one of the most effective therapy models for treating PPD. IPT is a time-limited form of therapy (12-16 weeks) and the main goal is symptom relief. An IPT therapist tends to be fairly direct and active in the treatment, and he/she will help to make insights regarding the sources of a new mom’s distress. IPT is based on the premise that postpartum distress is rooted in four “problem areas”: 

  • 1. Grief: Acknowledging the losses that occur to sense of self, changes in relationships, or more specific loss.
  • 2. Role Transitions: Life stage transitions and social transitions including loss of independence and changing social networks.
  • 3. Interpersonal Disputes: Ones that frequently occur after the birth of a child including unmet expectations and intimacy struggles within partnerships.
  • 4. Interpersonal Deficits: Looking at struggles with attachment in other relationships that may be causing distress.

A big part of IPT is the teaching of communication skills that assist in building relationships, stronger social support, and increased confidence. IPT is manual-based and follows a specific course of treatment.

Cognitive Behavioral Therapy (CBT)

CBT is best known for its efficacy in treating anxiety including OCD. CBT works with the understanding that the way we think affects the way that we feel, and so treatment is focused on helping mom have control over her thoughts so that she feels more able to change them. A CBT therapist will work with a mom to identify and acknowledge her automatic thoughts, evaluate these thoughts and become aware of when these thoughts are not helpful, explore and change underlying beliefs, differentiate between realistic and false threats, and develop new and more helpful perspectives. CBT helps a mom to develop coping strategies so that she feels better equipped to manage distress. CBT uses tools such as homework, relaxation, exposure therapy, thought stopping, mental imagery, and tools for changing catastrophic thoughts and irrational thinking. Mindfulness-Based Cognitive Therapy (MBCT) is a form of CBT that also incorporates significant component of mindfulness meditation.

Dialectical Behavioral Therapy (DBT)

DBT began as a treatment for Borderline Personality Disorder, but is now known to be effective in many instances where distress is prominent. Like CBT, DBT uses practice and homework as a part of its process. DBT teaches skills in the following categories: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.  DBT is often supported through both group and individual therapy and follows a specific guideline for teaching skills to reduce symptoms related to distress.

Psychodynamic psychotherapy

Psychodynamic psychotherapy is one of the earliest types of psychotherapy and focuses on unconscious and past experiences in understanding current behavior. Psychodynamic psychotherapists believe that our earliest childhood experiences have a direct impact on our present distress, and that when moms are able to identify and accept these experiences as playing a role they are able to begin the process of healing and becoming less entangled in the past. This type of therapy looks into early experiences that play a role in forming beliefs about ourselves as adults, and identifies those beliefs that are no longer helpful. When working with a psychodynamic psychotherapist, a mom will be encouraged to talk about relationships with parents and other significant people in an effort to uncover the unconscious content of a mom’s way of thinking. This process reduces tension and distress. A psychodynamic approach to treatment is thought to be important because change requires awareness and understanding to occur. Often in this type of therapy, the “aha” moments allow for self-validation, empathy, and, ideally, freedom from self-judgment.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is currently thought to be one of the most effective types of therapy when working through a traumatic experience and is being used more in the treatment of postpartum PTSD. This specialized type of therapy requires specific training and credentialing. EMDR uses elements of both CBT and Psychodynamic therapy along with specific techniques that are used to reduce the sensory impact of traumatic memories. Because traumatic memories are often stored in EITHER the right (feeling-based and emotional) OR left (logical and intellectual) side of the brain, EMDR uses a bilateral stimulation of the brain (though eye movements, bilateral sound, or bilateral tactile stimulation) combined with beliefs, visualization, and attention to body awareness as a way to re-process memories more effectively. A significant piece of EMDR involves helping mom to access thoughts and feelings that are positive, grounding, and healing.

Solution-Focused Brief Psychotherapy

Solution-Focused Brief Psychotherapy focuses on a specific issue and works toward positive change. Unlike other therapies that identify early experiences as playing a role in current distress, solution-focused therapy stays away from past problems and highlights, and instead, on a mom’s strengths and skills.  Much of this type of therapy is about setting goals and is solution-based rather than problem solving. This very short-term therapy often requires several sessions to be beneficial, however many other types of clinicians may feel that this type of therapy does not address the root cause of problems effectively enough to create lasting change.

Group Therapy

Group therapy uses the role of community in support. A true group therapy session is facilitated by one or more trained psychotherapists and uses the dynamics that occur between members of the group to help identify problem areas and interpersonal distress. A postpartum depression support group often combines psycho-education (teaching about maternal mental illnesses, causes, treatment options, life strategies for wellness, typical new mom stresses, etc.) with the important role of validation from others in the group. The goal of a PPD support group is to help build community, give space for a mom to be heard by others and to learn that she is not alone in her struggles, and to talk about and share ideas regarding stress management, coping, and early mothering.

Couples Therapy

Couples Therapy provides a space for partners to be heard during a time of crises. In a couples therapy setting, recurrent negative patterns within the relationship will be addressed and couples will learn communication and listening strategies necessary in working through these challenges. Often in postpartum work, couples therapy will address issues related to PMADs, changing dynamics in a relationship, intimacy challenges, individual needs that may be interfering in connection, and individual needs that are necessary in maintaining the health of a couple’s relationship.

When interviewing new therapists, it is absolutely appropriate to ask him/her what type of therapy he/she practices. However in most cases you will find that therapists use pieces of many different types of therapy in their work. A therapist who has a specific training and therapeutic background may allow for other types of therapy in his/her work when working with a mom struggling with a PMAD. Specialists in the treatment of PMADs will be driven by what is known about important aspects in PMAD treatment (biological causes, symptom reduction, life change management, expectation, infant-attachment support, etc.) and will either incorporate therapeutic approach into this work or wait to begin that phase of treatment until a mom’s initial distress is managed.

I hope this helps.