Aligning Pregnancy, Mental Health and Your Relationship→

Although most of us are familiar with postpartum depression, people are often unaware that mental health challenges may start before the delivery of a new baby and may affect the expectant or new mother and their partner.

In fact, medical and mental health providers now refer to the emotional distress that occurs during pregnancy until after one year postpartum as perinatal mood and anxiety disorders (PMADs). Not all of these concerns may meet the criteria for a mental health diagnosis, but they impact the individual experiencing them and their loved ones.

Research has shown us that becoming parents is one of the most stressful times for couples and nearly 67% of couples report a significant decrease in couple satisfaction after their first child is born (Shapiro et al., 2000).

This decrease in couple satisfaction is often difficult to navigate, especially if one or both partners are experiencing a PMAD and current research shows that 20% of women will experience a PMAD (Alderdice, 2020), while 1 in 7 men report mood disturbances during the perinatal period (Tissera et al., 2021). Some of the reasons that couples report a decrease in relational satisfaction during pregnancy and after the birth of a child include biological changes, impaired sleep, less time to spend as a couple, reduced communication, financial challenges, and more (Gottman et al., 2004). These difficulties are compounded if the couple has not spent time discussing their expectations of each other, their new roles, and sharing their ideas of what being a parent while still being a couple means (Dueger, 2021).

These conversations are particularly important because becoming a parent is generally the most significant identity shift that anyone will experience after puberty. If one partner shifts in a different direction than the other, it will strain the relationship.

Also, many new parents shift all their focus onto their new baby and put themselves, their partner, and others on the back burner. Over time this heightens levels of frustration, mood disturbances and relationship dissatisfaction. Of course, no one would suggest that the new baby is neglected or is not prioritized; however, there needs to be a balance between nurturing a new baby and taking care of ourselves and our relationship.

Most relationship experts recommend prioritizing the couple relationship and ensuring that partners create a sense of togetherness and a secure bond; Hoppe and Tatkin (2021) refer to this as a couple bubble.

To create a couple bubble most effectively, we need to work on understanding our own biological, neurological, and attachment needs so that we are able to understand how we are responding to one another and sharing our needs effectively; otherwise, our requests may be critical, and our partner may respond defensively or shut down.

Learning to recognize these different needs and communicating effectively is incredibly challenging because we don’t live in a world that provides many good examples of self-awareness, respectful proactive communication, listening attentively, and responding non-defensively. If one or both members of the couple are experiencing a PMAD, these skills become that much harder to master.

Often only the person experiencing mental health struggles will reach out for therapy, but research has shown that a supportive partner is a key aspect in overcoming a PMAD (Tissera et al., 2021). Other types of social support are also hugely helpful when navigating the challenges associated with becoming a parent, and there are some excellent resources, including peer support groups, available through Postpartum Support International and The Seleni Institute.

If you and your partner are considering starting a family, have recently added to your family, or are unsure of what growing your family during a pandemic will look like, I would be honored to help you navigate these challenges. I am a Certified Perinatal Mental Heath Profesional PMH-C and can be contacted here.

References:

Alderdice, F. (2020). What’s so special about perinatal mental health? Journal of Reproductive & Infant Psychology, 38(2), 111–112. https://doi.org/10.1080/02646838.2020.1734167

Dueger, S. (2021). Preparing For Parenthood. Author Academy Elite.

Gottman, J., Gottman, J., Abrams, D., & Abrams, R. (2004). Eight Dates. Thomas Allen & Son Limited.

Hoppe, K., & Tatkin, S. (2021). Baby bomb. New Harbinger Publications, Inc.

Shapiro, A. F., Gottman, J. M., & Carrère, S. (2000). The baby and the marriage: Identifying factors that buffer against decline in marital satisfaction after the first baby arrives. Journal of Family Psychology, 14(1), 59-70. https://doi.org/10.1037/0893-3200.14.1.59

Tissera, H., Auger, E., Séguin, L., Kramer, M. S., & Lydon, J. E. (2021). Happy prenatal relationships, healthy postpartum mothers: a prospective study of relationship satisfaction, postpartum stress, and health. Psychology & Health, 36(4), 461–477. https://doi.org/10.1080/08870446.2020.1766040

Navigating Pregnancy and Infant Loss

Discovering you are expecting a child can be very exciting and usually begins the process of creating a vision for your child and family. Your life’s trajectory immediately shifts. Maybe you immediately shared the news with family and friends, or perhaps you waited until the second trimester to share your exciting news.

But then the unthinkable happens, and you find out that you have lost your baby. You become filled with grief, uncertainty, confusion, and may not know how to respond. If you had not shared your pregnancy news yet, you might feel a sense of isolation because none of your family or friends know what has happened. If you and your partner shared the news, unhelpful comments, advice or questions may ensue. It’s common for family and friends to offer up words meant to console, but these words can fall flat and may actually intensify grief or isolation.

Adding to the difficulty of mourning the loss of a pregnancy or child is when partners grieve differently, which may intensify what already feels unbearable. Often one partner may feel the loss more intensely while the other is more pragmatic, looking at the loss as “this sometimes happens” or saying, “everything happens for a reason.” While these statements may help one partner cope with their feelings or be factually correct since 1 in 4 pregnancies end in miscarriage, these statements may feel dismissive and result in feeling isolated, unseen, unheard, and unloved. Some couples even report feeling that they are blamed for the loss of the pregnancy or baby if they perceive their partner wasn’t excited about the pregnancy or if there were genetic factors that contributed to the loss. These situations are heartbreaking but do not need to result in permanent damage to the relationships. Here are some points to consider after a pregnancy loss:

• Set boundaries to protect your emotional and physical wellbeing. This may mean asking people to respect your privacy or asking them to help with everyday tasks.

• Plan ahead for times that may be especially difficult such as the anniversary of the loss or the missed due date, or holidays like Mother’s/Father’s Day.

• Engage in self-care at a higher level, taking extra rest, spending time in preferred activities, working on mindfulness or spiritual practices, and slowly re-engaging in physical activity as directed by a medical professional.

• Allow yourself to grieve and understand that everyone processes loss differently, although many people find comfort in attending support groups.

• Reach out to a mental health professional or, if you prefer, a clergy person trained in grief and loss.

Unfortunately, for many years infant and pregnancy loss has been kept in the shadows, which has discouraged women from seeking support and sharing their stories. This may be even more true for their partner, who may feel they have less of a right to grieve.

October is pregnancy and infant loss awareness month. As a society, we are beginning to understand that these losses are profound, create grief like any other loss, and should be responded to accordingly. Below are some suggestions for offering support to loved ones who have experienced the loss of a pregnancy or child:

• Ask if they would like to talk about their loss, and then listen without offering advice unless asked.

• Offer to help with everyday tasks like grocery shopping, meal prep, or cleaning. It’s most helpful to jump in with something helpful rather than ask “what can I do?” to someone who can’t organize their needs during grief.

• Avoid rushing them to “move on” before they are ready. Hold space for their pace.

• Check-in with both partners; many partners who did not carry the pregnancy report feeling their grief is ignored, or they think they should put it aside to support the partner who carried the pregnancy.

• Grief requires that it be seen, heard and validated for it to be processed. Simply being a compassionate presence is priceless.

If you feel that you or your partner needs help working through the loss of a pregnancy or child, I would be honored to be part of your healing journey. You can contact me here. Some additional resources that may be helpful can be found at https://www.postpartum.net and http://www.seleni.org

Helping Your Teen Return To School

Is your head spinning because of recent developments regarding returning to school? What was a celebratory and exciting thought just a few short weeks ago has shifted. What can we do to help our kids?

How to help your adolescent return to school

Teens are an elusive species, they can be so hard to read and to support! To be sure, there is most likely some anxiety and grief bubbling underneath the surface. Most well intended parents want to help, but instead realize that they are making things worse or turning their kids away from them. Here are Do’s and Don’ts to help you navigate:

• Do: Ask open ended questions to open the door for more meaningful conversation. “I’d love to hear what you are thinking about x, y or z”. “Tell me about your new classes.” “Tell me about your table at lunch.” Don’t: Ask closed ended questions like “Are you excited/ready for school to start?” Do: Be curious about their lives. As much as it may seem they don’t want to talk to us, most kids really long for you to be interested in their lives.

• Do: Notice their emotions, name them, validate them and then allow them space to move through. Adolescents are still working on developing emotional intelligence and really need some guidance. Our emotions are all real and valid to us. If we don’t give them space to exist, they get stuck and we start to marinate. Don’t: tell your child to “just not stress out;” it leaves them feeling ashamed for their stress, judged, alone and they will not come to us the next time. Do: say: “I’m so glad you told me, it is hard isn’t it?” This allows them to identify their anxiety, justify it’s existence and then they can start to look for ways to manage it. Just stuffing it results in stomach aches, headachces, tense muscles, sleep problems, focus problems. Don’t: take it on yourself to fix their emotions. It’s not possible and you will get frustrated with them for not “complying.” Our emotions can be an important internal compass with which we can learn to notice and utilize. Emotions aren’t for fixing, they are for listening. Do: be compassionate with yourself, it’s so very hard to watch our kids struggle and keep ourselves from coming to the rescue.

• Do: Be aware that anxiety and grief in teens looks like: contempt(eye rolls, snarkiness, sarcasm), indecisiveness, lack of motivation, procrastination, moodiness, anger, silence, withdrawal, falling grades. Help them understand that while emotions are valid, we also need to be aware of how our reactions to our emotions can hurt others. Do: Teach accountability. Don’t: punish before teaching them how. This is a teachable opportunity, just ride the fine line of teaching vs lecturing. Do: Make sure your teen feels listened to consistently, (tune in often, even over seemingly small items) this provides fertile opportunity to do this teaching. If they feel lectured, this could be a sign that we aren’t working on other parts of our relationship with them.

• Do: Look for opportunities for giving them agency and choice-a feeling of control in this crazy landscape. This can be done in small ways: clothing, timing of chores/homeowork, decision making on things that are their problems (not ours). Don’t: micromanage everything. Do: Pick your battles on necessary items.

• Do: Before weighing in on any issue they face, determine whose problem it really is, (theirs or yours) and if it’s theirs, let the world’s natural consequences hit. This is the best teacher for future responsibility.

• Do: Model good self care in the face of societal stress-nutrition, exercise, limiting news tickers, compassion for others, healthy self talk.

• If they are returning to school for the first time in a while, Do: take it easy. Small steps, ease into the transition. Don’t: make elaborate plans right after school or in the first few weekends after school starts, they will most likely need to come home, decompress and collapse.

• Do: Speak to them in terms of a growth mindset vs fixed mindset. Growth mindset: “I saw how you managed your anxiety last week and was really impressed with how you’ve improved, you’ve come a long way.” Fixed mindset: “You are always so negative about school.” “Why are you always so stressed?”

We’d love to help you navigate your relationship with your teen! We offer individual counseling for adolescents or parents, family counseling and group therapy for teens(coming soon), Contact us today!

Body awareness in therapy

Do you ever feel like your body is trying to sabotage you? It could be a stomachache while preparing for a big meeting or fatigue while getting ready for a difficult conversation. These physical sensations, along with raised heart rate, shallow breathing, and other types of physical discomfort, are often early warning signs that something isn’t quite right. But what if our body has important information for us? Unfortunately, most of us have been trained to ignore our physical sensations and “push through” or “embrace the suck,” which contributes to mental health difficulties and may cause physical health problems. If we can learn how to align our mind and body and listen to it’s messages, we can gain important information for living a better life.

Therapy to integrate mind and body messages

If it weren’t hard enough to integrate our mind and body, we have a fast-paced world where productivity is prized. Work and family can draw our attention away from our bodies. We also are filling our days with more activities and electronic use, which drowns outs the physical and emotional messages our body is sending.

This disconnection between our mind and body fuels feelings of depression, anxiety, and disconnection to ourselves and with loved ones. When we are not connected to our body or ignore its messages we get stuck in negative behavior cycles and unhelpful thought patterns. For example, anxiety often presents itself in bodily sensations that are misinterpreted or attributed to the wrong cause.

If we are able to begin making connections between our thoughts and feelings while also exploring what our body is telling us we can begin to feel more aware of patterns of behavior. Aligning mind-body awareness also improves our ability to be compassionate to ourselves and others while also enhancing our ability to be patient, curious, and empowered. When we become more compassionate, patient, curious, and empowered we are able to live more authentically and connect to others more meaningfully.

Some questions you might begin to think about to increase your awareness of the mind-body connection include:

• When you feel worried, sad, frustrated, or angry, what do you notice going on in your body?

• Where is it, what might it be telling you?

• When do you feel most aware of your body?

• How do you respond to unpleasant physical sensations?

In addition to considering what you are feeling in your body and how you respond to it, there are other ways to foster awareness and connection to our body. Here are six ways to improve your awareness of the brain-body connection:

1. Engage in body scans or other mindfulness practices that include body awareness.

2. Set aside judgment about your body and work on identifying what allows you to feel your best.

3. Learn breathing techniques that lower heart rate and encourage physical relaxation.

4. Engage in gentle or rhythmic movements such as yoga or dance since these movements encourage neuroplasticity and have been shown to reduce symptoms associated with anxiety, depression, and PTSD (Gallegos et al., 2017).

5. Keep a journal to explore physical sensations and related emotional responses.

6. Reach out to a counselor who incorporates somatic modalities into the counseling session.

If learning how to improve body awareness and enhance mental health interests you, the counselors at Align Couples Therapy would be honored to be part of your journey.

References:

Gallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017). Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clinical psychology review, 58, 115–124. https://doi.org/10.1016/j.cpr.2017.10.004

Spring Renewal

This week marks an unwelcome anniversary and may be making you feel stuck, anxious, depressed, unmotivated, and frustrated. These difficult feelings are complicated by 2021’s difficult start, which may have intensified anxiety, isolation, frustration, and feelings of disconnection.

Most of us felt ready to say goodbye to the chaos of 2020 and usher in a year of new beginnings, but we have found that we continue to be bombarded with challenges ranging from the slow rollout for the COVID-19 vaccines, social-political division, financial difficulties, and the recent winter storms.

But, spring is around the corner; it’s an opportunity for us to move out of the darkness, frustration, and uncertainty of the last year. During these next few weeks, all of us can begin to prepare for a new season with less anxiety, sadness, and frustration by focusing on renewing ourselves and our relationships with others. Like our gardens, we need pruning to experience growth and to create new, more meaningful connections with others.

Here are some simple ways to begin working through the complex emotions of the past year and begin experiencing new possibilities:

• Engage in deep diaphragmatic breathing. Ideally, you want to breathe in for at least four counts and exhale for four counts feeling your belly expand and contract because this helps lower heart rate and blood pressure, which helps the body relax. This may reduce physical sensations associated with anxiety.

• Begin a mindfulness practice focusing on being present in the moment and noticing thoughts and feelings that pass through without judgment. This may mean taking a few moments each day to concentrate on breathing or using a mediation app; one of my favorites is Insight Timer. Recent studies suggest that mindfulness practices have similar psychological benefits as exercise.

• Move more often. Many studies have found that an hour of exercise each week (not all at once) reduces reports of anxiety and depression. The effectiveness of exercise is complemented by outdoor activity, and as the days get longer, it should be easier to sneak in some outside time.

• Create an evening routine that will support getting a good night’s sleep. Some common recommendations include reducing electronic usage 60-90 minutes before your desired bedtime, use blackout blinds, and keep your bedroom below 70 degrees.

• Work on reducing processed foods and increasing fruit and vegetable intake. Also incorporate high quality proteins as this reduces the inflammatory response in the body which supports brain-body wellness. Dr. Leslie Korn has a great book on eating well for improved physical and mental wellness called Eat Right Feel Right.

• Reach out to friends and family. Reconnect through meaningful conversation and activity as much as possible given physical-distancing guidelines. Trying open-ended questions like those found in the Gottman Card Deck app. Although not all questions or topics are appropriate for non-romantic relationships, many are including: “what do you need in a friend right now?” or “what do you find adventurous?” Taking the time to have meaningful conversations and reconnect has been found to help reduce feelings of loneliness, sadness, anxiety, worry, and frustration because, as humans, we are hardwired to connect to others.

• Reach out to a mental health professional. Recently, one of my children asked me why so many people wait to pursue counseling until their problems feel completely overwhelming and uncontrollable, but we go to the doctor for physicals and preventative care? You don’t have to be in crisis to need help and counseling can allow us to learn more about ourselves, act as preventative maintenance, help us have more meaningful relationships, and so much more.

If you feel ready to begin to process your new beginnings, please reach out! We would love to walk with you to resolve uncomfortable emotions, work on rediscovering yourself and new opportunities, improve your relationships, or develop habits of holistic wellness. Give us a call or send us an email today!

References:

Dekker, J., Buurman, B. M., & van der Leeden, M. (2019). Exercise in people with comorbidity or multimorbidity. Health Psychology, 38(9), 822–830. https://doi.org/10.1037/hea0000750

Beyer, K. M. M., Szabo, A., Hoormann, K., & Stolley, M. (2018). Time spent outdoors, activity levels, and chronic disease among American adults. Journal of Behavioral Medicine, 41(4), 494-503. doi:http://dx.doi.org.library.capella.edu/10.1007/s10865-018-9911-1

Goldstein, E., Topitzes, J., Brown, R. L., & Barrett, B. (2020). Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial. Journal of Health Psychology, 25(12), 1816–1830. https://doi.org/10.1177/1359105318772608