Do I Have Postpartum Depression?
Bringing a new child into the world is a huge life change and all life changes alter your emotional landscape, sometimes in ways that are unwanted or unexpected. After childbirth, it's common for a mother to experience a period of sadness, feelings of hopelessness and emptiness. Yet, most of these baby blues go away within the first week or two. Post-pregnancy—mothers who continue to have these feelings for more than two weeks may be suffering from postpartum depression.
“Postpartum” refers to the time after childbirth, but that doesn’t mean every mother should be on a specific timeline when it comes to their feelings after delivery. Experiencing some of the following symptoms for an extended period is normal, and it doesn’t determine your worth, future, or potential to be an excellent mother. Informing yourself about postpartum depression will help you understand how all of these physical body changes are impacting your thoughts. Understanding the symptoms and how mothers develop postpartum depression can be a first step in letting go of the secondary feelings of embarrassment, guilt, or shame you may have in reaction to the depression.
How common is postpartum depression?
Studies show that one in nine mothers suffer from postpartum depression, which is just over 10%. Seventy percent of mothers experience the short term “baby blues."
What causes postpartum depression?
Postpartum depression is a biochemical reaction that can be linked to several factors, and while every mother is different, here are some of the most likely causes:
Family or personal history of depression – Mothers that are genetically predisposed to postpartum depression are more susceptible to the illness. This means that women who have one or more family members that have suffered from postpartum depression are at a greater risk of developing it.
Also, mothers who have a history of mood disorders, anxiety, depression, or bipolar disorder, are 30-35% more likely to develop postpartum depression. Mothers who have already experienced it from previous childbirth are also more likely to experience it again.
Increased stressors and environmental factors - Major life changes after childbirth impact new types and levels of stress, from emotional to physical. High levels of stress negatively affect sleep levels, too, which can determine how a mom feels, and the level to which she can take on the responsibilities surrounding caring for her child. In this way, the lack of consistent sleep exacerbates and triggers other symptoms of postpartum depression. Inconsistent sleep and inadequate nutrition, along with different strains, can also lead to physical aches and pains.
Hormonal changes - A mother experiences record-high levels of the hormones estrogen and progesterone during pregnancy. But after birth, both of these levels quickly drop, which is the reason mood swings occur. This shift in hormone levels also contributes to anxiety, irritability, and sadness.
Oxytocin is the “bonding hormone” released after birth, but it also triggers maternal behaviors, causing moms to sense any present danger in their child’s life, thereby increasing anxiety. Progesterone, on the other hand, is meant to help combat some of the stress, but with the decrease in progesterone after delivery, anxiety becomes more difficult to manage. Even if you are suffering from postpartum depression for an extended period, these hormones will eventually find balance again.
What are the symptoms of postpartum depression?
While the symptoms for postpartum depression can be mild to severe, depending on the mother, it is a serious mental illness that impacts mental health, behavior, and physical health. It can interfere with your ability to connect to and care for your baby.
Seek professional help from your doctor, midwife, or nurse, if you experience any of these symptoms for more than two weeks:
Our nation is experiencing a pandemic, social isolation, economic anxiety and natural disasters. Anxiety and depression are at an all time high, especially for mothers. From worry of exposure to COVID-19, to bringing a child into the world at a time when the future holds more unknowns than it already did, the fear for new moms has been exacerbated.
If you are a mother living with postpartum depression, remember that you have done nothing wrong. You are not a bad mother; you are just one of many mothers who also feel this way. We recommend a circle of support; your physician, a support group, a psychiatrist and a therapist who specializes in working with new mothers.
Feedback-Informed care is a research-based system of mutual feedback designed to empower patient voices. The national drop-out rate for therapy is 47%. Research indicates that when there is an active dialogue between client and therapist, satisfaction dramatically improves. The therapeutic relationship can be a learning space for negotiating for what you want out of any relationship; romantic, family or the workplace. Many of us haven’t experienced a safe space to assert ourselves, to ask for what we want or to speak up when we are not satisfied, to practice vulnerability or to gracefully express uncomfortable feelings like disappointment, anger and fear. Our therapists are trained to help you practice authentic, empowered communication styles.
What to expect in a first session?
The first session is an assessment. Your therapist will listen to your story and ask a series of questions.
Your therapist will gather this information and develop a personalized approach to meet your unique needs.
Therapy begins at the second or third session.
Our therapists practice evidence-based care, meaning that our treatment methods are rooted in research and years of clinical training. However, research also indicates that the best outcomes happen when your relationship with the therapist feels like a fit. We hand-pick therapists based on their warmth and compassion---yet there is a diverse range of therapist personalities and personal backgrounds that inform their approach.
What is feedback-informed care?
You should expect to feel that your therapist gets you. You should feel heard, respected and deeply supported.
We invite you to share your expectations and preferences for your therapy experience.
Let your therapist know if your not sure what to talk about, prefer the therapist take the lead or if you would rather explore your relationships and life patterns. Share your preferences with your therapist directly. You are also are welcome to reach back out to your intake coordinator for a re-match.
The person ahead of you just went into their audition. You’re next in line, and you feel frozen with fear.
They’ll know you’re a fraud the minute you step in the room. Your throat feels tight, and you aren’t sure you can speak now.
The door finally opens, and they’re calling you in. Next.
Audition anxiety can feel like you’re being choked from the inside. Paralyzing fear can make your performance robotic, like you’re a ghost outside your body. Instead of giving up on auditions, shut down your inner casting agent. Take these tips for overcoming performance and audition anxiety for actors.
Do not try to repress, deny or fight anxiety. These defenses tend to make it worse. Instead, label the anxiety and allow it. Here is an example internal dialogue:
“I feel anxious. This is a normal response. It’s allowed to be here.”
Avoid over-identifying with the anxiety---don’t collapse into it. Zoom back and notice anxiety is a small, fleeting part of your experience, but not the total of you or your experience.
“I notice some anxiety, Nevertheless, I am still going to access the joy and passion of my craft.”
Use any of these techniques bleow when you need to calm the butterflies. Even better, put a few of your favorite techniques together. Train your body to stay grounded by creating a calming pre-audition ritual.
Mental rehearsal - Visualize a successful auditionIt’s tempting to describe a successful audition in negative terms, like “not screwing up,” or, “not sweating and shaking.” Instead, flip the script and do a positive reframe. Imagine the entire setting including the casting agents. Then, imagine yourself fully immersed in the character. Imagine yourself “in the flow” of your craft. Imagine yourself feeling satisfied afterwards. Repeat this visualization multiple times per day. Use empowering words to paint a picture in your mind.
Mental escape - Visualize your calm placeAnxiety can make you feel ‘out of body.’ You may spend more time self-spectatoring rather than feeling grounded and at ease. Take control of your nervous system several hours before an audition by spending 20-30 minutes getting relaxed. This will make it harder for your nervous system to get hyper-aroused and increase your chances of remaining centered.
Imagine a calm, soothing location. This could be a place in real life or something from your imagination. Daydream about this place in detail, getting down to scent, color, sounds, and physical sensations.
Create this full scene and allow your mind to experience it. The more details you add, the more realistic it will be in your mind. Visiting this place several times will help you bring it up easily when you really need it. You can also use one of the many guided meditations on Youtube.
Comforting touchTouching a soft or soothing object can calm you quickly, like a child with their favorite blanket. Find something that’s physically comfortable to touch, like a soft blanket to wrap yourself in. The calming effect can be even greater when it holds emotional meaning. When you pet a dog or cat for several minutes, your body releases hormones that help you feel relaxed. Your blood pressure drops and the amount of cortisol in your bloodstream decreases.
When your audition time draws near, find a smaller comfort object to keep with you. Stay in touch with your body by focusing on how the object feels next to your skin.
Get grounded with deep breathingDeep breathing is about more than just air. Taking several slow breaths will:
Feel the shoes on your feetWith this technique, pay attention to physical sensations you normally ignore. Start by consciously focusing on your toes and how they feel. Wiggle them around and notice how the rest of your foot feels in your shoe. How tightly is your shoe on your foot? How much can you shift your foot around? Squeeze your foot as hard as you can for a few moments, then release it.
Repeat this for your ankles, knees, and up the rest of your body. Also, try starting with your head and go down to your toes. See which direction helps you feel more relaxed or grounded.
Get Grounded and PerformUse these tried-and-true tips for overcoming performance and audition anxiety. Make your next audition authentic, confident, and grounded. For further techniques, pre-audition role-plays and a deeper exploration of your blocks, Silver Lake Psychology can connect you with a therapist that specializes in working with actors and entertainers.
THE SELF-ESTEEM ROLLER COASTER
Self-esteem is not static for most people. It often shifts from thoughts of inferiority and shame to grandiosity and euphoria.
Humans often evaluate themselves with universal appraisals: I am smart. I am beautiful. I am thin. I am talented. These broad, idealistic generalizations are followed by assumptions of social value. I am talented; therefore I am worthy and people will like me.
When we lack confidence, we try to boost our self-esteem with even more evaluative statements, repeating “I am beautiful” over and over again, hoping to internalize the statement. Perhaps you try to elicit this feedback from other people, posting photos of yourself on Instagram and other media platforms for likes and validation.
It feels good to make these statements. We experience a burst of positive self-regard. The euphoria is far from permanent, however, and many people who struggle with self-esteem notice that this high quickly deflates.
To end the roller coaster of fluctuating self-esteem, the key is not to focus on appraisal at all.
THE KEY TO LASTING SELF-ESTEEM
True self-esteem is built on an ongoing relationship with yourself, a relationship of self-support, an internal dialogue that says, “I see you exactly where you are, and I support you.”
Rather than seeking affirmations, try radical self-acceptance. It’s a completely different orientation of self. Radical self-acceptance is about recognizing your true self and accepting that person. You may notice qualities that you want to improve, and you allow yourself to be a work in progress. Rather than feeling shame that you aren’t perfect, you feel at ease with your imperfections. You are happy spend time nurturing your growth rather than perpetually striving for perfection.
Outcomes, such as your weight and your achievements, are less important than the process of relating to yourself. You are there to support yourself in any state. The feeling that comes with radical self-acceptance is not ego euphoria; it is a quiet peace and comfort in your own skin.
Self-acceptance requires a commitment to being true to ourselves each day.
An affirmation could be, “Today, I am committed to being exactly who and what I am.”
When we actually see ourselves (rather than evaluate ourselves through societies lens), the truth of who we are is nuanced rather than simple. You will notice the fine details of your personality rather than trying to fit into monolithic categories, such as “beautiful” or “smart.” You are working with whatever you are right now, in this moment. It is a humble position; you may be a work in progress, but the ongoing commitment to authenticity and radical acceptance creates a more sustainable self-esteem, a rock-solid foundation that allows you to feel peace within yourself, even when the world pushes against you.
Online counseling sessions can be just as intimate, if not more so, than in-person therapy sessions. The first week or two of tele-therapy were an adjustment to the technology for both client and therapist. Over the past few weeks, I've noticed that the sessions have become much more rich. Meditation and other contemplative practices have long been an excellent adjunct to therapy. Now that there is no more commute to our offices, I've been recommending that the extra time be used to create a special ritual. Below is a list of what I've been recommending. Repeat this process every week to provide a sense of grounding and to take your therapy process to a deeper level.
If you hurt me, you hurt yourself.
---my husband’s response when I said something mean
This profound statement reveals how intertwined our lives are when in a relationship.
I was halted. My anger wanted to do damage---and then walk away unscathed, feeling catharsis, feeling right.
This kind of gratification does not exist in a relationship. Hurting him would not lead to my happiness.
In a relationship, every action has a reaction.
Each day, we make choices that have consequences. Thousands of banal micro-choices that have a significant effect on another person; a dish left unwashed, a critical comment, a seductive overture unnoticed, looking at social media while someone is talking to you.
Your partner has an experience of your choices. Their experience is filtered through layers of their past experiences. They make myriad interpretations; I am loved, I am not loved, this person is selfish, I can’t depend on this person…… Profound interpretations---of your banal micro-choices-- are happening inside this person, in their silent, internal dialogue about you.
Your partner now chooses an action.
Perhaps, they fall quiet. Recoil from your touch. Snap at you. Avoid you.
These perceptions, choices and actions form patterns that repeat over time.
The content of the fighting may change, but the pattern remains the same. Couples feel stuck and often, partners blame each other. Our internal narratives, or stories about the relationship, are often epic tales with great villains and tragic victims. As a couple’s therapist, I’ve found that there are rarely clear victims or villains; more commonly, I see a series of cycling actions and reactions with mutual input. The truth is, whatever situation you’re in right now, you probably co-created it.
To say couples are interconnected is not a new concept, yet this notion still proves difficult to execute. In truth, awareness is mental labor. You would need to interrupt your own mental dialogue to consider the experience of your partner. You would need to ask yourself, ‘How will they feel about this banal micro-choice?). It’s fairly common to be self-focused, and rest assured, it is not necessarily clinically narcissistic. I’ve noticed that most people’s infractions were not intentional or malignant, but a benign blindness; an act of omission.
Shelter-at-home has turned our homes into relationship crucibles. There is an increase in domestic violence and a rise in relationship tension, irritability and conflict. However, it’s not easy to get distance from our partner or to break-up. What we can change---is how we fight.
The first step in un-packing a pattern, is identifying your conflict style. Here are some simple questions to get you started.
What is your Conflict Style?
How do I express anger and resentment?
How do I ask for what I want? Do I make demands or requests?
Do things need to be done ‘my way’?
Am I open to other perspectives on what is a ‘right way’?
Do I give my partner space to say no?
Do I ask about my partner’s perspective?
Am I able to tolerate different perspectives?
If not, do I get angry or need to convince my partner toward my perspective?
Am I able to compromise?
Do I tend to persuade or manipulate to get my way?
Do I put my partner’s wishes ahead of mine?
Do I assert my point of view when it’s different?
Do I ask for what I want?
Do I communicate my expectations out loud? Or expect the other to ‘just know’?
Do I teach my partner how to love me?
Do I try avoid my partner’s anger?
Do I change my behavior if I believe my partner will be disappointed?
Do I guess how my partner will react to situations rather than asking directly?
Do I share when I am upset?
Is it hard for me to tolerate differences?
Is it hard for me to tolerate tension?
Am I defensive when my partner expresses feelings?
Do I tend to attack rather than investigate and ask questions?
Do I prepare my next attack while my partner is talking?
Do I use criticism to get what I want?
Do I use criticism to express how I feel?
Do I avoid vulnerability statements? ( i.e. ‘I am sad,’ or ‘I am disappointed.’)
What does an equitable conflict style look like?
This is the starting point for unraveling toxic patterns. A good couple’s therapist will not shame you for using one of these conflict styles. A good couple’s therapist will not take sides. Your therapist would map out your problematic pattern, teach different approaches, and allow you to practice with role-plays. With guidance and support, you and your partner can grow and establish new, unifying patterns.
It is possible to do couples therapy over tele-health and if you’re feeling the heat now, it’s better to get started remotely before the situation escalates. Couples therapy works best when there is still some good will and faith that your partner can change with you.
What is Trauma?
Trauma is a term used to describe a person’s emotional response to a severe, distressing event that shatters one’s sense of security and safety. Highly frightening events such as assaults, car accidents, combat, or natural disasters typically contain an overwhelming amount of stress that disrupts mental health, nervous system and neurological functioning.
According to the American Psychiatric Association (APA), approximately one in eleven people that have survived or witnessed a traumatic event will develop posttraumatic stress disorder (PTSD) in their lifetime.
The term trauma is often used beyond the criteria for PTSD and refers to relationship traumas, reactions to a crisis such as the ongoing pandemic, and other acutely distressing experiences.
Trauma symptoms can be acute or chronic. It is important to address PTSD symptoms early, so you can start the healing process, and get your life back on the track.
What are the Symptoms of Trauma?
The most common symptoms of post-traumatic stress disorder are:
After the traumatic event, the brain keeps the memory of the event in the short-term memory (stuck in replay) rather than moving it into long-term memory. Having the trauma sit in the immediate, short-term memory (which is normally reserved for day to day functions), keeps people constantly hyper-vigilant for danger and the entire nervous system is constantly on guard as a result. This experience would be exhausting and obviously distracting, making it hard to get work done or feel normal in social situations.
As a result, people experiencing trauma symptoms often socially isolate or feel uncomfortable in social situations---even around friends and family. They tend to report feeling “not like myself,’’ joyless and ‘off in space’ (dissociation). Some people are overtly emotionally disturbed---they may experience crying spells or violent outbursts. Others become numb, foggy-minded and emotionally flat. Substance abuse is a common secondary issue. There is a real domino effect on all areas of people’s lives.
Other atypical signs of trauma may include body pain, severe migraines, sexual dysfunction, eating disorders, and a rapid weight loss.
These unusual signs and symptoms of PTSD may lead to inaccurate diagnoses. It is, therefore, particularly important to understand the signs of trauma, so you can get the appropriate trauma treatment.
What are the Benefits of Trauma Treatment?
The good news is that trauma treatments have research to support their effectiveness. There are several popular treatment approaches used by therapists. Traditional talk therapy is less effective than a specialized treatment protocol. I will outline the types of trauma treatment below. None of them are superior to the others; they are all excellent and have research to support their efficacy. We have therapists on staff with certifications in each of these trauma treatments. I’ve personally had great results with the Cognitive-Behavioral/Mindfulness protocol.
What to Expect from a Trauma Therapy Session?
Processing emotion, neurologically, biologically, and cognitively, is essential in trauma recovery and healing. The goal of trauma therapy is to reduce symptoms and teach skills to manage triggers. Many people experience a full recovery. The intrusive thoughts and feelings will subside as the brain moves the traumatic event out of your short-term memory and into your long-term memory.
Therapy sessions will be more structured than traditional talk therapy. The therapist will be focused on symptom reduction. As the symptoms become more manageable, therapy will focus on creating meaning and restructuring thought patterns.
Many patients feel scared of re-experiencing their trauma in therapy. In fact, avoidance of directly talking about the event is a hallmark of PTSD. It’s true that therapy does expose people to the anxiety, but therapists are well trained to incorporate anxiety management into the session and use exposure to the trauma in small steps. The sessions should feel emotionally evocative but tolerable—and you should walk away with a sense of learning and mastery. It’s wise to surround yourself with extra support when embarking on trauma treatment. Journaling and meditation are great adjuncts to therapy.
Some of the most successful PTSD therapy treatments involve Cognitive Behavioral Therapy (CBT) for trauma, Eye Movement Desensitization and Reprocessing (EMDR), and the Trauma Resilience Model.
In short, the main aim of CBT therapy for trauma is to decrease symptoms by using strategies to relax the body while introducing small amounts of exposure to the symptoms, then incorporating various interventions in the moment, then returning to relaxation at the end of the session. The goal is to work on the trauma but keep the client’s nervous system within a window of tolerance. The goal is to train the brain that the person is no longer in immediate danger so it will stop sending false alarms through the nervous system. Many bio-based interventions are used to calm and retrain the nervous system.
Eye Movement Desensitization and Reprocessing
EMDR therapy focuses on disturbing emotions and thoughts that result from a traumatic event rather than on trauma itself. This therapy approach can be used in all stages of trauma treatment, from the beginning to the end of treatment. Three stages of the recovery process for trauma include:
Trauma Resiliency Model (TRM)
The Trauma Resiliency Model is rooted in research on resilience. This is a skill-based treatment that teaches people about the neurology and biology of trauma and how to bring the body and mind back into balance.
I'm pleased to announce that my book "The Women on My Couch" made it to BookAuthority's best Psychotherapy books of all time!
BookAuthority collects and ranks the best books in the world, and its lists are featured on CNN and Forbes. I'm honored to receive this kind of recognition. Thank you to all my readers for your support!
The book is available for purchase on Amazon.
Should I Stay in this Relationship?
15 Smart Questions to Help You Decide
(Hint: How you were loved shapes how you love.)
.Are you contemplating a break-up or divorce? What kind of information do you need to make a good decision?
Perhaps you’re listing your partners infractions or looking at the frequency of conflict or assessing your alignment on values and goals. As a couple’s therapist, I’ve had the opportunity to witness hundreds of people make decisions about whether to stay or go. I’m interested in the way people make these life-changing decisions. What is the evidence? What is it based on?
We can all make lists of our partners failings. There is conflict in every relationship (even if you don’t fight). There are differences in every relationship. I’ve learned that differences and conflict are often not the real deal-breakers. At the core of most people’s decision-making is the experience of love; feeling loved in the way you need to feel it.
Here are some questions to take you on a deeper dive into the nature of who you are—and who your partner is-- in a relationship.
Go through these questions with your partner. Take turns listening deeply.
Repeat 3 times; once related to your mother, father and one significant relationship from your past.
1. How did your mother/father/significant past person express love to you? (Choose the ones that apply below)
2. What was your reaction to her expressions of love? Describe your felt experience both in feelings and physical sensations (choose any that apply or add others).
3. On a spectrum, did their expression of love feel like it was a good fit, too much, not enough? If overstimulated by a parent’s love and attention, did you feel irritable, strong desire for freedom, or angry. If the love wasn’t enough, did you feel longing, sadness, emptiness, loneliness, or anger. If their love was exploitive, did you feel shame, anger, controlled or manipulated. Was love safe or unsafe? Was love consistent or inconsistent?
4. How did you behave in response to their love style?
5. In what ways did you feel deprived? What was missing for you?
6. How did you react to not getting what you wanted?
7. How were your thoughts and expectations changed? (i.e. People are like this…men are like this…women are like this….)
8. Did you believe you were worthy of love? Valued in the family? Worthy of attention? Worthy of being heard?
9. Did you feel ignored? Unworthy of being seen or heard?
10. As a result of these experiences, do you believe you can count on/depend on others?
11. Do you feel comfortable letting others see your need for love (i.e. being vulnerable and open)?
12. Is it easier for you to receive or give love?
13. What fears do you have around giving love? What feels safe and what feels too vulnerable?
14. What is your fantasy partner? If you could waive a magic want and have your partner love you in a way that is perfectly designed for your needs, what would that look like?
15. What did my gender, sexual orientation, religion and culture teach me about my lovability and how to love others?
Make a list of what you’ve learned about yourself. You may notice that you’ve developed feelings, thoughts and expectations about what love feels like, should feel like and even your capacity to give love. Your most salient experiences shaped how you view your present reality---and often result in misinterpretations of reality. As a couple’s therapist, I’ve learned not to take anyone’s story at face value. Any event being discussed in couples therapy has two distinct perspectives. There is no shared subjective experience.
We all project our past onto our present partner. Rather than seeing them as they are, we see them through the lens of our past. As a result, we make faulty assumptions about other people (this principle extends into other relationships as well).
I’ve observed that these distortions change over the course of time. In the early stages of a relationship, we often project idealized fantasies on to our partner; feelings are positive and loving. In middle stages, disillusionment sets in as we realize this human being is not our fantasy; here, anger emerges then grief sets in. Years into the relationship, deeper, childhood pain re-emerges, and more intense emotions show up.
At the intersection of reality and projection, my job as a therapist is to witness how people make meaning out of both perceptions. I’ve noticed themes across their narratives; assumptions about the partner or a situation. These are some common assumptions:
“I can’t depend on you.”
“You don’t really care about me.”
“You are trying to control me.”
“You are selfish/neglectful.”
When said out loud in session to the partner, “ I don’t think you care about me,” and the partner is able to respond, it usually becomes clear that it was not the partners intention. As we work through each of these deep assumptions over the course of therapy, a heaviness is lifted and the couple begins to talk about these assumptions with levity or in a constructive way that allows them to correct their behaviors and reach for a better way to love.
In order to make a wise decision about staying in a relationship, you want to use evidence that is grounded in reality and not distortion. Once you're able to let go of your assumptions, you will see your partner more clearly. His/her infractions will be contextualized. Your differences and conflicts will take on new meaning. If you want to stay together, use the information that you’ve learned about each other to craft new ways of interacting; specifically-tailored to your deprivations and longings----not in a way that keeps you trapped in your past, but in a way that allows you each to overcome the past and grow. Seek to create a corrective, healing set of patterns.
Your deal-breaker question: Are you willing and able to create a brand new love?
If you are not both willing and able to learn and grow, then perhaps you should part ways.
Dr. Engler's Articles on the Huffington Post:
Should You Get Pre-marital Counseling?
Women's Health Magazine interviews Dr. Engler on the factors to consider.
Why Moving in Together Kills Your Sex Life, and What to Do About It.
Men's Health Magazine interviews Dr. Engler about how to improve your sex life, and reviews her book, "The Men on My Couch."
11 Things That Actually Surprised This Sex Therapist.
BuzzFeed reviews Dr. Engler's new book, "The Women on My Couch."