Why I took a risk and joined a therapy group

In May of this year, I published this in my newsletter. I want it to live on for others to read and learn more about group therapy so I’m sharing it here. (If you’d like to join my mailing list to receive future newsletters, please sign up here).

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Last October I enrolled in a group therapy training program. If you’ve been following along for any length of time you know I’m passionate about running groups. If you're new here— welcome!

Enrolling in this program seemed like a natural step to deepen my work. What I didn’t realize was just how much I would learn about myself. In addition to the monthly Saturday classes, students are required to participate in a weekly interpersonal process group. I was aware that one's role in the group often mimics interactions in the outside world. But I had no idea how that would FEEL.

To see myself more clearly has been liberating. From my interactions with colleagues, to the group of parents I’ve met through my child’s softball team, to my family of origin— I'm the same person, doing the things I do that keep me feeling safe and that simultaneously hold me back from being the person I'd like to be. 

The group provides an experimental place to try out new things and take risks in being the person I'd like to be in the outside world. With practice, the hope is that I will start making changes in all my real-world groups.

Participating in a group is a risk. We don't know how we will change, and if the group will deliver what we are seeking. It takes vulnerability and courage to show up, commit, and make changes where old patterns are no longer serving us. By the end of the group, most people feel more comfortable in their own skin.

I don't usually disclose so much about myself, but I’m sharing my experience because soon I will be offering process groups in my practice to provide a similar opportunity for others. Message me here with any questions you have about process groups. What would it be like to lean into being a better version of yourself? 

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As of August 2024, I’m opening enrollment for a women’s group I’m starting this fall. This group is open to everyone and anyone who identifies as a woman. Would you like to learn more about yourself, challenge old patterns, improve relationships at work, home, with peers? This group is for people who are interested in learning about their own reactions and interpersonal interactions. The focus is on what comes up within and between the members in the room. You can learn more about the group here.

Birth Trauma: Strategies for Healing and Prevention

This is the second part of a two part series on Birth Trauma. In Part 1, which you can read here, you met Sara who was fearful of becoming pregnant with a second child. Although she was riddled with anxiety, she was unaware she had a real problem: because she’d experienced trauma after the birth of her first child she feared getting pregnant. Although birth trauma is a real psychological condition, with concrete symptoms and a diagnostic criteria, many people internalize their experience, feeling shameful instead of seeking support.

My chance encounter with Sara was pivotal. A few weeks later she reached out asking for a referral to a local therapist. Through our informal talks I was able to help Sara understand how her unique experience left her vulnerable to experiencing a traumatic birth (also called postpartum PTSD), and that it was not only extremely common but treatable.

Sara, like many women I see in my practice, was unaware that her symptoms were worth paying attention to. The most common coping strategy I hear about is the attempt to ignore symptoms- to sweep them under the rug so to speak. But this approach is rarely successful for very long.

Women who eventually enter my office for therapy are typically struggling with one or more of the symptoms addressed in Part 1 of this series- symptoms that interfere with their ability to function at home or at work.  In this article I’d like to offer some recommendations for healing from traumatic birth and/or preventing a subsequent similar experience. 
 

Treatment of Traumatic Birth, or Postpartum PTSD

While many women who experience some symptoms of Postpartum PTSD will resolve their emotional stress with positive support from friends or family members, others will continue to struggle and will benefit from professional help. Recommended treatment for Postpartum PTSD starts with a thorough assessment by a trained mental health provider.

1. It’s critical to be assessed by someone who specializes in maternal mental health for a correct diagnosis to be made.  Therapists unfamiliar with postpartum PTSD might inadvertently recognize the symptoms as postpartum depression or anxiety. Although some of the symptoms are similar, the underlying experience of a birth trauma calls for a different treatment approach.

2. Both medication and therapy are evidence-based recommendations for treating birth trauma. Many therapies work quickly and effectively with postpartum PTSD, such as EMDR, which I offer in my practice. Narrative, group, and body-based therapy can be helpful treatment modalities.

Avoiding a Subsequent Traumatic Birth 

Whether you're anticipating a future pregnancy or currently pregnant, there are many things you can do to reduce the likelihood of experiencing a subsequent birth trauma.

1. Include your partner in this process. While it might seem obvious to some, others may feel isolated by their initial trauma and not realize the important role a partner can play in providing support and mitigating a subsequent traumatic experience.

2. Hire a doula. Simply put, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible. If for some reason the birth is not going according to your ideal plan, a doula will intervene during labor with the intention of alleviating the trauma to reduce a woman’s chances of developing PTSD.

3. Take a childbirth education class. It’s important for women (and their partners) to be educated about what is supposed to happen during childbirth and what happens in the body during the birthing process. Childbirth classes also help to inform expecting parents about options during birth including: pain management, birthing positions, and how to cope with complications during birth.

4. Develop a written birth plan with your birth team. Discuss and include the interventions you are open to, those you want to avoid. Explore your back up plan. Remember to plan for the postpartum period and to consider the support that will help ease your adjustment to motherhood, or to mothering an additional child.

5. Talk to someone you trust. Work through any past traumas with a therapist, or at the very least discuss your history with your care providers to best prepare for the experience of labor and birth.  Meeting with a psychotherapist or body worker specializing in perinatal mental health allows you to focus on beliefs, emotions, sensations and andy past experiences that may influence your upcoming birth.
    

Help Is Available

Birth trauma is highly treatable; the first step of course is to recognize there's a problem.  With help you can avoid additional suffering and complications for both mom and baby. In San Diego, Postpartum Health Alliance offers a warmline with trained volunteers as well as a provider directory to locate trained therapists and other birth professionals. Outside of San Diego, Postpartum Support International can connect you with therapists worldwide who specialize in maternal mental health disorders.

3 Differences Between Postpartum Depression and The Baby Blues

People often confuse the Baby Blues and Postpartum Depression. Some like to say that all moms have a bit of "postpartum". Have you heard that? When I hear that I presume they're not sure what the difference is between the Baby Blues, which are normal mood fluctuations after having a baby, and something more serious like Postpartum Depression or Postpartum Anxiety (and then there's the very important fact that "postpartum" is actually a period of time, not a condition).

For the purpose of this post, I want to clarify that PPD and PPA are NOT the only mental health concerns during pregnancy or postpartum. They fall under the umbrella of Perinatal Mood and Anxiety Disorders (PMAD), but I wouldn't have caught your attention with that title now, right?

Are there visual cues to detecting Postpartum Depression? 

It's not only regular folks who are confused about the differences, but some medical professionals are also a bit unclear. I've heard that some some professionals specializing in women's health don't formally screen for perinatal mood or anxiety disorders because they feel they can tell whether a mom is struggling with PPD just by looking at her. Is it possible, you wonder? 

Here's a quick quiz: below are two images of postpartum women. Which woman has the Baby Blues? Which has Postpartum Depression? If you're struggling with Postpartum Depression right now, or have in the past you know better than to fall for this one: you don't have to be sad and teary to be diagnosed with a PMAD. In fact, many women make an enormous effort to look put together. If this sounds like you, you're definitely not alone. 

Image A

image b

The Face of the Baby Blues

The massive hormonal shift immediately after birthing a baby will more likely have you looking like the image on the left, "Image A" than the one on the right, "Image B". A shocker for many despite the fact that the Baby Blues affects up to 80% of mothers and as I said earlier, are due to a normal fluctuation of hormones.

Danielle Haines, on the left (Image A), is a doula and midwife in-training. She posted this raw image of herself on Facebook a few months ago. It was taken days after giving birth to her son, and she shared it in an effort to shed light on what the adjustment to early motherhood really looks like. Sadly, there's still stigma attached to this normal postpartum experience. Women are unfortunately hesitant to share that motherhood isn't all ice cream and roses.

The Face of Postpartum Depression

The image on the right, of course, is Hayden Panettiere. She looks like so many new moms--walking on the beach, seemingly happy with her baby and fiancé. No visual cues that she is suffering. This is also how many women who are suffering survive, by projecting a put-together image of themselves, avoiding the shame and stigma that still persists. Meanwhile they're falling apart on the inside. Alone. Because they "look fine" no one pays attention. They slip through the cracks. Up to 20% of women experience a Perinatal Mood or Anxiety Disorder. 

When this photograph of Panettiere was captured her baby was three months old. She sought treatment for postpartum depression seven months(!) after that image was publicized. Fortunately, times are changing and celebrities like Hayden Panettiere are more open about their real-life experiences adjusting to early motherhood. Thankfully there is a growing effort to destigmatize PMADs, and to motivate others to get the help they need. 
 

Symptoms of Postpartum Depression vs the Baby Blues

So if we (doctors included) can't tell by looking, how can we know if what we're feeling is part of the normal adjustment to early motherhood or something more serious? Below is a cheat sheet describing the different symptoms one may experience with either the Baby Blues or Postpartum Depression. You may notice some similarities. Keep reading below to better understand the differences. 

It's not necessarily what you are feeling. It's how often you feel it, how long you have been feeling this way, and how much it impedes your functioning. 

1-Duration

How long have you been feeling this way? The baby blues typically resolves within 2-3 weeks after giving birth, whereas Postpartum Depression symptoms continue for longer, and may present several weeks or months after having a new baby (*or bringing one home-- PPD impacts adoptive parents as well as fathers/non birthing parents). 

2- Intensity

How much are these feelings interfering with your life? If you're not sure how to evaluate intensity, answer these questions:

• Do I find it hard to care for my own basic needs or those of my baby or other children? Is my eating or sleeping affected by these feelings?

• Are these feelings interfering with other important relationships? With my partner? Other family members? Friends? Work?

3-Frequency

How often are you feeling this way? Once a week? Once a day? Nonstop? There's a difference. 

It's important to recognize that some of the most common symptoms of postpartum depression-- rage and anxiety for example-- look nothing like the stereotypical image of a saddened, depressed woman who can't get out of bed.  Symptoms of the Baby Blues respond extremely well to rest and other forms of self-care. Here's an article that outlines 6 Ways to Improve your Postpartum Self-Care. 
 

Getting help for Postpartum Depression

If you've been struggling with distressing thoughts and feelings for longer than two weeks, I recommend that you reach out to your doctor or a psychotherapist who specializes in perinatal mood and anxiety disorders.

And if it's less than two weeks but you just "know" something's not right, pay attention to that inner voice. Trust that you know yourself best and reach out for help. It really doesn't matter what we call it; you and your baby both deserve the care and attention you need to thrive. It's also important to reiterate that Postpartum Depression as referred to in this article, falls under the umbrella of perinatal mood and anxiety disorders, PMADs, which encompass other illnesses such as postpartum obsessive compulsive disorder, postpartum anxiety, postpartum post-traumatic stress disorder and postpartum psychosis.

If you or someone you know is struggling with a Perinatal Mood or Anxiety Disorder, please reach out for support. PMADs are very treatable. In my private practice in San Diego, California where I specialize in Maternal Mental Health, I offer a free 30 minute in-person consultation to find out if I'm the right therapist for you. Postpartum Support International (PSI) is a national organization that maintains a warmline and a list of trained providers specializing in Maternal Mental Health.  If you’re in San Diego, CA, The Postpartum Health Alliance is our local chapter of PSI and a wonderful resource.

How Walk + Talk Therapy Will Change Your Life, Mama

I know what it’s like to have a new baby around the house. The dirty dishes piled high, the never-ending laundry, did you eat today? Just forget about exercise, you don’t even have time for a shower, right? You’re wondering if and when life will ever resemble those incredible Instagram photos you posted from your babymoon.

This is a typical scenario for a family going through the transition to parenthood, yes? Of course there are precious moments, but it’s intense. That first year of life is nothing short of a hurricane sweeping through your world. When you factor in the inevitable additional emotional stress parenthood brings, life is more challenging. You may know you want professional help in the form of counseling, but you just can’t figure out how to fit it all in.
 

ENTER WALK AND TALK THERAPY

A recent conversation with a friend reminded me that although I offer Walk and Talk Therapy sessions in my San Diego-based private practice, where I specialize in maternal mental health, many people are unaware of it’s existence.

In my work as a licensed psychotherapist, over the past 15 years I’ve found that Walk and Talk Therapy is helpful for clients who are going through life transitions, have anxiety, are experiencing some kind of loss or grief among other challenges. Mothers of young children in particular, seem to really gravitate towards this modality; it’s so easy to bring your baby and stroller and go. Walk and Talk Therapy combines traditional talk therapy with physical exercise. Want to know more? 

So here's the skinny on what Walk + Talk is and what it isn't

Walk and Talk Therapy is:

• a great option If you don't enjoy all the eye contact inherent in traditional office-based psychotherapy sessions.
• helpful if you're suffering from phobias, excessive anxiety, or are newly postpartum and not sure how to fit exercise of any kind back in your life.
• an opportunity to breathe fresh air and connect with nature (and another adult who happens to be trained to support your mental health)

Walk and talk is not: 

• a cardio workout.
• strenuous.
• the same thing as chatting with a friend while walking.

Sounds pretty good so far, yes? Walking side by side with a trained psychotherapist feels collaborative and encourages conversations. Clients often feel more at ease sharing personal information in this informal, outdoor environment than traditional office-based therapy. Some clients also find it less intimidating to talk to a therapist when you’re both doing something else. And be assured, your confidentiality will be maintained, just as if you were in an office.  

Here’s how Walk + Talk therapy will change your life, mama

1.    You will feel better
Participating in regular Walk and Talk Therapy sessions with a trained therapist has been shown to reduce anxiety and tension, improve mood and increase energy. Physical exercise releases endorphins (feel-good hormones), which naturally trigger positive feelings helping to reduce levels of depression and anxiety, and can actually help prevent depressive symptoms. Many people report improved self-esteem and feelings of well-being, improved sleep (clearly that research wasn’t conducted on parents of young children), and an enhanced mind-body connection

2.    You get to move your meat (aka exercise) AND take care of your mental health
It’s hard to fit in exercise as a new mom, or even an experienced one. Sure you could get a fancy jogging stroller but just the logistics of it all seem overwhelming. So here’s an opportunity to start small while also improving your mental health. Although Walk and Talk Therapy isn’t a workout, it is exercise and it can help you start to carve out time for what’s important.

3.    You don’t need childcare
Enough said.

4.    You will feel better
I already said this one but it’s worth repeating. As a new mother, it’s not uncommon to put everyone else first. After all, you have a new being that’s relying on you. But like they say on an airplane- you need to put your own oxygen mask on first before helping others. Self-care is important. If you don’t take care of you, not only will you suffer, but those you love will too.

If you’re struggling with your adjustment to motherhood, please reach out for support. Contact your doctor, Postpartum Support International, or a mental health professional. If you have more questions about Walk + Talk Therapy, or think it may be a good fit for you, check out these Frequently Asked Questions. And if you're in San Diego, give me a call! 

Setting New Year's Resolutions: Seeing Past Your Infertility

New Year's day has come and gone and if you haven't set a resolution for 2016 yet you're likely reminded through various forms of media multiple times a day. When you're struggling with infertility, "having a baby" feels like an obvious goal that's constantly on your mind. However, I encourage my clients to choose a resolution that they can be 100% responsible for. Infertility, as we know, is very often outside our control. So when you're consumed with thoughts about your next treatment, phone call with xyz adoption agency, finding your surrogate, or the miscarriage you're still mourning, it's important to find a way to harness your energy to navigate this stressful, anxiety producing time of life.

Setting a goal for an entire year can certainly be intimidating. As a therapist, I've spent a lot of time helping clients develop and modify goals, resolutions and aspirations. Using the SMART acronym helps me help my clients get set up for success; every goal needs to be specific, measurable, attainable, realistic, and time-bound. I also coach my clients towards choosing resolutions that promote their overall well-being, and specifically their mental health. 

Some of the most popular resolutions I've heard that support the big picture of having a baby this year include: yoga, meditation, walking, running, reading, healthy eating, connecting... What do these have in common? They will improve your well-being regardless of when or if you bring a baby home in 2016. 

Choosing a resolution

Take a moment and think to yourself: What do I need more of in my life? Really, I encourage you to stop reading for a moment (after you read these next three sentences), close your eyes and take a deep breath. Maybe two. Then, ask yourself: What do I need more of in my life this year? If you're coming up blank, here are a few questions to spark ideas: Could I benefit from a stronger mind-body connection through yoga, or running? Should I scale back on exercise and focus on building a meditation practice, walking, or being in nature? Nothing yet? How about your connections with others? Ask yourself if you need to take time this year to reconnect with those you love, or deepen your connection with yourself? Maybe you've been holding in too much for too long and really need to seek the support of a trained therapist this year. Dealing with infertility is intense. It can creep up on you just how stressful it is to juggle this unexpected life turn along with your day to day life. 

Setting your resolution in motion

So now that you've chosen your resolution for 2016, it's time to dig in. Lets make sure it's a SMART goal. I'm going to share one of my resolutions for 2016 as an example. But before I share my goal, please take out a piece of paper and pen or open up some app on your phone and work along with me. Here we go- My resolution is to camp more. Being in nature, unplugging from all there is to unplug from and taking a break from the day to day grind while breathing in fresh air and sleeping closer to the stars always makes me a happier person. It gives me the chance to connect more fully with myself and my fellow campers... It's food for my soul. 

While I'm instantly at ease envisioning this goal coming to life, it's hardly a SMART goal as is, so lets see how using the SMART format helps me flesh it out--

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Specific
My goal of camping "more" is not very specific. What's "more" for me might be less for some avid campers, right? According to the SMART Goals Guide, make sure your goal includes the "who", "what", "where" and "when". So, I'm (who) going to camp (what) 5 times in 2016 (when) in California (where). Specific- check. 

Measurable
How will you know you've achieved your goal? Can you see, hear, feel or taste it? Camping 5 times in CA-  Measurable, yes! At the end of 2016 I'll be able to look back and see whether I've reached my goal.  
 

Attainable
This is a key step in setting a SMART resolution. It's important to reflect on your own capabilities and skills when creating a goal that's attainable. Only you know what's going on in your life, what's a comfortable stretch and what's not. If you hate bugs and must have a flushing toilet, your goal would look different than mine. As an experienced camper, I feel my goal is very doable. 

Realistic
While your resolution should urge you to stretch and grow, maybe even learn a new skill, it should also be something you are capable of doing. Is the goal you're working on SMAR so far? I feel my goal is in fact realistic. But I have a confession to make: I originally wrote my goal as camping 10 times this year. But as I thought about it, I realized that last year I only camped once!!. ONCE. So I'm glad I went through this process and reassessed what is realistic for ME this year. Five will likely be a stretch after a mere one time last year, but there were other years I camped more, so it's a comfortable stretch and goal for ME. I'm stressing the ME here because setting a New Year's resolution is personal and only applies to one person- YOU. So make sure it's realistic so you can set yourself up for success in 2016.

Time-bound
Having a deadline for completing your goal is crucial. Since we're discussing New Year's resolutions, our deadline is built in. As we close out 2016 we'll check our progress and celebrate our success!

How's this going for you? Do you have your SMART resolution now? If you're wondering what you can do next to get moving on your New Year's resolution,  I want to invite you to 1, share your resolution for 2016 in the comments below, and 2, share this blog post along with your SMART goal with one other person. Think of that someone who you feel comfortable sharing with -- a good friend, your partner, your therapist-- and put it out there. Being accountable to someone other than yourself can be extremely helpful in reaching your goals. You can do it! 

If you're struggling with infertility, pregnancy or infant loss, or a perinatal mood or anxiety disorder, and think you could benefit from additional support in setting or accomplishing your New Year's resolution, feel free to get in touch by phone or email. 

How to Find a Therapist in San Diego

In San Diego, we’re lucky to have so many mental health practitioners. If only everyone in all corners of the globe were as fortunate as we are; choice is certainly a luxury. But having so many choices can also make it a challenge to find a counselor when you need one most. Typically you find yourself searching for a therapist when things aren't going so well, when you really need that extra bit of support. And with so many possibilities, you’re probably wondering— how do I choose!? Where do I start? 

Below are a few recommendations for finding a counselor that’s right for you. There are many many qualified and capable therapists here in San Diego, the task is to find someone for YOU.  The good news is that with so many options there’s bound to be someone who you can connect with and confide in. It will take some work on your end, but it will be well worth it!

Let's start with the logistics of finding a counselor in San Diego:

• Define your needs. Think about what you need from a therapist. Concretely– someone close to home, work, evening hours, morning hours, takes insurance, doesn't; has experience working with postpartum issues, infertility, anxiety, depression, parenting concerns…
• Look to your friends. When I need an ENT, a dentist, a car mechanic, I ask my friends for suggestions. Likewise, when I'm searching for a therapist for myself I also see if one of my besties has someone to recommend. But sometimes you're dealing with an issue that your friends haven't dealt with, or you're just not comfortable asking around. In that case, move on to my next suggestion. 
• Head to the internet. Psychology Today is probably the most popular website with nationwide provider listings along with a smattering of everything for your psychological mind. Mental health providers post their info and you, the consumer can peruse at your leisure. There are a variety of filters you can activate to find someone who fits your search criteria. For example, if finding someone who’s close to your home is important, you can plug in your zip code and narrow down your choices instantly. You can also filter by gender, specialty, language... You get the idea. Another good place to search for a therapist is through specific associations that support the issue you’re struggling with. So if you want someone who’s experienced with infertility, for example, you will probably stumble across Resolve, which is the National Infertility Association. So even a national organization can point you to a local therapist through their provider listings.
• More internet research. So once you have some names, regardless of whether it came from a friend, Psychology Today, or Resolve, now's the time to learn more and review their website. You can read the “About” and Specialty pages, and look over the FAQs to get a feel for the counselor and see if he or she might be a good fit for you.  
• Making Contact. Once you have 3 or 4 therapists that you’d like to get to know more, start making calls and sending emails. Many therapists in San Diego offer a free 15 – 20 minute phone consultation. It’s a great opportunity to ask questions and get a sense of whether this person may be able to help you before scheduling that first appointment.
• Meeting your therapist. You might want to schedule a couple of in-person appointments before deciding on a therapist. This is a great opportunity to ask more questions. Remember, you are interviewing this person to see if you want to hire them. Yes, you are hiring your therapist to help you through a difficult time, explore a specific issue, help manage challenging behaviors, etc. Pay attention to how patient they are with the process and your questions. How do you know you'll be able to work with someone? That is such a personal and individual thing– and a lot of it depends on knowing yourself and trusting your gut.

It is widely believed that the therapeutic relationship between you and your therapist is the most important factor in successfully resolving your presenting issue. The therapeutic relationship is the collaborative relationship between client and therapist, entirely focused on the client, to gain understanding of and effectively change the client in a way that supports their overall well-being.

The ability of the therapist to facilitate a strong working therapeutic relationship is everything. Theoretical orientation may be of interest to you, but as far as resolving the issue that brought you to therapy, it’s the counselor's innate abilities that matter most. 

Below are some things to consider during your initial phone consultation and throughout the initial sessions of therapy to determine if someone might be a good therapist for you:

• Do you feel the therapist is genuinely engaged with you, focused on your well-being and motivated to help guide you? Does he or she remember to follow up or discuss topics further that you feel require more attention?
• Are you comfortable with the therapist? Are you able to share personal information and express yourself emotionally? Do you feel the conversation is insightful? Do you feel you can trust the therapist? Can you comfortably express your concerns and doubts with the counselor or is there some fear of judgment?
• Do you find the therapist comforting, empathic, and compassionate? Is he or she responsive to your emotional and verbal expressions? Are they cold when working with you?

These are just a few important aspects within the therapeutic process to pay attention to when trying to find a new therapist in San Diego. Hopefully you're feeling ready now to begin your search. 

If you’re wondering if I'm a good match for you, call me for a free 20 minute phone consultation.