This Isn't What I Expected

Notes on healing postpartum depression

Good Things Are Going to Happen: Adaptation and Healing

Recovering might just feel better than you think...

"Good things are going to happen." These words are hand-painted on a ceramic plaque which hangs on the wall in our waiting room. In part, it's decorative, but in truth, those of us who work there secretly expect subliminal rejuvenation. It's part of the magic.

Most would agree that positive emotions help buffer individuals against negative outcomes, both psychologically and physically. Of course we must make allowances for temperaments and personality types that are more inclined to think positively or negatively, and, while at the same time, admit that adjusting thinking patterns to this extent is not an easy undertaking. Still, the implication for clinical practice is that we can present this as an option and a goal for those who feel inclined or motivated to move in this direction.

Optimism, or the anticipation of a good outcome, has been specifically associated with adaptation; while pessimism, particularly during stressful times, has been determined to have a negative impact on an individual's psychological health. (Scheier & Carver, 1992). Whereas it may be intuitive that during periods of greater stress, an optimistic outlook would help one feel and cope better, in a study by Grote & Bledsoe (2007) it is suggested that it also protects against depressive symptoms.

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In line with research on individual adaptation to stress and trauma, there are characteristics that have emerged as restorative elements for women recovering from postpartum depression. Although to date there is no rigorous study of this application to postpartum women, the value of strengthening these attributes, as part of her treatment, should be evident. The Characteristics of Positive Postpartum Adaptation below is inspired by the work of Carver, Scheier, Weintraub, (1989) and their research on coping strategies. It is a compilation of qualities we have determined, at our center, to be associated with a more positive adjustment to the illness of postpartum depression, as well as, its course and treatment. This list of attributes may be helpful for clinicians and consumers in their pursuit of coping strategies and ultimately, the development of resilience:

CHARACTERISTICS OF POSITIVE POSTPARTUM ADAPTATION1
  • Positive reinterpretation and personal growth
  • Active coping 
  • Planning
  • Seeking social support
  • Humor
  • Ability to accept and trust current state
  • Rearranging priorities
  • Insight
  • Capacity for or interest in intimacy
  • Self-expression
  • Spiritual search

Resilience is the capacity to recover from stress, adversity, or misfortune. A person's vulnerability to stress and capacity for resilience, and or recovery, is complex and can be understood as both contributing to depressive illness, as well as, providing protection from it. Are we able to look at a woman's personality type and unique characteristics to determine how we can best tap into her reserve resources and maximize her adaptive capability?

If clinicians are aware of the personality strengths and weakness of the client that were present before the onset of the illness, it enhances the overall picture and offers valuable information for therapeutic intervention. As we traverse this uncharted terrain with each client, we listen to the cues and watch for signs of who she is and who she was before. Not always, but occasionally, when we stay present with open eyes, we can see a woman sparkle with hints of virtues that will help her navigate the healing process.

If we review the list of characteristics of positive postpartum adaptation, we can imagine, for example, how the therapeutic alliance might address each, specifically. How we might, for example, teach coping strategies, encourage social networking, assist and expand her personal reflection as it relates to her experience, and help her adjust her expectations or engage in proactive planning. Sometimes, it is helpful to review this list with the client, creating a dialogue of what she thinks her areas of strengths are, and, which she hopes to cultivate. When the timing is right, this discussion can be extremely fruitful, as well as, encouraging for her, as we focus on identifying and enhancing resilience.

It is well established that stress generates more stress. A major stressor like a depressive illness can produce additional stressors, such as financial issues, relationship concerns, or isolation from social support. All of which, may then, exacerbate the illness or intensify the symptoms. The physical and psychological impact of this enormous amount of stress on the body and heart and soul of a woman, drives much of what we do. It follows, then, that one of our goals, in working with postpartum women, should be to foster resilience. Which of the characteristics listed does she embody? Which can she working on developing? There are several reasons to believe that if we tease out those characteristics that appear to be associated with a more positive outcome, we can augment recovery by decreasing her perceived helplessness and increasing adaptive functioning.

Adapted from "Therapy and the Postpartum Woman" (Routlege)

1Copyright © 1999 by The Postpartum Stress Center LLC/Adapted from the work of Scheier,Carver, & Weintraub (1989)

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Karen Kleiman is founder and director of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum mood and anxiety disorders. more...

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