Holding Perinatal Women in Distress

The paradox

Posted Feb 09, 2017

Source: Shutterstock/jaboo2foto

Resistance to therapy is as old as therapy itself. A professor in graduate school declared that if one does not encounter resistance to therapy, it is not working. Too much resistance is counterproductive. Too little may be, also. Either way, resistance is a well-known psychological phenomenon in therapy because, well, change is hard. People understandably stand firm against the prospect of learning new ways to think, or behave, or feel.

Let us break this down even further.

Postpartum women in distress do not have the time, the energy, the interest, the wherewithal, the resources, the finances or the motivation to go to even one more healthcare provider. Add a therapist to the mix? You’ve got to be kidding me. The stigma against mental illness, which is astronomical, doesn’t even come close to a mother’s embarrassment, shame and all around protest against seeing a therapist when she hasn’t slept through the night in weeks, has a screaming baby at her breast or a colicky infant who is relentlessly requiring attention and is trying to simply get through the day weighed down by piercing guilt and unrelenting grief. Seriously? A therapist?

If it weren’t a matter of life and death, it would be preposterous.

Your greatest task, as you share the sacred space with her pain, is to preserve the integrity of her wishes while you gently guide her toward a more complete state of well-being. 

You do this in spite of her resistance. 

You do this whether she believes she will get better or not. 

You do this as she leans away from you, tempted by the darkness. 

You do this to help her breathe whether she wants to be sitting there, or not. 

This is why she has summoned the strength to get dressed and be present in your office." 

My appeal to you is that you become comfortable with this paradox. You must refrain from seeking immediate solutions or quick fixes, (to reduce her anxiety or yours), you must sit, and wait, and embrace her suffering. In doing so, you set in motion the possibility of therapeutic engagement to take place.

This is the essence of holding.

Adapted from The Art of Holding in Therapy: An Essential Intervention for Postpartum Depression and Anxiety (Kleiman, K. Routledge, 2017)

About the Author

Karen Kleiman, MSW, LCSW, is the founder and Director of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum mood and anxiety disorders.

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