A Call for Comprehensive Perinatal Psychotherapy Training [English and Spanish versions]

Journal of Parent and Family Mental Health, Mar 2017

Research has provided us with a tremendously rich understanding of the perinatal period and the kind of psychotherapeutic techniques that can effectively address issues that arise during this time. It is now time to more fully integrate and disseminate this knowledge to providers who are working with the perinatal population so it can be widely used in thoughtful and nuanced ways. A Spanish translation of this publication is available to download under "Additional Files".

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A Call for Comprehensive Perinatal Psychotherapy Training [English and Spanish versions]

Journal of Parent and Family Mental Health Let us know how access to this document benefits you. 0 Part of the Family, Life Course, and Society Commons , Maternal and Child Health Commons 1 Commons , Psychology Commons, and the Women's Health Commons 2 Psychiatry Commons , Psychiatry and Psychology Commons, Psychoanalysis and Psychotherapy Follow this and additional works at: https://escholarship.umassmed.edu/parentandfamily Recommended Citation Broudy C. A Call for Comprehensive Perinatal Psychotherapy Training [English and Spanish parentandfamily.1003. Retrieved from https://escholarship.umassmed.edu/parentandfamily/ vol2/iss1/1 Carolyn Broudy - Journal of Parent & Family Mental Health A Call for Comprehensive Perinatal Psychotherapy Training Pmothers1, 2 and has been found to be as high as erinatal depression occurs in 10 to 15% of all new 23 to 52% in low-income populations.3, 4 Untreated depression during pregnancy and the postpartum period is associated with negative outcomes for mothers, infants and families. For instance, depression during pregnancy can influence maternal self-care and reduce the likelihood that women receive adequate pre-natal care.5 It is also associated with elevated risks of preterm birth, low birth weight, intrauterine growth restriction,6 pre-eclampsia,7, 8 illicit substance use9 and in severe cases suicidality and infanticide. Untreated depression during pregnancy is also one of the strongest predictors of postpartum depression (PPD), which is a wellknown risk factor for negative cognitive and emotional developmental outcomes for children.6, 10 Current Efforts to Address Perinatal Depression With the increasing awareness of the frequency and impact of perinatal mental health issues, public health efforts have been made to promote screening11 and provide follow-up treatment.12 For instance, some states have initiated programs that provide perinatal psychiatric consultations to primary care and specialty practitioners who can prescribe for pregnant and postpartum women, and care coordination services to promote access to psychotherapy.13, 14 Recently, a federal bill, Bringing Postpartum Depression Out of the Shadows as part of the 21st Century Cures Act, was passed to support the development of similar programs in other states. The Importance of A Family-Based Psychotherapy Approach While these efforts promote detection and referral to psychotherapy, they do not ensure the availability of adequate psychotherapy options. It is particularly important to focus on psychotherapy for this patient population for a variety of reasons. First, many perinatal women will only seek psychotherapy as they prefer not to take medication while pregnant or breastfeeding.15-17 Indeed, a large crosscultural study found that for those who seek professional help, “talk therapy” is seen as the preferred treatment.18 Secondly, psychotherapy is the only evidence-based treatment option during pregnancy and breastfeeding that is risk free for baby and mother and is therefore considered a first-line approach for mild-to-moderate depression.19 Thirdly, combined treatment approaches (medication plus psychotherapy) or psychotherapy alone tend to be more effective for co-morbid disorders, such as post-traumatic stress disorder, obsessive compulsive disorder, and substance abuse disorders.20-22 These are present in at least one half of women with PPD.23, 24 Lastly, but importantly, evidence suggests that treatments that target symptom reduction only, such as medication, are not sufficient to prevent the associated negative outcomes in children. 25-27 Rather, it is thought that the association between maternal depression and negative child outcomes occur, at least in part, as a result of a complex set of interactions within the family system that do not completely resolve after a mother’s depression remits.28-30 Certain types of psychotherapy interventions for perinatal women have shown positive outcomes for mothers, infants and families. For instance, psychotherapy interventions that address the infantmother relationship seem to reduce the impact of PPD on children’s cognitive and emotional development by improving maternal sensitivity, responsivity, affective involvement, reflective capacity, and attachment security.29, 31-38 Similarly, psychotherapy interventions designed to include partners in treatment can positively impact maternal mood, improve the quality of the coparenting relationships, and promote positive outcomes in children.39-43 Translating Evidence-Based Therapies into Practice Given the importance of psychotherapy that addresses the family system, there is a need to provide trainings for therapists in a family oriented approach to perinatal mental health issues. While several such evidence-based, manualized psychotherapies have proven effective,32,44-48 the use of these treatments remains limited due to the financial and logistical challenges of integrating new forms of psychoth (...truncated)


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Carolyn Broudy. A Call for Comprehensive Perinatal Psychotherapy Training [English and Spanish versions], Journal of Parent and Family Mental Health, 2017, Volume 2, Issue 1,