A Call for Comprehensive Perinatal Psychotherapy Training [English and Spanish versions]
Journal of Parent and Family Mental Health
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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
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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)