Therapy and the Postpartum Woman: A REVIEW

Cognitive Behavioral Therapy Book Reviews 1 2010, Vol. 6, No. 1
Copyright 2010 by the International Association for Cognitive Psychotherapy

Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help

While there are many books available for mothers and families on postpartum depression, this book is the first comprehensive work for the clinician. Postpartum depression is the most common issue facing new mothers. One out of every seven mothers will experience postpartum depression. Given this high prevalence rate, clinicians must become familiar with how to treat this potentially devastating illness.

In Part One, Kleiman describes the clinical picture of postpartum women citing many case examples as well as models of postpartum depression. She aptly describes why there is so much resistance to getting treatment in this population and how to help women overcome their resistance. She gives the reader concrete suggestions on how clinicians can respond to women struggling with postpartum depression drawing on the Winnicottian ideas of “the holding environment” and “the good mother”.

In Part Two, Kleiman devotes several chapters to intake, screening, assessment, collaboration, medication issues and alternative therapies. Initially, it was surprising that she spends so much time on the initial phone call. However, she makes a good case for the need to be thoughtful when initiating contact with postpartum women, given their tenuous emotional and physical state. She makes explicit the questions and responses that are effective in engaging this population in treatment. The many and very helpful assessment tools, symptom lists, and some other interventions mentioned in this part and the next are contained in the Appendix. Finally, the chapters on medication and alternative therapies for postpartum depression are thorough, highly informative, and condense a large body of research which will be useful to clinicians.

In Part Three, Kleiman tackles different aspects of postpartum depression ranging from obsessive thoughts, distorted beliefs, breastfeeding, sleep deprivation, marital issues, suicidality, mother-infant attachment and psychosis. She interweaves clinical observations with vignettes, research and theory to illustrate how these issues play out in the postpartum woman. She makes an excellent case for the importance of careful screening for suicidality and psychosis by urging clinicians to ask the difficult questions, and by specifically spelling out what these questions are and how to ask them.

Part Four addresses other theoretical and conceptual aspects of treatment for postpartum depression. Kleiman muses over the roles of meaning, recovery, resilience and parent-child attachment in the treatment of postpartum depression, showing her more psychodynamically oriented side. While providing case examples, this section is the least filled with research citations and practical tools. However, it is undoubtedly interesting from an intellectual standpoint and in terms of case conceptualization with this population.

Therapy and The Postpartum Woman provides tremendous breadth and depth of information, resources, theory, and interventions for treating this population. The book’s strengths are its infusion with research findings, its practical and explicit suggestions for how to treat postpartum women, and the interweaving of interventions from cognitive-behavioral therapy, Interpersonal Therapy and psychodynamic therapy. As a cognitive-behavioral therapist who works with women with postpartum issues, I find her illustration of the types of distorted thoughts and beliefs of depressed mothers to be extensive and her focus on workable solutions right in line with my own experience with this population. The book is not, however, a treatment manual or a comprehensive guide, and would not be appropriate for use by a novice clinician. Kleiman assumes that the reader already has knowledge of how to conduct therapy for depression and anxiety and, therefore, does not provide basic information on treatment of these conditions. It is up to the clinician to use her book as an adjunct to her own particular treatment protocol rather than as a guide. Given the high incidence of depression and anxiety in postpartum women, and the potentially lethal consequences of these illnesses, this book is a must-read for any clinician working with mothers and mothers-to-be.

Antonia M. Pieracci, Ph.D.
Senior Instructor University of Colorado Depression Center

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