An Open Letter to Postpartum Therapists Treating Women With Scary Thoughts

Women have been telling me, for almost 30 years, what they need, what they want, to help them recover. Most of what has been written in my books, came directly from their voices and their experiences. Postpartum women are very tuned in to what works, what doesn’t work, their sensibilities are often on hyper alert and most of the time, no always, but most of the time, they are very right about what they need and what they want, in order to heal. So, we listen.

But when it comes to scary thoughts, they are wrong. They are very wrong.

Because most postpartum women find it impossible to talk about the scary thoughts they are having. The paradox is, that unless they take the risk of sharing these thoughts, or images or impulses, they can get bigger, more powerful and way more scary for her.

Life is messy. Life with a baby is really mess.  Life with a baby and symptoms of depression and anxiety is out of control messy.

When life feels out of control, what does a postpartum woman (and perhaps many of us?) try to do? Of course, we try to maintain control, things and thinking become very black and white. Good or bad. Healthy or sick. Part of our job is to help her understand that we are not there to help her clean up her mess, but instead, we are there to help her embrace it. This is a notion that is often met with resistance or anger, but the truth is, until she can learn to embrace some of what feels so out of control right now, she will continue to resist and symptoms will remain.

But she feels like she must hold tightly. She doesn’t want to let go of this shield she has set up to protect her. The last thing she wants right now is to feel vulnerable. And letting go, feels vulnerable.

So she pretends.

She hides.

She denies.

She disallows.

This leads to the biggest problem: What is left to take center stage, when she retreats into silence, is shame.

Shame is highly correlated with depression. We can treat scary thoughts with medication or good therapy. But if we do not address the shame, we are only scratching the surface.

Shame is not the same as guilt, which is also huge during the postpartum period. While guilt is focused on behavior, what I did or did not do, shame is focused on the self. I am a terrible mother. I should never have had this baby. I am a terrible person for having these thoughts. A good mother would never think these things. Mothers in our culture have been socialized to do it all, do it perfectly and never let anyone see them sweat, or complain, or whine, or god forbid, ask for help. This leaves them with massive unobtainable and conflicting expectations. Of course it would.

Secrecy, most often due to fear of judgment, makes shame bigger.

Think about this: Vulnerability is not new for postpartum women. She has most likely opened her heart, opened her mind, she has opened her legs to various levels of invasive inspection. She has learned how to bleed, discharge, poop and lactate in front of strangers with little regard to judgment or consequences. I’m not saying that is easy to do, but she does it. It just goes with the territory of giving birth. However, the vulnerability that comes with admitting you have thoughts of harm coming to your baby, well, that is a state of nakedness that is simply too hard to bear.

Exposure takes courage. It’s hard to find strength when you are bone-tired and weakened by symptoms. Our job is to help postpartum women with scary thoughts find the courage to acknowledge this and talk about them.

Empathy is the key to reducing shame.

And the job of each and every clinician is to take a good hard look inside yourself and make sure you are able to tolerate the details and know what to do and what not to do, if your client trusts you enough to tell you what she is thinking.

Dropping the baby and other scary thoughts

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