Foreword to CBT

CBT for perinatal distress


Amy Wenzel and I were first introduced at the University of Pennsylvania, where we met with two colleagues to join forces on behalf of postpartum women. The four of us convened to contribute to what developed into a new screening tool for postpartum women. I confess I was simultaneously impressed and intimidated by the level of academic prowess surrounding me. I can usually hold my ground by maintaining eye contact and listening with fierce determination, but frankly, every time Amy spoke, I was struck by how little I really must know.  It was then I first realized how differently our brains worked.  When she asked me to join her for coffee after the meeting, I promptly donned my grown up hat so as not to reveal my hesitation about engaging in a private dialogue with her. After all, being twenty years her senior, how dare she already have published 14 books and authored 100 peer-reviewed journal articles?  Really? How could I possibly expect to carry on a respectable conversation with her? That’s when I pulled out my Oprah card. “You were on the Oprah Show?!” she gasped with amazement like a school girl.  Now, we could talk.

While individually, we claimed success and integrity in our accomplishments, we each wanted a taste of what the other had developed so well. She hoped to break into the self-help book market and move her scholarly work toward a more general audience, while I sought greater authority within the academic community.

Amy can rattle off statistics from current research like I can recite my shopping list in my head while I’m going down the grocery aisles. The obvious difference is that I’m thinking about eggs and broccoli; she is thinking about randomized clinical trials, pragmatic clusters and the regulation of GABA receptors in affective disorders. Sometimes I pretend to know what she’s talking about lest I give myself away and she regrets ever deciding to work with me! But truth be told, we each possess strengths that complement the other and when we combine our areas of expertise, we realize we have a great deal to learn from each other.

One thing is indisputable. Amy’s proficiency in the field of cognitive behavioral therapy (CBT) is unmatched. She is a master scholar, a frequently sought out expert in the field, trained by the father of CBT, Dr Aaron Beck, and when she isn’t helping clients change their lives for the better, she is teaching therapists how to apply these skills to their clinical work. I loved the idea of incorporating Amy’s expert knowledge and utilization of cognitive behavioral therapy as a treatment option at The Postpartum Stress Center. To my delight, she affiliated with us which afforded us the perfect place to send our pregnant and postpartum moms when we determined that CBT would be the best treatment choice.

But there was one problem.

I was not convinced that CBT was a great option for the majority of women in our practice who suffered significant levels of distress. Amy had some work to do to convince me that a pregnant or postpartum woman would appreciate and benefit from the CBT model. I was concerned it was too structured, too didactic, too rigid, with too much talking and way too much homework. And perhaps most important to me, I truly believed it went against the grain of my fundamental premise that “holding” (Kleiman, 2008) postpartum women is the key to healing. That is to say that the therapeutic relationship is paramount and that CBT would be too much work could interfere with that somehow. I worried that CBT would feel intrusive and counterintuitive both to me, and to the women I treat, at least at the height of their suffering.

Amy immediately refuted my apprehension and claimed I simply didn’t have all the information. She explained that CBT is flexible and the construction of CBT interventions accommodates beautifully to the specific needs of the client and absolutely embraced the therapeutic relationship as a vital component. Even so, when Routledge asked us to write a book for their CBT series, Amy jumped at the idea and I thought, well, here’s a challenge, how do we really make this work for the perinatal population? How do we modify the strategies and tweak the interventions on behalf of pregnant and postpartum women? Can we, at the same time, preserve the psychodynamic and supportive perspective that drives much of my work?  I felt like we were attempting to put a square block into a round hole. This is when I basically sat back and watched Amy do her magic. In Cognitive Behavioral Therapy for Perinatal Distress, Amy brilliantly teaches practitioners how to successfully integrate CBT skills into their practice, always taking into account the unique needs of pregnant and postpartum women. She was right, I didn’t have all the information.

Cognitive Behavioral Therapy for Perinatal Distress did two things for me. First, it validated what I suspected all along – I was already practicing aspects of CBT with my clients, I just wasn’t calling it that. Like so many other interventions that I think I’m making up or grabbing from my bag of good instincts, I have been helping women reframe their negative thinking for decades. It is precisely what needs to be done when a pregnant or postpartum woman surrenders to the overwhelming and misguided negative bias that permeates her thoughts. CBT is a hands-on, practical approach to problem-solving, which is both appealing to and essential for recovery from any postpartum emotional illness. In this book, Amy provides the tools and exquisite vignettes that help the clinician see exactly what needs to be said in response to the faulty thinking that is so pervasive in the perinatal population. She offers specific treatment strategies and a script to go along with them so the reader can experience firsthand how the interactions might take place. In this way, Amy superbly brings these theoretical constructs to life. The women she follows throughout the pages of this book will seem familiar to any postpartum specialist, making it an incredibly useful resource.

The second valuable lesson I learned from reading Cognitive Behavioral Therapy for Perinatal Distress is that CBT works. Pregnant and postpartum women respond well to the proactive style, the structured, time-limited commitment to treatment, and the tangible focus of CBT. Whereas I previously believed that cognitive therapy would be too much work for a tired mom encumbered by symptoms, I am now certain that moms who struggle with problematic beliefs and faulty thinking will be relieved by the collaborative effort to reduce the distress associated with those thoughts. The reader will see how carefully and purposively Amy pays attention the distinct nature of perinatal symptoms and adapts the expectations and coping strategies accordingly.

With greater emphasis being placed on non-pharmacologic interventions for perinatal depression and anxiety, women and their treating practitioners are seeking good, effective approaches that they can count on for symptom relief. Cognitive Behavioral Therapy for Perinatal Distress provides the evidence, the tools and the techniques to accomplish this. Amy has succeeded in blending her years of CBT research with her clinical work and offers it as a practical and effective protocol for the treatment of perinatal depression and anxiety. She has rounded off the corners and shown me that the block does indeed fit into the round hole. You just have to know what you are doing. Thank you, Amy. Now I know.

©2014 Cognitive Behavioral Therapy for Perinatal Distress, Wenzel and Kleiman

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