Karen Kleiman is the voice of mothers everywhere, empowering women to admit that they are not always okay. A pioneer in the maternal mental health field, Karen is brave, honest, and doesn’t sugarcoat the experience of motherhood. She inspires everyone around her to face their experiences, build their support systems, and talk about their feelings in a world that still does not encourage women to admit that they are imperfect and/or struggling. Karen’s work has touched lives internationally and her legacy continues to trickle through the providers that she’s trained and the readers and moms she’s interacted with through her social media pages. Karen is pioneering, determined, and insightful and faces every challenge that’s placed in front of her with strength, wisdom, and (whenever she can) dry humor. Her work is actively helping break down the stigma that exists around discussing maternal mental health and getting help. An inspiring and down-to-earth guest on talk shows, leader at trainings, and esteemed guest at events, Karen’s impact keeps growing. I’m honored to have gotten to work with Karen and I can only hope to have a small portion of the impact that she’s had on the world. I look forward to seeing her work continue to touch-and save-lives.
In Her Own Words:
Thirty-four years ago, after the birth of my second child, I sat on my living room floor, surrounded by baby paraphernalia, contemplating the future of my career as I navigated new motherhood. I wondered: How could I combine my education and interest in psychology with my new role as a mother? I started wondering how the mothering experience might impact other women and was there, in fact, suffering associated with this major life transition? I did not experience postpartum depression, so I knew my early quest for information and answers would come from the women themselves.
So I put this ad in our local newspaper:
POSTPARTUM DEPRESSION: If you have suffered postpartum depression or postpartum stress, I would like to interview you for my research. If you can share your experience for this research, please call to make an appt. Karen Kleiman, MSW, ACSW
I received three responses. What surprised me was that two the women who responded were over 70 years old. Each of the three women met with me separately and related their stories of unexpected and life-altering depressions. The two older women shared similar stories of secret suffering, despairing thoughts, and paralyzing shame. They described the agony of isolation, the unrelenting feelings of grief and loss. They expressed self-loathing and the shock of not recognizing who they had become along with the fear of letting anyone else know the thoughts they were thinking. Both of these women said they eventually found a way out of the darkness and that I was the first person they talked to about how bad they felt. I remember the unique pang of purpose in those brief yet powerful exchanges, which paved the way and later would shape the course of my professional journey.
Next, I typed up a questionnaire and continued the crusade by asking permission from baby stores and doctor’s offices to kindly display my undeveloped survey, complete with self-addressed stamped envelopes, titled: Are You Pregnant? Had a Baby? Are You Anxious or Worried About How You Are Feeling? I poured through the unexpected number of anonymous responses. It soon became very clear that the needs of postpartum women were falling through the cracks of the medical community. And no one was talking about it.
While loved ones were doting over the baby and focusing this being the “best time of your life” and physicians were primarily focusing on physical and medical recovery, emotionally, moms were largely left to fend for themselves. Due to the paucity of literature on the subject, I began literally knocking on doors, writing letters, and ultimately, learning what I needed to know from the voices of women who trusted me to listen to their stories.
In 1988, I founded The Postpartum Stress Center, LLC. Just me, in one office. Sitting face-to-face with women who collectively became the inspiration behind my passion and determination to help them express the inexpressible and validate that being a mother didn’t always feel so good. Furthermore, despite widespread expectations that they subscribe to cultural and social pressure to put forth a pretense of perfection and personal fulfillment, I would help them find a safe space to self-disclose and explore the darker side of motherhood.
Promoting this groundbreaking premise and distributing my contact information predominantly to male doctors, at that time, was both exasperating and motivating. Some listened. Many did not. Not surprisingly, when my first book, This Isn’t What I Expected, was published in 1994 by a (then) big New York publishing house (Bantam Books), people began to take notice. Publishing a book seemed to validate my single-handed pursuit of better support for postpartum women. It got me and the book on the Oprah show three times. It got the attention of national news/media outlets both televised and print. People were now talking about postpartum depression. Slowly but surely, the word got out that postpartum depression was real, it was serious and countless women were suffering.
Fast forward 30 years. In many ways, so much has changed. There is an impressive momentum toward greater public awareness, greater advocacy, new legislation and research, a new push to advance healthcare trainings and education, and a movement toward better understanding of maternal mental health issues. Women are speaking out on their own behalf with communal outcries through social media.
That’s the good news. The not-so-good news is that in many fundamental ways, things have not changed. Women are still not telling us how bad they feel. Healthcare providers are still not asking the right questions. Mothers and baby are still dying.
1 out of every 7 women walking into OBGYN offices is experiencing a clinical depression. This is not the blues, or an adjustment disorder, or transition to motherhood. We are talking about serious symptoms that meet diagnostic criteria of a major or minor mood or anxiety disorder.
You cannot tell by looking at her. You cannot assume that if she looks good, or says what you expect to hear, that she is fine. If you do not ask the right questions, you have no idea how she feels.
It has been well-established that pregnant and postpartum women are vulnerable to depression and anxiety disorders. It has also known that women with perinatal mood and anxiety disorders (PMADs) are at increased risk for pre-term birth, low birth weight, lower levels of positive maternal interactions, and are less likely to follow up with preventive health care. Moreover, it has been shown that perinatal PMADs can affect the child’s cognitive and behavioral development. In 2019, after concluding that counseling interventions are effective in preventing perinatal depression in women who are at risk, The United States Preventive Services Task Force (USPSTF) put forth their recommendation that “clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions.”
It is a matter of preventative care. It is a matter of cost-effectiveness. It is a matter of life and death.
And so my work as a pioneer in this field is far from over. In today’s uncertain climate, with unprecedented stressors and expectations, our mission to protect the mental health of new moms and dads is more imperative than ever. In our present clinical practice, The Postpartum Stress Center has 14 clinicians (independent contractors), including a perinatal loss specialist and infertility specialist. We collaborate with a couple of trusted psychiatrists and a psychiatric nurse practitioner. The Internet, social media, and the global appeal of our training program has brought international appreciation and use of our proprietary materials for both providers and consumers. In our day-to-day operations, Hilary Waller, our program director and co-trainer, has earned my respect and deep appreciation for her determined commitment to The Postpartum Stress Center as well as to my work, my reputation, and my legacy. Together, in addition to our clinical practice and our writing, our greatest professional pleasure and purpose is training other perinatal specialists. The Postpartum Stress Center initiated our professional trainings 20 years ago when there were no others in place. Now there are numerous, reputable trainings, along with ours, providing a solid foundation for clinicians working in this very specialized field. In addition to my (15) books on postpartum depression and anxiety and long-term clinical/supervisory/mentoring practice, my recent development of The Art of Holding Perinatal Women in Distress™ as a theoretical and treatment model is an exciting focus of our academic development and writing. My earlier work on this model, Principles of Supportive Psychotherapy for Perinatal Distress was published in the Journal of Obstetric, Gynecologic & Neonatal Nursing, 2017, with co-author Amy Wenzel, PhD. Presently, Hilary and I continue to develop The Art of Holding model, anticipating that future testing and research will endorse its use as a standardized intervention for perinatal distress. Hilary and I continue to educate professionals and write on the subject, promoting our mutual belief that excellent, specialized training makes a significant difference in a woman’s recovery from perinatal distress.
As I peek into the future of The Postpartum Stress Center and consider where I am in my career, my objective is two-fold. My foremost hope is to preserve the “concierge” culture of our practice. That is, working with clinicians and adjunctive providers who prioritize the well-being of their clients/patients; careful attention to protocols that can reduce wait time; precise and personal response system to decrease suffering before or between sessions; individualized treatment planning customized to the needs of each woman, and the intent to surround ourselves with like-minded professionals who believe in the power of our work and the value of remaining open-hearted in their belief in themselves and their capacity to make a difference.
Secondly, my hope is to preserve and expand upon our reputation for high-quality, expert training opportunities, for healthcare providers and especially for therapists who have the privilege to share the sacred space with a new mother who yearns to find herself again. Going forward with exceptional personnel, adherence to my decades-long perspective of what good therapy looks and feels like, and a commitment to continuing the education, creates the best framework for the future of The Postpartum Stress Center.
Karen Kleiman, MSW, LCSW