When you feel you have identified that you need professional help for Perinatal Mood and Anxiety Disorders (PMADs) there are some things to consider.
Finding a Provider
When you are looking for a provider you will need to know if they accept your insurance through contacting them or checking their practice’s website. You may also want to contact your insurance to inquire as to any limitations or co-pays that exist with behavioral health services. Insurance companies may only provide coverage for a certain amount of sessions per year (many times this is 52 sessions per year). If you receive Medicaid it is also important to inquire about service limitations as well as each state may have their own coverage limits.
Mental health professionals come from various educational backgrounds. Therapists can be psychiatrists (MDs), psychologists (Ph.Ds), counselors (their credentials may vary from state to state but LPC or PC are common) and social workers (also varied credentials but LCSW, LSW, or LISW are common). For counseling you will most likely see a psychologist, counselor, or social worker. Like counselors, social workers that specialize in mental health received training in graduate school in mental health interventions.Many people have a stigma towards social workers when it comes to seeing them for therapy because of the negative stereotype of us being people that take children away from their families. This article from Lifehacker explains the differences in these specialities in greater detail. The credentials of your therapist are not as important as finding a therapist that specializes in what you are seeking services for and the rapport you feel with them.
Visit Postpartum International’s link for a list of regional coordinators that can provide you with a list of local professionals here.
Visit Postpartum Progress’s page here for providers.
In Australia you can access PANDA’s directory of services and providers here.
If you have difficulties finding a provider that specializes in PMADs such as postpartum depression or anxiety you can seek professionals that specialize in depression, anxiety, OCD, or psychosis. Interventions will be similar whether or not your therapist specializes in PMADs, although therapists that specialize in PMADs may have better resources and experience that are tailored to pregnancy and postpartum.
It is perfectly common and acceptable to seek a therapist of your own gender or have a gender preference. It is always helpful to have a provider in mind when you call a large practice by doing research first but if they are unavailable and you are offered alternatives it is acceptable to request a female or male depending on your preference or trauma history.
If you believe medication may need to be part of your treatment it is a good idea to look for counseling practices that contain a psychiatrist and mental health professionals that provide counseling services. In many circumstances psychiatrists only provide medication management and not counseling. Having a psychiatrist and therapist in the same practice is beneficial because your therapist and psychiatrist are more likely to communicate if they are in the same practice which provides you better care. Your therapist can also help you advocate to your psychiatrist when you have concerns about medication.
What to Expect From Your Therapist
In your first couple sessions with your therapist you will be asked a lot of questions. This will consist of why you sought treatment, your current presenting symptoms, history of medical conditions or previous mental health history, family medical or mental health history, any history of traumatic events, and your current family situation. Understanding your symptoms, your history, and your environment all help the therapist form a context to help you.
Your therapist should inform you of the limits of confidentiality. Everything that is said in a therapy sessions is confidential with the exception of 1) plans to harm self or commit suicide, 2) a plan to harm someone, 3) child abuse/neglect. In this case the thearpist may contact an emergency room or police depending on the situation. This should not deter you from sharing thoughts of wanting to harm yourself or others. Therapists are able to deciper thoughts from an actual plan and if you are a potential harm to yourself or others it is best that the safety of yourself and others is protected. Therapist are also mandated reporters of abuse/neglect of children. If you disclose that your child or a child you know is being abused the therapist may work with you to contact family services so that the child’s safety is protected.
Your therapist should be conducting an assessment and may come to a mental health diagnosis. Diagnosis is an important part of being able to provide you with treatment because many insurance providers require a diagnosis for billing purposes. But in my first posts I mentioned the important of understanding diagnosis as a billing ticket and not a label that needs to follow you around for life. Diagnosis helps therapist receive compensation for services and also helps the therapist plan a course of treatment.
Your therapist should also inform you of the course of treatment and what approaches they will be using. This may vary as many therapists use an eclectic approach based on what you share in sessions. However, it is helpful to know the course of your treatment and what will be asked of you in sessions.
What You Need to Do in Therapy
It’s simple but difficult. Be open, be honest, be vulnerable. Be willing to hear feedback. Be willing to change your thinking. If it helps write symptoms, thoughts, or problems you experience during the week and bring that into the session. Sometimes the day of therapy is a great day and you may show up not thinking you need anything and forgetting that 3 days before you felt you were an absolute mess.
Try to think of what you want and need from therapy and communicate that. How would you like your life to change? What would that look like? Having a vision of what you want therapy to achieve will help your therapist get you there. Be prepared to talk about what is on your mind each session.
Some Signs That You May Want to Seek A New Therapist
He or she talks more than you do in sessions. Sometimes people that seek this line of work find the work more therapeutic for themselves. Sometimes therapists that want to connect to you find it important to find ways to relate and then end up monopolize the conversation. If you feel you can’t get a word in edgewise it might be time to look elsewhere.
He or she offers a lot of life advice. It may seem strange but it is really not our job to offer you advice. We offer you tools to develop insights into your own life so that you can arrive at the choice for you. We are taught to value self-determination which is to respect the client’s authority to make their own choices. We may offer information, tools, and provide you with questions or ways to brainstorm solutions but it is the cornerstone of our work to ensure that you are making your decisions based on your own values and opinions while knowing their impact.
He or she is acting like your best friend. It may sound harsh but therapy is not a reciprocal relationship. If a therapist becomes too emotionally invested in your relationship then their judgment is clouded when providing you with treatment. Therapists should not be meeting with you outside of your sessions for coffee. The boundaries in your therapeutic relationship should be clear.
You feel you aren’t making progress and you’ve communicated with your therapist about this. Sometimes thearpeutic relationships can reach a plateau and something the way a therapist is approaching your problems may not be the best way for you. As therapists we know this and understand that a different perspective may work best for you. But to show respect it is always best to have the conversation first and explore if there are ways your therapist can change her approach before you begin trying to find a new one.
You feel judged by your therapist. One of the most important parts of therapy is that if feels like a safe place. If you feel your therapist has responded with judgement or shamed you in any way for some of your choices you need to find a new therapist that validates your feelings, helps you find a path to self-forgiveness for mistakes, and helps you change shameful thinking patterns. You shouldn’t be hearing things from your therapist like “Why in the world would you do that?!” or “Well that wasn’t a good choice!” Any therapist that perpetuates your shame is not working in your best interest.
Making that phone call for help is sometimes the hardest part. But it is strength. It is vulnerability. It is love for your child, yourself, and your family.