Ask the Wellsprings' Experts

Relationships: Getting Back to the Basics

March 2014
Relationships
by Kelley Kitley, LCSW

Maintaining a strong and healthy connection with your partner is a MUST in any relationship. The special conditions of pregnancy, recovering from childbirth, running a busy household, balancing work and multiple children can make it difficult to prioritize your relationship and leave you feeling like you are living with a roommate not a romantic partner.

Many of the couples I work with have enormous responsibilities on a day-to-day basis, often feeling depleted by the end of the day with nothing left to energize their relationship. It is important to make a conscience effort to increase emotional and physical intimacy. Here are some tips!

-Once the kids are in bed, carve out some time to turn off the “screens” and check in with each other, rather than run through the list of things that need to get done the following day. Find out about a project your spouse is focused on at work, set up your next date night, share perspectives about a topic going on in the news.

-Be present and listen to what your partners needs are (and make sure they hear yours) so you can be a team rather than focusing on what your partner is NOT doing. Replace “You never put your clothes in the laundry basket and you always leave dirty dishes in the sink” with, “I don’t feel as exhausted at the end of the night when you help me get the kids to bed.” “I really appreciate being able to get to the gym on the weekends before we start all of the activities.”

-Keep a list of what is already working well, what you appreciate about each other, and continue to build on the strengths. “He compliments me when I am feeling less than attractive”, “she stopped at the grocery store on her way home from work and picked that gallon of milk we needed”, “we share common core beliefs about parenting”, “when I am worried about something, he is a good sounding board and helps simplify things”…

-Take turns initiating “sexy time” at least once a week. It can be a great way to relieve stress and help relax to get a good night’s sleep. Most couples report that they feel emotionally closer to their partner after they have engaged in some kind of physical touch. Put sexual intimacy on the calendar and make each other accountable. Often times we say we are too tired at the end of the day and physical intimacy is the first thing to go by the wayside. Try setting the alarm 15 minutes early - morning sex is a great alternative!

We need to slow down and be reminded of what made us fall in love with our partner in the first place. Remember how much you would look forward to seeing one another at the end of the day when you were dating, trying out new restaurants together, participating in common interests together, laughing, and what you were initially physically attracted to.

Loving relationships require continual work. You must be patient and make a commitment to keep it thriving.

How do I treat depression during pregnancy?

December 2012
Medications and Women's Health
by Allison Kurzman, MD

If you have a psychiatric illness, such as depression or anxiety, you may notice symptom changes or exacerbations during different phases of your reproductive life. Examples of these phases are premenstrual, pregnancy, postpartum and perimenopause. It is important for women to seek out appropriate mental health providers for treatment during these times. This treatment may include counseling and/or medication, depending on your individual circumstances. Before starting or stopping medication, it is important to have a careful discussion of the risks and benefits of taking medication, as well as the risks of untreated symptoms in order to ensure a conscientious and balanced decision in your treatment plan.

What supports are available after experiencing perinatal loss (the loss of a baby during pregnancy, delivery, or after)?

December 2012
Perinatal Loss
By Joey Miller, MSW, LCSW

The death of loved one can be devastating at any time, however, many families who experience the death of a baby during pregnancy, birth, or infancy often experience a double loss. It's not only the loss of all of the hopes and dreams expected for the future, but also the loss of a desired past and all of the memories that can be built over months and years.

Wellsprings Health Associates clinicians are available to provide clinical counseling to individuals, couples and families, but also to offer information; education, and resources on the unique aspects of grief following the death of a baby or young child. Whether the loss follows a miscarriage, stillbirth, or neonatal death, or follows pregnancy termination for prenatal diagnosis or maternal health indications, we are here to provide comprehensive and compassionate care. Other reproductive losses include abortion, unused embryos following fertility treatments, multi-fetal reduction, and adoption. Many of the families we work with eventually make the leap of faith to consider trying again. We are also available to provide support during a subsequent pregnancy, as often this can be as challenging emotionally as the initial raw grief. Our experience and training in the areas of reproductive health allow us to partner with you to explore the very real fears and challenges following loss, but also provide support as you gain courage to continue your journey, never forgetting the past.

What are some effective evidence-based treatments for mood disorders?

December 2012
Cognitive Behavioral Therapy (CBT) and Behavioral Activation (BA)
By Denada Hoxha, Ph.D.

Cognitive Behavioral Therapy (CBT) is a time-limited, structured, present-oriented therapy approach that was originally developed for treatment of depression and has been successfully used in treatment of other diagnoses including anxiety, substance abuse, eating disorders, bipolar, schizophrenia, and personality disorders (AT. Beck, 1967; A.T. Beck & Emery, 1985; A.T. Beck, Wright, Newman, & Liese, 1993; A.T. Beck; Fairburn, 2000; A.T. Beck, Rector, Stolar, & Grant, 2009; Freeman, Davis, & Associates 2004; Fairburn, 2000; Basco & Rush, 1996). According to CST model, our emotional experiences are influenced by our thoughts and behaviors and mental health problems emerge when people demonstrate maladaptive patterns of thinking and behavior. Additionally, from a CBT perspective, there is no one cause of mental health problems. Instead, the interplay among biological vulnerabilities, life stressors, maladaptive thoughts and behaviors, and intense emotional experiences, cause and maintain patients' mental health problems. The goal of CST is to create a structured individualized conceptualization and treatment approach targeting maladaptive thinking and behaviors. CST approaches and techniques are specifically tailored to the needs of the client and goals of therapy include psychoeducation, symptom reduction, and relapse prevention.

Behavioral Activation therapy (BA) was initially used as a therapeutic approach to treat depression but has been adopted and used in treatments of other disorders (Martell, Addis, & Jacobson, 2001; Jacobson, Martell, & Dimidjan, 2011). BA is a focused, brief therapeutic approach that helps patients identify and address environmental sources of their depression. BA is an individualized treatment approach that helps the client and therapist identify and address problems associated with avoidance, goal identification and accomplishment. The primary focus of BA treatment is creating meaningful contextual environments for the individuals that facilitate positive reinforcement through mastery and pleasure while overriding passivity, avoidance, and other secondary problems associated with depression.

How do I know if I have postpartum depression?

December 2012
Understanding Postpartum Depression
by Jennifer Levy, LCPC

The birth of a new baby is often a joyful experience -- greatly anticipated. However, up to 30% of women experience difficulty adjusting to this complex transition in their lives. Post-partum depression is experienced, most commonly, after six to eight weeks of giving birth -- usually following the more expected "baby blues". Short-lived, the baby blues are experienced within a few days postpartum and can last as little as a few hours or up to a few days. Typically, the baby blues are experienced as feeling sad, "down," punctuated with crying and spells of irritability or feeling overwhelmed and frustrated, the baby blues can usually be managed by getting some rest, taking a break and getting needed support from family and friends.

Post-partum depression (PPD)is much more challenging and often strikes women without warning and often without making sense -- that is, postpartum depression affects women both with and without a mental health history, women who had healthy pregnancies and uncomplicated deliveries, as well as women who experienced a difficult pregnancy, labor and delivery. In short, no one is immune. While women suffering from PPD can be been overlooked -- their symptoms going unrecognized by loved ones and medical providers, PPD is better understood today, and more commonly diagnosed than ever before.
How do you know if you are suffering from Post-partum depression? Review the following Postpartum Symptom Check list taken from This is Not What I Expected: Overcoming Postpartum Depression by Karen Kleiman, MSW and Valerie Raskin MD. If you agree with at least four or more of these statements, and these feelings have persisted for at least two or more weeks, you may be suffering from PPD. It's important to trust yourself -- you know better than anyone if your mood, level of day to day functioning and ability to cope has significantly changed since having your baby.

1. I can't shake feeling depressed no matter what I do
2. I cry at least once a day
   
3. I feel sad most or all of the time
4. I can't concentrate
5. I don't enjoy the things that I used to enjoy
6. I have not interest in making love at all, even though my doctor says I'm now physically able to resume sexual relations
7. I can't sleep, even when my baby sleeps
8. I feel like a failure all of the time
9. I have no energy; I am tired all the time
10. I have no appetite and no enjoyment of food (or I am having sugar and carbohydrate cravings and compulsively eating all the time)
11. I can't remember the last time I laughed
12. Every little thing gets on my nerves lately. Sometimes I am even furious at m y baby. Often I am angry with my husband.
13. I feel that the future is hopeless
14. It seems like I will feel this way forever
15. There are times when I feel that it would be better to be dead that to feel this way for one more minute.

If you suspect that you are suffering from PPD we encourage you to see a professional health care provider to assess your symptoms and develop a treatment plan that will best meet your needs and hasten your recovery.