In my practice I often see distressed couples. Many of them seek my help because of frequent fighting. What do couples fight about? Mostly money, house chores, disciplining the kids and relationships with in-laws. Through the process of therapy, however, we uncover the real reason why they fight and it usually goes much deeper than those topics; couples usually fight for LOVE.

In therapy, I often invite couples to describe their last significant fight and then a previous fight they can both recall. The partners will then each recount their perception of what happened. While the partners each describe the fights I look for recurrent patterns that make up their fights. Maybe one of them tends to start the fight with a complaint, pursuing the other partner, while the second partner tries to avoid a fight and withdraws. Maybe they each blame one another and “up the anti” until they both “explode.” When these patterns are uncovered and become clear to both partner we dig even deeper to try and find out what feelings fuel those patterns, whether there are old wounds that come into play during their fights or recent hurts or sense of dissatisfaction.

Time and again we find in therapy that feelings of anger and resentment are fueled by deeper feelings of being unloved, unaccepted or not important enough. Many times feelings of being unloved or not loved enough diminish partners’ willingness to be generous with their time, effort or affection in the relationship. It also affects partners’ willingness to be vulnerable in the relationship and, in the absence of vulnerability, deep love seems to be elusive. In therapy we gently encourage both partners to open up and allow themselves to be really seen by the other; to become vulnerable. At the same time, therapy moves cautiously to allow both partner to feel safe in the relationship as it is only when partner feel safe to be vulnerable with each other that true love is possible. When partners feel truly loved they tend to be more generous, collaborative and forgiving; they are more likely to allow their partner to influence them and are more likely to care for and about their partner. So what do couples really fight about, or for? It’s not really about money or the in-laws. The answer is, unequivocally, LOVE.

Pregnant women in Canada have been encouraged to make a birth
plan for over two decades. In her birth plan a woman is supposed to
state her wants, wishes and preferences regarding any interventions during
labour and birth. Many women choose to make a plan that is natural and avoids
any intervention including pain management. Indeed, many women give birth with
minimal intervention. However, for many other women, labour and birth develop
in a way which either necessitates an intervention like a c-section or they may
find that they cannot tolerate the pain and they end up asking for an
epidural.  In my practice I often see
women who are disappointed with themselves, feel that they have failed
themselves and/or their baby or feel they have been robbed of the experience of
a natural birth. I find that the more rigid the plan was and the more
determined a woman was to follow through with her plan, the harder it is for
her to come to terms with the way she ended up having her baby if it was
anything but intervention-free. While I support the idea of a birth plan,
allowing women to have choices in their own care, I encourage pregnant women to
be flexible and to keep an open mind about the birth. After all, a pregnant
woman making her birth plan is unable to foresee or control how her baby is
going to “collaborate” in the process of labour and birth. It may also be hard
for a woman who is giving birth for the first time to predict how painful the
contractions are going to be and how well she would tolerate the pain. Neither
can a woman foresee complications like the baby’s distress or her own blood
pressure jumping to a dangerously high level. My advice to pregnant women: Make
a birth plan but think of it as a rough draft. The final version is going to be
written together with your baby, in real time. Happy birthing!

Every new parent and, especially every mother suffers from some sleep deprivation in the first few week/months following the arrival of the baby. But researchers have now identified a strong link between excessive sleep deprivation and postpartum depression. At the 4th World Congress on Women’s Mental Health I attended and presented at last March in Madrid, Spain, some new and enlighting research in this area was presented. It turns out that women who have ongoing disrupted sleep and do not catch up on their sleep for weeks on end are 3 times more likely to become depressed than those who have the opportunity to catch up on their sleep. Also, women who are awake for many hours due to a long labor, night-time birth or inability to fall asleep after the birth (feeling tired and wired and can’t fall asleep even when the baby is sleeping) are at high risk for developing psychotic illness! This is an alarming finding that needs to be taken into account when caring for new moms shortly after the birth. Women who have gone through many hours of sleep deprivation or those who are unable to fall asleep have to be monitored closely by their care-providers. It turns out that sleep is a lot more important for our well-being than previously thought. Get some sleep, will you?

We used to think that pregnancy was a time of bliss for women; a time when extremely high levels of “feel good” hormones are present and protect the woman from a mood disorder. However, reseach in recent year puts the percentage of depressed and/or anxious women during pregnancy at 12%. In fact, pregnancy is now recognized as a vulnerable time for women; a time when mental health issues may either strike for the first time or recur.

Treatment is essential and available. If you’re pregnant and depressed or anxious you can get treatment and feel better. The question is, what treatment is the best for you. If you talk to your GP about how you feel, which may be a good idea, they are very likely to either refer you to a psychiatrist, who is likely to prescribe an anti-depressant medication or they will prescribe it themselves. The message to pregnant and postpartum women seeking medical advice is that the risks of not treating the condition outweigh the risk of taking anti-depressants during pregnancy. While the risks of not treating depression/anxiety during pregnancy and postpartum are significant, the question is not whether to treat or not but how to treat. Medication is definitely not the only treatment modality that is available or that has been shown to be effective. Psychological treatments, such as Cognitive-Behavioral Therapy, Interpersonal Psychotherapy and Marital Therapy have been shown to be as effective as medication in alleviating symptoms of depression/anxiety, if not more. Group therapy has also been found to be helpful. The question, then, should not be to treat or not to treat but, rather, how to treat. Women should be given updated and accurate information about ALL of the treatment options and should be encouraged to make a decision based on this information and their own needs and circumstances. Please, if you are pregnant and depressed and/or anxious-get help. It’s important for you, your baby and your whole family.

So you’ve had your new baby and you’re home now. Before you left the hospital the nurses gave you some important guidelines, like: “the baby has to sleep on her back, not her tummy” and “you should avoid giving her a bottle until breastfeeding is well-established.” But at home, aunt Susie, mom-in-law Christine or good old neighbor Sarah are telling you different things, like: “I raised 4 kids and they all slept on their tummy” or “listen to me, I worked at the nursery when I was younger and we always did xyz and the babies were fine.” Many new parents complain about unsolicited advice they get from family and friend. Advice that, many time, is contradictory to what they were told by hospital staff. The question is how to do what you believe you have to do or what you want to do without hurting well-meaning people’s feelings? How to tell mother-in-law off without putting her off? One thing is clear: you both have to be on the same page regarding who you listen to. Once you’ve established that, it’s time to practice your assertiveness skills. It may be difficult as a new parents to gather the energy to stand up to people who provide unsolicited advice. It may seem easier to just ignore them. But then they may get offended anyway. So what’s the best way? Saying something quite clear in a respectful way, like: “Thanks for the advice, I’m sure it makes a lot of sense to you but we have decided to follow the current guidelines and, so, the baby is going to sleep on her back.” If the person insists on offering their opinion again, just repeat what you said in the first place, in a calm and respectful tone. Do it until they get the message and don’t forget t o back each other up. Happy new parenthood!

Between 10-15% of new mothers experience postpartum depression. Postpartum Depression is a serious disorder that robs women and their families of the joys and elation that often come with a new baby. These women, and often their family and friends may ask themselves: Why am I (is she) not happy like I’m (she’s) supposed to be? What’s wrong with me (her)? Why can’t I (she) feel joy? After all, I (she) has a beautiful, healthy baby.

The truth is, that Postpartum Depression is, indeed, counter-intuitive. After all, most of us want to have children, have planned to have them and have dreamt of raising a family. Becoming a mother is often the dream and hope of adult women. How come, then, that so many women develp depression following childbirth? There are many explanations of this phenomenon but currently researchers and clinicians alike agree that a combination of biological, psychological and social factors play an important role in postpartum depression. An example of a biological component may be that brain chemistry is different in women who have postpartum depression than in women who do not have postpartum depression (as can be shown in brain imaging tests). We also know that women who have members of their immediate family who have had mental health problems are at a higher risk than women who do not have any family members with mental health problems. A psychological component for example may be a tendency to be a perfectionist or have a high need for control, and a social factor may be feelingl isolated, being a single mom or struggling with finances (these are just examples and there can exist any combination of challenges to put a woman at a high risk for postpartum depression).

What are the symptoms of postpartum depression?

Feeling down, hopeless, depressed or simply miserable

Feeling like you have lost interest in things you used to be interested in or have pleasure from before

Feeling lack of joy or happiness about the baby or life in general

Having uncontrollable crying spells

Being anxious or afraid of being alone with the baby

Significant changes is appetite and/or weight compared to your normal self

sleep problems above and beyond disruptions caused by the baby

Aches and pains

Difficulty focusing, thinking, making decisions

Avoiding or minimizing socializing

Having thoughts about harming yourself and/or your baby

If you have 3-5 symptoms that last more than just a few days, most of the day, you need to see a physician or a psychologist. If you have thoughts about harming yourself and/or your baby, please urgently seek help!

The good news about Postpartum Depression: There is great help out there and you can recover from it and be your normal self again. Different types of psychotherapy, such as Cognitive-Behavioral-Therapy, Interpersonal Psychotherapy and Marital Therapy have all been shown to be highly effective in treating Postpartum Depression. Anti-depressants, such as Prozac can also help. See a Registered Psychologist who can diagnose you and tailor the best therapy to you and your needs. Don’t go on another day suffering; You deserve to feel better and you can!

Nobody goes without sleep like new mothers (and often, fathers) do! Between feeding, changing, burping, soothing, feeding yourself, etc., there’s very little time for sleep. But how long can one go with little sleep and not be affected by it? The relationship between sleep deprivation and accidents has long been establised. In fact, more accidents happen due to sleep deprivation than to drinking and driving! The question is, is there a connection between lack of sleep and depression or postpartum depression? The answer is a resounding YES! Research has shown a significant relationship between chronic or ongoing sleep deprivation due to various causes and depression. More recent research looked at the role of sleep regulation in new mothers in preventing postpartum depression. For example, in one study new mothers were kept at the hospital for 5 days and nights after the birth of their baby. The baby was cared for by a nurse every night for 5 nights, allowing the new mother to sleep for 8 hours, thus putting her sleep cycle back on track. The results? Compared to new mothers who were not offered this intervention there was a decrease of 40%(!) in the incidence of postpartum depression. What can we learn from this? Most mothers care for their baby themselves and do not have the privilege of a night-nurse, nor is it a recommended practice for new mothers. However, new mothers should be aware of the importance of sleep and would well be advised to use any help they can get to catch up on their sleep. That means that house chores, meal preparation, entertaining, etc. should be put on a much lower priority than sleep. It would greatly help new mothers if the expectations others have from them are lowered and if help focused on caring for the mother while she is caring for her baby. New mothers’ expectations of themselves also have to be adjusted and self care, including sleep should be made a priority. Just like you wouldn’t expect your car to run on an empty tank, you shouldn’t expect yourself to be able to function and stay well on little sleep. Finally, a reminder to new dads: you can do everything except breastfeeding! The more you do, the better your relatinship with your baby and your wife (or partner) be. Happy new parenthood!

I recently had the opportunity to work with a couple who’s been married for 8 years and had two kids (6 and 3). The partners initially came to consult with me about their 3-year-old emotional and behavioral problems. Very shortly after we started working together it became apparent that the couple was having relationship problems; they were fighting a lot and resorted to yelling, door banging and even leaving the house when things got particularly heated. We started working on their relationship (using Emotionally Focused Therapy) and after only 6 sessions they reported not only that they were getting along better and were happier in their relationship, but also, that the teacher at their 3-year-old day-care told them that her behavior has gotten significantly better. After a couple more sessions they reported having noticed an all-round improvement in their daughter, both emotionally and behaviorally (less crying, less clingy behavior and fewer temper tantrums). Another interesting thing happened when their 6 year old, who had not exhibited any distress initially, told them at dinner time one night that recently she’s been feeling that her family was “the best.” She also commented that when her parents smiled at each other they were “beautiful” and that dinner was her best time of day. This family is a living proof that theory and research in the area of couples relationship and couples therapy, indicating a direct link between the quality of the couple’s relationship and the well-being of their children, is right. So hold each other close to your heart and, if there are challenges in your relationship, get some help. Your relationship could be the most precious asset of your family.

Just received word that my presentation on psychological treatments for pregnancy and postpartum depression got accepted by The 4th World Congress on Women’s Mental Health in Madrid, Spain (March 2011). I am a strong advocate for women who deserve to be educated and offered different choices when they are faced with the debilitating and devastating reality of having depression during pregnancy or postpartum. There are many effective treatments for depression and anxiety other than medication, which most pregnant and breastfeeding women are reluctant to take. Women are entitled to be given choices and get the best therapy available! Women are intelligent; they deserve to be partners in their own care and, given adequate and updated information, can make their own decisions about their own care.

I had the opportunity to speak with Sexy in Vancity radio producer and host, Caroline MacGillivray, last Wednesday about various issues for women, specifically in regards to an article I wrote recently entitled What Women Want… At 50. The interview was a complete hour of chatting and we covered some other topics including pregnancy and postpartum, work and couples.

I had a great time chatting with Caroline and hopefully you will gain some insight from our interview. You can listen to the entire podcast formatted interview HERE

Sexy in Vancity talks about all things sexy in Vancity. An entertaining, engaging and educational show airs on citr 101.9fm www.citr.ca (Vancouver) on Wednesday nights at 10pm PST.