Table Of Content“Congratulations to Karen Kleiman and Routledge for offering this Classic
Edition of Therapy and the Postpartum Woman: Notes on Healing Postpartum
Depression for Clinicians and the Women Who Seek Their Help. Kleiman’s
sensitive, astute and clinically expert guidance continue to be greatly needed
and valued by postpartum women, the clinicians who treat them and those
who love them. Kleiman’s wise yet down to earth approaches deeply connect
with the women who most need support during most vulnerable time in their
lives. What a gift that Kleiman continues to be a front-line resource, vigilantly
protecting women when motherhood brings pain.”
Susan Dowd Stone, MSW, LCSW, Past president
and President’s Advisory Council Member, Postpartum
Support International, Adjunct Associate Professor,
Silver School of Social Work, New York University, USA
“Karen Kleiman brings to light the unique clinical and social context of the
postpartum woman seeking therapy. Karen adeptly encapsulates the practical
aspects of working with postpartum women. She highlights the importance of
clinician qualities of warmth, compassion and empathic confidence for establishing
a strong therapeutic relationship and a supportive ‘holding environment’ for
the new mother.”
Dr Renée Miller, Principal Clinical Psychologist,
Antenatal & Postnatal Psychology Network, Australia
“Karen Kleiman has the magic touch when reaching parents on their journey
through perinatal mood and anxiety disorders. Her new book teaches all of us
her magic of common sense and research-based techniques. We are all better
off because of her.”
Chris Raines, MSN RN APRN-BC PMH-C, President,
Postpartum Support International,
Adjunct Professor UNC-Chapel Hill, USA
Therapy and the
Postpartum Woman
Written by a pioneer and continuing advocate for perinatal health, this book
remains an enduring reference for any therapist working with pregnant or
postpartum women and their families suffering from perinatal mood and
anxiety disorders. This Classic Edition includes a new foreword by Hilary
Waller that reflects on changes in the field since the book’s first publication.
Using a blend of professional objectivity, evidence-based research, and
personal, straight-forward suggestions gathered from years of experience, this
book brings the reader into the private world of therapy with the postpartum
woman. Based on psychodynamic and cognitive-behavioral theories, and on
D.W. Winnicott’s ‘good-enough mother’ and the ‘holding environment’, the
book is written by a therapist who has specialized in the treatment of postpartum
depression for over 30 years. Chapters address diagnosis, medication,
depression, psychosis, suicidal thoughts, bonding, as well as finding meaning
and the power to heal during recovery.
Bringing further attention to under-recognized illnesses that plague mothers
and cloud the childbirth experience, this Classic Edition serves as an accessible
companion tool for clinicians and the women they treat.
Karen Kleiman, MSW, LCSW , is a licensed clinical social worker and
internationally recognized expert on maternal mental health. With over 30
years of experience in the field, she is the author of several books on postpartum
depression and anxiety and is the founder of The Postpartum Stress Center,
a treatment and training facility for prenatal and postpartum depression and
anxiety disorders.
Routledge Mental Health Classic Editions
The R outledge Mental Health Classic Edition series celebrates Routledge’s
commitment to excellence within the field of mental health. These books are
recognized as timeless classics covering a range of important issues and con-
tinue to be recommended as key reading for professionals and students in the
area. With a new introduction that explores what has changed since the books
were first published, and why these books are as relevant now as ever, the
series presents key ideas to a new generation.
Psychotherapy: An Erotic Relationship
Transference and Countertransference Passions (Classic Edition)
By David Mann
Collective Trauma, Collective Healing
Promoting Community Resilience in the Aftermath of Disaster (Classic
Edition)
By Jack Saul
Unlocking the Emotional Brain
Eliminating Symptoms at Their Roots Using Memory Reconsolidation
(Classic Edition)
By Bruce Ecker, Robin Ticic, and Laurel Hulley
The New Handbook of Counseling Supervision (Classic Edition)
By L. DiAnne Borders and Lori L. Brown
Therapy and the Postpartum Woman
Notes on Healing Postpartum Depression for Clinicians and the Women Who
Seek their Help
By Karen Kleiman
Therapy and the
Postpartum Woman
Notes on Healing Postpartum
Depression for Clinicians and the
Women Who Seek their Help
Classic Edition
KAREN KLEIMAN
Cover image: Getty Images
Classic Edition published 2023
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Karen Kleiman
The right of Karen Kleiman to be identified as author of this work has been
asserted in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from the
publishers.
Trademark notice : Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
First edition published by Routledge 2009
Publisher’s Note
References within each chapter are as they appear in the original complete work
Library of Congress Cataloging-in-Publication Data
A catalog record for this book has been requested
ISBN: 978–1-032–16422–9 (hbk)
ISBN: 978–1-032–16378–9 (pbk)
ISBN: 978–1-003–24847–7 (ebk)
DOI: 10.4324/9781003248477
Typeset in Times New Roman
by Apex CoVantage, LLC
Contents
The Author ixxi
Foreword to the Classic Edition xiii
TInhtero Aduutchtioorn to the Classic Edition xviixi
Foreword xxxii
Acknowledgments xxxiiiiii
Preface xxxvv
P 1: T F : W , B , T
ART HE RAMEWORK OMEN ABIES AND HERAPY
1. Masquerade: Clinical Profile 3
2. Everything Gets in the Way: Resistance 13
3. Don’t Call It Therapy: Reframing 21
4. Anatomy of a Postpartum Depression Therapist 27
5. The Holding Environment 37
6. Making a Diagnosis 45
7. The Voice of Depression 55
8. Therapeutic Models for Women at Risk 63
9. Perfectly Postpartum 71
vii
vvii ii CCoonntteennttss
P 2: T T : D W W
ART HE OOLS OING HAT ORKS
10. The Phone Call: Initial Assessment 81
11. First Things First 87
12. Asking the Right Questions: Screening 97
13. Listening to Symptoms: Assessment 107
14. Collaboration 115
15. Sharing the Session 119
16. Medication: Clinician’s Perspective 125
17. Medication: Client’s Perspective 135
18. Alternative Therapies 141
P 3: T W : C C
ART HE ORK LINICAL HALLENGES
19. Scary Thoughts 155
20. Help-Resistant Complainer 163
21. A Good Girl 171
22. Breastfeeding to Death 181
23. Countertransference: When Is Yours Mine? 187
24. Sleeplessness 193
25. The Married State 201
26. Bonding 211
27. Suicidal Thoughts 219
28. Psychosis 225
29. Motherself 233
CCoonntteennttss viixi
30. Prevention? 239
31. Burnout, Boundaries, and Other Pitfalls 247
P 4 T H
ART HE EALING
32. The Umbilical Factor 255
33. The Bracelet 261
34. Therapy Exposed 267
35. Finding the Power to Heal 273
36. Recovery Revealed 283
37. The Search for Meaning 291
38. The Quintessential Mother 297
Appendices 301
A. Our Postpartum Pact 301
B. PPSC Suicide Assessment for a Positive EPDS Screen 306
C. PPSC Symptom List 308
D. PPSC Initial Session Instructional Pad 310
E. PPSC Phone Assessment 311
F. Edinburgh Postnatal Depression Scale (EPDS) 312
References 315
Index 327
