Aligning Pregnancy, Mental Health and Your Relationship→

Although most of us are familiar with postpartum depression, people are often unaware that mental health challenges may start before the delivery of a new baby and may affect the expectant or new mother and their partner.

In fact, medical and mental health providers now refer to the emotional distress that occurs during pregnancy until after one year postpartum as perinatal mood and anxiety disorders (PMADs). Not all of these concerns may meet the criteria for a mental health diagnosis, but they impact the individual experiencing them and their loved ones.

Research has shown us that becoming parents is one of the most stressful times for couples and nearly 67% of couples report a significant decrease in couple satisfaction after their first child is born (Shapiro et al., 2000).

This decrease in couple satisfaction is often difficult to navigate, especially if one or both partners are experiencing a PMAD and current research shows that 20% of women will experience a PMAD (Alderdice, 2020), while 1 in 7 men report mood disturbances during the perinatal period (Tissera et al., 2021). Some of the reasons that couples report a decrease in relational satisfaction during pregnancy and after the birth of a child include biological changes, impaired sleep, less time to spend as a couple, reduced communication, financial challenges, and more (Gottman et al., 2004). These difficulties are compounded if the couple has not spent time discussing their expectations of each other, their new roles, and sharing their ideas of what being a parent while still being a couple means (Dueger, 2021).

These conversations are particularly important because becoming a parent is generally the most significant identity shift that anyone will experience after puberty. If one partner shifts in a different direction than the other, it will strain the relationship.

Also, many new parents shift all their focus onto their new baby and put themselves, their partner, and others on the back burner. Over time this heightens levels of frustration, mood disturbances and relationship dissatisfaction. Of course, no one would suggest that the new baby is neglected or is not prioritized; however, there needs to be a balance between nurturing a new baby and taking care of ourselves and our relationship.

Most relationship experts recommend prioritizing the couple relationship and ensuring that partners create a sense of togetherness and a secure bond; Hoppe and Tatkin (2021) refer to this as a couple bubble.

To create a couple bubble most effectively, we need to work on understanding our own biological, neurological, and attachment needs so that we are able to understand how we are responding to one another and sharing our needs effectively; otherwise, our requests may be critical, and our partner may respond defensively or shut down.

Learning to recognize these different needs and communicating effectively is incredibly challenging because we don’t live in a world that provides many good examples of self-awareness, respectful proactive communication, listening attentively, and responding non-defensively. If one or both members of the couple are experiencing a PMAD, these skills become that much harder to master.

Often only the person experiencing mental health struggles will reach out for therapy, but research has shown that a supportive partner is a key aspect in overcoming a PMAD (Tissera et al., 2021). Other types of social support are also hugely helpful when navigating the challenges associated with becoming a parent, and there are some excellent resources, including peer support groups, available through Postpartum Support International and The Seleni Institute.

If you and your partner are considering starting a family, have recently added to your family, or are unsure of what growing your family during a pandemic will look like, I would be honored to help you navigate these challenges. I am a Certified Perinatal Mental Heath Profesional PMH-C and can be contacted here.

References:

Alderdice, F. (2020). What’s so special about perinatal mental health? Journal of Reproductive & Infant Psychology, 38(2), 111–112. https://doi.org/10.1080/02646838.2020.1734167

Dueger, S. (2021). Preparing For Parenthood. Author Academy Elite.

Gottman, J., Gottman, J., Abrams, D., & Abrams, R. (2004). Eight Dates. Thomas Allen & Son Limited.

Hoppe, K., & Tatkin, S. (2021). Baby bomb. New Harbinger Publications, Inc.

Shapiro, A. F., Gottman, J. M., & Carrère, S. (2000). The baby and the marriage: Identifying factors that buffer against decline in marital satisfaction after the first baby arrives. Journal of Family Psychology, 14(1), 59-70. https://doi.org/10.1037/0893-3200.14.1.59

Tissera, H., Auger, E., Séguin, L., Kramer, M. S., & Lydon, J. E. (2021). Happy prenatal relationships, healthy postpartum mothers: a prospective study of relationship satisfaction, postpartum stress, and health. Psychology & Health, 36(4), 461–477. https://doi.org/10.1080/08870446.2020.1766040

Top 5 ways to find a great marriage counselor

It can be so hard to find a good couples therapist. The confidential nature of the work and social stigma means that most consumers don’t spread the word. Marriage counselors are also ethically bound to not ask for online reviews to protect our client’s confidentiality, and therapists in general tend not to be business oriented. This often leaves the consumer in the dark.

I’d like to offer some suggestions. Here are a list of the 5 top ways to find a great marriage counselor:

1. License

Marriage counselors must be licensed by the state in which they are providing services. This license could be an LMFT(Licensed Marriage and Family Therapist), LPC(Licensed Professional Counselor), LCSW(Licensed Clinical Social Worker) or Licensed Psychologist. There are lots of well meaning folks that like to help couples and have good intentions, but if there is no license, there is questionable training and no oversight. To obtain a license, one must have at least a Masters degree in a related field and then complete 3000 hours of an internship and hundreds of hours of supervision, as well as completing continuing education each year. This is imperative to properly train a therapist. I once heard a friend compare a therapist with no license to her unlicensed hairdresser. The problem with providing couples counseling unlicensed is that the stakes are so much higher than a bad haircut. Families and marriages are on the line, mental health needs are being addressed, and an untrained therapist can do so much damage. Look for a relevant license.

2. Education and training

The beauty of a licensed therapist is that the licensing board has covered this step for you, vetting the therapists training and credentials. Additionally, a marriage/relationship counselor should have training to work specifically with couples. A therapist trained only to see individuals will not be competent to work with couples; they need additional supervision and relationship specific courses and experience. I also prefer to refer couples to counselors that primarily see couples. Most often when a client is relaying why couples therapy didn’t work well in the past, it was provided by a therapist who wasn’t trained to work with couples and was doing the same type of therapy they provide to individuals.

3. Couples specific certifications

In addition to an appropriate counseling degree, a marriage counselor may also have specialized certifications. I am a Certified Gottman Therapist, for example. This required completing 3 levels of intensive training(that took a few years) as well as working with a consultant who reviewed video recordings of my therapy sessions to determine that I was meeting the standards and technique required to be a CGT. There is also advanced training in Emotionally Focused Couples Therapy (of which I have completed an externship), as well as through a few other models. A counselor who has completed these trainings is deemed a specialist.

4. Niche specific

It is also helpful to look for a marriage counselor that may have a specific niche regarding your identified area of need. Infidelity, substance abuse, porn addiction, ADHD, or religion may be examples of specific niche areas. It is not possible for a therapist to be well informed and great at everything.

If you are looking for a faith based counselor, make sure you still cover items 1-3. Just because the counselor is of the same faith, doesn’t necessarily mean they are trained to work well with couples. And another important point is that a great counselor will respect, honor and integrate your faith, even if they do not share the same religion.

5. Rapport

Research consistently reports that the effectiveness of any given therapy is mainly due to the rapport with the counselor. That means you want to find someone with whom you have a good rapport and with whom you feel comfortable. This may take a few counselors to find, but when you make a good connection, the time investment is worth it!

Bonus tip: look for therapists that are grounded in a local practice. Online big box platforms often offer couples counseling, but their roster of therapists are often under trained for this specialty and the therapist turnover is very high. This means you will not get high quality or consistent care, even though it may seem cheaper at the beginning. Many of these platforms have also been fined for confidentiality violations and are generally tech based and not healthcare based. A local practice will also provide online care, but from consistent, high quality clinicians. Your relationship deserves the best!

5 reasons to feel safe in couples therapy, even though it may sound scary

• We are trained to keep conflict on track, productive, and will protect your relationship through the entire process. When choosing a couples counselor, make sure to pick someone who primarily works with couples and has specialized training and is licensed by your state to practice counseling. Counselors at Align Couples Therapy are trained in Gottman Method and Emotionally Focused Couples Therapy, two of the most effective couples counseling methods.

• We will not let you fight the entire session. We will non judgmentally intervene with science based tools and guidance. We will work to protect the healing atmosphere of the therapeutic space.

• We focus on strengths. We assess not only for what you would like to improve about your relationship, but also for your strengths. Each couple has special strengths about their relationship that we can use as a foundation for the work. Many couples find that they are healthier than they thought, especially with new tools in hand.

• We don’t take sides or tell you to separate. We aren’t here to decide who is right or wrong, but to help your relationship thrive. We also don’t “change” people, but focus on the space between two persons in relationship.

• We listen to what you need and adjust the process to meet your goals. A good therapist is always open to feedback and will be flexible.

• We complete a full assessment before jumping in. Our assessment process is detailed and takes a few sessions to complete. This way, we don’t jump in before we truly get to know you and what your identified goals are.

• Good couples therapy is based on science. Counseling is not about therapist’s relationship experience or unfounded ideas. Everything we do at Align Couples Therapy is based in science.

• Couples Therapy is not associated with divorce. Arriving in couples counseling does not mean that divorce is next, or that you are doomed. It’s usually the opposite. It’s the healthy couples that tend to show up for therapy. But remember, prevention is much easier than intervention!

Hopefully these ideas will allay some of your fears! Happy Halloween!

Krista J Miller, Marriage & Family Therapist is now Align Couples Therapy LLC!

I’m rebranding and expanding!  And I’m hiring!

I will be providing the same quality services to couples, individuals, adolescents and families, but will be hiring qualified therapists to offer more hours and offer more flexibility in scheduling.  I will soon be offering bilingual services as well as evening and expanded weekend hours.  Our therapists will all have quality, specialized science based training in working with couples and receive collaborate treatment team support to best meet the needs of each client.

We provide relationship science with heart. Optimize yourself and your connections in a boutique atmosphere.

Align Couples Therapy seeks to optimize each client within themselves and in their social contexts.  Aligning within and between.  This includes not only relationship counseling offerings, but also mental health services, self improvement, personal growth and educational workshops and retreats.  Heart and mind, aligned within self and between others.

If you are looking to work in a collaborative, creative and growth minded group practice please see our hiring page. We offer a turn key group practice experience, with a generous CEU stipend and potential for bonuses.

Stay tuned for new offerings! Sign up for the email list to be notified of upcoming events!

5 reasons to sign up for a marriage workshop

1. Invest in your marriage, the easy and fun way. Don’t wait until there is a crisis! Make time for your spouse and have some fun in the process. You wouldn’t invest in landscaping without watering it, our relationships need the same upkeep. You probably spent more for your wedding cake! This is an investment in your future or your relationship and your family.

2. Get more done in one day than in two months of weekly counseling. We cover so much! But in a very digestible way and lasting way.

3. Focused, guided learning over a 6-8 hour time frame will have more impact than distracted learning at home. How many times have you bought a relationship book and only one of you read it! Sounds like an argument I’ve heard before….

4. Your spouse will feel loved and valued. Attending a workshop together is a very loving way to give your spouse the message that they are a priority. Many couples feel better after only just signing up!

5. Your kids see that your relationship is important and deserves attention, teaching them to do the same in the future. They may roll their eyes at your affection, but they need to see it.

and a bonus:  Free donuts!

Sign up today for my online marriage workshop June 6th, 2020. I'd love to have you join us!

The truth about marriage counseling

Ever heard any weird stories about marriage counseling?  I sure have.  It’s no wonder people are worried about coming in.  Marriage counseling is a very misunderstood process due to a number of myths. You may have never been in a therapist’s office, but surely have some expectations based on movies or stories from friends and family. If the only thing you know about couples counseling is from a Vince Vaughn movie-please read on. Here is some help dispel some of these myths.

Counseling is a scam, it doesn’t work

Research consistently finds that therapy works. Counselors are ethically trained to only utilize theraprutic approaches where effectiveness is research based. Align Couples Therapy also participates in some of the current research studies being conducted by The Gottman Institute.

In the approach of Emotionally Focused Couples Therapy, for example, 90% of couples report improvements in their relationship. In addition, results from an article from the Journal of Martial and Family Therapy report that clients generally reported satisfaction rates between 91% and 98%.  For effectiveness of the Gottman Method, another theory I utilize, see this link.  Science is increasingly telling us what works and doesn’t work in relationships.  I am careful to work primarily from this standpoint.

You must be really broken to need marriage counseling. Others don’t need it.  

All relationships need tending.  Your marriage is your biggest investment.   You wouldn’t purchase a fancy sports car or beautiful landscaping and then forget it.  They need servicing, fertilizing, attention.  Even the best relationships struggle time to time. It’s the healthiest couples who are willing to try marriage counseling.  Relationship counseling is the most effective if you come in before a crisis.  Prevention is much easier than intervention.

The counselor will pick sides (and probably side with my wife since she’s a woman).

I am trained to be neutral. There is no side to pick and I will teach you that striving to “win” will not improve your relationship. If there is a winner and a loser the relationship breaks down.  My "side" is with the relationship and making it work for both of you.  I consider my client to be the relationship.

The counselor will boss us around.

My job isn’t to be bossy or dole out advice. This is one of the main differences between talking to a friend/family member or talking to a therapist. Many people in your life will tell you what to do. A counselor, on the other hand, is focused on listening, understanding and encouraging growth by utilizing proven theories and techniques.  I strive to create the atmosphere for enhanced connection.  I will work to keep us on track, focused and productive. 

The counselor will make us do stupid and embarrassing activities.

Showing up in a counselor's office can feel very strange at first.  A good counselor is going to work with your comfort zone. We don’t want to scare you off!  If you are uncomfortable, speak up. We work for you, not the other way around.  The silly things you see in a TV therapy session are not representative of what we do.

The counselor may make things worse.

It can be scary to think things could get worse. The situation probably already feels out of control.  But there is also risk in doing nothing. New behavior/new knowledge/new experiences = new results.

I will not let you needlessly rehash every argument you’ve ever had. I mediate and help you decrease conflict. I've got the road map and am driving the bus.  I will keep things on track.  You are validating your partner’s concerns about your relationship and showing good faith by showing up.  Often couples feel better before they even show up because setting the appointment together feels good.

BUT, when choosing a counselor, verify that they are properly licensed by your state and trained specifically to work with couples. Someone calling themselves a counselor, but not licensed to practice, can do harm. This means they were not properly supervised during their training and may not have the education and guided wisdom from supervisors necessary to do the job properly.  I will also do a proper assessment to determine if relationship counseling is right for you or if other avenues may be more helpful.

Seeing a professional is too personal and embarrassing.

It can feel very awkward to open up about private, embarrassing, and painful relationship problems. I have great respect for this.  Most people get over this pretty quickly and many times even forget that I am there.

Because I am neutral and an advocate for your marriage, it becomes easy to bring up the elephants that have been hanging out in your living room.

I’m ashamed of the mistakes I’ve made.

I am solution focused. You are not a sum of your mistakes. What brought you together? What challenges have you overcome? How are you each individually great? How can we make this all come together to move forward?

To put it simply, even in the midst of pain, there is something sacred and resilient. I will not judge.  I admire anyone willing to come in the door and do some work.

It’s too expensive.

How much did you pay for your sofa? Would you be willing to invest that same amount into your relationship? Counseling is substantially cheaper than a divorce.

I want to get you back out on the road as quickly as possible and work my way out of a job as soon as I can.

We shouldn’t have to work on this, it should be easy.

We would like marriage to be easy, but sometimes it just isn’t. That’s not to mean it’s awful. The more we invest, the more we receive. To quote romance novelist Nicholas Sparks: “Nothing that is worthwhile is ever easy. Remember that.”

Working on your relationship can teach your kids how to have a great marriage. You teach them that you invest time and energy into your priorities. When your priority is each other, you all benefit.

My goal is for this "work" to become easier and feel intuitive.  There is no need to struggle on your own.

The other person is the one that needs to change.

Finding fault won’t move you forward. If you are waiting on the other person, nothing will happen. Do something first.

The goal is not to “change a person.” The goal is to change relationship patterns and reconnect. Change can come from either side.

The counselor will tell us if we should break up or not.

It is never my place to make relationship decisions for you.  This is disrespectful and unethical.

Therapy will fix everything.

There is nothing magical about showing up and sitting on my couch every week. The real work is done by you between sessions.

We can’t do couples counseling because one of us won’t go.

We can do 1:1 therapy-it’s not ideal, but can work. Again, change can come from either side. That doesn’t mean things are your fault, the goal is to change the entire pattern and functioning of your system. One person can adjust the whole pattern, or at least get things started.  

So now I hope you have no more excuses and make the call to get started today!

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