Online therapy, or telehealth, is a new and growing field in the mental health arena—one that has divided professionals, some of whom say it is the future of all therapy, while others remain skeptical. But the prevalence of online therapy has only grown in this period of self-isolation due to coronavirus, and it’s likely that its place in treatment plans has been cemented. In my work as a psychologist specializing in maternal mental health, I see the particular advantages of online therapy for the pre- and postpartum period if it is set up to fit the unique needs of expecting and new mothers.
Perinatal mood and anxiety disorders (PMADs) are considered a major public health issue, affecting 15–25 percent of expecting and new mothers.
Emotional and mental health are crucial during this big life transition. Perinatal mood and anxiety disorders (PMADs) are considered a major public health issue, affecting 15–25 percent of expecting and new mothers. What’s more, the emotional health of mothers affects not just families but our society as a whole. PMADs are complex conditions with many biopsychosocial factors, but they are treatable.
Approximately one in five women experience a PMAD, and for some groups who are at higher risk, the number is higher. While the issue of PMADs is receiving increasing attention, there is still a significant gap between the number of women who experience PMADs and the availability of treatment. Sadly, only about 50 percent of women who experience PMADs receive treatment. Many barriers contribute to this gap, including geographical distance, costs, access to trained professionals, and stigma. One promising way to address this gap is online therapy.
When therapists offer a combination of in-person and online formats, new moms can keep seeing their therapist regularly even when in the hospital or home with baby.
Like any therapy modality, online therapy has pros and cons and will not meet everybody’s unique needs. For example, the online format inevitably lacks elements of connection, or attunement, that in-person therapy can offer. When I am in the room with a person, I attune to their emotional and physical state in many ways, including through nonverbal communication, to help them feel safe. But in my work with expecting and new mothers, I have found that online therapy provides the following advantages.
Online therapy allows new moms to seamlessly continue therapy even after their baby is born
Although some therapists have exclusively online practices, many therapists offer both in-person and online therapy. Starting therapy during pregnancy offers a unique opportunity for therapeutic work. If you are dealing with depression and anxiety during pregnancy, we know that the sooner you start treatment, the better—because unfortunately, delivery rarely makes it go away. The bad news is that depression and anxiety during pregnancy put you at higher risk for depression and anxiety after delivery. But the good news is that these conditions are very much treatable, especially if treatment is started early. You do not have to suffer alone. Many treatment options are available, and therapy is often a big factor in the healing process, often combined with other forms of treatment. For many moms, going to sessions before delivery is doable and preferable, but once the baby has arrived, everything changes. When therapists offer a combination of in-person and online formats, new moms can keep seeing their therapist regularly even when in the hospital or home with baby. This can be a crucial part of ensuring that care continues during a challenging transition.
Online therapy reduces logistical stress
Having a newborn is a major practical shift for all new parents. What was before a seemingly simple thing, like going to an office for care, is now a logistical hurdle that can produce significant additional stress. Some moms prefer to not have their baby present during their therapy session. For many moms doing online therapy, it’s much easier to arrange for childcare in their home just for the duration of the session as opposed to getting childcare for the time it would take to get to an office and back. Some mothers also find it reassuring to know that they are in the same location as their baby. I work carefully with mothers to track and process these concerns and reactions, so they become part of the therapeutic work. The key is flexibility, meaning the mother decides if she needs to step away from the computer for a moment to care for her baby—and I then explore the experience with her and continue to explore it as treatment progresses. There is no one right way to do this, and all mothers have different experiences and needs for how to move through separation from their baby. What matters is where you are and what you need at this point in your healing process. The flexibility of the online format is a significant advantage for this.
Online therapy lets you have sessions without having to navigate the world with a newborn just yet
There are many reasons why a mother might find it overwhelming to bring her baby to a therapy session. For mothers with a history of social anxiety, the thought of being looked at while holding one’s baby can be difficult. If you’re just starting therapy, it’s intense to be both working on your new relationship with your baby while also meeting a new therapist. And even if you already know your therapist, it can be a big step to bring the baby to the office. Will the office be mother-and-baby friendly enough?
Imagine being able to build up your new therapeutic relationship without having to simultaneously handle the big work of being out in the world with your baby.
It’s hard for new moms to fully relax in public because they are naturally so focused on the big task of getting to know their baby—which sometimes can feel like fumbling in the dark. Especially in the early days postpartum, mothers are constantly working to get a sense of their baby and how to be with them. It’s like mapping a new continent. This work is obviously easier to get a sense of at home. Home is where that first sense of oneself as a parent is established, and with time, one ventures out into the world. But this process is delicate and requires support! Imagine being able to build up your new therapeutic relationship without having to simultaneously handle the big work of being out in the world with your baby. You will get to that part when you’re ready!
Online therapy lets you see a therapist even if there are no therapists in your area with specialized training
Maternal mental health is a specialization that requires training beyond the normal requirements for licensure for therapists. The unique changes of motherhood make mental health highly complex during this time; a range of biological, psychological, and social factors must be carefully considered. Understanding how these factors interact and how they must be assessed and addressed in therapy goes beyond the general training for psychotherapists. The field is therefore (increasingly) recognized as a specialization; Postpartum Support International (the leading nonprofit organization for maternal mental health) launched the first professional certification in 2018. For expecting and new mothers who might be suffering from a PMAD, it is crucial to get help from a provider who is trained in working with these complex conditions. If there are no providers in your area with specialized training, there are likely specialized providers in your state who offer online treatment. Postpartum Support International has a provider directory.
If you believe you are suffering from depression or anxiety or other mental health issues, please know that:
It is not your fault
You are not alone
With the right help, you will get better.
This is Postpartum Support International’s universal message.
If you’re considering starting online therapy—either as a first foray into therapy or continuing sessions with your in-person therapist—there are a few things to consider before doing so:
– Do you have a good internet connection and an appropriate device?
– Do you have adequate options for privacy?
– Ask your provider how they are determining whether online therapy fits your needs
– Ask your provider about instructions for preventing and handling technical difficulties and a protocol for emergencies
– Find out if your provider has specialized training in perinatal mental health
The most important thing to remember, however, is that if you need help, options are out there.
If you are in crisis and thinking about suicide, PLEASE REACH OUT! You matter! Your life matters! You do not have to suffer in silence! Call for yourself or someone you care about; free and confidential; network of more than 140 crisis centers nationwide; available 24/7: National Suicide Prevention Hotline 1-800-273-8255.
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