Pre- and perinatal psychology grows in interest, need



Deborah Issokson, Psy.D. works with women and families, from conception to birth. Her offices are located in Wellesley and Pembroke, Mass. (photo by Tom Croke)

By Jennifer Chase Esposito

Conception. Life in the womb. Nursery decorating. Birth. Breastfeeding. Bonding. Pregnancy is in fact a miracle and for 50 years, popular culture has painted a picture of those nine months as filled with nothing but an expecting mother's dewy face, her penchant for pickles and ice cream and the gleeful chime of "... but I'm eating for two!"

But that's hardly every new mother's reality. And as a result, there's increased attention toward mothers suffering birth trauma, the rejection of difficult breastfeeding and the day baby goes home without a how-to manual. Pre- and perinatal psychologists and specialists in the growing field of infant mental health are at the ready to help treat mothers, families and their newborns as they navigate the world together. They also provide support to families mourning the loss of a child, their decision to abort or their inability to conceive.

The prefixes of these similar-sounding specialties differentiate them. Prenatal psychology is the psychological care provided to a woman before and during the birth of her child; perinatal is during and after childbirth. Infant mental health specialists work with nonverbal children.

"A lot of people don't know what pre- and perinatal means," says Deborah Issokson, Psy.D. "I tell people I deal with reproductive mental health issues. Sometimes they don't know what that means either. Sometimes I say I work with women and families, from conception to birth."

A common thread among these psychologists, says Issokson, is a longstanding love of babies and a hope to start families off on the right foot. A common thread between the two disciplines is that both view the pre- and perinatal experiences as crucial to the child's development. But according to Issokson, who has private offices in Wellesley and Pembroke, Mass., pre- and perinatal experiences are of equally high importance to the mother.

"A lot of people don't know that the reproductive time is a developmental time," says Issokson. "Being a parent is a huge developmental shift for adults. And all developmental shifts require self-reflection."

Most of Issokson's clients present with anxiety about getting pregnant, being pregnant, giving birth or loss. Much of the anxiety that prenatal psychologists see results from women believing there's a way they're supposed to be feeling or things they're supposed to be doing.

Claudia Yellin, Ph.D., is one of the founding members and first president of the Rhode Island Association for Infant Mental Health, a professional organization for people working with young children and families. Yellin has a general practice with a particular expertise in young children ages two to five.

"It's a fairly new field," she says. To that end, Yellin teaches at the Infant Parent Training Institute which is a program of the Center for Early Relationship Support at Jewish Family and Children's Services in Waltham, Mass. She is also on the board of the Boston Institute for Development of Infants and Parents in addition to her Rhode Island work and feels that this networking is a good way to meet and collaborate with colleagues about her focus on infant mental health.

"One of the key principles of infant mental health is that the patient is the parent-infant relationship, not the parent or infant alone," says Yellin. She works with young children and parents together, observing how they interact and helping them to relate in more positive and healthy ways.

"In a healthy parent-infant relationship, there is a look that the two have for one another that is so special and unique," Yellin says. Early in her career, Yellin became curious about that look and discovered that the gaze between infant and parent has been the focus of much study. It's the "why" behind that look that propelled Yellin toward her specialty - that and the benefits her profession has on older kids.

"I can see the impact of early relationships [as I'm] working with adolescents and adults," she says. Which reinforces her message to anyone on the fence about seeking help for their child presenting with the behavioral and anxiety issues Yellin treats regularly: "It's never too early to bring them in."

In these disciplines, the United States has a lot of catching up to do with Europe. "In our country, there's still such a split [between] physical health and mental health," says Issokson. Closer to home, the East coast has ground to make up behind its West coast cousin, as pre- and perinatal psychologists are a hard find in these parts. A referral search offered by the American Psychological Association provided only one name of a Massachusetts prenatal psychologist. And if you Google search the specialty, the majority of practitioners and the location for the 26-year-old Association for Pre- and Perinatal Psychology and Health - are on the West coast.

This situation isn't surprising to California licensed clinical psychologist Lara Honos-Webb, Ph.D., who along with teaching at Santa Clara University and writing books on ADHD and depression, also has a clinical practice where her clients include new mothers.

"Especially in the area of pre- and perinatal psychology, on the West coast I think there's much more attention to it and concern," says Honos-Webb. "I have lived, worked and been a parent on the East coast and West coast and you can't go anywhere here without seeing a nurture center," or another mother-child-related organization.

Additionally, Honos-Webb says that the attachment theory is much stronger on the West coast. "The emphasis on attachment and the value [placed on it by the parent] ... therapists will see it much more in clients."

Honos-Webb's latest book, "Listening to Depression: How Understanding Your Pain Can Heal Your Life," will be a relevant read for anyone experiencing depression but will be of particular interest to new mothers experiencing postpartum depression.

The book's main theme is that depression is a wake-up call to write new rules for yourself, and to break out of your comfort zone. "Many moms experience postpartum depression because they know their old way of living will no longer work," says Honos-Webb, who is also a mother of two. "It may be that the values of pre-baby are no longer appropriate for life after baby, it may be that they fall in love with their baby so much they can't go back to the life they used to live. It may be that the mom realizes she doesn't fit the mold of what a mom is supposed to be - she wants to go back to work, she wants to stay in control of her life more than culture says is okay.

"It's no wonder some new moms get depressed," she adds: "In some cases, the mom may need to grieve a former lifestyle and let go of it."

Adult women who have presented with anxiety or depression before getting pregnant are often more likely to experience postpartum depression. So pre- and perinatal psychologists agree that the earlier in a pregnancy that psychological services are sought, the better; especially if an expecting mother has suffered from mental illness during non-pregnant times of her life.

\"I think a lot of people don't seek help until it's postpartum depression," says Issokson. "I don't think it's popular, yet, to say 'I'm struggling.' The only standing ritual [of pregnancy] is that new mothers go to birthing class. One of my fantasies is to see routine screening as part of prenatal care with collaboration with prenatal care providers."

Services are, in fact, available in New England. Rhode Island houses the Postpartum Disorders Day Hospital at Women & Infants Hospital, the country's only day hospital for women who experience postpartum depression. Margaret Howard, Ph.D., is the director. Though that in itself is unique (most programs are inpatient), the day hospital runs as a mother-based program.

"The United States has lagged behind Great Britain and other developed European nations in recognizing perinatal mood disorders" such as anxiety and postpartum depression, says Howard. "So those countries for decades have had mother-based units in place. All of our postpartum mothers bring their babies to the program," she says. "We felt it was very important to keep the family together."

Open since 2000 Howard says the day hospital offers a better scenario for keeping real-time tabs on treatment. For example, if Monday's task of a mother of two is reading a book to her three-year-old at night while still caring for the newborn, progress can be followed up the next day.

Most of the center's patients are New Englanders. The center has also been the focus of models for more centers like it in different cities. To date, it still remains the only day hospital of its kind.

Pre- and perinatal psychology grows in interest, need (December 2006 Issue)

Pre- and perinatal psychology grows in
interest, need
(December 2006 Issue)