Fluff free therapy.
10 months of treatment with the perinatal mental health team.
Yesterday I was discharged from the perinatal mental health team (PNMH), after 10 months of treatment.
It has been the best mental health experience I’ve ever encountered. A bold statement, right? I found it hugely reassuring, empowering and affirming. I’m in the most stable mental space I’ve been in for years - and I don’t say that flippantly.
Quick back story.
I’ve long experienced symptoms of depression and anxiety from my early 20s, maybe even earlier. I’ve previously battled the long NHS waiting lists for counselling and Cognitive Behavioural Therapy (CBT), and been all too quickly placated with antidepressants from the GP but nothing seemed to work and the same problems kept occurring. I’ve long had strong self awareness of how I feel, what triggers my negative emotions, and where these triggers come from, but I’ve never received the tools I needed to equip me with moving forwards.
Moving into my third trimester, I knew my own mind wasn’t as strong as it needed to be for birth and beyond, compounded by the events of last year making things extremely stressful. So I reached out to my community midwife to get help. Unlike previous times I’ve self-referred to my GPs, with the PNMH team I was properly listened to, had a lengthy assessment looking at the full 360* picture of my mental health and was asked what treatment I’d prefer. Absolutely game-changing, but frustratingly, should be the norm.
You can read about initially reaching out and getting a diagnosis of C-PTSD HERE. But what happened next?
What has my treatment looked like?
After my assessment, meeting with my Care Coordinator (CC) and receiving my diagnosis, I still had about 6-7 weeks of lead time before baby arrived into the world. Not wanting to dig too deep and make things worse, we initially focused on calming and grounding techniques to help settle my stress and help me build up that juicy oxytocin needed to get me through birth, with my CC at the end of the phone if I needed her. We also made a plan for after the baby arrived, using different therapies and treatments to support me and get my mental health to where it needed to be.
Compassion focused therapy (CFT)
When my daughter was just 2 weeks old, I started an 8-week course of CFT. It’s a form of psychotherapy which harnesses the power of compassion and self-compassion to regulate emotions and minimise spiralling self-criticism, boosting mental wellbeing. The course was delivered online, for an hour and a half at a time, with a mixture of skill teachings, skill practises and open discussions.
I’ll be honest, I initially dismissed this therapy as being too top level and “fluffy” for what I needed, expecting it to not scratch the surface. But I cannot stress enough the positive impact this therapy had. Not only did it help me accept previous trauma and those responsible, but give me permission to value caring for myself (soothe system) as a biological need - as important as having a purpose (drive system) and dealing with a fight/flight response (threat system). It’s helped me to challenge negative thoughts and self criticism before they spiral and to truly value any compassion received from others; something which I’ve long found difficult to accept. It’s helped me not only join the dots between incidents in my past and behaviours today, but given me the tools and confidence to move forwards and heal, breaking the cycles of self-sabotage and trauma.
This was my favourite therapy throughout my time with the PNMH team - the mixture of skills, sharing and hearing other peoples experiences in a low-key setting was perfect for me. Plenty of epiphanies and learnings which I have continued to work and improve on. The only downside would be the digital side of things getting in the way of genuine connections and supportive friends being made, but such is life in the times of COVID.
Video Interaction Guidance (VIG) therapy
Next, I was recommended to try VIG therapy. This style of therapy is widely used not just in mental health settings, but also in HR, parenting, and teaching. It focuses on what is already successful, only emphasising the positives and never the negatives.
A cycle of VIG involves being filmed interacting with my baby for about 6 minutes, then the therapist uses this recording to find proof of something I feel I’m struggling with. She’d then show me this proof in the form of video clips and still images, which we’d discuss. The struggles would be discussed beforehand, and “helping questions” were set, which the video would aim to answer, giving me the proof I need. Mine for example were “how am I soothing my baby?” and “how am I being present for my baby”.
Running alongside CFT, this was hugely powerful to me as it was giving me the validation I needed that I’m doing a good job, allowing me to be more compassionate with myself. Yes, it was super cringy and awkward to start with, but I didn’t expect it to be as impactful as it was, and actually got quite emotional seeing some of the footage. Being flagged as high-risk for postnatal depression, I was worried about bonding with my baby and being present for her while there was a lot of family stress and worry happening when she was born. VIG helped me feel a lot of pride for the bond we already had and helped me to stand tall with confidence in my new role of mum.
Emotional coping skills
Finally, I was referred for an Emotional Coping Skills workshop. This course was 8 weeks of live webinars looking more closely at emotional regulation. Each week was a different focus, starting with general mindfulness, working up to distress tolerance for difficult situations. Each session would include 2-3 mindfulness exercises giving opportunities to pause and practise some meditations or visualisations to help calm the nervous system.
This is the therapy I was looking forward to most as emotional regulation in stressful or challenging situations is something I can struggle with. Whilst I found the content of these workshops extremely helpful, I didn’t find the format was the best for me. I really missed the open discussions I experienced in CFT, hearing other people’s experiences and having opportunities to collectively reflect on how we were putting our learnings into action. Having said that, the tools I’ve learnt from this and the resources we’ve been sent have been incredibly impactful and will be regularly used components of my mental wellbeing toolbox.
Other support
The biggest difference between mental health support with the PNMH team and previous GP referrals is the breadth of extra support I’ve received. Not only have I had a wonderful CC to speak to, be a sole point of contact, a constant piece of stability throughout my treatment and a personal advocate, but I’ve have access to several other benefits:
Emergency support - I needed emergency professional reassurance on just 2 occasions. Once, I was stressed, overwhelmed, mental health on a cliff edge and the other time I’d just experienced a dog attack and didn’t want the trauma to affect me long-term. In both cases, I messaged my CC and the team who listened to me, sympathised, validated my worries, helped me make a plan to move forward and sent me resources. It was so reassuring knowing I had professional support just a phone call away.
Nursing - at about 17 weeks after my daughter was born, I decided to try expressing and was finding it difficult. I mentioned this to my CC and she arranged private support for me through the PNMH feeding specialist within less than 24 hours, something that could have taken days or weeks to receive through my GP or Health Worker.
Moving Mummas - This was a new weekly walking group, run by peer support workers who had first hand experience of mental health struggles during the perinatal stage. This was great to get out with the baby, meet other mums under the care of the PNMH team, meet other babies, and have a great non-judgemental chat. I found these so much more beneficial than any other mum and baby groups I’ve been a part of.
Journaling - The team also has an online journaling group. It’s not something I engaged in, but I love how much variety they have in extra forms of support and social activities.
Partner support - not only was my CC offering continuity of care for me, but also my husband. If he had anything he needed to speak about or was struggling with mentally, there was opportunity for him to get help too. The opinion was that in order for my mental health to be strong, his mental health needed to be strong to best support me.
The results?
I’m not going to lie, the thought of beginning therapy with a new baby as a first time mum was daunting, not to mention counter-intuitive to the societal view that mothers should always put their baby first, sacrifice everything and not take time for themselves. But it’s the best thing I could have done for me and my daughter. I’ve swerved postnatal depression despite being flagged as high risk, I’ve got a wonderfully strong bond with my baby, I’ve kept my head on my shoulders despite a lot of family worries remaining, I’ve got a thriving relationship with my husband and our communication is better than ever, and I’m being kinder to myself more than ever before.
Proof of just how much impact this has all had, at my initial assessments I was scoring 18/40 for the state of my mental wellbeing and 2.05/5 (low) on the compassion scale. At the point of discharge, I scored 0/40 and 4.75/5 (high). I’m so proud of all of the work I’ve put in and getting to this point. *high five*
Looking forwards, I’m confident I’ll handle any future wobbles that come my way. I’ve got a library of self care tools and systems to use and a comprehensive discharge traffic light plan - both things I’ve never received before.
Reflecting on the amazing and thorough care I’ve received, I feel extremely grateful to have had access to this and it’s all happened so quickly. I can’t help but feel ALL mental health support should be like this, for anyone struggling and not a special level of care only reserved for new mums. We can dream.