We now join Anne Marie McKinley (a Midwife and Birth Trauma Specialist at Afterthoughts NI) for the final part of this sub-series and take a look at various trauma therapies available to both mums and dads.
Which Therapeutic Approach?
When either parent attend counselling in pregnancy, or post birth, several pathways may open up. If a woman is searching for a therapist herself, there are a number of things that may not be immediately obvious.
Therapy or counselling is often known to first time seekers through TV or film representations of how therapy works, or through reports from friends and family. Entering the perinatal timescale may also be the only space in the next number of years where parents can freely allocate time to heal old emotional wounds, deal with anxiety or depression, and come to terms with the journey of birth which may, for them, have been less than they had hoped and dreamed. It can be hard to prioritise self-care later on when there are little ones around your feet.
When it comes to the choice of type of therapy, a great deal will depend both on the main reason for requesting care and who is doing the referral. NICE guidelines provide guidance for therapists and those seeking care. 1 Many women are recommended to have counselling, due to anxiety or depression, either during pregnancy or in the postnatal period whilst others have prior diagnoses of mental health conditions. In terms of suffering a trauma response in the perinatal mental health pathway, access to services will vary greatly from area to area. Private care will look different to NHS. Waiting lists might be longer for NHS clients but there may be access to more sessions with your counsellor after an initial period of therapy.
Most GP referrals will go through a central assessment unit and are then allocated to a Cognitive Behavioural Therapist. Some GP’s have their own therapists. Another possibility, is being referred to a counselling centre which has a variety of therapeutic approaches, amongst a number of available therapists.
It is my experience that most women, who attend me for trauma counselling post birth, have never considered or needed therapy. They may feel unsure of what to expect, what is expected from them, and what this chosen pathway might look like. The following provides an outline only, of three main approaches:
1. Person-Centred Therapy
Person-centred therapy uses a non-authoritative approach that allows clients to take more of a lead in discussions so that, in the process, they will discover their own solutions. The therapist acts as a compassionate facilitator, listening without judgement, and acknowledging the client’s experience without moving the conversation in another direction. The therapist is there to encourage and support the client, and to guide the therapeutic process without interrupting or interfering with the client’s process of self-discovery. 2
Psychologist, Carl Rogers, was not prescriptive in telling his clients what to do but believed that the answers to the client’s questions were within the client and not the therapist. Accordingly, the role of the therapist was to create a facilitative, empathic environment wherein the client could discover the answers for him or herself. 3
2. Cognitive Behavioural Therapy
CBT is based on the concept that negative thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. The person is then shown how to change these negative patterns to improve the way they feel. This is unlike some other talking treatments. 4
CBT is based on the belief that thought distortions and maladaptive behaviours play a role in the development and maintenance of psychological disorders, and that symptoms and associated distress can be reduced by teaching new information-processing skills and coping mechanisms. 5
3. Eye Movement Desensitisation and Reprocessing
EMDR is a ‘reprocessing therapy’ which integrates old memories with the here and now. EMDR is a therapy for the entire spectrum of trauma. It can clear or reprocess single traumas – for example, a car crash or birth trauma – in a few sessions. EMDR can also work with complex trauma (cPTSD) and smaller traumas, working with core beliefs. It includes elements of mindfulness, somatic awareness, exposure and cognitive therapies.
EMDR is a powerful associative and integrative technique that uses visual, cognitive, and sensory cues to process old and new trauma memories. Part of this process is an alternation between therapist and client parts in the process which create healing dialogue in which the client plays a pivotal role. (Shapiro, 2010) Robin Shapiro offers 17 therapies for trauma and complex trauma. 6
The Two Main Types of Therapy, Psychology and Psychotherapy
Psychology is the scientific study of the human mind and its functions, especially those affecting behaviour in a given context. A person who studies in this way is identified as a Psychologist.
Psychotherapy is the treatment of mental disorder by psychological rather than medical means. A person who studies in this way is identified as a Psychotherapist.
The two disciplines tend to work separately within the NHS and Mental Health Teams. Counsellors or Therapists will also refer to themselves as Psychotherapists and here are some key points about psychotherapists:
- They help people with emotional/psychological concerns using talking therapies.
- Psychotherapists may work within a team of other medical professionals.
- They can choose to specialise in certain therapies, such as cognitive behavioural therapy.
- Depending on their training, they can work with individuals, groups, families or couples. 7
BACP provide a lovely concise A-Z summary of other types of therapeutic approaches. 8
All that these summaries do…
is give you an idea of the way you want to work in sessions. Books are written about all of them and training to be competent in any, take’s years of experience and study. Combining these things with a description found on counselling organisation websites, or recommendations from others will help. If you can afford private care, it certainly gives you more choice.
You are not obliged to stay in counselling even after you have begun; it matters that you connect with your therapist. If you have trauma symptoms which you attribute to a birth experience it is important that you are able to ask for trauma care to suit your needs. Few therapists will define themselves as trauma therapists; all the same, they should know if they are equipped to work with you. Some therapists may use EMDR or Rewind Technique alongside other therapeutic pathways. Ask.
Principally I use a Rewind Technique as a tool to alleviate the symptoms of birth trauma. I have been doing this for almost 9 years. My experiences with rewind are set in a more comprehensive counselling approach. While I have a great deal of experience in using rewind, I also recognise its limitations. The next 2 contributions will consider these perspectives. I plan to provide information on both the positive aspects of this care and balance this in a second part with a more cautionary note.
- Supporting women and their partners, families and carers – 1.3 Principles of care in pregnancy and the postnatal period (Antenatal and postnatal mental health: clinical management and service guidance)
- Person-Centered Therapy (Psychology Today)
- Person-centered therapy (Wikipedia)
- Cognitive behavioural therapy (CBT) Overview (NHS)
- Cognitive behavioral therapy (Wikipedia)
- Shapiro, R. 2010, The Trauma Treatment Handbook: Protocols Across the Spectrum. W.W. Norton and Company, New York-London
- Types of mental health professionals (Counselling Directory)
- Types of therapy – An A-Z of therapeutic approaches (BACP)
A growing list of other support, weekly…
- NHS Apps Library: Find digital tools to help you manage and improve your health
- Self-help tools (Relate)
Part 8 → Coming Soon