The Human in the Helper: I felt better pregnant than any other time in my adult life

Emily is passionate about mental health, Medicaid practices, and her pre-teen daughter. She serves as a consultant to therapy practices taking Medicaid and to folks wanting to build quality substance treatment programs that meet community needs. Although she’s feeling strong mentally and physically these days, she’s suffered from depression on and off in adulthood since college. Then Emily got pregnant and stopped her antidepressant. “It wasn’t contraindicated, but I wanted to be extra cautious.”

Although her pregnancy was labeled geriatric because of her age, Emily reported she felt her healthiest while pregnant, both physically and mentally. She remembers wanting to go with the flow regarding labor and delivery, which was the plan until her daughter decided to come 10 days late. At that point, her doctors scheduled an induction that she felt catapulted her into some postpartum depression and anxiety symptoms. “I remember questioning if I should have had a child. They kept us at the hospital for a few days because my daughter had jaundice. I struggled to breastfeed.”

Emily isn’t the only woman to notice a dramatic shift in mood based on the hormonal changes of postpartum. Because of her history with depression, she felt like she knew more what to look for, even if it took her awhile to seek support. “I didn’t have a therapist or medication provider at the time. That could have made my timeline to getting help look different,” she reflected. Emily noticed depression, anxiety, and being quick to cry as some symptoms that things weren’t right. “I was quick to cry and I’m not a crier.” Amidst balancing being a new mom, she shifted jobs postpartum as well. Unfortunately, her symptoms got worse before they got better.

“My relationship was impacted by my mood.” She realized things weren’t sustainable as they were, even with a schedule change, which resulted in separating from her daughter’s father. “I know now we weren’t compatible.” At the time of the separation, Emily was hard on herself, adding the relationship end to her list of things she didn’t feel she was doing well. Then she got the support she needed to regulate her hormones again.

In the present, Emily holds a lot of compassion for colleagues who are trying to balance work with being a new parent. “All these things that we think we are prepared for, we’re not. Be forgiving of yourself.” She encourages new parents to go with the flow, while also recognizing how hard this is when caring for an infant. Adjusting and embracing parenthood isn’t a perfect science, but Emily wants people to feel hopeful that things will get better. If colleagues find themselves getting stuck in the “shoulds” of parenting or work-life demands, Emily suggests channeling our inner therapists for some added gentleness towards ourselves. “Think of things you would work on with your client. Notice what you would say to them and say those things to yourself.”

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about the Human in the Helper Series!

Supporting Self-Esteem: Tools to Identify Strengths

“I don’t know what to say. I was raised not to talk about myself. I don’t want to sound cocky.” You are engaging your client in an intake session where you’ve created an intentional, positive shift from an otherwise heavy series of questions about symptoms including details as to why they are seeking therapy. Your new client appears caught off guard by your questions about strengths and they struggle to identify anything that is going well, or things they like about themselves. You make a note to identify a possible goal around self-worth and self-esteem, to be explored with the client upon building more rapport.

So how does one engage a client in exploring their strengths while acknowledging the vulnerability to do so? For many, talking about elements they like about themselves or their resiliency may be difficult when entrenched in negative emotions.  For example, a client experiencing a depressive episode may have a hard time identifying any emotions of hope or former pleasure based on their current negative cognitions around hopelessness and feeling stuck.

Look to the Past

For depression and being entrenched in symptoms, it can be easier for a client to recall the events or strengths of the past than experience the present or predict the future. By engaging a client in exploring what would formerly describe their circumstance, you can encourage the initial stages of cognitive reframing and thus rewiring from negative to positive thought. Some examples of questions to support access to the past can be found below.

• Is there a time you felt confident? Can you tell me more about that?
• When is a time you felt like everything was going well? What made it so?
• Wisdom, Sacrifice, Kindness. Can you share a time you demonstrated each of these strengths?
• What is one thing you are happy or satisfied with in your life?
• What is one thing you like about yourself?

Engaging a client in reflection on these elements can support new awareness and positive feeling through revisiting pleasant memories. By exploring former experiences, the client may be able to identify ways to rediscover those experiences in the present.

Likeable and Lovable

If a client continues to struggle with identifying their strengths, it can be helpful to engage them on the thoughts and statements of others that know them well.  You may find asking them what their mother, sister, friend, partner, or close colleague would say about them if those relationships are healthy. Here are some ways you could explore self-image through the eyes of others:

• What would your mom say is one of your strengths?
• What compliments have you received from others about your efforts at work?
• How would you be described by your best friend?
• What do you think your partner appreciates most about you?
• If you were represented by an actor for a movie, who would that be and why?

By encouraging the client to explore loved one’s statements or compliments as a reflection of their own strengths, it may remove some pressure to identify them on their own while still encouraging positive thought and reflection.

Sort and Seek

A reflection tool that can further encourage exploration of strengths and thus improve self-esteem is a value sort. A value sort instructs clients to review a list of values and narrow down their choices based on order of importance. This can allow clients to explore their values and make connections to how those values are being represented in their life. A favorite tool is the value card sort, currently being used by mental health professionals and some universities. In the value card sort, a stack of values is sorted into levels of importance including minimal, moderate, and most important. Client are instructed to go with their gut and sort quickly, supporting a narrowing of values to the top seven most important to the client. Reflection can then be encouraged by asking the client the following questions:

• How are these seven values represented in your life currently?
• How are these values represented in work, home, and relationships?
• What needs to be changed or improved to maintain these values for you?
• How would enhancing or improving these values in your life help you?

For many, exploring their values and current representation in their life can support a movement towards measurable goals to improve those values, thus improving sense of control, pursuit of happiness, and higher self-esteem.