Motherfectionism

Motherfectionism:  the cultural and intrapsychic insistence that mothers be perfect vessels of love and nurturance; responsible for, and in control of, all aspects of her child’s behavior and outcome.  

OK, so I made up my own word.  But it’s probably about time because it describes a process mothers often experience, and that I am witness to in my private practice and personal life. There are more examples of motherfectionism than I can count because women still bear the lion’s share of the emotional, logistic, and physical labor of parenting. And any form of perfectionism is first and foremost a coping strategy. 

Why am I framing the challenges of motherhood through this lens? Because I believe that our role as women’s mental health psychologists is to consciously not reinforce perfectionistic, unrealistic standards for mothers.  Indeed, there is a whole parenting advice industry that serves to replicate these standards, replete with two minute TikToks of confident, easy wins with our kids. I can’t tell you how many therapy sessions I have shared with mothers who feel confusion and shame in their parenting in the reflective glare of TikTok advice.

I believe our role as women’s mental health psychologists is to acknowledge the complexity of parenting,  and to shore up resilience within our female clientele for the emotional and pragmatic complexities - and labor - of motherhood. While we can offer parenting advice if needed, our job is to support you with all the flexibility and creativity that parenting requires.  Just like we do with every other important area in your life.

Shining a Light on Perinatal Mood and Anxiety Disorders

As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones. 

Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs). 

What are PMADs? 

PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis. 

According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies. 

Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).

In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.

Additional PMADs symptoms to be aware of include

• Feeling sad or depressed

• Irritability or increased anger

• Difficulty bonding with your baby 

• Feeling high or elated above and beyond what is typical 

• Reduced need/desire for sleep 

• Anxiety of feeling panicky

• Upsetting thoughts that you can’t get out of your mind

• Feeling as if you are “out of control” or  “going crazy”

• Feeling like you should never have become a parent

• Worries that you might hurt your baby or yourself

Treating PMADs

As many women feel shame, struggle to ask for help, minimize their symptoms, are fearful that they will lose their babies, or have limited support and awareness of PMADs, they often suffer their symptoms in silence. Fortunately for those affected, with proper intervention, PMADs are in fact highly treatable and have a favorable prognosis, often with a combination of medication management and psychotherapy.

Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy treatment for PMADs, as it empowers sufferers to work in the “here and now” - as opposed to focusing on family of origin dynamics that are likely not helpful to the crisis at hand - to experience symptom relief.   CBT works with the interplay of a patient’s mood, thoughts, and actions, to provide a patient with alternative perspectives and experiences of her situation, healthy practices that can support her mood, as well as providing immediate coping strategies to the patient.  

At CTWPS, the specialized training our practitioners have into the specific challenges of women with PMADs makes us uniquely qualified to work with affected individuals. We strive to not only provide our patients with effective symptom reduction strategies, but also to normalize, educate, decrease shame, and improve their quality of life. If you, or someone you know, may be experiencing a PMAD, we at CTWPS are here to help and provide support. Reach out today!

References

https://www.today.com/parents/family/mom-dies-suicide-twins-rcna88579

https://www.postpartum.net/learn-more/

Our Boys

My son, a freshman at a large university in the midwest, called me early this week to share the tragic news that a friend of his had died by suicide while on campus.  I write this post still struggling with grief for my son’s friend, his family, my son, their community, and for the many young men struggling with their mental health in seeming isolation. My son was profoundly shocked by his friend’s suicide, and saw no warning signs, no signs of distress, no drug or alcohol use, or any form of self-harm by his friend. He is unable to wrap his mind fully around this, nor am I, even as a psychologist and therapist.  What I often believe about suicide is that the suicidal person is in a profoundly altered state.  But of course, I can’t really know that to be true.

While we all have heard the statistics on the mental health crisis facing young people, it is important to acknowledge that young men sadly are more apt to commit suicide than young women, perhaps partially because they typically  use more aggressive means to do so. Per the CDC, men die by suicide nearly 4 times more than women. While the mental health of young men and women is deeply concerning, young women may be better at expressing their high risk ideation and seeking help as compared to young men. 

I mourn the seeming mental isolation of my son’s friend, but also the many young men in the world who may not be able to find a way to share their suffering with others.  I write this not to provide a psychoeducation on suicidality, but to encourage us all to reach out and connect more to the people that matter in our lives.  To talk more, to open up all sorts of conversations - especially with our boys and young men.  The conversations don’t have to be serious, psychological, or profound, I think it’s ok to start with the silly, the mundane, the playful.  

But however it is that we connect, are we willing to connect some more?

The CTWPS Commitment to Women*: Talking about hormones, periods and the full female experience

The CTWPS practice has always been dedicated to addressing the specific mental health needs of women. Our clinicians are passionate about the need for increased understanding of, and compassion for the particular biological, psychological and socio-cultural experiences of women. In our psychotherapy work, we often support women in developing greater insight around the ways in which their womanhood impacts their thoughts, feelings and behavior on a daily basis; and ultimately, how aspects of their womanhood influences their mental health. 

Given my exposure to many women at many different stages of life (e.g. perinatally, postpartum, premenopausal, menopausal) ,over the years, I have developed a wealth of clinical experience that continuously reinforces my belief that there can be close ties between a woman’s reproductive cycle and her mental state. This is not to say that every woman experiences the same fluctuations in mood and mental state at similar points in the reproductive cycle; but simply, each woman responds to the rise and fall of estrogen and progesterone in her body at different points throughout her cycle, to differing degrees, in different ways. Furthermore, the multitude of changes I have observed and tracked with my patients over time are not limited only to the days leading up one’s menstrual period, as popular culture’s interpretation of “PMS” might suggest. A woman’s body, mind and mood is truly influenced by fluctuating hormones throughout the full reproductive cycle - all month long, month after month. Notably and thankfully, these hormonal fluctuations do not always have a negative impact on life! In fact, some women report feeling energized, experiencing greater clarity of thought, and having increased libido at certain points of their cycle. 

Just as I have become more convinced of how tightly woven reproductive hormones are in women’s daily lives, I have also become increasingly aware of how infrequently this topic is brought into the therapy room. As normal as it is, menstruation is, and always has been, stigmatized around the world. Historically, menarche and menstruation has symbolized religious impurity and contamination, been linked to witchcraft and evil, and been blamed as the cause of hysteria, disease and disorder. Unfortunately, to this day, playful words, disparaging metaphors and misogynistic themes persist when describing menstruation, (if it is mentioned at all). These tendencies undoubtedly perpetuate the embarrassment, shame and discomfort many women continue to feel about their body and its functions.

Thus, I and my colleagues at CTWPS make it our business to (gently!) inquire about the menstrual cycle with each of our female clients. We encourage exploration of how each woman experiences her cycle, and actively support the destigmatization of these topics. We help women track and assess changes in their mental state, mood and functioning alongside their monthly cycle, in order to better understand when interventions might be most beneficial to alleviate the negative impact of reproductive hormones. We assist women in developing (and following through with) plans for making lifestyle changes and/or medication changes to address difficulties they experience at different points in their cycle. And of course, we continuously educate our clients (male and female alike!), about the role of reproductive hormones in women’s lives, to encourage increased awareness, understanding and compassion for the full range of female experience.

As a female-focused psychotherapy practice, CTWPS is committed to honoring all that it means to be a woman in today’s world. If you or anyone you know would benefit from our expertise treating menstrually-related mood disorders (e.g. PMS, PMDD, Perimenopausal Depression) or mood disorders that tend to be exacerbated by hormonal fluctuations (e.g. depression, anxiety, OCD, and insomnia for example), please reach out to schedule a consultation. 

* A note about inclusivity: The aforementioned writing uses terms such as “woman” and “female” to reference individuals whose biological sex assigned at birth is female, and who possess female reproductive organs. We acknowledge that some cisgender women don’t have periods due to menopause, stress, disease or a hysterectomy. They may have never started menstruating due to a variety of medical conditions or they may be transgender or intersex. We also acknowledge there are people who menstruate who aren’t cisgender women. They might be trans men, intersex, genderqueer or nonbinary.

Mastering Mothering: How Do We Know We Are Doing It Right?

Nearly all of the women we see at CTWPS have certain traits in common: they are smart, capable, curious and ambitious. So it follows that words like success, achievement, and mastery are frequently spoken in my office; and concepts of motivation, expectations and perfectionism are also often explored. Certainly, when topics of work and career are the primary focus, these are the types of conversations one might expect to hear in a therapy session. However, you might be surprised to learn how often these same concepts are explored when parenting is the topic at hand. 

Let’s be clear: most mothers are committed to raising happy and healthy children - first and foremost - and our patients at CTWPS also reflect this prioritization and selflessness. Yet the intensity of mothering today can understandably push some women to the emotional edge. How exactly does this happen? 

In her 1998 book “The Cultural Contradictions of Motherhood,” sociologist Sharon Hays described the ‘intensive parenting’ style that had predominated throughout the last decade as “child-centered, expert-guided, emotionally absorbing, labor intensive and financially expensive.” In short, intensive parenting is draining. And though proponents of ‘free range parenting’ have made valiant efforts to swim against this current in recent years, arguably, the trend toward intensive parenting has only gained momentum in the intervening 20 years. 

At the crux of this style is the idea that one can “succeed” at mothering. This presupposes there is a very specific outcome by which we might be measured - an outcome that might ultimately determine our success - and thereby ensure the consistent health and happiness of our children. This faulty belief lends itself to the pursuit of unrealistically high expectations and unrelenting standards for oneself as a mother. These standards extend well beyond providing physical safety and security, love, and guidance. Worse still, this high pressure, high intensity drive to “achieve” at mothering is further complicated by the stress of performance anxiety. In many middle- and upper-class neighborhoods across America, motherhood has taken on a performative quality in recent years - quite literally, in the case of social media. Today, many mothers suffer from not only self-imposed pressures of ‘intensive parenting,’ but also the performance anxiety that comes with feeling as if they have an audience of peers.   

So what is this proof of success - this imaginary finish line of mothering? Is it that we raised a human that is accepted into and welcomed by society? And if so, is this determined at age 5, 10, 20 or 40? Or are we hoping to raise a human who is so well developed and protected that they will never suffer at the hands of life, love, or even fate?

Each of these questions points to the absurd futility of any effort to fully “master” mothering. Yet, most of us seem unconsciously driven by the desire to guarantee these specific parenting outcomes, no matter how exhausting and debilitating this drive toward unrealistic and unrelenting standards truly is. (Unrealistic and unrelenting standards happen to be key features of maladaptive perfectionism, by the way.) We may be able to influence these outcomes - i.e. how our children turn out - but we will certainly never be able to guarantee nor control the end results. Why? For the simple fact that a child is a separate being with her own thoughts, wishes, and desires who will eventually grow into a fully individuated adult. This lack of certainty is often extremely troubling to the hard-working mothers I see in my office. Ambiguity is often intolerable, and unpredictability is often unbearable; uncertainty is always uncomfortable when it comes to our kids.

As a psychologist, there is nothing I can say or do to change these undeniable facts of life for a woman who sits across from me, suffering with the exhaustion, self-doubt or resentment brought on by the requirements of hyper-intensive mothering. However, I can help her acknowledge these truisms of life, acknowledge her role in aspiring to unrealistic and unrelenting standards, and acknowledge the value of adopting a healthier, adaptive approach to her mothering. I often work with mothers to re-frame their perspective on mothering from something they are hoping to accomplish, achieve and succeed at, to instead view mothering as an evolving process - importantly, one with no clear finish line, no clear “proof” of success. With this view in mind, the performance anxiety of motherhood decreases substantially, and the enjoyment of the process can increase exponentially. All the wasted energy thrown at mastering the unmasterable can be conserved, and instead, put toward building one’s stamina for the life-long journey - the process of mothering - that lies ahead. 

If you or someone you know might benefit from support navigating the journey that is motherhood, please reach out to one of our clinicians at CTWPS for expert guidance to help you along your way.

Motherhood During COVID-19

At CTWPS we specialize in working with a diverse group of women, and have witnessed that mothering as a COVID Mom is a particularly unique challenge. At this point there are countless think pieces and memes about the experience of parenting during the pandemic. The prevailing themes we see in media are of overstretched, barely-hanging-on mothers who have taken on a new level of responsibility and stress during this time. In this post I will review some of the typical stressors faced by Covid Moms in different stages of child-rearing, the cognitive distortions that we see manifest, and the coping strategies we help our clients employ to tackle Covid parenting effectively. 

The childbirth experience.

For those new mothers who had the unique challenge of delivering a baby during the pandemic, one challenge we see is the difficulty of coping with unmet expectations. A client may have held certain hopes or expectations of how her childbirth experience would go - in some cases spending months pre-Covid planning for it - but then had things go very differently due to the pandemic. Covid Moms have delivered without a partner present, labored in a surgical mask, and been restricted to few or no hospital visitors. To help these mothers process their experiences, we first want to validate and explore the impact of these unexpected events on her emotional state. We also work to incorporate them into her broader narrative of herself, her baby, and her motherhood. A distortion we might see here is that of mental filters, in which one component of an experience colors the whole thing. A woman may have the thought: “My childbirth experience, and my first months of being a mother, have been destroyed by the pandemic. I’m not able to have any of the special early moments of sharing my baby with others than I hoped to have.” With this woman, we would validate the kernel of truth at the center of her thought, which is that things are indeed different than expected, and that can be very upsetting. We would also challenge her to identify how a ‘mental filters’ distortion may be hindering her from enjoying the aspects of her baby’s early months that have been as expected, or maybe even better than planned. Our goal is to balance the unexpected with a healthy focus on mindfulness for the rest of the picture.

Toddlers and preschool kids.

For mothers of children in this age range, a big challenge has been the sense of responsibility for keeping kids occupied and stimulated while social distancing. Mothers may have worries about social development, the experience of having a young child masked, and how changes to childcare and routine may impact her child in the future. A common distortion we see with these mothers is that of fortune telling, in which one predicts a specific outcome, and emotionally responds as if that outcome is inevitable. In this case, a woman may have the thought: “My three-year-old is going to be totally messed up by this pandemic. He’s missed precious socialization experiences, and he is going to be permanently scarred by that.” With this client we would point out the assumption of inevitability in her thinking style, and challenge her to balance that with other possibilities. For example, it is also possible that kids will bounce back, that her child benefits from the extra time at home with family, and that as all kids are going through this, her child will be no more adversely affected than any other child his age. We play with these possibilities not to try to predict the future - just the opposite: to demonstrate that we can only predict so much. With moms struggling with fortune telling distortions, we would point out the emotional costs of fortune telling, and focus our energy on bringing her back to the present and what is within her control right now.

Kids in school.

Oh, the dreaded Zoom. While stimulation and socialization concerns also exist in mothers of school aged children, a distinct challenge for mothers of kids in this age group is how to manage remote schooling. The massive time demand of organizing, motivating, and focusing one’s child to engage in remote schooling requires a great deal of emotional energy from parents. Often things don’t go exactly as planned, a big challenge particularly as parents simultaneously juggle other children and their own job responsibilities. With these clients, the distortion of shoulds thinking is often present. Shoulds thinking occurs when one puts unreasonable pressure and demands on oneself to act and feel a certain way, without wiggle room. The outcome of a ‘shoulds distortion’ is the feeling of failure. A mother with a child in school during the pandemic may have the thought: “I should be better about managing my daughter’s schoolwork. She gets bored and frustrated and it’s my job to keep her motivated and focused. I’m failing her and failing as a parent.” In therapy we would examine the ‘shoulds thinking’ at play and begin to generate alternative narratives about the situation that are more in line with reality; for example, “I’m expecting myself to take on the full time job of schooling my child, on top of other responsibilities I have, and expecting it to go perfectly.” We would challenge this client to be more flexible in her expectations and standards for herself. Rather than going to distortions of failure, we would work toward helping her acknowledge that an imperfect, emergency set-up in the midst of a pandemic is not going to go smoothly all the time, and that this does not mean something terrible about herself or her child.

Never has the airplane safety measure of “put your own oxygen mask on first” been more critical. The instinct to do everything to ensure “business as usual” for one’s children is completely understandable; however, in many cases it is not sustainable, and mom ends up paying the emotional price. It is always true that mom’s oxygen mask needs to be on in order to most effectively support her kids, but during this year it is that much more important. Cognitive distortions at play in pandemic parenting only serve to deplete us and wastes our precious emotional energy.

If you find that one of the descriptors above fits your experience this year and you are seeking support, we encourage you to reach out. We at CTWPS are here to help you develop the skills and effective coping strategies to guide you through this unprecedented time.