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Dear Therapist,
I have a close friend who has been suffering from post-partum depression for over a year now. She has seen many therapists, which at first seem to provide a beacon of hope but eventually at some point she feels betrayed and ends the relationship. She has tried a variety of medications which have all backfired to the point of hospitalization and major suicidal thoughts. All authorities on the issue stress the importance of a support network. However she has one by one alienated her friends by confronting them and they have had enough. Her family doesn't know how to handle her and she feels that her husband can't be the one to save her. She and I have been unsuccessful in locating a support group and I have run out of ideas.
It seems as if nothing is working and there is no extensive network out there for a women suffering as she is. There are people in her life that are willing to do whatever it takes but they are at a loss. I reach out to this community for help and advice. What is there to do for this frum woman who once was a shining light and inspiration to all?
A Friend
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Dear Friend,
It's always challenging to watch a good friend go through a hard time; it sounds like a lot has been tried and that some interventions have even made things worse for your friend.
It is very hard to comment on this situation without knowing more about what you mean when you say that your friend has alienated everyone by "confronting them". You also mention that she seems to start out each therapy or treatment feeling hopeful, only to end the relationship when she becomes disillusioned. It is therefore hard for me to tell whether your friend is having a chemically-based depressive episode, an adjustment problem to having had the baby, or symptoms of a personality disorder (dysfunctional ways of relating to other people and her own feelings which are part of her overall personality- and yes, this can be treated in many cases!) that did not become evident until she gave birth.
For example, your friend may have appeared to be fine as long as people were taking care of her and she did not have to be in the position of taking care of someone else- like a baby. Or, she may have always been very good at managing everything and suddenly found that she couldn't handle everything on her own anymore- in which case, asking for help and seeking treatment may have felt like signs of weakness and actually exacerbated her distress.
It is also common for mothers who did not receive good parenting themselves to suddenly find themselves with feelings that are confusing and overwhelming to them when they are in the position of caring for a young and helpless child. Other mothers of young children feel angry about the demands of parenting but are too scared to acknowledge such feelings, leading to a lot of anxiety which can sometimes result in shutting down into a depression.
So, my best advice to you would be to encourage your friend to continue looking for the right treatment, until she finds the one that seems to address the right issue. If she has a pervasive pattern of alienating others, then I would recommend that she see a therapist who can discuss with her from the outset how the two of them will deal with it when she inevitably starts to alienate the therapist (push the therapist away) or becomes disillusioned with the therapy. In a successful treatment, there will be some kind of agreement ahead of time about how to weather those kinds of storms in the therapy- for example, that she will keep attending sessions for a period of time even when she feels it is not helping in order to see whether the therapy starts to feel helpful again once the "storm" passes. It may be important to start out the next therapy with a discussion about what it means to her to feel "betrayed" when someone who was supposed to help her turns out not to be able to rescue her after all...such a starting point may get the new therapy off to a useful start.
Mirel Goldstein, M.S., M.A., LPC
Professional Individual and Marital Counseling
3 Harding Court
Passaic, NJ 07055
303-204-7039
NJ License 37PC00391500
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Dear Friend,
It is incredibly good for your friend that you care so much and are willing to standby and help her through this very trying time. It sounds like she is really suffering.
I would not term what your friend is experiencing as "post-partum depression", as that may have been the precipitating factor, but it seems to me that that issue was responsible for triggering or releasing a long repressed depression and, apparently, rage (it is commonly believed that depression is really "anger turned inward").
I am struck by the fact that she experiences therapists as "betraying" her. That's an unusual and significant word, indicating, possibly, a slight paranoia. Additionally, the fact that her confronting her friends is done in such a way that they end up feeling alienated, means there is, most likely, anger and aggression that is being released during these interactions rather than a productive give and take in regard to issues.
I am very concerned that she has entertained major suicidal thoughts, obviously, a very serious situation. You say hospitalizations have occurred. Are these just emergency stop-gaps or any long term treatment? A few days are not going to help this woman, as some long term care might. And, to be honest, if that's in any way a possibility, not only do I think it's the best route, but possibly the only route that will provide sufficient treatment. If that's not possible, then a combination of individual therapy with medication and group therapy on a more than once weekly basis would be ideal.
You report that you've tried to get a support group but don't state which possibilities you've explored. It is also difficult to comment because I don't know where you both live, so I have no idea of potential resources. And, besides, this woman needs more than a support group, from what you've said she needs solid psychotherapy with a qualified professional. It sounds as if she feels most frightened and alone.
Are finances an issue? Does she have good health insurance? It is sad that these issues can determine what, how much, and what level of help she can get, but, obviously, at the present time, it's a truth!
Although not mentioned in your letter, there is also concern in regard to the baby. Who is taking care of this little one? It sounds like mom surely does not have the emotional resources to provide this child with the care and attention s/he requires to grow and develop in a healthy, emotionally supportive way. Is this at least a burden that people (family, friends) have been able to ease for her?
I just checked the internet and found three groups that offer some support. I don't think they will be enough, but they may be able to lead you and her to other places:
1. Postpartum Support International
2. Post Partum Depression Support Group - DailyStrength
3. Mother-to-Mother: Postpartum Depression Network
In addition, I suggest, if you have not already done so, contacting Jewish Family Service, any mental health clinic and searching for practitioners who may specialize in post partum depression.
I really wish I could be of more concrete help. I wish your friend a "refuah shleimah" and you the fortitude and continued desire to help her in this time of need.
Sincerely,
Nancy Silberman Zwiebach, MS, PD
Paramus, NJ
201-843-1373
Individual, Couple, Family and Group Psychotherapy
Psychometric Evaluations