Abstract
Intensive Short-term Dynamic Psychotherapy (ISTDP) is a treatment that has shown promise in addressing attachment ruptures that lie at the root of postpartum depression (PD). ISTDP can provide rapid symptom relief while also addressing the underlying maladaptive personality structures that cause and prolong PD. These vulnerabilities can include self-neglect, harshness toward the self and others, and difficulty regulating emotions. Research has shown that this self-critical personality style, usually resulting from having distant or harsh parenting, is highly correlated with PD. ISTDP directly addresses these self-critical patterns, commonly referred to in the psychodynamic literature as “superego pathology”. These patterns are thought to result from the identification with harsh caregivers. A woman may doubt her capacity as a caregiver, push away supports, minimize or ignore her feelings, project her fears and anger onto the baby, dismiss her instincts and idealize authority figures. If these tendencies are not addressed, a woman is likely to pass along these enduring patterns to her baby and future generations. Early, rapid, and effective psychotherapy treatments that address these underlying non-conscious defense mechanisms are essential in healing PD and ensuring a positive mother-infant bond. “If we want to shape the future, to truly improve the world, we have 1,000 days to do it, mother by mother, child by child. For what happens in those 1000 days through pregnancy to the second birthday determines to a large extend the course of a child’s life…”.
Highlights
Postpartum Depression affects 10-20% of middle class women worldwide [1]
Intensive Short-term Dynamic Psychotherapy (ISTDP) is a treatment that has shown promise in addressing attachment ruptures that lie at the root of postpartum depression (PD)
Rapid, and effective psychotherapy treatments that address these underlying non-conscious defense mechanisms are essential in healing PD and ensuring a positive mother-infant bond
Summary
Postpartum Depression affects 10-20% of middle class women worldwide [1]. The rates may double or triple when other risk factors are present, such as poverty, relocation, or medical problems during pregnancy [2,3,4,5]. Research over the past decade has demonstrated that the period from pregnancy through the first two years of life is by far the most important developmental window in a child’s life These first 1,000 days affect the child’s ability to “grow, learn, work, succeed-and, by extension, the long-term health, stability, and prosperity of the society in which that child lives” [11]. Given the high prevalence rates, the short developmental window of the first two years, and the long-term negative consequences of untreated PD, we urgently need treatments that will work quickly, deeply, and effectively to ameliorate the symptoms, while minimizing relapse rates for future depressions. A small number of clinical trials have been conducted to test several short-term manualized treatments on women during the postpartum period (Interpersonal Psychotherapy (IPT), Cognitive Behavioral Therapy (CBT). Patients with a significant prior history of depression and those with comorbid personality disorders are more likely to have residual depressive symptoms at the end of a trial of cognitive therapy, or unstable remission, which appears to put them at risk for relapse
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