The Art of Holding Perinatal Women in Distress.

Therapies like cognitive behavioral therapy and interpersonal psychotherapy are regarded as highly effective treatments for perinatal mood and anxiety disorders. Therapists appreciate robust research supporting the efficacy of these evidenced-based treatments and the structure of the tools these therapies provide for effective intervention. Less has been written on supportive psychotherapeutic techniques and few of those writings provide instruction or tools for therapists who wish to strengthen their skills in this therapeutic approach. This article describes The Art of Holding Perinatal Women in Distress™, a model of perinatal treatment developed by Karen Kleiman, MSW, LCSW. Kleiman instructs therapists to incorporate six "Holding Points" into their approach to therapeutic assessment and intervention for the purpose of establishing a holding environment conducive to the release of authentic suffering. This article reviews the Holding Points and provides a case study that elucidates how the holding points function within the context of a therapy session.

Principles of Supportive Psychotherapy for Perinatal Distress.

Although interpersonal psychotherapy and cognitive behavioral therapy have demonstrated efficacy in the treatment of perinatal distress, supportive psychotherapy has not been as widely studied by researchers. However, the principles of supportive psychotherapy are essential in the treatment of perinatal distress. The purpose of this article is to show that supportive psychotherapy is a plausible intervention that nurses and other maternity care providers can use with women who experience anxiety and depression in the perinatal period.

Development of a brief measure of postpartum distress.

BACKGROUND: Previous measures of postpartum distress have focused on depressed mood despite evidence that postpartum anxiety is just as prevalent. The purpose of this study was to develop a new, brief screening measure to identify postpartum distress, defined as symptoms of depression and anxiety. METHODS: In Study 1, potential items were assembled focusing on depressed mood and a variety of anxiety domains to develop a new postpartum distress scale. Women up to 12 months postpartum (n=289) completed the new scale items, the Edinburgh Postpartum Depression Scale (EPDS), and the Mood and Anxiety Symptom Questionnaire (MASQ) on the Internet. In Study 2, women up to 12 months postpartum (n=139) completed the new Postpartum Distress Measure (PDM), the EPDS, the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Relationship Assessment Scale (RAS) to validate the new measure. RESULTS: Data from Study 1 yielded a two-factor solution, and 10 items were selected for the new PDM. Six items were chosen for the PDM general distress scale, and four items for the PDM obsessive-compulsive scale. Data from Study 2 again yielded a two-factor solution, supporting both the general distress and obsessive-compulsive components. Psychometric data suggested that the measure had adequate internal consistency and construct validity. CONCLUSIONS: The 10-item PDM comprises general distress and obsessive-compulsive factors that were obtained from a wider pool of depressive and anxiety items. These data suggest that the PDM may be a helpful tool in identifying a broader range of postpartum distress, including obsessive-compulsive symptoms that were formerly neglected in clinical screening measures. More studies are needed to confirm its clinical utility.