The baby juggle

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Oh, I REALLY like this article from the ABC’s Life program about managing the competing demands of parenthood and work!  https://www.abc.net.au/life/juggling-motherhood-and-a-career-carla-gee/10325824  

This is a topic I spend a great deal of time discussing with new mums in my practice … because the reality is, for many families there is no financial choice but to have both parents return to work reasonably soon after they bring home a baby.  But there are so many questions so answer within this….

How do you decide to stay home with the baby or return to work?

How soon is “too soon” to go back to work?

Should I go back full time or part time?

How do you find the balance?

How will all of this impact my career?

How am I going to be able to wake up to get to work in time, and not find myself     covered in baby spew?

How do you deal with the judgement from (apparently) everyone else??

When I became a mother, I also became the recipient of loads and loads of unsolicited advice, whether it was from a friend over coffee, or from a stranger as I waited to cross the road with my kids.

How does “talking” help?

screenshot-2018-10-31-12-40-02.pngA question I get asked very frequently, is how could “just talking” possibly help.  There are probably 2 answers to the question.

Firstly, psychotherapy isn’t really “just talking”. It’s much more than a “chat”, and when done properly will require some pretty hard emotional work to be undertaken.

The second answer is a little longer, and has become a lot clearer in recent years with the help of clever brain imaging technology. The truth is, “talking” changes the way our brain works.  This article https://digest.bps.org.uk/2018/11/06/this-is-how-psychotherapy-for-depression-changes-the-brain/?platform=hootsuitein the British Psychological Digest helps break down some recent research.  So… is it time for you to talk it out?

“After CBT, patients with major depression showed less activation in the left precentral gyrus. This area is in the brain’s prefrontal cortex, which is involved in thinking and reflective processes. People who are depressed exhibit more activity in this area during emotional tasks, which appears to reflect their tendency to over-process and ruminate on thoughts and worries. As such, the reduction in prefrontal cortex activity after therapy may indicate the effectiveness of therapy in discouraging such negative cognitive styles – taking things for what they are rather than using them as a springboard into contemplating a worst-case scenario.

Another finding was that, after CBT or psychodynamic psychotherapy, patients showed more activation in the left rostral (pregenual) anterior cingulate (see image above; healthy controls did not show this change, suggesting it was not simply due to the passage of time or practice effects at the image-viewing task). This brain area is strongly connected with core emotion processing regions, including having a suppressing effect on activity in the amygdala. Evidence already suggests that the connections between the anterior cingulate and the amygdala are weaker in major depression, explaining why emotions may feel more overwhelming. So it appears that one of the effects of psychotherapy may be the re-establishment of this damaged connection. The meta-analysis can’t tell us exactly how, but one possibility is through practices such as “cognitive re-appraisal” – finding new ways of interpreting difficult experiences.

What role is there for Epigenetics in donor conception?

Many potential mums who are considering family creation through oocyte (egg) donation fell quite anxious that they are no more than a “third wheel” to their future child – that biology might somehow “trump” motherhood.  Often when I am talking to these women, I mention the emerging field of epigenetics, which, put simple, is the effect that nurture can have on nature.  I have just discovered this wonderful website which explains epigenetics really clearly http://www.beginbeforebirth.org/the-science/epigenetics and even has a cool video to explain the action of the process http://www.beginbeforebirth.org/for-schools/films#epigenetics.  I suspect that the years ahead will reveal just how much input a mother has on her developing baby, even if there is a genetic donor.Screen Shot 2018-10-12 at 9.56.23 am.png

Loving a person with BPD

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I frequently find myself working with people who feels bewildered by the behaviour of their partner/daughter/mother/brother/friend.  When I dig a little deeper, although I am clearly not in a position to diagnose someone who is not in the room, it starts to become clear that the absent loved one has features of personality disorder.  Quite often, that person seems to meet (at least some) of the criteria for Borderline Personality Disorder (BPD).  As described by the National Education Alliance for
Borderline Personality Disorder (NEABPD)
, BPD is “a serious mental illness that centers on the inability to manage emotions effectively. The disorder occurs in the context of relationships: sometimes all relationships are affected, sometimes only one. It usually begins during adolescence or early adulthood.  While some persons with BPD are high functioning in certain settings, their private lives may be in turmoil. Most people who have BPD suffer from problems regulating their emotions and thoughts, impulsive and sometimes reckless behavior, and unstable relationships.  Other disorders, such as depression, anxiety disorders, eating disorders, substance abuse and other personality disorders can often exist along with BPD.

My patient is often bewildered by the behaviour of their loved one – Why do they react so dramatically?  Why do they seem to take everything so personally?  Why do they threaten to hurt themselves over the (apparently) smallest upset.  Having something to read about BPD can be really handy and while there are some GREAT books on this (think “Walking on Eggshells“), sometimes you want to be able to get your hands on some down to earth coping suggestions quickly. So, I was pretty chuffed to find these Family Guidelines published online by theNEABPD https://www.borderlinepersonalitydisorder.com/family-connections/family-guidelines/ 

The guidelines contain some simple, but really helpful suggestions for how to cope with what might feel like very unfair or irrational responses from someone with BPD, and how to make those family/friendship relationships work, despite what can be a tricky set of personality characteristics.  An excerpt below…

Managing Crisis, Pay Attention, But Stay Calm

Don’t get defensive in the face of accusations and criticisms. However unfair, say little and don’t fight. Allow yourself to be hurt. Admit to whatever is true in the criticisms.

When people who love each other get angry at each other, they may hurl heavy insults in a fit of rage. This is especially true for people with BPD because they tend to feel a great deal of anger. The natural response to criticism that feels unfair is to defend oneself. But, as anyone who has ever tried to defend oneself in such a situation knows, defending yourself doesn’t work. A person who is enraged is not able to think through an alternative perspective in a cool, rational fashion. Attempts to defend oneself only fuel the fire. Essentially, defensiveness suggests that you believe the other person’s anger is unwarranted, a message that leads to greater rage. Given that a person who is expressing rage with words is not posing threat of physical danger to herself or others, it is wisest to simply listen without arguing.”

Whoa, slow down – what are we all doing to ourselves????

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A lovely reader of this page just sent this article from last weekend’s Weekend Australia through to me and it is SO GOOD.  For those of you who have kids and are also working (or maybe studying, or trying to start your own business, or helping out at your kid’s school, or taking care of your ageing parents – because it is all of the ANDs that we try to manage that are the problem), check it out.  Then, we just have to find the solution.  I suspect it is simple.  It’s probably called slowing down….. https://www.theaustralian.com.au/life/weekend-australian-magazine/working-mothers-families-and-the-secrets-we-keep/news-story/cff22f5c86fe6001ee780bdf12801e08

Twenty years ago, the average working day was about seven hours and many mothers didn’t have a job outside the home. In the years since, the working day has grown by an average of about two hours and a million more mums have jobs. This is partly because house prices have soared in that time. Most households now need to have two parents out of the house working for long periods of the day. But, in that time, the needs of our children and the structure of childcare and the school day haven’t changed at all — as every parent of a school-age child discovers when there are weeks of the summer holidays still left to go, their own leave is used up, their finances are spent and the kids are going bananas with the need for involvement and undivided attention.

Feeling safe and secure during obstetric and gynaecological care

With such a huge number of people living with a history of rape or sexual assault, it is astonishing that many services remain somewhat insensitive to the additional needs of these patient’s obstetric or gynaecological care.  Unfortunately, for many people undertaking routine sexual health checks, attending fertility clinics, having their antennal reviews or delivering their babies, the interventions undertaken by their doctors and nurses may service to retrigger old trauma.  Most of these doctors and nurses may notice that the patient is very quiet or leaving “oddly” but will have no idea what is wrong with the patient.  Clinicians may be unaware that what they are doing is causing a re-traumatisation, as patients often find it so difficult to disclose their sexual assault histories – or may have not thought that their treating team needed to know about a rape that may have occurred decades previously.  But when we consider that up to 20% of women will have been sexually assaulted or raped in the past, the reality is that every doctor, every day treats many, many patients who are at risk of having their past traumas triggered by standard medical care.

I absolutely love this clinic established in the UK a couple of years ago which provides care to people who have disclosed their past assault, and explores clinical interventions which are more sensitive to the needs of these patients.  There is so much we can learn from this model to apply to every clinic and every patient.  Please note that some of the material in this video is quite distressing.  https://www.independent.co.uk/news/uk/rape-survivors-maternity-clinic-uk-nhs-a7073536.html  If you need support  If you need support or would like more information about this, please contact a health professional, or you may wish to check out http://www.dvrcv.org.au/help-advice/mothers/pregnancy-parenting

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What Happened to Me? Is “Baby Brain” really a thing?

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If you have had children, you are likely to feel like almost has everything changed in your life when you became a parent – the way you think, your sleep patterns, your relationship with partner and family, your social situation, your economic capacity, your body (oh goodness, how that changes, especially during pregnancy!!), your house/car, etc etc.

Many people (especially mums) will say that their brains also work different after having a baby: especially their emotional responses and memory abilities.

Recent research shows us that these perceived changes are real: having a baby actually changes the way our brain works, and functions like memory and emotion actually  change.  Check out this great article to understand these changes better and maybe discover why you just can’t find your car keys…. http://www.developmentalscience.com/blog/2015/11/30/the-transition-to-parenthood-what-happened-to-me

“The researchers found two main regions of the brain particularly active in new parents. The first is the “emotion-processing network.” This is located centrally and developed earlier in evolution than the neocortex (see below). It involves the limbic, or feeling, circuitry and includes:

  • The amygdala, which makes us vigilant and highly focused on survival
  • The oxytocin-producing hypothalamus, which bonds us to our newborns
  • The dopamine system, which rewards us with a squirt of the feel-good hormone to make us motivated and enjoy parenting

All together, this network creates a heightened emotionality in parents in response to their babies. In fact, according to researchers Laura Glynn and Curt Sandman, the volume of gray matter (or number of neural cell bodies) increases in the above regions in new mothers and is associated with their positive feelings toward their infants. (See Glynn and Sandman’s review article on brain changes in pregnant mothers.)

The second region is the “mentalizing network” that involves the higher cortex, or the more thinking regions of the brain. This area, along with additional superhighways that develop between the emotion and mentalizing systems, focuses attention and grounds in the present moment: Who couldn’t stare at a new baby forever? It also facilitates the ability to “feel into” what a baby needs: Areas of the brain that involve cognitive empathy and the internal imaging of, or resonance with, a baby, light up. These regions help a parent read nonverbal signals, infer what a baby might be feeling and what he/she might need, and even plan for what might be needed later in the future (long-term goals). These regions are also associated with multitasking and better emotion regulation. In other words, parents’ brains are remodeled to protect, attune with, and plan for their infants.

Other research has found that hormonal changes in pregnant women dampen their physical and psychological stress response, as if to make more space to tune in to their babies’ needs.

But along with all these changes, there seems to be a collateral cognitive hit: In a meta-analysis of 17 studies, 80% of women reported impaired aspects of memory (recall and executive function) that began in pregnancy and persisted into the postpartum period.”

PND -“In a few short weeks, I went mad”

I am doing heaps of research at the moment so I keep finding amazing articles to share.  This one from the SMH is a few years old, but is a truely brilliant piece of writing about a personal experience of becoming unwell in the context of having a new baby.  Miki Perkins has written an incredibly honest and powerful piece about her own experience of postnatal anxiety and depression, but also manages to deliver a message of hope – that recovery is possible https://www.smh.com.au/national/perinatal-depression-in-just-a-few-short-weeks-i-went-mad-20151117-gl1daw.html

“My anxiety and flat mood had been building for weeks. Circling, mercurial thoughts. I couldn’t sleep. After broken nights I would rise at dawn with my two-year old. Find something suitable to wear to work and stretch it over my growing belly. Throw up my breakfast. Drop my child at creche, and launch myself towards the station, hoping the momentum would carry me. Work was something of a relief, a focus. But under it all, the humming dread. It was happening again.”

The transition to “parenthood”

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The transition into becoming parent to another person is often described as the biggest (and frequently most abrupt) transition we undertake during our lives.  It causes the other common role transitions to seem much more gradual and manageable: becoming an adult has many, graduated steps; becoming a partner is something we can warm up to as our relationships become more permanent; but becoming a parent can feel like it has it like a hammer!

When does it happen?  At the moment we decide to have a child?  At the moment a child arrives in our lives?

Is it different depending on how we become a parent – is the experience different if we use IVF? A egg/sperm donor? A surrogate? If we adopt? If we become a foster parent?

And very importantly, what process is there to help us adjust to becoming a parent?  Where is the “manual” to help us know what to do and how to do it “right”?  What model of parenting can we use – the one our own parents provided?  Maybe we want to “do better” – if so, where do we turn?

I find the transition to parenting to be a fascinating process, but I see that this time is fraught for many parents – often feeling inadequate, overwhelmed, scared.  Sometimes dealing with extra complexities of kids with special needs or strained personal resources.        This article from the Huffington Post describes some of the changes that one new mum dealt with after she had her first child https://www.huffingtonpost.com/entry/transitioning-to-parenthood-part-1-birth-of-a-mother_us_587ce3f0e4b094e1aa9dc816

“Experiences don’t always match expectations, something which can make real life profoundly frustrating. On first glance, the transition to becoming a mom seems like a one shot deal – you have the baby, bring him or her home, traverse the steep learning curve of caring for a newborn, and boom – you have transitioned to motherhood. Not exactly. Welcoming a new baby is life-altering and potentially jarring but is only the first stage of a thorough metamorphosis”.

Remember, if you are struggling with the transition to becoming a parent, it is ok to ask for help – it is a really important job to parent another human, but it is tough too.

 

Can we really change our brains?

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There is a lot of talk currently about neuroplasticity – the idea that we can rewire our brain.  But what does this really mean?  How does it happen?  Why is it important?

An important part of the work of a psychologist is helping people to change behaviour, to learn new ways of thinking and behaving, and hopefully, also to regulate the way we feel in certain situations.  These changes can be critical in learning to manage our mental health, coping with stress and getting rid of old, unhealthy habits.  I have just found this great little video which explains how this occurs, and how we can control and change our brain – even as adults – check it our here https://youtu.be/ELpfYCZa87g

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