Therapist Corner #2: Postpartum Rage

Q: I am 3 months postpartum and am shocked by how angry I am all the time. I expected I might feel sad or even depressed after giving birth, but not angry. I blow up and yell at my husband all the time, and I’m worried about my baby being around all this anger. I’m not an angry person, and I don’t know why I feel this way. What is wrong with me?

A: Postpartum rage is not an uncommon experience (see books How Not to Hate Your Husband After Kids and All the Rage: Mothers, Fathers & the Myth of Equal Partnership). While anger in our society is often seen as a dangerous and destructive emotion that should never be expressed (especially for women!), anger often is an indicator of unmet needs, limits that are being pushed past, or boundaries that are being violated. Anger is a signal that there is some threat to you in the environment.

The postpartum period is, understandably, a prime time for a mother’s needs to go unmet, and often by necessity. Of course, you often need to prioritize your baby’s needs over your own. And you absolutely have to place your needs high enough up on the priority list that you are able be there for your family in a whole and healthy way. You cannot pour from an empty cup.

With postpartum rage, it is always important to zoom out and look at the big picture to see what changes can be made to better ensure that your basic needs are being met. It is essential that you are eating regular meals, getting adequate sleep, and having some (even small) amount of time to yourself without the responsibility of caring for baby every day.

For most people, getting at least one stretch of 4 consecutive hours of sleep as well as additional hours of broken sleep can make an incredible difference in their mental health and ability to function. Sometimes this means going to sleep early in the evening (if that’s when your baby sleeps the longest) or pumping earlier in the day/supplementing with formula so that your partner can feed the baby without waking you up if breastfeeding is significantly impacting your sleep.

What supports do you have in your life? Is your partner participating in the care of your baby and the home the way you need? Do you have others in your life you could enlist for support? It is absolutely imperative (and not selfish) to make sure your needs are being met during this intense first year of your baby’s life.

If you are ever concerned that you are about to take your anger out on your baby, always put your baby in a safe place (e.g. crib or bassinet) and leave the room. It is ok for your baby to cry while you take the space you need. Call a supportive person in your life if you are concerned that you can’t go back to care for your baby after taking that space.

If you feel like you need extra support figuring out how to make changes to get your needs met or don’t know whom to turn to, please reach out for either individual or couples counseling. We would gladly come alongside you to figure out how to get your needs met so that the anger is no longer needed.

-Grace Carpenter, MS, LMHC

Grace Carpenter is a therapist at Samaritan Center who focuses on perinatal, postpartum, and infertility concerns.

 

Welcome to the Therapist’s Corner, a place where people can ask questions about struggles, relationships, or the rest of life, and therapists at Samaritan Center can give their quick and thoughtful answers. We hope you enjoy these responses and find them helpful. If you have a question that could benefit from the thoughts or advice of a trained mental health professional, send it our way at contact@samaritanps.org to have it answered.

Renewed Resolutions

 

There is renewed hope every new year as the struggles of the previous year give way to a fresh start. As January 1st strikes, people all over the world join on a journey of change as they make their resolutions for 2024. It is the day gyms are most crowded and the most promises are made. Well, we’re now into February. How are we doing, folks?

Did you know that the second Friday of January is referred to as Quitters’ Day, and that Ditch New Year’s Resolution Day falls on January 17th. We know that the vast majority of people will not keep their resolutions: in fact, a study from Sundried.com found that 43% of people begin the year already anticipating that they will give up by the end of the month. Many people decide to give up altogether, resigned that things cannot and will never change.

In many ways, the phenomenon of New Year’s resolutions reflects the larger process of change we experience as humans. Even though we have a desire to grow, change is hard. It’s hard to begin, and it’s hard to sustain. Sometimes, the pressure and overwhelm associated with stepping out of a comfort zone keeps a person from even thinking about it. But the New Year is upon us.. well, the lunar one that is. Perhaps it’s as good of a reason as any to make some new resolutions. Are you willing try again? If so, here are some tips that may help:

1. Keep it simple. It can be tempting to try to change everything all at once or to engage goals with full abandon, but that often leads to taking actions without the underlying structures to sustain them. It’s like a runner who starts off the block too quickly and begins to fade because they do not have the energy left to finish strong. Instead, focus on smaller increments of change that will challenge you to grow but are still manageable. Gradual steps can build towards greater growth. Bruce Lee once said, “I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.” Building depth and not breadth by simplifying goals is a good way to build long-term and sustainable change.

2. Find your meaning. According to Angela Duckworth, a leading expert on grit, one important ingredient for follow-through and perseverance is to identify and focus on your passions. The more an individual action is attached to a larger meaning and desire, the greater the motivation to complete that action. We see this play out all the time. Students grind to achieve a grade at the end of the year. Athletes run wind sprints because every rep gets them closer to the championship. What might be your larger reason to work out, stop drinking, or try something new? Focusing on that can provide continued direction when you run into the dog days of summer.

3. Don’t do it alone. Reaching out to another person can be an incredibly important resource when it comes to follow through. Someone who gives consistent encouragement and accountability can provide a secondary, external source of motivation when internal willpower falters. Furthermore, working with another person offers an opportunity for feedback and reflection that is vital to learning and growth. Not only are there external benefits to reaching out, research has also found sharing goals with another person–particularly someone we hold in high esteem–can actually increase internal motivation as well.

4. Try again… again. Unfortunately, we will all face failure. Research from the University of Scranton found that a whopping 92% of people do not keep their New Year’s resolutions. Just as telling, however, is a study by Norcross and Vangarelli which found that those who successfully kept their resolutions still averaged 14 setbacks over a two-year period. A big part of success is learning what to do with failure. Failure is often thought of as the end of the story and is connected with feelings of incompetence, embarrassment, or rejection. One effective way of overcoming that mindset about failure is to see it as part of the growth process rather than the end result. As Thomas Edison famously said, “I have not failed 10,000 times, I’ve successfully found 10,000 ways that will not work.”

Regardless of where you are with your resolutions, whether you are still going strong, have crashed and burned, or never started to begin with, we hope that this message can be a little bit of encouragement to continue, restart, or begin your journey of change. There is always the next opportunity to try again. There is always a new chance to grow. As the scriptures say, “His mercies are new every morning.” Have at it once more!

 

This writing was originally posted in an email sent to our mailing list on February 9th, 2024. Please enter your email at the bottom of the page if you would like to sign up to be part of our mailing list.

Therapist’s Corner #1: Right Time for Couples Therapy

Q: My partner and I argue frequently, sometimes bitterly. I think some arguing is normal, right? Yet I do worry that it’s become a problem. When is the right time to start couples counseling?

A: Thank you for this question! It is such a common one for many couples who are trying to decide what is normal and what is a serious warning sign. The first thing I would say is that couples therapy does not have to be a last resort. It can greatly ease difficulties in relationships, even longstanding ones. And it is a resource that many people avail themselves of proactively—to nurture generally healthy bonds.

You are correct, of course, that some amount of conflict in a couple’s relationship is to be expected and even healthy. For it to be submerged or circumvented routinely would be troubling in itself. Couples can engage in conflict in constructive and beneficial ways. Or quite the opposite. When argument becomes the norm, especially when it feels hurtful or even abusive, an outside resource such as therapy can be critical.

For couples who identify their fighting as a problem, the right time to start is, well, before it’s too late. That sounds glib, and it is, but it is also completely true. Therapy generally proves useful in identifying deeply ingrained patterns that have a way of taking over a couple’s interactions. Each partner can benefit from seeing the patterns clearly on their many levels: behavioral, perceptual, and emotional. With help from the therapist, partners can explore their contributions to these patterns and can support one another in their growth and change.

So why do people resist therapy, given the potential benefits? The reasons are many and are understandable. As already mentioned, expense is often one factor. For another thing, therapy can be intimidating. It opens a couple’s private life to a stranger, which can feel unwelcome or even shameful. Many people find that vulnerability even more distasteful than the strains and discontent of the ongoing relationship.

In addition, there is simply the complexity of a relationship, especially one that has evolved, however unhealthily, over many years and changes and cycles of up and down. Sometimes the memories of better times early in the relationship create a false sense of hope that a healthy state will surely somehow return on its own. If only circumstances—infants or adolescents in the household, or bouts of illness—would change, then the relief would allow the relationship to recover.

In fairness, this is not without validity. Circumstances can be a big factor in couples’ difficulties, and their skills and capacities for resolving the distress in their relationships can prove adequate for the necessary healing and resolution. Or they can be adequate in some circumstances but not in others.

So the question of seeking counseling comes back to a couple’s own discernment. If a couple has sufficient resources and trust in the process, they might seek counseling to nurture an already secure relationship. If circumstances are distressing, it might be helpful to seek guidance simply to deal with the circumstances more effectively. If the patterns of dysfunction are hurtful, it is almost always better to seek help now if possible rather than allow the hurts to accumulate and compound.

The right time for couples counseling can be whenever there is a clear sense of opportunity or urgency. Couples do quarrel, some seasons of “coupledom” are inherently more challenging than others, and people and relationships do change, but couples are wise to assess their relationship health regularly and honestly—and even that assessment can be a short-term goal to pursue with a therapist.

-Eric Stroo, MA, LMHC

Eric Stroo is a therapist at Samaritan Center. He currently works with individuals and couples.

 

Welcome to the Therapist’s Corner, a place where people can ask questions about struggles, relationships, or the rest of life, and therapists at Samaritan Center can give their quick and thoughtful answers. We hope you enjoy these responses and find them helpful. If you have a question that could benefit from the thoughts or advice of a trained mental health professional, send it our way at contact@samaritanps.org to have it answered.

Change Your Mind

A friend recently shared with me their copy of Nikita Gill’s book, Where Hope Comes From. The first poem, entitled “And a Message from the Universe,” goes like this:

In every moment of your existence,
Several realities
Are bursting across the cosmos. 

Planets explode.
Stars burst.
Solar systems dissolve

Or welcome a new planet
Into the orbit of their own
Sun-like star. 

The universe gives them life
And says,
Now help me live. 

Listen.
I am saying that if you change your thoughts,
You, too, can change your universe. 

As I reflect on this, part of me is skeptical: Change your universe?  Really?  Another part of me nods along, “We CAN change our/the universe If we allow our “same-stuff-as-stars” cerebrums to shift. For there is a whole universe in there.

And, somewhere in my same cerebral space are swirling around words from the August 27 lectionary passage, the starting words of Romans 12:

“Do not be conformed to this world, but be TRANSformed by the renewing of your mind, so that you may discern what is the will of God—what is good and acceptable and perfect.” 

Perfect—not meaning without blemish or error—instead perfect meaning whole and integrated. Such is God’s good will for each of us, that we might find wholeness and healing in our holy lives.

Perhaps the Apostle Paul and Nikita Gill are onto the same thing. That by God or by grace, these mysterious and wonder-filled minds are key to our transformation, even the changing of our very universe.  Which for us—and for those we hold in our hearts—begins right here… begins right now.

Knowing Our Strengths

One of the strengths of Samaritan is that we are available to help people in an ongoing way with the problems that inevitably arise in life. Created in 1960, with therapists who stay with us for 10, 20, and 30 years, we serve families in a variety of ways—often beginning with individual or couples therapy, sometimes including additional family members, and when it’s indicated, referring them to another therapist with specific expertise. Clients sometimes come with a specific issue that is resolved in a few sessions, but frequently they find that the issues are more complicated and they engage in deeper, longer-term work.

An example of Samaritan as an ongoing family resource is a couple in their mid-40s who came to Samaritan for the first time 10 years ago. The problem was the “out of control” behavior of their two teenagers. They wanted to know how to set limits and provide support for their adolescents, both of whom were taking risks that could have serious long-range consequences. Their therapist helped them examine and make changes in how they were parenting and, at the same time, focused on protecting and strengthening their marital relationship.

A second round of therapy occurred when one of their aging parents needed to move from home to an assisted living facility.  The loss of independence was devastating for the parent and put our clients in the position of making hard but necessary decisions while being viewed as “the bad guys.” The therapy setting created space for them to voice their grief and frustration without appearing weak or unfeeling.

Later, health issues for each of the couple coincided with the husband’s planned retirement.  It brought them face to face with questions of their own mortality and an urgent need to re-think their financial expectations.  Again, having a therapist who could listen deeply to their fears, bringing both her history with the family and her training in life transitions, helped them move forward.  The couple pulled together their considerable resources—among them their love for each other, their strong Christian faith, their experience of meeting adversity with determination, and a soul-saving sense of humor.

The belief that both the couple and the therapist held as they worked together, once again, to find a way through very difficult circumstances is what Samaritan has always offered our community. A belief in our ability to care for one another and to create positive change.

 

 

Making a Difference

Life isn’t always easy to navigate or easy to understand. Samaritan Center exists to help people cope, rebound, and heal from the unexpected difficulties life can bring.

In the third year of pandemic-driven change, we are determined to continue to live vibrantly into that mission. No matter their ages or their circumstances, our clients tell us they are weary, worn thin by the stress of isolation, unpredictability, and the incessant troubling news. For example, there is the woman in her 70s who meets with her therapist every other week. She lives alone in low-income housing, is largely estranged from her adult children, and worries continually about her health, her finances, and the uncertainty of the future. She talks about her faith and experience of decline: ‘You’re the only one I have to talk to,” she says. “I don’t know what I would do without being able to meet with you.’

Those of you who so generously support this ministry make it possible for us to continue to be a healing presence for people who are in need of care. Without these donations from our spiritual partners – church congregations and individuals – helping those in need simply can’t be done. We pray that you will stand beside us in this difficult time. We thank you.”

Braiding Sweetgrass – Book Review

Braiding Sweetgrass
Review by Peggy Hansen

In the preface, Robin Wall Kimmerer writes: “I could hand you a braid of sweetgrass, as thick and shining as the plait that hung down my grandmother’s back. But it is not mine to give, nor yours to take. Wiingaashk belongs to herself. So I offer, in its place, a braid of stories meant to heal our relationship with
the world. This braid is woven from three strands: Indigenous ways of knowing, scientific knowledge, and the story of an Anishinabekwe scientist trying to bring them together in service to what matters most.”

In this beautifully written book, Kimmerer moves back and forth between stories of relationships with her family and her students, very detailed and scholarly descriptions of the plants she loves and their (and our) endangered environment, and the beloved traditions and wisdom of her elders. She describes the ceremonial giveaway, the minidewak, one of her peoples’ oldest teachings.” Generosity is simultaneously a moral and a material imperative, especially among people who live close to the land and know its waves of plenty and scarcity. Where the well-being of one is linked to the well-being of all. Wealth among traditional people is measured by having enough to give away…. In a culture of gratitude, everyone knows that gifts will follow the circle of reciprocity and flow back to you again. This time you give and next time you receive. Both the honor of giving and humility of receiving are necessary halves of the equation.”

She introduces us to the Thanksgiving Address, which embodies the Onondaga relationship with the world. ”Each part of Creation is thanked in turn for fulfilling its Creator-given duty to the others. It reminds you every day that you have enough,” she writes, drawing on the words of Freida Jacques, a teacher at the Onondaga Nation School. “Gratitude,” says Kimmerer, “doesn’t send you out shopping to find satisfaction, it comes as a gift rather than a commodity, subverting the foundation of the whole economy. That’s good medicine for land and people alike.” The recognition of loss is also a theme of her book, as she recounts the taking of children from their tribe and families, isolating them in boarding schools and forbidding them to speak their native language. She mourns the ecological destruction that has changed her beloved Onondaga Lake into “the most chemically contaminated lake in the United States.” But she says: “Despair is paralysis. It robs us of agency. It blinds us to our own power and the power of the earth. Environmental despair is a poison every bit as destructive as the methylated mercury in the bottom of Onondaga Lake…. Restoration is a powerful antidote to despair. Restoration offers concrete means by which humans can once again enter into positive, creative relationship with the more-than-human world, meeting responsibilities that are simultaneously material and spiritual.”

Good Faith Estimate

Good Faith Estimate

Effective January 1, 2022, a ruling went into effect called the “No Surprises Act” which requires practitioners to provider a “Good Faith Estimate” to individuals who are uninsured or utilize self-pay. The Good Faith Estimate (referred to throughout this document as “GFE”) works to show the cost of items and services that are reasonably expected for your health care needs for an item or service, a diagnosis, and a reason for mental health services. The estimate is based on information known at the time the estimate was created. The GFE does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur and will be provided a new GFE should this occur. If this happens, federal law allows you to dispute (appeal) the bill if you and your provider have not previously talked about the change and you have not been given an updated GFE.

Under Section 2799B-6 of the Public Health Service Act (PHSA), health care providers and health care facilities are required to inform individuals who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request, or at the time of scheduling health care items and services to receive a GFE of expected charges.

Note: The PHSA and GFE do not currently apply to any individuals who are using insurance benefits, including “out of network benefits” (i.e.., submitting superbills to insurance for reimbursement). 

Timeline requirements: Providers are required to provide a GFE of expected charges for a scheduled or requested service, including items or services that are reasonably expected to be provided in conjunction with such scheduled or requested item or service. That estimate must be provided within specified timeframes:

  • If the service is scheduled at least 3 business days before the appointment date: no later than 1 business day after the date of scheduling;
  • If the service is scheduled at least 10 business days before the appointment date: no later than 3 business days after the date of scheduling; or
  • If the uninsured or self-pay individual requests a GFE (without scheduling the service): no later than 3 business days after the date of the request. A new GFE must be provided, within the specified timeframes if the individual reschedules the requested item or service.
Samaritan Center of Puget Sound recognizes every individual’s mental health treatment journey is unique and personalized. How long you need to engage in mental health services and how often you attend sessions will be influenced by many factors, including, but not limited to:
  • Your schedule and life circumstances
  • Your provider’s availability
  • Ongoing life challenges
  • The nature of your specific challenges and how you address them
  • Personal finances

You and your provider will continually assess the appropriate frequency of services and will work together to determine when you have met your goals and are ready for discharge and/or a new “Good Faith Estimate” will be issued should your frequency or needs change.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises 

We Can Only Be Human Together

Archbishop Desmond Tutu, who died on December 26, believed in and actively lived the South African principle of ubuntu. The word ubuntu is part of the Zulu phrase “Umuntu ngumuntu ngabantu” which literally means, “A person is a person through other people.

”In The Book of Joy, which the Archbishop wrote with the Dalai Lama and Douglas Abrams, he said: “Ubuntu says when I have a small piece of bread, it is for my benefit that I share it with you.… In a very real sense we’re meant for a very profound complementarity. It is the nature of things. You don’t have to be a believer in anything. I mean, I could not speak as I am speaking without having learned it from other human beings…. I learned to be a human being from other human beings. We belong in this delicate network. I am, because you are. It is actually quite profound.… We are bound up and can be human only together.”

At Samaritan, we are deeply aware of how foundational it is to wellbeing to have reliable, caring relationships with others.  Mind, body, spirit, and relationship are bound up together, and healing occurs as we give attention to each of these elements of our humanity and actively seek to integrate them. We are grateful for the example of those, like Desmond Tutu, who have faced adversity without losing their ability to identify with others and live, not in separation but in solidarity with them.

As the pandemic has stretched now from months to years, we all have experienced the significant, sometimes catastrophic impact that it has had on relationships. Stress that arises from multiple directions can drain away the ability to connect with one another in meaningful ways. It affects everyone, parents and their children, husbands and wives, friends, work colleagues, and casual acquaintances. Reaching out to one another in nurturing ways is sometimes simply more than we can do. In the resulting isolation, our sense of the warmth of human connectedness – ubuntu – withers.

How are we to respond to the unchosen stress of this time and the fears that arise in our mind, our body, and our spirit?  Ubuntu tells us that, as individuals and in community, we can choose to intentionally express to one another respect, dignity, reciprocity, compassion, and mutuality.

When we feel overwhelmed by circumstances, it’s hard to know what that would look like. What can just one person do?  Mindfulness suggests that, first of all, we should simply pause, taking time to acknowledge what we’re thinking and feeling. As we’re able to accept and calm our anxiety, we will see the situation more clearly. We’ll see the possibilities, where we have some control or influence and how we can use that. We’re more able to let go of the things that are beyond our control.

As our minds become quiet, refraining from worrying and judging ourselves and others, we are able to respond to the problems in more creative and confident ways. We find that we can act with the energy and compassion of ubuntu, secure in the experience of our common humanity, our interconnectedness and our responsibility to one another.

Re-entry from Covid

And Now… How Do We Think About Re-entry?

It’s spring. We can feel the changing, evolving season. Light that lasts longer. New growth appearing. A taste of warmer days to come. People venturing out of hibernation.

It’s been a long winter, a long year, and we’ve become accustomed to the many ways in which we’ve been separated from one another. Many of us are wondering what this season of re-entry–the emerging from separation–will look like. There’s a feeling of uncertainty, a forgetting of how everyday relationship with the outside world is done. Used to be done. Should be done. Can be done.

Some of us feel the questions more intensely than others. Instead of embracing the new freedom, we look at it with a raised eyebrow. Our habits of caution outweigh our impulse to engage. That can lead us to wonder in a self-critical way–about ourselves, our resilience, our ability to adapt.

We know that distressing situations can trigger our feelings of anxiety and depression. When this happens, we do well to remind ourselves of strategies that can help manage these feelings. We may have learned some of them through Cognitive Behavioral Therapy and the practice of Mindfulness. While they’re simple skills, they’re not easy to maintain when we’re feeling stressed. Our efforts, however, can be rewarding.
Here is a reminder of some of those useful strategies:

  • Stay in the present–don’t ruminate about the past or try to predict the future
  • Focus on what you can control and set aside what you cannot
  • Appreciate those things that are going well
    Maintain healthy habits of eating, sleeping and exercising
  • Seek out pleasurable activities and meaningful connection with others
  • Extend an attitude of generosity, both to yourself and to others

It seems fortuitous that our emerging from this highly restrictive year of the pandemic coincides with our calendar’s emergence from winter into spring. Access to vaccines and lower numbers of serious illness and death from the virus are allowing us to move about more freely. Sunny days are inviting us to come outdoors, shedding our raincoats and boots and woolen scarves.

So, is there a way to step into this re-entry, this emerging from separation into reconnection, with lightness, the spirit of spring? Can we bring what we’ve learned in this past year, about ourselves and others and reality itself, to a clearer and more compassionate understanding of what life is about? Will our inner conversations and our relationships with others thrive in this warmer climate? Will our sense of gratitude and hope speak to our experiences of loss and grief? Will we agree to move forward with a smile – one that may still at times be hidden by the masks we agree to wear but will surely be visible in our eyes.