What Therapy Can (and Can’t) Do for Moms

You're sitting in the car after daycare drop-off, engine still running, and you can't make yourself go inside. Nothing is technically wrong. The baby is fine. Your partner is trying. You just don't feel like yourself, and you've started wondering whether therapy would help or whether it would be one more appointment that doesn't change anything.

Moms ask me some version of this all the time: "What would therapy actually do for me?" It's a fair question, and as a psychologist and a mom I want to give you an honest answer. Therapy can do a lot. It also has real limits, and knowing both helps you decide whether it's worth your time.

What therapy can do for moms

Help you name what's actually going on

A lot of moms start their first session with "I don't even know what's wrong." That is a perfectly good place to start. Part of my job is helping you sort it out. Is this postpartum depression? Anxiety that has been running in the background so long it feels like your personality? Grief for the life you had before? Rage about doing most of the invisible work at home? Plain exhaustion? Once something has a name, it usually feels less overwhelming and much more workable. Here are the signs of postpartum depression and the signs that anxiety has crossed a line.

Give you tools you can use in the middle of the day

In good therapy, you also leave with things you can do at 3 a.m. or in the middle of a meltdown in the grocery store: how to catch the thoughts that send you spiraling and check them against the facts, how to calm your body when it's sounding the alarm, how to ask for what you need without it turning into a fight. With depression, I often remind moms that the harsh things their mind says about them are symptoms of the depression.

Help you make sense of who you are now

Becoming a mom reorganizes almost everything: your body, your work, your friendships, your marriage, your relationship with yourself. Therapy is a place to work out who you were, who you are now, and what you want to keep, without having to have it figured out yet.

Help you see your patterns and choose new ones

Having a baby has a way of bringing old things back up. How your own parents raised you, old losses, the habit of saying yes when you mean no, the perfectionism that worked fine at your job and is crushing you now. A large part of my week is high-achieving moms with exactly that kind of perfectionism. Understanding where a pattern came from is often what lets you choose a different one.

Work on your relationships

Arguments about who does what, feeling alone in a full house, a partner who doesn't get it. Therapy can help you figure out what you need and how to say it. Your partner is welcome to join a session as part of your therapy if that would help. Here is more on postpartum relationship strain.

Types of postpartum therapy, in plain language

If you've been handed a list of therapists and a pile of acronyms, here is what the main approaches are. I use all of these, often together, because different moms and different problems need different things. One isn't better than the others.

• Cognitive behavioral therapy (CBT) works on the loop between your thoughts, your body, and what you do. You learn to notice the thoughts that feed depression and anxiety, test them against what is actually happening, and slowly start doing the things you've been avoiding. Here is a closer look at CBT for postpartum depression.
• Interpersonal therapy (IPT) focuses on the huge role change of becoming a mom and the relationships under strain because of it. It's a good fit when so much of what hurts is about feeling unsupported, isolated, or unsure who you are now.
• Psychodynamic therapy looks at how your history shapes what is happening now. It's especially useful when having a baby has stirred up your own childhood, old grief, or patterns you swore you'd never repeat.
• Exposure and response prevention (ERP) and inference-based CBT (I-CBT) are made for intrusive thoughts and postpartum OCD, the scary unwanted thoughts and the checking or avoiding that comes with them. Regular talk therapy isn't enough for those on its own. Here is more on postpartum OCD and intrusive thoughts.

You don't need to pick the approach yourself. A good perinatal therapist will figure out with you what fits. What matters more is that they understand pregnancy and postpartum. Here is how to choose a perinatal therapist.

What therapy can't do

It can't change other people

Therapy won't make your partner do more dishes or your in-laws stop commenting on how you feed the baby. What it can do is change how you respond: clearer boundaries, asking directly, and putting down responsibility for everyone else's feelings. That often changes the whole dynamic, but the work is yours.

It can't replace sleep, childcare, or help at home

If you are running on three hours of broken sleep with no one to hand the baby to, therapy can help you cope and help you ask for support. It can't create the support. Sometimes the most useful thing we do in session is make a real plan for getting you one hour a day that is yours, to nap, shower, walk, or read, and then figure out who is going to cover it.

It isn't always enough on its own

For mild to moderate depression and anxiety, therapy is often enough. For more severe symptoms, therapy plus medication tends to work best. I don't prescribe, so medication decisions belong with your OB, primary care doctor, or a psychiatrist, and I'm happy to work alongside them. I wrote about the medication questions moms ask most.

It isn't emergency care

It isn't instant

Most moms I work with notice real change within the first several weeks and feel substantially like themselves within a few months. Usually we meet weekly for the first eight to twelve weeks, then every other week or monthly as things get better. The first session or two can feel like a lot because you're finally saying things out loud. Here is what a first session is like.

How to tell if therapy is working

You should feel, within a few sessions, that your therapist understands what being a new mom is actually like and that you can tell them the hard stuff without being judged. Over the first couple of months, you should notice changes: a little more sleep when you have the chance, fewer spirals, a little more patience, a few more moments where you feel like you again.

If that isn't happening, say so. A good therapist wants to know and will adjust. And if the fit is wrong, it is okay to try someone else. I'm often the person moms come to after another therapist didn't work out, and one bad experience doesn't mean therapy can't help you.

Working with me

I'm a licensed clinical psychologist, a certified perinatal mental health specialist, and I work with moms through pregnancy and the years after a baby. I use CBT, interpersonal therapy, and psychodynamic work, plus ERP and I-CBT when intrusive thoughts are part of it, and I'm happy to coordinate with your OB or prescriber. I see moms in Austin or on video, and babies are always welcome in my office.

You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.

The first step is a free 15-minute call. Tell me what has been going on, and I will tell you honestly what I think would help.

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