Dr Emma Haynes

Perinatal Psychotherapy

Welcome to my blogspot

I have chosen to set up a blogspot on my website as I often get asked about various newspaper articles, how I feel about new research, what is going on in the psychotherapy and counselling world, etc. I aim to bring a new topic each month and I value feedback and dialogue, so if anything touches one of your buttons please contact me at emmafhaynes@aol.com.

The most recent blogs are at the beginning and the older ones are further back. During the 5 years of my PhD between 2014 and 2019 I had virtually no time to write on here. My aim is to begin to add a little more content as and when a particular subject hits a raw spot!


Why Relational Psychotherapy for Perinatal Mental Illness?

I am a TA psychotherapist, from a humanistic, relational background. The most crucial aspect of my work as a psychotherapist is to listen and truly hear the narratives that my clients form about their experiences and my work is focused on helping my clients to interpret these experiences and the meaning and context attached to them. I work primarily as a relational Transactional Analyst, meaning that the relationship between myself and my clients, and my clients’ relationships with themselves and others, past and present, is at the core of my clinical work. Relational TA as a theoretical model puts the deficit, or dysfunction within interpersonal and intrapsychic relationships in the primary position, within the treatment focus.

No matter what my client brings, distress and fear will be key components. The most important aspect of my work is to help clients to reduce their distress. I am passionate about teaching people to regulate their emotions (affect regulation). Most often this is the element I find missing within my client’s learning. If I think about a distressed child, that child cannot regulate itself without first learning self-regulation from its caregiver. A baby cries for very good reason. In those very first weeks of life there are only two states for a baby – distress (crying) and no distress (asleep). A baby does not know what is going on in itself when it is born, it only knows it has a pain (hunger, tummy ache, dirty nappy, wind). When the baby is attended to, and its needs are recognised, it can settle and go back to sleep. It is totally and utterly reliant on the (m)other to attend to it and our role as its caregiver is literally to regulate that baby’s emotions.

From the moment of conception, pregnant women are in relationship with their fetus. For some women, this relationship may form even prior to conception, particularly if there has been difficulty in the conception of the baby, or it has been conceived through in vitro fertilisation. This relationship continues through birth and life, until there is a rupture. A woman experiencing perinatal mental illness may be struggling with this relational aspect. It may even be the baby itself that is seen as the cause of trauma, particularly if a woman experienced a highly traumatic birth. Therefore, it makes absolute sense to me that the way to help and heal this type of illness is through the relationship. Helping to forge a good enough relationship between myself and my client, so that she can take that model into her own relationship with her baby. The transition to motherhood can be very difficult and disturbing for some women. This period is mired with uncertainty, the unknown, as well as huge cultural, societal and familial expectations about the birth and the baby. Using curiosity and creativity, my work is to enhance a woman’s ability to engage, attach and bond with herself, her baby and her wider family and friends.

My work as a clinician is with all sorts of clients. However, one of my specialisms is focusing on clients who have been diagnosed as having mental illness in the perinatal period. I use the term ‘mental illness’ because motherhood can be a time of many different types of mental illness, although the media and NHS seem to focus mainly on postnatal depression which I find frustrating and also quite baffling. I work with clients experiencing anxiety, distress, stress, psychosis, Tokophobia (extreme fear of childbirth), Hyperemesis Gravidarum (extreme sickness in pregnancy), birth trauma, IVF, miscarriage, stillbirth and infertility. Basically, I work with any aspect causing distress to the woman in front of me. I see men, couples and adoptive parents too if they are struggling. I work in private practice and these clients can self-refer or alternatively are referred via a doctor, or health practitioner, such as a midwife or health visitor. Many of my clients tell me they have struggled to gain any kind of treatment for their distress, and as such have turned towards the private sector for help. I use TA psychotherapy in my work with my clients and I find it a useful form of treatment. I believe there are elements in TA theory, particularly within relational TA theory (Cornell & Hargaden, 2005; Fowlie & Sills, 2011; Hargaden & Sills, 2002), as well as Co-creative theory (Summers & Tudor, 2000) and Transgenerational Scripting (Noriega, 2004), that are particularly useful and valuable in increasing a women’s understanding of her distress. Relational TA theory also highlights the importance and value of a mother’s bond with her infant, the importance of conscious and non-conscious patterns of relating and experience, the importance of the relationship, its co-creative nature, and the importance of the mother/father/caregiver in modelling behaviour both explicitly and implicitly within the infant/parent bond.

I continue to research TA because I find it to be a useful model of therapy. I am always curious to hear how women experience TA as a treatment option and whether it may be suitable for future adaptation into a protocol for this client group, which could be used in the NHS and elsewhere. I believe it is important to listen to, hear and understand the experiences and perceptions of women affected by this condition, as these seem to differ from the medical and biological attributions that women continue to be given.

I am also absolutely passionate about working with the uniqueness of my client. No client is ever the same as another. Each client I see gives me their story, their experience, their emotion. It may be similar to another, but it is never the same. So treating each of my clients as an individual and addressing their needs, rather than trying to fit them into some medical box, is the way I find my clients can shift and change most quickly.

Perinatal Mental Health in Hampshire

This is an area I am passionate about. I have chosen to research psychotherapy as a treatment option for perinatal mental health difficulties for my PhD. This is because there are few options open to women with this truly awful condition, here in Hampshire. I work with women who suffer from depression, stress or anxiety in the perinatal period and in my experience, psychotherapy can be powerful for these women and can help them transform their relationship with themselves, as a mother, and importantly with their infants, as well as with their partners and/or other family members. For me it is one of the most important areas of specialism because it can have such a profound impact on so many, not just the mother and her infant, but the wider family and on society as well.

I want psychotherapy to be viewed as an alternative treatment option, and as I am a TA psychotherapist I do believe this type of psychotherapy works really well with perinatal mental health as we work with the relationship, with transgenerational scripting (a TA version of epigenetics that has been around for an awfully long time), with scripts we carry through our lives, with Parent, Adult, Child ego states, with so much that really features for women with these difficulties, helping them to let go of those messages which prove to be unhelpful in the transformation to motherhood. I really enjoy helping women find a happier place within themselves that allows them to be less critical of their own mothering and who they are as a mum, to be able to enjoy those elements of being a mum which are so precious. Helping them to understand that this baby is actually a living being who is growing up and will be an adult themselves, and is a clever little thing, learning and discovering new things each day, even as a tiny infant.

It is so hard being a parent. Society seems to only talk about the joy of being a mum. There is also a continuous myth put about that women know how to be a mother just because they are women. This puts an enormous strain on women, not only do they think they should know instinctively how to parent, but they also want to be the perfect parent too (whatever that might mean). We don't know instinctively. For many of us it is a steep learning curve, full of unknowns. Just learning to cope is exactly that, a learned skill. All of it is learned. And no wonder it is so full of anxiety. We are fearful we are doing the wrong thing, that we will damage our babies in some way, that we will be judged by others because our baby cries, etc. And where can we go for help? There is little help out there, and what help is provided is often short term, quick fix, medication, or has a hugely long waiting list.

I work long term with mums (and dads, they get mentally unwell too) helping to unpick the societal, familial pressure to be the perfect mum. Working instead towards being a functioning, loving, happy unit of mum, partner, baby and family, in whatever way this presents itself.

Do you value your own mental health?

Are you happy to purchase a gym membership and not use it (ever?), or slimming aids and promptly put the weight back on a few months later, or perhaps you enjoy buying magazines telling you how to lose weight, get fit, or feel happy only to find it gathering dust on your coffee table?

What about all those self help books that might be lurking on your bookshelves? Ever opened them or read them, got past the first two pages? Or, is the hope that you will magically change simply because the book is now owned by you?

Do you yearn to feel less depressed, to have a better relationship or marriage, to give up smoking, drink less alcohol, lose weight, engage more with your children, if only …….? My hunch is that you wouldn’t be reading this blog if you didn’t.

So I could preach to you just in the way that some people do. Or I can attempt to get you to think a little more about the value you place on various parts of your life and most importantly (in my mind) your psyche, your mental health.

So, a few questions to think about over the next few days or weeks –

- What is more important to you? Your mental health or your physical health?

- Do you think that feeling low, anxious or fearful is a normal state of affairs and you should just get on with it, that it shows weakness to seek help?

- How would you value a permanent positive change in a part of your life or a change in behaviour? Is it possible to value this?

- Are you happy to bump along continuing to spend money on the fantasy of changing your life and never actually doing it?

There are no right or wrong answers, by the way, and this is not to catch you out. The only answers are truthful ones, truthful to you, that is.

In my mind behaviour is very important. We can talk for years about what we want to change, we can moan to our friends, we can blame others for stopping us changing. We can keep on walking down the same old road and falling into the same old hole. And we can choose to do something different. I think you are worth it, but more importantly, do you?

Post Natal Depression

I became really interested in PND when I spent time working in an in-patient mother and baby unit as part of my Mental Health Placement for my Masters. This interest has continued onwards and I am now about to embark on a PhD at Salford University and my aim is to research the effectiveness of TA Psychotherapy in the treatment of PND. I believe it is really effective, I know it works and my hope is to be able to prove this, so that TA Psychotherapy, in fact any professional Psychotherapy, can become the treatment of choice within and without the NHS. At present there is so little help for this condition yet it affects not just the sufferer, but also the family and most importantly the baby. At present the belief is that the effect on the baby will be lifelong. Neuroscience may be able to prove this shortly. My wish is to reduce the statistics, to "plug the gap" using the term coined by the NCT in July 2014 in an article published on the BBC website.

I offer psychotherapy for this distressing condition and this can be on a one-to-one basis, or with partners if that is more suitable. I see mums even prior to the birth of their baby, especially if they are beginning to struggle in pregnancy. I have also seen mums who have suffered from PND with a previous baby and want to have a second (or third), working with her prior to the pregnancy, if possible, and through the birth and afterwards, supporting the mum in whatever way she needs. I am a relational psychotherapist so the relationship is the most important aspect for me with my clients. This can mirror to a mum the relationship she could have with her baby, which can be particularly helpful for some mums who have had dysfunctional parenting and want to do it differently with their own children. But even if the parenting was good enough, I believe the relationships we build with others are fundamental to our own mental health and wellbeing. So it is within this relationship that the distress can be reduced, the deeply disturbing thoughts and feelings can be explored and the healing process can begin.

Of all the placements I have undertaken this was by far the most rewarding. Not only was it about treating the deep depression and disturbance but also many of the mums (and dads) were struggling to bond with their babies. In such a stage of deep depression some of the mums struggled even to hold their babies to feed them, let alone cuddle them and begin to develop their relationship that is so fundamental to the baby's development. Most of these parents didn't understand the need for this bonding and therefore by beginning to develop a relationship with these parents and helping them to understand their babies and how sensitive they can be, I was able to encourage them to begin the bonding phase. I was deeply moved by the response from some parents, in particular a couple with twins. The mother was really struggling with her baby daughter, translating the baby's head turning as rejection of her (the mother). By teaching that some babies become overwhelmed and can turn their head away, but that it is not rejection, this mum's experience of her baby literally changed immediately. The mum became much more sensitive to the baby, and tried not to overwhelm her, and in return the baby responded to the mum, returning her gaze, allowing the mum to connect on a deep, visceral level with her. That mum was shortly able to be discharged from the unit, with the beginnings of a healthy bond towards both her babies. A fantastic outcome for both parents and babies.

Couples therapy - Why won't I see couples separately as well for one-to-one therapy?

This is a question that I get asked about quite a lot. If I see someone on a one-to-one basis and then that person wants me to see them as part of a couple, I will always say that this is impossible. Also, if I see a couple, I won't be able to see one of the couple on their own and then go back to seeing them as a couple.

There are many reasons for this on a personal, professional and ethical basis. When I see a client I am there totally for that client. They often share a great deal of very personal information, quite often about their own relationships. To then see that person as part of a couple would feel unprofessional and unethical to me, because I would know about the "other" in the relationship from the clients perspective only, without that "other" really knowing what I do and don't know. This causes tension within the therapy and within the couple as often there can be an unconscious feeling of anxiety, "what does she know?", "what has she heard about me", "what does she think about me, when she doesn't even know me?". When I see a couple I want to experience them together, to find out how they relate to each other and also to me. This is really important for me as then I can begin to discover why the couple may be struggling in their relationship. We begin all three of us together, I then hear what both of the couple have to say, knowing that every person in the room knows what everyone else has said about them and about their relationship. This reduces the potential for misunderstanding and assumption, both of which play a large role in relationship difficulties.

Everyone is in the "know" then, we all know what the other has said and what concerns they have expressed, which allows there to be a semblance of a level playing field.

Equally, if I see a couple together and then go on to see one of that couple on their own, it would not be right for me ethically to see the couple together again, for similar reasons as above.

I know that some counsellors and therapists do not share my views. These are personal to me and may not be held by others. This is the way I choose to work. I find that psychotherapy works when there are boundaries, and those boundaries are held and not crossed. Particularly couples psychotherapy, where boundaries between the couple may be crossed and muddied. For me, this is exactly the reason why I choose to hold such boundaries. Then everyone within the therapeutic relationship knows where they stand. For me, this is a necessary starting point from which to move forward with a couple experiencing difficulties.

A good relationship is life enhancing and nourishing.

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