If Mama’s not happy then nobody’s happy: Preparing for pregnancy with a mental health diagnosis

by Lisa Everhart, DNP, APRN, PMHNP

Hey, babies happen! Having a mental illness doesn’t mean pregnancy should not or will not happen for you. And having a pregnancy doesn’t mean sacrificing your mental wellbeing for baby’s wellbeing. Untreated mental illness increases risk for multiple maternal and newborn problems, so your mental wellness matters now more than ever (Hardy & Reichenbacker, 2019).

What can you do to promote smooth sailing through pregnancy, delivery, and beyond? Consider the

checklist below:

• Start taking a daily folic acid supplement now.

  This is the single most important step you can take to prepare for a healthy pregnancy. Folic acid is essential for closure of the neural tube that will develop into the brain and spinal cord and eventually the baby’s entire nervous system. It is complete before most women know they are pregnant. The recommended pre-pregnancy folic acid dose of 400 micrograms (mcg) a day can be taken as a single supplement or as part of a multivitamin. Already pregnant? Bump your dose to 600 to 800 micrograms (mcg) a day. Any prenatal vitamin will cover this dose. Your OB/GYN, fertility, or mental health provider may recommend a higher dose in certain cases, but if you are unsure, start with the typically recommended dose.

• Plan if you can.

With any existing health condition, a planned pregnancy allows time to optimize health and manage risk for pregnancy complications. There are a range of contraceptive options that are effective, and reversible when the timing is right. If you are not planning a pregnancy in the near future, start your folic acid supplement anyway and see your primary care or OB/GYN provider to discuss contraception.

• Check in with your mental health provider.

Mental health symptoms tend to wax and wane with hormonal, physical, and life role shifts during pregnancy and postpartum periods. Fertility treatments will affect symptoms too. You and your mental health provider will want to review your medications to ensure they are optimized and safe to continue with pregnancy and breastfeeding. For the at-home health researcher, there are reliable summaries of fertility/pregnancy/breastfeeding risks for specific medications and conditions at https://mothertobaby.org/fact-sheets/

• Check in with your primary health provider or OB/GYN.

  Untreated conditions like high blood pressure, diabetes, and autoimmune disorders can lead to serious complications for moms and babies. Your primary care or OB/GYN provider can offer screening, interventions, and non-psychiatric medication adjustments to promote your best state of health for pregnancy and birth.

• Discuss substance use habits with your providers.

  Whether prescribed, over the counter, natural, legalized, or otherwise, all substances carry a level of risk for unwanted effects. An open discussion about all substance use will help us create your safest plan for pregnancy. Your providers will collaborate with you to determine your readiness for help with cutting back or quitting potentially harmful substances and prepare for specific interventions if complications arise.

• Check in with your therapist.

  We all have skeletons in our closets and pregnancy, birth, and parenting have sneaky habits of inviting them out. Studies show that Adverse Childhood Experiences (ACEs) increase risks for physical, mental, and substance use disorders in adults that can impact pregnancy outcomes (Felitti et. al., 2019). There are interventions that can help you address past trauma and bolster your resilience against the potential effects of ACEs. If you are interested in learning your ACEs score, take the quiz here! To learn more about steps you can take to support healing from a traumatic past check out “Healing from a Dysfunctional Childhood.”

Your therapist is the best person to help you sort through the good, bad, and ugly parts of your past and navigate the bumps on the road to becoming a parent. Our intake staff at Forward can help connect you with one of our excellent therapists who may be a match for your needs. Missed the planning stage? It happens to the best of us! Your primary care, OB/GYN, and mental health providers are here to help with that too. If you check in with an “I’m pregnant, now what?” appointment we are happy to work with you to optimize pregnancy/postpartum wellness from any starting point.

References

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M. Edwards, V., ... Marks, J. S. (2019).

Reprint of: Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 56 (6), 774-786. DOI: 10.1016/s0749-3797(98)00017-8 Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactation. Archives of psychiatric nursing 33 (3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

A better you: the benefits to seeing a life coach

Life Coach

EVERY goal is within reach with a bit of help from a trained guide like Purpose and Life Coach Lauren Baker, pictured above!

The pressures in our society today seem to engrain within us that finding passions and reaching success is the most important part of life. People are expected to work hard and become successful without any help, and feelings of deep shame arise when one feels lost in the journey to success. In reality, it is extremely difficult and maybe even unattainable to figure out one’s purpose in life and know what the steps are to reach goals without any help at all. Whether it be career goals, relationship goals, or even just an ambiguous goal of wanting to feel better about life, it can feel daunting to know where to look to begin moving forward.

Finding help is especially difficult for people who are not dealing with a mental health issue which requires a therapist or counselor. The good news is there is a whole realm of coaches who work with clients with these exact goals in mind. Life Coaches have the training and knowledge needed to guide clients through the recognition of goals and aspirations in life, and how to best go about attaining those. Read more to learn how a Life Coach is the catalyst for reaching success, with information from Purpose and Life Coach Lauren Baker, M.Ed, LMSW.

Lauren likes to consider Life Coaches the “personal trainers” for life goals. They teach clients how to improve ways of thinking and provide techniques for living a more purposeful life to people who do not feel like they have mental health issues. Most people who see Life Coaches have a specific issue they are struggling with- like wanting to change careers, resolving conflict in the work space, hoping to break a pattern in relationships, or looking to analyze weak areas in thinking/lifestyle choices.

Life Coaching is typically more short-term than therapy, with clients experiencing progress within an average of 6 sessions. The sessions are short and easy to fit in, typically lasting only 45 minutes. They provide clients a space to visualize, recognize life goals and identify the limiting beliefs and actions keeping one from reaching them. After choosing those goals, Lauren helps provide the education needed to make those next steps. The Coaching process continues outside of the session- with homework, outside reading, and exercises to continue reaping the benefits of the session in between (and for the rest of the client’s life).

Seeing a Life Coach at least once in life is the most helpful thing many people may do for professional and personal success. The Coach not only helps clients work through current issues, but also provides knowledge about how to apply what is taught outside of the coaching sessions, too- meaning when other problems arise in months and years after meeting with the life coach- the client has the knowledge needed to best address that problem.

Whether it be finding the courage to ask for a promotion, figure out a career path, or a general feeling like there is an internal struggle keeping one from reaching their best self, a Life Coach is the guide who can lead the way to full success, self-actualization, and identification of limiting beliefs that cause repeated negative patterns,

To book a session with one of our awesome Life or Success Coaches like Lauren Baker, click the button below or fill out a contact form on our site at forwardcounseling.com/contact

The Benefits of Play Therapy for Children

Calvin’s Play Therapy Room at our location in Jackson, Tennessee

Parents aim to raise children to make the best choices in life, while also giving them the room to grow and make mistakes without judgement. Sounds easy? You’re not alone if your answer is a resounding “NO!” Regulating emotions and behaviors can be especially difficult with children who are not old enough to understand their emotions.

Finding the middle ground between discipline, guidance, and acceptance can be one of the most difficult yet important things you do for your children. Play therapist Calvin Clark is trained to help children realize they are equipped with the ability, knowledge, and confidence in their internal locus of control to be able to independently make the best decisions possible in life, and ultimately become an amazing adult who makes the world a better place.

Play therapy is a therapeutic approach that utilizes games and play to provide a safe space for clients to express feelings and explore behaviors, thoughts, and experiences (Landreth, 11). Typically before age 12, children are not yet equipped with the words and skills to fully express themselves in a typical talk therapy environment, like an adult can. Play therapy utilizes the language children already know; play.

Clients are encouraged to spend the sessions doing whatever they may wish to do at that moment; some kids like to play a board game, with a sand tray, wooden blocks, a doll house, or a punching bag. Purposeful play allows creativity and imagination to be the door through which children can walk through and reflect on their experiences and emotions.

In the playroom, the first session is with the parent/guardians to discuss the family history and create an individualized plan for treatment. Calvin is open to providing suggestions to help equip parents who may be working on developing their personal parenting styles, as well. Calvin explains how he creates a safe space in the playroom which allows even the most apprehensive of children to process emotion, gain confidence, and realize their true power.

Calvin opens the floor to whatever the child wants to do at that moment and encourages risks, exploration, and discussion of behaviors. He utilizes recognition of behavior patterns and the way a child may interact with him while they play. For example, take a child asking questions they may seemingly know the answer to- in the playroom, that may be as simple as a child verifying with Calvin if a toy they have is green.

“Children often question what they already know to be true, to verify if their perception is reality.” Calvin will often reflect the question back to the child to validate that they are equipped with the correct answers. By equipping children with the ability to stop questioning themselves and looking to the outside world for validation, the growth of a healthy individual is fostered. Calvin has the belief that children already have everything they need internally to process and move through difficult experiences. His role as a provider is as observer, affirmer, reflector, and creator of the safe space through which one can use their creative, playful minds to best grow.

Play therapy is a useful tool for helping children recognize positive and negative actions and behaviors. Negative behavior is not the sign of a bad child but the sign of a child dealing with emotions, thoughts, feelings, and adverse experiences which need to be explored. With Calvin, the therapy session is not punitive in nature. Negative seeming behaviors will not be shamed, but explored, in order to analyze the symptoms and encourage the healing of the underlying cause of those actions.

Children may try to test limits, and Calvin explains a great way to set the limit is by using Landreth’s “ACT” method: acknowledging the intention of the action, communicating the limit, and targeting an acceptable alternative. Every child has the ability within them to recognize positivity and replace behaviors.

Children behave in a way that gets their needs met, and they can often recognize when a behavior is no longer of benefit to them. When a behavior is in need of being changed, limits are set and an alternative behavior is introduced. By helping kids realize they have the power to make a different decision, and the power to make the BEST ones, life is improved. Calvin provides an example of utilizing the ACT method with a kid who is acting out by hitting. Utilizing the “ACT” method in session, Calvin would:

Acknowledge the feeling: “I can see that you’re really frustrated right now.”

Communicate the limit: “but I am not for hitting.”

Target an acceptable alternative: “If you want to hit something, you can choose to hit the bop bag or a stuffed animal.”

Whether it be at home or at school, we want to equip our children with the knowledge that they are capable of making choices and decisions that are in their best interest.

Choosing which type of therapy is best for you or your child can be daunting. Reach out to us at forwardcounseling.com/contact and our trained intake specialists will help you find the best fit for you and your children. Play therapy and typical talk therapy can both be useful in adolescents. Play therapy and the creation of a safe space to explore emotions, feelings and behaviors fosters the realization in children that they are powerful, amazing individuals with the creativity and self management to grow into a wonderful, happy, and fulfilled individual who helps make the world a better place for all.

Calvin Clark is available for sessions at our location in Jackson, Tennessee!

For more information, visit: https://cpt.unt.edu/what-is-play-therapy

For parenting resources, visit https://www.parentingpurposefully.com/

Sources:

The Art of the Relationship (3rd ed.), Landreth (2012) defined child-centered play therapy.

Center for Play Therapy. (n.d.). Retrieved from https://cpt.unt.edu/what-is-play-therapy

by Alex Williams, Office Manager at Forward Counseling

AFRICAN AMERICANS & MENTAL HEALTHCARE: Silence, Stigma, Barriers, and Disparities

Do African Americans shy away from mental healthcare?  Or, do we fail to see the underlying issues that keep African Americans from seeking and obtaining the care needed for mental health?  We must continue to shed the light on the silence, stigma, barriers, and disparities within the black community.

WHY THE SILENCE?

Being of the African American community, it was very taboo to speak about seeing a therapist when I was growing up.  I know firsthand that the silence may come from shame, fear, or avoidance of having a stranger pry into your family’s vulnerabilities and trust.  The silence may also be a result of relying solely on one’s faith and spirituality.  We must also consider that silence may derive from the unknown, misunderstandings, and not being properly educated about mental illness.  According to the National Alliance on Mental Illness (NAMI), “Many African Americans have trouble recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions” (NAMI, 2019). 

WHISPERS OF STIGMA

Stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person”. Stigma clouds the reality of mental illness.  In the black community, stigma is like a dark cloud that carries bolts of never-ending thunder and lightning.  Research by NAMI in 2018 indicated more than 6.8 million African Americans who were diagnosed with mental illness were not able to escape the negativity of stigma within the black community (Baoku, 2018).  As a result, this stigma leads to shame, isolation, self-medicating, masking mental health conditions, and avoiding professional help (Baoku, 2018).  African  Americans from generation to generation were taught to be strong, to overcome, and to stand on their spiritual faith, not realizing whispers of stigma have been a strong-hold against professional care.  While resiliency is being birthed and developed in the black community, many are still suffering in silence under the shame of stigma.

BARRIERS UPON BARRIERS & DISPARITIES

Barriers that we cannot ignore are systemic barriers. Systemic barriers can oppress the mind from believing help is possible, can oppress one’s willingness to seek needed help, and can oppress one’s soul from the hope of healing physically, socially, emotionally, and mentally.  Multiple barriers lead to disparities.  There are multiple types of barriers, such as: historical, economic, social, political, environmental, and psychological, which all put African Americans at a disadvantage (Hackett, 2014).  Historical barriers are a result of oppression, racism, colonialism, and segregation, which have a lingering traumatic psychological and emotional effect on the African American community (Hackett, 2014).  The historical barriers lead to cultural and medical mistrust between African Americans and healthcare professionals – they may not be able to relate interpersonally to the same types of social and health disparities experienced in the black community, which affects the communication for proper services, correct diagnoses, and treatment (Cuevas, 2013).  Also according to NAMI (2019), “African Americans, like many minority communities, are also more likely to experience socioeconomic disparities such as exclusion from health, educational, social, and economic resources. These disparities may contribute to worse mental health outcomes” (para 3).

ADVOCATE FOR CHANGE

Silence, stigma, barriers, and disparities all distinctively contribute to African Americans’ disadvantages and lack of mental healthcare.  What can we do in our communities to bridge and close the gaps for all minorities regarding mental health?  I have heard time and time again that it starts with a conversation, but the conversation must not remain stagnant.  I believe there must be a fluid conversation—one of advocacy that leads to action and change.  We must come together, crossing communities, to see beyond race and ethnicity.  We must cross social and economic statuses and begin to see the human being who is suffering in silence and shame.  We must embrace all individuals and families with a heart of healing towards improving the mental, emotional, and social well-being of all communities.

Written by Terkessa Frison, MSW Intern

References

Baoku, H. (2018, July 27). Challenging Mental Health Stigma in the Black Community. Retrieved from https://www.nami.org/Blogs/NAMI-Blog/July-2018/Challenging-Mental-Health-Stigma-in-the-Black-Comm

Cuevas, A. G. (2013). Exploring four barriers experienced by African Americans in healthcare: Perceived discrimination, medical mistrust, race, discordance, and poor communication (Doctoral dissertation). Retrieved from https://pdxscholar.library.pdx.edu

Hackett, J. R. (2014). Mental Health in the African American Community and the Impact of Historical Trauma: Systematic Barriers. Retrieved from http://sophia.stkate.edu/cgi/viewcontent.cgi?article=1322&context=msw_papers

National Alliance on Mental Illness. (2019). African American Mental Health. Retrieved from https://www.nami.org/Find-Support/Diverse-Communities/African-Americans