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Appendix - Reproducible Client Worksheets

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Track 1 Symptoms and Factors
I have found that certain women are at great risk if they present the five following characteristics.  These symptoms include:

  • Previous psychological troubles
  • Postnatal depression after a previous childbirth
  • Heredity, such as a mother, aunt or sister having postnatal depression.  In addition to a genetic predisposition, I have found that women who have seen their own mothers suffer from depression may be more prone to depression themselves.
  • A bad experience during fertility treatments
  • A difficult pregnancy.

Track 2 When a Woman Becomes a Mother
Technique: Icing on the Cake
When women express to me a desire for their partners to apologize more often, I suggest that they try the "Icing on the Cake" Technique.  I state, "Try asking for what you want, and be specific.  You might start out by saying, ‘I’d like you to apologize.  It’s important to me.’  Of course, knowing what kind of an outcome you want, what’s most important to you, and what’s realistic is not always easy."  I explain that the wishful thinking part, the ‘It would be nice if he’d say…’ part gets in the way.  I call this "the principle of cake and icing."  I state, "The cake is the solid part, the act of clearly stating how your partner may have wronged you.  Eliciting an apology is like the icing, and it may not always be realistic to expect.  You may never get an apology from your partner for certain things."  If someone feels so strongly about something that he or she doesn’t want to apologize for it, I state, "You might consider saying that you’re sorry that the situation occurred, or that you hurt his feelings, even if you’re not sorry for what you actually said."

Track 3 When a Man Becomes a Father
Technique: Easing the Father’s Fears
If a new father feels left out or abandoned, I suggest that the woman try the "easing the father’s fears" technique.  I have found that a few simple gestures can ease the tension and show the father that there is room for everyone.  A few gestures that I suggest include trying to talk about something other than the baby, agreeing to go out once in a while without the baby and planning a weekend getaway in the future.

Track 6 Unplanned Pregnancy
Technique: Acceptance
Reesa expressed concern about parenting her toddler, Sarah, considering she was so overwhelmed with her own feelings.  Reesa asked, "How can I take care of Sarah if I can’t even take care of myself?!  Riley rejected her at the same time that he rejected me!"  To help Reesa feel more in control as a parent, I suggested that she try the acceptance technique.  I stated, "You may want to validate Sarah’s feelings about Riley’s absence too, and also continue to encourage her to express her feelings."  I explained to Reesa that helping Sarah accept the situation meant recognizing and respecting the differences between her needs and Sarah’s needs.  I continued to explain that by letting Sarah develop a well-defined sense of self, with good personal boundaries and self-esteem, she could develop a sense of her own emotional and physical space that could be carried into adulthood.  Reesa asked, "How can I take steps to help Sarah develop her sense of self while I’m going through this?"  I stated, "You can continue to offer Sarah your love, patience, understanding, empathy, praise acceptance, and a sense of self-worth.  You can continue to give Sarah opportunities for learning and mastering skills and provide her with a true standard of reality.  You can accept who Sarah is as an individual and encourage her expanding independence.  Last of all, you can help to prepare Sarah for life, instead of protecting her from life."

Track 14 Postpartum Dads
Technique: Ten Reassurances and Advice
The following are ten reassurances and advice that I give the partners of women suffering from postpartum depression. 

  1. I state, "Your partner’s illness is treatable.  Don’t be afraid of it."
  2. I state, "Don’t be impatient with the treatment process."  I tell fathers that it may take weeks if not months for their partners to recover.  I explain to them that women may be irritable or depressed, have crying spells and be unpredictable.  I tell fathers that these symptoms are to be expected but that postpartum depression can be overcome.
  3. I state, "You may need to go with your partner to the doctor."  I explain to fathers that a woman may find it difficult to communicate openly and properly, not because she doesn’t want to, but because her depression can negatively impact her ability to do so.
  4. I state, "Don’t let your partner discontinue treatment."  I explain to fathers that once the acute phase of a woman’s depression is over, she may be tempted to stop her medication or treatment.  I encourage the partners of these women not to let this happen.  In fact, the woman may have to continue treatment for many months after the acute episode is over in order to avoid a relapse.
  5. I state, "Don’t try to ‘talk her out of’ the depression."  I encourage fathers to remember that depression is a disease.
  6. I encourage fathers to try to keep their own emotions in check, as difficult as it may be.
  7. I state, "Try to avoid statements such as ‘You look a bit down today; have you taken your Prozac?’"  I explain to new dads that these kinds of comments may only make the woman feel worse.  I encourage fathers to remember that people who don’t understand depression may look upon those who are depressed as "crazy." The woman may already feel that way, and I encourage men to be supportive.
  8. I state, "Don’t be shy about asking for support from other members of your family."
  9. I state, "If your partner is feeling acutely suicidal or homicidal, or you feel that your baby or other children are in danger because of her illness, take her to the nearest emergency room and have her admitted."
I state, "The good news is that your partner will recover."  Last, I reassure fathers that their partners will come back and be mothers and partners to them, and I encourage men to hang in there.
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