Perinatal Mental Health and OCD

Summary

Breaking the Rules: A Clinician's Guide to Treating OCD

Episode: Perinatal Mental Health and OCD
Hosts: Dr. Celin Gelgec (B), Dr. Victoria Miller (C)
Date: December 1, 2025

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Episode Overview

This episode explores the unique challenges and approaches involved in treating Obsessive Compulsive Disorder (OCD) during the perinatal period. Dr. Celin Gelgec and Dr. Victoria Miller discuss the vulnerability that new and expectant parents face, how OCD can capitalize on this, and how clinicians can provide meaningful, compassionate, and effective support during this critical time. They focus on clinician self-awareness, psychoeducation, practical planning, and the importance of creating a collaborative and nonjudgmental therapeutic space.

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Key Discussion Points & Insights

1. The Vulnerability of the Perinatal Period (02:22 – 04:45)

• The perinatal period (before and after birth) is an especially vulnerable time for both mothers and fathers.
• OCD can "love that vulnerability," often seizing on the major changes and anxieties around parenthood.
• Not just postpartum, but conception and recovery periods are all considered high-risk for OCD flare-ups.

Notable Quote:
"OCD just bloody loves that vulnerability." – Dr. Victoria Miller (03:09)

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2. Therapy Experience: A Dividing Line (04:45 – 07:26)

• Clients with prior therapy experience are generally better equipped to recognize and articulate OCD symptoms if they emerge during the perinatal period.
• Those without previous therapy often feel more blindsided and face increased difficulty identifying and disclosing intrusive thoughts.
• Time pressure (upcoming birth) intensifies the drive to “fix” issues quickly.

Notable Quote:
"It hits them harder... it's more difficult for them to understand what it is they're experiencing and why, while there's this enormous pressure which is: baby is coming, or baby is here." – Dr. Victoria Miller (06:12)

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3. The Nature of Intrusive Thoughts & Barriers to Disclosure (07:44 – 11:27)

• Intrusive thoughts in new parents can be extremely distressing (e.g., harming the baby, contamination, or sexual themes) and are often accompanied by intense shame.
• Clients may lack the language to distinguish between intrusive thoughts and intentions, leading to increased fear, secrecy, and self-stigma.

Memorable Moment:
Examples of harm thoughts:

• "I'm having intrusive thoughts about just smashing my baby's head against the counter every time it cries..." (08:10)
• Highlighting the importance of clinicians normalizing distressing thoughts to reduce shame and encourage disclosure.

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4. Psychoeducation and Building Safety (11:27 – 12:27)

• Early, overt psychoeducation is crucial—prepares clients for possible symptoms and normalizes the experience.
• Building trust ensures clients feel safe to share their distress without fear of judgment or repercussions.

Notable Quote:
"We can offer a lot in terms of providing psychoeducation about what to expect and what is okay for them to tell us." – Dr. Victoria Miller (10:48)

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5. Dealing with Shame and the Importance of Open Dialogue (12:33 – 14:24)

• Even with strong rapport, shame around perinatal OCD can inhibit clients from disclosing new or deeply stigmatized symptoms.
• Clinicians must actively invite discussion about these experiences rather than waiting for clients to bring them up.

Notable Quote:
"The more rapport you have, the more afraid your client will be sometimes to bring stuff... there's a bigger vulnerability there." – Dr. Celin Gelgec (14:07)

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6. Clinician Self-Reflection and Managing Internal Reactions (14:25 – 16:28)

• Clinicians must be aware of their own biases, discomfort, and reactions to confronting intrusive thoughts—clients are intuitive to these cues.
• It's crucial to be "alert but not alarmed" and understand the ego-dystonic nature of OCD.

Notable Quote:
"...the phrase you use is 'alert but not alarmed'." – Dr. Celin Gelgec (16:09)

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7. Proper Assessment and Avoiding Harmful Reactions (16:28 – 20:41)

• Be diligent in assessing risk, but avoid alarmist reactions that could worsen symptoms or damage trust.
• Anecdote: A previous therapist’s inappropriate response to sexual harm obsessions resulted in trauma for the client, underlining the cost of misunderstanding OCD.

Memorable Moment:
"A client... had thoughts about harming his children in a sexual way and the therapist told him to bring his wife to the next session. [The therapist said,] 'I'm concerned for the welfare of your children. You need to call the police. You need to remove your children from your husband.'... It was just intrusive thoughts." – Dr. Celin Gelgec (16:45)

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8. Practical Strategies for Perinatal OCD Care (20:41 – 27:20)

• Increase session frequency to support clients during pregnancy and after birth.
• Proactively schedule sessions around due dates and early postpartum periods—even brief telehealth check-ins can be invaluable.
• Coordinate care with medical professionals (GPs, obstetricians) to enhance support.
• Be flexible about having babies in therapy—allows exposure work and can reduce barriers to treatment attendance.

Memorable Moment:
"I love having babies in therapy. I love it. Yeah, I'm so open to that." – Dr. Celin Gelgec (23:32)

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9. Exposures and Using Real-Life Context (26:01 – 27:20)

• Including the baby in therapy sessions facilitates exposures relevant to the client’s obsessions (e.g., feeding, changing, managing fears around SIDS or harm).
• Flexibility and client autonomy: support clients’ preferences regarding bringing their baby to sessions.

Notable Quote:
"If a new parent is having intrusive thoughts about sort of pedophilic themes, harm themes, contamination themes...having baby in therapy is actually really helpful." – Dr. Victoria Miller (26:26)

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10. Building the “Village” and Sustained Support (28:01 – 30:49)

• Therapy can and should integrate both reflective space and proactive, practical planning.
• Clinicians help parents construct and maintain a support network—"the village"—before and after birth, including boundaries, connection, and collaborative care.

Notable Quote:
"That really is part of that process of creating the village around parents... help them feel supported... helping them manage boundaries, helping them manage their treatment..." – Dr. Celin Gelgec (29:08)

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Final Reflections (30:24 – 30:39)

• The perinatal period is both special and chaotic for parents.
• Clinicians have a vital role in grounding clients, offering both reflective and practical support, and navigating the complexity with compassion and confidence.

Closing Quote:
"I hope that that helps clinicians feel a little bit more grounded in what the role is... during this time and things to watch out for and spaces to take for therapy." – Dr. Victoria Miller (30:28)

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Summary Table: Key Takeaways, Moments & Timestamps

| Segment | Topic / Message | Notable Quote/Speaker | Timestamp | |------------------------|-----------------------------------------------------------|----------------------------------|-------------| | Perinatal Vulnerability| OCD loves the vulnerability of this life stage | "OCD just bloody loves that vulnerability." – C | 03:09 | | Therapy Experience | Prior therapy helps, pressure intensifies symptoms | — | 06:12 | | Intrusive Thoughts | Disclosure is hard, language often missing | — | 08:10 | | Psychoeducation | Normalizing thoughts, encouraging openness | "We can offer...psychoeducation..." – C | 10:48 | | Shame barrier | Rapport may hinder disclosure | "The more rapport you have..." – B | 14:07 | | Clinician Self-Work | Alert but not alarmed | "Alert but not alarmed" – B | 16:09 | | Mistaken reactions | Importance of assessment vs. alarmism | Client anecdote – B | 16:45 | | Practical Strategies | Frequency, advanced scheduling, medical collaboration | — | 21:04+ | | Babies in Sessions | Encouraged for flexibility and exposures | "I love having babies in therapy." – B | 23:32 | | Building the Village | Ongoing support system after birth | "That really is part of...creating the village..." – B | 29:08 | | Clinician Role | Blend reflection, direction, and care | — | 30:28 |

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Concluding Thoughts

This episode is an invaluable listen for clinicians working with perinatal populations. Gelgec and Miller deftly combine clinical wisdom, empathy, and real-world strategies—demystifying common OCD presentations and emphasizing the centrality of curiosity, normalizing, and genuine support. Their reflections on clinician self-care, collaborative planning, and advocacy for client autonomy offer listeners both reassurance and practical direction in navigating the complex, emotion-charged perinatal landscape.

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Transcript

[A]

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[B]

Hi, I'm Dr. Celine Gelgich.

[C]

And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On Breaking the Rules, we talk about all things OCD.

[B]

Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.

[C]

Catch us every fortnight wherever you get your podcasts. Hey, Seline.

[B]

Hey, Tori. What's happening? Not a lot. We find our back. Our back selves, ourselves back here again. I don't know who my back self is, but anyway. Oh, my goodness.

[C]

Interesting part of self, right?

[B]

Yeah, yeah, yeah. It's nice to be back here again. Yeah, it is.

[C]

It is. Talking today about perinatal.

[B]

Yes, yeah.

[C]

The perinatal period and ocd.

[B]

Yeah.

[C]

So for those who have listened to us before, you'll know that we've had a couple of discussions about perinatal, the perinatal period, perinatal mental health and perinatal ocd, which are great interviews that are worth going back and listening to.

[B]

Definitely.

[C]

But today we thought we'd, we'd bring it to sort of the skills episode and, and start thinking about sort of from the practicality. So, you know, we've Talked a bit in our past episodes about the complexities of the perinatal period.

[B]

Yeah.

[C]

And what it's like for new parents and how OCD just bloody loves that vulnerability.

[B]

Oh, yeah, absolutely.

[C]

But now let's talk about what it's like to be a clinician working with someone.

[B]

Yes.

[C]

During their perinatal period and with. Yeah, I love it with OCD and how to, you know, how to support them.

[B]

I love that it's such a. It is such a vulnerable time. Those. Not just the six weeks postpartum, but the whole time leading up to it. Even the idea of wanting to conceive and all that sort of stuff can feel really full on for a lot of clients and the, the recovery afterwards, but also just adjusting to parenthood.

[C]

Yes.

[B]

I think for both mums and dads.

[C]

Yeah.

[B]

Is really tough.

[C]

Yeah.

[B]

And very vulnerable. And like you said, OCD loves to hang on to that. And so what do we do when it shows up in our. In our therapy rooms? I think is a great question and one that we're going to delve into today, as you mentioned. And so I think for me, one of the things that I often find myself involved in is when I've been working with clients for a little bit and they decide to start a family or, you know, that sort of stuff. So you get to carry them on that, you know, go with them on that journey.

[C]

That's pretty nice, isn't it?

[B]

It really is. And so being able to be there with them, I often find, because it's one of the questions I get asked a lot as a supervisor, is how do people respond? Like, how intense is it in terms of therapy and treatment?

[C]

Yeah.

[B]

Is it worse? Is it easier? What's it like? What if they're already in treatment, etc.

[C]

Etc.

[B]

And so I think one of the things that I always say is I. I'm curious to hear your experience too. What I often find is if a. If a client has already been in therapy and the intrusive thoughts shift to motherhood, baby pregnancy, etc, they kind of anticipate and know what it's going to feel like and can stay on top of things. Yeah. Other times it just comes out of nowhere or unexpectedly and throws them off or presents a lot of triggers that they didn't anticipate. But I often find those that struggle a little bit more have not likely been in therapy or had an experience like that. Like, do you find that as well? Like, what do you notice?

[C]

No, I would, I would agree. I think that people who have had Experiences of therapy before, even if it might have been back in adolescence, I think have a sense of, of an understanding of themselves, a more developed vocabulary to articulate their difficulties, greater so self awareness about, you know, what they're feeling, why they're feeling it. It's just about applying all the things that they've done previously to this new time of life. And I think that that framework really helps them think it through and, and I think to come back to therapy with ease, whether it's with the same clinician or somebody else.

[B]

Yeah.

[C]

I think it just helps the move back into the room and I think that that's, that's much easier. But I think, I think for people who have never done therapy before, it hits them harder.

[B]

Yeah.

[C]

And it's also, I think, more difficult for them to understand what it is they're experiencing and why while there's this enormous pressure which is baby is coming.

[B]

Yes.

[C]

Or baby is here. Like there's this time crunch.

[B]

Yeah. I've got three months left or four months left or whatever it is.

[C]

Yeah. And this pressure to like, want to resolve it before the, the babies due date. So that actually I think adds a degree of, Of. Yeah. Of stress, I think, to the process.

[B]

Yeah.

[C]

Yeah. And I think also pregnancy and becoming a new parent can bring up old wounds.

[B]

Oh, totally.

[C]

And things that have been dormant or perhaps active but not functionally impairing, or.

[B]

You thought you had dealt with it. Yeah. And you're like, oh, there's that.

[C]

Or things that maybe hadn't felt so urgent and so now they're bubbling up and there does feel like there's that sense of urgency, which I think, and, and then so teasing that apart, as, you know, it's. Am I anxious about becoming a parent or is this old stuff that's coming up in this new context? Yeah, it's. It's a tricky time. But yeah, I agree that. And I think that's good for a clinician to know.

[B]

Yeah.

[C]

If someone has or hasn't been in therapy before, I think that, you know, thinking about that gentle start with someone and holding them and making room for nervousness, confusion, stress, panic.

[B]

Yes.

[C]

You know, dread, you know, all of those things. It's really useful.

[B]

Absolutely. Especially if they're having harm thoughts, you know, which we've often spoken about. But I think it can leave a very vulnerable. Feel like a very vulnerable space. Because imagine saying to a maternal and child health nurse, oh, hey, I just thought about. I've just been having intrusive thoughts about, like, put it, you know, Putting the formula in the baby's bottle but thinking that I'm putting arsenic in there.

[C]

Yeah.

[B]

Or rat poison or some other thing.

[C]

Yeah.

[B]

Or I'm having intrusive thoughts about like just smashing my baby's head against the counter every time it cries or shaking it, which is really distressing.

[C]

But also I think the thing is though, Right. Is if someone doesn't. Hasn't been through treatment before, potentially, they might not even use that terminology.

[B]

No.

[C]

They might not say I'm having it.

[B]

No. They want.

[C]

With that separateness. They might not say I'm having an intrusive thought. Or I'm might say, yeah, I'm. I'm not sleeping because I'm scared I've poisoned my baby. Or I. I just can't stop thinking about throwing my baby against.

[B]

Yeah. I'm worried this. Yeah, I'm worried about this.

[C]

Yeah.

[B]

Or whatever else. They might not even articulate it as well.

[C]

Yeah. I think, I think I'm gonna poison my baby.

[B]

Yes. So it feels more definite. But even just like worrying about or the anxiety around, I can't tell anyone this.

[C]

Yeah.

[B]

You know, so it would be like you're describing one step removed.

[C]

Yeah.

[B]

From the ability to articulate that separateness and having this huge fear. So I think we need to be mindful of and also curious about when we do, when we are working with parents. Yeah. Or expecting like, you know, mums to be, dads to be, whoever it might be. Or people even thinking about it. Just checking in. Yeah. I mean, just wanting to check in and see how your thoughts are going in terms of how are you thinking? Like, what are you thinking? What are you feeling? Yeah. And just leaving space for that and even normalizing going. Some parents to be. Start to experience these weird kind of really scary, uncomfortable, distressing thoughts. How are you going with your pregnancy or how are you going with this idea of trying to conceive or adjusting to parenthood or whatever that might be. Because a lot of the time I don't think we have that space in the maternal and child health.

[C]

Yeah.

[B]

I think it's getting better. Yeah, it's getting a lot better. We don't always have that space. Space.

[C]

And it's also, I think, the luxury of time. Right.

[B]

Yeah.

[C]

You know, I mean, there's a difference between spending 50 minutes with someone and having a 15 minute consult.

[B]

Yeah.

[C]

You know, there's only so much.

[B]

Yeah, exactly.

[C]

You can get done.

[B]

Yeah. Yeah. I remember in those appointments it's very much so quick weigh the baby.

[C]

Yeah.

[B]

Check their milestones.

[C]

Checking on mom. How's my.

[B]

Do this stuff? And then it was a two second. And how are you going? Yeah. Do you feel safe at home? Okay, great. Like, actually, I could tell you a whole lot more, but. All right, out you go. Next.

[C]

Yeah.

[B]

Yeah. That is sort so true. Yeah. Yeah.

[C]

And I think. I think that that's what you've articulated is beautiful, which is the importance of psycho education.

[B]

Yeah.

[C]

That when. If we are in therapy with someone who is thinking about falling pregnant or is pregnant or has had a baby.

[B]

Yeah.

[C]

We can offer a lot in terms of providing psychoeducation about what to expect and. And what is okay for them to tell us.

[B]

Yeah.

[C]

And. And to normalize the beginnings of whether it's OCD or not, the presence of these distressing, intrusive thoughts.

[B]

And.

[C]

And just normalize that so that if your client starts to experience those, they feel like they can come and tell you and it's not actually this shameful thing or they're not left there sitting with themselves thinking, I can't tell anyone this because they're going to take my baby away.

[B]

That's right. Yeah. Living in sheer terror.

[C]

Yeah.

[B]

You know, or feeling like you can't touch your baby.

[C]

Yeah.

[B]

Or cuddle them or console them or bond with them because you're worried that if you change their nappy, you're going to molest them. Yeah. Or hurt them in some way.

[C]

Yeah.

[B]

You know, so I think it's a huge, huge component of building that safety and trust for disclosure to happen.

[C]

Absolutely.

[B]

Which is a part of therapy in any case. But I think in this instance, even more so.

[C]

Yeah.

[B]

Because it already is such a vulnerable time. Yeah. Like I would say, maternal anxiety just kicks in naturally anyway.

[C]

Absolutely.

[B]

Like it's just a natural process. But then there are levels of it. Yeah. You know, as with anything. And it's this idea of when it starts to become insidious or it's keeping you up at night or it's. You feel paralyzed or it interrupts your attachment with your child or whatever else it might be. That's when it's not. Okay.

[C]

Yeah.

[B]

But we want our clients to be able to tell us about.

[C]

Absolutely.

[B]

So psycho education.

[C]

Yeah.

[B]

Thank you.

[C]

Yeah.

[B]

In a really roundabout way is really the first. And actually that sense of safety.

[C]

Yeah. And what you were saying also about, I think, not taking your rapport for granted. Let's say you've been working with someone for a while.

[B]

So. True.

[C]

And you've worked on OCD or you've worked on whatever.

[B]

Yeah.

[C]

Don't Automatically presume that they're going to come to you with this.

[B]

Yes.

[C]

Because particularly in the parental space, there is so much shame.

[B]

Oh my God.

[C]

And so, especially online, like, it's really intense and. And the expectations that people put on themselves because coming from a beautiful place, this strong desire to be a wonderful parent. A wonderful parent. And so that is a really hard thing to. You know, even if you've got a really good relationship with your clin, you know, with your clinician, you can't necessarily presume that your client is going to come and disclose these new things. And so I think that's what psychoeducation in this space does, is it opens the door and gives permission.

[B]

Yes. Which is so important. Yeah. I. I think the more rapport you have, the more afraid your client will be sometimes to bring stuff. Because for some people, and it's not all the case, but for a lot of people that develop this connection and this want to be liked and this image of what your relationship is like, and if there is intense shame, which often there is around thoughts like this, there might be this thought of what will Celine or Tori or whoever it is start to think about me? If I disclose these thoughts, will I lose that connection?

[C]

Yes.

[B]

Will I lose the rapport?

[C]

Yeah.

[B]

Or whatever else. Will I disappoint them? Will I upset them?

[C]

Yeah.

[B]

Will they fire me as a client? You know, I think there's a bigger vulnerability there. So we definitely need to open the door.

[C]

Yeah.

[B]

And we can't just make the assumption.

[C]

No, absolutely not.

[B]

Or at least invite the discussion.

[C]

I think other thing is doing some self work as well. I think a lot of what we have to do when we're treating OCD is be really aware of how we're feeling. Our own internal.

[B]

Yes.

[C]

Biases or fears. OCD content is. I don't know, it's.

[B]

Is it weird, man? Yes. And really up.

[C]

I mean, that's just like. Isn't it Jonathan Grayson who talks about. About Stephen King, about how, you know, then. In fact it's not people with OCD who have, you know, these, these crazy thoughts. We all have them and some people have OCD and some people build a mad.

[B]

And with the Game of Thrones. Yeah.

[C]

That's a career out of it by putting these thoughts to paper and, you know, making something incredible out of it.

[B]

Yeah.

[C]

I think we as clinicians have to be really aware of our own internal reactions to some of these things. And I think for people who are very experienced working with O, I think that, you know, if you've done that work you've spoken about insupervision, it's all been normalized. Then if someone comes to you and says, I'm imagining throwing my baby against the wall, or I'm imagining, you know, kissing my, my son's penis or something like that, I think we sit with that fairly well.

[B]

Yes.

[C]

But if you've not had that experience, that can be very anxiety provoking. It's. As a clinician and our clients will know that 100.

[B]

They're already.

[C]

Yeah. Self monitoring for people's reactions, every look.

[B]

On your face, every change in body.

[C]

Language, micro signs, all of that.

[B]

You know, what you don't want to be doing is ringing child protection services straight away. You want to be curious, having these discussions, but also not. I think the phrase you use is alert but not alarm. Yeah, sorry, is that alert but not alarmed? Yeah, but also having an understanding of what OCD is.

[C]

Yeah, that's right.

[B]

And this is something we've talked about in terms of truly understanding the ego dystonic nature of these thoughts and making sure that when you do your assessment, yes, we want to make sure that no child is coming to harm or anyone else for that matter. That's important. But we don't want to do it in an alarmist way.

[C]

Yeah, that's right.

[B]

Like I'll never forget, I was sitting in a workshop and the presenter was talking about a client that they had had where they had worked with another therapist and came to see her and the experience of him. So he had thoughts about harming his children in a sexual way and the therapist told him to bring his wife to the next session. And in that session, the therapist then proceeded to say, I'm concerned for the welfare of your children. You need to call, we need to call the police, you need to remove your children from your husband, etc. Etc. She was, she, the wife understood OCD. The husband was terrified and he's like, I don't want to do these things. Like I don't, you know. And so the wife didn't react. This was overseas, so I don't know what the reporting requirements were like, but, but nothing had happened either. Like he was just experiencing intrusive thoughts to people of ocd. And so the wife then found this particular therapist and this therapist understood OCD and was like, you've got ocd. This is what we're going to do. And ended up making an almost full recovery, which is a lovely story, but kudos to the wife for sticking with it and understanding it and not reacting I think the scary part that could have been really damaging was this poor man being not dobbed in but, like, you know, questioned and what that could have done for not just his treatment but for his symptoms as well. So I think we have to be really careful as to where it goes. But I can understand, like, when you're working, if you're a maternal and child health nurse or you're working in these sorts of areas where you have to make quick decisions.

[C]

Yeah.

[B]

When you hear these phrases, alarm bells go ringing, like you said, we don't have. They don't have the luxury of the 50 minutes or the hour that we have. And so to be able to be curious and assess it more as opposed to. Yeah, so we don't want to be alarmist.

[A]

Yeah.

[B]

With it. But we don't want to be dismissive and be like, oh, yeah, that's just OCD either.

[C]

Absolutely.

[B]

Yeah.

[C]

Yeah. But we can do both of those things whilst also managing internal responses and making sure that we're taking care of the client while we. While we undertake that process.

[B]

That's right. And not kind of. Yeah. Reacting.

[C]

Yeah.

[B]

Being responsive.

[C]

Yeah.

[B]

Because. Tell me more about that.

[C]

Yeah. Because let's say it is actually a parent who has postnatal depression.

[B]

Yes.

[C]

And is not. Okay.

[B]

And actually is not coping or prodrombing for postnatal psychosis.

[C]

And. And actually it is not.

[B]

Yeah.

[A]

A.

[C]

An obsessive thought.

[B]

Yeah.

[C]

And they actually do need additional support.

[B]

Yes.

[C]

Because they actually might be at risk.

[B]

Of hurting their child or themselves.

[C]

It. That would be. It would be awful in that space to be dismissive of what they're. They're saying to you. If they've come and. And divulge this thing, like I'm.

[B]

Yeah.

[C]

Quite. Regardless of. Regardless of. Of how you formulate it in the end.

[B]

Exactly. Yeah.

[C]

Holding space for that very vulnerable moment is essentially. Yeah.

[B]

One way or the other. And that's part of that curiosity.

[C]

Yeah.

[B]

And that responsiveness and not reacting and holding it. Because the other thing that allows you to do is it helps you to think about all these other things we need to be aware of, as opposed to then us becoming anxious, thinking only one thing and then heading down that pathway. Yeah. Because then we forget about all the other possibilities as well. Which is unhelpful, you know. Yeah. As we get anxious as clinicians if we allow that to enter the room. And it interrupts our assessment, it interrupts our formulation and our curiosity. Because we're acting out of fight flight ourselves.

[C]

Absolutely.

[B]

Yeah.

[C]

Yeah. I was thinking about Some other things that if you were, if, if you either referred or were working with a client who had, had become pregnant or, you know, partner was having a baby. Yeah, I think I would be, I would, I would be wondering about whether increased frequency of sessions.

[B]

Yes.

[C]

Might be useful as sort of a practical strategy.

[B]

Yeah, most definitely, yeah.

[C]

I mean, being collaborative, you know, we don't. But I think actually providing a bit of additional support as well as making plans for sessions. Having them in the diary for after the baby arrives as well.

[B]

Yes.

[C]

Even if it's via telehealth. Even if it's a 30 minute appointment but have some things already set up.

[B]

Yes.

[C]

I mean, it may be that you have some flexibility there where you say to your client, look, if you can't, like if life happens and you can't make it, you know, we can cancel the appointment, but let's have it there in case you need it so that you don't have to think, oh, gosh, I have to book an appointment. Oh, but it's 2am And I can't call the clinic and, oh, now I've forgotten and it's been three weeks and I'm not well and, you know, I think actually having some.

[B]

Being proactive.

[C]

Yeah, absolutely. Having some strategic planning. I was thinking also about working with the care team, working with the gp, working with your obstetrician, if you do have concerns about your client's mental health.

[B]

Yeah.

[C]

Don't be afraid. We're often, I think pretty, pretty thoughtful about working with a psychiatrist or perhaps a speech pathologist. But if we, if someone's moving into this space, I think working with their medical specialists as well, I think is really important.

[B]

Yep. I would agree. Yeah. Yeah. What else would you have always been gold for clients? Like, you know, where we anticipate. Okay. A rough due date is around this time. Let's go for two or three weeks straight after. You know, oftentimes baby comes in, which is so adorable.

[C]

I know. Yeah.

[B]

And so whether it's on telehealth or in person, and it's just worth its weight in gold, you know, clients are like, I'm so glad we booked this in.

[C]

Agreed.

[B]

I was so relieved knowing that I was going to come in here and it's just a place of where they know they're going to be held.

[C]

Yeah. You know, because also it may not. It's also an opportunity to reflect on the experience of birthing.

[B]

Yes, yes. Yeah, yeah. Which is so important you don't get a chance to talk about it. No, yeah, no, not from an emotional perspective anyway. Very much a. Is your body good? How's your scar if you've got one, like.

[C]

Yeah, that's right.

[B]

You know, as opposed to how it felt emotionally.

[C]

Absolutely.

[B]

Yeah.

[C]

So I think that's. That's really great. And. And then extending the offer to partners as well, if needed.

[B]

Yeah, yeah. Definitely.

[C]

Important.

[B]

Yeah, yeah, yeah.

[C]

I think I have your answer.

[B]

Yes.

[C]

But I was going to ask you about your opinion on babies in therapy.

[B]

Yeah.

[C]

Yeah.

[B]

I love having babies in therapy.

[C]

Well, yeah, I figured based on how you responded before, I assumed that that was going to be what you would say, open.

[B]

I love having babies in therapy. I love it. Yeah, It's. I'm so open to that.

[C]

Yeah.

[B]

We need to be flexible.

[C]

I ask only because you hear things around. I get it. Right.

[B]

Yeah.

[C]

I've heard. In fact, it's been some of my friends who needed some support postnatally and were discouraged from bringing baby to therapy. Now, I respect that perspective because if we're talking about a parent needing some time to talk and think and they're simultaneously trying to feed or soothe a baby, I completely understand why you'd say, no, no, no. Your mental health is a priority. Let's find someone to take care of baby so that you can come in and just focus on you. Like, I really, really get that.

[B]

Yeah.

[C]

But what I also know, the other half of the experience is that that stopped some of my friends going to therapy because they didn't have anyone to ask or they weren't ready to separate.

[B]

Yes.

[C]

I mean, this is totally not the same thing, but for me, I didn't get a haircut after my first was born for so many months because I wasn't ready to separate. And I didn't know if I was allowed to bring her to the hairdresser. I know now, of course, I was.

[B]

What an idiot.

[A]

Right?

[C]

Of course. I don't know. I think I thought I had to be this, like, cool parent who was able to, like, still have a life and still be, like, all cool, even though I had a baby now. Because it wasn't all about baby. Even though it was all about baby and I was all about baby.

[B]

But. Yeah.

[C]

But I went without for so long because I didn't know how to navigate that. And I. Yeah. And it was a haircut. Imagine therapy.

[B]

Yes, exactly.

[C]

Right. And so I think I would like to think that we could have that conversation with our clients and give them the choice about what supports do they have, what would they like to choose? And giving them permission to make the choice either way because it could go the opposite way. I don't want to bring baby, but are you going to think I'm a bad mother because three weeks out I'm not with all.

[B]

Absolutely. Yeah. Very much. Leave it up to the client to decide.

[C]

Yeah.

[B]

Like clients always just. It's really sweet how they're like, what, what if I need to bring. Oh my God, please bring the baby. And if you need to bring baby and that's okay. As opposed to just assuming that they can't. Because a lot of people would assume that they can't.

[C]

Yeah, yeah, yeah. And I think the other thing is also thinking about it from an exposure perspective and whether this is on telehealth or in the clinic, is that if a new parent is having intrusive thoughts about sort of pedophilic themes, harm themes, contamination themes, whatever it happens to be where the fear is that their baby will be hurt in some way. Having baby in therapy is actually really helpful. It is because you can do a feed together. You know, you can change nappies together.

[B]

You sure can.

[C]

You know, you can do all sorts of things to.

[B]

You can even time a nap.

[C]

Nap. Yeah.

[B]

Or time the session with a nap to. If you're worried about SIDS or breathing or whatever. To like leave the pram baby in pram behind the parent and just sit with, not checking. Yeah. You know, that kind of stuff. Yeah. As well. Like therapeutically, it has so much value. Yeah, absolutely. And. And these are just some exposure ideas as well in terms of what do we do from a treatment perspective. Yeah, very similar. But go gently. Lots of education, lots of grounding, lots of checking in and all that sort of thing as well. And just applying what we would normally apply to these situations. It feels scarier because you've got a real life.

[C]

Yeah.

[B]

You know? Yeah.

[C]

As opposed to imaginary baby. You know. You know, I know. You won't hurt your imaginary baby.

[B]

Yes. But what if you hurt your real baby? I know. And that's the doubt we've got to sit with. With our own. Like you were talking about before. We've got our own. Yeah. Going. Please don't be that one person who bucks the trend. But again, it comes down to not just trust, but understanding OCD and your formulation as well.

[C]

Yeah.

[B]

And working with your client in that way. But yeah. It brings in so much therapeutic value.

[C]

Yeah.

[B]

But like you said, if the client is not wanting to and they can find the space to. Then that's okay too.

[C]

That's okay too.

[B]

Yeah.

[C]

But I think We've got to make these things explicit, don't we?

[B]

Yeah, we do.

[C]

And I think that this is where I think. I mean, I really love the therapy as a reflective space. I've had both roles in. In my career as both sort of taking on a sort of more case management role where I was doing lots of sort of strategic planning and. And management of someone's clinical care as well as sitting in the more sort of just reflective psychology specific space. And I think this is. This is one of those moments where the two can merge really beautifully, where it is okay to be a bit more directive and say, this is how I think we should map out the next few months. How does that sit with you?

[B]

Yes.

[C]

This is what I'd like your therapy to look like. These are the things I think we should plan for. These are the things I want. I think we should put in place, of course, collaboratively work with the GP, work with other specialists, etc. Etc.

[B]

Yeah.

[C]

In a really integrative way. But I think that it's okay to step out of just having that sort of reflective role and leave it up to the client and actually. Yeah. Help lead them through. Because I think that that. That actually helps reduce the mental load and also can be really, really containing.

[B]

Yes, absolutely. That really is part of that process of creating the village around parents.

[C]

Yeah.

[B]

Or parents, depending on who's involved in the kit. Like in that. To be able to help them feel supported. Yeah. Because a lot of the time, you know, people often talk about, you know, when are you having kids? Or this, that and the other.

[C]

Yeah.

[B]

But then everyone kind of disappears once baby turns up.

[C]

Yeah.

[B]

Unless it's for cuddles or something cute or whatever else it is. And it can feel really lonely. Yeah. So I think. Yeah, definitely help. I love that. I love what you've articulated in terms of being able to help your client build their village and stay in the village.

[C]

Yeah.

[B]

After baby comes. But even as they're preparing for it, I think that's important too. Helping them manage boundaries, helping them manage their treatment, helping them make sure that they're staying connected. So all of the wheels keep turning.

[C]

Yeah.

[B]

But also to be there if one of them falls off. I know as well. Yeah.

[C]

I love this period.

[B]

Yeah, it's.

[C]

It's.

[B]

Yeah. And it's a really special time, but also a really crazy time. Chaotic. Chaotic, I think. Yeah, yeah, yeah, yeah, definitely.

[C]

Lovely.

[B]

All right, well, what do you think of that?

[C]

Yeah, I hope that that helps clinicians feel a little bit more grounded in sort of what the role is of a psychologist during this time and things to watch out for and spaces to take for therapy.

[B]

Yeah. Amazing. All right. Thanks everyone for watching and listening. We'll catch you in our next episode.

[A]

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[C]

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[A]

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