9.1 Psychotherapeutic implications
The phenomenological perspective helps us to reorient our focus from considering symptoms as the main problem to be resolved towards exploring, describing and understanding how depressed women exist in their world. Thus a fundamental goal of clinical intervention is to recognize and validate the depressed women’s way of existence, or being-in-the-world.
PPD
From a phenomenological perspective it is of vital importance to understand and validate how our patients exist in their world. We found that PPD can be described first and foremost as an existential crisis which is lived as the looming alienated and threatening world. The women suffered an existential depression which can be understood as a form of sudden desynchronization. On the basis of our findings, psychotherapy should assist the patient in the process of resynchronization. Different therapies which focus directly on the mother-baby relation and on attachment, such as the Circle of Security intervention (Powell, Cooper, Hoffman, & Marvin, 2009) and the Marte Meo method (Vik & Bråten, 2009), may be effective in promoting increased attachment. Other activities to enhance the mother’s attunement to the baby such as increased emotional and physical contact through e.g. imitation games or baby massage could form part of the therapeutic process.
Previous studies have shown the importance of paternal support in the treatment of PPD, which indicates the potential benefits of triad oriented therapy including the mother, baby, and partner (Misri, Kostaras, Fox, & Kostaras, 2000; Montgomery, Baily, Purdon, Snelling, & Kauppi, 2009). Also, planned activities involving social contact with others, especially other mothers, can help restore synchronicity to the social world. The experienced guilt and shame underscore the need for a therapeutic atmosphere of openness, trust and assurance of confidentiality.
Our findings harmonize with Stern’s (1995) description of the essential themes in the motherhood constellation. According to Stern, psychotherapy for new mothers needs to take into account the special type of self-organization involved in the motherhood constellation. He stresses that depressed mothers primarily need a holding environment
provided by experienced maternal figures in order to successfully solve the different essential issues involved.
Our case study, however, revealed how important the traumatic past can be for the development of PPD and it might be possible to prevent this type of depression by identifying and alleviating the traumatic experiences of some women before the birth.
One might gradually and tactfully help her to perceive and acknowledge her self-restricting patterns of being in the world and subsequently introduce the unfolding possibilities of existence (Mook, 1985). We hypothesized that mothers suffering from a loss of primordial my-ness (PPD, Structure 2) might also benefit from pharmacological treatment directed towards restoring synchronization of fundamental biorhythms.
Considering their unbearable anxiety and internal pain they are at high risk for
committing suicide, underscoring the need to assess possible suicidal ideation and plans.
NPPD
Our findings indicate that the NPPD women’s depression is caused by a combination of feeling entrapped, sensitivity to others’ negative emotions, feelings of guilt and shame, excessive feelings of responsibility and overworking and ignoring their own emotional body.
The depressed women’s feelings of guilt and shame were described as the motivating factor for their engagement in self-destructive activities, such as overworking to the extent that they became overwhelmed and exhausted. Thus treatment should aim at reducing these excessive feelings of responsibility, shame and guilt. Emotion focused therapy (Greenberg & Watson, 2006) might help to elaborate on, differentiate and change the underlying feeling of weak or bad self and thus reduce the excessive feelings of guilt and shame. Treatment which increases the depressed women’s attention to their
emotional body, such as mindfulness oriented therapy (Fjordback, Arendt, Ørnbøl, Fink,
& Walach, 2011; Michalak, Burg, & Heidenreich, 2012), and encourages them to act on the corresponding signals could help the women to control their urge to overwork or over-involve themselves.
9.2 Research implications
On the basis of our findings on PPD, future phenomenological research could investigate whether other major transformations or existential crises would give a similar essential meaning structure to “the looming threatening and alienated world” or whether it would be essentially different. Also, it would be interesting to investigate the essential meaning structure in men’s experience of PPD and compare it with our findings on PPD in women.
Another interesting line of research would be to further explore the essential meaning structures of how anxiety and depression interact in both in PPD and NPPD from within the descriptive phenomenological perspective.
The phenomenological aspects discussed in the separate articles might inform and generate hypotheses for future larger-scale research. For example, one could investigate how frequently women with a history of child sexual abuse develop PPD after birth and whether the sex of the baby is an associated risk factor. Knowing the scale of the problem would provide important information when considering implementation of screening for CSA and other childhood trauma in pregnant women. Another line of research suggested by our findings would be to study differences in the quality of anxiety experienced by patients suffering from different types of depression compared to those suffering from primary anxiety disorders.