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The Perinatal Patient: A Word from Karen Kleiman



I am encouraged and hopeful about the direction perinatal education, trainings, research and advocacy are moving in recent years. Perinatal mood and anxiety disorders and the interference they impose on young families have finally received the academic and clinical attention they deserve. The aspect that remains elusive is how to uncover what the perinatal woman may not be telling you. This is the precious piece that lives silently inside each perinatal woman in distress -- the piece that reinforces the enduring stigma and stifles her cry for help. As much as we try, our words and our efforts have proven to fall short of a woman’s innate urge to silence and protect herself and her baby from a society that she believes doesn’t understand, doesn’t support, and doesn’t really get it.

Those of us who have dedicated our professional lives to the study of perinatal women in distress believe we do get it. We believe that women suffer in silence for many reasons, but first and foremost, they are terrified that they will be misunderstood, that their baby will be taken away and that they are losing their mind. Although they are not losing their mind, and their baby won’t be taken away, they are far too often completely misunderstood. Health care providers, including many therapists, think they know, hope they understand, and believe they have studied enough to effectively intervene on behalf of a pregnant or postpartum woman who is struggling with depression and anxiety.

Unfortunately, this is often not the case. Why ? Because it’s not enough to read a book. It’s not enough to have experienced perinatal depression and anxiety yourself. It’s not enough to listen to what your patient tells you is true. Training matters. Training that focuses on what lies beneath the surface, beneath the shroud of perfection and bliss. Training that emphasizes tuning into the subtle and excruciating feelings and thoughts that are not being expressed. That is the beginning of healing. Maternal health care providers who are trained in holding techniques are finally in position to listen, really listen, to agonizing details from a mother who cannot bear her own thoughts and feelings. When we access this authentic suffering, we have succeeded in helping her feel heard. To date, there is no antidepressant, no manualized therapy guide, and no certificate of achievement that comes close to helping a perinatal woman in distress feel cared for. In this important way, holding is the gateway to healing.

I am completely honored and immeasurably grateful that Hilary Waller demonstrates such mastery of this subject and sees the value of carrying on my work. This book is a testament to her indescribable capacity to translate my gut-drenched creations and turn them into constructive formulations. Simply put, she has taken my magic and put meaning behind it. If you are a serious perinatal therapist, or if you are a maternal care provider who wants to enhance your clinical work, this book is a must-read. Because if you don’t understand what is not being said, you will provide insufficient treatment. For women who are having difficulty adjusting to motherhood, not receiving excellent care can be disappointing and frustrating. But for women experiencing a serious perinatal mood and anxiety disorder, missing the mark can mean the difference between life and death. We implore you to be informed about and dedicated to this population if you take on this specialized and exceptionally rewarding work.


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