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Narrative practices in treating postnatal depression

After many years of running therapy groups for women struggling with postnatal anxiety and depression, and trying lots of group therapy tools, I have come to the conclusion that one of the best recovery instruments for postpartum mothers (and fathers) is a journal, a diary, a notebook, a computer file or using the recent tendencies in the digital world… a blog (or v-log).

Depression is one of the so-called "highly effective problems". It thrives in an atmosphere of silence, stigma, and self-criticism. This is why I do not meet many postpartum women who help themselves, by actively seeking accurate information, clarification, support, reassurance, comprehensive evaluation, and treatment from someone knowledgeable in this field. The majority of women choose to remain isolated, without any resources or… are resistant to accept help. But, regardless of when the symptoms of depression emerged, the immediate goal is to reduce the impact that depression is having in women’s life. Accordingly, one of the ways to limit depression’s influence is “to bring her to clean water”, a Russian expression, which means to make her visible when she would normally choose to remain invisible, - is to create a supportive community and to encourage women to participate in group work. , Often, going to counselling or joining a support group is not at the top of things a postpartum woman wants to do. For various reasons, some women do not have this as an option. Most women just seek for symptom relief and to get back to their normal life. And here the self-exploratory writing can be of great assistance, not less effective than evidence-based therapies used to treat perinatal mood disorders, such as supportive psychotherapy, cognitive-behavioural therapy, interpersonal therapy, and group therapy. Narrative practices are for both those who join a therapy group and also for those who prefer to help themselves independently.

* This article is part of the recent PADA publication (May 2018 ) " Are you OK? ...Really?"

So where do we get inspired to explore the benefits of narrative therapy? First of all, from narrative classics such as James Pennebaker, Ira Progoff, Michael White& David Epston, and recent great narrative authors such as Kathleen Adams and Deena Metzger.

James Pennebaker recommends: “Write 3-5 days in a row for 20 minutes per day. Write your very deepest thoughts and feelings about the most traumatic experience of your entire life or an extremely important emotional issue that has affected you and your life in the past or currently. Let go and explore your deepest emotions and thoughts. All of your writing will be completely confidential. Don’t worry about spelling, grammar, or sentence structure. The only rule is that once you begin writing, you continue until the time is up. At the end delete or… destroy it.” What a postpartum woman gains? Time for herself and with herself, the unspoken story of her depression sees the light, thoughts, and emotions are de-cluttered. And… motivation to get better! It’s called expressive writing.

The Pennebaker’s method is now most thoroughly studied from all types of written practices (more than 300 scientific studies detailing the mechanisms of its work and effectiveness). It is widely used in different countries within the framework of psychotherapy and psychological support of people who survived traumatic situations or live in difficult life circumstances. Its effectiveness has been proven, in particular, to alleviate the symptoms of chronic diseases and to heal surgical wounds, to treat and prevent depression, and to relieve the symptoms of post-traumatic stress disorder.

Ira Progoff’s Intensive Journal Method is a series of writing exercises using loose-leaf notebook paper in a simple ring binder, divided into sections to help in accessing various areas of the writer's life. The notebook has four main sections, each with subsections, corresponding to four dimensions of living: personal experience and history; depth or symbolic experience; relationships with persons, work, the body, and society: the ongoing search for meaning and connection. Using such an instrument gives to a postpartum woman the possibility to take care of her-self, to deal with the unpredictability of the current situation day-by-day, and to take the responsibility for change. In the end, the silent narrative conversations trigger an upward spiral of improvements. “Growth takes place in a person by working at a deep inner level in a sustained atmosphere of silence”, says Ira Progoff.

Practicing Michael White& David Epston narrative therapy techniques give to postpartum women a chance to step out of their stories through the third-person voice and to identify the places where they get stuck. They see themselves separated from the problem and because of it, their skills, abilities interests, competencies, and commitments become more visible. And here happens the magic – in the process of writing, they create a distance between the person who experienced depression, and the person who is now sitting at the table; a distance between the person who writes, and what is written; a distance between the one who feels, and by this very feeling; the distance between thoughts and the person who thinks. And it gives them a new perspective, a new look and often new solutions. This is the power of externalisation.

Our group therapy program using narrative practices has shown that it takes about 12 weeks to make writing - an established habit for self-care and to learn how to use journaling for problem-solving, to take time for yourself, to get to know yourself better, to record a personal story of overcoming depression, to create a sustainable self-care system and to start having fun!

Whatever type of narrative practices (journaling, expressive writing, narrative therapy, etc.) women decide to use, the benefits are enormous. They are restorative, universally applicable, evidence-based, appealing, enjoyable, life skills building, and… affordable, as Kathleen Adams states in her book: “…the 79 cents therapist”. “In moments of ecstasy, in moments of despair, the journal remains an impassive, silent friend, forever ready to coach, to confront, to critique, to console, and to heal. Its potential as a tool for holistic mental health is unsurpassed”.

Narrative techniques can be a magic tool in a wide number of situations where women and members of their families experience difficulty expressing their thoughts, feelings, and experiences during the child-rearing years. It can be helpful for those who live remotely and for different reasons cannot access mental health support directly. Narrative practices can be a respectful and nonjudgmental approach to psychological support for perinatal mood disorders, which focuses on the client as the experts in his/her own life. It can be used widely by health professionals, counsellors, and community workers. Narrative tools help to externalise oppressive experiences, to move from problem-focused and a saturated perspective to find alternative solutions. It helps to explore client’s skills, competencies, beliefs, values, commitments, and abilities. It works and helps to reduce the impact of problems in people’s life.

I invite almost every client to try narrative practices. Where to start, you might ask? As James Pennebaker suggests: ''Write about what keeps you awake at night. The emotional upheaval bothering you the most and keeping you awake at night is a good place to start writing.'' Starting your journal can be first and one of the most successful steps toward reclaiming control in your life. Keep asking yourself honest questions and find honest answers. Because, as long as you write, you maintain the meaning of your life, you save the hope, and you save yourself - as an author of your life. It’s healing and it works!

Recommended reading:

  1. Expressive Writing: Words That Heal, by James Pennebaker and‎ John Evans.

  2. At a Journal Workshop: Writing to Access the Power of the Unconscious and Evoke Creative Ability, by Ira Progoff.

  3. Narrative Means to Therapeutic Ends, by Michael White and David Epston.

  4. Journal to the Self. Twenty-Two Paths to Personal Growth - Open the Door to Self-Understanding by Writing, Reading, and Creating a Journal of Your Life, by Kathleen Adams.

  5. Writing for Your Life: Discovering the Story of Your Life's Journey, by Deena Metzger.


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