The Motherhood Marathon

Q: I have clients who have been overwhelmed by motherhood. How can I help them with the challenges of raising a family today?

A: Three in four women will have a child, and most will say it’s the most fulfilling thing they’ve ever done—and the most demanding.

Motherhood isn’t, in itself, a psychological or medical problem. But the challenges inherent in childbearing and childrearing can lead to clinical consequences, with studies showing that mothers are more likely to have:

– depressive moods

– more stress than fathers or women not raising children

– frequent conflicts with their partner

– lower marital satisfaction

– health ailments ranging from fatigue and intensified PMS to nutritional deficits, type-II diabetes, thyroid disease, and autoimmune illnesses.

Parenthood affects men, too, but unless there’s an adoption, women face unique physiological demands, and they typically do most of the childrearing and housework. The effects are exacerbated by the fast pace, chronic stress, and diminished social support of modern life, which are at odds with the hunter-gatherer template to which family-making is adapted.

Of course, a mother may have issues unrelated to being a parent, and these should be addressed in the ordinary course of therapy. But for those women who are having difficulty coping with the changes brought on by motherhood, here are five ways a therapist can help a mother cope with stress, lift her mood, stay energetic, and build teamwork and intimacy with her mate.

Honor her journey. Motherhood can feel like a roller coaster, with its unavoidable difficulties downplayed by others and increasingly hidden behind the required “mask of the contented mother.” Exploring her journey helps a mother make sense of it, feel understood, and see that its bumpy parts aren’t her fault.

My client may take several sessions to explore her original dreams about raising a family, the decision to have a child, the pregnancy and birth, the first months with a new baby, and life since then. I’ll normalize the ups and downs and point out her strengths and coping skills. In particular, I’ll support her in taking good care of herself. Many mothers think that’s selfish and are helped by being given explicit reasons for doing so, such as: “It’s good for your kids. It’s good for your marriage. And your needs matter in their own right.”

Ask about her health. Mothers commonly report multiple pregnancies, extended breastfeeding, sleepless nights, poor nutrition, little exercise, chronic stress, and hormonal irregularities. These factors contribute to psychological symptoms; motherhood is a profound illustration of the mind-body connection.

In addition to encouraging good medical care, a therapist can make a big difference by helping a mother pay attention to her body and replenish herself through such means as:

– getting protein with every meal, especially breakfast

– taking vitamin/mineral supplements plus a B-vitamin complex and several capsules of purified fish oil

– making sleep a top priority by getting to bed earlier, insisting on more help at night, and taking naps whenever possible

– exercising routinely, whether it’s walking vigorously with the baby in a stroller or joining a gym offering good childcare

Encourage connections. Nowadays, the village it takes to raise a child typically looks more like a ghost town. This unprecedented departure from the evolutionary paradigm for families has led to less support for parents and children, and more strains on everyone.

As a result, a mother often finds it helpful to discuss how she can increase her sense of community, particularly with other parents. We may start by exploring the judgments that get in the way, like embarrassment about having a misbehaving preschooler. Then we’ll discuss options such as joining a mothers’ club or playgroup, getting involved in her kids’ school, or exploring mother-related websites.

“Community” includes extended family, and any issues there typically intensify after children come along. We’ll discuss what she wants from her relatives, the support she needs from her partner, and the little things she can learn to roll with, versus the big things that are intolerable and need to be worked on.

Address the psychological consequences of motherhood. For many women, the intensity of making a family worsens preexisting problems and raises new issues, such as feeling torn between home and work. Besides using relatively generic approaches for these (e.g., shoring up temperamental vulnerabilities to maternal stress and cognitive skills for thoughts of inadequacy), I’ve seen the benefits of adding more “mother-specific” elements:

– Prime the pump. Many of my clients are sprinting their way through the marathon of motherhood, so they benefit from finding ways to slow down and get more refueling. These might include getting more help from their partner or others, scheduling (and protecting) some down time, or resuming self-nurturing activities (e.g., crafts, meditation).

-Explore “ghosts in the nursery.” Developing more coherent narratives about one’s childhood both promotes well-being and fosters better parenting. So I’ll help my clients reflect about their upbringing and how it shapes their reactions to being a mother today.

– Emphasize stress-relief skills. I routinely teach methods like diaphragm breathing, soothing imagery, and recalling pleasant feelings, and we’ll discuss how a client could use them during a hectic day.

– Take in positive experiences. Unlike negative experiences, positive ones usually must be held in awareness for many seconds to become stored in emotional memory. But mothers routinely zip from activity to activity without “soaking in” good experiences that could become resources for resilience and self-worth. So I’ll often review a simple, four-step method: turn a positive moment into a positive experience, savor it, sense it sinking in, and imagine it replacing old negative experiences.

– Consider medication, with caution. Psychotropic meds must be evaluated carefully for breastfeeding and pregnant women, with referrals to psychiatrists who have real expertise with mothers.

Support teamwork and intimacy with her partner. Many couples disagree about childrearing and sharing the load, and there’s little time for the conversation and affection that reknit relationships. As a result, a mother often feels inadequately supported, while her partner feels sidelined. So I’ll try to help a couple to:

– Cultivate empathy. To build bridges, we’ll explore how each has been affected by becoming a parent. Asking about empathy in the early days of their relationship helps spotlight its importance today, and they may practice its central skills: paying attention, looking beneath the surface, and checking back.

– Settle conflicts over childrearing. We’ll begin by identifying where they already agree, and then explore the childhood experiences and deeply felt values underlying the issues that remain. With greater understanding, they’re more able to compromise on practical solutions. Sometimes it helps to refer them to neutral experts as tie-breakers, to teach specific negotiation skills (e.g., focusing on solutions for the future) or to referee as they resolve a concrete issue like how to handle tantrums.

– Tackle workload inequities. The average mother is on-task about 20 hours a week more than her partner. This is a source of conflict with many couples. To help a couple work through it, I may start by asking them to record their time for a week, and the plain facts alone often prompt greater fairness. By discussing beliefs such as “working for pay counts more than caring for children,” it usually becomes clear that childrearing and housework are more stressful than most jobs, and for more important stakes. Then it’s easier to come up with practical agreements, such as making a base schedule for a typical week and deciding who’ll do what.

– Buttress the foundation of intimacy. We’ll explore what each partner wants in terms of time together, good conversation, and nonsexual affection. Then we’ll discuss how to make that happen, such as sometimes having dinner together by feeding the kids first, a daily hug, a regular date night, or doing more childrearing activities together.

– Nurture sexuality after children. I’ll help a couple talk candidly about the changes in their sex life and how each would like it to be. We’ll often explore ways to increase the sensual aspect of their relationship and troubleshoot roadblocks, such as a baby in the bedroom. This often helps couples come to an understanding about how often they hope to make love, as something important that they both want to share reasonably often.