Had Ms. B expressed interest in exploratory therapy – or if we had doubts about her commitment to her child and ability to be a responsible caretaker – we would have referred her to additional resources. However, we sensed that she could be lost to treatment altogether if we demanded more treatment than she was ready to embrace. We drew inspiration from "High-Yield Cognitive-Behavior Therapy for Brief Sessions" (Arlington, Va.: American Psychiatric Publishing, 2010) and used the limited time available to ask targeted questions. Specifically, how did she react to tragic news about untreated postpartum depression?
Dr. Michael Ascher
We were not surprised to learn of Ms. B’s secret fears that her depression and dreams could progress to the level of Andrea Yates, the Texas woman with untreated psychosis who responded to delusions and hallucinations by murdering her five children in 2001. Again, we reassured Ms. B that many people share such fears, and that was one reason why the Yates case garnered such media attention. We pointed out differences between Ms. Yates’s life and that of Ms. B, stressing that Ms. B’s decision to seek timely treatment (instead of avoiding it), coupled with her husband’s support and the absence of psychosis dramatically distinguished her situation from Ms. Yates’s.
Ms. B accepted this explanation. Her distress subsided, and she gained a greater sense of self-efficacy. She remained in treatment, attending monthly appointments, and expressing joy about her baby. Ms. B revealed to us that she planned to return to college part time when her baby starts preschool.
Dr. Packer is an assistant clinical professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, New York, and is in private practice. Her most recent book is "Cinemas Sinister Psychiatrists: From Caligari to Hannibal" (Jefferson, N.C.: McFarland, 2012). Dr. Ascher is a postdoctoral fellow in addiction psychiatry at the University of Pennsylvania Perelman School of Medicine, Philadelphia, and a candidate at the New York University postdoctoral program in psychotherapy and psychoanalysis. He is a new Clinical Psychiatry News editorial advisory board member.