How do you know if you have postpartum depression?

How do you know if you have postpartum depression?

By Ian Hammonds

“If you ask me what’s the most terrifying and difficult emotion we experience as humans, I would say joy.”—Brene Brown 

It’s important to state from the outset that as a male, I obviously cannot fully empathize with postpartum depression. I write here from the point of view of a mental health practitioner, with the goal of helping others both in and out of the field recognize the signs of this all-too-common disorder, which has historically been unrecognized and misunderstood. 

Until I became a therapist, in fact, I would only heard or read about the condition in a remote manner. I only once associated postpartum depression with such extreme and tragic cases as that of Andrea Yates. Fortunately, times have changed—both for myself, and for mental health on a macro level. 

Postpartum depression (PPD) is a multifaceted phenomenon that cannot go unrecognized or untreated. Until relatively recently, PPD has been hideously underdiagnosed. The baby blues affects 80% of women and goes away within a 7 to 10 days.  Today, an estimated 1 in 7 women are believed to suffer from some form of postpartum depression. And while, thankfully, most cases reach nowhere near the severity of Yates, PPD can still be debilitating for many new mothers, who are already under an extreme amount of physical and emotional pressure. It’s crucial to develop a deeper understanding of what postpartum depression entails, as well as how to look for its signs.

A Cultural Understanding:

Before delving into the specific criteria for recognizing PPD, it’s important to state that this illness is distinctly separate from more frequently diagnosed disorders as Generalized Anxiety Disorder or Major Depressive Disorder

“It takes a village…”

According to Cheryl Tyler, LPC, “In most of the world’s cultures, when a woman becomes pregnant and bears a child, it is expected that her entire tribe of people help her through the process. If there is any kind of isolation or if the mother has moved away from her tribe, this could lead to feelings of depression once the baby is born.” It is fair to say that the act of having a child is reliant on a community. And if a new mother doesn’t have one, she may not have the support that can be so essential in the first weeks or months following a birth. A question every therapist should ask a mother who could be suffering from PPD is: “Who are your people?”

In transplant cities such as Austin, it can be isolating to have a child and raise a family when most people don’t have the same kind of intergenerational support they might otherwise have if they had stayed in the same town as their parents/extended family. Tyler goes on to explain, “To expect mothers to have to pay for their communities while pregnant, such as ‘mom groups,’ is classist, as these groups tend to be expensive. Support is huge and should not come at a huge cost!”

“But you love being a mother … right?”

Aside from the element of isolation, new mothers also have cultural pressures to contend with. Even today, most girls are raised with the expectation that they will one day have children, and love every second of it. Women throughout history have been treated as though it’s their “duty” to reproduce. And the message that a mother should be infatuated with having children has been mistakenly repeated over and over again throughout generations. A lot of mothers are essentially set up to meet a rigidly high expectation, and when they realize that being a mother is not a solely blissful and joyful experience, they’re at a high risk of depression. 

It’s common for a woman to have a child and feel a shift in attention from her as a pregnant mother to the newborn baby. This sudden change can feel minimizing and further isolating. It is also common for mothers, as well as their partners, to feel exhausted and ashamed when the household goes through the change of bringing a child home—there is endless pressure on a new family to know how to seamlessly navigate such a drastic lifestyle shift in such a short amount of time. 

Another myth for young mothers is that they are expected to love each child equally, which is not always a realistic standard. This can set some mothers up to feel as if they have failed at being parents, which can also contribute heavily to PPD.

How do you know if you have postpartum depression? Recognizing the Signs:

Unfortunately, there’s no defined diagnosis in the DSM-5 for postpartum depression. Many therapists, doctors, and psychiatrists have historically underestimated this condition. It’s also important to note that symptoms for PPD vary between women, making it harder even for seasoned clinicians to diagnose. 

“I’m not depressed, I just have baby blues.”

Postpartum depression often starts out by being described by the mother as “baby blues”—the period of 7-10 days after birth when the mother is exhibiting such criteria as sadness she cannot shake, irritability, diminished interest in activities, too much or too little sleep, and other classic signs of depression. If more than 10 days pass and these symptoms haven’t lifted, this is when the mother should seek help from a therapist or doctor. The US Preventive Services Task Force (USPSTF) updated their protocols in 2019 to include more careful screening prior to childbirth and early interventions after childbirth to help identify those who are at greater risk for PPD.

It’s important to note that baby blues are NOT an automatic precursor to PPD. Baby blues can fade, but PPD can go undiagnosed for months if the signs are not caught. This is harmful not only to the mother, but the entire family. 

Other signs to look for when assessing for PPD:

  • Genetic predisposition of depression—If depression runs in the mother’s family
  • History of depression—If the mother was depressed prior to becoming pregnant
  • Isolation—If there is any kind of cut off from family, friends, or other necessary resources
  • Feelings of shameLowered feelings of self-worth, heightened feelings of worthlessness, essentially frequent feelings of “I am not enough”
  • Suicidal thoughts—feelings of wanting to harm oneself as well as potential suicide attempts

Other Postpartum Illnesses:

  • Postpartum anxiety: Anxiety after birth is just as prevalent as PPD but much less recognized. Mothers with this illness typically look scared most of the time, can become hyper-focused on their newborn child, have difficulty breathing, or exhibit other signs of generalized anxiety disorder. It’s important to note, however, that after giving birth, mothers develop more gray matter in their brain, which increases feelings of hypervigilance and hyper-awareness.
  • Postpartum psychosis: Though rarely diagnosed, this is a disorder in which mothers begin to hallucinate, feel rapid mood swings, have delusional thinking or beliefs, feel paranoid, and become easily irritated. An extreme case, as mentioned in the beginning of this article, is the tragedy of Andrea Yates, a Houston mother of five who drowned all of her children in 2001. For far too long, this was commonly misconstrued as a defining case of any kind of postpartum illness due to the story making national headlines—thus minimizing the realities of millions of new mothers who are in need of a clinical diagnosis of depression without stigma. 

Next Steps:

If you’re a new mother and feel that you’re suffering from postpartum depression, anxiety, or psychosis, we’re here to help. There is no reason that you should have to feel depressed for prolonged periods of time after giving birth. As therapists, we’re actively deconstructing toxic and negative ways of thinking that have been accepted in past generations. PPD, PPA, and PPP should no longer be swept under the rug and treated as an afterthought. Consult with a doctor after giving birth on whether you have any of the abovementioned symptoms. The earlier you get screened, the better. 

If you’re a partner of a new mother, or you know a new mother who is experiencing these symptoms, we recommend checking in with them to make sure they know they’re not alone. 

At Just Mind, we have several therapists who specialize in postpartum depression counseling. Contact us today to make a counseling appointment. Another great resource for postpartum depression is the University of Texas medical clinic that specializes in Women’s Mental Health, who Just Mind frequently works with. 


Breaking Codependency in Relationships

Breaking Codependency in Relationships

Ian Hammonds, LPC Intern

“Islands in the stream, that is what we are. . .”

As a therapist, I frequently work with clients on breaking codependency in relationships. In this post, I will give you tips to help do this on your own. In a world that places so much emphasis on relying on our partners or spouses, we can all too easily become forgetful of our sense of self and who we are, both independently as well as in a relationship. We frequently put entirely too much pressure on our significant others, leading to a loss of the ability to rely on ourselves as well as the relationship becoming a burden. It is not to say that leaning and depending on our partners is unwelcome; however, the goal of this article is to create an opportunity to ask yourself if you are in a codependent pattern with your partner, and if so, create a healthy space for yourself.

Codependence can also exist within families and friendships. We have seen many clients who are struggling to find a healthy space with family members whom they might be relying on too much and who feel taken advantage of by their friends, or who have an overall lack of healthy boundaries with virtually anyone in their lives. 

Codependence vs. Interdependence

Codependence is essentially the opposite of interdependence. Codependence is putting your own needs, wants, desires, and values aside to feel complete in a relationship; the idea of integrity in a relationship is either hidden or completely lost as well as your own sense of self.  Interdependence is understood as a healthy idea of your own wants, needs, desires, and values and having a space to healthily distill them in a relationship. Your view of self is fully realized, and you are not afraid to do things like advocate for yourself when needed, ask for help when necessary, and utilize integrity in your own loving relationships. Ultimately, the goal of the therapist who is treating a client in a potentially codependent and hostile relationship is to bring them to a healthier space of interdependence and self-reliance.

Ways to Avoid Codependence:

Learn how to advocate for yourself: Do not be afraid to put your needs first. Your own sense of comfort is always necessary in order to feel whole as a person as well as in a loving partnership. Being able to speak up for yourself if you are feeling uncomfortable or unsafe is key in any interdependent relationship.

Establish healthy boundaries: In codependent relationships, there tends to be either very rigid boundaries or a lack of boundaries completely. It is never too late to say “no” when you feel your boundaries are being crossed or violated. Learning how to manage boundaries can take a lot of time as you are unlearning old unhealthy habits that might have been in place since childhood.

Not being afraid of conflict: To mimic the first two tips, advocating for yourself and establishing new boundaries can often bring up conflict in the persons with whom you may be codependent. However, every change that is long-lasting is always uncomfortable at first and might bring about some distance from those in your life who might be relying on you too heavily. Be mindful of those who are willing to accept the change you want and of those who want you to stay the same for their own benefit. Use your discretion when you realize who belongs in your life and who needs to be kept at a healthy distance.

Finding your “happy place”: Do not ever feel afraid to take time for yourself, do some self-reflection, and ask yourself what makes you feel happy as a person. At Just Mind, we often do a mindfulness-based exercise with clients; we have them close their eyes and allow them to go to a place that makes them feel safe, secure, wanted, and fully able to be their authentic selves. We emphasize that the feelings this brings up should be felt in their lives and in their relationships more often. Often, when clients realize what they need to make themselves feel safe and less codependent, their partners can sometimes catch on and meet their needs in this, making the relationship a healthier space for each partner to co-exist.

Finding your self-care: This again is tied to finding our “happy place.” It can be understood that in all codependent persons, there is a lack of self-care and an unnurtured inner child. We often tell our clients (sometimes exhaustively) that the way to become more self-reliant and less dependent on others is to take moments to breathe, ask yourself how you’re taking care of YOU, and become comfortable with nurturing the parts of yourself that may be still wounded from some kind of trauma or painful family upbringing.

Listen to your gut: Have you ever been dating someone and have always had a funny feeling in the back of your mind that something was off? Or that there was this need for space for you but it was never respected? If you are in a codependent relationship, chances are you are not listening to what your gut is telling you. You are dismissing your feelings of discomfort to appease the very relationship that is probably bulldozing over your life. Do not ignore what your body is telling you!

Ask yourself who you are in a partnership. Be able to take time to take a step back and ask yourself eye-opening questions like: “Am I relying too much on my partner emotionally?”, “If I saw myself through my partner’s eyes, how would I feel?”, and “Is this relationship helping my partner and I grow as individual people?”

Ask yourself what kind of love was taught to you. The family therapists at Just Mind are always mindful of what childhood was like with our clients. Such things as divorces, alcoholism, and physical and emotional abuse can have a profound effect on how we love as adults. Codependence is usually what happens accidentally to children from an abusive or chaotic household—they grow into adulthood, searching blindly for what they were deprived of as children. Having an understanding of what led us into codependence can give us a fuller understanding of ourselves individually, as well as in a partnership. 

Thank you for taking the time to read an article on something that is sometimes painful and controversial. We hope that this article was helpful and eye-opening. We realize that some of the wording in this post was strong and potent, so please be kind to yourself if you feel that this has awakened a painful part of your relationship history or triggered some past childhood trauma. If you feel that you need to do some work on yourself or that you are feeling hopeless in your ability to love, Just Mind has a wonderful selection of therapists who specialize in everything this article discusses. If you feel like you may need relationship or marriage counseling due to lack of boundaries or codependent patterns, contact us as we also have a dynamic team of couples therapists who can help with this!


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ADHD in College Students

ADHD in College Students

by William Schroeder & Scott Allen

Attending college is an entire new level for every young adult. Subject matter becomes more dense, hours invested in studying dramatically increase, and tests and homework become more challenging. Along with this, many young adults are now on their own, so they have to manage work, school, and personal affairs simultaneously. All of this can seem like attempting to organize chaos, which can lead to stress, depression, and anxiety, especially for individuals with ADHD. If you are or know a recent high school graduate or an upcoming one who has ADHD, you may be wondering how to navigate the college admissions process and how to select a university that will be comfortable and have an adequate amount of resources and support. In this blog post, Just Mind therapists William Schroeder and Scott Allen answer some of the questions regarding applying and selecting a college with ADHD and ADHD in college students.

1) Advice for Students With ADHD Who Are Beginning the College Application Process:

We suggest taking a broad look at the needs and desires of the individual. Finding an environment that will be supportive of their growth and will inspire them is crucial. If they needed a lot of structure in high school, then it makes sense they might also need that in college. Identifying schools with good support programs might be vital. Loyola University in New Orleans has a program called the Student Success Center, which is an excellent example of this. They provide various levels of coaching, tutoring, and career support. Other schools have programs that are more focused on disability services like the SALT (Strategic Alternative Learning Techniques) Center at the University of Arizona. This program is even more intensive for those who need it. Each of these programs offers varying levels of support (executive function, peer support, advocacy, etc.) but identifying those which you or your child would most benefit from is essential.

We also suggest that you think about things like:

  • What is the size or layout of the college?  Taking “the leap” from high school to college is a big step for any student.  First-year classes at larger universities tend to be massive and can be overwhelming for individuals with ADHD, as it is more challenging to access the layers of support they had in high school.  Is the campus easy to navigate? Are support personnel easy to identify and access? Would they benefit from a smaller classroom size and more direct teacher time?
  • Could a gap year benefit them so they can work, mature, and take community-college classes to better their chances in college (and their acceptance rates and scholarship opportunities).
  • How is the academic calendar setup? Some kids might like a quarter system with short but intense classes. Others may prefer a semester as it’s longer and slower. We have even had individuals opt for programs like Colorado College’s Block Plan, which allows kids to take one class at a time.
  • Evaluate the environments of learning, support services, academic departments, and the general culture to see if it’s a good environment for you or your child and if they all are supportive of ADHD.
  • Are you worried about dividing work and play time? If so, be wary of party schools. Work  to find ways to balance competing priorities. This is a personal disclosure here; I (William) went to Millsaps College, and it was just the small school environment my parents thought would help me. From growing up in New Orleans, I was bored out of my mind, as most kids were at home on the weekends, and the school had minimal support services. I transferred to Loyola in New Orleans and found the exact balance that I needed between fun and a supportive environment.
  • Another important consideration is the distance of the school from home.  Is your young adult ready for dorm or apartment life? Have they had prior experiences of separating from your family for trips or sleepovers?  If not, it might be worthwhile to consider a college close to home and to work up to moving away in gradual steps if the young adult wishes to go to a particular program or college.   
  • The reality of the situation is that adjusting to college can be both positive and challenging for students with ADHD.  On the positive end, there is greater access to peers with similar interests, coursework/majors can be high-interest subjects, there is greater flexibility in scheduling (which is great for people who are “owls” rather than “larks”), and there is greater freedom on the part of the student.  On the more challenging side, there is a ton of more unstructured time, which can be problematic for students with ADHD, as time management is a typical struggle in the population. Students may need to add layers of structure with jobs or scheduled studied times in order to help “stay in the game.”  The out-of-class course demands are also much higher in college than in high school. There are more long-term projects and papers, requiring students to complete more work on their own. Research papers and projects tend to be executive-functioning challenges, as they require so many skills (e.g., planning, organization, time management, etc.) to get from start to finish.  Students with ADHD who soared through high school may struggle for the first time in college. We can’t emphasize enough the importance of obtaining outside assistance (e.g., tutors, coaches, etc.) to help early when students struggle with the executive-functioning challenges of college.

2) Should students address or disclose their ADHD in their college application? Or is this something they should address with the university after being accepted?

We wouldn’t say there is a uniform way of addressing this as we have seen it done both ways. Personally, our vote is for disclosing any disability and making it an open part of the criteria for evaluation. This helps you to see the full spectrum of services a school may have to offer. That said, as long as you have your evaluations and documentation ready for the university, you can also do it after being accepted. We’ve had a parent describe disability disclosure as an “insurance policy.”  In many ways it can be preventative in nature and it opens the discussion for the types of accommodations and supports that the school can offer.  Keep in mind that it is unlawful for any school or program to reject a potential student based on a disability. Where we often see the most resistance is from students who fear the stigma or label associated with a disability.  Many times, this fear can be eased by stating that disability status can not be made public to other students and even if accommodations are offered by a university/program, they don’t have to be used by the student.

3) What campus resources should students with ADHD look for when selecting a university and why?

We would reiterate some of what we said above and add more depth to it. See if schools have disability advisors that can help them to get their accommodations in place with teachers and if your child is allowed to schedule early with them. It helps to have an advisor who understands difficulties in time management, organization, scheduling, and other areas. Ask if they charge additional fees for tutoring and support. Find out what support services are available to students with ADHD—extra time, tests in a solitary environment, tests with assistive devices that read text aloud, is coaching included, etc. Most, if not all, schools will have a disability office, but there will likely be differences in the types of supports provided and how they are offered.  It is important to ask specific questions relevant to your young adult on the front end. For example, if you know that your young adult struggles with taking notes (and you have an assessment report to support that), ask what the school can do to help your young adult fully access the curriculum (e.g., audiotaping lectures, note sharing, instructors providing slides to students, etc.).  No question is a bad question!

4) How important is a university’s community and resource center for students with ADHD?

It depends on the individual. Some kids need a full spectrum of support, while  others may benefit from one or two helpful items alone, such as smaller classroom size and an accessible teacher. That said, we do think it helps to have a coach who can check in on the identified areas of need, see how things are progressing, and re-evaluate support measures as the semester progresses. Let me (William) give an example. When I went to Loyola, they had a class on how to organize and structure yourself for learning. This class was incredibly helpful to me as it went through a lot of areas of structure and organization I would never have thought of on my own. I met once a week with a coach to check in and see how things were going. She was a bit of a blind spot detector for me, and it helped me to see what worked, what was a challenge, and what I could do differently. She was instrumental in my success. It reminds me of the importance of finding a program that helps students who have difficulty planning ahead (oftentimes they go in when in crisis), that can help with academic issues, and that have centers staffed with trained professionals (tutors and otherwise) that understand learning disorders.

5) What are ways a university can support students with ADHD while they are completing their degree?

Most of what we said above would hold true for this as well. As therapists who specialize in ADHD, we would add that they should work to understand what motivates someone with ADHD and what their pain and shame centers are. The more you know that, the more you will understand what gets them stuck and how to get them unstuck. Well connected support mechanisms between coaching, advising, and mentors can help to identify these areas and keep them on the right track. For each person, we like to believe there is a recipe for success. Sometimes it takes time to identify all the right ingredients. Heck, even recognizing the wrong elements helps to make progress. We think the most important thing to remember is that every individual with ADHD is different.  One profile or list of supports does not help every student. It is great for the student to have a “point person” who can assist the student with not just the academic demands, but also issues with socialization and executive functioning. If the student cannot find a “point person” (or people) on campus, it still may be possible to access these supports in the community.

We hope that this post was informative for you and will help you (if you are a student with ADHD preparing to attend college) or your child (if you are a parent of a student with ADHD who is preparing to attend college) and make the entire process of applying to college and selecting a school much easier.  If you would like more ADHD resources, you can read more about it on our ADHD counseling and Aspergers counseling pages. Additionally, if you are seeking more help in the management of ADHD, you can contact us to make a counseling appointment. We have several therapists that specialize in treating individuals with ADHD. For more blog posts on ADHD, you can also read What ADHD Looks like in College, ADHD and Time Management, and Simple ADHD Treatment Strategies.  

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How to Connect with Your Teenager

How to Connect with Your Teenager

Yes, the teenage years are collectively a cringe-worthy and uniquely challenging time for many parents. How vividly do you remember the chaos and stress that you bestowed upon your own parents many years ago? It is a point in your child’s life that can be fulfilling, as they are developing their own interests, trying new hobbies, making new friends, and slowly learning how to become an adult. However, it is also a point when the paradigm shifts and your child will want to become more independent and try to make their own decisions. They will ask for more freedoms, your car keys, if they can spend more time with friends, and about dating, which means, uh-oh, sexual activity. Teenagers, as we all remember so well, are also newly exposed to a plethora of different stressors from school and their peers and there are many biological changes occurring within their bodies that they do not understand, which can result in them being temperamental. The important thing to remember during this time is that you should connect with your child before you correct them because they need you. The teenage years are critical molding years and connecting with them is vital, as it will make these turbulent times easier for you both. Below are some pieces of advice on how to connect with your teen.

  • Keep an Open Door Policy – As mentioned above, once a child becomes a teenager and enters high school, they are exposed to a monumental amount of new stressors: grades, preparing for college, bullies, rejection, rumors, working, peer pressure; the list goes on and on. Your child may not fully understand how to deal with many of these issues, so it is important that you, the parent, be an open source of guidance and comfort that they can come to when they need help or someone to talk to. This will help you and your teen develop a healthy, trustworthy, and open relationship and stronger emotional bond.
  • Show Them Love – Despite the fact that many teenagers think they are “cool”, grown up, and independent, they still want love and affection. You can easily display this to your teen by regularly saying “I love you,” giving them hugs and kisses, surprising them with their favorite snack or breakfast, greeting them when they come home, and saying “goodbye” when they leave. Simple gestures will show them how much you care about them and are always appreciated.
  • Take an Interest in Their Interests – Even you may not like the kinds of activities that your teen does, it is important to support your child’s interests and get involved with them. If your child is into sports, you can offer to play with them outside or watch a game together. Do they like art? You can take some time to paint with them or even take a pottery course together. This will be a perfect way to strengthen your emotional bond and spend time together. Hey, you may also develop some new interests of your own.
  • Talk to Them – This one is simple and straightforward. Ask how their day at school was, how they are feeling, do they need help with anything, how their friends are doing, etc. A good way to keep this consistent is to have dinner as a family every night. That will always serve as an ample opportunity to talk with your teen about their day or anything else. On days that you are both super busy, still try to converse with them, whether it be during a car ride or even on the phone. This is a great way to connect on a daily basis and show that you have an interest in their lives.
  • Develop Rituals – Taking part in traditions as a family can be a great way to have fun, create lasting memories, and bond. Rituals can involve biweekly trips to see a new movie, dining out at your favorite restaurant on the weekends, taking them shopping when they receive good grades, going on a yearly vacation together, and anything unique that your family can think of and that everyone enjoys. Pick something unique and remember to stick with it.
  • Do Work Together – Ew. Chores. One of the dreaded parts of weekends or breaks for both parents and their children, but, unfortunately, they need to get done. Instead of commanding your teen to perform all of the cleaning or mowing by themselves, offer to help them with it, making the experience more tolerable and quicker for everybody. You can also make it more enjoyable by playing music or listening to a podcast together. This can also serve as a good opportunity to teach them new things and life skills for when they finally reach adulthood and move out. Two examples of this are: cooking together and teaching them how to change the oil in a car.
  • Be Affirming – During these years, many teenagers are always judging their self-worth and seeking affirmation from their peers, teachers, and others around them. It is important to remember that they are also mostly seeking affirmation from YOU, their parents. They want to know: Are you proud of them? Are they doing a good job? Are they pretty? Smart? Capable? Saying affirming things to your teen can have an amazing effect on their lives. And, if you are in a situation when you do not want to embarrass them, as sometimes teens get embarrassed when you say these things in front of their friends, send them a text or leave them a note for later reading.

We at Just Mind hope that this article will help you build a relationship with your teenager. If you are interested in other blog posts related to teens, you can read Five Ideas for Supporting Teens in a Tough Moment. If you feel that you need additional help regarding your teen, you can read about teen counseling or contact us to make a counseling appointment. We have several counselors that work with teens and parents that can help you. Even if we are not the right fit, we are tied to an expansive network of counselors and will help you find the right match.

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