Chapter 18: Cognitive Behavioral Therapy

I recently published my memoir Adventures with Postpartum Depression. I’m sharing several chapters on my blog. You can buy the ebook or paperback on Amazon – woot woot! In this chapter, I describe how cognitive behavioral therapy helped me process and come to terms with the fact that I had a mental illness.

My psychologist—I was now the sort of person who had a psychiatrist and a psychologist—shook my hand and showed me into his office. It was early August, about one week since my discharge from the hospital. Nathan, Pippa and I were still staying at my parents’ house. While I was still in the hospital, the psychiatrist had suggested I meet with this psychologist, promising he would help me become the master of my anxiety.

The psychologist sat down on a chair next to a desk with a computer and told me to sit wherever I liked. There was a pair of chairs by the window, but I chose an armchair closer to the psychologist.

This would be my first experience with cognitive behavioral therapy (or “CBT”). The psychologist explained that our sessions would involve lots of talking but he would also give me homework assignments.

“To start, why don’t you tell me why you are here?” The psychologist spoke perfect English but had a lilting accent. I eventually learned that he was from a small village in Spain and that I could always depend on him to be running at least twenty minutes behind schedule.

“I’m here because I have a lot of anxiety and my psychiatrist thought this would help me manage that. I’ve always been an anxious person. When I was young, before I was even in preschool, I had this thing about doors. I always wanted the door to be closed . . .”

For the next fifty minutes, I relayed my life story to the psychologist. Near the end of the hour-long session, I finally started to describe the past few months of my life. With hardly any time left, I said, “I thought about throwing Pippa as hard as I could against the floor. And I thought about taking a knife and slitting my wrists to end my suffering.”

“Let me stop you there.” The psychologist had been listening attentively and taking notes. This was the first interruption. “These dark thoughts—are these the reason you are here?”

My brow crinkled. “No. I had those thoughts and I went to the hospital and I got better. I’m here because I want to be less anxious.”

“So you do not want to talk about the dark thoughts you had about hurting yourself and your daughter Pippa?”

“I do not.”

“Okay. Well, we are out of time, so let’s continue next week.”

Relieved, I paid the receptionist and hurried to my car. When the psychiatrist had suggested I try cognitive behavioral therapy, he had only mentioned it in the context of my anxiety. He had not indicated there would be any need for me to rehash the worst moments of postpartum depression. There must have been a communication error between the psychiatrist and psychologist.

I shuddered as I turned the key in the ignition. If the psychologist expected me to talk about the dark thoughts, this CBT thing was not going to work.

* * *

“So last week, at the end of our session, you mentioned that you had dark thoughts about hurting yourself and Pippa.”

“Yes.”

“Are you still having these thoughts?”

“No, no, not at all. I haven’t had any dark thoughts since before I admitted myself to the hospital.”

“How do you feel about having had those thoughts?”

“What do you mean?”

“Do you have any feelings about the fact that you thought about hurting yourself and Pippa?”

“Oh.” I took a quick emotional inventory. “No. I feel fine.”

“I want to tell you something important.”

I nodded.

“You do not own your thoughts.”

I frowned.

The psychologist said it again, slowly and forcefully. “You do not own your thoughts.”

I frowned a little more deeply.

He said it again. “You do not own your thoughts.”

My brain recoiled. What was he suggesting? When I thought about hurting Pippa, those terrible thoughts originated within me. It wasn’t like they had been whispered by a demon. Of course they were mine.

“You do not own your thoughts.”

“I don’t understand.”

“Let me give you an example. Do not think about an elephant.”

An image of an elephant popped into my head. I smiled. “You put that thought into my head by saying ‘elephant.’”

“That’s right. And the dark thoughts you had about hurting Pippa and yourself came from a chemical imbalance. They did not come from you.”

I nodded slowly.

“You are not your thoughts. You are your actions. Did you act upon the thoughts you had of hurting Pippa?”

“No, never. I shoved them away.”

“That was you. The thoughts were just thoughts. The act of pushing the thoughts away—that was you.”

I smiled. The psychologist was making sense . . . sort of. Although I still did not understand why we were wasting our time talking about this.

“Would you like to talk some more about your experiences with postpartum depression?”

“No.”

“No?”

“I had postpartum depression but I recovered from that in the hospital. I’m better now. There’s no need to talk about what happened. I’d rather just deal with all this anxiety I’m still feeling.”

“So let me make sure I understand you correctly. You do not want to talk about the postpartum depression anymore?”

“Correct. I don’t want to talk about the postpartum depression.”

Case closed.

Or so I thought.

* * *

“I never knew there were so many teethers.”

“This place has everything.”

It was mid-September, about six weeks since I had been discharged from the hospital and four weeks since I returned home to Pasadena. Except now Pippa and I were staying with my parents again. Nathan was working on a trial in downtown Los Angeles and staying at a hotel near the courthouse. (More on the experience of being a pseudo-single mom with postpartum depression later.)

On this lovely September day, I was at buybuy BABY, a massive store devoted to all things baby, with my parents and Pippa. There were aisles upon aisles of toys, clothes, strollers, sippy cups, first aid supplies, and everything else that a twenty-first-century parent might covet.

It did not take me long to find the books.

I focused on the baby books. There were parenting books as well, but I had burned out on parenting books during the first months of Pippa’s life. They had exacerbated my anxiety. It was safer to admire the selection of Dr. Seuss and Sandra Boynton. I added several to the cart before heading back to my parents.

I paused mid-aisle.

A self-help book had caught my eye. The cover said something about secrets to being a happy mom.

I wanted that book.

I started to reach for it but stopped myself. This was silly. I knew everything I needed to know about happiness. Besides, we had made a pilgrimage to buybuy BABY, not buybuy Mom.

But I adored self-help books. I grabbed the book off the shelf: The Happiest Mom: Ten Secrets to Enjoying Motherhood by Meagan Francis. I started to skim through the chapters and did not want to put it down.

My mom called for me to look at something. I dropped the book into the cart and strolled back to the toys. I needed some new bathroom reading anyway.

* * *

Within hours of our return from buybuy BABY, I had inhaled The Happiest Mom. It gave me a lot of great ideas, but more importantly, it got the wheels in my head turning. Since Pippa’s birth, I had been reading a lot of books about raising a happy, healthy child.

But what about me?

I started looking for books about motherhood on Amazon. My searches returned lots of results. Clearly I was not the first woman to seek a little guidance on the subject.

As I skimmed synopses and reviews, a thought tickled the back of my mind. I ignored it at first and kept looking at memoirs and self-help books that addressed the art of motherhood in general. The thought, though, persisted.

What about books on postpartum depression?

I shoved the thought away. I did not need books about postpartum depression. My experience of the illness was in the past tense, thank you very much. All I had to do was keep taking my medications. I did not need to learn about symptoms or alternative treatments.

Or did I?

I put my phone away and played pat-a-cake with Pippa. She burbled and giggled.

Hadn’t Brooke Shields written a memoir about postpartum depression?

I typed her name into the Amazon search bar and clicked on Down Came the Rain, her memoir about maternal mental illness. I felt as if I were doing something dangerous and forbidden. I needed to put as much distance between myself and the diagnosis as I possibly could. Reading a memoir about postpartum depression would place the illness front and center on the stage of my life. How could I linger on a subject that had landed me in the mental ward?

Below Down Came the Rain, Amazon suggested some other books I might like to read, including Postpartum Depression for Dummies by Dr. Shoshana Bennett. This was a revelation. I had read Dummies books on topics as diverse as California wine, American history, sewing, and football. If the For Dummies series had published a book about postpartum depression, that meant there was a market for it.

I hesitated.

To get the most out of the book, I would have to order a physical copy. That meant there would be a book about postpartum depression in my house. Which meant that a visitor could stumble upon the book and then they would know.

I clicked order anyway. I would have to keep the book somewhere safe. That ought to be easy enough. It wasn’t like I was going to read any more books on the subject. One was enough.

* * *

One was not enough.

Postpartum Depression for Dummies was enlightening and empowering. I learned about so many important things, like the risk factors for postpartum depression and how my new medications worked. Surely that was all I needed to know about my illness.

Except I couldn’t stop thinking about Brooke Shields’s memoir.

I added the book to my virtual shopping cart.

What was I doing? I had to stop associating with the subject matter. What would people think if they found out? I’d be exiled to the island of depressed mommies.

But no matter what I did—wash dishes, change diapers, answer emails—my thoughts wandered toward Down Came the Rain. What had postpartum depression been like for Brooke? Had her experience been anything like my own? How had she recovered?

I had to know.

* * *

“How does the book make you feel?” the psychologist asked.

“Awful.” I was a fast reader and Down Came the Rain was short. Technically speaking, I should have been able to read it cover to cover in one sitting. But I could not finish it in one sitting, or two or five or ten. Whenever I started to read it, chills crawled all over my body. Then my stomach churned until I thought I would puke. It was too difficult for me to read for more than ten minutes in a row.

“Why do you think that is?”

“Well.” I inhaled slowly. “It makes me remember the way I felt when I had postpartum depression.”

“You said before that you did not have any issues to discuss in regards to your postpartum depression.”

“Can I change my mind about that?”

“Of course.” The psychologist kept a neutral expression on his face.

“I think I have some issues from the postpartum depression, but I don’t understand why. I had postpartum depression. I went to the hospital. I’m taking sertraline. Shouldn’t I be better?”

“No, no, no. You have been through a traumatizing experience. It is natural to have a lot of thoughts and feelings about it. Would you like to talk some more about having postpartum depression?”

I sat and thought. “Yes. I would.”

“Here’s what I think you should do. Before our next session, read Down Came the Rain very quickly, over the course of two or three days at the most. Write down any thoughts or questions you have. Then we can talk about your experience reading the book together.”

A few days later, I picked up the book, this time with pen in hand, and started reading. I followed the psychologist’s advice and underlined the passages that resonated with me. For example, Brooke wrote about her despair of ever feeling better. I easily related to that. Just like my mom, Brooke’s mom suggested she stop breastfeeding to give herself a break. Brooke also thought she should be able to handle motherhood all by herself. It was almost as if Brooke had access to my innermost thoughts.

I did a lot of underlining.

At our next session, we had a book club for two. “I struggled a lot with Brooke’s descriptions of wanting to throw her baby.”

“Why?”

“Well.” I paused. “I thought about throwing Pippa. So it made me flash back to those moments.”

The psychologist nodded.

“I don’t understand why I’m having so many feelings about stuff that happened a month ago.”

“You have been through a traumatic experience.” The week before, he had said the exact same thing. The psychologist rarely repeated himself, so I knew this was important stuff. “You needed some time to distance yourself from the event before you could acknowledge and consider your feelings.”

“I do feel better now. I felt so shitty while reading Down Came the Rain, but now that we have talked about it, I feel lighter.”

“It’s like you are a pressure cooker. You needed to let off some steam.”

“That makes sense.”

“And maybe, some more steam will build up and you will need to let it out again.”

Externally, I nodded in agreement; inwardly, I registered my vehement protest. Surely I had felt enough crappy feelings. Surely I had released enough steam for one lifetime. Surely I was done with the subject of postpartum depression.

As we wrapped up our discussion of Down Came the Rain, the psychologist said, “I know you love writing.” As part of my homework assignments, he had me write about the things that made me anxious. I usually had at least twenty pages for him. This was apparently a bit more prolific than his other patients.

“You could write a book about your experiences with postpartum depression, just like Brooke Shields did. That would be very good for you. It would help you understand and release your feelings. And it would help so many other moms, too. Just like Brooke Shields’s book has helped you.”

“Maaaaaybe.” I did not want to hurt the psychologist’s feelings, but all I wanted to do was move on with my life and forget that this dark chapter had ever happened.

Besides, a memoir would advertise to the world that I was the sort of mom who got postpartum depression. There was no way I would ever be able to do something like that.