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Treatment of Attachment Traumas in Postpartum Depression with Intensive Short-Term Dynamic Psychotherapy: Addressing the Self-Critical Personality

Elke Schlager

Intensive Short-term Dynamic Psychotherapy (ISTDP) is a treatment that has shown promise in addressing attachment ruptures that lie at the root of postpartum depression (PD). ISTDP can provide rapid symptom relief while also addressing the underlying maladaptive personality structures that cause and prolong PD. These vulnerabilities can include self-neglect, harshness toward the self and others, and difficulty regulating emotions. Research has shown that this self-critical personality style, usually resulting from having distant or harsh parenting, is highly correlated with PD. ISTDP directly addresses these self-critical patterns, commonly referred to in the psychodynamic literature as “superego pathology”. These patterns are thought to result from the identification with harsh caregivers. A woman may doubt her capacity as a caregiver, push away supports, minimize or ignore her feelings, project her fears and anger onto the baby, dismiss her instincts and idealize authority figures. If these tendencies are not addressed, a woman is likely to pass along these enduring patterns to her baby and future generations. Early, rapid, and effective psychotherapy treatments that address these underlying non-conscious defense mechanisms are essential in healing PD and ensuring a positive mother-infant bond. “If we want to shape the future, to truly improve the world, we have 1,000 days to do it, mother by mother, child by child. For what happens in those 1000 days through pregnancy to the second birthday determines to a large extend the course of a child’s life…”.