Psychiatry & Psychotherapy Podcast - Postpartum Depression and Problem-Focused Psychodynamic Psychotherapy: Understanding the Five Core Conflicts

Episode Date: September 11, 2026

In this episode, Dr. Puder talks with reproductive psychiatrist and psychoanalyst Dr. Alyson Gorun and Dr. Fredric Busch about postpartum depression and problem-focused psychodynamic psychotherapy. They focus on the five core conflicts (difficulty tolerating anger, idealized expectations of parenthood, struggles with dependence, fear of separation and abandonment, and fear of intrusion) that often underlie symptoms, shame, attachment reactivation, and stuck behaviors in the perinatal period. This episode explores: -How these dynamics emerge even when parents know what they "should" do -How to integrate psychodynamic insight with medication, sleep, social support, and evidence-based care -Practical ways clinicians can help mothers and fathers mentalize their experiences, reduce guilt, and improve bonding.   Link to blog Link to YouTube video

All right, welcome back to the podcast. I am joined today with two psychiatrists. We are going to be talking about postpartum depression and the psychotherapy component of postpartum depression. Allison Gorin is a psychiatrist, doctor, psychoanalyst, who is a reproductive psychiatrist. And as well, we have Dr. Frederick Bush, who is a psychiatrist, doctor as well. who was on prior, we talked about problem-focused psychodynamic psychotherapy. They have co-written a book together on postpartum problem-focused psychodynamic psychotherapy. And it is good to have both of you in the room. Alison, why don't you introduce yourself really, maybe a little bit, just how you're interested in this topic, your background, and then Frederick, I'll have you do that as well. Good to do so. So thank you for having me. So like you mentioned, I'm both a psychoanalyst, and a reproductive psychiatrist. And so I'm really lucky to be able to, you know,

combine the two of those specialties and really think about how they can complement each other. I'm also the acting director of the Aaron Stern MD PhD program in psychodynamic psychiatry. And that also has a focus on using psychodynamic concepts across all medical specialties, so not just with psychiatrists. So this is sort of one out. sort of outposting of that in the sort of OB-Gyne productive psychiatry territory. Great. Okay. Frederick, anything you want to add to how you're interested in this topic and

specifically and how you guys got connected? Yeah, so thanks for having me, again, by the way, and have an opportunity to talk about this book, which, by the way, I just want to emphasize I said, up front that it is about depression, but also about the range of issues that people have in the postpartum period. So depression, anxiety, behavioral issues, relationship problems. I mean, we'll talk more about that. But as we've talked about before, I've done a lot of work on problem-focused, psychodynamic psychotherapies, and a more general approach and focusing on specific topics like depression, panic, trauma. And, you know, Allison came to me and said, like, hey, we need, we really need to do something on postpartum, psychodynamic psychotherapy, because it's such a,

there's some, such a broad and difficult problem. There's not, there's not adequate treatments. And we also learned that there wasn't a whole lot out there in terms of manualized focus approaches. to postpartum difficulties. And this is really important, given limitations and availability of care, we got to work on this. So that's how we came to do it. It's been a great collaboration. And I think one of the things that I can just add,

that what I was seeing was that with my patients, I was sort of recommending the evidence-based things to do in the postpartum, like, OK, you need to get enough sleep. all right, you've got to take off some of this workload, child care workload, and give it to your partner. And, or they were recommended to supplement with formula while they were breastfeeding. It's a way to sort of, you know, either because you had weight issues or, you know, there's something going on with feeding. And then what I found was that despite me sort of in a sort of supportive intervention way, telling them, like, this is what you really need to do, they weren't able to do it. They were getting kind of stuck.

And so despite them wanting to it. It's like there was some force pulling them backwards. Me with my psychoanalyst hat, it's like, okay, there's probably something unconscious happening here that is kind of pulling them in the other direction. And it kind of forced me to put on my psychotanamicat and say, okay, we need to really use psychotidia of concepts to get these problems fixed because not sleeping, not taking care of yourself is really driving this depression or anxiety or relationship conflicts. So that's sort of where the idea came from. And I thought, wow, this problem-focused framework is such a good place to kind of put that where you're really focused on. There's a lot of stuff going on here. There's a lot of problems we have to fix and we kind of have to do it quickly.

Okay. So how would you like to kind of start out in terms of like introducing this idea of like how this kind of fits into the larger thing of, you know, there's a person that. that's coming in, who's probably sleep deprived, who's probably working really hard, who has maybe a lot of internal, self-critical thoughts, how does it kind of fit into the big picture to think about therapy and to think about, you know, how we think through, is this a biological issue? Is this a psychotherapy issue? So what are you, how do you start to think through that? Well, maybe I could give an overview of a little bit of the approach. And certainly you're talking about also, you know, differential diagnosis. I mean, and is the treatment appropriate? Certainly, you know, we look at issues of if there's great, you know, severity of these problems, then we want to think about other kinds of measures, medication, you know, safety interventions. Those are, those are critical. out front. But, you know, assuming that these are depressive or anxiety syndromes that are more

mid-range or under some controller impact with medication in some instances, the first thing we want to do is work to identify, you know, the range of problems or particular causes that people are having. So do they have, you know, self-criticism, anxiety, you know, lack of self-cuitous Are they a behavioral issue? Are they struggling around, you know, breastfeeding? Are there problems with their partner? And then we start to look at, you know, where do these problems arise? Is it, you know, kind of is a situation?

Certainly, we know the major stressor is the new baby, but there are problems around the baby crying, you know, over worry about the baby. the baby and then, you know, separation, you know, pressures to care for the baby that are, that the person's struggling with, and look to outline or identify these issues with them. And then we start to look at, which we'll talk, we're about, explore, you know, what are the factors that are affecting it. And we are looking at that people have our heavily influenced by underlying, attachment issues, conflicts, trauma that they dealt with growing up or with their parents that are

affecting them that they may not be aware of. So we begin to think about that in our approach. Yeah, Alison, kind of like, what are you listening for for the deeper, for the deeper things that are going on, you know, beyond symptoms? What are you listening for? one of the things that I that to me tips me off that there's something sort of deeper going on is of course you know sort of classic psychodynamic theory but you know intense affect so you know sometimes women and by the way I'm using I'm using women you know because that's just for ease of use but this book is really for parents in general it could be for fathers and also it's a family configuration so just just want to say that but so yeah so if you know so if a woman comes in and she's sort of telling me about, you know, something that, yes, might cause some distress to most mothers, but it just seems so much harder than what it should be. Like, you want to go out and get a coffee, you know, for a few hours and then come back. But there's so much distress about it. Like, she just can't do it. That tips me off. There's something else

going on here that's amplifying this kind of normal, you know, parental developmental task in some way. So when that happens, I really kind of leaves your focus on that and that try to explore sort of, you know, variables around that. Okay. Yeah, I would add it like an instance in terms of tolerance of feeling. So we'll talk about certain core dynamics that people can struggle with, others can struggle with in these circumstances.

and by the top of our list is angry feelings. So, you know, there's inherently going to be angry feelings at the baby. That's just part of how it works. But, you know, is that some people have a terrible time, you know, tolerating those feelings or, you know, feel tremendous guilt or, you know, struggle with try to back away. or deny them. So that may be,

that would be another thing that I would be looking for, you know, people having such intolerance that they then, you know, are taking extra efforts to care for the baby or that they can't,

they're having trouble tolerating or experiencing any kind of, you know, crying or, you know, any kind of that the baby's needs feel overwhelming to them and they're doing everything they can, wearing themselves out just to try to avoid

those sort of painful feelings. Yeah, I appreciate you bringing that up. The anger, it's almost like taboo for someone to think like I should, I could ever have any frustration or anger towards my infant. Allison, what do you say to mothers to allow them to express that safely in the session or decrease the internal shame of having those feelings. Definitely. I'm so glad you're bringing that. That is one of the primary kind of psychodynamic themes that we see in the postpart of my cause is a lot of distress. So one of the things that I, you know, I say to women, just like you said, is that, you know, it's actually having ambivalence in any relationship is completely normal. There's actually,

a whole literature around paternal end of those. And that's the idea that you could have mixed feelings about people. You can love them to death. And sometimes you just hate them. Sometimes you just want to, you know, box up your baby, put them in a package, something to your in-laws, right? So there's something about kind of putting it into words for them that is more sort of acceptable that it just lowers the talent. This is something everyone feels in every relationship. So, of course, you'd also feel it about your baby. And that it doesn't mean anything about you.

A lot of women think that means maybe, you know, for whatever internal reasons about their past or conflict stuff they have, I'm a bad mother, this anger could hurt the baby, I need to sort of stay away from them, you know, or feel very guilty about it, very self-critical. it's kind of overcompensate. I have to be with the baby all the time. So, you know, if it's not able to just be sort of expressed, then it can kind of lead to all these issues. And, you know, I have been happy to see that in social media and in sort of mom groups, it's been a lot more normalized,

I think, to just be like, this is really hard. Sometimes I want to break. Sometimes I don't want to see my kid. And so I think, I think that actually helps a lot that it's not. It's getting a little less reinforced kind of in the culture than it used to be. Just to follow up on it, a piece of that. I mean, of course, if there are issues around, you know, impulse, control, and management, then do that, you want to take that very seriously, but most months are coming, and do we have more with struggles around having these feelings? And just as though, that part of what Alice is referring to, you know, a second of these dynamics, the first being anger, sort of idealized expectations of oneself as a mom or the baby, you know, that, you know, this kind of this pressure, super mom, you know, pressure.

Or I shouldn't be having angry feelings. I should be able to take care of everything. I should always be able to. you know, to breastfeed, you know, the baby should be just right or everything perfect. You know, people, obviously, you know, people want to do a good job as well, but some people feel not only at tremendous pressure, but they also feel like, I'm failing. I'm not, they're their internalized standard is so high that no matter what they're doing, they feel, oh, that's not good enough. I'm a bad mom. And that's something where we've got, you know, it's very important to look for an interbeam. Okay. So, yeah, we're talking about kind of idealizing our own sort of experience that we will have as parents and then kind of coming into the reality of having

some more complicated feelings. And then, Alison, I appreciate how you talked about how ambivalence is normal. Mixed feelings is normal. Actually, it's very healthy, right, to be able to hold those attention. So talk a little bit about how the baby can reactivate the parents' own attachment history. Let's talk about that a little bit. Yes. So, you know, I think that what, I mean, if you think about what a baby is, it's a baby isn't able to communicate in any, coherent way of it been just saying I'm distressed or I'm hungry. So it's kind of like the perfect blank thing to reject everything into. And by the way, this happens with everyone with, you know, daycare workers, nannies, teachers. This is like constantly happening to babies and kids. And so what

happens is that there is a lot of shifts in identifications that happens. It can get very complicated sometimes. I talk about this with my patients. So on the one hand, suddenly, you as the mother, you've been the child up until this point in your life. And then you have a baby and suddenly you're in the role of parent. And then you have a child. And everything kind of switches a little bit. And then you're somehow, wait a second. Now I'm kind of in a really abrupt way, almost mentalizing with my parents' experience of what it must have been like with me.

And so there can be this funny. It's like this role, almost like a role reversal where you're suddenly, now you're the parent looking at this baby as if it was your parent looking at you, but you're still you, and the baby is actually separate from you. So it kind of brings all of that back in some way. It makes it all much more alive again. And a lot of people will revisit their childhood, their relationships. It kind of gets really put to the fore of their minds.

when they have a baby, and that's one of the reasons why these things get reactivated, because you're sort of renegotiating everything. What am I going to be like as a parent? How am I going to relate to this baby? Am I going to do the same things my parents did? Do I want to do something different? Am I afraid to be like this part of that? You know, when the baby cries and I decide I want to take a break,

does that mean that I'm not going to be as responsive as my parents were? It just gets, everything gets kind of. renegotiated and you sort of have to learn about yourself as a parent and how you're going to interact with the baby. Absolutely. And I would just add to that that the baby pulls for, you know, very powerful feelings. So certainly, you know, anger, total, total, you know, dependency of the baby, you know, have separation, abandonment fears. And whatever issues that someone's been had with regard to their own attachment, let's say there's a parent who was, you know, rageful that they may think, well, I'm not going to have that kind of thing with my baby or I'm not going to get mad.

You know, again, going to this other kind of idealized expectation of themselves to not, you know, be like the parent. or they may feel like their parent did something, oh, I do want to be like that. And then whatever issues people may have around, you know, dependency, which is kind of a third-core dynamic, would be reactivated because the baby is totally dependent. So some that might trigger inside the son of me moms and fathers as well. their own wishes to be taken care of that they're fearful of whether they'll be able to banish.

And instead of taking care of the baby, how will happen, what about how am I going to be taken care of? Or others may have had experiences with parents who are not terribly responsive to their needs, and they may have a kind of a heimer independence. oh, I have to do everything because I can't depend on anyone to you to help me. So those are, you know, these very powerful kinds of feelings get reactivated

and whatever issues one would have along those lines, those are likely to be triggered in a significant way. Okay. Maybe we can talk a little bit about like how, like let's say their early experience, let's say the parents earlier experience. And I do like to say parents, because I think the father will have this as well,

the mother, and, you know, like, let's say you had, like, a lot of neglect growing up. How could that show up? And now you're taking care of a child, and you're aware, maybe you've done some therapy, maybe you've, you know, work through some of this. But nevertheless, it's going to show up in a unique way all of a sudden with, you know, the first child, right?

And it's like you're aware, of things in maybe new ways. How have you seen that show up? Yeah, I think the two themes that kind of pop up for me, for someone who, maybe has a history of emotional neglect, are issues with, it's going to be a dependency, and then also with separation from the baby. So, you know, in terms of dependency,

like what fraud was saying, if you sort of didn't always have your needs met by your parents, there wasn't that responsiveness there, then you may be afraid to say your needs, to say that you need help to rely on other people because you're so afraid that they're not going to be able to meet that. And what happens in the postpartum is maybe you are able to kind of get along in your life by being completely self-sufficient. You could kind of figure it out. You can kind of do it on your own. And then you have a baby and it's really impossible. You have to depend on other people.

You need to be able to ask for help and ask for things. And so I commonly see that this pops up with people having difficulty kind of asking for help, asking for support, delegating things to someone else. They feel like they just want to be able and they should be able to kind of do it all in or out. So that's sort of one big category, I would say. And then thinking about, you know, the theme of kind of kind of. separation. So, you know, if you grew up with sort of a bond that was more fragile and more inconsistent, then you may be more concerned about disrupting the emotional bond between you and

your baby. So, you know, things, again, like kind of going back to work or, you know, going away and letting your partner take over, you may be more afraid of how much of an impact that's that I have on the baby. It might feel like catastrophic almost in terms of how much it might disrupt the relationship. And that's because to you, these little moments with your parents, it never felt stable enough. Like it never felt like sort of enough. So you're always worried about, I don't want my baby to ever feel that way with me. So you're very vigilant to that and making sure that you're always feeling connected.

Yeah, we talked about an example of someone who had grown up and told the father had, you know, left, the family abandoned her when she was a baby. And that had, you know, several consequences. First of all, at one point where she got very upset and left the house with the baby. But the father felt like, oh, no, now I've abandoned my... And this wasn't abandonment. It was just she needed to get out of there, but because she felt so much guilt and pain in terms of what she experienced that she felt, oh, this is, this is terrible the way that I behaved. And also that she had learned from her mother that she needed to not express any kind of needs and be the good kid. So she didn't feel safe. She didn't feel safe.

that, well, I can't bring up with my husband that I need this help or that or that kind of support because I need to be, I need to keep quiet about this. And, you know, this ended up creating tremendous anxiety for her in terms of, you know, all the pressure that she felt to do everything. And she began to get depressed too because she'd say, oh, yeah, she put combined. possibly to all the things that she needed to feel okay or to feel like a good boss. So it's very important to spell out those dynamics and that history to help her to understand where these feelings were coming from and how she got into trouble with them. Good, yeah.

So, okay, so kind of getting deeper on this theme of like how the infant, kind of like stirs up the mother's own attachment stuff, maybe on her own trauma that hasn't been processed. Let's say specifically with the mother starting to feel anger and then feeling guilt about the anger, how are you going to in this model work with the mother and help them work through that conflict? Yeah, I mean, maybe I'll start with that.

I mean, one of the things we want to identify about their struggle with angry feelings, it's part of what we're working to do is help people to develop these skills to observe what's going on internally and understand about themselves and that we identify like, okay, well, look, your angry feelings cause extremely, you know, discomfort for you, guilt. or you get anxious about them. Because people oftentimes, they don't recognize that. These things are going on, you know, sort of under the radar or automatically. So you help them to recognize that piece.

Then, as Allison was saying, partly through kind of reassurance or partly saying, you're overly threatened by these feelings. They're not creating the kind of danger. that you feel they're creating or the kinds of problems where you can find a way to express your anger, I'd say, towards your partner, if you're frightened of doing that, or maybe if you reduce the pressure on yourself, you will, you know, feel so much of it towards the baby. And then we want to be linking it to their past experiences. So helping them to understand, okay, here's where this comes from, you're trying to go, you get a rageful, this rageful parent. And so you'd say,

oh, no, I shouldn't have any anger because I don't want to be anything like that. Or all the anger I felt was dangerous, but I don't want to, so I should, I should be shutting it out entirely. And that that's, that's not a possibility of that doesn't need to be done in that way. So, you know, With those, it's a series of things, series of steps help them understand that they're conflicted about the anger, that they feel overly negative towards themselves, and then even to think about how does that affect them with their partner with getting the help that they need, the pressure they brought on themselves. Our dynamic approach also includes that we want to affect the behaviors that they have

their relationships because those are so crucial. So we definitely be awesome, we want to emphasize how these struggles, you know, affect those things and what changes they might make. Allison, do you with that correspond to? Definitely.

And the other thing that I, you know, that I would definitely do also is part of this person is really focusing in. So where is this coming up practically that is making things really hard for you? your experience with this part very difficult. So let's say, you know, one place that I see this pop up a lot is, like, really having a hard time tolerating baby crying.

Like, it's just too much. They cannot do it. It's like nails on a chalkboard or something. And, you know, there's definitely, I just want to say this, there's definitely gender differences here. There's something, I think, evolutionarily with hormones that make women much more sensitive to the baby's cries, but putting that aside, if it feels intolerable, well, sometimes what's behind that is actually the mother's feeling angry at the baby for crying because they

can't soothe them. It's making them feel inadequate and making them feel like a bad mother, like they're failing and they're angry at the baby for making them feel that way. So if you kind of can just help them see, like, the baby is not communicating that they're really angry at you or that you're doing a bad job. Sometimes it's almost like that's when the baby's crying. It's like they're communicating that to the mother. If you can kind of break that down and just be like, the baby just cries. Sometimes the baby just cries.

And sometimes there's nothing you can do to stop the baby crying. You don't need it almost like you don't need to take it personally. Then you can kind of help reduce, sort of understand the anger, feel okay with it, and then help reduce it. And there's a lot of different places this can pop up. There's another kind of common example thinking about, you know, kind of common problems that happen. Maybe a mother's feeling is sort of disconnected, like doesn't really want to be around the baby as much. And, you know, one sort of synthesized way that I've seen this happen is make, you know, if there's issues with feeding, sometimes women sort of have an expectation or a desire to really kind of breastfeed and have that bonding moment.

That's those loving feelings that's, you know, sort of supposed to come with it. But some babies just can't breastfeed. There's a difficulty with the latch. Your supply isn't right. You know, it just doesn't work out. And then either you have to pump or you have to use formula. But you're kind of disappointed by that. You feel upset at the baby that you guys aren't able to have that bond.

And then you can kind of reframe that. Yeah, you're kind of upset at the baby that they, you know, you can't, you guys can't do this together. But that's just because you really want to feel bonded to that. That's what's really behind it is a desire to feel close, desire to feel connected. And how can we help that happen in other ways? So you sort of just normalize the anger. Usually what's behind it, there's a good intention there. And then you try to see if you can kind of come at that from somewhere else.

David, I want to emphasize one one piece of what Allison said about specificity, where we're looking for, you know, where do these feelings come up, you know, specifically. How is the person being affected because partly we're saying like, okay, if you have anxiety and depression and a lot of approaches these days, it's like, okay, well, you know, medication is indicated or let's talk about how, you know, you're feeling too negatively about yourself and you shouldn't feel so negatively. But in it, we're saying, but these particular ways, these manifests have meanings. And that understanding those meetings help people to have a better understanding of what's going on in themselves. And often in the baby, what we call mentalizing the baby and the mom developing those skills. or the father, you know, developing those skills so that someone's, they have anxiety, it might be about the baby's health and worries.

So what's the meaning of that? Or they're depressed. They're like, I'm a bad mom. Well, how are you a bad mom? What way? What's our understanding of that? It's not just a generalized symptom. It takes a specific form and meaning for them that.

important for them to understand. Really good, yeah. And I think going through just the list of the five core conflicts might make sense. Difficulty tolerating anger, idealizing expectations of being a mother and the baby, difficulties with dependence, fear of separation and abandonment and fear of intrusion. Okay, so we talked about, we sprinkled through all of these a little bit, right but I think I think this is like a very different framework for a lot of maybe my audience nurse practitioners, PAs that are psychiatric nurse practitioners, psychiatrists you know we're wanting to do the right thing for the mother I think there's a lot of

anxiety that providers have especially in this time in this moment with the court cases going on like are we doing the right thing are we you know and yeah so it's like how do you go from okay there's a very depressed, anxious mother here to, okay, there's other threads we can pull out that are deeper, there's reasons for these deeper feelings, right? And I think one of the other conflicts I have as I'm listening to this is like, okay, mothers have, an infant's having an issue latching. Well, is there a tongue tie, right? Or is there a lip tie? You know, like if you put your finger at the bottom of the lip and you feel this kind of cordish, thing that's tying between the gum and the lip might be harder for the baby to nurse.

So at what point do we think through as physicians, like, okay, there could be a medical issue here versus, you know, this is a thing that psychotherapy can take place. Or one of my other thoughts is I'm, sorry, maybe I'll just pause here and let you address some of these things. Yeah. So one thing I would say is that definitely. And, you know, the first thing, the first thing just context-wise is that, you know, being a parent, especially for first-time parents, you've never done this before. And you have to give the patient benefits to the doubt that they actually don't know certain things.

So a lot of psychoeducation has to happen first. You get, you know, meaning like you need to sleep and, yes, wait, okay, let's evaluate the difficulty with feeding. You need to see a lactation consultant. Is there a tongue tie? You know, you need to talk, whatever, there's something in your diet, you know, get a consultation, whatever it is. So you kind of start out first with providing the evidence-based interventions that every, you already know about. So you need to evaluate for medication. Are they not, you know, do they have the opportunity to sleep, but they cannot fall asleep? Is that, you know, the difficulty with bonding so much? It doesn't kind of come and go. It's just kind of persistent. Are there suicidal thoughts? So you can't. kind of go through, you know, mild, moderate severe, or you figure out medications need it. And you do a lot of supportive interventions first. You problem solve. You come up with a schedule for the day. Okay, when the baby's sleeping, this is when you're going to try to go to sleep. You do all that, but then this is where

you know the psychodynamic part has to come in. You're going through all this. You're giving the recommendations, you're problem solving, but then they can't do it. They logically they want to do it. They want to do it, but they can't. They know what's good for them. Somewhere they know that, you know, the crying shouldn't irritate them as much as it does, but it just does.

They want to be able to, you know, their wish the baby was different in some way. They know they shouldn't be feeling that way. And despite you kind of telling them, like, it's okay, you don't know what they're, you know, feel like, it's like they can't accept it. There's something stuck. So that's the point where you really want to consider using these psychodynamic interventions.

It's like you've done everything else, you've done the support of interventions, and they can't use them. That's sort of what I would say. So, you know, everyone should kind of keep doing what you're doing, but we want this as an additional tool for if you're getting stuck. They want to drop off the kid at daycare, but it's like they just can. they get there and they're thinking about them all day long and is it okay and trying to go check on that you know okay like let's talk about this what could be going on there behind the seams yeah and i would i would you know add to that i mean again first of all as i said earlier we wanted do you know very careful initial evaluation around safety around you know impulsivity you know where

any thoughts that are, you know, being, I mean, obviously if they're psychotic, you know, then we need to emphasize, you know, safety, medication. Those are, those are part of our initial evaluation. And people may need antidepressants and anti-anxiety medication to do this kind of work, because some of their, if their symptoms are problematic enough, they're so pervasive, it's hard to identify the meaning. You know, it's hard to take out from the mirror or to work with it because they're so affected by it. So those are, those interventions are crucial. But I think for someone working this to have these frameworks in mind that they're inherently going to pop up. These are universals, you know, anger and self-expectations and dependency and separation.

abandonment and this it can provide a framework that people can think about to help them to understand and to communicate you know to the mom oh you know look I think you're you're really stuck

on this one area that you're overstating the dangers around separation and you think oh I'm going to abandon the baby when you're not doing that and those are elements we want to understand more about. I do want to make it to be because we hadn't mentioned

intrusion and because of the way I think about the stuff, just to emphasize another inherent universal, how do you set boundaries and somebody feels they can't set boundaries or they can't get help and they feel the babies always have impaying their space and their life is taken away. And, you know, we have an example in the book of one person whose mother was very needy and dependent. And she felt pressured that she needed to be the one taking care of the mother. And this added to the pressure she felt and the intrusion that she experienced and made that the most powerful element. So, you know, I think that's a way that people can use this framework or think about this framework. work and work with it alongside there is, as Allison points out, the other approaches that they use.

Yeah, Alison, do you want to speak about the fear, the fears of intrusion anymore? Any more thoughts come in your mind? Yeah, I mean, one, you know, one thing that we want to do is make this really, you know, almost like a cliffin's version, sort of psychodynamic themes that could happen that was part of it. The most common kind of thing that women say to that's tip off for me for intrusion is I'm feeling trapped. Like, I'm feeling trapped by the baby, feeling trapped by the situation of it, or even I'm feeling controlled by the baby. Like, I can't be. Or, you know, like, or something bad's going to happen.

That, to me, is a signal that there's something overwhelming about the baby's needs, and they feel like they don't have control over, like, modulating that for something. reason when you do. You know, you can, you know, put the baby down or give the baby to someone else if you want to break, right? But it, but it doesn't feel that way to patients. So, so that's, you know, so that's the most common way that I see it. And I think the other place that intrusion can pop up is for parents, women, who have histories of, you know, specific kind of abuse in some way where their bodily boundaries, maybe were being respected by those around them. And, you know, having a baby is very physical. There's a lot of holding, I mean, if you're, you know,

even if you're holding the baby while you're feeding, they eat to be rocked. It's just, there's a lot of touch involved. And for some people, you know, not feeling like they have control over their bodily boundaries to be very overwhelming. And it's confusing. I'm at that. I'm at some, setting to have sort of abuse memories come up when you're holding your baby as well. So that can be very hard to sort of acknowledge. But again, we kind of gently go through, you know, sort of, you know, what's the reality of, you know, what the baby's feeling. You know, the baby is just wanting, you know, some comfort, but you can also, you know, play with the baby or do something else. It is feeling overwhelming. So that's sort of where I see that pop off a lot.

And maybe I should add, as long as working on the psychoanalytic standpoint, I picked up on something else and said, you know, another area that can be a problem, it's, you know, sexual feelings. There could be a lot of discomfort about, you know, sexual feelings towards the baby. Sometimes they kind of put out of their mind or they people have thoughts, oh, okay, you know, but other people that can be. be quite, you know, very uncomfortable, you know, for them to experience or threatening. And as I mentioned, particularly if they experienced abuse, they may be very fearful that could they abuse the baby. Now, well, some people are going to say, oh, no, I don't want that to, you know, to happen. and that they can experience normal kind of holding and closest and physical feelings is, oh, is something, is this not okay? And this can cause conflict and distance.

So that's another area that can't emerge. And Alice, I think you've said about, you know, people who can be fearful about reporting some of their feelings, right? That's another factor that you have to manage. Right. Sometimes. My experience is, if you don't ask, they're not going to usually tell you some of the darker thoughts that they've had, right? And especially when I'm assessing like OCD in postpartum OCD, which is something I've treated a number of people, it's like the obsessionality and the obsessive thoughts, the unwanted obsessive thoughts are sometimes very graphic, distressing.

Sometimes they've never had to deal with obsessive thoughts of this type. of nature, violent thoughts or sexual thoughts. It's egotistonic, right? So they don't want to have these thoughts. So, yeah, and I think especially with what's in the news, it's like if you, what, if I've had these thoughts, does that mean I'm going to do this? That could be very, very scary. And so, yeah, any thoughts on this, Allison? Yeah, definitely. You know, there's, I got to tell, there's just so much shame with becoming a parent. It's just, you know, there's so much pressure. Everyone wants to be a good parent. So if there's anything that you're thinking or doing that goes against your image of that, it can be so hard to talk about.

It can be so hard to experience. And especially if you had, you know, the idea of sexual intrusive thoughts is part of OCD. Most people don't even know about that or that exists. So I definitely proactively bring up a lot of very common kind of shame-induced. feelings or thoughts that, you know, women or parents can have. So absolutely when I'm sort of assessing for intrusive thoughts, OCD thoughts, I'll be very explicit. Like, sexual thoughts about the baby or doing something sexual is a really common example of an intrusive thought. Is that something that you've had? So I just lay it out on the table. The other thing that,

you know, might not be as obvious is feeling a difficulty with bonding or feeling disconnected for the baby, that can be really hard for parents to talk about because that also, I think, induces a lot of shame. But that's a really common symptom of depression, you know, all these other psychological conflicts. So that's also something that I'll actually be very explicit about and ask directly. You know, this can be symptom actually. So, you know, is that something that you sometimes feel? So yes, I completely agree with you. You have to be really proactive about it and you kind of have to make suggestions for, you know, is that something that you're experiencing? Yeah, I think in terms of this, you know, this approach, the problem

focus approach, we have focus on identifying problems. So it's like, oh, here's your problem, and C that you report that people can be so embarrassed or shamed or fearful. about certain kinds of feelings, or in denial about them, that it can take a while to identify what the problems are. So that's part of the process. Or they might think a problem is normal. Well, of course, I'm not getting any sleep

because you have to be up the whole night taken care of the baby, you know, completely not, you know, recognizing or normalizing. you know, something that they're struggling with just because they think, well, that's, that's the way it, you know, that's the way it works. And I said, well, that doesn't have to be the way it works. Yet, gosh, I think you, and maybe we talked about this, but I'm also saying that you have said needing to keep in mind that some people actually worry about if they bring up certain things that they might get reported or, right? That's another. Definitely. Yes.

The worry about, you know, it's called different things to different states, but, you know, child protective services being called. I mean, it's really, it can be a fear that might actually be reality-based based on your, you know, background, your ethnicity. It's more likely to be called in some ways. Or it might be amplified by kind of internal, you know, very harsh criticism of yourself or fears of being punished in some way. in that, you know, that's kind of a common kind of transference, countertransference, you know,

dynamic that really needs to be explored. Like, you know, I did this thing, but if I tell you about it, I'm concerned that you're going to think that I'm an unfit parent and you're going to try to take my, you know, take my child away from me or something like that. And, you know, why I always do in that situation is you kind of just want to be really transparent and kind of let them know, you know, these, this is, this is actually the, you know, the boundaries of our confidentiality. These would be the reasons why I would need to call if you actually or hurt the child in some way. But sometimes it ends up being something like, you know, they were angry at the, at the baby and they just, they didn't put them down as gently as they usually do. Or maybe they removed a sibling who was being aggressive. They kind of like abruptly moved them over.

and they become afraid that that was something really aggressive, really bad, and that that would be a reason that, you know, I would call, you know, some authority on them. So, you know, I think kind of setting the frame like, this is actually what's a problem and this isn't can sometimes give, you know, a little bit more space for us to kind of explore it non-judgmentally to what actually happened. Yeah, and you could see how with all that sort of internal self-criticalness, rumination, you know, that sometimes gets really black, really black, right? So all or nothing thinking, they can kind of go all bad on themselves. They might even imagine that here's some authority figure who's going to, you know, take my baby away or report me, and that could be a nightmare. And so what I hear you saying is that you go into kind of more details if you've sensed this is the issue, right?

If you sense they have this fear into like, hey, I'm not going to report you unless you actually abused your kids and you could potentially describe what that would look like, right? Is that what I'm hearing? Yeah, that's exactly right. Like this would be the reason why if you were like, if you hit your child and your child is danger, you know. Yeah, what it usually ends up happening. Yeah. Yeah. And, you know, in psychotherapy, we keep things in words, and we actually find that even if you're angry, if you can put it to words in a psychotherapy office, it'll actually give the parent more control.

If a parent has these taboo thoughts and then because of the taboo thoughts, they're defending in different ways against having the thoughts, right? what are some of the more common ways that you see parents defending against the negative thoughts and then that may create problems in and of itself right yeah i mean certainly just i mean and maybe maybe talk about you know different elements uh you know but one you know one kind of the what we call you know referred to reaction formation sort of going out of their way to do to do extra or more the point of, you know, wearing themselves out to try to not be experiencing anger or, you know, try to, you know, dismiss feelings out, you know, out of their mind, you know, or even sometimes, you know, do things that are self-putative that are not very good defenses, but, you know,

not allow themselves enough sleep for something. There's one person we talked about. if it was a way of punishing herself for these feelings without really being aware that she was doing that. I mean, maybe Allison and you know, other defenses that are. Yeah, I think the other really common one is avoidance. So, you know, so doing anything that might elicit that thought or taboo thought, you just stop doing. So in the way that you can really assess for that, as I always do this, is I do it very

specific, sort of by counting of what their day is. What are you doing in the morning? How are the division of responsibilities done? So, and then, you know, you might discover, wait a second, this person's never changed the baby's diaper. Okay, that's not typical. Is there something getting avoided there? And then you can kind of explore that way. And then, you know, again, one example that we have is, well, there's a concern that that's when, you know, when you're not doing the diaper, that that's when the sexual abuse might have. so that you just stop changing the diapers so that you don't feel that way. Yeah.

Yeah. Just to mention, I left out one month. I'm sorry. But, you know, it could be displaced towards the partner. And that is another key to emphasize. How do these things get played out with the partner? There's what, for instance, 1% that we were talking about is, you know, angry at the partner for not getting up to take care of the baby during the night, but then not

really giving him the opportunity to do it, you know, because of her, some, her ambivalence or her struggle around that or all the anger at the baby's getting displaced onto him and we're not talking to the partner because of, you know, fears of asking for having help that the partner's not going to be responsive. So then they avoid, like, I was the same, dealing with these issues with the partner, sort of talking them out, or, hey, what can we do to do this? So that, I, I've I've seen, that's a very important piece that the work that we, that we do. You know, one thing that, Whenever I start to have these sort of thoughts in my, or these kind of conversations, I think to myself, how much of these problems are uniquely USA problems compared to like places like Sweden where they have,

you know, more than a year paid time off when you have a child? Like how much does this kind of like a social structure that we have in the U.S. that hasn't really prioritized. women's health postpartum, how much, how much that is at play, you know? And how do we balance these kind of like deeper things of like, okay, I'm having maybe some attachment issues with my parents and because of that, like they're playing out in the child. Whereas like how much this is just the structure that we're in. Do you have any thoughts on this, Alice? Maybe I'll start with you. Yeah. Oh, definitely. I mean, like 100%. Sometimes that's the only issue. It's like they just they need more time off from work or like they need, you know, they need some ability to,

they need a vacation, they need to sleep. They need someone who can watch their baby while they, you know, take a nap, that there's so many structures in place in, you know, it makes it really hard for women to take care of themselves. And so, you know, but, you know, you do a biopsychosocial formulation with these patients. You think about the biological aspects, this person needs medication, you know, is this. is this OCD and then you should really be doing, you know, exposure response, you know, prevention therapy and CBT, what is going on here. And then you think of the social, just like what you're talking about, like, it's just something in their environment that's causing this, that if, you know,

if things were different, they would feel this way. But what I found is that, you know, sometimes I get, you know, but I get these patients that they actually, you know, they have a lot of support. They have a lot of family around, but they can't utilize it. So then, that tells me it's not, it's not just the environment of structure, right? You kind of always want to start there. You want to see if you can improve their environment, access to resources, psychoeducation, you know, a group. You kind of, you want to start there and see if that helps, if that works.

But if it doesn't, again, it's sort of, well, then what do you do? There are these kind of residual symptoms. Well, then maybe that's when you need to think about a psychodynamic approach. And, Alison, I just want to, you know, that there is, there, we do have a chapter on, on cultural factors. And maybe I'd maybe want to speak, say a little bit about that, about taking that into account as well. Absolutely. Yes. So with a lot, and with one of these issues, you want to have a lot of cultural humility.

because, for example, you know, practices around co-sleeping or sleep training, there's a lot of sort of, you know, cultural expectations around that or how much the families fall, not involved. You know, so with sort of Western, we might think that that's, you know, too much family involvement. But, you know, for them, that's actually how it should be. So when you're assessing these problems, you want to definitely keep in mind sort of, you know, how cultural aspects might be influencing the problem and its expression and, you know, sort of not, you know, pathologize something that's actually quite sort of novel for, you know, kind of just part of childbearing practices. Yeah. Or you might, you might need to help someone who feels a certain cultural expectation deal with that. that, say, for example, somewhat where the culture thinks there's a lot of involvement of the family, but that they're to feel intruded upon or boundaries reached. And, you know, how did they contend with that?

This internalized expectation of the culture and their own needs or wishes to do things a little bit differently from that. There was one study. I was wondering if I could just bring it up here. and see what you guys think of this, kind of thinking about the cultural aspect. It was economic and health predictors of national postpartum depression prevalence, a systematic review, meta-analysis, meta-regression of 291 studies from 56 countries. So in the findings, they found that there is a very different prevalence of postpartum depression in different countries.

It's around 17.7%. Some countries as low as 3% and some as high as 38%. And that nations with significantly higher rates of income inequality, maternal mortality, infant mortality, or women of childbearing age working greater than 40 hours a week

have higher rates at postpartum depression. Together, these factors explain 37% of the national variation and postpartum depression prevalence, which I thought was pretty significant, like this idea that, like, a lot of the difference in the rates in different countries is because of these things that, like,

it seemed very hard for psychiatrists to change, right? It's like, we can only do so much. So, yeah, I'm guessing, like, I think we've kind of already answered this question, but any thoughts on that or any kind of reflections on that study in particular? Yeah, definitely. I mean, one thing I'd say is that,

you know, like depression isn't always depression. It's always depression. So we, you know, we use the word depression for a lot of things. So, you know, like just not having enough money to feed your baby. You know, it's that, you know, that's going to make someone feel really down, really bad, but like not doing enough. But like you're saying, is that really depression, ours, that sort of response to sort of what's happening. And then I see, you know, the high rate of infant mortality, you know, into our countries. Well, that sounds like there's going to be a lot of grief trauma as well. It's probably getting picked up with spark of depression.

So, you know, and then, you know, thinking about these psychodynamic factors as well. Yes, it's kind of under the heading of depression and depressed me, but it's more like psychological conflicts that are happening that are causing you to feel very down. So just, you know, just wanted to add that. Yeah. And just, you know, obviously, you know, really to emphasize the need for social support, you know, mental health support, you know, all kinds of things in terms of targets or goals that are important for, you know, moms, you know, from, you know, standpoints of what, you know, what might be done, you know, otherwise. in our, you know, from the political standpoint, just to, you know, help in those circumstances, that that's important as well.

And obviously, there's also, like you say, there's limits around what we can do, too, but, you know, do what we can. Yeah, we do what we can. Yeah, and I think this kind of like attach, kind of the attachment base, you know, helping the mothers mentalize better what's really going on decreasing the shame decreasing the guilt these are themes that are coming up a lot and what we're talking about are there are the big sort of categories of things that you guys think about that we haven't touched on yet well let me let me let's a piece just about you know mentalization i mean mentalization based approaches are you know we

emphasize those those are people brought out by you know other authors as well that that that that that he's by helping the parent to understand about that, okay, the baby isn't, like, mad at them. Or they may say, like, oh, the baby, he's just like his dad. He's such a jerk, you know, trying to help them understand, well, yeah, that's not really, that's not what's kind of, baby isn't mad at you or why mom was deeply affected by a sense that about being rejected. when the baby would turn away. Well, the baby's not, or not, we've always been smiling, not always smiling. So trying helping them understand how what's going on with the baby and the baby is not directly that turns in.

That's a very, that's a very important piece because that can fit in with their kill, bad mom feelings. So I do, I want to, I want to emphasize that piece. One thing that we haven't talked about is also is countertransference. So what are the feelings the practitioner is having and that people can have their own reactions to these very powerful kinds of issues that are struggling with their babies? And it's important to be aware of that. And maybe, you know, comments about that.

But also, how do you work with that? How do you be alert to that, to understand, you know, that you maybe you're struggling with something that's coming up and be able to communicate that in some way to the patient? Definitely. And I think, you know, very common carotranspence responses that can happen just when working with parents and babies is, you know, there can be like an identity, almost an identification with the baby and sort of. of a concern that the parent is doing something wrong, almost like an overreaction of wanting to be overly protective. And, you know, that's really what the parent is already feeling. They're already feeling like, you know, they're talking about all these shameful things and that they're doing a bad job. So I always come in with a lot of empathy. Like,

you know, first of all, you're coming to me for help and you're doing the best you can. You learned this way of coping, reacting for some reason. Maybe there's a good reason that you are responding in this way. And now just trying to help you introduce some choices. Let's introduce some flexibility here and how you can respond. Need ways to look about this. So, you know, I always keep that in mind if I'm having a very strong countertransference of, you know, feeling like I need to somehow protect this.

child, this baby from this parent, it sort of reframes that for me and helps me have, you know, some empathy. Okay. I'm curious, you know, when you have a mother coming in with her child to your session, and let's say you see like some good attachment going on, but the mother maybe has a perception that she's not really attached to this child or like she's not a good mother, how do you utilize what you observe between the mother? and the infant in kind of how you're helping the mother. Yeah, so one thing, so one thing that I'll do is, you know, you always want to have a foot in reality with these patients.

So, you know, I will be very explicit and sort of listing the good things that they're doing where sort of what I'm seeing indicating that there's good, you know, a secure attachment kind of developing. And then I'll sort of say to them like, huh, so I'm kind of wondering why there's a disconnect here between how you're viewing yourself and what's going on and then what's sort of the reality going on. Let's be kind of curious about that together. Let's try to explore that and understand it. And then I'll just try to open it up and say, what could that have come from and let the patient kind of tell me what comes to their mind and what and what maybe what actions, what things that happened in the past, what behaviors that doing, that they think are evidence that there isn't a good attachment of that they're doing something. wrong. When a mother brings an infant into a session, are there certain topics you don't talk about? Are there certain things that maybe you don't, you kind of like psychoeducate the mother? Like, we're not going to talk about certain things today because you're, you know, because the infant's in the room or like, how do you feel about that personally as a provider?

Oh, that's such a great question. You know, it's something that a lot of mothers ask me. Like, is it okay to have the infant in the session and can I understand anything? And it really, I mean, it depends on the age. I'm assuming it's under one, one years old. If they're bringing them to the session, baby can't understand anything. They don't know what's going on. So you can really feel free to say whatever's on your mind. And, you know, like you're saying,

it's actually very useful for me sometimes to observe the interaction. I kind of comment in real time how the baby seems comfortable, seems calm. You're sort of attuned to them or whatever else I am observing. But, you know, I will explore if there are certain topics or thoughts that they're sort of afraid of talking about because the baby's there. That actually is really good data for me. That tells me that those might be some of those more, you know, taboo or thoughts that they're ashamed of. They're sort of like, I wouldn't want my baby to hear he say, X, Y, C.

Okay, well, that's interesting. Like, we should sort of explore what those things are. I was thinking as well in terms of like levels of like dysregulation. Like it's like do you want to to enter into certain like traumatic memories, for example, when the infants in the room in a way that would make the mother maybe dissociate or be more dysregulated? Or do you find that you kind of like run the session differently? Yeah. So I'm so good, you know, before entering into any psychodynamic treatment, I definitely want to sort of assess. their capacity for emotion regulation and if it seems like, you know, going into traumatic memories

or they just sort of are having issues with emotion regulation, then I might not do a psychodynamic psychotherapy approach with them as much focused for on sort of skills, learning how to regulate, you know, before I sort of enter into that more for exploration. So I am always monitoring that, but it feels like it's sort of overwhelming the patient in a way that is, really effective. I'll immediately kind of shift my my stance, take a step back, do a grounding skill, whatever's needed to sort of bring the patient back. Okay. Very good. Okay, so we talked about kind of these five, five areas and I wanted to make sure we kind of hit them in a way that you felt like was meaningful for this. So the first one is like experiencing struggling with the mothers

or the father's own anger, then it was like idealizing the experience of what it would be like to be a parent, and then the reality of the parent, the mismatch. Anything from those two that you feel like is still kind of floating in your mind that you really want to share? Yeah, I mean, I guess that, you know,

sort of difficulty-tolerating anger, there's sort of two categories you can kind of fall into, which is some people may be completely unaware that they're angry. It's really deep down and it's really sort of out of their awareness. And then there's people who it's like a little bit more conscious. They're aware that they're angry. But then they feel sort of guilty about that or critical about themselves about that.

So those are sort of almost two different levels of severity and that might change kind of your approach with that. And then with the idealized expectations, definitely idealized expectations. of what parenthood was going to be like, what it was, you know, how things were going to feel. But it can also, you know, sometimes get directed to the baby as well for a perfectionistic standard. So, you know, there's a lot of attention sometimes around milestones. Are they meeting their milestones on time? Are they kind of checking out the list?

I have to, you know, teach them sign language and I have to make sure they're doing this and that on time. And so that can definitely be a place where ideal. expectations or perfectionism can kind of come up as well. Or, you know, alternatively, it's that there can be a worry that, you know, there's, they sort of, there's something wrong with their baby. There's something defective about them. And so I can kind of go in a lot of different directions. Okay. What about the panic of leaving the baby alone when there's that panic of leaving the baby alone? Like, how do you work with the mother with that? Definitely. Well, and we didn't, you know,

Well, we would leave them alone somewhere safe, right? Not, but like in a crib, like to sleep. No, no. Good point. Let's specify what we mean by that. I mean, like, it could be like leaving the baby alone with your partner. That's what I'm thinking of. Okay.

Right, exactly. But it's funny you did that because that's how it feels to women. That's how it feels to parents. Okay. Like they're leaving them alone. Is there, right? Dr. Pudor, we're not going to leave the baby alone. Okay?

We're not going to do that. Yeah, it can, but it can feel that way. Like if you as the parent aren't there, it's like the babies alone, even if they're with the trained professional in the daycare or even if they're with your partner. And so that's, so that's really interesting. And sometimes that's an intervention, which is like they're not, they're actually not alone. They're being very well taken care of.

And actually, there's a benefit for them to be taken care of by multiple people. You know, they learn, the baby learns a lot about that. So there can be, but so then there can be a reason why that person needs to maintain that belief that only they can do it, right? So there's a lot of different reasons for that, you know, wanting to be special, feeling like that's necessary for bond. But one of the biggest kind of psychoeducation sort of like give around that with the separation fears is that, you know, a lot of times, the reason this is coming up is because the person, parent has had an experience of an abandonment, either a real abandonment or, you know, a loss like brief or some kind of emotional abandonment that happened. Maybe the parent was sick or, you know, there was a divorce or something like that. And, you know, what's missing is the leaving

and then the coming back part. So it's almost like the coming back part is missing for the parents. You leave and then you come back. And actually, that's a really important lesson for the baby to learn. That's a skill that they're going to be able to flex for the rest of their life. And the idea is that when you leave and come back, the baby learns that you're there when they come back. So to give them sort of the confidence, it kind of helps them develop their independence in some way, which you want. So it's just reframing it as actually a positive thing to sort of practice separation and the return. rather than something that could be really harmful.

Yeah, that's good. I was, like, let's say a person has a huge conflict with leaving their child alone with someone who's probably trustworthy, you know, like there's no reason to not think that this person is trustworthy, but they just don't want to leave them alone with another person outside of their spouse ever, right? So it's like one of the things in my practice, I think it's like really good to find trusted people. But then I think what you're what you've hit on in this talk with me so far and I'm like reflecting on is like, oh, there's probably a good reason why they're having difficulty leaving their child alone with someone. So what. So yeah, any other thoughts on that? Yeah, that that's exactly right. And I always say this is a way to reduce shame.

It's like there's a reason. There's a real reason for you. It might not be related to what's actually happening, but something, there's an emotional logic for you that you're sort of following here based on something that either happened to you or sort of an imagining of something that, you know, sort of how you kind of understood certain events in your life, how you kind of put things together.

So, yeah, so it's important to sort of, you know, like you did, you kind of reality check or is like, well, do you, is this person trustworthy? And sort of have that, again, foot in reality. Yes, you do trust this person. And yet you can't leave the baby with them. And that kind of engages the patient's curiosity. There's something else going on here. Maybe it's something with my unconscious of my experiences that are making me really afraid.

And there's a whole, there's a long list of reasons why someone, you know, might be, might have that energy of wanting to protect their child from harm, which is how they're kind of feeling. yet. Yeah. And for good reason, for good reason, you know. And, okay, so let's wrap it up. This is good. I, this was, this was amazing, like, just, just meeting you and, gosh, I wish you lived in Florida so I could send, send you some people. It's so nice to meet with you. And, and you're doing so many things. Like, how do you balance everything that you're doing? You know, Columbia, psychoanalytics, private practice. luckily they all overlap you know they're all kind of integrated into each other but it it helps that i really like what i do um so it's all you know interesting and fun um but you know that was the you know thing that i had to work through my work life balance oh yeah that's good well okay so yeah

any other final thoughts as we kind of bring this to a close i don't think so okay well this is great It's been great to connect with you and Frederick. And yeah, we will just put a final plug for your book. You know, it's a good place to kind of dive into this topic different. It's called postpartum problem focused, psychotemic psychotherapy. And also if you're in, you know, Columbia, is, do you guys do Zoom or do you have to be in person for your psychoanalytic Institute? Some of it's in person and some of it's in Zoom, but they have some programs. that are completely virtual.

Yeah. So that's a great opportunity, I imagine. And, yeah, are you going to be given any other lectures anywhere sometime soon? Yeah, I'm planning it. Well, this book just actually came out about a week ago, so we're hoping to get a lot of lectures about it in workshops and be able to answer people's questions about it. So I'm going to work on.

Very cool. Well, we'll put on the website different links to your your website and if anything other links any other links you want to give me i'll put put them on there are you on social media i am i'm on linkedon yes okay i'll leave it there for today thank you so much for coming on thank you thanks for having me bye