by Carissa Gustafson, PsyD, PMH-C
Most therapists will work with clients navigating pregnancy, postpartum, infertility, reproductive loss, or early parenthood at some point in their careers. And yet, many clinicians receive very little formal training in perinatal mental health.
That gap becomes obvious quickly once you start working with parents. Clients come into therapy describing intrusive thoughts that scare them, anxiety that feels relentless, rage they do not recognize in themselves, persistent sadness or feelings of emptiness, grief over how much life has changed, or shame about not feeling the way they thought they “should” feel after having a baby.
Often, they also believe they are the only ones struggling this way. They’re not.
Perinatal mood and anxiety disorders (PMADs) are among the most common complications of pregnancy and postpartum, impacting approximately one in five mothers and one in ten fathers. Yet these experiences are still widely misunderstood, minimized, or treated like a niche specialty area rather than something most therapists will encounter.
The Perinatal Period Is Emotionally Complex
There is a version of parenthood many people expect. Then there is the actual lived experience.
The lived experience often includes sleep deprivation, overstimulation, identity shifts, relationship strain, loss of autonomy, uncertainty, and constant mental load. Even deeply wanted pregnancies and babies can come with grief, fear, resentment, or disorientation.
A lot of parents quietly wonder:
“Why does this feel harder than I expected?”
“Why do I feel so anxious all the time?”
“Why do I feel like I’m failing?”
For high-achieving or perfectionistic clients especially, the transition into parenthood can feel deeply destabilizing. There is no way to fully control pregnancy, birth, sleep, feeding, development, or the emotional reality of caring for another human being.
Many parents spend enormous amounts of energy trying to get certainty where certainty simply does not exist.
Why ACT Fits So Naturally with Perinatal Mental Health
One of the reasons I am so drawn to acceptance and commitment therapy (ACT) in this work is because it makes room for the reality that parenthood is hard.
Not pathological. Not hopeless. Just hard.
ACT helps clients build psychological flexibility instead of getting stuck fighting every difficult thought or emotion that shows up. In the perinatal period, this matters. Because parents often become consumed by worries about something bad happening, accidentally harming their child, or not being cut out for parenthood at all.
The goal is not to convince clients to never have scary thoughts. The goal is helping them relate differently to those thoughts so fear stops running the show.
ACT also helps therapists work more effectively with guilt, shame, perfectionism, identity loss, and emotional overwhelm without turning therapy into a constant search for reassurance or symptom elimination.
I find many parents are relieved when they realize they do not need to feel calm, confident, grateful, or certain all the time in order to still move toward being the kind of parent they want to be.
Parents Don’t Need to Be Perfect to Be Well
One of the things I come back to often in this work is that many parents are trying incredibly hard to avoid failing.
But that fear itself is often what keeps them stuck.
When parents learn how to make room for difficult emotions, loosen the grip of shame and perfectionism, and reconnect with what matters to them, they often stop feeling so alone in their experience.
Therapists—and ACT—can play a huge role in helping make that possible.
Therapists Need More Practical Training for This Work
Many graduate programs barely touch perinatal mental health. Even therapists who feel comfortable treating anxiety or depression can feel unprepared when a postpartum client says:
“I’m terrified by my intrusive thoughts.”
“I don’t recognize myself anymore.”
“I love my baby, but I miss my old life.”
“I feel angry all the time.”
“I feel guilty no matter what I do.”
These are nuanced conversations. And clinicians deserve better support in learning how to navigate them.
That is one reason I created my upcoming training with Praxis: ACT for Perinatal Mood and Anxiety Disorders: Liberating Parenthood Through Psychological Flexibility.
The training is designed to help clinicians feel more confident and grounded when working with clients navigating pregnancy, postpartum, infertility, reproductive challenges, and early parenthood.
Across three sessions, we will cover:
- PMADs and common misconceptions
- Intrusive thoughts and anxiety
- Rage, guilt, shame, and perfectionism
- Identity shifts in parenthood
- ACT interventions for perinatal mental health
- Helping clients reconnect with values and meaningful action even during overwhelm
The course also includes an ACT-based workbook clinicians can use with clients to support psychological flexibility during the perinatal period.
My hope is that therapists leave the training with both a stronger clinical foundation and practical tools they can actually use in session.