Postpartum Depression and Relational Family Therapy

Poporodna depresija v veliki meri zaznamuje materinstvo, odraža pa se tudi v intimnih partnerskih odnosih, kar mnoge pare privede tudi do iskanja pomoči zakonskega in družinskega terapevta. V doktorski disertaciji smo želeli raziskati intimne partnerske odnose in funkcioniranje v izvirni družini v povezavi s poporodno depresivno simptomatiko pri partnerki. V raziskavo smo vključili tudi proces relacijske družinske terapije pri parih, kjer partnerka izraža simptome poporodne depresije. Poporodna depresija in relacijska družinska terapija, kot je pričujoča doktorska disertacija tudi naslovljena, se v osnovi členi na na dva dela: teoretični in empirični del. V teoretičnem delu smo najprej izpostavili problematiko duševnih motenj in dosedanjih spoznanj o depresiji. Sledila je predstavitev poporodnih duševnih motenj s poudarkom na poporodni depresiji. Slednjo smo razčlenili tako z vidika preventive in kurative, kot tudi z vidika materinstva in razvoja otroka. Dotaknili smo se tudi poporodne depresije pri očetih in njenega vpliva na očetovsko vlogo. V nadaljevanju smo se posvetili intimnim partnerskim odnosom in odkrivali, kako intenzivno lahko vplivajo na razvoj poporodne depresije, ki smo jo razdelali tudi z vidika starševske vloge in razvoja otroka v najzgodnejšem obdobju. Zadnji poglavji v teoretičnem delu smo posvetili predstavitvi relacijske družinske terapije v povezavi s poporodno depresijo, in sicer ob spremljavi duhovnosti oz. v kontekstu biblično-teološkega vidika. Tudi empirični del smo razdelili na dva dela: na kvantitativni in kvalitativni del. V kvantitativnem delu so nas zanimale razlike v zadovoljstvu znotraj partnerskega odnosa in funkcioniranju v izvirni družini pri partnerkah, ki izražajo simptome poporodne depresije, in tistimi, ki jih ne izražajo. V raziskavo je bilo vključenih 245 prostovoljnih udeleženk, od katerih je polovica izražala simptome poporodne depresije. Na podlagi rezultatov analize smo ugotovili, da med ženskami s poporodno depresivno simptomatiko obstaja statistično pomembna razlika v zadovoljstvu s partnerskim odnosom, prav tako obstaja statistično pomembna razlika v avtonomiji in intimnosti v izvirni družini. V pretežno kvalitativnem delu smo želeli raziskati, ali z relacijsko družinsko terapijo lahko odpravimo simptome poporodne depresije. V raziskavo smo vključili pet parov (10 udeležencev), pri katerih partnerka na podlagi vprašalnika EPDS izraža simptome poporodne depresije. Podatke smo zbirali skozi vseh 12 srečanj, ki obsegajo en terapevtski cikel. Zanimalo nas je, kako bodo pari po terapevtskem procesu doživljali spremembe na intrapsihičnem, interpersonalnem in sistemskem nivoju, ter, ali se bodo zmanjšali oz. odpravili tudi simptomi poporodne depresije.Ugotovili smo, da so vse udeleženke identificirale vsaj en ključni trenutek spremembe, do katerega je prišlo zunaj ali znotraj terapevtskega procesa. Pri udeleženkah je prišlo do pomembnih sprememb na različnih področjih življenja, poleg tega se je pri nekaterih parih zvišalo zadovoljstvo v odnosu. Simptomi poporodne depresije so se pri vseh udeleženkah zmanjšali oz. odpravili. Izsledke celotne raziskave je potrebno razumeti z upoštevanjem nekaterih omejitev. Te se kažejo kot nereprezentativen vzorec in odsotnost kontrolne skupine. Prav tako je potrebno upoštevati pogosto izostajanje partnerjev, kar je vplivalo na potek terapije in končne rezultate zadovoljstva v odnosu. Omeniti je potrebno tudi alternativne metode pomoči v obliki podpornih skupin za mame po porodu, na podlagi katerih lahko sklepamo, da so zelo verjetno pripomogle k boljšemu počutju in zmanjšanju oz. odpravi depresivnih simptomov. Upoštevati pa bi bilo vredno tudi druge dejavnike, ki se lahko izkažejo kot pomemben faktor pri pojavu depresivnih simptomov (npr. genetske in hormonalne). Smiselno bi bilo izvesti še en ciklus terapij, tokrat v polni prisotnosti obeh partnerjev ter ponoviti meritve. Izsledki naše raziskave se ujemajo z ugotovitvami predhodnih raziskav, obenem pa prinašajo pomemben prispevek k razumevanju poporodne depresije v povezavi z intimnim partnerskim odnosom in izvirno družino, ter odstirajo nova spoznanja o značilnostih terapevtskega procesa in partnerskega odnosa, kjer je prisotna poporodna depresija. Raziskava izpostavlja tudi spoznanja o ključnih trenutkih terapevtske spremembe ter z njimi povezanih pozitivnih spremembah na številnih področjih življenja udeleženk. Vse to pa omogoča bolj celovito razumevanje obravnave parov v procesu relacijske družinske terapije pri predelavi simptomov poporodne depresije.Postnatal depression significantly influences motherhood, yet it simultaneously affects the intimate relationship between two partners, which can result in many couples seeking help of a marriage and family therapist. This doctoral dissertation endeavoured to study intimate relationships and the functioning in a family of origin in relation to the symptoms of postnatal depression present with a female partner. The study also encompassed the process of relational family therapy with the couples in which a female partner exhibits symptoms of postnatal depression. The doctoral dissertation called Postnatal Depression and the Process of Relational Family Therapy is divided into two parts: the theoretical and the empirical one. The theoretical part first emphasised the problem of mental disorders and the findings about the postnatal depression presented so far. Afterwards followed the presentation of postnatal mental disorders with the focus on postnatal depression, which is further elaborated on from the point of view of prevention and curative, as well as from the point of view of motherhood and child development. What is more, postnatal depression with fathers and its effect on the role of a father is also touched upon. In the following chapters, the attention was drawn to intimate relationships and their impact on the development of postnatal depression, which is studied with respect to the role of a parent and from a point of view of child development in the earliest period. The last two chapters of the theoretical part presented a process of relational family therapy with reference to postnatal depression, which is discussed from a spiritual perspective or biblically theological perspective. The empirical part is subdivided into a quantitative and a qualitative part. The emphasis of the quantitative part was on differences in satisfaction within a relationship and its functioning in a family of origin with female partners who suffer from symptoms of postnatal depression and those who do not. Two hundred and forty-five female volunteers were included in the research and a half of them experienced symptoms of postnatal depression. On the basis of the analysis’ results, it was ascertained that there is a statistically significant difference in satisfaction with a relationship amongst females displaying symptoms of postnatal depression and that there is also a statistically significant difference in autonomy and intimacy in a family of origin. The predominantly qualitative part tended to examine whether symptoms of postnatal depression can be suppressed through relational family therapy. Five couples (ten participants), in which a female partner exhibited symptoms of postnatal depression based on the EPDS (Edinburgh postnatal depression scale) questionnaire, were included in the studythe data was obtained during twelve sessions, which represent one therapeutic cycle. The primary interest in this part of the study was whether the female participants can identify the key moments of therapeutic change, how they experience changes on an intrapsychic, interpersonal and system level and whether the symptoms of postnatal depression will be reduced or suppressed. It was discovered that all female participants identified at least one key moment of therapeutic change which occurred inside or outside of the therapy process. The female participants experienced salient changes in various domains of their life, what is more, some couples observed an increase in satisfaction in their relationship. All the female participants were subjected to the reduction or suppression of the symptoms of postnatal depression. To correctly understand the results of the entire study, some restrictions need to be taken into account, such as an unrepresentative sample and the absence of a control group. Moreover, the fact that male partners were often not present needs to be considered as well since this affected the course of the therapy and the final results concerning satisfaction in a relationship. In addition, alternative methods of help, such as birth mother support groups, need a special mention since they are liable to have ameliorated the well-being of a mother and reduced or suppressed the symptoms of depression. Other factors that are of great significance for the emergence of the symptoms of postnatal depression would also be worth considering (for instance: genetic and hormonal symptoms). It would be thus reasonable to undergo an additional therapy cycle, this time with both partners present all the time in order to reobtain the measurements. The research’s results, proved to match the findings of previous studies in this domain, significantly contribute to the understanding of postnatal depression with regard to an intimate relationship and a family of origin, and they simultaneously reveal new discoveries concerning the characteristics of a therapeutic process and an intimate relationship where postnatal depression is present. The research also emphasises the findings concerning key moments of therapeutic change and the correlated positive changes observed in various spheres of the female participants’ lives. The study, therefore, allows a more wholesome understanding of couples’ treatment in the process of relational family therapy aimed at relieving the symptoms of postnatal depression