You Must Be Some Kind of Therapist

Swell AI Transcript: 79. Samantha Green.mp3
Samantha Green Most women will laugh when I say this, but like there are times when you truly do need to just kind of white knuckle it through periods of time. And usually the first few weeks of your baby being born is kind of one of them. And often women are breastfeeding. So it's not like dad can do a ton to help on the feeding front, but they could change a diaper. They're usually awake because they're sitting next to you. So like, even if they're there for moral support, there are times when you do just kind of need to push through and get through that tough phase, but once you're past it, take the help. If your baby's starting to sleep three, four, five hours a night, make sure you're sleeping during that time.

Stephanie Winn You must be some kind of therapist. Today I'm speaking with Samantha Green. She is a licensed mental health counselor in private practice in the state of New York, as well as a mother of two healthy kids who experienced a high-risk pregnancy. She was actually pregnant during grad school, studying counseling psychology, and that is how she became so interested in this subject. Today we're going to talk about issues affecting women around pregnancy and postpartum, like maternal burnout, what Samantha calls mom rage, postpartum depression, the impact of hormones on our moods, polyvagal theory, which might be of interest to the therapist in the room, as well as health care issues facing modern families that can be difficult to discuss in a politically polarized environment, things like cesarean, co-sleeping, breastfeeding, returning to work, increased maternal age, and fertility issues. Samantha, it's great to have you. Welcome, and thanks for joining me. Thanks so much for having me here. Excited. All right. So what are some of the main issues that you're seeing affecting your mom clients?

Samantha Green I think some of the main ones that people kind of come to me about, whether it's citing as actual postpartum depression, but usually mom rage. People come in saying they're just so angry. They feel like they've got a switch that just flips, turn red like a cartoon character. Sometimes it's intrusive thoughts, which always feel very scary to admit that they have. The mom rage is definitely the main one though, and I think it all kind of lands under the umbrella of like what I call maternal burnout. Like not quite depression, not quite anxiety, kind of like has features of both, but it's just kind of like an overwhelming physical, emotional exhaustion, feeling overstimulated, feeling overwhelmed. Again, feeling that anger, feeling that need to flee, that really can just be very overwhelming for new moms or experienced moms.

Stephanie Winn How do you think we got here, where so many women are feeling pushed to their edge? I mean, we've been mothers since the dawn of time. How is it that so many women are feeling like they're in a situation that's so unsustainable, given that it's natural and the species depends on it?

Samantha Green I think the pressures that we put on women nowadays, it's just it's reaching a breaking point. A lot of it, I think, definitely has to do with social media, not to blame social media too much. I know I am pretty open about my bias against social media, even though I do have a Twitter account. I think it leads to a lot of unrealistic expectations for women, kind of this like super mom myth, the super woman myth, where like you can earn over $100,000, you can do all of the childcare duties, you can look fabulous and wear heels like Victoria Beckham while carrying around your infant. It's kind of this idea that like you can have it all and I'm not saying you can't, like you know, enjoy your life. But it's it's a lot of pressure to put on women to cook. You need to work. You need to put the glass ceiling, break the glass ceiling like you need to do all these things and look well, like look fabulous doing it. And it's just incredibly, incredibly like an incredible amount of pressure.

Stephanie Winn I would imagine then that some of your work with these moms is helping them sort out those pressures and expectations, where they're coming from and which of those expectations are actually connected to their own values as opposed to just kind of like values are absorbing from society. And what are some of the things that. That you find women have to let go of or how are their priorities shifting?

Samantha Green I think a big one is a lot of women who are very career-driven early in their lives and expect to really go back to work very quickly, not take the full maternity leave. They have no problem putting their kid in daycare. I find that those aren't the most important things after having a kid, whether it's their first kid or second kid. I find that those things start to change more often. Other things that'll change are like where they want to live. People who are city dwellers might find that they want to get out of the city after having children, which they never expected. It's really interesting to see kind of like how people's values and thoughts on life and kind of just in general start to shift after having kids. I think it's very unexpected for most people. That's why it causes such distress for them. So that's a lot of what we're doing too is like identity work. Like, who are you? You can have multiple facets. You're allowed to change your mind about things. But it can be pretty distressing for women.

Stephanie Winn It is a shift in identity, a shift in priorities. For many women, it sounds like a shift in who they thought themselves to be. And it's a lot to be processing all of that while at the same time. Your focus is shifting so that 95 percent of your energy is now dedicated to this precious, vulnerable little being.

Samantha Green Yeah. And I think, not I think, I know what ends up happening is that we tend to overcorrect kind of our priorities, as you said. So like 95% usually goes towards the kid. Often what the overcorrection does is like 110% goes towards our babies and nothing's left for us. And that's kind of where burnout typically happens is people, they're not eating, they're not sleeping, they're not taking care of themselves. You know, husbands are asking, what do you need help with? And we're saying nothing. I can do it myself. And then we run into a situation where everyone's resentful and tired and overstimulated. And mom hasn't eaten a meal and hasn't showered. And it. And can take some like reminding that like you need to take care of yourself, too. And that feels kind of counterintuitive when people first become parents. Is it like you should let your husband take care of the baby for a little bit so you can go take a shower and eat a hot meal?

Stephanie Winn Funny when you said nothing, I can do it all myself. That wasn't what I was expecting when I was expecting you were going to say. And I think probably an equally common reaction is look around and figure it out. Right. That the sort of difference between men and women that we have evolved the instinct to be very aware of all these little details that can impact the safety and well-being of a vulnerable being. And for men who don't necessarily have that same instinct, they could be great dads, great husbands, they could have all love in the world, not necessarily wired the same way. And, you know, again, like here we are talking about things that are difficult to talk about in a politicized environment where we're all supposed to pretend that men and women aren't different or that to talk about the differences on average between men and women is to discriminate against those outliers. And I want to clarify, that's not what we're doing. We're not discriminating against men who have more stereotypically feminine traits or women who have more stereotypically masculine traits. But just to say that how many of us have had that situation arise where a man didn't notice something in the corner of the room for six months until you pointed it out, right? They don't have the same peripheral vision. They don't have that same Spidey sense. So this is also I want to kind of frame it this way. It's a known issue in our field of mental health, and you probably know it better, but better than I give in your specialty. But we all know that the first couple years of a baby's life can be some of the hardest years in a marriage because of that kind of growing divide. So when you talk about mom rage and burnout, how much of that ends up being directed at the husband?

Samantha Green A lot, most of it, a lot of resentment can be built during that time, especially if there was like a traumatic birth. Because not only did dad not like go through it when he was there, like typically they are there, but because they didn't go through it, they still don't totally understand the impact that they have, even with regular, you know, uncomplicated births. Women are just like, well, you don't understand, you didn't go through it. A lot of the anger, of course, gets directed at dad because he is the one that's there. It'll get directed towards dad, unfortunately. And if they're within their own mind and they can understand what's going on, usually they can balance it out. Unfortunately, they're usually tired, too, and it can it can lead to a lot of, like, difficulty in communication within relationships. And that ends up being a lot of work, too, is like doing communication work within relationships when you work with moms.

Stephanie Winn Well, and letting dad help knowing that he's he's not going to do it the same way you would do it. But there is there is a gap between. Someone being able to take care of your baby in a way that truly meets your standards versus not being able to take care of the baby to a basic standard of safety. Right. And so I'd imagine that you have to have that conversation with mom sometimes about like it's the better for you in the long run to have dad fill in imperfectly than for you to be this burnt out.

Samantha Green And parent like mothers and fathers do parent differently, which I think moms forget sometimes. We are just like typically, again, we're talking about big generalizations. Women are generally more empathetic. We're much more caring. We're the ones that are going to kiss the boo-boos. Dads are the ones that are going to be on the floor, you know, rough housing and stuff like that. just because their parenting looks different than mom's doesn't make it better doesn't make it worse it's just different that often why we work so well together too and so it's like you have to let dad do those things like he might put the diaper on differently he might forget to pull the ruffles out but he'll learn and I think often new moms feel like they can do it best so it's often just reminding them like It's okay that he does it differently. It's okay if he threw it up differently when they're a little bit older. Like I promised, they'll be fine. So a lot of it is just kind of like moderating our expectations and like learning to really trust your husband. Because like, it sounds so silly, like usually people are like, of course I trust my husband. And as soon as they have that little tiny vulnerable baby in their arms, they're like, oh my gosh, I just, I don't, I don't want anything to happen to them.

Stephanie Winn What about dad jealousy? Do you encounter situations where it's hard for the dads to adjust to, like, I'm not the center of her world anymore. I'm I'm the sidekick who's never quite helpful enough. And this little this little guy is taking all the attention.

Samantha Green Yeah, I think actually. So, you know, I work with some dads, certainly mostly moms. And I think kind of on the flip side of that, what ends up happening is that women will, again, put all of their focus on to baby, none on themselves and unfortunately none on the husband. And you have to also make sure that you are keeping that relationship like at the center. Like, you know, again, I know I'm talking about a lot of different things. How do you do them all at the same time? But like, you can't just let your relationship get sidelined either, because that's also how resentment grows. And it's not even really intentional. It's more just like, you know, are you guys, are you a team? Are you partners? Like, making sure you're on the same page. Because dads can build resentment just as easily as moms can. Like, again, it's their baby too. They want to help. It's very different. The big difference between moms and dads usually is that kind of gut feeling that moms typically will have where they'll say, like, when the baby was crying, like, I felt it in my gut. Like, it hurt my heart. And dads don't experience that as much. Like they may not want to hear their kids cry. They want to help them. They love them so dearly. But moms really, it's especially like when you give birth to the baby, their DNA actually is like part of you for the rest of your life. There was this very interesting study where they found this woman's son, her son's DNA was like in her brain post-mortem. So like our kids are with us for the rest of our lives. And we feel it in a very instinctual way that dads don't. But that doesn't mean that they're not good dads and that they can't do things in their own way. So a lot of it is, yeah, moderating expectations, making sure we work at it from the mom's perspective, because women have a very difficult time letting go often.

Stephanie Winn What are some of the hurdles to letting go? Some maybe unhelpful thinking patterns that you gently challenge with your mom?

Samantha Green She's like the my way, my way or the highway. I found a lot of Moms who come from families of divorces are kind of just like, well, if it doesn't work, it doesn't work. And so we have to kind of be like. you know, unless he's abusive, like, maybe there is a way that this can work. You know, like, what are we looking at here? You know, I think it is important to remember that, like, again, like they are supposed to be a team. So, like, we try to make sure we encourage that. I try to make sure we can encourage, like, husbands also aren't mind readers, like you said before. If there's something you want him to do and he's not doing it, like, you should tell him because he can't read your mind and you can't read his mind. And again, so there's there's always like a lot of communication work going on. behind the scenes. When you're tired, your communication kind of gets tossed out the window too.

Stephanie Winn Absolutely. And you become more easily emotionally dysregulated and have a harder time concentrating. The prefrontal cortex sort of goes offline. So something really interesting I've learned in the last few years, Dr. Sarah Hill's book goes into this, the impact of birth control on the brain. So, you're probably aware of how since birth control alters a woman's hormones, one of the things that it can do is shift her patterns in attraction. So, it's been well documented at this point, women who begin a relationship on birth control, they're attracted to certain qualities in a man, and then when they go out of birth control, their attraction can shift. It can actually increase or decrease. So I'd imagine that some of, you know, I see you kind of reacting in this knowing way. Have you observed these sort of hormonal-related attraction shifts in marriages?

Samantha Green I've seen a lot. So the hormonal birth control is something that, like, I never really paid attention to much until I started working mostly with women. And the amount of women that will say that they, you know, they went on birth control, usually at a young age, you know, again, we're around the same age, so it probably was the same thing. Like you go on it for cramps, you know, you start becoming sexually active, like for a plethora of reasons, and then just never go off of it until they really start trying to conceive. And it causes, like, so many mental health issues. I can't remember if it was actually on one of your guests on your podcast that was saying it was like the criminal birth control, it's a like SSRI pipeline and it's just like a cause of so many issues. Yeah, like I absolutely wouldn't be surprised if it was like the birth control that causes all these issues like later on in marriages like go off it and they feel like different people. They're like, I don't know who I am anymore. It can just cause so many different hormonal issues. We don't really realize what we're doing when we start pumping young girls filled with hormones at such young ages. Yeah. And then, again, people often don't know that they might even be struggling. We talked about fertility. They might struggle to actually get pregnant, and they won't know that if they've been on hormonal birth control, some of them not even getting regular periods for years, if not decades. It can cause a lot of issues to the body. in the mind.

Stephanie Winn My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. Eight Sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show. So let's talk more about hormones and how they shift during pregnancy, postpartum. Before we started recording, you had also mentioned that there are significant hormonal shifts when a woman weans and stops breastfeeding. So kind of walk us through those hormonal shifts that a woman goes through at these different stages and then the impact on mood.

Samantha Green and other mental health issues. Most women we understand that like there's going to be hormonal shifts, our moods are going to change. Like when we get pregnant, postpartum, I think what really surprises women is the extent to which it actually does. So when people get pregnant, they're like, I didn't, you know, you see people on commercials and TV shows like weeping, weeping kind of for no reason. And it hits differently when it happens to you. They don't really know what to do. They don't know how to feel it again. Usually they've been on hormonal birth control for years beforehand, so that's all been blunted. So they're experiencing all this for the first time and exaggerated. Postpartum, there's always this period when you're about to leave the hospital that the nurses will kind of snip in at the end and they'll say, you're going to feel very hormonal for the next few weeks. If it lasts longer than that, it's postpartum depression and you should call your doctor. And I don't mean that as a knock against the nurses. I know they're trying to help, but often that does last. Sometimes it can be three weeks. And what I find is that when it lasts more than like, you know, one to two weeks that women panic, they call their doctor, they get put on antidepressants. But again, I work with a lot of great doctors. I know a lot of great people who are trying to help. Sometimes it can be helpful, but most often that stuff does actually go away fairly quickly. Same thing with weaning off breastfeeding. The faster you do it, the more extreme those mood swings can be. And if people are worried, they immediately go to their doctor, they get put on antidepressants, and much like an adjustment disorder, they don't really need them. That will pass on its own as long as you're not having any kind of maladaptive coping skills. like harming yourself, but for the vast majority of women that stuff passes and they're totally fine. It's just a very tumultuous few weeks that they experience.

Stephanie Winn Isn't it interesting that we know in many cases that the changes in mood someone is experiencing are hormone related, and yet the so-called treatment is to mess with serotonin, norepinephrine, dopamine. these other brain chemicals. This might be stepping outside of the bounds of your qualifications as a mental health practitioner. Maybe it's more in the realm of endocrinology or nutrition. But wouldn't it seem like if the issue is hormonal, then the treatment should be hormonal? In some cases, that just means riding out those hormonal waves and letting your body rebalance. But maybe there are other things someone can do as well.

Samantha Green Yeah, I mean, I would think so. I mean, usually my my approach is always first and foremost, like like stick to the basics. Like, again, are you eating? Are you sleeping? Like we need to take care of like your mind and your body are the same thing. So like to take care of your mind, you've got to take care of your body and then we can go from there. You know, what can we do to help regulate your nervous system? I don't think typically, again, like most therapists, like I don't think just jumping to medications right away is usually the right cause. I think typically we can take care of things. On our own, you know, I'm always trying to learn more about nutrition because I think there's a lot we can do on that front even though I'm not super well-versed in it. But yeah, it's like you got to take care of your body to take care of your mind. And that's usually the first thing that we stop doing when we get upset. So that's always my first approach, especially with like hormonal issues.

Stephanie Winn The sleep piece has got to be huge for moms. Oh my gosh. Tell, tell someone all you want that they should eat and sleep. But, uh, but before I started reporting, you were talking about, you know, that baby that's waking up every half hour. How's the thing? What, what can a woman do when she's not getting enough sleep and when that's just the lay of the land?

Samantha Green Usually, and most women will laugh when I say this, but like there are times when you truly do need to just kind of white knuckle it through periods of time. And usually the first few weeks of your baby being born is kind of one of them. Again, often women are breastfeeding, so it's not like dad can do a ton to help on the feeding front, but they could change a diaper. They're usually awake because they're sitting next to you. So like even if they're there just to like for moral support, there are times when you do just kind of need to Just push through and get through that tough phase. But once you're past it, take the help. If your baby's starting to sleep three, four, or five hours a night, make sure you're sleeping during that time. Again, women usually laugh when I say this because it's so hard to do in practice. It's so easy to say. But you really should be sleeping when your baby sleeps. I know that there's a zillion things that we need to do. I promise the laundry will get done. You don't need to check your email. You don't need to scroll through TikTok or Instagram. Just lay down. Rest your eyes at least. I know it's so tempting to do so many other things. I am certainly no one to talk since I've done all those things as well. But it really is best for you. This is a do as I say, not as I do situation.

Stephanie Winn When people think about mood issues or depression, they think about sadness, tearfulness, maybe even suicidal ideation. But when you talk about mom rage, you talk about anger. And I think typically there is sort of the trope and there is some truth to it that women go towards sadness and repress anger and men go toward anger and repress their sadness. I think you were talking about women as a symptom of postpartum depression or hormonal imbalance or burnout experiencing this rage. And I'd imagine that that rage could easily fade into a guilt cycle. I mean, we see this as therapists in so many ways with whatever the issue might be, right? A person has a feeling. and that feeling is uncomfortable, or it doesn't fit with their sense of who they are, or that feeling provokes a reaction, and then there's the shame and guilt and remorse of, I can't believe I just did that or expressed that, right? And as a mom, you feel so much responsibility towards this precious, vulnerable little being. Does the mom rage? create a vicious cycle or do you find your clients have difficulty accepting their anger and moving forward from there?

Samantha Green I think that's maybe why it's so distressing to women is because it is more unnatural to most women. Especially if they've never been an angry person before, they just become so distraught over this idea that they're seeing red, maybe they're yelling at their husband, sometimes they're yelling at their kids, and they're just like, yes, the guilt, the shame, usually that does kind of lead to this wanting to flee where they're like, maybe they're better off without me, maybe I'm a bad mom. Yeah, it could be burnout, it could be postpartum TSD, could be a part of depression. So sometimes just like picking apart, like, you know, when did you start to get angry? Like, what are we, what are we actually upset about? Sometimes it's just a symptom, like within the burnout of like overstimulation. If you get hit with too many, too many things at one time, people just kind of like snap, so to speak. But usually, again, yeah, like it's all workable, like we can all work with those things. But that is definitely a main feature that people come in with.

Stephanie Winn When women are in that state and they're far from their best self, they're having distressing thoughts, at what point do you find it's useful to label the thoughts intrusive thoughts? And how do you make that distinction?

Samantha Green So usually and typically in the past, women did not like bringing up intrusive thoughts because the fear was always that it was going to get mislabeled as like suicidal thoughts or like homicidal thoughts. They were worried that somebody is going to think they're going to harm their baby. Like, I think I'm trying to think of just like a regular generic example. Like if somebody was very fearful that they would accidentally like drop a knife and it would fall onto their baby, who's in like the bouncer on the like on the ground. Like that would be an intrusive thought. Like it just like pops into their head and they're like, oh my God, that's horrifying. Like I'm going to lock up the drawers. This can also lead to like postpartum OCD sometimes. Whereas like a thought about hurting your baby or hurting yourself would be like, I should grab the knife and hurt the baby. And those are two very different thoughts. So usually, again, people don't typically come in and say like, I'm having intrusive thoughts. Sometimes it happens, but not typically usually they're just like I'm so I'm so anxious is usually how it comes out I'm so worried. I have so many fears about the baby, you know, like what if I leave the baby in the car? It'll just pop into my head at random times or like, you know, I Other intrusive thoughts might be something like what if I'm walking down the street and like a car comes out of nowhere And they're like, I can't get it out of my head. It's so distressing Again, kind of all under the umbrella of anxiety. So it's like we do a lot of work with that.

Stephanie Winn I can't remember where I originally Absorbed this model because it's been years but I was once introduced to a framework for conceptualizing of intrusive thoughts and OCD that was really helpful for me, which is that people who are prone to OCD tend to be people who are fairly conscientious. And this is my way that I have internalized this model, right? That we all have, I like to call it a disaster detector in our brain, right? We all have this little part, you can think of it as an alien or a robot that's like scanning your thoughts and experiences, inner and outer, looking for something wrong. And your disaster detector, well, you're having thousands of thoughts and observations a day, but certain ones are especially alarming, like the idea of harm coming to your baby is a very alarming thought, so your disaster detector It goes, deet, deet, deet, deet, deet, and like, warning, warning. And so it starts sounding the alarms about this thought and then all your inner resources become focused and zoomed in on this thought when really it's just one of a thousand thoughts you had that day. There are plenty of other ones that were just as irrelevant or nonsensical. But that it's the conscientiousness and this part of you that's on the lookout for something wrong that ends up exaggerating, highlighting, spotlighting this thought. And that part of the treatment, therefore, with OCD, we know the standard treatment, exposure therapy, sometimes that means exposure to your own thoughts in a way that helps you realize you would never act on them. that it's just a thought, that it's that the thought is not a reflection of your character. So that's been helpful for me. And I'm curious how much that resonates with the way that you help women with intrusive thoughts about their babies.

Samantha Green I do really like that. I might steal that and I will make sure to give you credit when I do use it. The disaster detector, usually with any kind of like anxiety, fear, intrusive thoughts, I'll kind of describe it like on a bell curve. We want emotions. Emotions are good. We're not trying to get rid of emotions within therapy, but we just want the correct amount of those emotions. So with like fear and anxiety, we need the right amount because some of it helps us keep our baby safe. It helps us pay our bills. It helps us get places on time. You know, if I wasn't a little stressed, sometimes like I wish I would never be anywhere on time. A little bit of fear, like you said, the disaster detector, it's like a little bit as good because it keeps us safe. You know, it makes sure we're pushing the stroller on the right side of the road, not down the middle. But too much is intrusive and too much is it's going to debilitate us. We're not going to be able to do anything. Not enough. And we're going to start doing dangerous things. But yeah, usually it's like you have to finish the thought with those intrusive thoughts. Like I say, like it's a car accident, like watching a car, like you have to just finish it. You can't stop it. Usually then we do some mindfulness afterwards. I do a lot of belly breathing with my clients. I find it incredibly helpful. I've experienced intrusive thoughts like when I was postpartum with my oldest so like a lot of this too like I've been through it like I know that it's it's distressing and I know that you're going to be fine eventually too. It's like I've been able to use these techniques on myself and then distraction afterwards. It's simple. That doesn't mean it's easy. But a lot of the stuff I do is simple. And it's things that most postpartum women, even sleep-deprived women, can put into action.

Stephanie Winn We do know that sometimes people with mood disorders, at the extremes, that mood disorder can head into psychosis. This is more common with bipolar 1 disorder, someone having a full-blown manic episode. And that's easier for anyone to imagine when you consider the fact that during manic episodes, people typically aren't sleeping. You know, they may go weeks of sleeping three hours a night while anyone deprived of that much sleep is going to start probably hallucinating. Right. So we know that, you know, certain conditions, even though a person might not have something like schizophrenia, schizophrenia or schizoaffective disorder, that yes, someone during an extreme mood episode can experience psychosis. Obsessive-compulsive disorder, although it's considered a neurotic rather than psychotic condition, there's times where it can become pretty detached from reality, right? If you think about the magical thinking that goes into, I must Walk circles around the house six times or else this will happen. Like, you know, that's that starts to get into delusional territory, depending on the degree of insight that person has about their obsessive compulsive disorder. So but a little known fact is a little known outside of the therapy community. Most therapists know this, right, that that in the throes of a severe major depressive episode, people with no history of psychosis can end up experiencing some psychotic states. And we know that the types of conditions you're dealing with, the postpartum depression, when women are dealing with all of that hormonal fluctuation, plus the lack of sleep, the major, major life adjustments, and so much fear about keeping their baby safe. At what point does it cross the line? Do you ever see symptoms of psychosis in women with postpartum depression? How does that change your understanding of what they might need?

Samantha Green Luckily, it's it's pretty rare. I've only seen it like less than a handful of times, like in the last five years. So very, very rare. And I think that's important to remember, because that's what a lot of moms kind of worry and panic about is like, if I've got depression, I'm going to start to have psychosis. I'm going to start to have like suicidal thoughts, homicidal thoughts. So it is exceedingly rare. The good news is it is very treatable as long as you've got a good support system around you. You do need medication. I know I'm contradicting myself when I said earlier, but that is one of those that you would want to seek help immediately. You would want to get on some kind of medication to help with that. But the good news is, is because it is postpartum, it goes away relatively quickly as well. Usually, I think the few cases that I've seen, it's like less than a year's worth of medication and they were all better. They were able to wean off of it. They were fine. I know there's some places, I don't think we have any in the United States. I know there's some in Australia where they actually have mother-baby units for people that are experiencing very severe postpartum depression, postpartum psychosis, where they can actually safely keep baby with mom to keep that bonding there. Just because that can be very difficult Usually any kind of like postpartum psychosis happens pretty quickly after they give birth Like I want to say within the three months I could be wrong on that exact time frame But like you're not typically gonna see postpartum psychosis 11 months postpartum. It's gonna be a little sooner to the birth Which is good news because that's usually kind of the danger zone, especially with any kind of like bipolar disorder psychosis disorder in the past Which I would suspect probably has something to do with the sleep to like we talked about

Stephanie Winn That's good news and definitely seems ideal to keep mom and baby together while also making sure that mom is safe as well as baby being safe. So you said that you use polyvagal theory quite a bit in your work and that you have ways of explaining polyvagal theory to your patients that really resonate with them and shed a light on the issues they're facing. We do have some therapists in the audience who are familiar with polyvagal but probably an equal or greater number of people who aren't familiar. Lay out some of the basics of polyvagal theory for us, if you don't mind. If you're looking for a simple way to take better care of yourself, check out Organifi. I start every day with a glass of their original green juice powder mixed with water. It contains moringa, ashwagandha, chlorella, spirulina, matcha, wheatgrass, beets, turmeric, mint, lemon, and coconut water. 100% organic with no added sugar. It's the best tasting superfood supplement I've ever tried. It's super easy to make, and it makes me feel good. Organifi also makes several other delicious and nutritious superfood blends, such as red juice, immune support, protein powders, a golden milk mix, and even superfood hot cocoa. Check out the collection at Organifi.com slash Sumtherapist. That's O-R-G-A-N-I-S-I dot com slash Sumtherapist. And use code Sumtherapist to take 20% off your order.

Samantha Green Yeah, so usually I try to go a simple way to explain it, which if you're familiar with it, doesn't seem simple at all. So there's the sympathetic nervous system and there's the parasympathetic nervous system. Fight and flight, rest and digest. And typically as therapists, that was the model that we were taught. That was the one I taught. I was taught in graduate school, you know, anxiety, your heart rate's going to go up and sympathetic, your breathing's going up, your digestive system's shutting down, and then the other one is shutting it off. So, for example, In terms of motherhood, if your kid runs into the street, you need to be able to kick into gear to go get them. And then once you've brought them back to safety, you need to be able to relax, have your breathing go down, have your heart rate go down, have your pupils constrict back to normal. But then there was always this third part that we never really knew where to fit it as therapists, the freeze state. We always kind of lumped it into the sympathetic state, but it didn't really fit because you were still sort of in that parasympathetic state of shutting down. And so the polyvagal theory, that's like the poly and polyvagal theory. They call it dorsal vagal. And so what that looks like is people start to say, I feel numb. I feel disassociated. I don't feel anything. I don't want to do anything. Nothing seems happy. And so that's kind of where we typically will land. So we'll see what symptoms are you experiencing? Are you elevated? Is your heart rate up? Are you anxious? Are you alert? Or are we down here? Have we shut down? And that's usually how people will describe it, is I feel shut down. I don't feel like doing anything. And so from there, we can kind of work on, OK, depending on which two are those, are we fluctuating between the two? What is the treatment that we're going to come up with? How are we going to help you? We're going to help the symptoms. You know, diagnosis is great. We need it for insurance purposes and to help us kind of dictate stuff. But really, like, how do we treat this? Because that's what's bothering people. And so that helps me kind of dictate where we're going. Usually people are able to say, I'm elevated or I'm not. I'm shut down. And that's kind of where we go.

Stephanie Winn A lot of people would say that we can only sustain a high anxiety state for so long and that depression, oftentimes if you look back in that person's history, even if you as a therapist are meeting them during a time that they're very depressed, if you look back, there was anxiety before there was depression. And the depression sort of arises as a coping mechanism, as a way of conserving energy because costs a lot of energy to be in that high strong sympathetic state all the time. I've often said that a healthy nervous system isn't one that's always calm or never alarmed. A healthy nervous system is one that can fluidly shift gears between the modes that it needs to so that you're you can go into a state of alarm like you said in an alarming situation you can run after your kid, you have that instinct to protect them, but then you can quickly recover. And from the little bit that I've studied polyvagal theory, people in that school of thought will often kind of compare what's different about us as humans to animals in the wild. If you look at a zebra running from a lion, that zebra can, you know, it's got the adrenaline and cortisol or whatever zebra's equivalent of those hormones. Oh, I don't really know. But, you know, it can it can bolt when it needs to bolt. But once it's made it to safety, it just kind of shakes it off and then chills. Right. And that's what's different about us as humans is that we have these chronic stressors. So yes, it's appropriate to go into that sympathetic state to fight or flight when we need to. But what do you do when the stressors are ongoing, whether that's because you're constantly being exposed to war and strife and alarming things in the media, social media, or whether that's more relevant to your work that the state of a mom who's got mom anxiety about something bad happening to her baby and you have to be on alert 24-7 for several years. So when you're in that kind of state of chronic stress, people can only sustain the sympathetic state for so long before some mechanism kicks in to conserve energy and goes into that shutdown mode, which depression is frankly more sustainable.

Samantha Green So yes, there's kind of two different things and I can't really figure out how it happens. But there's so there's one person who, yes, they tend to be very anxious. you know, whether it's trauma, anxiety, whatever's going on, and that at some point they shut down. They might they might fall back and put if something's happening, but like that will happen. I found there's also some people that like their stress response is to shut down like. If they had a really tough morning, they had a long commute, a fight with their spouse, whatever. And they're just, they shut down entirely. So there, and I don't really know kind of what the difference is, like how, why are some people more prone to just shutting down right away? How come some people will stay in this anxious, this sympathetic state for so long before they shut down? I don't know the answer to that. I just know that I see it. But yeah, it's tough. You know, I will say to people that like Armani's were really built for the 21st century. You know, the stressors that we face now are not easily fixed. You know, at least, you know, if we recover our child from the street and come back, we know that they're safe. We can hold them in our arms. We can feel their heart beating. But these other ones like this, comparing ourselves to other people on social media, the guilt that we feel that we're not doing enough, you know, in society or with our parents compared to other people or as parents, not with our parents, excuse me. But like those are not really tangible things that we're like, OK, we're safe. Done. Check it off the box. So it can be really hard to remind ourselves that we're safe when all of these things that are stressing us out are not tangible things like I gathered the meat, I, you know, I, I, you know, the crops, you know, all the stuff that we used to do back in the day.

Stephanie Winn I have a bit of a theory. I think it's somewhat temperament, somewhat inborn nature. that there are individual personality differences, but I would also speculate that early life experiences shape whether someone is more prone to go into one coping response versus another. So I, for, you know, in case it isn't obvious, I go into fight mode pretty easily. And that's kind of like, I have a survival instinct that comes from certain life experiences that where in order to survive, I had to fight for myself. I had to like gear up, ramp up my energy. And sometimes that means fleeing, but sometimes it means standing up for myself. Right. And so that's a place that I tend to go more easily. I don't shut down into that depressive, learned helplessness state as easily. But in my clinical work, what I've observed is that people who are more prone to, as their go-to stress response coping mechanism, to go into that shutdown state. Often if you look in their histories, there's learned helplessness from early on, right? There was something in their environment, in their upbringing, that was like there is no point to trying anything. You better just stay quiet, stay out of the way, or you will be punished for trying to do anything about the situation. So kind of an adaptation, that's usually what I've observed. So I think oftentimes, whether a person tends to more easily go into that high, strong, anxious state, whether they tend to be more of a fighter like me, where my default coping mechanism under stress is to perceive threat and react as if someone's trying to pick a fight with me. That might not be the case. Or whether someone tends to shut down and go into that, I believe you say dorsal vagal is the term for it in polyvagal theory, that shutdown state, often tends to correlate with early life experiences from what I've observed. Although, again, there's that kind of nature nurture, like how much was this person by temperament or disposition sensitive to cues and interpreting those cues in such a way as to say, there's no hope, why bother, why try?

Samantha Green Yeah, you've got a good disaster detector, she put it. Yeah, no, I think, yeah, there's definitely a lot of temperament. There's definitely a lot of upbringing. It's been interesting to see, and this is not on the topic of mothers, that like with all the work I've done between community clinics and private practice, the difference to and between like socioeconomic statuses to kind of like how people in general, mothers, people Kind of react to things has always been fascinating to you definitely see a lot of that My community clinic work or like clearly it was their upbringing there might have been trauma and the work I do now It's definitely a little bit more affluent and the challenges of like much different. It's very fascinating to see the difference

Stephanie Winn It's been a few years since I studied polyvagal. I honestly can't remember, like, did I read a book? Did I do a CEU training? I can't remember where I learned this stuff. I'm kind of a generalist when it comes to these theories. I like to learn a little bit of everything. But it was my understanding at the time, from whatever it was that I read, that for people who are in shutdown, and oftentimes this correlates with something like persistent treatment-resistant depression, as they sometimes call it, that one of the challenges in treatment is that they actually have to move through the discomfort of that fight-flight response in order to eventually make it back up to that safe and secure. I remember in polyvagal theory that sort of idea that safe and secure is in the face, right? That when we're calm and at ease and we're in a social mode, we become more animated, we use our facial expressions to communicate with others, and our body is at ease. And that fight-flight experience, you know, that's more in the gut and in the limbs. I think, if I recall correctly. So this idea that we want to help people get to that safe and social mode whenever appropriate, hopefully most of the time it is actually safe and appropriate to be in that mode, we want to help people get there, but that it can be this obstacle for people who are shut down who have repressed all of those scary and maybe angry and unwanted feelings that no you have you have to like reawaken those sensations to go back up the what is it called the polyvagal ladder

Samantha Green Yeah, yep. Probably Deb Dana is what you listen to if you're talking about Polyvagal Ladder. That was her big, like, she talks about that kind of stuff all the time. Stephen Portis was the guy that created the whole theory, but Deb Dana was the therapist that she really, like, we've kind of absorbed it like an amoeba therapist. But it is very fascinating. Yeah, I usually will compare it to, like, a wound for people. Whether it's the kind of just general therapy stuff or like, you know, postpartum PTSD, like trauma, it's like you kind of have to go back in. You might have to scoop out the infection. Time heal. Time does heal all wounds, but like if there's something in there that's preventing it from healing, we have to go back and address it and then it can heal on its own. I think people often expect to be able to forget these things and that's not how it works either. Like you will remember whatever it is that happened, but it can be very uncomfortable for people. And I'm sure you probably know, and many of the therapists already know too with trauma, what can happen is that as people start to get better, there'll be like a setback almost where it's like as they get more coping skills, as they're able to really handle what's going on, they'll take a nosedive. And all of a sudden, they'll be like, I'm having nightmares again. I'm having X, Y, and Z symptoms. It hasn't happened in a while, and that's usually when they'll bail on therapy. So I usually will tell people ahead of time, too, that might happen. If and when it does, stick with me, because I promise that means that you are improving. And so it's like if you hang on for just a little bit longer, you will really truly start to feel better. And I have seen that play out clinically, which is always nice to see. Again, nowadays, it's definitely more postpartum PTSD that I'm dealing with, but it's not That's not the only thing. A lot of parents will come to therapy because they've had traumas in the past and they don't want to pass them on to their kid. So there is a lot of that kind of work in there as well. And a lot of it definitely is sitting with that discomfort, working through it.

Stephanie Winn When you say postpartum PTSD, it sounds like you're talking about women with a trauma history prior to pregnancy that gets reactivated perhaps by the vulnerability of the physical experience of pregnancy and childbirth? Are you also talking about women who've had maybe traumatic experiences during pregnancy and childbirth?

Samantha Green Could be both. Both, either, all. Some women have experienced, you know, sexual abuse, you know, trauma, physical trauma and abuse in the past. And certainly being pregnant and having to go through labor and postpartum is very triggering and it can cause kind of all that stuff to kind of like feel like it's happening again. More often than not, there's just a lot of things, and I hope I'm not scaring any viewers that have not gone through birth yet, but there's a lot of things that could potentially go wrong. Either, you know, just in the doctor's office, the medications they give you, Just getting the baby out, sometimes even like semi, you know, like mostly uncomplicated births just can feel very traumatic if you don't know what's going on. If you get the wrong doctor who, you know, maybe isn't explaining what's happening or you won't know what's happening. Sometimes there's more blood loss than women anticipate and that can feel very traumatic. Some women, you know, end up having to have hysterectomies after they're born or after their babies are born for one reason or another. God forbid there's a stillbirth. or have their child born, you know, die shortly after birth, like all these things can be incredibly traumatic. And they can, you know, or even, you know, if baby's born too early, like that can cause all kinds of issues as well. Like there's just so many, so many different things that could cause it that all kind of look the same afterwards, even though they're all different reasons. Yeah, it's a lot. It's a lot for women to handle. They often feel very isolated and alone because there's so many different kinds, so it's so hard to find somebody that's been through exactly what they've been through.

Stephanie Winn You can now watch No Way Back, the reality of gender-affirming care. This medical ethics documentary, formerly known as Affirmation Generation, is the definitive film on detransition. Stream the film now or purchase a DVD. Visit nowaybackfilm.com and use promo code SUMTHERAPIST to take 20% off your order. Follow us on Twitter at 2022affirmation or on Instagram at affirmationgeneration. What are your thoughts on helping women through pregnancy when they have PTSD? I recall at one point it came up in my work with colleagues that certain colleagues recommend against doing trauma therapies like EMDR when a woman is pregnant. Sort of the idea that now is not the time to be digging up the past. She really needs to just be staying safe and feeling safe in her body. And so something like EMDR, which can reactivate that trauma, some people would consider it contraindicated. And yet also sometimes when women are pregnant, that's a time that they want to make sure that they're not going to pass along their trauma or have it impact their parenting.

Samantha Green Depends a little bit on a case by case basis. There's typically two approaches I'll take. And again, I am very upfront with my clients kind of on what I'm thinking and what I'm doing and whether they agree with me and want to continue. So this is the first one. And usually that's like if somebody has a continuous trauma from their past, if they were abused over a long period of time, something like that. I don't know if it's always the best approach to go back and start digging it back up. Often in that case, we'll we'll address the symptoms first. What do we need to, you know, what do we need to do to stem the bleeding? What do we need to really help with the symptoms? We can always go back later, but there's so much, we're not going to talk through everything. We're probably just going to cause more damage at that point. If it's just like a singular incident, like it was an extremely traumatic birth or something like that, or there was just a moment in the pregnancy that was an issue or, you know, it was kind of like a, an event, then it usually is helpful to talk about it. Usually, again, hopefully in an ideal case, baby made it out relatively OK, mom's OK. And now we're discussing it afterwards. It's not always the case, but hopefully that's the case. If that's the case, you know, we're working on symptoms. We might be going back and gently discussing the events, trying to kind of piece it together with their life, because what will happen is you're like, I feel like a different person. It feels like a different life. So we need to pull it all together into like one cohesive story almost. But those people that the more long-term stuff. I agree that sometimes taking it back up is not always the best case, whether they're pregnant or not. Sometimes it's just not the right move. And it's better to focus on, like, what can we do to help you move forward and to heal?

Stephanie Winn Yeah, sort of that idea that if someone, let's say, had a stable upbringing, but then a single incident trauma occurred or a few, then at least they have some sort of foundation to return to. But if they grew up in an unstable environment, let's say a parent was incarcerated or on drugs or they witnessed domestic violence, you know, these sort of things that are not only disruptive, but that interfere with the development of a secure foundation, then It tends to be more valuable to help that person build stability now, now that they have the freedom to build stability as an adult, rather than rehashing everything.

Samantha Green They need to learn to trust their own coping skills, learn coping skills to begin with. And often people like that. feel like they don't have any, maybe because they had a caregiver who wasn't able to provide them for them. The simplest one, again, just for listeners, viewers, usually whatever you do for a baby is usually what we would do for ourselves as coping skills. That's kind of my quick and dirty way to think about a coping skill. You know, are you walking back and forth? Pacing isn't a terrible one. Rocking in a rocking chair. That's why music, I feel like, is so soothing often. White noise, showers, baths, anything to kind of help with the stimulation. And I think often people do know what to do. Like our bodies are better at taking care of ourselves than we know. And we really have to just trust it and do it a little bit more intentionally, because sometimes we'll fight against it and be like, that doesn't seem right. You know, the classic one is like, I don't want to talk to myself. But self-talk, as we know, can be very helpful for people. It's how we work out problems. By sometimes being in therapy, just having somebody to balance ideas off can be so helpful. I do try to encourage all of those like super basic coping skills.

Stephanie Winn observed at all that women with small children that, let's say, if she had a trauma at a certain early age, that when her child reaches that same age, it tends to bring up issues related to that trauma for her?

Samantha Green Yeah, some people will reach out kind of around stuff like that. They'll be like, something happened to me when I was a child. I'm worried that it's going to happen again. Often that ends up circling around like sexual abuse, physical abuse, very fearful. That's where intrusive thoughts may start to occur too. And kind of branch into OCD where people may not want to take their kids out into public for fear of whatever happened to them may happen to their child. So making sure you piece apart to like, is there a true danger? Because I would never look to somebody who lived like in a dangerous area and be like, no, just take your kid for a walk. Like, that's not always the right move either. So you do have to kind of go case by case. But that happens a lot. A lot of people will come in like mothers will come in because of whatever happened to them. They're fearful of happening to their kid, you know, whether it's a realistic fear or not.

Stephanie Winn There could be some strange parent child dynamics evolving from that if it's not addressed, like mom projecting it.

Samantha Green on to the child. Yep, especially if grandma or like you know her like the mom's parents are still around usually there's some like You know, enmeshment, there could be some complex family dynamics involved, especially if they're still around and if those things haven't been addressed. I feel like all these things end up interweaving. It's always interesting. People will say, you know, you know, I'm, you know, I'm pregnant and postpartum, but I also have issues with my parents, my family, with my in-laws. Like, do you work with that as well? And I'm like, they're all connected. Like, it's all connected. You can't work with just moms and like only work with postpartum depression because that is all these other things. You know, it is communication with a husband. It is, you know, trauma from youth. It is all of these things connected, kind of like in a big, big spider web.

Stephanie Winn I mentioned at the beginning of this episode, so I want to make sure to get around to this, that there can be certain issues that are challenging to talk about because they're highly politicized. Even though, you know, it's ideal if we can just talk about these issues from the perspective of what do we know tends to work best for people. Doesn't mean everyone's going to live up to all the ideals all the time. And that's OK. It's just. you know, if there are certain aspects of your family decisions that are less than ideal, then it just maybe there's, you know, a little more to be done to kind of soften the blows of the less than ideal things or help with the adjustment. But there are so many issues pertaining to motherhood. And earlier you talked about sort of the supermom myth and the pressures that women put on themselves. So I just want to kind of like rattle off a few of those that come to mind, right? So one of them is cesareans. We know they're overused, oftentimes for the convenience of the doctors. Then there's the breastfeeding issue, right? We know that breastfeeding is best for baby. It doesn't mean that's what's always going to work for mom in every situation. But sometimes there's this kind of like chilling effect where it feels like you're not even allowed to talk about the fact that we know breastfeeding is best for baby. And then there are things like increased maternal age, right? So again, there's a conflict with our culture of values because we know that pregnancy, childbirth, child-rearing is all going to be easier relatively. Your fertility is going to be higher if you have children younger. Doesn't mean it's right for your situation, right? But we know that increased maternal age, you know, it can mean that there's issues with fertility, birth defects, things like that. And then returning to work, which is another one where, again, what's best for baby certainly is if baby can have as much time with mom as possible, doesn't mean it's going to work for every family. Another one you had mentioned before we start recording was co-sleeping, that it feels like the hospitals put, you know, kind of really terrify moms out of co-sleeping. So being a therapist to women, having real talk conversations, helping individual women make the decisions that are best for them. Any thoughts on these politicized issues? What tends to work for people? How we can make it easier to talk about them?

Samantha Green I mean, other maybe going in reverse order, other than just like really starting to talk about them, like really opening up a conversation, I think is important. The co-sleeping one usually is the first one to come up right after giving birth because women are tired. I guess going along with that, the breastfeeding, because we know the breastfeeding is best for babies again. Is it always possible? No. Like, again, I have two kiddos. One of them was exclusively breastfed and one was not. And I did the best I could. And I am glad that I was able to give my son the breastfeeding experience because it was really good. But those usually come up hand in hand. And typically what will happen is, assuming mom can breastfeed and there's no issues and there's no problems, the next question they have is they're basically nervous to say, like, oh, and I also co-sleep. They put the fear of God to be in hospitals as far as co-sleeping. It's got to be a baby jail. No blankets, no pillows, no stuffed animals, nothing. And women find that when they're breastfeeding, you know, every 30 minutes in the beginning of postpartum, that they're exhausted. They wake up in the middle of the night. They can't they can't keep holding baby in their arms while they're trying to sleep. They're sleep deprived. Baby's not sleeping. So they do what all moms do, which is they lay on their bed or they lay on the floor. with their arm up on the sides and try sleeping like that. And it's almost always what ends up working. Usually parents will do the thing where they kick all the covers off. You know, maybe dad got relegated to the couch. It happens all the time and people are terrified to say it. And usually I will say, it's OK, I'm not calling CPS any for co-sleeping because that's what happens. Most families that I talk to end up co-sleeping at some point. It's usually not a forever thing, but it's very taboo to talk about. And people will be like, that's bad. That's illegal. You're going to hurt the baby. As long as you're not intoxicated, you're not drunk. It's almost more dangerous to be sitting up right and trying to feed that baby all night long. It's exhausting. So co-sleeping, it's like, go ahead. I was trying to think of the other ones that we had rattled off. The advanced maternal age. Yeah, people really don't like talking about that. Again, we have this very big obsession with youth in our country, so the idea of getting older and anything not happening because you're getting older is upsetting to people. And you hit advanced maternal age at 35, which is young by today's standards, especially if you live in a bigger city. But it's something that needs to get talked about because I think we put a lot, again, put a lot of pressure on women to get the career, do all these things, and they're not ready to have kids until their mid-30s. And they need to know that, like, it's a distinct possibility that it may not happen at that point. And if we're not honest about that, we're going to lose a generation of kids because people aren't able to have kids.

Stephanie Winn That's so sad.

Samantha Green No exceptions to every rule, but. That's what happens. And I feel bad for women like that. It's a lot of people in my generation who are struggling with fertility now in their 30s because they wanted to make sure they were very stable, which is a great thing, but there's a tradeoff. I find, too, that, again, because of the pressures that we put on women, a lot of women are surprised to find that they do want to stay home longer with their kiddos. You know, someone will say altogether they want to quit their job. Some are like surprised to find that they want to work part-time or cut back a little bit, especially if they've got, you know, everyone's got successful careers, but doctors, lawyers, the people that spend years and hundreds of thousands of dollars to get where they are, are very distressed when they find that happening to themselves and knowing that that's normal. It's okay to want to be home with your kiddo. I think, luckily, we do live in a society today where, like, you can't have a career and be a mom, and it just takes a little bit of maneuvering and finagling, and you just kind of have to figure it out on a case-by-case basis, and it might not look exactly like you thought it was going to be.

Stephanie Winn I have one last question for you based on all of the wisdom that you acquired working with women during this time in their lives, which is that if we have a 25-year-old woman listening who is contemplating her future and thinking about how to make wise decisions. If you could distill, again, not to shame anyone who's made less than the platonic ideal decision in every way of their life. I know I certainly haven't and, you know, few people have. But if you could distill the wisdom you've learned about what really tends to make people happy and fulfilled in the long run, what tends to make for healthy families and mentally healthy women. Any sort of life lessons that you would offer that younger listener?

Samantha Green I would say if you're married, don't wait to have kids. There's always a reason to not have a kid. There's always more debt to pay off. There's always another vacation that you want to take. There's always another promotion to get, but you can do all those things with a family. You can even go back to school once you've had a kid. That's not off the limits either. We talk about staying home with kids, but I think having kids really is extremely fulfilling. And I'd say that as long as you're married and you're in a healthy relationship and there's no abuse or there's nothing like that, You'll figure it out. You will figure it out. There's always help out there. There's a ton of like new perinatal help out there. Do what feels right. I think your instincts are better than we think they are. Nobody thinks they have them, but I promise everybody does. And that like it's normal to feel hormonal when you're pregnant. So like when that does happen, it'll be OK. You know, if you need if you need a community, if you need support, they're out there. You just have to reach out. I know. I'm trying to, like, distill everything and it's so difficult now.

Stephanie Winn And if she's not married?

Samantha Green Find the right guy. Enjoy your life. Get a career. Again, until you find that, because there's no reason not to have a fulfilling career and life until then. And we live in a time where you can have both. It just is going to look different than it did 50 years ago, 100 years ago. I love my career, what I do. I love being able to work part time and be home with my kiddos. And I wouldn't have it any other way.

Stephanie Winn It also sounds like there's an element, too, in there of be prepared for that to change, that it's OK. Things change. It's OK if you pursue a career and then your priorities shift as you have a family.

Samantha Green Things will change as you get older. Your expectations, your priorities will change. That's OK. We don't need to be so rigid with everything that nothing changes. Usually changes for the better.

Stephanie Winn So Samantha, I know you're largely not on social media, you don't do podcasts. This is actually your first and I think you did great, by the way. Thank you. You're a natural talking about, you know, the things that you know and are passionate about. So that said, you are, are you accepting clients now or in the future in your private practice, if there's anyone in New York?

Samantha Green I do have a limited number of spots open right now. I typically am working while my oldest is at school. I do have a website, LMHC.com, where you can submit questions, inquiries. And I do have a Twitter that I'm only occasionally on, where I follow you, which is Sam Green, at Sam Green LMHC, I believe. So I go through waves of using it, but I do use it sometimes.

Stephanie Winn All right, well, Samantha, it's been a pleasure. Thank you so much for sharing your expertise with us today.

Samantha Green Of course. Thanks for having me.

Stephanie Winn I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit sometherapist.com or follow me on Twitter or Instagram at Some Therapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to my producers, Eric and Amber Beals at Different Mix, and to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.