What Therapists Need to Know

What Therapists Need to Know About Perinatal Mental Health

Lisa Marie Bobby, PhD, LMFT, BCC

Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.

For many therapists, perinatal mental health represents one of the most important yet frequently overlooked clinical issues in practice. When clients are pregnant or newly postpartum, clinicians often minimize emotional distress as “just part of the transition.” Fatigue, anxiety, low mood, disconnection, and overwhelm can feel easy to normalize, even when something more serious unfolds beneath the surface.

That tendency to explain distress away creates real risk. When therapists dismiss perinatal mental health concerns too quickly, they miss meaningful opportunities for assessment, support, and early intervention. The issue rarely stems from a lack of care. More often, therapists simply never received training that prepared them to recognize how profoundly pregnancy, childbirth, and the postpartum period shape a client’s emotional world.

In this episode of Love, Happiness, and Success for Therapists, I sat down with my colleague Catherine Fredrickson, LMFT, a Perinatal Mental Health Certified Therapist and Board Certified Coach, to explore what therapists need to recognize, assess, and respond to when working with clients during this uniquely vulnerable stage of life.

Why Therapists Often Miss Perinatal Mental Health

One of the most striking parts of this conversation involves how familiar the warning signs of perinatal mental health struggles feel—and how easily clinicians dismiss them. A pregnant client says she doesn’t feel like herself. A postpartum client shares that she feels disconnected from her baby. Another new parent describes numbness, anxiety, or shame because motherhood does not feel the way she expected.

Outside of pregnancy, those statements would immediately prompt deeper clinical assessment. During pregnancy or postpartum, however, clinicians often reframe them as “normal,” even when they signal deeper distress. As Catherine explains, this reflex to normalize discomfort can prevent therapists from identifying perinatal mood and anxiety disorders that respond well to treatment.

Research reinforces this concern. A large meta-analysis on the prevalence of perinatal depression found that perinatal mental health conditions affect a significant percentage of birthing parents worldwide (Woody et al.). This issue does not sit on the margins of clinical work. Many therapists already encounter it regularly in their caseloads, whether they recognize it or not.

This gap reflects a broader professional reality explored in Why Therapists Need to Grow Too: licensure alone does not prepare clinicians for every complex life transition their clients will face.

Perinatal Mental Health Assessment: What Therapists Need to Ask

Effective work with perinatal mental health does not require abandoning familiar clinical frameworks. Instead, it asks therapists to apply existing skills with greater curiosity and less dismissal.

Catherine emphasizes the importance of gathering a thorough perinatal history, beginning with conception and continuing through pregnancy and postpartum. Therapists should ask about fertility struggles, pregnancy complications, physical symptoms, energy levels, appetite, mood changes, and body experience. They should also explore beliefs about motherhood, expectations around parenting, and fears about how this transition may affect relationships, identity, and support systems.

Validated screening tools play a critical role. Clinicians can use the Edinburgh Postnatal Depression Scale, originally developed to improve detection of postnatal depression (Cox et al.), alongside the PHQ-9 and trauma-informed assessments such as ACEs. What matters most is resisting the urge to attribute distress solely to hormones and instead treating perinatal mental health as clinically significant from the outset.

Ethical care also requires knowing when to seek additional training, consultation, or referral—a topic explored further in Therapist Scope of Competence: Recognizing When You’re Out of Your Depth.

Normal Adjustment vs. Clinical Perinatal Mental Health Concerns

One of the most nuanced aspects of perinatal mental health work involves distinguishing expected adjustment from symptoms that require intervention. Hormonal shifts after childbirth are real and significant, and many parents experience mood changes during the early postpartum weeks.

Timing and functional impact help clarify this distinction. While the “baby blues” often resolve within two weeks, symptoms that persist, intensify, or interfere with daily functioning call for clinical attention. Language provides important clues as well. Statements such as “My baby deserves a better mother” or “They’d be better off without me” signal risk that extends far beyond exhaustion.
Evidence-based approaches, including interpersonal psychotherapy, effectively treat postpartum depression and related perinatal mental health conditions (Stuart).