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Heidi Koss, LMHCA – Postpartum Support Int 2013 Conference

Originally posted April 1, 2013.

Behind the Scenes

Spotlight: Heidi Koss, LMHCA

Biography: Heidi Koss, LMHCA, has been an activist in many areas of Maternal Mental Health for two decades. She has volunteered for Postpartum Support International (PSI) of Washington for sixteen years and is the Postpartum Support International Washington State Coordinator. She runs a busy Marriage & Family psychotherapy practice, working as a marriage & family counselor and specializing in trauma and perinatal mood disorders. Her passion for helping others is rooted in her own personal experiences with perinatal mood disorders.

Heidi provides individual psychotherapy as well as marriage & family counseling in Kirkland, Washington. Her specialties are working with sexual abuse survivors; pregnancy and postpartum difficulties such as depression, anxiety, miscarriage, or birth trauma; couples struggling with parenting or relationship issues after having kids; as well as the challenges of having special needs kids.

Heidi is a compassionate clinician who has a special philosophy; she doesn’t believe in reducing people and their individual situations to a label or a diagnosis. She supports her clients to get beyond just surviving, shifting to something closer to THRIVING.

Heidi is speaking at Postpartum Support International’s (PSI) Conference in June 2013 in Minneapolis. Q: How did you become interested in your particular niche, Maternal Mental Health? Professionals who have dedicated their lives to helping women and families with perinatal mood disorders usually have very personal reasons for entering into this specialty.

Initially, my own experience with Perinatal Mood Disorders (PMAD), which I had with the birth of both of my kids, drew me into this work. Nineteen (19) years ago, I had been accepted to a clinical PhD program to study PTSD in rape survivors.

However, I became pregnant just prior to starting the program and withdrew due to my own postpartum mental health descent. When my first child was 18 months, I became a postpartum doula and lactation educator. I realized how much support I wished I had had in my own postpartum period, and wanted to provide that for other mamas.

I became known as the ‘go to postpartum depression doula’ – most of my clientele became either moms who had already had a previous experience with PMADs, or were at high risk, often due to their own mental health history, or abuse history. I worked as a doula for 12 years.

When my first daughter was 2, I also started volunteering with our state perinatal mental health non-profit organization, Postpartum Support International of WA.

I knew that I wanted to help parents experiencing PMADs at a deeper clinical level, never giving up my original attraction to clinical psychology work. So, when my youngest entered kindergarten, I went back to school to earn my Master’s Degree as a family therapist. Of course my niche naturally became perinatal mental health issues, but I also specialize working with sexual abuse survivors.

It took me many years of experience, training and hard work to finally manifest my original direction with my deferred PhD!

Q: I’d love to know more about how you became interested in working with trauma and birth trauma.

My trauma interests initially began as an undergraduate over 20 years ago, working as a clinical psychology research assistant studying domestic violence and sexual assault. Eventually, as a postpartum doula, I supported many families who had traumatic birth experiences.

I knew addressing Post-traumatic Stress Disorder (PTSD) and complex trauma was an importance piece of the perinatal mood disorder spectrum that needed to be addressed, and was often overlooked.

Q: Looking at your website, I see that you offer Birth Trauma group work. This sounds fascinating, I’d love to hear more about your experiences!

Actually, I’ve suspended the group for now – I actually had a really hard time getting anyone to attend, and they only trickled in one at a time during the ‘group’ sessions so it never ended up being a real group. 

I’ve noticed that most folks that find me for birth trauma counseling in general come from referrals from doulas, lactation consultants, childbirth educators or other therapists. Rarely has there been a trauma referral from an OB or Midwife, although those professions refer plenty to me for other perinatal mental health such as depression, anxiety or bipolar. I’ve been curious if the lack of referrals from OBs and Midwives might be litigation fear driven – if they acknowledge the mama’s birth trauma experience, might they be concerned that they are opening themselves to becoming a target of blame the care provider for her experience and outcome? Given that OB’s are the most litigated against of all physicians, I can see how this fear might be so. Just a hypothesis at this point…

Q: Tell us more about your upcoming presentation at the PSI conference, Failure to Progress: The Paradox of Pain in Childbirth and Subsequent PTSD, with Walker Karraa

Pain in childbirth is a contributing factor to developing PTSD postpartum. Conflicting paradigms regarding the role of pain in birth create a paradox for women that confound decision-making regarding pain management and contribute to perceptions of failure.

Both medical models and natural childbirth models maintain significant orientations around pain that can influence a woman’s experience of pain during childbirth contributing to unwanted interventions, disappointing birth experiences, perceived trauma and perceptions of failure.

Pain is in the Eye of the Beholder – meaning that the neuropsychiatry of pain perception is based on cumulative life experiences, linguistic and social constructions. PTSD is often a result of a lifetime of cumulative traumatic experiences.

I will also be using real clinical examples from my practice of mothers treated for birth trauma PTSD.

Q: What are some of your other projects going on now?

I am still volunteering with Postpartum Support International of Washington (WA). I’ve been with them for over 16 years now. I’m also the Washington State coordinator for Postpartum Support International.

I’m also collaborating with putting together several 2-day PMAD trainings coming up around Washington state this year and next year. These workshops will train health care providers in the best practices for prevention, identification and treatment of PMADs, as well as have a more in depth curriculum of psychotherapeutic clinical treatments.

We are trying to address the needs of our community when they say “Ok, now I know WHAT PMADs are, but now what? HOW do I work with them?” An additional focus of our upcoming trainings is to simultaneously forge community perinatal collaborative consortiums organizing local perinatal health care providers and programs to work together more successfully and grow more sustainably as well as learn where their service gaps are in their communities and work to bridge these gaps together.

I’m also busy at my private psychotherapy practice, helping launch a local Dialectical Behavioral Therapy (DBT) program with the mental health clinic I’m affiliated with. Lastly, my 2 daughters also keep me on my toes!

Q: Do you have some professional mentoring-type advice to those clinicians who are working in the perinatal mood disorders world?

First to all you clinicians working so tirelessly– THANK YOU!

I am so grateful for all the contributions by others in this field to help support the families we serve as well as supporting each other.

Continue to grow your perinatal health care community – as the PSI motto says, “You are not alone” — make connections! Many providers often end up working in isolation, and can get frustrated with lack of professional support and lack of services for families. Get involved. Join PSI. Join online forums, and professional social networking such as on Facebook and Twitter. Subscribe to relevant blogs, newsfeeds and professional memberships.

Bridge gaps – take chocolates to the midwives and doctors and therapists. Have tea with local doulas, childbirth educators, lactation consultants. Talk about Perinatal Mood Disorders with other providers.

Connect with WIC, Department of Social Services, low-income women’s health clinics, etc.

Remember this is not a topic that’s part of standardized curriculum in most mental health or physician degree programs – many of these organizations and practices are open to learning about this topic as they realize how in the dark they are. Shedding light, expanding your community, helps ourselves to help others.

Q: Anything else you’d like to add?

You rock! And so does Walker!!!

Well, Heidi, you rock, too!

Thank you for your valuable time & your work in Maternal Mental Health!

See you in Minneapolis!

Namaste, Kathy


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