Originally posted June 7, 2013.
Behind the Scenes
Spotlight: Leslie Butterfield, Ph.D.
Biography: Leslie Butterfield, Ph.D. is a clinical psychologist specializing in pre and perinatal psychology and women’s health. She also works tirelessly in several not-for-profit organizations. She is on the Board of the Prevention and Treatment of Trauma in Childbirth (PaTTCH) and volunteers in various capacities for Postpartum Support International (PSI), including serving as the Chair of the 2011 Annual PSI Conference. In addition, she is very active in Postpartum Support International of Washington. Dr. Butterfield has written and teaches a year-long maternal mental health counseling course at the Seattle School of Midwifery, has been involved with the renowned Gottman Institute regarding their Bring Baby Home classes and provides ongoing consultative services for not-for-profit organizations regarding maternal mental health. I want to thank her for writing the Foreword for my book, BirthTouch Healing for Parents in the NICU.
Dr. Butterfield says her clinical goal is to provide loving support and challenge to each individual or couple. Her clinical areas of expertise include: promoting healthy marital and parent-baby attachments; the prevention and treatment of pregnancy and postpartum mood disorders; and the repair of reproductive loss or trauma. In her clinical practice, she works by using the information, intuition, training and skills she’s acquired over many years of practice and has an integrative approach in therapy, applying what will be the most effective and comfortable “fit” for a client. She often uses interpersonal, gestalt, cognitive – behavioral, psychodrama, and positive psychology modalities.
You are quite an activist in many areas of Maternal Mental Health: you represented PSI at the 2012 Marce Conference, you were the Chair of the last PSI Annual Conference in 2011, you developed and teach the perinatal mood disorders curriculum at Bastyr, and you are one of the leading go to people regarding emotional support for parents in the NICU.
Q: Marce 2012 sounds like it was a blast! I read about it on the PSI website! Do you have anything to add for us about that experience (yum yum, Paris is my favorite city!)?
Oh, I did love Paris. The Marce conference itself was an extravaganza of information. There were so many topics covered, and so many countries represented that it was overwhelming. I’m quite sure it could have lasted twice as long and everyone would have stayed. The city itself was as gorgeous as ever, with the elegant old buildings and the many sidewalk cafes and restaurants. Absolutely everyone wore scarves, including the young men, who looked oh so handsome and sophisticated. The Musee d’Orsay was the most fantastic museum I’ve ever been in, and the Moulin Rouge was the worst show I’ve seen in my life. It was all wonderful.
Q: How did you become interested in your particular niche, Maternal Mental Health?
I didn’t realize this until several years into my graduate training, but it was a stillbirth my mother had when I was twelve years that started me on this path. She was so devastated. Her doctor had ignored her earlier remarks that something was wrong, and was cruel to her after the delivery of a little boy. I was furious on my mother’s behalf, and remember thinking, “I could do a better job than that doctor.” And I set out to. As soon as I was old enough I volunteered at Planned Parenthood, and each step after that was a deeper commitment to caring for women around reproductive events. Can you think of anything more important – or interesting – to do? I can’t. I love my work.
Q: I’d love to know more about how you became interested in your niche, emotional support for parents in the NICU and facilitating attachment for families in the NICU. There’s got to be a fascinating back story to your passionate work!
Well, in light of the above life story, I would have to say that throughout the years of my practice, “new” areas for helping have continued to present themselves, each one emerging from the one before. In my graduate program I was the only person – student or faculty – who was interested in attachment. I wrote my whole graduate exam about it, and I think they had to pass me because nobody knew what I was talking about! I also had the abiding interest in pregnancy loss, and started working with women who had both grief and PTSD issues around around fertility, abortions, miscarriages, stillbirth, and neonatal deaths. Then I had my own children and became aware of the depth of love we feel for our babies, as well as the anxieties we feel about their safety and happiness. With all that “tucked under my belt,” I met my first few clients with babies in the NICU, and it seemed pretty clear to me that a great many of them were struggling with combinations of PTSD, grief, anxiety, AND depression. I was knocked out by the energy and courage it took for these parents to love a frail baby who literally might die before the week was over. I recognized the truth in that old Shakespearean sentiment, “Tis better to have loved and lost, than never loved at all.” Moms and dads who attached to their babies suffered AND loved; parents who couldn’t attach only suffered. I saw the importance of helping attachments to develop, for the good of the babies and the parents both.
Q: You are such an innovator when it comes to training as well. It is wonderful that Bastyr has integrated perinatal mood disorders into their midwifery program. That seems like a leap that many midwifery programs should be making. How did it come about that you were able to provide such support to the program?
About six months after moving to Seattle, I received a brochure from Seattle Midwifery School and noticed that of all their advertised courses, only one didn’t have an instructor named. It was the counseling class! I sat on the couch telling my husband how I couldn’t possibly teach it, I was very pregnant, didn’t know how to get childcare in this new city, blah blah blah. And he said, “Hey – they’re midwives. Give it a try. Maybe they’ll let you bring the baby to work.” I interviewed for the position the next day and got the job. The class grew from one quarter to two, and then three, and now lasts a whole year. We focus on everything from basic counseling skills, to managing perinatal loss, helping women with sexual abuse histories, and the transition to parenthood. SMS is now the Department of Midwifery at Bastyr, and I’m teaching my 16th year!!! My young son accompanied me to classes until he was about four, at which time he started (unknown to me) imitating my every move and gesture behind my back, causing my students to crack up during a very serious lecture. When I finally realized what was going on, I recognized it was time for me to find him something new to do while I taught.
Q: Tell us more about your upcoming presentation at the PSI conference, “Surviving the NICU Experience: Postpartum Moms, Moods, and Strengthening Attachments.” It sounds wonderful!
Well, I’m really excited and a little nervous about speaking in Minnesota, where they already have such fantastic programs going on. I’m not employed by a hospital, so most of what I’ve learned has come from what my clients have shared with me about their experiences and the research that’s out there. I’m going to be focusing on the ways in which NICU moms have to adapt their ideas about what it means to be a “good mother,” and on ways that attachments with their babies can be formed and strengthened in spite of adversity. Mood and anxiety disorders make it extra challenging to remain attached, and there are so many things about the NICU experience (and, often, the situations that precede a NICU admission) that provoke feelings of anxiety, depression and posttraumatic stress. We really must find ways to help families through this extremely difficult time. Their emotional, physical, spiritual, and financial resources can be depleted in a very short time.
Q: How do you see PATTCh fitting in with the maternal mental health field?
PaTTCh is such a fabulous organization, focusing on ways to provide education and support to women who have gone through traumatic birth experiences. All of us in the organization have had the opportunity to work with women in this situation, and have a deep commitment not only to help them find resources but also to educate health care providers about the prevalence, prevention, and treatment of traumatic childbirth. Numerous research studies suggest that approximately 20-50% of mothers report having experienced a traumatic birth, in spite of the fact that medical personnel perceived these same births as “normal.” Approximately 3 – 7% of postpartum women meet the diagnosis for full blown PTSD, and another 20-50% report PTS (a condition of physical and mental distress characterized by PTSD symptoms but not meeting the full diagnostic qualifications for a PTSD diagnosis.) There are numerous risk factors associated with traumatic birth; some located within the mother and her history, and a great many linked to the situational components of the birth itself. The list is too long to present here, but it is clear that many of these risk factors could be reduced if medical staff and pregnant couples were presented with better preparation and education around the emotional elements of birth.
Q: What are some of your other projects going on now? PATTCh?
Right now I am working with Heidi Koss, State Coordinator of Postpartum Support International of WA, to develop a training module that we can present all over the state. We are developing a one day overview of perinatal mood disorders, as well as a one day presentation regarding more specialized topics, such as postpartum PTSD, perinatal OCD treatment, working with military moms, perinatal mood disorders in a cultural context, and more (including working with NICU parents, of course).
PaTTCh hopes to offer seminars, conferences, and web-based tools for both consumers and health care practitioners to help manage this often overlooked problem. We just got our 501-C3 status and are ready to rock!
Q: Do you have some professional mentoring-type advice to those clinicians who are working tirelessly in the perinatal mood disorders world?
I do think it’s important to maintain a hopeful frame of reference. Remember that the majority of women do not have traumatic births. The majority of women do not have postpartum mood and anxiety disorders. And the majority of parents do not have babies in the NICU.
There are many families to help, absolutely, but there are also a lot of families living and loving well on their own. We can certainly learn from them and translate the lessons into our own work, so that we can approach families with an attitude of hopefulness. We must have an accurate picture in mind in order to maintain balance and find joy in our work. Speaking of joy, I certainly would say that it is important to sustain a practice of positivity – whether you achieve it through mindfulness practice, your faith, gratitude lists, or random acts of kindness. I guess I would also say, never underestimate the power of good sleep, and belly dancing can be lots of fun.
Q: Anything else you’d like to add?
Remember that any loving act you commit acts like a stone thrown into a pond – it ripples ever outward and will touch people you never know. Your work counts. A lot.
You and your work shine bright in our world!
Thank you for your valuable time & input!
See you in Minneapolis!