Episode 19 Podcast > Full Transcript
Nicole Witt, Intro:
In previous episodes, we've talked a lot about the adoption process itself. We've specifically covered the importance of self-care during the process and ways to best maintain and even strengthen your relationship with your partner, if you're adopting as part of a couple.
Today, we're going to jump ahead a bit and talk about shortly after you've adopted. Of course, everyone expects this to be an incredibly joyous time, and it will be in many, many ways. But adoptive parents are not immune to the range of emotions that biological parents feel. Post-adoption depression is very real. It's just as real as postpartum depression. And although there's still a bit of a taboo around postpartum depression, that's a condition that people are more comfortable talking about than in the past and it's recognized as the true illness that it is.
However, post-adoption depression is not. On top of that, there's a lot of guilt that can come along with it. Adoptive parents know how much time, effort, emotion and even money they've put into becoming parents and that to ever acknowledge not being 100% blissful 100% of the time can feel like they're being ungrateful.
So, as a result, I think this is a really important topic to raise awareness about. And to talk about it with me today, my guest is Caitlin Fay. She's a licensed clinical social worker and she's co-owner of New Growth Counseling. Caitlin has worked with children and families throughout her career. The mental health of families choosing adoption and children in foster care is what brought her to therapy in social work. She opened a private practice in Florida with her friend and now business partner, where they both strive to empower parents through a mix of increasing support, fostering stronger family connection and cognitive behavioral therapy. Thank you so much for joining us today, Caitlin.
Caitlin Fay:
Thank you. Happy to be here.
Nicole:
As I mentioned, post adoption, depression is real and for a variety of reasons, it often goes either unrecognized or unreported by the person experiencing it so that they and(or) their loved ones know what to look for. Can you start by describing to us what post-adoption depression looks like?
Nicole:
Sure. So, post-adoption depression and postpartum depression actually have a lot of similarities. And I think it's important to remember, just as I'm talking in general, that a lot of what causes depression and anxiety after bringing a child home is due to the nature of the massive life change, and not necessarily how the child was brought into our family, whether that was through adoption or biological means. And so, I like to think (I don't like to think of it) but I like to think of post-adoption depression and postpartum depression being sneakier than other forms of depression. And the reason why I say that is because if I were to ask you to tell me what a depressed person looks like, we would all be able to kind of paint a picture. We all have that idea in our head of what that looks like. But when you're experiencing depression after you bring a baby home, it can be really difficult to tell, “Am I depressed or am I sleep deprived?”
Nicole:
Right. Am I really tired?
Caitlin:
Right. “Am I angry because I'm sleep deprived or am I too angry?” And also, like you said in your intro, it's this joyous occasion. So, yes, like you may be feeling incredibly sad or incredibly distressed over this life change, but then there's also these moments of cuteness or snuggles or like the things that we like to think of when we think of bringing a new child home. So, when you have your day, from start to finish with a new kid, it's a lot of times looking like, “Hey, I felt really bad this morning, but now it's dinnertime and I'm feeling better. Maybe I'm not depressed.”
Nicole:
That's a great point.
Caitlin:
And that's why it's sneaky, because you're convincing yourself you're not feeling these things that you are feeling. And this goes for moms and dads. Dads get ignored a lot in the conversation around mood disorders or depression or anxiety after a kid comes home or a baby comes home. So, I have my little list here of like the top symptoms that I would have on my radar if you were my client and you were telling me, “I just adopted a baby…” or “I just adopted a child and here's what I'm struggling with.”
The number one thing would be excessive and intrusive guilt. Guilt gets so normalized as a new parent.
Nicole:
All right.
Caitlin:
And guilt is really toxic. I think most people in my personal and professional life are experiencing clinical levels of toxic guilt. So, if you are feeling guilty over anything and everything that is absolutely a symptom of depression or anxiety.
Nicole:
That's a really interesting point. I did not know that.
Caitlin:
And then, like I said, depression and anxiety are different sides to the same coin. So, you may be feeling a lot of anxious symptoms, which is the other thing that gets extremely normalized as a new parent, “Oh, you're just going to be anxious forever. Now that you have a kid, you never stop worrying about them.” That is not 100% true. So, if you're feeling all these anxiety symptoms, they can be covering symptoms of depression. And same thing, if you're feeling a lot of depression symptoms, you could be also experiencing a lot of anxiety. That’s just a kind of you flip the coin and what's up today.
Nicole:
Right.
Caitlin:
So, anger would be another one. I think dads tend to relate to anger more, but there's a lot of women who experience a lot of anger as their main symptom; post-adoption or postpartum depression. Something a little more classic would be frequent crying, loss of interest in things that used to be enjoyable. I think sometimes, second-time parents tend to notice this more. I have a really good example of like with your first baby that you brought home, you were going on lots of walks in the stroller, in the good weather, and then you bring your second baby home and all of a sudden, like the idea of bringing that baby out in the stroller is like climbing Mount Everest. That's a good sign that you're struggling in a way maybe you didn't the first time.
Nicole:
So, a lot of these emotions that you're describing, though, I imagine, are completely ubiquitous for new parents of all types. So, at what point do they cross that line into, “This is just part of the normal experience.” Like you said, “They can be normalized in that way” to “They shouldn't be normalized in that way. This is a little bit too much.”
Caitlin:
So, let's say you really enjoy getting some time outside, having a cup of coffee, and you have kind of hit your limit from the night before or you guys had a really rough day with your child that you adopted and you brought home and you're like, “I need to go home and do this thing that I really enjoy,” that should bring feelings of anxiety, feelings of depression down and allow you to kind of restart your day or continue on with your evening and bring your mood to a place where you're more used to feeling. And it should kind of stay that way.
But if you're experiencing a lot of ups and downs or you're feeling very down and nothing ever tends to bring you back up to a happy place and kind of stay there. So, the amount of how long you've been feeling this and how intense is it, and then also how much is it interfering with my life?
And again, I just want to say the sneaky part about post-adoption depression would be if you were spending a lot of time at home with your child or your newborn, that, “How is it interfering with my life?” can be a little hard to put your finger on because a lot of the thoughts are like internal, not outward. So, you may be sitting at home, spending a lot of time rocking a crying baby and having these thoughts like, “I hate this. I wish things were different,” or maybe more guilt thoughts around like, “I'm doing something wrong. I'm not a good parent.” And then they're easy to just kind of brush under the rug and ignore. And so, I think like a lot of times those kind of quieter thoughts during those times tend to get ignored or pushed aside.
So, if you're having thoughts like that and you kind of look back and realize, “Hey, this has been going on for several weeks now,” that's a good sign that it's time to maybe seek additional help or support.
Nicole:
Yeah, I imagine it's part of why it's so sneaky is because you don't have the comparison point. So, like you said, if it's somebody's second child, they have the comparison point; how did they feel with the first child? But when it's your first child, you don't have a comparison point about, “How am I supposed to feel right now? Of course, I'm going to feel differently than I did before.” So, that is sneaky, as you say.
So, now that we have an idea of what to look for, people might be wondering how often this is something they really should have an eye out for. So, how common is depression and anxiety after becoming an adoptive parent?
Caitlin:
So, I did some Googling, because I wanted to find the most recent and accurate statistics, and I was reminded why there aren't very good statistics on this. So, if you Google it, you can find anywhere from 10% of parents to like 30 or 40% of parents. And that's a really wide range. And the reason why that range is so wide is because of things like stigma or, “This should be the happiest time of my life” and that goes hand in hand with stigma and people aren't reporting it. Or people are kind of just pushing forward and suffering, when they don't have to, until they feel better. And sometimes, they feel better after six months to a year and sometimes they don't feel better, but just are now in this habit of pushing forward. And so, there really isn't good statistics on who and how often suffers from post-adoption depression or postpartum depression for that reason.
And the statistics on fathers who've experienced that are even more inconsistent, because if women aren't reporting it, men certainly aren't reporting it. But there is more talk around both moms and dads and their experiences, in that we just don't really have good statistics to back it up yet.
So, I would say, thinking about the inconsistency of that, don't rule yourself out as potentially having this problem. And not that we have to think of it as like, “This is going to happen to me 100%,” but let's just practice being aware of ourselves and how we feel normally, so after we bring a baby home or a new child at home, if we start to notice these changes, it's kind of already primed in our brain to notice them.
Nicole:
So, certainly, even with those statistics, those are surely underreported. So, why do you think it's so common? Because this is such a joyous part of people's lives. Is it just because it's such a drastic change?
Caitlin:
Yes, that is part of the reason why. I think kind of the larger social issue here is that in the United States, we are not set up to support new families, however they are made. Our natural supports are often really small. Our access to medical and mental healthcare is often low, and due to gaps in insurance and costs and expanding your family and on and on. And adoptive parents, especially, suffer that cost of bringing a new child into your family. And financial strain is a huge source of depression and anxiety. Finding good child care; the list goes on and on and on. And so yes, that life change.
Your entire identity is shifting. Before you were Caitlin Fay, LCSW, now you are a parent, whether you're a mom or a dad or whatever; whatever you are, that is a new identity for yourself. And nobody gives that enough credit for how that just jumbles you up.
And especially if it's your first child, you're going from living a life that's pretty free; even if you work a lot of hours or have a lot of responsibilities, they're still on your own time and you can kind of control what you want to control and let go of what you want to let go of. And then you bring a baby or a child home and that entire focus now has to shift to, “I want to go out to dinner tonight, but I can tell that my child has had enough. And so, I need to change my plans.” And that can be really upsetting. It sounds so trivial.
I think it's really common for adoptive families to be really excited to throw that party of like, “We adopted and here's our new family member and we all love her so much or we love him so much.” And that's all true. And that event can be really overwhelming for a kid. And so, the loss of these expectations of like, “I've been dreaming and planning about this for so long and now my kid is here and I have to make adjustments.” It's okay to not like that, but our culture or our society doesn't like for us to feel that way or think that way.
And so, I think as Americans, we tend to kind of want to reject our feelings and push them away and so, all these things compound. It's no wonder – I kind of like to use the phrase, “Of course, you're depressed after expanding your family.”
Because you should have feelings. You should feel sad sometimes. You should feel mad sometimes. That's all part of adjusting. And I think some people are kind of, I guess, have higher emotional IQs and kind of have learned along the way to like go with the flow and kind of adapt and change. And that's fantastic. And then there's other people who still have some things that they could learn. And that's kind of where I think people get caught up in the, “I didn't realize my life would change like this.”
Nicole:
Gotcha. Okay. So, we're going to talk in a moment about getting professional help, if you're experiencing post-adoption depression. But before we do, are there things that people can do to reduce the chances that they get to that point? Are there ways to fend off depression or anxiety?
Caitlin:
Yes. Prepare before the baby comes home or your new child comes home. Take the time to kind of like talk with your partner, to think hard about yourselves and about your relationship with each other; what are our strengths and weaknesses? Do I have a history of depression or anxiety that I have never sought treatment for? How do I deal with change? Do I like to control everything or am I more of a go-with-the-flow type person? Just look inward and kind of have those thoughts. And if you're feeling like the answers to these questions are like, “Okay, I'm happy where I'm at. I think we've got a lot of strengths here. I think I feel good,” okay. But if you're answering these questions and you're like, “Oh man, I never really thought of it like that before,” that would be a really good time to seek therapy.
I think talking with who are your natural supports and talking more often with them about this upcoming life change. So, a natural support may be your mom, your dad, your neighbor, your sister, or your brother, your best friend, just your coworker; anyone who you can trust and rely on. And start practicing now, reaching out to the people in your support circle, because it's not a joke when people say, “You need a village to raise a child.” And again, kind of circling back to what I was saying earlier, we don't like to do that in America.
Nicole:
Right. It's hard for a lot of people to ask for help.
Caitlin:
So, start practicing now, because if you don't practice before the baby comes home or the child comes home, it's like now you're in this life upheaval and you need help and you realize you need help. And maybe you're not ready to see a therapist or you're not sure yet. And that's fine. But I do need 2 hours to just kind of be by myself and maybe my mom will come over and hang out for a bit with the baby kind of thing. If we don't practice that beforehand, it's going to be harder afterwards and kind of contribute to these feelings of depression.
So, talking with people too, who have children, whether they were adopted or not. Ask them to give you real talk about what it's like bringing a baby home. And if they start with all the sunshine and rainbows, say, “Thank you” and say, “But like, tell me, really.” \
Nicole:
Right. Right.
Caitlin:
You may be surprised how willing they are to have that conversation. And you may be the first person who they felt like, “Wow, I've never talked about this myself because I was so afraid to.” And I think that that will be like a really good balance for people to hear of, like the joyous times and the hard, “This was really hard for me in my experience” times. And that's just all going to help you kind of prepare ahead of time and know what you're kind of walking into. So, when you do maybe have that first, “I hate this” moment, it won't feel quite so shocking. It'll be like, “Okay, I know other people have felt this way,” and that in itself is a huge protective factor for things like depression and anxiety.
Nicole:
Okay. Okay. Very helpful. So, if people are not experiencing as many of the ups to offset the downs or it's going on for four weeks and so on, and they realize that they really could benefit from some professional help, what is the most effective way to find an adoption-competent therapist?
Caitlin:
Good old Google. You can search “Adoption-competent therapists.” There's a website called PsychologyToday.com that is, it's kind of like a clearinghouse for, I mean, most therapists are on there. And you can filter through the different therapists on the site and see pictures of them and read their bios. I checked it out before I hopped on here, so I would have good directions to give people. And one of the filters they have is called “Pregnancy Prenatal Postpartum.” And obviously, it doesn't say “Adoption” in there anywhere, but what I was finding as I was scrolling through the different therapists listed is that all of them focus on the transition into parenthood.
Nicole:
Okay.
Caitlin:
So, is that title not super inclusive? It's not. But you would find people who specialize in what you are looking for as a parent who's maybe experiencing post-adoption depression. And then you could always ask someone if you know. People are getting more and more open about the fact that they're seeing a therapist.
Nicole:
Right.
Caitlin:
So, if you know someone who is seeing a therapist, ask them how they like their therapists, ask them what things they work with, and that can oftentimes help us find a good one quicker. So, that would be my advice on how to find that therapist.
Nicole:
Okay. So, then once they find somebody, what might that help look like? In other words, what can they expect from therapy sessions?
Caitlin:
When they actually expect to feel nervous before you go, and it's okay to be nervous. The person you meet with, you should feel comfortable with. And if you don't or like after the session, you're feeling like – I would say after a couple sessions, you're like, “I don't know if this is really working,” don't ever, ever, ever feel like you can't switch.
The therapist is probably going to ask a lot of questions in the first session or two, but you, the client, should definitely be doing most of the talking. If you've got a therapist that's not letting you have any air time, that's not a good sign. The basis of talk therapy centers around helping people see their patterns in their behavior and thinking, and then helping a client reframe those harmful thoughts and behaviors.
So, if you're experiencing post-adoption depression, like, say, we're having a lot of sneaky thoughts, sneaky feelings that we're trying to make sense of, you yourself are not going to be able to see these patterns. Or sometimes we get very stuck and It's always bad and it's not always bad, but we can't see it. And so, that's a big part of therapy, is helping you see the patterns, the good times, the bad times, and kind of making sense of all of them. So, you should expect just to come in and kind of talk about what you've been seeing and feeling and all of this and the therapist is going to do the work for you.
They're also going to kind of poke around at what the root cause of this depression and anxiety is. And a lot of people experience these symptoms of depression since they were teenagers and they kind of just got in this habit of pushing along and pushing along. So, you may be surprised how far back the root of these feelings may go. And yeah, this big life change is kind of what kicked it off from, “I managing it every day” to, “Now, I'm not.”
The thing that my clients usually tell me is the best part about therapy is that it's like the only time in their lives that they get to go and just talk about their stuff and they don't have to hear the other person, because the other therapist shouldn't be like, “Oh, same here” or like, “Well, when that happened to me, I did this.” And that's what our friends do, right? And that's great when it's your friend, but when you're having clinical symptoms of depression and anxiety, that is your time. And they're like, “It's so freeing, just being able to come here and just get to talk about my stuff and it's kind of all in this safe space and it doesn't follow me out the door.”
So, I share that because I think it's hard for people to envision what therapy looks like before they get here. And a lot of times, I think that stops people from coming, especially like the thought of, “I'm not depressed enough. I don't want to waste anyone's time.” And please just try and get that thought out of your head, if you're feeling that thought or thinking that thought, there is no such thing as, “I'm not depressed enough” or “I'm not anxious enough.” Go talk to someone, if you're feeling in your heart, it's what you need.
Nicole:
That's a really important tip. And also, something you said is a great segue. So, we know that infertility and adoption are draining in many ways, including financially, which you've already alluded to. And parenting takes up every moment of spare time that one might have. So, I imagine the time and financial commitment might really keep people from seeking help. So, what might they realistically be looking at, from that perspective, in order to get back to a place of mental wellness? What do they need to be willing and able to invest, time wise and money wise?
Caitlin:
So, there is actually a lot of really creative ways to kind of get you feeling better. Let's say you're in a place where you have a newborn and it's colicky and you just cannot imagine leaving your house at the moment to start therapy. So, in our post-COVID world (I'm not sure if we are post COVID yet) but telehealth is more accessible than it's ever been. And for a new parent, I really like this idea because it could be as simple as asking your neighbor to pop over for 2 hours, so you can just hop on your session. And you don't have to shower. You don't have to get dressed.
Nicole:
Right.
Caitlin:
Probably just like you pop in the other room and do your therapy and go back. Or your mom, whoever is your natural support. So, that's one way. There are, I think, like an awesome, cost-effective way that not everyone knows about is there are many, many private practices out there who utilize interns. So, these interns are new and they're learning and they are under supervision, which is the important part here.
Nicole:
Okay.
Caitlin:
So, I think people wonder like, “Oh, are they going to be a good enough therapist?” And they may not be as quick to pick up on certain things as other therapists, but they are under supervision. So, they have to go every week and meet with their supervisor and run through like, “Hey, this happened in therapy and I'm struggling how to help this person.” And this very experienced person is going to be able to help and guide them.
So, interns sometimes cost as low as $25. I have heard of interns that are 100% free. That can take a little time to find where those people are, though. So, that would be a good thing where let's say you are like, “Hey, I have a history of anxiety and depression. I want to prepare for this post-adoption experience, just in case.” I would like kind of Google around and see the local practices in your area and send them some emails or inquiries and see if they offer. It's called sliding fee, which would be like reduced rates or if they offer interns at a greatly reduced cost and just write those numbers down. So, if you need them later, they're there and you don't need to spend 2 hours Googling and sending inquiries with a screaming baby or a child who's adjusting to the transition to your home and they're just handy and they're there when you need them. So, I think like using interns is something that most people don't know about or think of unless they kind of happen to stumble upon them.
The other thing that I think is a little controversial for some people, and I know that many people feel very uninterested in starting this, but medication can be a really great way to find relief from like intrusive thoughts or guilty thoughts or angry feelings quickly and in a way that's really easy on your body. Like Zoloft, in particular, starts off at like a very low dose. And for most people, they just start at that first dose and they instantly, as soon as the medicine kicks in, in 1 to 2 weeks, feel enough relief where they're like managing again. And as they kind of get used to being a parent and navigating this life change and their new identity and all of that, typically within like six months, they can kind of talk to their doctor about stopping. Usually, when the baby is sleeping through the night a little more.
Nicole:
Okay.
Caitlin:
What I'm trying to say is you don't have to be on it forever. And I think that some people feel that way, like, “If I start an antidepressant, it's going to be years before I can get off of it.” It is not an addictive drug. It's not something like that. And it's very cheap. I had one client tell me that their Zoloft prescription in particular costs them $1.08 for a 30-day supply.
Nicole:
Wow.
Caitlin:
Yeah. So, if we're talking about a situation where, like, “It is no longer in my budget for therapy and there's no these kind of sliding fee or free interns in my area,” that would be something I would definitely consider talking to your doctor about. And a lot of doctors, when they know you're bringing a baby or a new child home, consider that basis enough to send you home with a prescription for Zoloft and it's there if you need it. And we can feel about that how we feel about that. But it's just something to think about, and there's no shame in utilizing that as opposed to talk therapy, if that's what is fitting your lifestyle and your budget best at this point in time.
Nicole:
Okay. Okay, great information. So, now that we've spoken generally, I'd like to dig deeper into some more specific situations. So, if an adopted baby or child has extra medical needs, does that increase the likelihood that the adoptive parents experience depression?
Caitlin:
It can. So, all the things that we kind of talked about, the different things to look out for, the importance of planning and getting used to asking for help, using your natural supports. Actually, you said it in your intro, but I don't think I mentioned it at all. Practicing self-care before a baby comes home, these things become much more important if you know that you are hoping to open your heart to a child who may have been exposed to drugs or alcohol, or a child who may have some PTSD from their past-lived experiences. Practicing these things before kind of becomes doubly important because these are all skills that you will need when raising a special needs child.
And that goes, again, for adoptive families or families who gave birth to a child who has special needs. These skills are important to maintain your own levels of functioning, your own mental health, your own happiness, because there are joyous moments and you’d still get these happy times with kids with special needs. But if we don't, as parents, know how to put the oxygen mask on ourselves first, like when you're on a plane, before you turn around and help your child, kind of like the easiest way I know how to say it is, it will completely drain you. So, you need to be able to take care of yourself and use these skills and be in your best place in order to help your child who needs you and loves you so much.
So, it can lead to increased depression, but it doesn't have to. I think the preparation piece becomes just a lot more important. And I would say that you should definitely consider starting therapy before bringing a baby or child home with special needs. So, that way you just have that extra layer of support already in place in case things are going vastly different than you had hoped or maybe you were kind of led to believe. In some situations, it's like you can get through this and you can do it and your baby or your child will get through this. But that support is really, really, really important.
Nicole:
You've shared some super valuable information and tips and guidance. Is there anything else you want to share with us about post-adoption depression? Is there something I haven't asked that's important for us to cover?
Caitlin:
I think, podcasts like this, and I think a lot of people who are working with adoption agencies have a lot of access to other people who are in the process and maybe in a different stage than they are. Talking to them about their experiences and getting information that way can be so much more worthwhile than Google sometimes, because it's like we're Googling and Googling and we're getting more and more worried and anxious. But hearing someone who lived it say, “Oh yeah, like that was really hard there for a while, but this is what helped. And now we're doing really good,” is the reality, whereas sometimes, the internet can be like everyone's different reality and you can't make sense of it. So, I would say just remember to reach out to people. And if that's hard for you, just to start practicing now.
Nicole:
Okay.
Nicole:
Yeah.
Nicole:
Well, thank you so much for being here and for sharing all this super valuable information.
Again, listeners, my guest today has been Caitlin Fay, licensed clinical social worker and co-owner of New Growth Counseling. The best way to reach Caitlin is through her website. It's New Growth Counseling.
But of course, listeners, most of all, I'd like to thank you for tuning in. I hope you've learned something today that will keep you and your loved ones as healthy as possible during the initial weeks and months of parenthood. Take care and I'll catch you next time.