Jan is a Chartered Psychologist. In 2014, she created a birth trauma service for women/men where they can access individual, couple, and group therapy to help them adjust to life following their birthing experiences. For a number of years, she has supported clients through their clinical negligence litigation case, and/or investigations with the Trust where their trauma occurred.
I first came across Acceptance and Commitment Therapy (‘ACT’ said as one word) in 2006. Not only did it change how I lived my own life, it changed how I support clients experiencing trauma following life-changing injuries. ACT is an evidence-based action-oriented approach to psychotherapy that stems from traditional behaviour therapy and cognitive behavioural therapy. It is based on the premise that it is ineffective to try and control painful emotions or psychological experiences, because suppression of these feelings ultimately leads to more distress (Hayes, 2009). By practicing mindful strategies, attending to personal values, and committing to action, ACT philosophy believes this helps clients to stop avoiding and struggling with their inner emotions and accept deeper feelings, regardless of what is happening in their lives.
Why does ACT help with Birth Trauma?
Birth trauma can have a profound impact on mums/dads and the ripple effect of this experience can be far reaching in a number of areas of their lives. Many therapeutic approaches support clients to overcome their traumatic experience.
So, what makes ACT different to these other approaches?
Cognitive therapy, for example, targets and attempts to modify problematic thoughts related to birth trauma, in order to subsequently affect emotion (to feel better) and behaviour (to behave more positively). Other approaches, like exposure therapy, focus on preventing avoidance behaviour, so that individuals’ reaction to birth trauma stimuli can be unlearned, or deconditioned. Although these therapies offer an alternative and more helpful way to cope with the birth trauma, there is an underlying message that some part of the client’s internal experience is not as it should be, so needs modification. Therefore, rather than trying to alter the client’s thoughts, feelings and physiological reactions, ACT alters the functions of these, and the therapist supports them to see that such internal responses are separate from the self. Indeed their ability to make valued life choices is not dependent on changing or controlling these internal experiences, rather ACT teaches client’s to not hold these so tightly, therefore freeing them to live intentionally rather than reactively (Walser & Westrup, 2007).
For example, a mum presented feeling preoccupied with intrusive thoughts surrounding her labour and these were impacting on her being the loving, nurturing, and caring mum (her mum value) she wanted to be. ACT addressed this by actively working to help her accept (through acceptance-based strategies) that her thoughts are just that- thoughts- an internal phenomenon that is just one part of her, distinct from her core self. Applying these acceptance strategies requires practice. In accepting that she has no control over any of her thoughts, but she has control over the behaviours she does that are reflective of her values as a mum (to be loving, nurturing and caring) this frees her to behave in that way. Therefore, she can begin to live more intentionally in accordance with her values, rather than reacting to her internal thoughts.
Although this might seem like a simple reductionist approach, acceptance of such thoughts, feelings and sensations requires significant practice and ongoing commitment for clients. ACT can also be used alongside more traditional therapeutic approaches in an integrative way.
The Healing After Birth Group
For over 10 years I have been using ACT successfully with clients to help them adjust to life following life-changing traumatic events, including birth trauma. I support mums/dads who experienced birth trauma predominantly as a result of medical negligence, and have observed a steady rise in referrals to our service over the past 5-6 years. Time and time again parents ask two questions- ‘how can we prevent this happening to another family? And ‘are we the only people this has happened to?’. The sense of isolation for families who experience birth trauma can compound their difficult feelings further. I decided to design an ACT birth trauma group, for mums (4-5 per group). This is a not-for-profit 12-week intervention, each session running for two hours, where the first hour is focused on the ACT approach and the second half is a facilitated support group. When the group finishes, it is intended that mums will have a small network of other women with shared experiences, who can also reinforce the ACT approach learned.
Some of the topics covered during the 12 weeks include: ‘Psychoeduction of Trauma’, ‘Accepting Your Thoughts’, ‘Bonding with Your Baby’, ‘Reclaiming Your Relationship’ and ‘Getting Pregnant Again’. I have manualised the intervention, so if other therapists would like to run this group and have experience of practicing ACT, I am happy to share. Part of agreeing to facilitate this would also be helping to develop an evidence-base, on group-based approaches helping in supporting women’s birth trauma. There is an inclusion/exclusion criterion for who the group is appropriate for, and also an expectation that the facilitator would complete pre/post measures and share this anonymised data to create an evidence base.
If you would like any further information about the group, or would like to run one, please feel free to email me at firstname.lastname@example.org.