Postpartum therapy for the worry, guilt and exhaustion nobody warned you about
Fifty-minute sessions with Dr. Elena Vance, a licensed psychologist in California: $180 a session, in person in Pasadena or by secure video anywhere in California. The 15-minute consultation before you book is free.
What postpartum worry looks like day to day
Postpartum anxiety is ongoing worry, checking and dread after a baby arrives, and it can begin during pregnancy as well as in the first year. It is common, it is treatable, and it rarely looks like panic. More often it looks like competence with a lot of checking underneath. These are the things clients describe in the first session.
You check on the baby more often than you tell anyone
The monitor is on even when someone else is watching, and you get up to check the breathing before you can settle.
The worry does not stop when the baby finally sleeps
You lie down and your mind starts auditing the day, planning tomorrow, or rehearsing a conversation you are dreading.
You feel rage or dread you were not expecting
A flash of anger at a small thing, or a flat heaviness instead of the joy you were told to expect, followed by guilt about both.
You are keeping a private list of what you are doing wrong
Feeding, sleep, screen time, your own patience. The list is long and it updates itself without being asked.
People say you are doing amazingly and it does not land
From the outside it looks handled. Inside it feels like you are one interrupted night away from being found out.
You cannot remember the last hour that was not about someone else
Performance is unaffected, which is exactly why it goes unnoticed, including by you.
Who this is for, and what can actually change
This work suits mothers in the first three years after birth, whether it is your first baby or your third, and whether you are on leave, back at work, or somewhere in between. It is not a replacement for medical care: if medication or a psychiatric assessment is part of the picture, I would rather coordinate with your doctor than work around them.
Worry that fits around the day
Anxiety that lets you work, parent and look fine from the outside, while quietly taking your sleep and your patience.
A plan for the intrusive thoughts
What to do in the moment a thought lands, instead of arguing with it for the next hour.
Room for the anger
Naming resentment or rage without treating it as evidence that you are failing at this.
A standard you can actually meet
Separating the standards you chose from the ones you absorbed, and letting some of them go on purpose.
Something that survives a broken night
Approaches that work in ten minutes during a nap, rather than a quiet hour you are never going to get.
One hour a week that is about you
Fifty minutes where you do not have to perform being fine, and nobody needs anything from you.
What we actually do in the room
I use cognitive behavioural therapy, acceptance and commitment therapy, mindfulness-based work and strengths-based work. Which one leads depends on whether your week is dominated by worry, by avoidance, or by a standard you cannot meet.
Cognitive behavioural therapy
We separate the thought from the fact, then test the prediction. Postpartum worry is full of predictions that turn out to be wrong, and noticing that changes how much weight they carry.
Acceptance and commitment therapy
For the thoughts that will not be argued away, we practise making room for them and putting your attention where you want it. Useful at 3am, when logic is not available.
Mindfulness-based work
Short attention practices that fit inside a nap or a feed. The aim is to notice a spiral earlier, not to empty your mind.
Strengths-based work
We name what is already working, because most mothers arrive with far more skill than they give themselves credit for.
What sessions look like with a baby in the picture
Sessions are $180 and last fifty minutes, by video anywhere in California or in person in Pasadena. The fifteen-minute call before you book is free. These are the questions new mothers ask most often.
You can bring the baby
Feeding, settling and nappy changes are part of the hour. A sleeping baby on your chest is fine, and so is stopping mid-sentence to see to them.
Partners are welcome
Bringing your partner to a session helps most in the early months, especially when the two of you are reading the same week very differently.
When to start
Most clients begin somewhere between six weeks and the first birthday. There is no window you have missed, and no diagnosis needed before you call.
How often you come
Weekly at first, then less often as things settle. The pace stays yours, and nothing is fixed beyond the session you have booked.
Questions mothers ask before the first session
If yours is not here, the FAQ page covers fees, insurance and confidentiality in more detail.
Can I bring my baby to a session?
Yes. Babies are welcome in person, and online sessions often happen with a baby asleep nearby. If your baby needs you mid-session, we work around it. It disrupts the hour far less than you expect.
When is the right time to start after birth?
There is no minimum and no deadline. Some clients come at six weeks, others when their child is two. If you are wondering whether it is too early or too late, that is a good question to bring to the free consultation.
Do I need a diagnosis or a referral?
No. You can book without a referral from a doctor and without a diagnosis. If you plan to claim through insurance, your plan may have its own conditions, and I am out of network.
How do I know whether this is postpartum anxiety or just tiredness?
That is a reasonable question and part of what the first sessions are for. We look at how often it happens, how much it interferes with your days, and how long it has been going on. Tiredness lifts with sleep. Anxiety tends not to.
What is postpartum anxiety?
Postpartum anxiety is persistent worry and vigilance after a baby is born: checking, dread, intrusive thoughts, sleeping badly even when the baby sleeps, and a body that will not settle. It can begin during pregnancy or at any point in the first year, and it is different from postpartum depression, though the two often occur together. It responds well to therapy.
Still deciding whether to call?
Fifteen minutes is usually enough to know whether this feels workable. There is no charge and no obligation to book.
If postpartum is not quite your situation
The same practice covers anxiety that has been with you for years, and the squeeze between work and home. The method does not change, only what we focus on. Both start with the same free 15-minute call, so you can hear how I would approach it before you book.
High-functioning anxiety
Anxiety that coexists with a demanding job and a capable exterior. Often mistaken for a personality trait until it starts costing you sleep and patience.
Work-life integration
For the stretch when work and home both want the best of you. Practical work on boundaries, guilt, and deciding what actually has to give.
You do not have to be in crisis to start
The consultation is a conversation, not an assessment. Describe what is going on, ask what therapy would look like with a baby in the picture, and decide afterwards.
