Psychotherapeutic modalities

Diversity of Psychotherapeutic Approaches and Modalities Most Commonly Used in the Work of a Perinatal Psychologist
I will attempt to describe below the variety of psychotherapeutic approaches and modalities most frequently integrated into the work of a perinatal psychologist.
Practice shows that each approach has its own strengths and limitations when applied in the field of perinatal psychology and reproductive mental health. The greatest effectiveness is achieved by combining methods and maintaining flexibility in selecting the most appropriate forms of psychological support.
Below is a brief overview of the modalities (and closely related ones) most commonly used in perinatal psychology:
1. Psychodynamic Psychotherapy
Brief Description
Psychodynamic therapy focuses on unconscious conflicts, early experiences, and their impact on current behavior. In the perinatal period, it helps explore deep fears, birth-related trauma, and parental projections.
Rooted in Freud’s work, psychodynamic psychotherapy is a depth-oriented approach that investigates how unconscious processes, early childhood experiences, inner conflicts, and defense mechanisms affect present-day functioning. The perinatal period brings particular relevance to this method, as pregnancy, childbirth, and early parenting often activate unresolved childhood conflicts, archaic fears, ambivalent feelings toward parental figures, and projections onto the unborn child.
This method enables work with the so-called “ghosts in the nursery” (Fraiberg, 1975), where parents’ unresolved traumatic experiences unconsciously re-emerge in interactions with their infant. A perinatal psychologist working within the psychodynamic paradigm creates a safe space for exploring deep psychological layers, analyzing transference/countertransference, and facilitating integration of past experiences—thus supporting the development of more conscious and freer parenting.
Key Figures:

• Sigmund Freud (theory of the unconscious)
• Melanie Klein
• Donald Winnicott ("good enough mother" concept)
• Alice Balint (perinatal aspects of object relations theory)

Evidence-Based Efficacy:

1. Meta-analysis by Shedler (2010) confirms long-term efficacy in treating depression and anxiety (American Psychologist).
2. Clark et al. (2017) showed a 40% reduction in prenatal anxiety (Journal of Affective Disorders).

Perinatal Relevance:

• Addressing childhood trauma affecting parenting (Slade et al., 2019 Infant Mental Health Journal).
• Reducing risk of postpartum depression through analysis of unconscious conflicts (Nietzel et al., 2020).

2. Attachment-Based Therapy
Introduction
This modality is based on Bowlby’s attachment theory and focuses on forming secure relationships between mother and child.
Attachment-based therapy emphasizes the fundamental human need for secure, reliable, and emotionally significant relationships. In the perinatal context, it plays a central role, as the quality of attachment between the infant and the primary caregiver (most often the mother) lays the foundation for the child’s subsequent psychological, social, and even physical development.
This approach aims to enhance "maternal/parental sensitivity"—the parent's ability to accurately perceive, appropriately interpret, and timely and proportionately respond to the infant’s signals (Ainsworth, 1978). It also helps parents process their own attachment histories (internal working models) and develop mentalization skills—the ability to understand mental states in themselves and their child.
Key Figures:

• John Bowlby
• Mary Ainsworth ("Strange Situation" method)
• Patricia Crittenden (Dynamic-Maturational Model)

Evidence-Based Efficacy:

1. Meta-analysis by Bakermans-Kranenburg et al. (2003) shows high efficacy of attachment-based interventions (Psychological Bulletin).
2. The “ABC” (Attachment and Biobehavioral Catch-up) program reduces disorganized attachment in 70% of infants (Dozier et al., 2019).

Perinatal Relevance:

• Prevention of attachment disorders in at-risk groups (Sleed et al., 2020 PLOS ONE).
• Improvement in maternal sensitivity (van IJzendoorn et al., 2022).

3. Family Counseling
Introduction
A systemic approach working with the “mother-partner” dyad to resolve conflicts and improve communication.
Family systemic counseling views the individual not in isolation, but as part of a dynamic family system, where each member’s behavior is interconnected with the system's functioning. The arrival of a child transforms the family structure, roles, rules, boundaries, and balance.
The perinatal psychologist helps families:

1. Navigate the transition to parenthood;
2. Strengthen the couple’s bond to support the parental alliance;
3. Build effective communication patterns;
4. Set healthy boundaries with extended family;
5. Adapt to crises (e.g., reproductive loss, child with special needs).

Key Figures:

• Salvador Minuchin (Structural Family Therapy)
• Virginia Satir

Evidence-Based Efficacy:

1. Shadish et al. (2015) confirm efficacy for family crises (Journal of Marital and Family Therapy).
2. “Couple CARE for Parents” program reduces couple stress by 35% (Halford et al., 2017).

Perinatal Relevance:

• Reduction of conflict during transition to parenthood (Petch et al., 2012 Family Process).
• Support during reproductive loss (Badenhorst et al., 2021).

4. Reality Therapy (Choice Theory)
Introduction
Focuses on current behavior and responsibility for choices. Helps with planning and adaptation in the perinatal period.
Developed by William Glasser, reality therapy (based on Choice Theory) emphasizes present/future orientation, personal responsibility, and intentional behavior to meet basic psychological needs: belonging/love, power/significance, freedom/autonomy, fun/pleasure, and survival.
It helps clients:

1. Define what they truly want (“quality world”);
2. Evaluate current behavior (“Is what you’re doing bringing you closer to your goal?”);
3. Create realistic action plans (SDAPs);
4. Take responsibility for choices.

This method is particularly useful in dealing with adaptation difficulties, procrastination, loss of control, and interpersonal conflict in new parenting roles.
Key Figures:

• William Glasser
• Bob Wubbolding

Evidence-Based Efficacy:

1. Wubbolding (2017) confirms behavioral improvement efficacy (International Journal of Choice Theory).
2. Reduction in procrastination among pregnant women (Kim et al., 2019 Journal of Obstetric Nursing).

Perinatal Relevance:

• Assisting in decision-making around childbirth and infant care (Huang et al., 2021).

5. Transcultural Psychotherapy
Introduction
Considers cultural traditions, beliefs, and migration experiences—crucial for perinatal rituals.
Transcultural psychotherapy actively integrates the impact of cultural factors—norms, values, beliefs, traditions, religious practices, migration experiences, and language—on mental health and crisis experiences.
During the perinatal period, cultural context is vital: beliefs about motherhood, childbirth rituals, parenting practices, and attitudes toward the body are deeply rooted in culture.
A culturally competent psychologist avoids ethnocentrism, respects traditional practices (when not harmful), recognizes somatization, and addresses acculturation stress and discrimination—key for effective support in multicultural contexts.
Key Figures:

• Patricia Arredondo (Cultural Competence Model)
• Nossrat Peseschkian (Positive Transcultural Psychotherapy)

Evidence-Based Efficacy:

1. Bhugra et al. (2021) show reduction in culture shock in migrants (World Psychiatry).
2. Hinton et al. (2020) adapted CBT for various cultures.

Perinatal Relevance:

• Consideration of cultural birth practices (Stern et al., 2023 Transcultural Psychiatry).
• PPD prevention among migrant women (O'Mahony et al., 2017).

6. Body-Oriented Therapy
Introduction
Integration of body and mind: breath, movement, sensory awareness.
Body-oriented psychotherapy is based on the inseparable unity of psyche and soma. It recognizes that trauma and stress—especially early, preverbal ones—are stored in the body through muscular tension, posture, breathing, pain syndromes, and altered body image.
Perinatal experiences—pregnancy, childbirth, postpartum recovery—are deeply embodied. Somatic methods (e.g., Somatic Experiencing® by P. Levine, Sensorimotor Psychotherapy by P. Ogden, Hakomi) help process trauma and stress through interoception, breath, movement, and grounding techniques.
Key Figures:

• Peter Levine (Somatic Experiencing)
• Pat Ogden (Sensorimotor Psychotherapy)

Evidence-Based Efficacy:

1. Payne et al. (2015) meta-analysis on PTSD (Journal of Trauma & Dissociation).
2. “Mindful Movement” program reduces prenatal stress (Khoury et al., 2022).

Perinatal Relevance:

• Addressing birth trauma (Montgomery et al., 2019).
• Anxiety reduction through grounding techniques (Czarnocka et al., 2021).

7. Art Therapy
Introduction
Using visual art to express complex emotions when words are insufficient.
Art therapy utilizes creative processes (drawing, painting, collage, etc.) within a therapeutic relationship to enhance emotional well-being.
In perinatal psychology, it is essential because:

1. It enables non-verbal emotional expression;
2. Facilitates access to unconscious, symbolic thinking;
3. Externalizes inner experience for reflection;
4. Provides calming, resourcing effects;
5. Offers diagnostic insight into maternal representations.

Key Figures:

• Edith Kramer
• Cathy Malchiodi

Evidence-Based Efficacy:

1. Uttley et al. (2015) systematic review on depression (PLOS ONE).
2. 50% anxiety reduction in pregnant women (Blomdahl et al., 2018).

Perinatal Relevance:

• Processing fear via mandalas (Pénzes et al., 2020).
• Projective diagnostics of parent-child dynamics (Cohen et al., 2022).

Conclusion
Each modality offers a unique contribution to perinatal psychology, yet the greatest effectiveness lies in their integration and collaboration among specialists. Research confirms: attachment-based and art methods are most effective in preventing postpartum depression (PPD), while psychodynamic and body-oriented therapies are essential for trauma work. Personality disorders and structural deficits are best addressed through psychodynamic techniques. It is my hope that perinatal psychology will continue to embrace all approaches, leaving behind the era of "competing methods" in favor of integrative care.