Kim Howard 00:04
Welcome to the Let’s Talk EMDR podcast brought to you by the EMDR International Association or EMDRIA. I am your host Kim Howard. In this episode we are talking with EMDR, certified therapist consultant and trainer, Mara Tesler Stein about EMDR therapy during pregnancy. Mara splits her time between Lincolnwood, Illinois and Jerusalem, Israel. Let’s get started. Today we are speaking with EMDR certified therapists consultant and trainer Dr. Maura Tesler Stein about EMDR therapy and pregnancy. Thank you, Maura for being here today. We are so happy that you said yes.

Maura Tesler Stein 00:38
Thank you for inviting me.

Kim Howard 00:40
So Maura, tell us how did you become an EMDR therapist?

Maura Tesler Stein 00:44
Well, it’s it’s sort of funny, I’ve been trained in EMDR and using it for 20 years. And I was already a licensed clinical psychologist working increasingly with the perinatal population. And I kept finding that many times working with people after a perinatal loss, a traumatic delivery, premature birth. And then often people were pregnant again, coming in to see me because they were getting reactivated from the trauma and they would get better. And then they would hit what I visualized as like a cul de sac, they were just sort of keep going round and round and round. And at that time had been hearing about EMDR. And I thought all the things that people unfamiliar with EMDR thought like, oh, it’s the flavor of the month Oh, that sounds wacky. And that it occurred to me that perhaps I ought to get trained in this thing that I thought was wacky before I decided what I thought about it. And so I went ahead and I started my EMDR training, which was great. But the thing that really solidified my understanding and passion about utilizing this, this model was that the very first time I used EMDR therapy in the office with a client after a perinatal loss, who was pregnant again, and who was getting activated, it really felt like magic. And so that’s really how I got started and just has just gone up from there grow from there.

Kim Howard 02:09
Well, you’re not the first person on this podcast to say that they were a little hesitant about it sounded a little too good to be true. Is it pixie dust? Is it magic? Is it snake oil? Those are all the terms that we have talked about on this podcast. So totally, we inferred clients and for all the people that you’ve tried to we were happy that you found EMDR therapy and that it works for all of those populations. Thank you for all that work that you do. Thank you. What is your favorite part of working with EMDR and pregnancy?

Maura Tesler Stein 02:37
Well, so, you know, I always conceptualize and talk about the perinatal period as a whole, which certainly includes pregnancy, conception, pregnancy birth as a really important developmental period. So this is my area of specialty, my area of passion. And so seeing pregnant people, seeing families who are working on family building, and, and really getting to, to hold them and engage them and getting to know what’s going on with them around past losses, past traumas, areas of absence in development, things that are that are missing, where we need to fill in the gaps. So the most exciting thing for me is that opportunity to get in there really was a really powerful, efficient, compassionate, strength based client centered method and relationship based method that supports their development. That’s what I see myself as being there to do is to be developmentally supportive and relationship based with people and I just see our work with EMDR as a really phenomenal method and avenue for doing that.

Kim Howard 03:49
Yeah, that’s, that’s a good way to put it. You know, I mean, I’ve had two children and know pregnancy losses, thankfully. But you know, even if you’re in a healthy pregnancy, it’s still scary, all the things that could possibly go wrong when you’re pregnant, or during the labor and delivery or you know, postpartum when you have a newborn at home, and you’re trying to manage all of your things and advantage, this new baby. And so thank goodness that, you know, EMDR therapy is out there for people who need it. So we’re going to dig in a little bit later about, you know, some of the myths and everything because like we see some chatter about that. So it’ll be good to toughen up that here today. So what successes have you seen regarding use of EMDR therapy in pregnancy?

Maura Tesler Stein 04:30
Well, the process of kind of getting to know a person’s internal and historical landscape when they’re coming in in this really vulnerable state, because being in this perinatal period, people are vulnerable, and that is also an opportunity. It’s an opportunity for growth. It’s an opportunity for heal healing. So you know, I may see a parent coming in or prospective parent coming in feeling really anxious about what it will mean to be a mother to A baby when they haven’t been mothered in ways that they feel like they can then utilize and see as a model, or even having, you know, an available parent that they want to lean on or that they can lean on. Or, for example, somebody who has had some devastating loss, the death of a baby, for example, in a prior pregnancy and longing so much for another child and not wanting to lose hold of their attachment or bonding to the baby who died and being so afraid of what’s going to happen with a subsequent pregnancy. So there’s healing to be done around the laws. And then there’s developmental support, to engage in together around development of parental identity, strengthening the bond, the growing bond between parent and and, and baby, wherever they are, in that process. When you’ve had, I’ve hadn’t seen many parents who have had premature babies or babies and newborn intensive care, and wow, talk about layers of trauma, layers of loss layers of rupture, to developing sense of self, as a parent to this baby, even if you have older children. So I’ve seen so much shifting happening for people kind of walking in the door, feeling like failures, believing themselves to be not good enough, being afraid they’re gonna fail their baby, or that they have already failed their baby feeling also rupture or disconnect with with a primary partner, whether that’s the other parent or another person in their lives, whether it’s with their own, you know, family of origin, could be also with close friends, like if my experience is different than yours, then who am I in this peer group? Right? If we think about if we think about our core themes, right, our trauma themes now we really have become so much more aware that belonging is one of the really important ones. And in my research over the years with families after perinatal trauma, you know, we talk about the three core tasks that families face the parents face in a perinatal trauma, and one of them has to do with managing those relationships and all the different layers. Yeah, relationship with the baby, medical team, all the people.

Kim Howard 07:14
Yeah, it’s good that you brought that up, because it’s hard for us as humans to accept that sometimes things just happen in nature.

Maura Tesler Stein 07:20
Yes.

Kim Howard 07:21
We can’t…I think it’s part of our sense of, we have to control things or we could have controlled things, to have a better positive outcome, when really, you really could not have you know, it was nearly impossible for you to prevent a premature baby situation, or your baby possibly dying in the womb or dying post birth. And, and so it’s, it’s hard for us, I think, as humans to realize that we sometimes just don’t have control or say and things that happen in our lives. But…

Maura Tesler Stein 07:47
Particularly for parents…

Kim Howard 07:48
Yeah.

Maura Tesler Stein 07:49
There is this myth that parents should know that we should be omniscient and omnipotent, somehow. And I will hear a lot of times parents, particularly pregnant people say, How can I not have known something was wrong with my baby? Or how could I not have known that my baby died, in utero?

Kim Howard 08:07
I remember when my children were were newborns and especially my daughter, you know, she had a latching issue. I was trying to nurse her. And you know, everyone’s like, Oh, nursing is so beneficial for the baby. And it’s so much healthier, and the mother daughter, mother child bond, and you’re like, yes, that’s great, except when the infant has trouble latching on.

Maura Tesler Stein 08:27
Except when it doesn’t work!

Kim Howard 08:29
Then it becomes a lot harder to have that happening. And so you put something that you perceive or that you have been told, or your whole life is supposed to be natural, and you’re like, what’s wrong with me, this is not working. And so it’s good that we’re getting the word out there that sometimes things are not regular. And that’s okay. And here’s how we handle it. And here’s how we can help, so.

Maura Tesler Stein 08:49
So many different roads to get to the same outcome. And so much sense of self is wrapped up in all of those things. Right, you know, and everything from I shouldn’t have complications if I did everything, right. Like I went into preterm labor with my twins at 24 weeks, and I felt like an absolute failure. Wow, that there must be something wrong with me that this happened.

Kim Howard 09:10
But it’s not uncommon for women to do or birthing people to go into labor early if they’re having multiple births. So that

Maura Tesler Stein 09:18
Well, I went into I went into labor significantly earlier than we would expect, even with twins. I mean, with twins, you’ll see like 3637 weeks, but that feeling of like Okay, wait, this is not supposed to be happening right now. Right? This is not how this is supposed to go. You know, I don’t have that on my calendar for today. Yeah, normally bingo card.

Kim Howard 09:40
Yeah, no, my bag is not packed for the hospital that is not packed. We don’t have car seats in the car. Yeah, yeah, totally.

09:46
Well, and one of one of my memories from bedrest. I was on bedrest for six and a half weeks in the hospital trying not to deliver my my very small twins and a nurse from newborn intensive care would come up periodically to talk to me and so you know, this will give you an idea Have like you’re talking about breastfeeding or a nursing and about, you know, our dreams. As I said to this nurse, I’m still pregnant, and I’m sitting in the bed hoping to be pregnant longer saying, so do you think I’d be able to nurse them together? Like simultaneously? Just the look on her face…

Kim Howard 10:17
Oh, you’re so innocent sweetheart?

Maura Tesler Stein 10:21
Totally, because me having no idea how difficult it can be for many people anyway….

Kim Howard 10:26
Yeah.

Maura Tesler Stein 10:27
To get babies latching and nursing. And premies?

Kim Howard 10:30
Yeah, are even hard.

Maura Tesler Stein 10:30
And preemie twins? Yeah. Yeah, complicated. Yeah, absolutely. Yeah. So I see all of this stuff in my office, this kind of stuff.

Kim Howard 10:38
Well, that’s a good segue to our next question, which is, are there any myths that you would like to bust about EMDR and pregnancy? And if you have too many just list the top three or five.

Maura Tesler Stein 10:48
Yeah, well, you know, the big one, that that I see coming up. And that has led me to, to do quite a bit of reviewing the literature in this area, is this idea that doing reprocessing during pregnancy is somehow dangerous. And so I think that probably any of the other myths around EMDR, during pregnancy kind of come out of that overarching umbrella. This idea that somehow we’re going to do harm by doing reprocessing. And so I was very confusing to me when I first started hearing this from people. And then I started asking, when, when I would hear this, where’s your research to support that? What’s the data that you’re using to say, stop don’t do this during pregnancy? And what would happen is either people would sort of disappear. Look, if it was on social media be like, I’m

Kim Howard 11:48
Woof, not answering that one.

Maura Tesler Stein 11:50
Not answer. Oh, yeah,

Kim Howard 11:51
Hot potato – done.

Maura Tesler Stein 11:52
Yeah. Or it would be I would hear, well, better to be careful, which is really the line in Francine’s book, which I think is the origin of all of this, and I’m gonna speak to that in a minute. Or I would hear something about cortisol. Something something cortisol. So I thought, okay, so So I need to make sure I’m understanding this I need to consult with with various experts, you know, in the physiology, both of EMDR and of pregnancy. And also, I’m a perinatal specialist. So I have heard this kind of omission bias, which is what this is before, for many years around antidepressant use in pregnancy. Now, I’m not a psychiatrist, so I don’t prescribe, but I make these referrals quite regularly when appropriate. And I cannot tell you how many times I have heard psychiatrists who are not perinatal specialists, or sometimes even obstetricians, although I must say, I think this is improving in recent years, say to someone when they become pregnant, who’s been on an SSRI, you have to get off your SSRI, or it just in popular culture, certainly, we also people get this idea. And that is absolutely not correct. And there is a mountain of data to support the safety of SSRI use. And so similarly, this idea that doing nothing, or stopping to do something therapeutic, when there is some concern about a side effect, or, well, do we have enough data when we have no data to support that it’s adverse? Is it what’s better to do? And so the omission bias is this heuristic. That is that in medicine is very common, actually, again, is runs the risk of being a cognitive bias, a cognitive distortion that says, better to do nothing than to do this, this other thing without actually looking at risks and benefits of inaction. And action.

Kim Howard 13:55
I mean, you’ve got a woman who’s you know, you’re pregnant for 40 weeks, that is a long time to be without your medication if you need it, or a long time to be without therapy if you need it.

Maura Tesler Stein 14:05
Right.

Kim Howard 14:06
And my goodness, that’s almost a whole year, going without those things that help your mental health. And so …

Maura Tesler Stein 14:12
that’s right. And we have a mountain of data in perinatal mental health, the demonstrates the adverse effects of untreated symptomatic, post traumatic stress, depression and anxiety during pregnancy, as well as in the postpartum. And those negative impacts affect a developing fetus affect the pregnancy itself, and effect that child wants born throughout their life. So if you’re comparing risks and benefits, we really need to look at what is it that we think we’re doing? So this is another question for me. At some point, I would say to people, what is it that you think we’re doing to the body during reprocessing phases? because that is so dangerous. And so then I went into the EMDR literature. And there again, is lots of lovely data to show that the reprocessing phases of EMDR are pro parasympathetic, meaning what we see is we see reduction, we see some elevation, heart rate and then reduction by the end of the session, we see elevation and reduction in so stress symptoms. So there’s a very brief elevation, and then a reduction and then the reduction staves, which we all know we’re doing in EMDR therapy in our offices, right? We see this constantly. But this idea that any amount of distress or disturbance is going to send cortisol through the roof and do damage is is not evidence based mean I have found nothing to demonstrate that. And in fact, it honestly just think like, okay, so you have a pregnant person, what are you going to do? Wrap them in bubble wrap and put them in in, you know, cold, you know?

Kim Howard 15:59
How many people are pregnant and your cortisol levels increased because of stress, just regular normal? Well, everyday stress, I mean, that’s you have to have you normal it, you don’t, you don’t all of a sudden stop becoming stressed out because you’re pregnant.

Maura Tesler Stein 16:13
That’s right. And also, interestingly, so here’s an interesting cortisol tidbit, cortisol levels actually increase naturally over the course of pregnancy. And it is thought to be a buffer, a way of protecting the developing fetus and the pregnant person from the intensity of whatever inputs may be coming either from the environment or internally, so you get this kind of muffling effect anyway. So cortisol itself is not, it’s not all good, all bad, just like stress. It’s not like all stress is bad. We have different kinds of stress, we have, we have stress, and then we have the reaction of the person’s body to stress and their recovery from stress. All of these things are factors that we need to look into. And if you look at the phases of EMDR therapy, actually, it all really lines up. If you think about how are we preparing people? How are we assessing? What needs to be done? What the problem is? How do we prepare? Right? Where’s the shock absorption? Where’s the resiliency? Where’s our adaptive information? What’s the recovery capacity of a person when they’re distressed to shift states? Right into come back to a more contained place a more grounded place? And then can they maintain dual attention for reprocessing phases? Right? So pregnant or not? We need to be doing all of that.

Kim Howard 17:38
Right.

Maura Tesler Stein 17:39
Right?

Kim Howard 17:41
Are there any specific complexities or difficulties with using EMDR therapy with this population?

Maura Tesler Stein 17:48
So okay, so with this population, when we think about perinatal mental health, in general, I have so many things that I can say, let me start with pregnancies specifically. You know, it it’s so funny, because, you know, I’ve, I’ve, I’ve sort of become this person who is talking about EMDR use during pregnancy so much. And I think it’s really just because I’ve dived into the literature, and I’ve read about but, you know, my passion is just so much broader than that, and my knowledge, base and experience, but I do think of it as all intertwined. So, so if you think about pregnancy, right, you have people coming in, sometimes they come in at the end of a pregnancy, and we have, you know, time crunch considerations, where somebody may have had a traumatic delivery in a prior pregnancy for whatever the whatever made a traumatic, they’re coming in, and maybe they’re 30 weeks pregnant. And you think, Okay, I’ve got, hopefully, if they go to term, 10 weeks or so, to do this work? Well, I don’t yet know what the history of this person is prior to pregnancy prior to any pregnancy, right? Somebody coming in with a history of complex trauma, you know, what sort of what’s their internal self state? Like? What are their? How resourced? Are they walking in the door, so I don’t know, you know, I may have somebody for whom staying in our Phase Two preparation, resourcing work is would be appropriate for them, regardless of their pregnancy status. And yet, here I have somebody where there’s their strong motivation to want to reduce and read reduce the chronic stress, which is something we do worry about in pregnancy, right, untreated PTSD, untreated anxiety and depression, it falls into the category of toxic stress. And chronic stress hits that toxic stress criteria. And so that’s where we see those adverse impacts. So if I’ve got somebody coming in, and I have a limited, very limited amount of time before delivery, and the remainder of the pregnancy, part of me is thinking I really want to see if we can clear some of this trauma. But if I’ve got somebody here for whom that’s really not accessible, because perhaps they can’t maintain all attention yet, right? Or, you know, I mean, that’s really kind of the bottom line, right? Are they well resourced enough to keep afoot in the present moment? Can I keep them kind of in that space, so that I would think about, you know, some of our other procedures and ways of working to help get somebody able to utilize standard protocol, you know, that can help to turn down the heat on that traumatic memory so that perhaps they can maintain dual attention. So So So, you know, I think that as clinicians we need our fellow specialists to consult with and to talk to and to say, Okay, I’m feeling a real pull to do this. And there’s a part of me that’s like, Oh, am I gonna, you know, is this going to be too much for this person? You know, how, how would you proceed? What do you think? And so, you know, I just really encourage people to find community, to think through these, some of these clinical dilemmas of enter, remember that face to work is also very powerful. Yeah, you know, and not to minimize that, as well. Because very often people, when we do this phase to work with them, they themselves, some of the some of the trauma starts to kind of untangle and digest just organically, because what was missing? Was that adaptive information.

Kim Howard 21:18
That’s good, thank you. Maura, how do you practice cultural humility?

Maura Tesler Stein 21:23
Oh, I listen a lot. I listen a lot. I, you know, there’s so many layers, to, to, to culture and to diversity. And all I can tell you is, the more I learn, the less I know. And so the really working to surround myself with people who, who know things that I don’t know, who have life experiences that are different than mine, and who are curious, and who are receptive to my wanting to understand more deeply what these different experiences are like, and, and I I’m thinking about all kinds of experiences, whether they be, you know, with, with racial diversity with religious diversity, diversity in things like disability language, and, you know, drawing on my own experiences as a way to remember how unique each person’s experiences.

Kim Howard 22:31
I used to work for a CEO many years ago who talked about his hire and philosophy of staff. And he said, You know, I hire people who don’t necessarily have the skill sets that I have, but they fit in, in terms of our staff and our and our vision and our mission for the organization that we’re working for. And that’s what you do when as a as a boss, or a leader or manager, you know, and so we should take that concept out of the workplace and put it into our personal lives and fill in those gaps with people who are different than us. Because you learn so much more. You know, I grew up a military brat, and, you know, grew up on Army bases, and you learn very quickly, as a young child, if you don’t want to play with people who are different than you, you’re not going to have a lot of friends. Because, you know, we lived across the street from the Mexican couple who lived next door to the Iranian couple who lived across the street from the Black couple who live next to us; all of the children, we all play together. And so we were literally a melting pot at that point. And so you can kind of learn that, that that the world is this big, huge world, and people don’t look and act and think like you do, and so it’s okay to surround yourselves with different thoughts.

Maura Tesler Stein 23:41
Right. And I would say I would add one more element that I, I returned to over and over again for myself, which is to be open to this idea that you may not know what you think, you know, you know, I think that in lots of spaces, we develop certain ideas that are based on some degree of information, but so often our information is incomplete or not nuanced. And so, this idea that, that there may be some things in this in a particular domain or cultural domain, that you think you you have a handle. And you may not know all things are enough or certain a certain subset of things. And so being open to considering and listening, when somebody says, Well, did you know about this, this aspect, or this fact? And sometimes it’s really hard to hear? Yeah, yeah. Because it can challenge a sense of yourself in the space and a sense of your relationship to others who are different or others in that space, or to people who you think are like you who maybe it turns out. Well, there actually are some distinctions here that I haven’t I haven’t quite recognized, right. So just It’s just endlessly nuanced.

Kim Howard 25:02
That’s a good answer. Thank you. Maura, do you have a favorite free EMDR related resource that you would suggest other for the public or other EMDR therapists?

Maura Tesler Stein 25:12
I do. At the Touchstone Institute, we have started this cool thing called Tuesday Tea with Touchstone. And we have invited many people on our training team, some of my consultants and training facilitators who we adore and who worked with us when we do basic trainings, who are specialists in sub specialists in different areas of perinatal mental health, and they just have this phenomenal knowledge base and experience days. And so different cultural points of view. And so as we’ve invited them in to just talk about their passion and talk about an area of expertise for them, we call it we do that for an hour every other Tuesday. And that’s our Tuesday Tea, and those offerings are free. So they’re they’re streamed live on Facebook, and then they are available, we’re in the process of making them available on our training page for the Touchstone Institute as well. And they’re going to keep going. So we’ve had, we’ve had, you know, in depth talks about phase two resourcing, again, with an anti oppression lens, a diversity lens, a perinatal lens, complex trauma, I’m looking at neuro divergence is coming up in two weeks, we just have, we’re booked out through the end of this year, and we’re, we’ve got people, you know, ready to ready to schedule into 2024. And so we hope that there’ll be a library, we also have speaking of library, we have, we have on our website, a list of both internal and external, external resources that we’ve made available. So lots of podcast interviews, I’ve done a whole bunch of podcast interviews, and so have members of my team that are just wonderful, you know, just such generosity in our community. So if you come to our website and look and you can filter for for podcasts, you can filter for articles. There’s an article I did recently for the go with that magazine for EMDRIA. Right, so there’s so that’s a perinatal mental health focused one, the podcast interviews that are on our website are also focused on perinatal mental health across different different areas. So lots and lots out there. And we want it to be a resource to like a one stop place, at least for people to be able to find a whole variety of resources. And also, we have a therapist directory of specialists who have trained with us now we primarily taught EMDR and EMDR advanced courses, we do have now some courses that are not only EMDR specific, but you can look at our if you’re looking for a referral for therapists who is a perinatal specialist who is knowledgeable about the integration of EMDR. In perinatal mental health, we have this freed directory is free to the therapists who are on it. And of course free to to people too.

Kim Howard 27:55
It’s great. If you send me the link, I’ll include it in the description for the awesome so people can can go check it out. Thank you. That’s very generous. We appreciate that.

Maura Tesler Stein 28:03
Oh, our pleasure. I really just want to support the community and the community is it’s also just so warm and welcoming, and so generous. And really anybody who has an inkling of an interest in perinatal mental health, just know that no, there’s no entry exam, you know, come on, come on over, come in and join us. And you know, we really just want to help support you because really, every therapist, every EMDR therapist, at some point has had does have a will have somebody in their office where perinatal issue has impacted them. Correct. And so we just want to help you navigate and orient.

Kim Howard 28:43
Yeah, absolutely. What would you like people outside of the EMDR community to know about EMDR therapy while pregnant?

Maura Tesler Stein 28:52
I want people to know that it helps. I want them to know that it will support their development in their sense of self as a parent, that it is, when done using EMDR best practices, it is safe. It is it will help prepare them for this for the arrival of this baby no matter what the conditions are. So whether whether you’re somebody who knows that your baby has a life limiting diagnosis, whether you’re not sure that your pregnancy is going to continue because there’s complications in the state of the pregnancy. EMDR therapy can help you in your therapy could help you to feel to connect with the parts of you that know that you can handle what’s coming and to reach for support in your world. And to certainly to put out the fire the trauma starts, right and then to help. I always think of this as like pulling out the shrapnel from the explosion and then supporting the weaving and re weaving of connective tissue in supporting development.

Kim Howard 30:04
That’s a great way to put it. Thank you. Is there anything else you’d like to add Maura?

Maura Tesler Stein 30:09
Come on over to EMDR and Perinatal Mental Health on Facebook and in the in the SIG [Special Interest Group], here at EMDRIA. And you know, just know that, you know, there’s a growing community of people who are interested in this population who would be thrilled to support you. And if you already are a specialist and you didn’t know about us, come, we need you. We want you. Alright.

Kim Howard 30:33
We appreciate your time.

Maura Tesler Stein 30:35
Thank you so much. Thanks for inviting me.

Kim Howard 30:36
This has been the Let’s Talk EMDR podcast with our guest Maura Tesler Stein. Visit www.emdria.org for more information about EMDR therapy, or to use our Find an EMDR Therapist Directory with more than 15,000 therapists available. Like what you hear? Make sure you subscribe to this free podcast wherever you listen. Thank you for listening.