Transcript for
Diet, lifestyle, relationships, and wellbeing: A holistic approach to working with mums

Narrator (00:02): Welcome to the Emerging Minds Podcast.

Dan Moss (00:07): Hi, everyone. Welcome to the Emerging Minds Podcast. My name is Dan Moss and today is my great pleasure to talk with Dr. Angie Willcocks. Angie is a psychologist experienced in helping clients overcome problems such as depression, anxiety, grief, postnatal depression, and relationship difficulties. Angie is also an author and has co-written a book about baby sleep called The Sensible Sleep Solution, A Guide to Sleep in Your Baby’s First Year. Angie also has a PhD looking at nutritional medicine and postnatal depression. So, Angie, it sounds like we’ve got a lot to talk about. Welcome to our podcast series.

Angie Willcocks (00:46): Thank you.

Dan Moss (00:46): So can you describe the work you do as a psychologist with moms during the perinatal period and when their infants are first born?

Angie Willcocks (00:55): Sure. So I work in private practise mainly, and I work with moms and dads and for families in the perinatal period, which is pregnancy well, actually fertility as well, so fertility, pregnancy, and the postnatal period, generally up to the age of one year. And I do counselling so moms come in to see me, or lately we do telehealth as well on Zoom or Skype. And we just talk through whatever might be going on. It might be anxiety. It might be depression. It might be related to birth trauma or fertility issues or sometimes women recovering from postpartum psychosis as well, so a broad range. And increasingly dad’s coming in to deal with becoming a dad and even issues around fertility and how to be the dad that they want to be.

Dan Moss (01:45): Yeah. Great. Thanks, Angie. So given lots of work that you’re doing at the moment is with moms, both before and after birth, what are some of the pressures on new moms these days?

Angie Willcocks (01:57): I think there are huge pressures on moms these days. And obviously I can’t speak to previous generations, but many women that I work with are trying to juggle a huge amount, even through pregnancy of maybe working full-time or even part-time often looking after other family members, maybe who also have mental health issues, maybe parents and maybe siblings and looking after partners often as well, male or female partners, who also might have mental health issues. So I think women are juggling a lot and often trying to just include pregnancy and having babies sort of on top of that as an extra. And I think it comes as a surprise to them that they can’t just have it as an extra, that it becomes a thing in and of itself that they need to manage.

Dan Moss (02:42): Is there a sense from those women when they come and see you, as a psychologist, that you might be there in a capacity to tell them what they’re doing wrong or to tell them what to do better?

Angie Willcocks (02:52): I would very strongly try not to tell women what they’re doing wrong. And actually that’s just my philosophy that they’re often doing a lot right. And even if they’re struggling with parenting, I think there’s a lot of information already on what they’re doing wrong. And I wouldn’t see it as my role to sort of point that out. I would always look for things that they’re doing right. Also, if they’re struggling in relationship with their partner, I’d look for what they’re doing right more than what doing wrong. Women often know what they’re doing wrong. They will tell me already what they’re doing wrong. And they’re often very distressed about that, which is why they’re coming to seek help. So often women will come to see me because they’re not able to parent in the way that they want to parent. And that’s actually what drives them to seek help.

(03:37): So assessment would depend on when they’re coming. Are they coming around fertility issues? Are they coming around pregnancy issues? Or are they coming postnatally? And if they’re coming postnatally, then the assessment would ideally involve their infant as well. So I would always want them to bring their infant to session. And I would subtly sort of observe how they’re going while I’m looking after their infant. And I would also invite their partner to come into the second or third session to get some assessment on the level of support that’s available and also how that partner’s going in their own mental health. The assessment is very broad because I’m interested in the whole woman. I wouldn’t just be looking at, as you say what she’s doing wrong or what the symptoms are, but also who she is as a person and what she wants to get out of counselling.

Dan Moss (04:26): And you said before, it’s very important for a mom to be able to bring in her infant. Why is that important to you?

Angie Willcocks (04:32): Well, it tells me a lot of information. If she doesn’t bring the infant in, then I want to know where the infant is and who’s looking after the baby and not from the point of view of even judging that, but also it tells me something about support. So maybe it’s good that she has a level of support. She might tell me that her mom is walking around the block with the baby, which is great. And then I would still ask her to bring the infant in so that I can see how she’s responding to the baby and see a little bit what the baby’s like. We can tell a little bit about temperament and I can see if a baby’s actually really tricky to settle. And sometimes that would be an important thing for mom to hear, like that baby looks a bit tricky, especially with first children so that she would understand that objectively her baby is a bit tricky.

(05:19): And often there are that I can say you did a really lovely job settling your baby then, or it looks like that’s going well. Sometimes I would notice things that worry me a little bit, which might be that mom’s actually not responding to baby. Maybe baby’s crying a lot in session and she’s too busy telling me what’s happening for her to respond. And that tells me something a little bit about how at the moment, she’s not able to meet the baby’s needs because her needs are so big. And I wouldn’t draw her attention to that immediately, but it would form part of my case formulation of what needs to happen to support the mom and baby.

Dan Moss (05:58): Yeah. So if that does become something which is standing out to you, there’s some work that you need to do first with mom before you might draw her attention to what you’re observing?

Angie Willcocks (06:09): Yes. Yes. And so often it would be around me, I guess, giving her space to talk. Obviously she’s got a lot that she needs to get out and process. So it would be in my case formulation, I guess, allowing time for that to happen, seeing if somebody else can look after the baby while she comes in to session, and then over time asking her to bring the baby back in and see if there’s been any change in that. I would often also give a little bit of homework around just eye gazing with the baby at home so that she can start to, I guess, connect and see the baby as a person who also has needs. So it would depend on the situation, but primarily it would be around supporting the mom first and encouraging her to get as much support as she can in terms of caring for the infant so that that baby can have its needs met, if not by her, then by somebody around her, in the family, ideally.

Dan Moss (07:07): Is a lack of support for mom’s a prevalent issue in the work that you do?

Angie Willcocks (07:12): Yes. It can be. We know there’s heaps of research, so, so much research over so many years that shows a lack of support, or a lack of perceived support, has a huge risk factor for developing perinatal mental health problems, particularly depression and anxiety. And that support can be practical support, so sort of in instrumental support of dishes and other children and that sort of stuff, but it can also be emotional support. So we know that a lack of these things is a huge risk factor and that support probably even moderates other effects, so support is very, very important. And we live in a strange world at the moment that that support primarily has to come from a partner. We don’t really live, particularly in COVID times, in a place where a mom can get a lot of support from extended family. And so there’s a lot of emphasis on that needing to come from the partner and often partners are struggling as well so it can be tricky.

Dan Moss (08:09): So how would you begin a conversation with a mom to help her to think about the kinds of supports that she needs to be able to be the kind of mom that she wants be?

Angie Willcocks (08:19): Well, it would partly be about normalising that you can’t parent alone and that she’s not failing because she can’t do it all by herself. I think there’s a strong, I guess, social message that women should be able to just be at home with a baby by themselves and cope really well and have everything organised. And I don’t think that’s the way we’re built to mother. So it would be normalising that she needs support. Often women who come to see me are quite perfectionistic and quite used to being able to do everything for themselves and by themselves and quite independent.

And so it’s a shock to them that they actually do need to rely on other people so that they can provide for their baby. So it would be normalising it first of all. And then it would be encouraging them to view different people as potential sources of support that maybe they hadn’t thought of also breaking the support down, as I said, into practical support and emotional support. So they might think my partner’s completely not supportive, but it might be that he can offer practical support and that maybe she needs to get emotional support from somebody else. So it would be, I guess, problem solving. You need support. Let’s have a look at where you can get it from and it might not all be from your partner.

Dan Moss (09:33): So I just want to go back for a second to the comment you made about where you’re observing that maybe mom might not be as attentive to her baby’s needs, and this is causing you some concerns. So at what point might you start to have this conversation in your process with the mom?

Angie Willcocks (09:51): I wouldn’t have it in the first session, unless it was very severe, if there was a very severe detachment from the baby, as in no capacity at all to meet the baby’s needs. In that case, I would talk quite openly about it and even consider referral if there was a severe problem that I noticed, but that’s unusual. And so usually I would just leave it for the first session, give some strategies, talk about getting some support, and then reassess in the second or third session.

Also when the dad comes in, because sometimes when the dad comes in, we can see that he can provide that for the baby, where the mom is unable for the moment to. And so then that would offer me some reassurance. And then maybe in the third or fourth session, I would talk to the mom about how she thinks she’s going meeting the baby’s needs. And again, she would often know, I know that I can’t meet the baby’s needs and I know that the baby cries and I don’t know what to do. So that would be the opening conversation that mom’s often know when they’re role and that’s part of the problem because then they have the guilt and shame on top of not being able to do what they want to do.

Dan Moss (11:04): Yeah. So I suppose for you, as a psychologist, that’s a really significant challenge to be able to engage mom in a way which offers solutions rather than intensifies that self blame.

Angie Willcocks (11:15): Yeah. Absolutely. So that’s just to conversation and, yeah, I think women are way harsher on themselves than I ever would be. So I don’t need to be. If anything, I can be reassuring and offer them, I guess, a problem solving way forward.

Dan Moss (11:31): You’ve talked about the importance for you in wherever possible, bringing dads along to the session as well. And we know that there’s a lot of research and thinking about engaging fathers at the moment.

Angie Willcocks (11:41): Right.

Dan Moss (11:42): Can you tell us a little bit about your journey in doing that? You know, what works, and what what’s been effective, and what are some of the challenges?

Angie Willcocks (11:49): Yeah. Sure. Well, first of all, I do always like to invite the partner in and he doesn’t always come. So that’s some information for me. Sometimes it is around logistics around work. If, for example, he works away or he can’t get to appointments, but if that’s the case, he often will come at some point. And I don’t know, it’s a conversation with the mom saying to me, he does want to come. It’s just that he can’t come at this time. So that’s quite clear. Other times it seems that there’s a real lack of interest in him participating and maybe a view that he views this as sort of like her problem that she needs to deal with and nothing to do with him.

So if he doesn’t come in, I guess that’s information for me. If he does come in, then it’s a session around just asking him how he’s going, what he’s enjoying about being a dad, what he’s not enjoying, how he thinks his partner’s going. And it’s sort of me collecting information on my client, who’s the woman, but also having an assessment of how he is going. And sometimes that will be really reassuring for me that he’s adjusting quite well and can offer support. And other times it raises some concerns for me about how he’s coping or not coping and how he maybe is quite disengaged or not adjusting to the demands of being a dad, in which case I would suggest to him that maybe he might like to get some counselling as well.

Dan Moss (13:18): Does that counselling often happen with you, yourself, or you would refer on?

Angie Willcocks (13:23): No. I would refer on where possible because my client is the woman. And normally by then I’ve worked with her for one or two or three or four sessions. And so we’ve built a therapeutic relationship and I don’t want that to be, I guess, sidetracked or hijacked by whatever’s going on for the dad. So I would really strongly encourage him to get support elsewhere. There’ve been a couple of occasions where I have actually engaged with the dad for two or three sessions in a sort of contracted way because I’m pretty concerned about him and I want to keep an eye on him while he’s waiting for support from elsewhere.

Dan Moss (14:03): And what are the main objectives of those conversations with dads?

Angie Willcocks (14:08): If I’ve identified that there’s something going on for him, maybe like his own anxiety and depression, it would be, I guess, just offering him support in understanding that that’s what’s happening for him, that it is depression and this, I guess, it’s around psycho-education in saying this is what’s happening for you, normalising the normal bits. So normalising the adjusting to being a dad and why that’s tricky and highlighting the bits maybe that are not so normal. And that might be, I don’t know, suicidal thinking or wanting to run away or drinking too much or using drugs or sort of sorts of unhealthy behaviours that he’s engaging in that are actually not normal or great. And so it would be pointing that out.

Dan Moss (14:52): Okay. So going back to your kind of therapeutic journey with mom for a second, what can happen for women when they stop maybe being so harsh on themselves and start to see some of the possibilities or the strengths that they have in their own lives, but also in their relationship with their child?

Angie Willcocks (15:12): Sure. I think that women who are harsh on themselves in the perinatal period have probably been harsh on themselves for a long period of time. They often, as I said before, have a sort of perfectionistic side where they are quite harsh on themselves in wanting to do the right thing and be a great person and do all the things for everyone all the time. And so part of it is coming to understand that they do sometimes have to put those things aside and look after their own mental health in ways that maybe they haven’t before so taking time for themselves for exercise, or prioritising sleep, looking after their own body in a way that maybe means that other people don’t come before them. An example of that would be they might be used to, I guess, looking after their partner ahead of themselves. And then when they become a mom, they’ve also got a baby to look after and that can reshuffle things and they maybe have to sometimes look at taking care of themselves and letting their partner take care of himself.

Dan Moss (16:13): And that brings us to your PhD. And within that, I understand that you studied issues such as a lack of support for moms, other issues, such as diet and partner conflict and how these can influence a mom during her perinatal period. Can you describe for us the results of these studies?

Angie Willcocks (16:32): Sure. So I was interested in my PhD in having a look at the effect of diet quality on mom’s mental health. And that arose from a conference that I went to that Felice Jacka, who’s in the food and mood study, was talking about the impact of nutrition and diet on general mental health. And I was working with moms at that time and I thought that’s an area that hasn’t really been studied. So that’s why I decided to do my PhD on that, because there’s increasing evidence that diet does matter for mental health really broadly. So my PhD had a look at that in Australian women throughout pregnancy and into the postnatal period. And what I found out was that the quality of diet does matter for women’s mental health. And so a poorer quality diet in the time around conception increase the risk of depression and anxiety in pregnancy and postnatally and also a poorer quality diet during pregnancy also in acted on risk of depression and anxiety.

Dan Moss (17:37): So were these results surprising to you? Or did they confirm many of the things that you’ve been observing in your practise?

Angie Willcocks (17:43): It’s not really so much about what I observe in practise because you can’t necessarily just see it in one person, but they definitely confirm what we know more broadly from epidemiological research, having a look at the effects of diet on mental health. And there’s some growing research on the effects of diet for mental health, particularly for women. There’s some research that shows that maybe diet and nutrition is more I important for women than for men. I’m not sure why. And particularly during pregnancy, we know even in a developed country like Australia, a very small percentage of people actually follow the dietary guidelines. And so pregnancy where there’s increased need for nutrition, there’s increased demands because you’re growing a baby, many women don’t actually get the nutrients that they need during pregnancy. So it is going to have an effect on mental health. So it didn’t surprise me because of what we see more broadly in research as in whole emerging body of research on the importance of lifestyle factors like diet for mental health.

Dan Moss (18:46): Does this have an exacerbating factor, do you think for women who are socially and economically disadvantaged maybe have less access to quality diet?

Angie Willcocks (18:56): Definitely. And, in fact, another finding from my study was that women who have a poor diet and stress have worse outcomes than women who have a better diet and stress, meaning that if you’re already stressed and you have low nutrition, then that’s going to have a worse effect for you than the same stress with a better quality diet. And so all of these factors sort of come in together to result in poorer mental health for women and men and families. And that’s something that I think would be great to intervene with or offer some support with in terms of, if we know that a woman who is pregnant, has a lot of life stress going on, that we could maybe offer some support for her in terms of nutrition, I guess, and even access to healthier foods.

Dan Moss (19:48): Is this something that you’ve been able to incorporate into your own practise?

Angie Willcocks (19:53): I don’t hugely incorporate it into my own practise because of the fear, I guess, I have of, I don’t want to shame women or increase stigma or make things more difficult for them. So in my assessment, I would always talk broadly about lifestyle factors anyway. These are things like, how do you move your body? What is your diet like? How’s your sleep? How’s your relationship? What substances do you use or not use? So they’re the broad lifestyle factors that I’d always have as part of my assessment. And in terms of diet, I certainly wouldn’t go in gungho and say, oh my God, what do you eat? You need to change your diet. It would more be, how can we improve healthy habits overall? Because it can be quite empowering. So can you move your body more? Can you add in, you know, even a piece of fruit every few days? Just really simple things that, again, women often know and want to do themselves. So it would form part of a broader conversation on what she can do in an empowering way to feel better about how she’s going.

Dan Moss (20:56): And this is, again, coming back to that practise ethic, which you described about the whole woman.

Angie Willcocks (21:00): Yes.

Dan Moss (21:01): And that’s a bit different to only talking to mom about the responsibilities she has to her child. Isn’t it?

Angie Willcocks (21:08): Oh. Definitely. And I am quite passionate about women looking after their mental health for themselves, not just for the infant or not just so that they can care for others better. There’s so much, I guess, rhetoric around, you’ll see it in research papers, always the opening paragraph around, you know, women need to look after their mental health because the effects on their infants. And we know the effects on infants and we know that that can make moms feel really guilty and it doesn’t necessarily flow on to improved outcomes. So I think it’s really important that we talk to women about them looking after themselves because they matter in and of themselves as women, their mental health is important, not just because it affects others, but because it affects their quality of life.

Dan Moss (21:55): And I’m wondering what effect that might have on women to be able to have those kinds of conversations when they go and see a professional such as yourself.

Angie Willcocks (22:02): Well, I hope it’s good. I think it’s unique because so often I think from the time a woman and finds out she’s pregnant, she’s told about the effect of what she’s doing on her baby. Don’t eat this. Don’t do that. And it’s always all about because of the effect that this will have on your baby. Even like don’t stress too much. Make sure you get enough sleep because it’s going to harm the baby in some way.

And whilst I think it’s important that these facts are known, I think that maybe it’s also important that a woman is encouraged to look after herself for herself and that it doesn’t always have to be because of the effect that she’s having on other people. So I hope that it’s a positive conversation for women, but they’re often given strong messages in another way that says you need to do a better job at looking after your baby almost that you don’t matter. Even when moms have a baby and people come around and they’re just saying, how’s the baby? How’s the baby? How’s the baby sleep? How’s the baby going? And not so many conversations around how are you going? And how are you going becoming a mom? And what’s this like for you?

Dan Moss (23:08): So Dr. Angie Willcocks, in your own psychology practise, can you tell us a little bit about the effects that this type of approach might have for moms where they do have the opportunity to think about themselves as a whole woman? Does that, in your experience, at some stage have some positive effects on how they’re able to be with their infant?

Angie Willcocks (23:28): Definitely. I think even though it’s not the intention that they’re then able to mother better. In reality, women are coming to see me often because they want to mother better. So we then have the backstory of her as a whole woman and who she is, which, I guess, inadvertently allows her to mother better in a way that suits her and her family. So whilst I certainly wouldn’t go in saying you need to be a better mother, as I said, that’s often her intention and we can get there by her looking after herself better.

Dan Moss (24:01):Is there something though about how she might be with you when you have an understanding of the context of her whole life?

Angie Willcocks (24:08): Yes. I think there’s a big relief for her to remember that she is somebody apart from a mother and an understanding of the importance of somebody seeing her for her, not just as a mom and not just that she has to improve herself for others. So I hope that it’s a relief. I think it’s engaging for women. And I think that they really do resonate with it and it makes a lot of sense to them and then they can go and have those conversations with other moms as well.

Dan Moss (24:36): Yeah. And I suppose it takes away that kind of sense of a punitive role that some psychologists might be assumed to have?

Angie Willcocks (24:44): Yeah. I hope psychologists don’t have a punitive role. I don’t think that’s ever their intention. I think we have, as psychologists, we have a lot of knowledge about all of the factors that come in as risk factors, I guess. And maybe sometimes that could come across as a little bit shaming or blaming, but, you know, women are always doing their best as everybody is. And by the time women come to seek help, it’s clear that they want to make changes. And so I think we can engage with them in a really positive way and a really supportive way. It shouldn’t be, and it doesn’t have to be, punitive.

Dan Moss (25:19): So, Angie, just going back to your PhD for a moment, and I know I’m going from your practise to your PhD so bear with me.

Angie Willcocks (25:25): That’s okay.

Dan Moss (25:26): You talk about diet being one of the modifiable and practical issues that you can talk to moms about.

Angie Willcocks (25:32): So my PhD was particularly looking at adherence to the Australian dietary guidelines and that was for a reason. And that was that I wanted women to have easily accessible information. I didn’t want to reinvent the wheel. And I know there’s a lot of information and out there on diet, you know, vegetarian, paleo, gluten free, all sorts of different things that’s very confusing. So I wanted something that was accessible through my PhD. The Australian dietary guidelines basically cover eating fresh fruit and veg, lean meats, whole grains, or if not lean meats, then other sources of protein. So initially I maybe even would just say to women, in a nice way, do you even know what a healthy diet is? And maybe just provide a little bit of information on simple things that they can do. And the main one would be, can you eat more vegetables? Yeah. Because hardly any people eat enough vegetables. So in my study about 10% of women had the daily requirement for vegetables in pregnancy and that’s quite high. In other populations, it can be around four or 5%.

Dan Moss (26:37): Did your study, or from your observation, has it noticed any connections between people’s approaches to diet before having children, and maybe the dietary habits of children within families?

Angie Willcocks (26:49): I didn’t particularly study that, but we know that that’s a factor and there’s a lot of research in sort of having a look at how families make decisions about which foods to eat and the impact that that will then then have on physical outcomes, such as obesity, diabetes, et cetera, in families, as well as mental health issues in families. So while I didn’t look at it, there is definitely research in that space. How can we support families to, I guess, have healthy habits that will mean lower risk of physical and mental health issues in the children and their families as a whole?

Dan Moss (27:25): Yeah. And I suppose that’s such a difficult area at the moment where we are seeing families who are struggling with dietary health, and obesity, like being able to have those conversations with, you know, families and again, moms without adding shame.

Angie Willcocks (27:40): Absolutely. And I think most people do, you know, want to make healthy decisions. And there’s a lot of confusing information out there, even in terms of food labelling. I think people want to make good decisions often and they can struggle to know how to do that and can be completely overwhelmed with other stresses. We know that people who are stressed, or depressed, or anxious are less likely to make healthy choices, not just about food, but about exercise and sleep and everything like that. There’s this bidirectional approach of stress and mental illness with healthy lifestyle habits. And they go around and around and around.

Dan Moss (28:18): Yeah. Thanks, Angie. So I know that your PhD contains some practise tips for practitioners working with mothers and parents in the perinatal period or in the first days of a child’s life. Can you describe some of that practise advice?

Angie Willcocks (28:32): Sure. So it’s really around, maybe as I said, when a woman first finds out that she’s pregnant or is even trying to conceive, I’d love it if she was able to be told by her sort of first line health professional, did you know that what you eat is actually important for your own mental health? And then just some very basic even just handing out the Australian dietary guidelines for pregnancy so that people can see that they are simple and that they can be followed or they can at least maybe try to eat more fruit and vegetables, for instance, or remembering to get some protein in their diet, et cetera. So that’s part of the practise recommendations would be conversations from really early on.

Dan Moss (29:15): Yeah. It’s really fascinating. I mean, I know we’re doing a lot of work at the moment. I’m thinking about the whole of child. It sounds like you are really talking about that whole of mother, a whole of parent approach being really critical as well.

Angie Willcocks (29:28): Yeah. I don’t know. For me, it seems crazy to talk to a woman just about her, you know, if we’re doing cognitive behavioural therapy, for instance, to be talking with her just about her mind or just about her thinking. And I think it’s really important that we remember that she has a body as well, and that it can be empowering to start to make some decisions that help her body feel a little bit better.

Dan Moss (29:52): So, Angie, you describe the effects of unsupportive or maybe problematic relationships with partners as a risk factor for the mental health of mothers and of children. Could you maybe provide some advice for practitioners listening to this podcast around how they might have those conversations with moms or involve with the same sex or partners within those conversations?

Angie Willcocks (30:17): Yeah. I think it’s really so important to always include the relationship and availability of support in assessment. Like we’re talking about the whole woman, we’ve also got to talk about the whole family and where there is a partner, we have to be looking at how that’s going and really can’t work with a woman in the absence of her relationships, I don’t think, particularly when we are talking about her being a mom. So first of all, it’s allowing space for that sort of assessment and coming from a framework of recognising and understanding the importance of relationship, which is never more important to a woman than when she is becoming a mother. So first of all, it’s understanding that and understanding the, I guess, the research literature that really unequivocally says how important quality of support is, and in particular, the risk around family violence. And I guess conflict within that relationship is a really significant risk factor for moms and their babies. So first of all, it’s understanding that. And then secondly, I guess, it’s around supporting the woman and where possible engaging the partner and referring him for support as well.

Dan Moss (31:34): Angie, thanks so much for joining us today. That’s been really fascinating insight into both your practise and your PhD. Thank you.

Angie Willcocks (31:42): Thank you. Thanks, Dan.

Narrator (31:45): Visit our website at www.EmergingMinds.com.AU to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health led by Emerging Minds, The National Workforce Centre for Child Mental Health is funded by the Australian government Department of Health under the National Support for Child and Youth Mental Health programme.