"Even if you're not working with couples, especially in the perinatal world, you are working with couples." – Patrick Monette, LMHC, CASAC
As mental health professionals, we often focus on the individual sitting in front of us—but in perinatal mental health, no one exists in isolation. Relationships shape how our clients experience stress, trauma, and healing.
Your client may be the only one in the therapy room, but they bring their relationships with them—their expectations, their disappointments, their longing for support. If we understand relationship dynamics, we can help individuals navigate these challenges more effectively, communicate more clearly, and feel less alone.
Research confirms that relational stress significantly impacts perinatal mental health outcomes. Studies show that birth trauma can cause ongoing psychological distress for both the birthing person and their partner, often leading to avoidance, relational tension, and difficulties in postpartum adjustment (Ayers et al., 2016). When partners struggle to process these experiences together, the emotional burden often falls entirely on the client sitting in our therapy room.
This is why understanding relationship dynamics is essential—even for therapists who work exclusively with individuals. A trauma-informed approach allows us to better assess the relational factors contributing to distress, help clients make sense of their experiences, and support healthier relational patterns.
Perinatal Mental Health is a Relational Experience—Even in Individual Therapy
Perinatal distress rarely happens in a vacuum. The social and relational context of a client’s life directly shapes their mental health (Molecular Psychiatry, 2023). Whether it’s inequitable caregiving roles, unresolved birth trauma, or emotional disconnection, understanding these factors allows us to provide more effective, holistic care—even when the partner isn’t present in the therapy room.
Here’s how relationship dynamics show up in individual therapy:
The “Invisible Workload” of Parenthood
"I feel like I do everything."
The mental load of caregiving—often carried disproportionately by one partner—has been identified as a major factor in perinatal mental health outcomes (Molecular Psychiatry, 2023). Clients often express resentment, exhaustion, or emotional isolation due to unbalanced household and caregiving responsibilities. When clients feel overwhelmed by these dynamics, therapy can offer tools to set boundaries, communicate needs effectively, and advocate for shared responsibility.
Birth Trauma That No One Talks About
"We don’t talk about what happened."
A traumatic birth experience affects both partners, yet the non-birthing partner’s distress is often overlooked. Studies indicate that birth trauma can contribute to relationship distress, anxiety, and avoidance behaviors in couples (Ayers et al., 2016). If clients feel like their partner isn’t processing the experience with them, they may withdraw, leading to deeper feelings of isolation and emotional burden. Therapy can provide space to process relational rupture and explore ways to rebuild connection after a traumatic birth.
From Lovers to Roommates
"I love them, but we’re just not... us anymore."
Parenthood transforms intimacy—not just sexually, but emotionally. Exhaustion, shifting identities, and the demands of caregiving can leave partners feeling like they are simply co-existing. Research in perinatal mental health highlights how these changes in relational roles can exacerbate stress, worsen pre-existing trauma, and lead to long-term dissatisfaction (Molecular Psychiatry, 2023). When we help clients name what’s missing, explore their changing needs, and rebuild emotional connection, we’re addressing a key factor in perinatal well-being.
Understanding Trauma in Relationships
"When couples come in, it's usually because things aren't going well. What's missing from most approaches is a trauma-informed component."
— Patrick Monette, LMHC, CASAC
Many perinatal clients enter parenthood with unresolved attachment wounds that shape how they communicate, set boundaries, and seek support. Trauma-informed care emphasizes the importance of recognizing relational trauma patterns and addressing them systemically (Royal College of Psychiatrists, 2021). Even when only one partner is in therapy, we can help them understand how their past experiences shape their relational dynamics and develop strategies for healthier connection.
Expanding Cultural Competence: Supporting Diverse Relationships in Perinatal Therapy
"BDSM, Kink, and Leather [communities] have offered great models for consent—but also for how to engage in relationships with care and respect." — Lana Holmes, PsyD
Not all relationships follow the same blueprint. Many perinatal clients are in non-traditional partnerships, including ethical non-monogamy or BDSM/kink relationships. Therapists who lack understanding of these relationship dynamics may unintentionally alienate or misinterpret their clients' needs (Tandfonline.com, 2023).
Research suggests that therapists who approach these topics with openness and cultural competence can significantly improve client trust and outcomes (Tandfonline.com, 2023). For clinicians seeking to deepen their understanding, Dr. Lana Holmes, PsyD, brings her expertise in trauma, marginalized communities, and relationship diversity to her training at The Touchstone Institute.
Dr. Holmes’ Kink and Clinical Practice 101 course offers essential training in working with BDSM, kink, and non-traditional relationship structures, ensuring that therapists can provide affirming and effective care for all clients.
"Many therapists simply haven’t been trained to understand BDSM, kink, and ethical non-monogamy. And that lack of knowledge can be harmful—because if clients sense judgment, they will withhold important parts of themselves." — Lana Holmes, PsyD
Learn from Lana in her on-demand training:
Kink and Clinical Practice 101
▶️ On-Demand
An intro course for mental health professionals seeking to provide informed, stigma-free care for clients in kink communities.
This course helps therapists:
Understand BDSM, kink, and ethical non-monogamy in clinical work
Address misconceptions and reduce stigma in therapy settings
Explore perinatal considerations for clients in these communities
By expanding our cultural competence, we ensure that all clients feel seen, understood, and supported in their mental health journey.
Deepen Your Skills: Trauma-Informed Training for Individual Therapists
At The Touchstone Institute, we know that even individual therapy is shaped by relationships. That’s why we offer trauma-informed training on relational dynamics, led by Patrick Monette, LMHC, CASAC, a specialist in trauma, perinatal mental health, and couples therapy.
Patrick brings years of experience in helping clinicians understand the intersection of relational trauma, EMDR, and perinatal mental health, offering practical, research-backed approaches to integrating these concepts into individual therapy.
"When you're working with couples, you’re not just working with individuals—you’re working with two nervous systems, two trauma histories, two different ways of responding to stress. Understanding these dynamics can completely transform how we approach therapy." — Patrick Monette, LMHC, CASAC
Learn from Patrick in these upcoming courses:
Trauma-Informed Couples Therapy
🗓️ March 11, 2025
Learn how to bring a trauma-sensitive approach to your couples therapy practice.
Trauma-Informed Couples Therapy: Integrating EMDR Components
🗓️ March 11-12, 2025
Explore how to apply EMDR techniques within couples therapy for deeper relational healing.
Recipe for Love: Integrating EMDR into Couples Therapy
▶️ On-Demand
Gain confidence in applying EMDR with couples, using trauma-focused tools to support healthy relational dynamics.
When we work with perinatal clients, we aren’t just supporting individuals—we’re supporting their whole ecosystem. Whether you work with birthing parents or non-birthing partners, understanding relationship dynamics deepens your impact and helps create stronger, more resilient connections in the lives of your clients.
References
Ayers, S., Wright, D. B., & Thornton, A. (2016). Development of a measure of postpartum PTSD: The City Birth Trauma Scale. Frontiers in Psychiatry, 7, 180. https://doi.org/10.3389/fpsyt.2016.00180
EMDR International Association. (n.d.). EMDR therapy and pregnancy: Working with women during the perinatal period. Retrieved from https://www.emdria.org/blog/emdr-therapy-and-pregnancy/
Molecular Psychiatry. (2023). The impact of social determinants on perinatal mental health. Molecular Psychiatry, 28(2), 194–210. https://doi.org/10.1038/s41380-022-01864-7
Royal College of Psychiatrists. (2021). Perinatal mental health services: Recommendations for the provision of services for childbearing women. https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr232---perinatal-mental-heath-services.pdf
Tandfonline. (2023). Addressing cultural competence in kink-aware clinical practice: Insights for mental health professionals. Journal of Sex & Marital Therapy, 49(1), 15-29. https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2232801
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