I get a LOT of emails from people asking for career advice about how to get into perinatal and/or birth trauma work. The short answer is that there’s no direct pathway and it really depends what you want to.
This is a LONG response, which, hopefully explains why I can’t answer this in an email! It’s detailed, but remember:
This is MY experience. As an Australian. My training reflects one place, at one time, on a tiny remote island in 2006. I can’t answer questions about registration and degree length/structure in other countries.
I didn’t plan on a career in birth trauma. I started as a Clinical Psychologist with an interest in Perinatal mental health. I took additional supervision and professional development for over 5 years, as there was no particular pathway into perinatal psychology when I was studying. My training took me 12 years, full time, which is definitely not for everyone! It’s also not necessary. Rather than freak out, just keep reading 😊
Which path should you take?
It’s an annoying answer straight up, but it really depends. There really isn’t a specific career path for how to support people through birth trauma.
If you’re primarily looking for evidence-based education and information about how to support people, My Birth Trauma Training for Birthworkers course is the best place to start. Many people who take that course also benefit from my book, More Than a Healthy Baby. I also have a course for people who have personally experienced birth trauma in a course that complements the book.
Experienced your own traumatic birth?
Work on your own stuff first. Learn to stay in your body so that you can fully be there for other people. Working vicariously through other people is not the way to do it. With love, don’t take people to places you’re not willing to go for your own trauma. Helping other people is not a replacement for your own work. Period.
I’m not an expert. There’s dozens of options you could choose and only you know what is right for you. However, here’s a brief overview of some pathways I’m familiar with. Please do your own research:
Option 1: Perinatal Psychiatry.
You have a medical degree and want to be able to assess, diagnose treat and support severely distressed people, and you want to be able to prescribe medication.
Most Psychiatrists take at least 14 years to get to the end of their official training.
Option 2A: Psychology (Clinical)
You want to assess, diagnose, treat and support people through working with thoughts, feelings and behaviours. You don’t prescribe medication, but you study psychopharmacology to understand all the interaction effects.
In Australia, you might want to work with referrals from medical practitioners within the Medicare Better Access scheme. This means you get a bigger rebate.
You need a masters degree or a doctoral degree, so you’re looking at 6-8 years of full time study, possibly longer. Placements and waiting for thesis marks will definitely take longer than your think it will. You’ll also need to factor in extra supervision, experience and professional development specifically related to perinatal work.
Option 2B: Psychology (Generalist)
You can choose another branch of psychology and still end up in perinatal work by carefully selecting supervision and professional development. You might even find an institution that offers a perinatal psychology specialization. Without clinical endorsement, you won’t be able to receive the bigger Medicare rebate, which may or may not matter.
Option 3: Social Work
If you enjoy helping clients solve and cope with problems in every day life, social work might be a good option. You need a degree. The perinatal/clinical social workers I’ve worked with are great at helping with all the practical things that psychologists generally don’t do (e.g., help organise childcare, meals, transport, support for family issues and linking in other professionals). They do way more than this of course, this is just an overview.
Option 4: Counselling
Counselling means different things to different people. Counselling psychology is a field of practice where you use the skills of deep listening, empathy and encourage clients to arrive at their own insights. A degree and/or diploma potentially gives you better work opportunities.
You don’t ‘technically’ need a degree to offer counselling as this is not a licensed term (in Australia), so there is wide variety.
Option 5: Coaching
Coaching psychology is also a recognized field, but you can be a coach for anything, with or without qualifications.
If you want to work with acute to moderate mental health, you need a degree. Usually more than one. This work is complex and there’s no short cuts. You need good self-reflective practices, an understanding of your own nervous system and coping and trusted people to guide you.
If your aim is to offer deep listening, validation, boost confidence and offer simple coping strategies (i.e., no clinical assessment, diagnosis, treatment or targeted support) AND you stay in your lane, coaching or counselling is a great option for many people. Regardless, I recommend you (a) get supervision/have a mentor or 3 you can reach out to for self-reflective practice, (b) you get crystal clear on what you do and do not offer and know when you need to refer on. You have a list of people to refer out to when you are presented with something outside your area of expertise.
There are other modalities – postpartum doula, somatic experiencing practitioner, therapeutic dance, Chinese Medicine Practitioner, yoga instructor, group facilitator….I could go on and on about the many varied and wonderful people I’ve met and worked with over the years. Again, the list above is specific to my experience within the discipline of psychology.
The goal is to be transparent and self-aware by communicating to potential clients what you can and cannot offer. Come from a place of doing no harm, even if it means discomfort to your ego. If you are not the right person with the right skills to help someone, you need to be able to communicate this. Trauma, and indeed the perinatal experience in general, can be made so much worse by a moment of distraction, overconfidence, shallow listening, generalizations and not truly ‘seeing’ the person in front of you. My job as a supervisor (in part) is to protect vulnerable people from helpers who could do harm.
Questions to ask yourself in self-reflection
This is the most important question to get right first. Why do you want to work in birth trauma? List all your internal (e.g., to find fulfilment) and external motivations (e.g., to help others).
Do you want to provide individual emotional/psychological support OR
Do you want to change the system?
Of course we want both! However, you are but one person. If your gut says that what you really want is to change systems of birth and maternal mental health outcomes you might be better off going into politics and/or law. Sometimes, when I say this people seem surprised.
Here’s the thing though – many of us in this field are empathic and passionate, but don’t know enough about how to pass bills or change legislation. A university degree/s in mental health will not teach you this. Your doula training will not teach you this. Unfortunately, it’s often the parents who are left to figure this stuff out. I’m serious when I say consider if this is your bigger WHY and if serving people 1:1 in counselling (or other therapy) will get you closer to this goal?
The desire to help people and give back is amazing, but to be that blunt friend who will tell you like it is – perinatal work is brutal. I get quite concerned about the number of unqualified people offering ‘miracle’ solutions for trauma for parents desperate for relief. Some of these people are really well-meaning about their intention to help, but have no effing idea how much damage they can do. To their own mental health and to that of others.
When working with someone with very mild trauma, validation and empathy can go a long way. For many, compassion and feeling seen and understood may be enough. However, for people with Posttraumatic Stress Disorder, a few kinds words isn’t going to cut it. People will PTSD are unlikely to find relief without specific, targeted support.
Trauma work is difficult. Progress is often slow. The practitioner burnout rate is high, and this is seldom talked about. Doing this work can easily lead to overwhelm. You need clear boundaries around finances, your social media use, email inbox, self-care and time. You’ll also need strong strategies for how you’ll cope with the system and a constant stream of stories about how it’s letting families down.
While birth trauma affects 1 in 3 birthing people, it’s not as straightforward as finding clients and booking them in. It’s a myth that private practice only attracts the ‘worried well’. Private practice regularly attracts really unwell people who have been discharged/let go from other public or community services. Sometimes, it’s a soft place to fall and you really can help people this way. Other times, someone’s needs are simply too complex for a solo practitioner.
Trauma work requires crystal clear communication on what you can offer and what is outside your area of expertise. It requires extra admin time as people often cancel, turn up late, drop bomb shells in emails, ghost you, disappear for months, re-appear and then go through the cycle all over again. I will be honest with you in saying that as a childless Psychologist working full time with a waiting list, this was much easier to manage than it has been working part time with young kids. I simply can’t be there for people in the ‘witching hours’ as I’ve got my own witching hours at home 😊
For many psychologists, social workers and counsellors working within an organization, they’ll have a manager or managers who don’t understand the nuances of mental health. A client constantly shows up late or doesn’t show up at all? You’ll probably be expected to discharge them. Managers have turnover and financial goals to meet for the organization that often don’t match our goals for our clients’ mental health outcomes.
If you would struggle to work in a system where a Mum comes to you and you have to tell her there’s no appointments for 6-8 weeks, then working in a perinatal service may not be for you either.
If you have limited childcare hours and you financially can’t manage regular no-shows, then trauma work may not be for you (at this stage of life, anyway).
Beware the ‘me-search’. As in, reflect on whether you are pursuing this work in order to vicariously heal your own difficulties. Your clients are not a way for you to work through your own trauma. Do your own work first.
Who exactly do you want to serve?
Are your clients experiencing mild difficulty, or will you work with dual diagnosis and more complex presentations?
People from low income and marginalized backgrounds? Amazing, but think about who is going to fund it? If you’re thinking of offering private sessions do some research about bulk billing and the private practice model. It’s rarely sustainable once you factor in ALL your business costs.
What do you want to call yourself and what will you spend your days doing?
What model do you want to work in?
Generally speaking, if you want to receive referrals, assess and treat trauma then you’ll have a relevant degree and work under the ‘medical model’.
What insurance (and qualifications) do you need to perform said activities?
If your clients mostly want to have open-ended conversation, validation and compassion then counselling or coaching might be appropriate.
In fact, meeting with an emotional first responder whom the clients trusts (e.g., their midwife, doula, child maternal health nurse, yoga teacher and so on) can be most appropriate as a first step. So long as you stay in your lane so to speak.
Where do you want to work? On the phone or Zoom? In a rented office space? In a GP practice? In a hospital? On your own or with a team? No one who works with complex trauma should be working in isolation.
Would you want to move countries at some stage? Would your qualifications be recognized? I once wanted to move from Melbourne, Australia to California. While they would recognize my PhD, if I wanted to work as a Clinical Psychologist I’d have to take my placements and get licensed all over again. After 12 years of full time study that was a ‘no’ for me!
Coaching and counselling can be global (check specific guidelines) meaning you can work anywhere.
When can you see clients? Will it be in addition to another job?
If you’re offering coaching, counselling or other 1:1 work, parents will often want to see you after hours when the kids have gone to bed or on weekends. Is this something you can do? Or will you need to set clear boundaries about business hours?
How will you know if you are in the right headspace for this work?
How will you know if you are in over your head?
Do you have a mentor or supervisor in place?
How will you cope if you are unexpectedly triggered or impacted by a certain client or presentation?
Do you know what to do if someone suddenly has a panic attack, dissociates or dips into a manic or psychotic episode? Do you have the skills to help them through it if they become ‘stuck?’
How would you know if someone is depressed or really sleep deprived?
How would you know if someone is experiencing delusions versus family violence or again, good old sleep deprivation?
How will you know if your client is able and ready to engage in self-actualisation? Note that starting any therapeutic work is extremely difficult when you’re in the midst of unemployment, family issues, lack of suitable housing, poor sleep, inadequate access to nutritious food and childcare.
How will you support yourself financially, emotionally and practically when you need to take a break?
These points of reflection are not designed to put you off. These are real questions and scenarios that I’ve covered in supervision with psychologists, counsellors, social workers and other practitioners.
Ways to work with me:
- I offer 1:1 business mentoring for people in perinatal work. Most of my clients are established psychologists, social workers, midwives and nurses who are in the early stages of building their business. We often do a hybrid of (1) supervision and/or client case discussion and (2) business mindset work – visibility and impostor fears, building passive income streams and making global impact beyond 1:1 work.
You can book into my calendar HERE
Soulful Strategy – a 10 week mastermind for mental health practitioners who want to step into growth and leadership without all the bro-preneur hustle. It will re-launch 2022.
Course Creation for the Caring Professions – a self-paced guide to creating and marketing online courses. I teach you everything I know and take you under the hood of my 4 courses with over 2600 students in 3 countries.
Birth trauma and perinatal mental health courses
Birth Trauma Training for Birth Workers online course
Motherhood, Mental Health & Social Media will be released 2022.
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