Working with Women in Recovery Across the Perinatal Period Interview with Clinical Psychologist, Joanne Sparrow, PhD., Integrative Psychological Services of Seattle
By Kima Tozay, LICSW
About Dr. Sparrow
Dr. Sparrow has worked in the field of community mental health for several years and has provided therapeutic services to individuals, couples and families presenting with various challenges.
She has experience in infant mental health and received training in many evidence-based practices including The Incredible Years, Parent-Child Interaction Therapy (PCIT), Promoting First Relationships (PFR), Dialectical Behavior Therapy (DBT), Emotion-Focused Therapy (EFT), and Eye Movement Desensitization and Reprocessing (EMDR).
Dr. Sparrow is also trained in the Families Moving Forward Program, an intervention designed for parents and caregivers of children (ages 4 to 13) with prenatal alcohol exposure histories or a fetal alcohol spectrum disorder.
Therapeutic Approach
Her role in working with women and addiction during the perinatal period is to make sure she is coordinating care with their PCP, Family, and OB. She works from an attachment perspective, focusing on the quality of early relationships as templates. Dr. Sparrow also uses feminist and trauma informed approaches, works collaboratively and considers the intersectionality of gender, identity, color, SES, and cultural background in her assessments. Motivational interviewing, Cognitive Behavioral Therapy (CBT) and EMDR are just a few therapeutic modalities she uses in her work with this population.
What the Research Says
She noted that the literature on this topic points to the importance of women having relationships with their provider, and safety and trust within that relationship for them to embrace it. “Research finds that when women find providers and programs where they have support, women tend to do better and stay in recovery longer.”
Dr. Sparrow went on to explain that the literature indicates women are starting to use more alcohol. “It’s a concern because we metabolize differently, become addicted more quickly, and we experience higher levels of heart disease and liver functions.” She described women and drinking as a public health concern. She noted that 15% of pregnant women do use alcohol during their 9 months of pregnancy and has been as high as 20% of women (1 in 5). The impact that alcohol has on the fetus is that as the fetus is exposed to more alcohol there is more potential for Fetal Alcohol Spectrum Disorders to develop.
Challenges with Stigma and Disclosure
Dr. Sparrow shared that using alcohol during pregnancy is difficult for women to disclose because of judgment and stigma. There is a double standard and women carry a lot of shame and guilt around their substance use. There are a lot of misconceptions and judgment such as if they want to stop drinking, they would. It is not that easy. Women also drink for different reasons than men; it cannot be one size fits all.
How the Pandemic has Taken a Toll
According to Dr. Sparrow, “Women have experienced the brunt of the pandemic.” She noted that one way the pandemic has made an impact on women, is that many women turned to alcohol to cope. Studies suggest social media plays a role in alcohol being seen as a cure all. A recent survey conducted 1 year ago, suggested alcohol use rose by 54% at the beginning of the pandemic, and there was a 17% increase in alcohol consumption and a 41% increase in heavy drinking for women.
What Providers Can Do
Dr. Sparrow stresses that providers need to be aware of gender and the roles that cultures carry for women. For example, being mindful of other things that may be impacting a woman’s experience if they’re struggling with substance use such as what it is like for marginalized groups like Women of Color, disabled women and LGBTQ populations. “We need to think more broadly.”
She also states that “recent models to treat addiction issues were based on studies on men. We have a different type of body; we don’t have the same enzymes to break down alcohol as men. If providers don’t come from a trauma informed perspective, we are doing more harm than good.”
12 Specific Ways Providers Can Support Women in Recovery
Dr. Sparrow highlighted specific ways providers can effectively support women during the perinatal period who are also dealing with substance use issues:
Hold the women with compassion; don’t add to their guilt and shame.
Recognize the shame, stigma, and guilt that women feel.
Look at your own biases.
Create safe spaces for women to say, “I think I have a problem and need help.” If they don’t feel safe, the problem goes undiagnosed and undetected.
Friends and family need to recognize barriers at the inter and intra personal level and structural level.
Postpartum relapse happens, it is not uncommon for her to return to alcohol use after childbirth. Remain vigilant and keep support in place. If a woman is struggling with depression and anxiety, these can be huge triggers.
Look at women’s issues from a BIOPSYCHOSOCIAL framework. What factors influence her substance use? Look at her social and economic environment, support system, gender, and culture. Women need treatment in a safe and nurturing environment. The therapeutic relationship is important.
Research shows that confrontation doesn’t really help, but breaks them down.
Create an atmosphere of acceptance, support and hope.
Address primary needs for trust, safety, building strengths. Women are strong and resilient.
Provide gender sensitive treatment and women do well.
Pregnancy is a time when women are more willing to take treatment if it will benefit their child. Counselors need to be supportive and have to stress that it is never too late to stop. Whenever she stops, the benefits can start.
If they have partner support, that is a protective factor. It can be key in supporting a successful intervention.
Resources for Providers Who Work with Women in Recovery
Screening tools:
Providers who work with pregnant and postpartum mothers need to familiarize themselves with a variety of validated assessments and screening tools to collect information on substance misuse and associated health and mental health issues. These tools include the following:
● Patient Health Questionnaire – 9
● Edinburgh Postnatal Depression Scale for maternal depression
● CAGE survey for substance misuse
● Hurt, Insulted, Threatened with Harm and Screamed (HITS) Domestic Violence Screening Tool
● Partner Violence Screen
● Adverse Childhood Experiences
Recovery Programs in Washington State for Pregnant Women
· CUP Services (Chemically Using Pregnant); CUP Women providers
· HarborCrest Behavioral Health
Grays Harbor Community Hospital
1006 North H Street
Aberdeen, WA 98520
Phone: 360-537-6258
· Providence Recovery Program
Providence Regional Medical Center Everett
916 Pacific Avenue
Everett, WA 98201
Phone: 425-258-7390
· Swedish Medical Center
Ballard Community Hospital
5300 Tallman Avenue NW
Seattle, WA 98107
Phone: 206-781-6048
· EvergreenHealth Monroe Recovery Center
17880 147th Street SE
Monroe, WA 98272
Phone: 360-794-1405
· Therapeutic Health Services (THS Pregnancy and Family Recovery Program):
1-833-278-HELP