Atlas›Domain XV · Nature, philosophy, social & rites of passage›Guide 106
Guide XV-106

Matrescence and new-parent rites

Dana Raphael, Aurélie Athan1975
A 35 · L 47 · M 1823 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Aurélie Athan's matrescence framework as set out in her 2024 Frontiers in Psychiatry perspective (ten developmental domains, strengths-based assessment alongside screening), together with her reproductive-identity work at Teachers College; for living-tradition rites, only what the religious bodies themselves publish (Church of England Thanksgiving for the Gift of a Child used as the worked example); for designed rituals, Imber-Black and Roberts, Rituals for Our Times (HarperPerennial, 1993); for cultural assessment, the DSM-5 Cultural Formulation Interview (CFI) and its supplementary modules as the American Psychiatric Association publishes them.

What it is. Matrescence is not a therapy. It is a developmental concept: becoming a mother, seen as a transition comparable to adolescence. Athan credits the medical anthropologist Dana Raphael with the term, from a 1975 chapter in Being Female: Reproduction, Power, and Change that framed matrescence as a "new/old" rite de passage, and quotes Raphael: "The critical transition period which has been missed is matrescence." Athan says the term was largely neglected for about fifty years until she revived it [source: Athan 2024]. Athan describes it as a lifelong developmental transformation across biological, neurological, psychological, social, cultural, economic, moral, ecological, existential and spiritual domains, with challenges and opportunities in each [source: Athan 2024]. Her related concept, reproductive identity (how a person self-identifies about "if, when and how" to have children, to which she adds "who"), is fluid, non-binary and covers men, LGBTQ+ people and anyone facing the question of parenthood [source: Teachers College 2020].

New-parent rites are the ceremonies families and traditions use to mark a birth or adoption and the parents' new status. Examples include religious services of thanksgiving and naming, postpartum confinement periods, and recently invented "mother blessing" gatherings. The guide covers the therapist's work around these rites. It does not cover running them.

How change happens (as the sources frame it). Athan's claim is that giving a developmental name and frame to what a new mother goes through ("you have to name it to tame it") lets clinicians tell normal developmental upheaval apart from disorder, see growth as well as risk, and treat what is impairing without pathologising the rest [source: Teachers College 2020; Athan 2024]. Rites, whether inherited or co-designed, give that transition a shared, witnessed form. The therapist helps the client find what the rite means, work through conflict around it, and grieve rites that were missed [synthesis]. Athan says the framework has not been validated as a clinical framework, and the 2024 paper is a perspective without new data [source: Athan 2024].

Cross-references. Death, miscarriage and mourning rites: Domain XV 112 (mourning rites). Infant genital cutting and other harmful practices: Domain XVI (cross-referred only, not described here). Pilgrimage: XIII 307. Menstrual and postpartum seclusion harms: XV 099 (menarche rites and seclusion of girls at puberty), which includes a harm account on chhaupadi.

2. Framework

There is no published manual, phase model or session count for using matrescence in therapy. The phases below are a working structure built from the sources' recommendations [synthesis]. Sources give no session numbers, so none are stated.

  • Phase A: Assessment and safety. Goal: screen for perinatal mental disorder and risk, and assess the person's experience as development (positive and negative) across domains [source: Athan 2024]. Format: individual, with partner or family by invitation. Move on when risk is assessed and managed, and when you and the client agree what is development and what needs treatment or referral [synthesis].
  • Phase B: Naming the transition. Goal: introduce the matrescence and reproductive-identity frames if the client finds them useful, and map the domains where change is happening [source: Athan 2024; Teachers College 2020]. Move on when the client can describe their transition in their own words [synthesis].
  • Phase C: Culture, tradition and family. Goal: use the CFI core interview and relevant supplementary modules (Spirituality, Religion, and Moral Traditions; Social Network; Psychosocial Stressors; Caregivers; Cultural Identity) to understand which rites the family expects, who holds authority over them, and where conflict lies [source: APA CFI Supplementary Modules]. Move on when the client knows which rites they want, which they are ambivalent about, and which they refuse [synthesis].
  • Phase D: Preparation for a rite. Goal: prepare the client for a traditional rite (or co-design a personal one) as its author, with consent, access and cost planned [source: Imber-Black and Roberts 1993 (chapter structure); synthesis].
  • Phase E: Debrief and reincorporation. Goal: process what happened at the rite and fold its meaning into the client's ongoing identity, relationships and work. Return to Phase A whenever symptoms or risk change [synthesis].

These phases overlap and repeat, because Athan describes matrescence as ongoing rather than a single event (emerging, middle and late motherhood) [source: Athan 2024].

3. Guiding principles

  • Development before diagnosis, but never instead of it. Use developmental language alongside diagnosis, and still assess impairment and refer when warranted [source: Athan 2024].
  • Positive and negative together. Ask about strengths, growth and "perinatal flourishing" as routinely as about symptoms, to reduce false-positive pathologising [source: Athan 2024].
  • Listen to her story. Athan cites Cox's guidance for EPDS use: alongside the score, listen to the mother's story and consider listening visits or referral [source: Athan 2024 citing Cox].
  • Many domains. Ask about social, economic, moral, ecological and spiritual change, not only mood [source: Athan 2024].
  • Inclusive identity. Becoming a parent includes non-birthing, adoptive, surrogacy-involved, LGBTQ+ and male parents. Use the client's words for their role [source: Teachers College 2020; Athan 2024 mentions surrogacy and adoption; synthesis].
  • Culture can help or hinder. Cultural norms and postpartum practices can support or hinder development. Help the client sort outside expectations from their own preferences [source: Athan 2024].
  • Traditions speak for themselves. Describe a rite only as its own institution publishes it, in outline. The client and their religious authority, not the therapist, define what the rite means and requires [synthesis].
  • Do not appropriate closed ceremonies. The Diné Blessingway (Hózhǫ́ǫ́jí) is a sacred ceremony. Diné people have objected to non-Native use of it and of its name. Do not offer, adapt or name a non-Native ritual after it [source: Navajo Times 2023; RNS].
  • Client as author. In designed rituals, the client chooses the purpose, people, place, symbols and words. The therapist helps them plan [source: Imber-Black and Roberts 1993 (chapter 4 covers preparation, people, place, participation and presents); synthesis].
  • Cultural humility. Ask, do not assume, and check your own reactions to unfamiliar practices [synthesis].
  • Safety first. Risk to parent or infant comes before meaning-making. A helpline is not an emergency service [source: Illinois DocAssist (PSI HelpLine note)].
  • No health prescriptions. Give no diet, food, fasting, supplement, exercise or medication advice in connection with postpartum traditions. Route those questions to the midwife, health visitor, physician or registered dietitian [synthesis].
  • Boundaries and roles. If you are also a doula, celebrant or member of the client's congregation, think through multiple relationships before acting (APA Ethics Code Standard 3.05, Multiple Relationships) [source: APA Ethics Code]. Train and insure for any role you take on beyond therapy [synthesis].
  • Religious or spiritual problem. Where distress centres on a rite or a crisis of faith around parenthood, "Religious or Spiritual Problem" can be recorded under ICD-10-CM Z65.8, whose Includes list names religious or spiritual problem [source: ICD-10-CM Z65.8 (Unbound Medicine)]. DSM-5-TR's own wording is [uncertain: not verified].

4. Intervention inventory

The sources describe a concept, assessment recommendations, a ritual-planning structure and published rites. They do not describe a full set of named techniques. Interventions marked [synthesis] are therapist procedures built on those sources.

4.1 Introducing the matrescence frame

  • Purpose / when: For a new or expectant parent who feels "not themselves", fears they are failing, or worries that the changes they feel are illness. Use it after risk screening [source: Athan 2024; synthesis].
  • Steps: (1) Ask how the client would describe what is happening to them. (2) Offer the term as one option: a developmental transition, like adolescence, named by Raphael and developed by Athan. (3) Ask whether the frame fits, partly fits or does not fit. (4) If it fits, use it as shared language. If it does not, drop it [source: Athan 2024; synthesis].
  • Example language (illustrative): "Some researchers call this matrescence, a period of change as big as adolescence. Does that match what you're living through, or does it miss something?"
  • Watch for: The frame being used to dismiss real symptoms ("it's just matrescence"). It is working if the client feels less shame and can still name what needs treatment [synthesis].

4.2 Ten-domain developmental review

  • Purpose / when: Early in therapy, to map change beyond mood [source: Athan 2024].
  • Steps: Ask about each of Athan's domains, in your own words: biological (body, sleep loss, being "touched out"), neurological (how the client experiences their thinking), psychological (sensitivity, mental load, rumination, perfectionism), social (relationships lost, gained or mended; comparison), cultural (norms and postpartum practices), economic (career, unpaid work, pay), moral (unfairness noticed in work, healthcare, childcare), ecological (new concern for the environment), existential (shifting priorities and boundaries) and spiritual (reproductive grief, faith). For each domain, note both a challenge and a possible opportunity [source: Athan 2024 (Box 1); steps are synthesis].
  • Example language (illustrative): "We've talked about your mood. Can we also look at what's changed in your work, your friendships and what matters to you? Some of it may be hard, and some may be growth."
  • Watch for: Overload. Spread the review across sessions if needed. It is working when the client names at least one area of growth as well as strain [synthesis].

4.3 Positive-and-negative assessment alongside screening

  • Purpose / when: Whenever a validated screen is used, to balance symptom counts and lower false-positive diagnoses [source: Athan 2024].
  • Steps: (1) Give the screening measure your service uses (for example the Edinburgh Postnatal Depression Scale or the Whooley questions; do not improvise items). (2) Then ask open questions about what is going well, meaning, competence and connection. (3) Record both [source: Athan 2024; synthesis].
  • Example language (illustrative): "Thanks for filling that in. Now tell me what's been good, even small things, since the baby came."
  • Watch for: A high score must still be followed up, whatever strengths are present. It is working when the formulation includes resources as well as risks [synthesis].

4.4 "Listen to her story" after screening

  • Purpose / when: After any screening result. Athan cites Cox's advice that practitioners listen to the mother's story and consider listening visits or referral, in addition to checking for clinical depression [source: Athan 2024 citing Cox].
  • Steps: (1) Invite the birth or arrival story in the client's own order. (2) Reflect without correcting. (3) Ask what the score does and does not capture. (4) Agree next steps: more listening, a treatment plan, or referral [synthesis].
  • Example language (illustrative): "The questionnaire gives me a rough picture. I'd rather hear it from you. Where does your story start?"
  • Watch for: Traumatic birth material. Pace it, and assess for post-traumatic stress if indicated. It is working when the client reports feeling heard [synthesis].

4.5 Risk assessment and emergency routing

  • Purpose / when: At intake and whenever presentation changes [synthesis].
  • Steps: (1) Ask directly about thoughts of suicide, self-harm and harm to the infant, using your service's standard risk assessment. (2) Treat confusion, rapidly changing mood, unusual beliefs or perceptions, or severe sleeplessness after birth as a possible psychiatric emergency (possible postpartum psychosis) needing same-day medical assessment [synthesis]. (3) Give crisis resources. In the US: 988 for crisis; the National Maternal Mental Health Hotline 1-833-TLC-MAMA (1-833-852-6262), call or text, 24/7, English and Spanish; the Postpartum Support International (PSI) HelpLine 1-800-944-4773, call or text, which returns messages and "does not handle emergencies" [source: Illinois DocAssist]. In the UK and Ireland: Samaritans 116 123; local perinatal mental health services [synthesis]. (4) Lethal-means counselling covers safe storage and removal only [synthesis].
  • Example language (illustrative): "Many new parents have frightening thoughts they never act on. I ask everyone: have you had thoughts of harming yourself or the baby?"
  • Watch for: Shame-driven concealment, and fear that the baby will be removed. Explain clearly what you must do with what you hear [synthesis].

4.6 Separating developmental distress from disorder

  • Purpose / when: When client, family or clinician are unsure whether the client is ill. Athan calls "perinatal distress" a vague catch-all and asks for clearer distinctions [source: Athan 2024].
  • Steps: (1) Review duration, impairment, risk and history. (2) Name what looks like normal transition and what meets criteria for a disorder. (3) Treat or refer the disorder, using perinatal psychiatry for medication questions. (4) Keep the developmental frame for everything else [source: Athan 2024; synthesis].
  • Example language (illustrative): "Feeling unsure who you are now is very common. Not sleeping even when the baby sleeps, and feeling hopeless most days, is something I want us to treat."
  • Watch for: Never advise starting, stopping or changing a medicine; route this to the prescriber [synthesis].

4.7 CFI with the Spirituality, Religion, and Moral Traditions module

  • Purpose / when: When a tradition, faith community or moral expectations shape the transition or the planned rites [source: APA CFI Supplementary Modules].
  • Steps: Use the module as published, without improvising items. It covers the client's tradition and community ties and family backgrounds, how the tradition shapes daily life, family decisions and celebrations, private and communal practices and their importance, whether leaders, texts, prayer or rituals help with the problem, and whether tradition-related stress, discrimination or conflict has contributed to it [source: APA CFI Supplementary Modules].
  • Example language (illustrative): "Does your faith or your family's tradition have anything to say about this time after a birth? Is that a support, a pressure, or both?"
  • Watch for: Assuming one tradition per family. Ask about each parent's background. It is working when you can describe the expected rites and who decides about them [synthesis].

4.8 Family and caregiver modules

  • Purpose / when: When grandparents, in-laws or a partner are central to postpartum care or to rites [source: APA CFI Supplementary Modules; Ahuja et al. 2023].
  • Steps: Use the Social Network and Psychosocial Stressors modules with the client. With consent, use the Caregivers module with a family member providing care. It covers their caregiving tasks, rewards and strains, cultural traditions of helping, and others' support [source: APA CFI Supplementary Modules].
  • Example language (illustrative): "Your mother-in-law is doing a lot. Would it help if I heard how she sees this time, with you in the room?"
  • Watch for: Family members speaking over the client. Keep the client's preferences central [synthesis].

4.9 Mapping the family's birth and naming rites

  • Purpose / when: To surface expectations before they collide [synthesis]. The CFI parent addendum for children's assessment lists naming and the role of religion in family life among its topics [source: APA CFI Supplementary Modules].
  • Steps: (1) Draw a simple genogram. (2) For each generation, ask what was done when a child arrived: naming, blessing, religious service, seclusion period, celebration, and for whom (for example, boys only). (3) Mark what the client wants to keep, adapt or drop [synthesis].
  • Example language (illustrative): "When you were born, what did your family do? And your partner's family?"
  • Watch for: Old grief, such as rites given to a brother but not the client. It is working when the client can say what is theirs and what is inherited [synthesis].

4.10 Working with postpartum confinement traditions

  • Purpose / when: When the client's family keeps a postpartum rest or confinement period (for example, a 40-day confinement described in rural Punjab; also known as "doing the month" (zuo yuezi) in Chinese traditions and la cuarentena in Latin American traditions [uncertain: not verified]) [source: Ahuja et al. 2023; Athan 2024 citing Withers et al. 2018].
  • Steps: (1) Ask the client what the practice involves for them and who directs it. (2) Explore support (being cared for, rest) and strain (isolation, restricted movement or visitors, loneliness), both of which Ahuja et al. report [source: Ahuja et al. 2023]. (3) Problem-solve contact and mental-health access within the practice, for example by phone or video [synthesis]. (4) Send all food, diet and infant-care health questions to the midwife, health visitor, physician or registered dietitian. Give no diet advice [synthesis].
  • Example language (illustrative): "Some people find the confinement month restful, and some find it lonely. What is it like for you so far?"
  • Watch for: Restricted eating, or fears about food and body after birth. Screen for disordered eating and refer to an eating-disorder service or registered dietitian. In the US, the National Alliance for Eating Disorders offers support [synthesis]. Also watch for movement restrictions that block access to care [source: Ahuja et al. 2023].

4.11 Gendered celebration and son-preference distress

  • Purpose / when: When celebrations differ by the baby's sex, or the client feels judged for not having a son. Ahuja et al. note that such ceremonies could distress mothers without a son [source: Ahuja et al. 2023].
  • Steps: (1) Name the pattern without blaming the culture as a whole. (2) Explore the client's feelings and the family's messages. (3) Consider a celebration the client designs for this child (see 4.15) [synthesis].
  • Example language (illustrative): "It sounds as if the family celebrated differently this time. How did that land for you?"
  • Watch for: Pressure toward further pregnancies, or coercion. Assess safety and domestic abuse [synthesis].

4.12 Preparing for a religious new-parent rite

  • Purpose / when: When the client is planning a rite in their tradition and feels ambivalent. For example, the Church of England offers a Thanksgiving for the Gift of a Child, in which the child is named and blessed, alongside baptism. It is intended for parents who see it as a step before baptism, who do not want baptism yet or at all, or who are unsure they can make the baptismal promises. The parish source says the two services differ in "the extent and depth of Christian commitment" [source: Binsey Mission].
  • Steps: (1) Ask what the rite means to the client and to each family member. (2) Clarify the options the tradition itself offers, by asking the client to check with their minister or leader [synthesis]. (3) Explore what the client can honestly say or promise. (4) Plan practicalities: access, cost, who attends, the baby's and parent's physical needs [synthesis].
  • Example language (illustrative): "You said you aren't sure you can make the promises. What would it be like to ask your vicar what other options the church offers?"
  • Watch for: The therapist advising on doctrine. Leave that to the tradition. It is working when the client makes a choice they can stand behind [synthesis].

4.13 Interfaith and mixed-family negotiation

  • Purpose / when: When the parents come from different traditions, or from faith and no faith, and the families expect competing rites [synthesis].
  • Steps: (1) Run the CFI spirituality module separately for each partner [source: APA CFI Supplementary Modules]. (2) In a joint session, have each partner say what they need the child's welcome to include and what they cannot accept. (3) Generate options together: sequential rites, a joint ceremony, or one rite plus a family celebration. Check each option with the relevant religious authorities if the couple wishes [synthesis].
  • Example language (illustrative): "Let's hear what each of you can't do without, before we look at what could fit together."
  • Watch for: One partner conceding under family pressure. It is working when both partners can explain the plan to their own families [synthesis].

4.14 Collaboration with the client's religious leader

  • Purpose / when: When the client wants guidance from their tradition, for example on options for an unbaptised child, an adoptive family, or a parent excluded from a role [synthesis].
  • Steps: (1) Get written consent and agree exactly what will be shared. (2) Let the client lead the contact where possible. (3) Ask the leader about options, not doctrine for you to apply. (4) Debrief the client afterwards [synthesis].
  • Example language (illustrative): "Would you like to speak to the rabbi yourself, or would it help if I joined the call with you?"
  • Watch for: Breaches of confidentiality, and the leader being drawn into clinical decisions [synthesis].

4.15 Co-designing a personal new-parent ritual

  • Purpose / when: When no inherited rite fits, or one is wanted in addition: for example after adoption, surrogacy, a NICU stay, a single-parent or LGBTQ+ family, or a parent who wants their own transition marked [source: Imber-Black and Roberts 1993; synthesis].
  • Steps: Follow Imber-Black and Roberts' planning headings (chapter 4: preparation, people, place, participation and presents) and their attention to symbols and symbolic actions (chapter 5) [source: Imber-Black and Roberts 1993 (contents)]. (1) Purpose: what change is being marked? (2) People: who is invited, who is not, and who speaks. (3) Place: home, outdoors, place of worship. (4) Participation: what each person does. (5) Presents and symbols: objects or actions chosen by the client. (6) Consider what the client's own heritage offers, and avoid borrowing closed ceremonies (see 4.16) [synthesis].
  • Example language (illustrative): "If this ceremony said one thing about who you've become, what would it say? Let's build from that."
  • Watch for: The therapist's taste taking over. Write the client's words, not yours. It is working when the client describes the ritual as theirs [synthesis].

4.16 Mother blessing gatherings and cultural appropriation

  • Purpose / when: When a client is planning or invited to a "mother's blessing" (a spiritual alternative to a baby shower), or has been offered a "Blessingway" by a non-Native practitioner [source: RNS].
  • Steps: (1) Explore what the client hopes for: support, witness, spiritual meaning. (2) Share, without lecturing, that Blessingway (Hózhǫ́ǫ́jí) is a sacred Diné ceremony. Diné people have raised concerns about its appropriation, and Native representatives objected to the term's use in a 2004 book on these gatherings. Many organisers now use "mother's blessing" instead [source: Navajo Times 2023; RNS]. (3) Help the client build the gathering from their own or freely shared traditions (see 4.15) [synthesis].
  • Example language (illustrative): "What you want sounds like being held by the women in your life. We can design that without borrowing a Diné ceremony."
  • Watch for: Practitioners selling ceremonies from closed traditions. It is working when the client's gathering stands on its own sources [synthesis].

4.17 Debriefing and reincorporation after a rite

  • Purpose / when: In the sessions after a rite, whether traditional or designed [synthesis].
  • Steps: (1) Ask what happened, what moved the client, and what hurt. (2) Ask what the rite changed: how they see themselves, how others treat them. (3) Link these changes to the domains map (4.2). (4) Note unfinished business for further work [synthesis].
  • Example language (illustrative): "Now that it's over, what do you carry away from it?"
  • Watch for: Anticlimax or conflict at the event. Normalise this, and work through it [synthesis].

4.18 Missed, refused or disrupted rites

  • Purpose / when: When a rite could not happen (for example the baby was in neonatal care, travel restrictions, migration, or family estrangement), or was refused to the client or by the client [synthesis].
  • Steps: (1) Name the loss. (2) Explore grief, shame or guilt, including toward the client's parents or community. (3) Consider a belated rite, an adapted one, or a personal ritual (4.15), or ask the tradition whether a later rite is possible (4.14) [synthesis]. Where the distress is mainly religious, consider recording Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)].
  • Example language (illustrative): "You never got the welcome you had imagined for her. It makes sense to grieve that, and we can think about whether it's too late."
  • Watch for: Self-blame, depression and complicated family dynamics [synthesis].

4.19 Reproductive grief and rites

  • Purpose / when: Infertility, miscarriage, stillbirth or loss alongside a living child. Athan names reproductive grief as a spiritual-domain challenge, with faith or practice as a possible comfort [source: Athan 2024].
  • Steps: (1) Assess grief, and assess prolonged grief per DSM-5-TR and ICD-11 criteria if indicated. (2) Ask whether the client's tradition offers mourning or naming rites for the loss. (3) Support a personal memorial ritual if the client wishes [synthesis]. Cross-refer XV 112 (mourning rites).
  • Example language (illustrative): "Is there anything your tradition does, or anything you'd want to do, to mark the baby you lost?"
  • Watch for: Suicidal thoughts. Follow safe-messaging practice and give crisis resources (988 US; Samaritans 116 123 UK and Ireland) [synthesis].

4.20 Reproductive identity across family forms

  • Purpose / when: For non-birthing partners, fathers, adoptive parents, LGBTQ+ parents, people using surrogacy, and people unsure whether to parent. Athan's reproductive identity covers "if, when and how", plus "who", across all genders [source: Teachers College 2020; Athan 2024].
  • Steps: (1) Ask how the client names their role. (2) Explore how their wish to parent formed and what influenced it. (3) Explore social forces such as family, work and policy [source: Teachers College 2020]. (4) Identify rites or recognition the client lacks, and plan for them (4.15) [synthesis].
  • Example language (illustrative): "Everyone keeps asking how your wife is. How are you becoming a parent?"
  • Watch for: Exclusion from religious or family rites because of sexuality or gender. Validate the hurt and explore the options (4.14, 4.18) [synthesis].

4.21 Matrescence education groups

  • Purpose / when: Athan recommends matrescence education alongside childbirth preparation, and prevention and early intervention within stepped care [source: Athan 2024].
  • Steps: (1) Hold groups for expectant or new parents. (2) Introduce the domains. (3) Invite peer sharing of challenges and growth. (4) Cover warning signs and resources (4.5). (5) Set up referral pathways for those who need treatment [synthesis].
  • Example language (illustrative): "Tonight we'll talk about what changes when you become a parent: not just sleep and feeding, but who you are."
  • Watch for: Comparison and shame inside the group. Screen individually as well [synthesis].

4.22 Economic and moral-domain work

  • Purpose / when: For returning to work, career setbacks, unpaid labour or anger at unfairness. Athan lists advocacy, entrepreneurship and social-impact roles as possible responses [source: Athan 2024].
  • Steps: (1) Validate the client's anger at systemic unfairness. (2) Separate the factors they can influence from those they cannot. (3) Plan concrete steps, such as negotiating leave and using values-based problem solving [synthesis].
  • Example language (illustrative): "Part of what you're feeling is a reasonable response to unfair conditions. What would you want to do with that energy?"
  • Watch for: Burnout, and self-blame for structural problems [synthesis].

4.23 Safeguarding and harmful practices around birth rites

  • Purpose / when: When a family rite or home remedy may put the infant or parent at risk [synthesis].
  • Steps: (1) Ask neutrally about planned practices. (2) Refer health questions to the paediatrician, midwife or health visitor. Ahuja et al. describe health professionals advising against harmful home remedies for newborns while supporting helpful practices such as family support [source: Ahuja et al. 2023]. (3) Follow child-protection duties where the infant is at risk. Infant genital cutting and other harmful practices are covered in Domain XVI and are not described here [synthesis].
  • Example language (illustrative): "I'd like you to check that with the baby's doctor. Many families keep the parts of a tradition that help and drop the parts that could harm."
  • Watch for: Coercion of the parent. Postpartum seclusion that cuts the parent off from care or safety [source: Ahuja et al. 2023]. Chhaupadi-type seclusion has a harm account in XV 099.

5. Handling problems

The sources address few of these problems directly. Guidance is [synthesis] unless a source is tagged.

  • Client rejects the matrescence frame ("I'm just depressed"). Accept it. Use the client's own language and keep developmental questions as background. Athan presents the term as an addition to diagnosis, not a replacement [source: Athan 2024; synthesis].
  • Frame used to minimise illness, by client, family or clinician. Go back to the screening and impairment review (4.3, 4.6) and state your clinical opinion clearly [synthesis].
  • Overwhelm and exhaustion in session. Shorten the session, focus on one domain, offer a flexible format (for example a remote session or the baby present), and build in sleep and practical support with the client's network. Give no sleep schedules. Route persistent insomnia to the physician or sleep medicine; CBT-I is the first-line treatment (cross-refer Domain II 069, 068) [synthesis].
  • Non-attendance. Treat missed sessions as an expected part of early parenthood rather than resistance. Offer brief check-ins, and keep risk follow-up active [synthesis].
  • Family conflict over a rite reaches the session. Return to each person's needs (4.13). With consent, invite the key family member using the Caregivers module (4.8). Do not take sides on the tradition's requirements [synthesis].
  • Client asks you to rule on religious questions. Decline the role, and offer collaboration with their leader (4.14) [synthesis].
  • Therapist discomfort with a practice. Seek consultation. Separate cultural difference from actual risk to safety, and act only on the risk (4.23) [synthesis].
  • Rupture after you questioned a tradition (or a borrowed ceremony). Acknowledge it, apologise for any lack of humility, and restate that the client is the author of their decisions. Return to their goals [synthesis].
  • Requests for diet, fasting, supplement or exercise guidance tied to a postpartum tradition. Do not advise. Refer to the midwife, physician or a registered dietitian. Screen for disordered eating, and refer to an eating-disorder service (in the US, the National Alliance for Eating Disorders) where indicated. Never advise on starting, stopping or changing medicines [synthesis].
  • Dual roles. If you are also the client's doula, celebrant or fellow congregant, assess the multiple relationship under APA Ethics Code Standard 3.05 before agreeing to take part in their rite. Prefer referral to an independent celebrant or leader [source: APA Ethics Code; synthesis].
  • Partner or family coercion, domestic abuse, or pressure toward further pregnancies. Assess safety, use safety planning, and follow safeguarding and legal duties for adults and children [synthesis].
  • Risk escalates. Use emergency services or same-day psychiatric assessment. A helpline is not an emergency service: PSI states its HelpLine "does not handle emergencies" [source: Illinois DocAssist; synthesis].
  • Grief after a missed rite turns into prolonged grief or depression. Assess formally, and treat or refer (4.18, 4.19) [synthesis].

Sources

← Previous · XV-105Marriage ritesNext · XV-108 →Vocational rites (white-coat ceremony, Iron Ring)