Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 3 Goals & Objectives 6-7 Practical Considerations 7-8 Group Details 7 Rules & Guidelines 8 Methods & Research 9 Group Format 10-41 Session One 10-16 Session Two 17-21 Session Three 22-25 Session Four 26-29 Session Five 30-32 Session Six 33-37 Evaluation Methods 38 References 39-41 Appendix A 42-59 Appendix B 42- Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J Topic & Rationale The widespread rates for postpartum depression range from 5% to 25% depending on the characteristics of the population (Gaynes et al., 2005). Many things are believed to contribute, interact with, or trigger postpartum depression including psychological, social, and genetic factors. The stress of being a new mother, the responsibility of caring for an infant, and the

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 6 how to cope. Goals & Objectives The main goal for the psychotherapy group is to allow women who have postpartum depression to understand that they are not alone in their struggles with their newfound motherhood. The support group will promote improved mental health and a healthy relationship between mother and child. This will be achieved by addressing and recognizing their frustrations and depressive symptoms and the effects that they have on their lives and the lives of their loved ones. It is important to address the negative implications and ideas presented by society, and ensure members that their struggles and symptoms do not make them bad mothers, weak, or insufficient. Another goal within the group will be to discover a way for each member to manage their depression, whether through the psychotherapy group alone or by consulting a medical professional. Goals will be measured upon completion as well as weekly evaluation. Facilitators will develop goals for each session. Initial focus of the group sessions will be on education regarding PPD including prevalence, disease process, and implications. The following sessions will focus on depressed mood, irrational thoughts/beliefs, and improvement of internal dialogue. The sessions will apply coping skills and thought improvement exercises to attain the desired goals for each session. Practical Considerations

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 9 Hansotte, & Payne, 2017). This approach places focus in the beginning stages of group therapy on education, evolving in later sessions on strategic applications to reduce negative aspects of PPD while increasing positive internal processes. Group Format Group Session 1: The Initial Stage Kelly Evans, LPC Introduction This will be session 1 of 6 extensive therapy sessions for women who are suffering from Postpartum Depression. The first session of group therapy is part of the initial phase. This phase usually involves orientation and is usually a time when member’s responses will be socially acceptable. During this phase most members of the group may feel anxiety and be unsure of their place in the group. There will be an uncertainty of what will be expected as members of this group, questions of confidentiality and concerns on acceptance. This will be a time of getting to know what each member feels is socially acceptable to say and what the norms of the group will

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 12 ● The therapist will record the responses from both icebreakers to use in later sessions. ● Therapist will then have the group members divide into groups of two. This will be a dyad that is posing the question: What would the perfect day look like for you? ● After 5-7 minutes the dyads will rejoin the group and discuss their partner’s results. ● The therapist will attempt to link members who have similar answers. Final Round-Robin Discussion: Fears and Questions ● The therapist will open the final round-robin discussion with this question: What concerns you the most (if anything) about group therapy? Go around the group and allow each group member a chance to state their concerns. ● The next question will be: Is there anything that you would like to discuss or any questions that you would like to ask before the next session? ● Provide “homework” for each member. Keep a small notebook by your side to record your emotions/thoughts throughout the next 7 days until the next group meeting. Then we will discuss these things in the next session. (Therapist will handout small journals with a pen for each of the members to record their thoughts.) Closing Out the Session: ● Therapist will say: It looks as if our time is coming to a close. ● Once again ask if there are any questions. ● Review next week’s meeting time and date. ● Remind them of their journal homework. ● Reiterate the importance of confidentiality.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 15 PPD may suffer bouts of anger, have difficulty concentrating, and making decisions. She may also suffer from physical symptoms such as aches and pains, including headaches, stomach problems and muscle pain. Lack of eating or eating too much and withdrawal from family and friends are often symptoms of PPD. A mother may also have trouble bonding with her baby or forming an emotional attachment with her child. A woman with PPD may doubt her ability to care for her baby and even have thoughts of harming her baby. While all of these symptoms are common with PPD, it is important that the mother seek help for this disorder immediately. (NIH, 2012) Counseling Techniques That Will Be Used: ● Active Listening ● Clarification ● Eye Contact ● Appropriate Responses ● Empathy ● Summarizing ● Questioning ● Linking ● Dyads ● Rounds ● Use of Props Group Session 2: The Transition Stage

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 18 ● Group leader will remind group of the homework journal given out in the first session. ● Icebreaker #1: Group leader will ask if any member would like to discuss any emotions or thoughts in their journal. ○ Group will discuss any emotions of thoughts that group members bring up. ○ Group leader will ask if anyone else shares the same emotions or thoughts at this time. ○ Individuals will learn that they are not alone on some emotions or thoughts. ● Icebreaker #2: Group leader will ask the group the question, What was your first thought this morning? ● Every member will state their first thought. ● Group leader will have the group contemplate on why they felt that way. ● Group will discuss similarities and differences in morning thoughts. ● Group leader will distribute Thoughts and beliefs chart. ● Group will discuss how thoughts and beliefs about a situation can influence choices of an action ● Group leader will discuss why the activity was done and orient to topic of self- understanding as a unique person or awareness and ability to understand one’s own actions and reactions. Second Round Robin Discussion: I Am A Person Who? ● Group Activity ● Group leader will hand out “I Am a Person Who?” worksheet with pencils: Appendix

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 21 to the light; exposing and challenging the things that haunt a mind throughout the day. During this phase most members of the group may vulnerable and emotional. Some trust will be built by this session and all members should actively participate. Members will be working through emotions and will require support from other members. In this stage we will build the members trust in themselves. While this place is safe and confidential, we cannot address all concerns when it comes to questions of confidentiality and concerns on acceptance since this an open group setting. It will be up to the leader to explain the group rules, confidentiality expectations, objectives and goals of the sessions. Session Procedures: ● Welcome: Introduction of Leaders/Qualifications/Mission Statement ● Discuss confidentiality and its limitations. Responses from each session will be documented for later therapy sessions. ● Summarize previous sessions ● Homework - journal review ● Icebreaker #1: What kind of animal do you feel like? ● Discussion: Fear ● Group Activity: Fear in a hat. ● Discussion: Perspective ● Group Activity #2: Tell me a story ● Discussion: Summarization ● “Homework” of keeping emotions/thoughts journal for the next week to be discussed

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 22 at next session. ● Close out session. First Round-Robin Discussion: Group Rules, Objectives, and Icebreaker ● The group leader will thank everyone for attending and welcome them to the group, offer water bottles/coffee. ● Leader will give credentials of leaders ● Leader will go over confidentiality and its limits. Ask if there are any questions? ● Leader will then say their qualifications and the mission of the session. ● Leader will let the group members know that the group is a safe place and that everyone is there for the same common goals but will also stress the gaps in group confidentiality. ● Summarize previous sessions ● First Icebreaker: Ask members what animal they relate with today. ● Discussion: Fear and anxiety ● Group Activity #1: Fear in a hat ○ Members will write their fear on a slip of paper and put in in a hat. ○ Go around the circle one by one drawing out fears and explaining why they feel the person could feel this way.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 23 Second Round-Robin Discussion: Perspective ● Discussion: Perspective ○ Discuss how different people see things vs. how they are experienced ● Group Activity #2: Tell me a story. ○ Place a series of pictures on the table ○ Ask the member to put them in order ○ Then ask them to tell the story picture by picture ● The counselor will record the responses from both icebreakers to use in later sessions. ● The counselors will attempt to link members who have similar answers. Final Round-Robin Discussion: Fears and Questions ● Closing Activity: On a scale of 1 to 10 how confident do you feel about moving past your depression? ● Ask if there are any questions or final thoughts/words of encouragement. Closing Out the Session: ● Counselor will inform group of closing session

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 24 ● Once again ask if there are any questions. ● Review next week’s meeting time and date. ● Remind them of their journal homework. ● Reiterate the importance of confidentiality. ● Closing thoughts and reminders that we are all here for the same purpose and no one is alone. ● Give the main office’s outreach/after hour’s numbers if someone needs to reach out. Materials: ● Slips of paper ● Hat ● Pencils ● Water bottles/coffee Counseling Techniques That Will Be Used: ● Active Listening ● Clarification ● Eye Contact ● Appropriate Responses ● Empathy ● Summarizing ● Questioning ● Linking ● Rounds

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 25 Emotion is comprised of three design levels; the visceral, behavioral and reflective. These three complementary aspects are present in even the most basic emotions, such as fear. The Visceral level is explained for this example as “gut” in reference to the concept of “gut instinct”. It’s a subconscious reaction that occurs when the body and mind are subjected to to certain circumstances or experiences. The visceral reaction, also known as the initial reaction, occurs when a sensory scan is performed of the experience. It’s immediate and involuntary. The behaviour level is explained by the reaction we have when we use our senses. How does it feel, look, smell, etc. Most of our experience with something comes from the time when we put it into use. These are the most meaningful of experiences because it displays “how it is” and not how we perceive it. The reflective level is explained as the experience that goes beyond the initial introduction or use; it’s the experience of association and familiarity. If the object of affection is taken away, it brings about emotion. Pathological anxiety is derived from interference in balance of the three levels. This imbalance interferes with the ability to cope successfully with life challenges. Once anxiety is involved panic follows and then fear shortly after that. Fear holds us back from doing things we would normally do and shelters us away from the things we love. It doesn’t always have to be a tangible object, it can be a thought that you ruminate on. Feeling exiled, physically or mentally, by your own doing or others, in anyway can lead to depression. Group Session 4: The Working Stage Rachel Hyler, LBSW

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 26 Introduction Session four of six will be the working or performing stage of this postpartum depression group. The working stage involves therapeutic methods and applications of counseling theories. This stage begins delving deeper into the symptoms of the underlying issue. At this point in group, the members will have built rapport with the therapists as well as their peers. This grounded rapport can be used as a therapeutic intervention by allowing not only the members to feel free to share, but also the desire to uplift one another. Session Goals & Objectives ● Understanding and improvement of positive self-talk ● Understanding and application of thought replacement ● Overall objective: Improve internal dialogue Session Procedures ● Topic: Positive Self-Talk & Thought Replacement ● Review ground rules ● Rose & Thorn Round: State one positive and one negative thought. ● Review & Evaluation of preceding session ● Icebreaker # 1: State one positive thing about the person to your right. ● Icebreaker # 2: Introduce quote “Your life is a reflection of your mind” ● Homework: Thought restructuring exercise ● Close session

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 27 First Round-Robin Discussion: Facilitator Introduction, Ground Rules, Session Review/Evaluation ● Facilitator will state name and qualifications ● Review Ground Rules ○ Confidentiality & Limitations ○ Respect for other members ○ Participation encouragement ● Review & Evaluation ○ Review skills from previous session ○ Application of skills learned during last session ○ Discuss outcome ● Topic will not be discussed until second round Second Round-Robin Discussion: Building Topic Positive Self-Talk ● Rose and Thorn Round ○ State one positive and one negative thought or feeling from the last week. ■ Counselor will write them on the whiteboard ● Counselor will hand out “Positive Words” handout: Appendix (__) ● Icebreaker # 1: State one positive thing about the person to your right. ○ Discussion: “How hard was it to state something nice to that person?”, “Would it have been that easy to tell them something negative?”

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 28 ○ Linking: “Was it harder for you to find something positive than it was negative about yourself?”, “Are the positive statements you gave to your co-member part of your self talk?” Third Round-Robin Discussion: Grounding Topic Improve Internal Dialogue ● Icebreaker # 2: Quote: “Your life is a reflection of your mind” ○ Discussion Round: “What does this statement mean to you” ● Counselor will discuss positive self talk ● Encourage members to create a positive internal dialogue ○ “Most people want to build up others but put themselves down.” ○ “Speak to yourself as if you are complimenting someone else.” ○ “When a negative thought arises, cast it out, don’t let it linger. Replace it immediately with a positive thought.” Closing Round ● Homework: Thought Replacement Activity: Appendix (__) ● Thank everyone for their participation ● Ask members if there was anything else they’d like to add before closing the session ● Next session date and time reminder Materials: ● Whiteboard ● Dry erase markers

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 29 ● Positive Words handout ● Thought Replacement handout ● Water bottles & coffee ● Tissues ● Notepad & pen Group Session 5: Working Stage Samantha McCreary, LPC Introduction This will be session 5 of 6 extensive therapy sessions for women who are suffering from Postpartum Depression. This session will be a part of the performing, or working, phase. At this stage members will begin delving into deeper and more significant issues, allowing for greater progress within the group. Members have established trust and relationships within the group, and can use this to grow as a group and as individuals by feeling more comfortable sharing and encouraging others to share. Session Procedures ● Welcome, introduction of leaders, qualifications ● Reminders about confidentiality, contract ● Summarize Past Sessions ● Icebreaker: Favorite Compliments ● Discussion Round: I feel most like myself when… ● Discussion Round: Biggest change/difficulty since having a child?

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 30 ● Homework ● Close Session First Round Robin Discussion: Facilitator Introduction, Ground Rules, Session Review/Evaluation ● Facilitator will state name and qualification ● Review confidentiality, limitations, respect for members, and participation encouragement ● Review topic and what was learned from previous session Second Round Robin Discussion: Insecurities and Confidence ● Icebreaker: Favorite Compliments ○ Think of one very important person in your life whose opinion carries great weight. Assume they are being completely honest. What is the compliment you would most appreciate receiving from them? ■ Why do you think this compliment, from this person, is so important to you? ■ Are there any common insecurities or shared favorite compliments within the group? Allow discussion. Third Round Robin Discussion:

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 31 Changes and Sense of Self ● What has been the biggest change for you since having a child? ○ Has this group helped you to adjust to that change? ○ How have the changes in your life challenged your sense of self? ● Finish the statement: ○ “I feel most like myself when…” ■ Have you been able to do this activity/be in this state since having your child? How can you make time to do what you need to feel like yourself? Closing Round: ● Make time at some point this week to do an activity you enjoyed before having a baby, but haven’t had time for since (hire a babysitter and go on a date with your spouse, go out with your friends, spend a few hours by yourself, etc.) ● Ask members if there is anything they’d like to add or discuss briefly before the end of the session. ● Thank everyone for participating ● Summary of session ● Next session date and time reminder Materials Needed: ● Water Bottles/Coffee

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 32 ● Tissues ● Notepad and Pen Group Session 6: The Termination Phase Jennifer Brooks, CRC Introduction: This will be session 6 of 6 extensive therapy sessions for women who are suffering from Postpartum Depression. The last session of group therapy is also considered to be the adjourning or termination phase. The final phase of the group is a time for members to consider what they have learned in the group and develop strategies for applying what they have learned in their daily life outside of the group. At this time the members will be encouraged to express and process their feelings and thoughts about this group. For many people, endings are difficult, and they may need to learn how to how to say goodbye in a productive manner. It is believed that if the group sessions has been fruitful for the members, that they will be able to extend their learning to the outside world, even though they may feel a sense of loss. During this phase, the members may put up a wall and become distant, argumentative and problematic, as in the past they may have negative experiences and the termination of the session may bring up these feelings of negativity. If this should happen, the leader should remind the members what they have learned from the group and lead them to properly display their feelings towards situations of termination as this experience should help them translate to the outside world. Materials:

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 33 ● Yarn ● Tissues ● Water bottles ● Coffee Session Procedures: ● The therapist will introduce herself and state her qualifications and purpose of the group. Remind the members of the group about the importance of confidentiality. ● Remind the members that participation is a strong determinant for successful treatment; therefore members will be expected to participate. ● Reflect of what took place in last session. ● Reflect on the homework assignment from the week before. ● Icebreaker #1: Have the members express what this group has done for them, how that they are different from the first meeting and state where they intend on go from this point. ● Discussion ● Icebreaker #2: Are there any” unfinished business” within the group, and if so, after the discussion, given the limited amount of time, it’s unrealistic that the problem may be solved, however the leader can discuss the impact of the member’s choice to leave this unfinished business at the end of the group and hopefully the members can translate to the outside issues the importance of not leaving things undone to the last minute. ● Discussion First Round-Robin Discussion: Group Rules, Objectives, and Icebreaker

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 34 ● The group leader will thank everyone for attending and welcome them to the group, offer water bottles/coffee. ● Group leader will then say their qualifications and the purpose of this session of the group. ● Group leader will remind the group of the confidentiality and that participation on every step is crucial to their progress. ● Group leader will remind the group members to the group is a safe place and that everyone is there for the same common goals. ● First Icebreaker: Have the members express how attending the group has been of benefit to them and their families, and how that they are feeling differently from the first meeting and state where they intend on go from this point. ● Discussion Second Round Robin: Dealing with feelings and Unfinished Business ● Icebreaker #2: Are there any” unfinished business” within the group, and if so, after the discussion, given the limited amount of time, it’s unrealistic that the problem may be solved, however the group leader can discuss the impact of the member’s choice to leave this unfinished business at the end of the group and hopefully the members can translate to the outside issues the importance of not leaving things undone to the last minute. Members are encouraged to share their feelings about the group closing, even if they have no “unfinished business”. At this stage, members are encouraged to provide feedback to one another, and say good bye. ● Discussion

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 35 Third Round Robin: The Closing Web ● Ask the members to stand in a circle. The group leader will be holding the start of the string as one member will pass it to another member of the group. Have each member take a moment before passing the string to another member of their choice to state how they have seen that person change since the first meeting or any other words of positivity or inspiration. ● At the end of the game the group leader will comment that we all played a part in creating this unique web and if one person was gone it would look different. In the same way it's significant to realize that we all take part to make the group what it is, distinctive and special. ○ After the activity, the members will discuss how the activity made them feel and any other reflection upon what they have learned from the group sessions. Closing Out The Session ● Group leader will ask if anyone has anything left to discuss or any questions. ● Group leader will remind group of confidentiality. ● Group leader will remind group that we are here together and no one is alone. ● The group will be reminded of main office outreach/after hours number if someone needs to reach out. ● Group leader will provide information for the members to other organizations that may be

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 36 equal of benefit to the clients. Counseling Techniques That Will Be Used: ● Active Listening ● Clarification ● Eye Contact ● Open Posture ● Empathy ● Summarizing ● Questioning ● Linking ● Rounds ● Use of Props Evaluation Methods Evaluating the group is a process that goes on throughout the group process. After each group session, the leader will evaluate the individual and the group to see what has happened in the session. The leader will ask if any changes came from the session and if any therapeutic and/or nontherapeutic forces are present in the group. The leader will also teach the group how to evaluate, so they can direct the movement or flow of their own group. They can decide if any changes need to be made to make the group a cohesive community. Sometimes a follow up evaluation can be extremely useful. Follow up evaluation is useful to assess outcomes. The follow up will be built into our program, and the

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 37 leader will schedule follow up meetings 6 weeks after the sessions to allow members some time on their own after sessions. At the follow up evaluation, the women can share and discuss the issues that they have run into since parting the group, talk about their processes and techniques they have taken to stay open for change, and to remember positive moments of the group. The follow up evaluation will give an outlet to express thoughts and feelings about their group experience. References Babich, S., Hansotte, E., Payne, S. (2017). Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: A systematic literature review. Public Health Reviews , 38 (1), 1-17. Baker, A., Fitelson, E., Kim, S., Leight, K. (2010). Treatment of postpartum depression: Clinical, psychological, and pharmaceutical options. Retrievedfrom: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/#__abstractid577560title Bennett, E. & Sylvester, A. (2012). “Postpartum Depression: What Every Counselor Should

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 38 Know”. Counseling.org . Retrieved 7 March 2017, from http://www.counseling.org/docs/default-source/vistas/postpartum-depression---what- counselors-need-to-know.pdf?sfvrsn=12 Dubber, S., Reck, C., Müller, M. et al. Archives of Women’s Mental Health (2015) 18: 187. doi:10.1007/s00737-014-0445-4 Gehart, D.R. (2013). Theory and treatment planning in counseling and psychotherapy. Boston, MA: Cengage Learning. Kettunen, Pirjo; Koistinen, Eeva , & Hintikka, Jukka, “The Connections of Pregnancy-, Delivery-, and Infant-Related Risk Factors and Negative Life Events on Postpartum Depression and Their Role in First and Recurrent Depression,” Depression Research and Treatment, vol. 2016, Article ID 2514317, 7 pages, 2016. doi:10.1155/2016/2514317 Mure An-Madar, A., Badan, A. (2015). The development and piloting of a CBT group program for postpartum depression. Journal of Evidense-Based Psychotherapies , 15 (1), 51-64. NIMH » Postpartum Depression Facts . (2017). Nimh.nih.gov . Retrieved 5 March 2017, from https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml Norman, D. A. (n.d.). Emotional Design . Cambridge, MA: Basic Books. Schneider-Corey, M., Corey, G., & Corey, C. (2014). Groups Process and Practice (9th ed.). Belmont, CA: Beooks/Cole Cengage Learning. Rubertsson, C., Hellström, J., Cross, M. et al. Archives of Women’s Mental Health (2014) 17: 221. doi:10.1007/s00737-013-0409-0 Schneider-Corey, M., Corey, G., & Corey, C. (2014). Groups Process and Practice (9th ed.). Belmont, CA: Beooks/Cole Cengage Learning.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 39 Tietz, A., Zietlow, AL. & Reck, C. Archives of Women’s Mental Health (2014) 17: 433. doi:10.1007/s00737-014-0423-x Yawn, Barbara P., Olson, Ardin P., Susan Bertram, Pace, William.,Wollan, Peter., and Dietrich, Allen J. “Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010,” Depression Research and Treatment, vol. 2012, Article ID 363964, 9 pages, 2012. doi:10.1155/2012/363964 Mackin, D. (2011, September 22). Teaming: Getting Past the Storm in Team-Building. Retrieved February 13, 2017, from http://thinknewdirections.com/leadership-engagement/blog- getting-past-the-storm-in-team-building-2/ Institute, S. (n.d.). Working With Student Teams. Retrieved February 13, 2017, from http://sites.psu.edu/schreyer/stages-of-the-teaming-process/stage-2-storming/ Storming: Clouds on the Horizon. (n.d.). Retrieved February 21, 2017, from http://humanresources.umn.edu/work-group-development/storming

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 40 Appendix A Support Group Talbot County Community Center Skipjack Room Tuesday Evening 6:00 pm FREE OF CHARGE Join the Talbot County Counseling Partners in our therapeutic group. Private atmosphere. Open to women suffering from postpartum depression.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 41 For more information: Talbot County Counseling Partners Www.TCCP/wecare .org phone (410) 725-0000 or fax (410) 634-0000 Appendix B Talbot County Counseling Partners Intake Form-Group Name: _____________________________ DOB: ___________________ Male: ___________ Female: _______ Marital Status: ________________ Address: _________________________________________________ # Of Household Members: ___________ Phone: (___) _____________________ (is it ok to say TCCP?) Yes___No____ Would you prefer to communicate through email? If so, please provide your email address below: _______________________________________________ Employer: __________________________ (TCCP will never contact your employer without your consent and only in cases of emergency.) Employer Address: _____________________________Phone: (___) ________________ (Ok to say TCCP? Yes__ No__) In Case of Emergency Notify: _____________________Phone: (___) ______________ (ok to say TCCP? Yes ___ No____)

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 42 Responsible Adult (if minor): _____________________ Phone: (___) ______________ Primary Care Physician: _________________________ Phone: (___) ______________ Psychiatrist: __________________________________ Phone: (___) ______________ Medical Problems: ______________________________________________________________________________ List of Medications you are currently being prescribed: ________________________________________ How did you hear about TCCP? ___________________________________________________________ Type of support group: _____________________________________________ Please circle the symptoms you are currently experiencing: None Mild Moderate Severe Sadness or Depression 0 1 2 3 Inability to Concentrate 0 1 2 3 Suicidal Thoughts 0 1 2 3 Obsessive Thoughts 0 1 2 3 Sleep Problems 0 1 2 3 Tension/Anxiety 0 1 2 3 Change in Appetite 0 1 2 3 Panic Attacks 0 1 2 3 Weight Change 0 1 2 3 Memory Problems 0 1 2 3

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 43 Compulsive Behavior 0 1 2 3 Hopelessness 0 1 2 3 Social Isolation 0 1 2 3 Strange Thoughts 0 1 2 3 Other: __________________________________________ 1: Please Circle the words that best describes how you are doing at your job: (0) Not Working (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 2: Please Circle the words the best describes how you are doing in your marital/significant other relationship: (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 3: Please Circle the words that best describes how well you are doing in your family relationships: (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 4: Please Circle the words that best describes how well you are doing with people outside of your family:

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 44 (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 5: What word best describes your current physical health: (0) Very Poor (1) Declining (2) Moderate Changes (3) No Changes 6: How would you describe your mood swings (if any)? (0) None (1) Mild (2) Moderate (3) Severe Please Circle : Alcohol Use: Never 1-3 times a month 2-3 times a week daily Intoxication Frequency: Never 1-3 times a month 2-3 times a week daily Illegal Drug Use: Never 1-3 times a month 2-3 times a week daily If you use illegal drugs, what drugs are you using? Marijuana Sedatives Stimulants Opiates Hallucinogenic Have you ever been in a drug/alcohol rehabilitation problem? Yes ____ No _____ If yes, When: ____________________________ Where:_______________________________________ Does anyone in your family have a history of alcohol or chemical abuse? ________________________________________________________________________ __________________________________________________________ Is there a history of mental illness in your family? _____________________ Whom? _____________________ Does anyone in your family suffer from Depression? ____________ Whom?

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 45 ________________________ Would you like to discuss other counseling options available? Yes ____ No _____ Disclosure: We at Talbot County Counseling Partners are all licensed counselors/LSBWs. We respect each one of our client’s and our potential client’s right to privacy. Please be aware however that any services provided by TCCP will be subject to a client/therapist contract and strict adherence to all laws pertaining to the state of Maryland and its mandates to report all abuse. Appendix C Talbot County Counseling Partners 10028 Ocean Gateway Easton, MD 21601 Phone (410) 725-0000 Fax: (410) 634-0000

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 46 Letter of Agreement for services with Talbot County Counseling Partners Contract for Clients in Psychotherapy Group: Postpartum Depression Welcome, I hope your time with us is worthwhile. We at Talbot County Counseling Partners (TCCP) are excited to offer this free counseling group to members of our community. This contract is not only to insure confidentiality in the group but also to show you our administrative practices and guidelines of our groups here at TCCP. Please go over this contract carefully and be comfortable with the details it provides. At the end of this letter/contract will be a place for you to sign and date. Your group counselor will sign this contract also and every participating member of the group has the same contract. Guidelines: 1: Confidentiality- What happens in the group, stays with the group. By signing this agreement you are stating that you understand. You agree that it is important for each member to feel comfortable in sharing their experiences and feelings with the group; therefore all information obtained within the group must stay there. You understand that any sharing of information obtained in this group on social-media, with family or friends will not be tolerated and may grounds for termination of group membership. All sharing must be done within the group setting and not outside of the group. You understand that there are boundaries for confidentiality, and that we at TCCP are all licensed counselors and are mandated by the state of Maryland to report all abuse of the elderly, handicapped and all children. 2: Participation- You understand that you are in no way obligated to participate in any discussion,

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 47 or counseling technique that you feel uncomfortable with. However in understanding this, you also acknowledge that a lack of participation may inhibit your ability to receive the full therapeutic experience of group counseling. 3: Dignity- No member of the group is ever allowed to disrespect, belittle or be condescending to another group member. Actions of this sort will be automatic termination of group membership. 4: Punctuality and Attendance- TCCP offers this counseling group free of charge to its members, however the meeting place is rented by the hour, therefore it is imperative for members to be punctual. This will allow the group to utilize the time available to us each week. Our designated meet time each week is (insert here). Should you be running late or cannot attend please contact us at the number provided in this contract or email us at www.TCCP/wecare.org 5: No drugs or alcohol- No drugs, smoking or alcohol will be permitted in the group sessions or on the grounds of the meeting place. These substances have an effect on the user that may be negative and therefore have no place in the positive atmosphere we are going to be creating. There will be no exceptions. Anyone breaking this rule will be terminated from the group immediately. 6: Intimidation/Violence- At no time will it be acceptable for any counselor or member to intimidate, coerce, threaten another person in this group. This includes any destruction of property of the meeting place or the other group members. Anyone breaking this rule will be terminated from the group immediately.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 48 7: Relationships outside of group- While is understandable that the commonality of some issues that arise in group may place a strong desire on members to form a bond outside of group; it is imperative to understand that this may disrupt the dynamic of the group. It is discouraged to seek this exclusivity between members outside of the group in order to insure equality in the group setting. 8: Termination- If at any time you feel that you would like to leave the group, we ask that you come to the meeting and tell your fellow members. This allows the other group members a chance to say goodbye and ask any questions that they may have. It also prohibits a group member from feeling as if they are the cause for your leaving. By signing this contract you agree to a final group meeting to allow closure for your time with us. (***yall can change this last line) 9: Responsibilities- I understand that it is the group leader’s responsibility to not only follow these guidelines but also enforce them. 10: Reaching Out- If at any time you would like to talk with a counselor about private counseling or other avenues of counseling, please do so before or after class. During group there is a lot of ground to cover, so questions of this sort should be reserved for another time. By signing/dating below you are stating that you agree to the terms of this contract. You understand that any breaches of this contract may be cause for termination of your participation of this group.

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 49 Group Member Date __________________________________ ________________ Counselor Date __________________________________ _______________ Disclosure: We at TCCP are in no way in placement of a medical doctor, nor can we diagnose any medical issues. Please see a medical doctor prior to this appointment to answer any medical questions you may have. We at TCCP care about your well-being and want you to explore all avenues in your best interest. Appendix D Thoughts & Beliefs Chart

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 50 https://iveronicawalsh.wordpress.com/2012/05/13/thoughts-cause-feelings-and-behaviours/ Appendix E I Am A Person Who...

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 51 Appendix F

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 52 Appendix G

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 53 Appendix H

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 54 Power Of Mind Thought: _____________________________________________________________________ Thought Replacement: _____________________________________________________________________________ Thought: _____________________________________________________________________ Thought Replacement: _____________________________________________________________________________ Thought: _____________________________________________________________________ Thought Replacement: _____________________________________________________________________________ Appendix I

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 55 Positive Words Kind Intelligent Hardworking Loyal Attractive Down-to-earth Goofy Creative Accepting Strong Friendly Flexible Nurturing Thoughtful Confident Optimistic Respectful Determined Skilled Helpful Motivated Humble Forgiving Enthusiastic Decisive Brave Listener Relaxed Reliable Self-directed Cheerful Resilient Trusting Independent Serious Modest Generous Honest Realistic Patient Funny Insightful Sensitive Organized Selfless Practical Mature Focused Courteous Grateful Open-minded Positive Responsible Cooperative Frugal Tolerant Balanced Appendix J Client ID#________________________ Date________________________ Postpartum Depression Group Follow-Up Evaluation Tool

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 56 1: Please Circle the words that best describes how you are doing at your job: (0) Not Working (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 2: Please Circle the words the best describes how you are doing in your marital/significant other relationship: (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 3: Please Circle the words that best describes how well you are doing in your family relationships: (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 4: How well you are doing with people outside of your family: (0) Not Applicable (1) Cannot Function (2) Serious Problems (3) Mild Problems (4) No Problems 5: What word best describes your current physical health: (0) Very Poor (1) Declining (2) Moderate Changes (3) No Changes Client ID#________________________ 6: How would you describe your mood swings (if any)? (0) None (1) Mild (2) Moderate (3) Severe Symptom None Mild Moderate Severe Sadness or Depression 0 1 2 3 Inability to Concentrate 0 1 2 3 Suicidal Thoughts 0 1 2 3 Obsessive Thoughts 0 1 2 3 Sleep Problems 0 1 2 3 Tension/Anxiety 0 1 2 3

Running head: POSTPARTUM DEPRESSION GROUP PROPOSAL 57 Change in Appetite 0 1 2 3 Panic Attacks 0 1 2 3 Weight Changes 0 1 2 3 Memory Problems 0 1 2 3 Compulsive Behavior 0 1 2 3 Hopelessness 0 1 2 3 Social Isolation 0 1 2 3 Strange Thoughts 0 1 2 3 Other______________________ 0 1 2 3