A Conversation on Women’s Mental Health

Ariel Kloss, MSW, LCSW

As a new mother myself, this is a topic I was just recently discussing with my own therapist. It’s hard to know where to start here because I have so many opinions on this topic!

To start, I think it’s important to note that “self-care” looks different for everyone. I am a mother who struggles with separation anxiety from my baby and I thought my self-care needed to look like leaving the house and doing something for myself which often times actually just increased my anxiety and depleted my reserves even more. I started to accept that for me, self-care usually looks like doing less, not more. So, instead of being with my baby and feeling like I need to be constantly engaging him in developmentally appropriate play- I learned it’s okay to sit with my baby, read a book (as much as he’ll let me), and just exist with him in a way that wasn’t driven by anxiety. I could do what my heart is driving me towards- existing with my baby- and do it in a way that exhibited less pressure on myself.

Self-care can also look like asking for help. Lowering unrealistic standards. Ordering out. Letting the laundry sit. Letting the dishes stay dirty for another 12 hours.

“Self-care can also look like asking for help. Lowering unrealistic standards. Ordering out. Letting the laundry sit.”

This version of self-care- the self-care that involves less rather than more, is often paired with shame and guilt. Why is that?

I think this kind of self-care is so often paired with shame and guilt because, especially as women and mothers, we are taught that our value is tied to how much we can carry. And for some of us, that message started long before motherhood. Maybe you learned as a child that being “good” meant being easy, helpful, independent, high-achieving, or not needing too much. Maybe keeping the peace meant paying close attention to everyone else’s needs before your own. Maybe rest had to be earned, mistakes weren’t tolerated, or asking for help was met with disappointment. Those lessons don’t just disappear when we become adults—and motherhood has a way of bringing some of our oldest wounds right back to the surface. Suddenly, letting the laundry sit isn’t just letting the laundry sit. Asking for help isn’t just asking for help. Doing less can bump up against deeply rooted beliefs about what makes us worthy, lovable, or “good.” So when self-care looks like doing less, the guilt that follows isn’t necessarily evidence that we’re doing something wrong. Sometimes it’s the discomfort of challenging something we learned a long time ago: that our needs should come last.

Dr. Wayne Chen, PsyD

I think this can be very difficult to discern, and there are perhaps many theoretical models that might suggest how one could approach this differentiation. To me, the question at or near the heart of this concern is something like: “Am I behaving ethically by doing something for myself?” Perhaps ethics could be simply framed as: “Am I attempting to do what is good for those I love while also doing what is good for myself?”

I think one potentially helpful starting point for making this assessment is to consider our emotions. I find that self-care is often grounded in needs that are fundamental to our long-term health and well-being. If our needs cannot be deferred indefinitely, perhaps anger, frustration, irritation, or even rage can sometimes serve as indicators that we have become personally depleted and that our coping resources are insufficient for managing the various stressors currently present in our lives.

Another potentially helpful consideration may lie in the nature and quality of our guilt. When we behave selfishly or in ways that violate our own values, we may naturally experience guilt. Some theoretical perspectives might describe this as a kind of “organic guilt”—a feeling that emerges when we recognize that our behavior has violated something we genuinely value. This guilt may bother us precisely because it encourages us to make amends and, when another opportunity arises, to behave in greater accordance with our values.

But what if someone is actually behaving in self-preserving or self-caring ways while being told that they are selfish? Perhaps a different kind of guilt can arise. I have heard this described as toxic guilt, irrational guilt, or synthetic/induced guilt. Rather than arising primarily from our own assessment that we have violated our values, this guilt may be something we have learned or been encouraged to feel—perhaps through authority figures or other important people in our lives who may even have leveraged our relationship with them to evoke it. If we are afraid of losing that relationship, we may be highly incentivized to accept and internalize this guilt, particularly when we were helpless or dependent children.

Perhaps one possible indicator that this kind of irrational or induced guilt is present is an accompanying feeling of resentment. Resentment might, in some circumstances, be understood as anger that has been kept secret, suppressed, or hidden. Again, perhaps this anger is attempting to tell us something about needs that are going unmet, while its outward expression has been inhibited by fear of what might happen if those needs—or the anger surrounding them—were openly expressed.

What further complicates this discernment, however, is that our feelings can emerge for many different reasons. Anger does not necessarily indicate that an important need is going unmet, nor does resentment necessarily indicate the presence of irrational guilt. Emotions may provide us with important information, but they still require interpretation.

“Emotions may provide us with important information, but they still require interpretation.”

For this reason, I believe it can be crucially important to have a relational space in which we can talk through the emotions we are experiencing and practice something resembling what Gabor Maté calls “compassionate inquiry.” In simple terms, we might ask ourselves: “If I have understandable reasons for feeling this way—rather than assuming that there is simply something wrong with me—what might those reasons be?”

I find that having the opportunity to talk through and examine our feelings with someone who is emotionally supportive, curious, validating, and nonjudgmental can gradually help us answer these difficult questions: Am I being selfish, or am I engaging in necessary self-care? What is this guilt trying to tell me? What is this anger protecting or asking for?

Not everyone has access to relationships that can provide this kind of reflective space. When those relational resources are unavailable—or when these questions have become especially difficult to untangle—this is one place where a compassionate and skilled psychotherapist may be helpful.

Ariel Kloss, MSW, LCSW

Boundaries have become a word that is often misused and misunderstood with pop psychology and the commodification of mental health. So I’m excited to talk about boundaries! But I don’t think I can give you a clear answer of what a boundary really is, because, like everything- it is so dependent on the individual.

I will say that some years ago, the word “codependency” became a four letter word and the ultimate “no-no” in some circles. I believe like what can happen to lots of hot topics like this, this led to everyone going too far in a different direction and ended up with an increase in isolation. The word “boundary” became a way to cut all of your ties and forget about the importance of human connection and interdependence.

So, before going into boundaries- I want to stress that it is in our human nature to be interdependent with others. We are relational beings who thrive in community. Interdependence is actually a path towards healing, health and happiness.

So what’s the difference between interdependence and codependency?

I think the difference lies less in how much we need other people and more in what happens to our sense of self within those relationships. Healthy interdependence says, “I need you, you matter to me, and my life is impacted by you—but I am still allowed to be a separate person.” There is room for two people to have different needs, feelings, opinions, limits, and identities. Codependency, on the other hand, can happen when maintaining the relationship, keeping someone happy, or managing someone else’s emotions begins to require abandoning parts of ourselves. We might consistently ignore our own needs, feel responsible for another person’s emotional state, or believe that saying no will threaten the relationship itself. The goal, then, isn’t to become so independent that we never need anyone. It’s to learn how to be deeply connected to other people without disappearing inside of those connections. And I think that distinction is incredibly important when we start talking about boundaries.

“The goal isn’t to become so independent that we never need anyone. It’s to learn how to be deeply connected to other people without disappearing inside of those connections.”

A boundary, at its core, is an understanding of where I end and you begin. It is recognizing what I am responsible for—my needs, my choices, my behavior, my limits—and what belongs to someone else. A boundary isn’t a rule I create to control another person’s behavior, and it isn’t necessarily an ultimatum, punishment, or reason to cut someone out of my life. It also doesn’t mean that I never inconvenience myself, compromise, or put someone else’s needs before my own. Sometimes I choose to do those things because relationships matter to me. A boundary is knowing when those choices are mine to freely make and when I am abandoning myself out of fear, guilt, obligation, or a belief that I am responsible for keeping someone else okay. Healthy boundaries don’t eliminate our need for one another; ideally, they help us stay connected to others without losing our connection to ourselves.

Dr. Wayne Chen, PsyD

Maybe a boundary is the place where I remain responsible for myself while recognizing that you remain responsible for yourself. It helps us stay connected without either of us having to disappear into the other person or lose ourselves in the process.

“Maybe a boundary is the place where I remain responsible for myself while recognizing that you remain responsible for yourself.”

Sometimes this is described as being interdependent. Perhaps interdependence can be thought of as the ability to shift between being independent—caring for ourselves—and being dependent—seeking care and support from others.

Another way I think about boundaries is as an effort to remain a subject within a relationship while also supporting the subjectivity of the person with whom I am relating. In other words, I don’t allow myself to become an object that exists only to support the needs, wants, or wishes of others, and I also try not to reduce others to objects that exist primarily to satisfy my own needs or desires.

From this perspective, boundaries could be understood as supporting each person’s individuality while trying to figure out how to interact and coexist in ways that don’t cancel out either person’s sense of personhood. This can be very difficult to achieve and may require considerable discussion and examination, especially in the aftermath of relational mistakes, when one or more people feel that their subjectivity has been negated in the process.

Perhaps this kind of problem-solving cannot rely on domination or control, because those processes risk further negating, suppressing, or overriding another person’s subjectivity, whether we consciously intend to do so or not. I believe it is this loss of our sense of self or subjectivity within relational patterns of domination and control that ultimately contributes to a loss of closeness between people.

Perhaps Daniel Hughes, a clinical psychologist associated with the development of PACE, offers a useful model for engaging in this process more effectively. His PACE model emphasizes relational attitudes that we might all consider when engaging loved ones in conversations about boundary-related challenges. PACE stands for:

1. PPlayfulness Bringing appropriate lightness, warmth, and spontaneity into the relationship.
2. AAcceptance Accepting the other person’s internal experience without necessarily approving of every behavior.
3. CCuriosity Approaching another person’s behavior with genuine interest—“I wonder what was happening for you just then?”—rather than immediately assigning motives or intentions.
4. EEmpathy Communicating that the other person’s emotional experience is recognized, taken seriously, and emotionally understood.

I find that conversations in which these attitudes are reliably present are often better able to arrive at increasingly creative and ethical ways of resolving conflicting needs while preserving—and perhaps even deepening—a sense of emotional intimacy.

Ariel Kloss, MSW, LCSW

First, and foremost, I want to stress that if you are new to motherhood or parenthood and feel like it’s all consuming- that is completely okay and natural. I know, as a new mother, when I felt like all I wanted to talk about was my baby I felt this weird shame, like I should be cooler than that. But, the more I thought about it, I thought- I just built a whole human with my body and then birthed that human into the world. How weird would it be for me to NOT be obsessed with this? To not be completely fascinated and absorbed with this? You do not need to push yourself outside of that place before you are ready.

For those who do feel ready—or maybe even a quiet pull—to reconnect with who they are outside of these roles, I think we first have to acknowledge how difficult our culture makes that. I would be remiss not to talk about the ways living under late-stage capitalism teaches us to understand ourselves through productivity. We are constantly asked: What do you do? What have you accomplished? What are you working toward? Even our hobbies can start to feel like they need to be productive—something we’re improving at, monetizing, documenting, or turning into another goal. Then parenthood adds another role in which there is seemingly always something we should be doing. So when someone asks, “Who am I outside of being a parent, partner, or employee?” it can be surprisingly difficult to answer. We’ve gotten very good at identifying what we do for other people and much less practiced at noticing who we are when nobody needs anything from us.

I think reconnecting with yourself can start much smaller than some grand journey of “finding yourself.” Instead, get curious. What makes you laugh? What music did you used to love? What opinions do you have that belong entirely to you? What do you want to learn about for absolutely no practical reason? What clothes make you feel most like yourself? Who do you enjoy being around? What did you love before you started worrying about whether you were good at it? And maybe most importantly: what do you enjoy when there is no audience, no accomplishment, and nothing to show for it afterward? Reconnecting with yourself doesn’t necessarily mean reclaiming the exact person you were before parenthood. That person may not exist anymore—and I don’t think that has to be sad. Maybe the invitation is to get curious about the person you are becoming now.

“Reconnecting with yourself doesn’t necessarily mean reclaiming the exact person you were before parenthood.”

Dr. Wayne Chen, PsyD

This may be an extremely challenging, but equally important, question to consider. Perhaps one avenue for exploring it is through a therapeutic approach called Acceptance and Commitment Therapy (ACT), developed primarily by clinical psychologist Steven Hayes throughout the 1980s and 1990s.

In ACT, one question we might consider is: Who are you outside of your roles? Being a parent, partner, employee, caregiver, or friend can represent profoundly important parts of our lives. But perhaps there is also a sense of self that cannot be entirely reduced to any of these roles. Exploring who we are outside of them can prove remarkably difficult, and this challenge may be greater for some people than for others.

If you find it difficult to separate your sense of self from your roles, perhaps there are understandable reasons for this. A number of experiences can contribute to this difficulty, and none necessarily point to some personal defect. Trauma, for example, may sometimes help explain it. Trauma can take many forms: some are readily recognizable, while others can be subtle and so pervasive that they become rather like the very air we breathe.

Growing up, if even well-intentioned caregivers, teachers, or mentors gave us a felt sense of acceptance primarily when we were successfully performing certain roles, we might gradually become more and more identified—or psychologically “glued”—to those roles. If few people showed genuine interest in our authentic experience, or if there was little room for us to discover and express who we were, we might eventually come to believe that whoever exists beneath our roles has little value apart from what they can provide, accomplish, or perform.

If this has been our experience, reconnecting with a deeper sense of self may not be easy, but it may still be possible with persistence and with approaches that create conditions in which this exploration can safely occur. I find that compassion, empathy, curiosity, playfulness, and non-judgment—both toward ourselves and from others—may be especially important as we gradually approach the question: “Who am I beneath my functions?”

The 20th-century French psychoanalyst Jacques Lacan developed ideas about subjectivity that might be loosely conveyed through the phrase “the subject is a question.” Perhaps one implication is that becoming a subject involves remaining open to the question of who we are rather than allowing that question to be permanently answered by the functions we perform for others.

This may also illuminate the importance of having other people express persistent, abiding interest in who we fundamentally are—not merely in what we accomplish or provide. I find that another person’s genuine curiosity about our inner life can sometimes awaken and support our own curiosity about the question: “Who am I underneath my functions and roles?”

This is where I think an experienced and skilled psychotherapist can be especially helpful. I find that psychotherapy can be understood as more than symptom reduction; it can also become an exploration of the subject. Who are you if you are not reducible to your symptoms, roles, accomplishments, failures, or deeds? And what might become possible when the answer is not decided in advance?

“Who are you if you are not reducible to your symptoms, roles, accomplishments, failures, or deeds?”