A sizeable percentage of women develop psychiatric symptoms after the birth of a baby. Postnatal depression (PND) is the most widespread of such conditions, with an average incidence rate of 13 %. Postnatal depression represents a serious public health concern because it may have adverse effects on the physical, emotional and cognitive development of children, as well as affecting the mother herself, the mental health of fathers and the marital relationship. It is imperative to treat postnatal depression early and effectively. Mothers consistently indicate that they prefer therapy to antidepressants, because of concerns over their safety when breastfeeding. However, there is still a scarcity of research on psychological treatments for this population, and what research is available indicates lower response to psychological treatments compared to other populations. This qualitative study investigated mothers' experiences of therapy, to understand how therapists can best respond to the needs of mothers suffering from postnatal depression. Eight semi -structured interviews were carried out with mothers who were recruited via the Association of Postnatal Illness. Data collected was subjected to an Interpretative Phenomenological Analysis. Three themes emerged that encapsulate how therapists can facilitate recovery from postnatal depression: creating a safe space, assuaging guilt, and empowering. The themes articulate how therapists can adapt their therapeutic stance and the therapeutic focus to address some of the needs of this population. Tailoring of assessment, formulation and therapy to each individual client emerged to be imperative given the heterogeneity of needs, symptoms and vulnerabilities characterising mothers suffering from PND. Findings are discussed in the context of previous research on psychological treatments for postnatal depression.

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This portfolio thesis comprises of three parts: a systematic review paper, an empirical report and appendices. Part one is a systematic review in which the literature relating to the empirical paper is reviewed. Literature concerning the prevalence of paternal distress within the first year postpartum is addressed. The review attempts to determine levels of severity and aims to stipulate when distress is more prevalent within the year. The usefulness of such epidemiological data is also considered. Part two is an empirical paper examining the discourses around the postpartum father. The study aimed to conceptualise how the father's discursive position may limit the acceptability of distress in this period. The paper outlines popular competing constructions of postpartum fatherhood and paternal affect drawn from the accounts of first-time parents, midwives and health visitors. The impact of such discursive inconsistency on the recognition of this clinical issue is discussed. Clinical implications are then described. Part three comprises the appendices. A reflective summary drawing on the overall research process is included.

L’épisiotomie est un élargissement chirurgical de l’orifice vaginal réalisé à l’aide d’une incision du périnée au cours de l’accouchement et notamment pendant la dernière étape de l’expulsion. Très souvent étudiée sous un angle somatique, cette pratique chirurgicale a été très peu abordée sous un angle psychologique. Ce manque de donnée est d’autant plus marqué qu’il n’existe aucune étude d’orientation psychodynamique portant sur l’épisiotomie. Le but de ce travail de thèse est d’évaluer l’impact psychique de l’incision du périnée en divisant trois axes d’évaluation : les effets de l’épisiotomie, les facteurs de risques et les facteurs protecteurs inhérents au vécu difficile de l’épisiotomie et enfin le vécu de l’épisiotomie en fonction des caractéristiques individuelles du sujet. Pour ce faire une étude longitudinale comparant l’effet de l’épisiotomie aux autres modes d’accouchement (césarienne, voie basse avec périnée intact ou pseudo-intact et déchirure) a été réalisée sur 43 femmes. Elle s’est appuyée sur une rencontre prénatale 1 mois avant l’accouchement, une évaluation 2 jours et 2 mois après l’accouchement et enfin 3 rencontres post-natales (3 mois, 9mois, 1 an). Chaque rencontre s’est appuyée sur la réalisation d’entretiens (semi-directifs et libres), de questionnaires (SF36, QIC, EPDS, CPQ, WOMBLSQ4, Traumaq) et l’emploi du test de Rorschach. Les principaux résultats montrent que l’épisiotomie implique une satisfaction liée à l’accouchement plus faible 2 mois après l’accouchement. De même, elle est préférentiellement associée à la présence de douleurs, dyspareunies et dépressions 3 mois après l’accouchement. En outre, elle est considérée avec la survenue d’une déchirure comme un des modes d’accouchement les plus difficilement vécus. Notre étude a également montré qu’une qualité de mentalisation effondrée préservait les femmes d’un vécu difficile lié à l’épisiotomie. Enfin, l’analyse qualitative a mis en évidence la présence de dysfonctionnements sexuels et angoisses somatopsychiques spécifiquement liés à l’épisiotomie. Pour finir, nous avons montré que le vécu subjectif personnel colorait la perception de l’épisiotomie notamment au travers de la dynamique transférentielle projetée sur l’équipe médicale mais aussi lors de la reviviscence de traumatismes psychiques. L’ensemble de ces résultats est également commenté en fonction des perspectives théoriques et cliniques soulevées visant à améliorer le bien-être des femmes en salle d’accouchement et en suite de couche / Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum during the delivery and especially during the last stage of expulsion. Mostly studied in a somatic angle, this surgical practice has been very little studied from a psychological point of view. Moreover, there is no psychodynamic study on episiotomy. The aim of this research is to evaluate the psychical impact of episiotomy with three different types of evaluations: the effects of episiotomy, the risk and protective factors associated with the difficult experience of episiotomy and finally the subjective and individual experiences. We conducted a longitudinal study which was performed on 43 women. It compared the effect of episiotomy with other modes of delivery (caesarean section, vaginal approach with intact or pseudo-intact perineum and perineal injuries). It relied on a prenatal appointment (1 month before delivery), an assessment 2 days and 2 months after the delivery and finally 3 postnatal meetings (3 months, 9 months, 1 year). Each one of them was based on interviews (semi-directive and free), questionnaires (SF36, QIC, EPDS, CPQ, WOMBLSQ4, Traumaq) and the use of the Rorschach test. The main results show that 2 months after delivery, episiotomy implies a lower satisfaction related to childbirth. Perineal incision has stronger correlation with the presence of pain, dyspareunia and depression 3 months after childbirth. In addition, with the perineal injuries group, episiotomy is considered as one of the most difficult ways to give birth. Our study also showed that a low quality of mentalization protect women from a hard experience related to episiotomy. Finally, the qualitative analysis showed that episiotomy is specifically linked to sexual dysfunctions and somatopsychic anxieties. To finish, we have shown that personal subjective experiences influence the perception of episiotomy (particularly through the transferential dynamics projected on the medical team and the revival of psychical traumas). All these results are also commented in a theoretical and clinical point of view which aims to improve the well-being of women in the delivery room and afterwards