2nd Edition

The Art of Holding in Therapy An Essential Intervention for Postpartum Depression and Anxiety

By Karen Kleiman, Hilary Waller Copyright 2025
    300 Pages 2 B/W Illustrations
    by Routledge

    300 Pages 2 B/W Illustrations
    by Routledge

    Written by a pioneer in the field, this second edition provides updated skill-building tools and a more developed, comprehensive understanding of how therapists can use the holding approach when treating perinatal distress.

    First conceptualized by D.W. Winnicott, the ‘holding’ approach refers to a therapist’s capacity to respond to postpartum distress in a way that facilitates an immediate and successful therapeutic alliance. This model has continued to advance, and this newly updated edition will help readers learn how to contain high levels of agitation, fear, and panic in a way that cultivates trust and the early stages of connectedness. Filled with vignettes throughout, this book includes chapters on what holding is, how to prepare using this model, the emotions specific to postpartum mothers, the essential holding elements, and the practice of holding. This book uniquely addresses the needs of therapists who may find themselves confronting, struggling with, or recovering from their own reproductively related journeys, with chapters discussing the professional’s identity, clinical challenges, and a new chapter on cultural humility.

    This book is essential reading for all of those in the perinatal mental health community, such as therapists, social workers, and clinicians.

    Chapter 1         Postpartum Women and Therapy

    Chapter 2         Preparing to Hold

    Chapter 3         Theories Behind the Concept

    Chapter 4         Postpartum Mamas

    Chapter 5         Mother and Therapist: On Being Good Enough       

    Chapter 6         The Practice of Holding

    Chapter 7         Authentic Suffering and the Holding Elements

    Chapter 8         The Postpartum Voice of Depression

    Chapter 9         Hands on: How to Hold Better

    Chapter 10       Hard-to-Hold

    Chapter 11       The Anatomy of Holding

    Chapter 12       Your Professional Identity

    Chapter 13       Holding Diverse Families

    Chapter 14       Clinical Challenges and FAQs

    Chapter 15       Holding and Letting Go


    Karen Kleiman, MSW, LCSW, is a licensed clinical social worker and internationally recognized expert on maternal mental health. With over three decades of experience in the field, she is the author of several books on postpartum depression and anxiety and is the founder of The Postpartum Stress Center and The Karen Kleiman Training Center.

    Hilary Waller, MS, LPC, . is a psychotherapist in private practice and provides training to perinatal providers and women and their families.

    "The generosity of knowledge, spirit and empathy is and has been deeply touching to me. As someone who has experienced postpartum depression and 'activity' after all three of my children’s births. I can say from direct experience that Karen Kleiman walks her talk and offers profound space holding for the scary, overwhelming and terrifying parts of postpartum. As well as space holding for the possibilities available and the needs buried within the vulnerability of postpartum. 

    This empathy in the form of masterful space holding is the antidote to the abyss of pain and challenge that lies within the vulnerable postpartum time. The information in this book supports the healing of the strange and lonely and disorienting space of postpartum vulnerability. 

    Having experienced, three times, the perfect storm of hormonal, emotional, trauma triggering, cultural, circumstantial, social, physical challenge… I have had the privilege of being supported by Karen in the way that is described very eloquently and astutely in this book. To say Karen Kleiman helped me through a tough period post birth is an understatement. I would go as far as to say she helped save my life. 

    And while Karen may quietly laugh at the passion of my appreciation for her, I am very clear: Karen’s wisdom, knowledge, empathy, vision, insight, experience and humor helped me return to who I know myself to be during a time where all seemed lost and stuck in the tar and molasses of postpartum depression, anxiety and invasive/intrusive thoughts. One investigation at a time. With a kind of space holding that instantly heals and re-connects.

    My gratitude for Karen Kleiman and her powerful work knows no bounds.

    I wish for the emotional, somatic and wholistic intelligence of Karen Kleiman to be available to every single birthing person who finds themself at a loss on every level during the postpartum period."

    Alanis Morissette