2nd Edition

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

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

304 Pages 2 B/W Illustrations
by Routledge

304 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... Read more

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 Parents


Chapter 14       Clinical Challenges and FAQs


Chapter 15       Holding and Letting Go

Epilogue: Therapist, Hold Thyself

Biography

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

"Karen Kleiman’s words are a balm for new motherhood; they normalize the myriad of emotions and feelings and call attention to the inadequate systems that continually fail American mothers. Karen warmly and expertly reminds providers and parents alike that motherhood is just as much a job as it is a joy and that all moms are deserving of help, care, and rest."

Cassie Shortsleeve, journalist, founder of Dear Sunday Motherhood, co-founder of Two Truths & Chamber of Mothers

"Karen Kleiman's newest book provides a gentle and important guide for therapists who work with birthing parents struggling with anxiety and depression. Embedded throughout her approach is a deep empathy for the experience of new parenthood, which often leaves mothers feeling alone and unsupported."

Nichole Fairbrother, Ph.D., RPsych, CACBT-ACTCC Certified Cognitive Behaviour Therapist and Founding Member