Treating the Maternal Stress Response in Group Therapy

Perinatal women undergo various levels of increased stress during pregnancy, birth and the postpartum. The first year of parenting an infant adds additional demands on the mother to cope with infant feeding and sleep patterns. Mothers in this therapy group reported increased depressive, anxious and body dysmorphic symptoms since the birth of their one-year-old infants. Half of the members reported increased marital discord. The major goal of therapy in this group is to alter the neurological pathways of the mothers from over activated sympathetic and limbic system functioning to increased parasympathetic and whole-brain functioning through creativity, movement, empathy and play and reduce mental health symptoms.

Exposure to stressors increases the production of vasopressin to activate the hypothalamus-pituitary-adrenal (HPA) axis, enabling a fight, flight or freeze response. “Physiological and anatomical processes responsible for individual adaptation may enhance survival, but the susceptibility of these systems to change also leaves these same systems vulnerable to modifications that in a later context may be maladaptive (Carter, 2003, p. 383)”.  The health risks associated with chronic HPA axis reactivity include transgenerational vulnerabilities, including those seen in African-Americans as a result of structural racism (Kuzawa, 2008).

Oxytocin is similar to vasopressin in structure, but it’s function in reproduction and lactation is antagonistic to vasopressin. Research has shown that oxytocin can decrease the reactivity of the HPA axis in mother rodents, and produce increased nurturing behavior toward their young, having long-lasting positive effects on developmental outcomes (Carter, 2003).  In this group, we co-create a safe and nurturing space, inducing the release of oxytocin through social connection during experiential psychotherapy sessions. Porges argues that safety is a prerequisite to birth, nurse and care for infants and to elicit the social engagement system (2003).  Following is an example of one of our experiential processes designed to utilize nature, art and sharing to promote restoration and resiliency.

           Two dyads from my Creative Mothers therapy group participated in the experiential. The group meets evenings on the eastside of Austin in a studio that is nestled into a garden with meandering borders, wildflowers and perennials under the shade of old oaks. The garden has been a resource for our group over the course of our meetings, and the clients have consistently expressed a sense of peace from its presence. Thus, the idea of “allowing nature to become the guide for mothers to find inner peace” emerged over the course of my work with them. I was delighted to discover similar ideas in the international literature on nature therapy to support my hypothesis. According to Berger and McLeod (2006), nature becomes a therapeutic partner free from the power and control of the therapist. Ecopsychology, a growing subfield in clinical psychology, seeks to find evidence and therapeutic frameworks for the long-held belief that nature heals the psyche.

I gave the following instructions: Go out to the garden and see what draws your interest. Stay with your connection to that object or being for a period of about five minutes and notice yourself in relation to that object: how you feel, what information you receive from “being with” that object or being.

I observed my group members seeking inspiration in the garden, wandering and lingering until they each discovered an object or being on which (or with whom) to focus. With wide-eyed curiosity, acute observation and/or symbiotic relation, group members seemed to join with their surroundings in a manner that appeared embodied in nature. Squatting , stooping and reclining were common physical positions. Watching them, I felt a sense of wonder emerge from within myself as well as radiating connection to the groups’ process.

I gathered each dyad together at the end of the brief session with nature and we walked together back into our studio. Oil Pastels and textured paper were provided with the following second set of instructions: Record your sense of the experience you had in nature with an image. After the image is complete, ask what the object or being represents, what message it has for you. Write this message on your paper.

            During this part of the task, group members drew while in a sitting position on their yoga mats. Their work seemed intrinsic, focused and absorbing, much like Csikszentmihalyi’s Flow (1990). My goal was to facilitate the interaction with nature from a non-verbal sensory experience to creative visual form and verbal expression.  Group members produced individualized images and messages that included insights that were resilient and full of hope. Here are some examples:       From a bee hovering over a detailed purple drawing of a Larkspur flower: “I’m too busy to bother you.” The client reported that she was typically afraid of bees. Then she wrote, “Everything doesn’t have to have meaning. Sometimes things are just beautiful. Enjoy it; life is short”.

From a grouping of Bachelor Button Flowers, each at various stages in the life cycle: “Sisterhood: sacred feminine; gratitude in motherhood and life; baby@birth; nurturing; embracing change; branching out”

            From the canopy of a Wisteria vine: “No matter how lost you feel, your source will find you again. In fact, it already has.”

From the bees visiting a group of white flowers: “Just bee…focus, yet seems effortless…pair, duo, team…easier and more fun when in harmony”

Each member then shared their drawing and words with the group, as well as keynote aspects of their nature experiential. Sharing during the session provided an opportunity for each member to be witnessed by the group with her insights from connection with nature, and it offered observers an opportunity to learn from other members’ insights.

To further integrate and embody the lessons from nature, I loosely guided a ten-minute movement to classical guitar music using the words that group members had harvested from their interaction with nature. While observing their movement, which started low on their mats and rose to standing, I inserted guiding words to assist and encourage expansion of movement. The mothers rose at various paces to a standing position, mostly with their eyes closed. Swaying was the most common rhythms of movement, but I also saw some undulating mimicking birthing rhythms, as well as floating. One member found stasis (stillness) once she ascended to her full height, her hands branched out at hip level. Eventually, each person ended her dance in a resting pose, accessing support from the ground.


The cumulative response of nature interaction and sharing insights with the group was calming, as evidenced in movement patters. The rocking, swaying movements observed in the final (movement) phase of the experiential are indicative of vagal nerve activation. “Rocking provides an efficient and direct influence on the vagus by stimulating vagal afferent pathways via the baroreceptors. Moreover, activation of the social engagement system dampens the neural circuits, including the limbic structures that produce fight, flight or freeze behaviors (Porges, 2003).” In effect, the safety established in the group as well as the social connection among group members contribute to the inhibition of sympathetic response of the HPA through neuroception.

The decision to extend the experiential beyond the drawing and sharing component of the nature interaction was based on my clinical judgment at the time. I had witnessed hope and excitement when group members shared their insights.   Had we not continued with the amplification through dance, I would not have gathered additional evidence of peaceful embodiment from my clients’ movement.   Moreover, the clients would not have had the opportunity to “put it in their body”, or embody their resilient insights from nature. My rationale is that amplification of resiliency pathways provides greater access to the same neurological resources in the future. When timely and appropriate, interventions such as these may buffer effects of chronic stress over the course of a single organism’s lifespan that may counteract earlier risk exposures and protect their offspring from vulnerability.




Berger, R. & McLeod, J. (2006) Incorporating nature into therapy: a framework for             practice . Journal of Systemic Therapies, 56 (2), 80-94.

Carter, C. S. (2003). Developmental Consequences of Oxytocin. Physiology &            Behaviour ,79, 383-397.

Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New          York: Harper & Row.

Kazawa, C.W. and Sweet, E. (2008). Epigenetics and the embodiment of race:          developmental origins of US racial disparities in cardiovascular health .        American Journal of Human Biology 21, 2-15.

Porges, S.W. (2003) Social engagement and attachment: a phylogenic perspective.            Annals of New York Academy of Sciences 1008, 31-47.



The Perinatal Professional Healer Weekend Intensive in Austin 4/24/15-4/26/16

Ellen Stansell and I are leading a Perinatal Professional Healer intensive weekend in late April at Balance Studio in south Austin.  The workshop is appropriate for therapists, midwives, doulas, pre-and-post-natal yoga teachers, childbirth educators and pediatric and L&D nurses.  The focus of the weekend is to develop skills to hold mother through the attachment process with her prenate, neonate, infant or young child.  Each day, we will meet 4 hours, and assignments will be given for deep reflection between sessions.  Our intention is that together, perinatal professionals can raise awareness of the special journey of mother-baby dyads for the parents and communities we serve.

Ellen Stansell, PhD, RYT and Illysa Foster, M.Ed, CPM, LPA
Ellen Stansell, PhD, RYT and Illysa Foster, M.Ed, CPM, LPA

Ellen is a philosopher and yoga instructor specializing in eastern philosophy and yoga teacher training.  She is also a mom of two young boys whom she birthed with midwives.  You can learn more about Ellen here:

Throughout the weekend, Ellen and I will be guiding perinatal professionals through content and experientials designed to assist the caregiver in embodying and integrating eastern wisdom and developmental psychology and neuroscience into their practices.  For more info, call 512.809.3132 or email


Here are some of the areas that we will be exploring with participants over the weekend:

Introduction to Relationship Qualities in Developmental Psychology, Neuroscience and Clinical Care

Attunement and Empathy

Dyadic Synchrony Neuroscience and Mindfulness in Clinical Interactions with Perinatal Patients/Clients as informed by Clinical and Developmental Psychology/Attachment Theory.

Anatomy and Physiology for care of mother and mother/baby (lecture)

Developmental Models of Attachment

Neuroscience Research on Attachment

Case Study in Small Groups (Discussion)

Applications of ecological systems and caregiver sensitivity to client contexts: Ethics and witnessing in clinical relationships

Psychoanalytic Concepts and Clinical Applications

Best Practices for Perinatal Care

Ethical principles of yoga briefly introduced.

Apply ethical principles of satya (honesty), ahiṃsā (non-violence) and aparigraha (non-grasping).

Centering activity.

Theory of the five kośas. Theory of Sāṃkhya psychology, chariot metaphor, goal of yoga. Value of the witness consciousness according to Indian psychology.

Meditation through the five koshas to the witness consciousness.

Relationship of Krishna (ideal healing practitioner) and Arjuna (idealized student, client) in Bhagavad Gītā.


Moving meditation with a partner. Includes partner yoga postures.

Group Meditation.

The use of a tattva to focus you when you get distracted

Identify your tattva.

Lecture: The importance of home meditation practice

“What steps do you plan to take to implement what you’ve learned in your own practice.”, and  “How will this change the way you practice?”

Goals of a Play Therapy Group for Moms


Our Creative Mothers Group has enjoyed two sessions of internal and relational processes, and the experience has deepened our understandings of the potential for healing, which is also described by Christine Caldwell, Ph.D., LPC, BC-DMT in her article Adult Group Play Therapy: Passion and Purpose.

“One of the features of adult group play is that it can provide social resourcing for its members. Members of an adult play therapy group effectively become playmates for each other, a recapitulation of a developmental need that can counteract the social isolation so common in adults who seek therapy. Altruism and helping behavior also increase when we feel bonded to people, which not only provides for the health of a society but also helps people feel good about themselves”(Caldwell, 2003).

My friend Tobin Quereau also writes about the potential of healing for adults through play. He and his colleague Tom Zimmerman identified blocks that adults encounter in attempting play. These include: fear of loss of control; fear of looking foolish; fear of failure; acting your age; and finally, the sense of “I don’t have time”.  As counselors, they interpret these blocks largely as the effects of growing up too soon and carrying the role of the “superchild”, one of over-responsibility at a young age. It follows that the group process could hold the potential for adults to explore their feelings of resistance to play, to face the choices that they have made (to play or not to play) and to begin to make choices that value play (Quereau & Zimmerman, 1992).

“One of the other features of adult play behavior is its capacity to facilitate embodiment. Embodiment locates us in our bodies, in the present moment. We generate and attend to sensation, and we move in ways that both nurture and challenge lungs, muscles, and bones. Our bodies in turn generate endorphins and dopamine, our internal pleasure-inducing neurotransmitters. We experience a deep immersion in the present moment, a sense of focus that feels both intense and effortless. “(Caldwell, 2003).

I was happy to run across Caldwell’s article today, which so eloquently describes the purpose of adult play in group therapy.  Below I list the goals for the current therapy group, Creative Mothers.  We are still accepting new members to the closed group.  Please contact me directly at or to learn more about the group.

Goals of Group Therapy:

By engaging in play, imagination and creativity, mothers will:

  • build more resiliency to the challenges of day-to-day life
  • improve their mood
  • connect in more rewarding a playful manner with their children
  • experience the joy inherent to being a human being
  • heal trauma in the body and psyche
  • foster “mindsight “and healthy attachments with their children

Target Population for Clients:

  • currently in individual therapy or have been in therapy in the recent past
  • desire to engage with their creativity
  • open to a movement-based therapeutic model
  • a mother with at least one child over the age of 12 months

How to evoke the imagination of adults who are starved for it:

  • First, start with a game, word, or phrase to uncork their creativity.
  • Take them out of their fear (sympathetic nervous system) state through relaxation (parasympathetic nervous system).
  • Focus on process rather than product (Quereau & Zimmerman, 1992).
  • Create a sense of challenge (Quereau & Zimmerman, 1992).
  • Promote freedom (Quereau & Zimmerman, 1992).
  • Expose them to beauty (create a sense of timelessness).
  • Give them toys with which to play (promote FLOW).

How to access play through dance:

  • Provide a fantasy structure that allows for ample client-directed exploration.
  • Ignite a freedom of spirit-with humor and curiosity.
  • Give permission to indulge while avoiding evaluation.
  • Keep the focus on the experiential components.
  • Choose music that evokes the imagination, free of media-associations.
  • Keep participation voluntary (Quereau & Zimmerman, 1992)


Caldwell, C. (2003).   Play Therapy with Adults, ed. Charles Schaefer, John Wiley & Sons, Hoboken, NJ

Quereau, T & Zimmerman, T. (1992). The New Game Plan for Recovery. Ballantine Books: New York, NY.

Ritual Rhythm and Relaxation in Creative Mothers Group


Relaxation, rhythm and ritual (the 3 R’s) was first identified by Penny Simpkin, a physical therapist, doula, author and childbirth educator who describes these qualities in relation natural childbirth. Birthing women benefit from relaxation while in labor, which engages the parasympathetic nervous system and diminishes sensations of pain while promoting a cognitive state of ‘surrender’. Rhythm is utilized in labor to facilitate structure.  It requires adjustment as the stages of labor progress in order to meet the demands of the system homeostasis as pain and related need for pain-tolerance increase. Finally, ritual, gives the mother a sense of meaning to the “mad” state that labor can produce. Rituals remind the deeper consciousness that there is meaning to the process of birth.

The application the 3 R’s to a psychotherapy group for mothers is appropriate because mothers of young children are typically body-centered. The day-to-day work of caring for their infant or young child has kept them in contact with bodily demands. Yet, these demands are typically of the ‘other’, the small infant. Mothers in therapy can benefit from the safety provided by the 3R’s to begin exploring their own bodily needs in a compassionate manner. Here is my template for the 3R’s in this group:

We start with a sitting/ gentle movement meditation to calm and engage the group. This important first step engages the parasympathetic nervous system through relaxation. Following relaxation, a brief check-in provides a transition for entering the group experience.  This ritual can bring the group together through attunement.  The circle feels sacred, and the elements of structure and safety provide additional ritualistic-feel to the souls. Once centering and empathic attunement is established, I  provide an experiential focus from a theme that emerges from the group’s needs and interests. Then, I assist with its expression by use of creative imagery and developmental movement patterns, mirroring and witnessing. With sensitive leadership, the group process provides opportunities to extend the improvisation, promoting an indulging attitude toward play.  This extension may involve another form of creative expression, such as art or journaling so that the women in circle begin to come back to their own inner experiences of the experiential and process individually.  When it is time to close the experiential and inward process, we hold a reflection circle.  This closure provides ample opportunities for the group members to share and witness for one another, building group cohesion and deepening the group process.

Imagination in Group Therapy

Perhaps imagination is only intelligence having fun. ~George Scialabba

My utilization of creativity in group therapy is to entice the imaginations of clients to explore the mystery for the endeavor in itself, in addition to harvesting its potential for healing, especially when play is the primary focus. While upholding the premise that creativity is a confluence of various human qualities and conditions, as a group leader, my role is to maximize the potential for creativity to blossom in each member, encouraging exploration of one’s unique capacities in an environment that is fecund with acceptance for the person and nurturing of the imagination. As the group develops trust, openness and empathy, allowing time for processing at the end of play sessions will be a key factor in building cohesion. Once the group itself becomes that vehicle for dynamic play, I sensitively extend more power to the group and allow the sparks of creative energy to grow while fanning their flame within a safe play space.

Creative Mothers is a new therapy group meeting once a week for 12 weeks at Soma Vida in Central East Austin on Thursdays from 6:30-8:30 beginning in Feb.
For more information, please contact Illysa at or 512.809.3132.  Read more about Creative Mothers here and learn more about the therapist at

Creative Mothers Group Now Forming

dointhegoddessdance1A new psychotherapy group for mothers with children over 1 year is forming in central Austin under the leadership of Illysa Foster, M.Ed, LPA, CPM.  Illysa currently has two therapy groups for mothers in north and south Austin.  This group is unique in its focus on creative expression and imagination as a vehicle for healing and personal growth for mothers who are psychologically returning to their own development after the early year(s) of parenting.  Illysa can be contacted at 512.809.3132 or

Creative Mothers Group will meet:

Thursdays beginning Feb. 5th from 6:30-8:30pm at the Garden Studio in Soma Vida 1210 Rosewood Ave. Austin 78702

More information about the philosophy and purpose of the group follows:

Creative people are curious, flexible, persistent, and independent with a tremendous spirit of adventure and a love of play. ~Henri Matisse

“Creative Mothers” attempts to repair the nervous system that has been stretched and deprived of freedom during early parenting. Stuart Brown, a renowned psychiatrist, professor and play researcher, argues adamantly for the hope in play for reviving joy, “once people understand what play does for them, they can learn to bring a sense of excitement and adventure back into their lives, make work an extension of their play lives, and engage fully in the world” (2009, p. 11). Neuroscientists have found that play stimulates nerve growth in the amygdala and dorsolateral prefrontal cortex and cerebellum, effectively assisting in “whole brain” growth, facilitating greater capacities for connections between the brain stem, limbic system and the cortex. Daniel Siegel and Mary Hartzell differentiate between integrative functioning and non-integrative processing, arguing that parents who heal past traumas and build new neural connections between higher and lower brain functioning are better equipped to support healthy attachments with their children (Siegal & Hartzell , 2003). In Play: How it Shapes the Brain, Opens the Imagination and Invigorates the Soul, Brown makes a case for play as a mediator of mood. Play deficits lead to anhedonia and mood disruption. Further, play provides adults with greater cognitive reasoning, abilities to see beyond the perceived environmental limitations and effectively problem-solve. The rebound effect from play is observed with animals.  Much like catching up on sleep, mammals demonstrate a biological drive to play and to catch-up on missed play. After nine months of pregnancy followed by a year of sleep-deprivation and intensive childcare, mothers are vulnerable for depression, anxiety, physical ailments, illness, endocrine imbalance and adrenal fatigue (Northrup, 2006). A playgroup for mothers will provide a rich environment for therapy clients to heal after early parenting challenges and reclaim themselves as creative individuals who are capable parents.

To learn more about Creative Mothers therapy group, please contact Illysa at 512. 809.3132 or  For more information about Illysa, please visit


Brown, S. (2009). Play: How it shapes the brain, opens the imagination and invigorates the soul. Avery: New York, NY.

Northrup, C. (2006). Women’s Bodies, Women’s Wisdom. Bantam Dell: New York, NY.

Quereau, T & Zimmerman, T. (1992). The New Game Plan for Recovery. Ballantine Books: New York, NY.

Seigel, D. & Hartzell, M. (2003). Parenting from the Inside Out. Tarcher/Penguin: New York, NY.

Simkin, P. Relaxation, Rhythm and Ritual: The Three R’s of Childbirth, DVD (date and publication information not available).

Sternberg, R.J. (2006). The Nature of Creativity, Creativity Research Journal, 18:1, 87-98, DOI: 10.1207/s15326934crj1801_10






Illysa Head SHotIllysa Foster, M.Ed, LPA, CPM is a psychotherapist in Austin offering strong therapeutic support for mothers and their families in the childbearing years.  An experienced educator, midwife and parent, Illysa offers her clients deep wisdom and individualized care that is holistic and integrative.  A licensed psychological associate with over 60 hours of graduate studies in psychology, Illysa is supervised by Joellen Peters, Licensed Psychologist and is training as a dance therapist with Kalila Homann, LPC-S  Illysa also participates in group training and supervision in Jungian psychotherapeutic models, such as sand tray and dream analysis.