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When Reality Shifts: Ethical Recognition and Response to Postpartum Psychosis

Tuesday, October 20th, 2026   10:00 AM EDT -4:45 PM EDT
Rebecca Canzonieri, LCSW-C, LICSW
$99.99 USD

When Reality Shifts: Ethical Recognition and Response to Postpartum Psychosis

Postpartum psychosis (PPP) is a rare but severe perinatal psychiatric emergency characterized by rapid changes in mood, thinking, perception, and behavior that can place both the birthing parent and infant at significant risk. Despite its urgency, PPP is often misunderstood, stigmatized, or mistaken for more common perinatal mental health conditions, creating critical challenges for clinicians responsible for recognition, assessment, and intervention. This continuing education training will provide mental health professionals with a practical and ethically informed framework for identifying and responding to postpartum psychosis. Participants will explore common clinical presentations, warning signs, risk factors, and important distinctions between postpartum psychosis and conditions such as postpartum depression, anxiety, OCD, and intrusive thoughts. Particular attention will be given to assessing safety, differentiating intrusive thoughts from psychotic symptoms, responding to impaired insight and judgment, and determining when a higher level of care is necessary.

Through an ethical and trauma-informed lens, the course will also examine clinicians' responsibilities related to risk assessment, confidentiality, informed consent, documentation, family involvement, mandated reporting, and coordination with emergency and psychiatric services. Case examples will help participants navigate the complex balance between protecting safety, preserving dignity and autonomy, and avoiding unnecessary stigma or punitive responses. Participants will leave with increased confidence in recognizing postpartum psychosis, responding effectively during psychiatric emergencies, and advocating for compassionate, coordinated care for individuals and families experiencing one of the most serious—and treatable—complications of the perinatal period.

About the Presenter

Rebecca Canzonieri, LCSW-C, LICSW, LCSW, is a clinical social worker with nearly a decade of experience specializing in women’s mental health and perinatal mood and anxiety disorders (PMADs). Drawing from both specialized training and personal experience, she brings deep expertise and passion to supporting individuals navigating these often-overlooked challenges. Rebecca currently maintains a private practice dedicated to perinatal mental health. Her previous clinical experience includes providing emergency psychiatric services in the emergency department, supporting stabilization on an inpatient psychiatric unit, and delivering outpatient care through a hospital setting. In these roles, she provided individual therapy, facilitated intensive outpatient program groups, offered employee assistance program services, and collaborated with medical practices. Licensed in Maryland, South Carolina, Illinois, and Washington, D.C., Rebecca is dedicated to educating clinicians on the unique nature of perinatal mental health while advocating for greater awareness and systemic change to better serve this population.

Learning Objectives:

  1. Identify at least five clinical signs, symptoms, and risk factors associated with postpartum psychosis, including early warning signs that may indicate an emerging psychiatric emergency.
  2. Differentiate postpartum psychosis from other perinatal mental health presentations, including postpartum depression, anxiety, OCD and intrusive thoughts, bipolar disorder, trauma-related symptoms, and other conditions that may affect reality testing.
  3. Assess immediate safety concerns associated with postpartum psychosis, including suicidality, risk of harm to the infant or others, impaired judgment, disrupted reality testing, and ability to safely care for an infant.
  4. Apply ethical principles—including autonomy, beneficence, nonmaleficence, confidentiality, informed consent, and protection from harm—to clinical decision-making when postpartum psychosis is suspected.
  5. Determine appropriate clinical interventions and levels of care based on symptom presentation and risk, including when emergency psychiatric evaluation, hospitalization, consultation, and interdisciplinary coordination are indicated.
  6. Demonstrate trauma-informed communication strategies for engaging an individual experiencing psychosis without reinforcing delusional beliefs, escalating distress, or increasing shame and stigma.
  7. Analyze ethical and clinical considerations related to involving partners, family members, emergency services, and child-protection systems while balancing client autonomy, confidentiality, and immediate safety.
  8. Develop an ethically informed response plan for suspected postpartum psychosis that incorporates risk assessment, documentation, consultation, referral, family support, and continuity of care.

Agenda:

When Reality Shifts: Ethical Recognition and Response to Postpartum Psychosis

6 Continuing Education Hours

30 Mins| Understanding Postpartum Psychosis

  • Welcome, introductions, and learning objectives

  • Defining postpartum psychosis (PPP)

  • Prevalence, onset, course, and clinical urgency

  • Common misconceptions and stigma

  • Why early recognition matters

1 Hour | Recognizing When Reality Shifts

  • Signs and symptoms of postpartum psychosis

  • Delusions, hallucinations, paranoia, confusion, and disorganization

  • Mood symptoms, agitation, insomnia, and rapidly changing presentation

  • Risk factors and vulnerability

  • Bipolar spectrum disorders and PPP

  • The role of sleep disruption

  • Recognizing subtle or evolving presentations

15 Mins | Break

1 Hour | Differential Diagnosis in the Perinatal Period

  • Postpartum depression and anxiety

  • Postpartum OCD and intrusive thoughts

  • Differentiating intrusive thoughts from psychotic beliefs

  • Bipolar disorder, mania, and mixed states

  • Trauma-related symptoms and dissociation

  • Medical and substance-related causes

  • Clinical examples: OCD, anxiety, trauma, or psychosis?

45 Mins | Assessing Risk & Responding to a Psychiatric Emergency

  • Assessing suicidality and self-harm

  • Assessing risk of harm to the infant or others

  • Evaluating reality testing, judgment, insight, and ability to safely care for an infant

  • Asking direct questions without increasing shame or stigma

  • When outpatient care is no longer appropriate

  • Emergency psychiatric evaluation and hospitalization

  • Creating an immediate response plan

45 Mins | Lunch

1 Hour | Ethical Decision-Making When Safety and Autonomy Collide

  • Ethical principles: autonomy, beneficence, nonmaleficence, and dignity

  • Capacity, impaired judgment, and informed consent

  • Confidentiality and its limits during psychiatric emergencies

  • Involving partners and family members

  • Navigating resistance to treatment

  • Mandated reporting and child safety considerations

  • Avoiding reflexively punitive responses to psychiatric symptoms

  • Documentation and ethical risk management

  • Case discussion: What would you do next?

15 Mins | Break

15 Mins | Trauma-Informed Intervention & Supporting the Family

  • Communicating with someone experiencing psychosis

  • Validation without reinforcing delusions

  • Reducing stimulation and maintaining safety

  • Preserving dignity during crisis intervention

  • Supporting partners and family members

  • Hospitalization, separation from the infant, and potential trauma

  • Recovery, grief, shame, and rebuilding trust after an episode

  • Supporting attachment and family reintegration

15 Mins | Case Applications: From Recognition to Response

Participants will work through clinical scenarios involving:

  • Emerging postpartum psychosis

  • Intrusive thoughts versus psychotic symptoms

  • A parent reluctant to seek emergency care

  • Family disagreement about the severity of symptoms

  • Ethical conflicts involving confidentiality and safety

For each case, participants will identify:

  1. Clinical warning signs

  2. Immediate safety concerns

  3. Differential diagnoses

  4. Ethical considerations

  5. Appropriate level of care

  6. Documentation and consultation needs

15 Mins | Integration, Resources & Closing

  • Key clinical takeaways

  • Developing a personal PPP response framework

  • Referral and crisis resources

  • Interdisciplinary collaboration and continuity of care

  • Questions and final discussion

  • Course evaluation

This presentation is open to:
  • Social Workers
  • Professional Counselors
  • Therapists
  • Psychologists
  • Licensed Mental Health Practitioners
  • Medical Doctors and Other Health Professionals
  • Other professionals interacting with populations engaged in mental health based services
Course Level: intermediate
Level of Clinician: intermediate
  • New practitioners who wish to gain enhanced insight surrounding the topic
  • Experienced practitioners who seek to increase and expand fundamental knowledge surrounding the subject matter
  • Advanced practitioners seeking to review concepts and reinforce practice skills and/or access additional consultation
  • Managers seeking to broaden micro and/or macro perspectives

Participants will receive their certificate electronically upon completion of the webinar and course evaluation form.

Disability Access - If you require ADA accommodations, please contact our office 30 days or more before the event. We cannot ensure accommodations without adequate prior notification. Please Note: Licensing Boards change regulations often, and while we attempt to stay abreast of their most recent changes, if you have questions or concerns about this course meeting your specific board’s approval, we recommend you contact your board directly to obtain a ruling. The grievance policy for trainings provided by NEFESH INTERNATIONAL is available here Satisfactory Completion Participants must have paid the tuition fee, logged in and out each day, attended the entire workshop, and completed an evaluation to receive a certificate (If this is a pre-recorded program, a post-test with a passing grade of 80% to receive a certificate.) Failure to log in or out will result in forfeiture of credit for the entire course. No exceptions will be made. Partial credit is not available. Certificates are available after satisfactory course completion by clicking here.
There is no conflict of interest or commercial support for this program.
  • Therapist Express is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed creative arts therapists. #CAT-0122.
  • Therapist Express is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0129.
  • Therapist Express is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors. #MHC-0325.
  • Therapist Express is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0275.
  • Therapist Express is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0129.
  • Therapist Express is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors. #MHC-0325.
  • Therapist Express is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0774.
Refund Policy:
Full Refund until 48 hours before scheduled date.
48 hours before: full refund less $5.00 processing fee. After event no refund will be given.
*exclusions apply for reasonable need and cause.