Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression
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Kleiman, K., with Wenzel, A. (2014). Tokens of affection: Reclaiming your marriage after postpartum depression. New York, NY: Routledge.
Postpartum depression reshapes a couple's world in ways they rarely anticipate. It creates distance between partners who once moved in sync, turning shared exhaustion into isolation and unspoken resentment.
Tokens of Affection is a practical guide for couples who want to find their way back to each other. Written by Karen Kleiman and Amy Wenzel, Ph.D., ABPP, the book introduces eight relationship strategies that help partners restore communication, rebuild trust, and reconnect after the strain of postpartum depression.
About the Book
Kleiman, K., with Wenzel, A. (2014). Tokens of Affection: Reclaiming Your Marriage After Postpartum Depression. New York, NY: Routledge.
Who Is Tokens of Affection For?
This book addresses multiple audiences, each approaching postpartum depression from a different angle:
Postpartum couples rebuilding closeness and communication after a difficult period
Partners and spouses who are supporting a loved one through perinatal depression
Perinatal mental health clinicians looking for a structured resource to recommend to clients
Couples therapists seeking a research-grounded framework for relationship repair
How Postpartum Depression Can Affect a Marriage
Postpartum depression does not affect only the person experiencing it. A meta-analysis of nineteen cohort studies published in the Journal of Psychiatric Research in January 2025 found that low marital satisfaction was the most significant predictor of postpartum major depressive disorder, with a pooled relative risk of 3.47 compared to women with high marital satisfaction.
The core symptoms of postpartum depression, including persistent sadness, anxiety, fatigue, irritability, and difficulty bonding with a baby, each place a strain on the relationship. A 2025 review in the MDPI Journal of Clinical Medicine reported that PPD affects approximately 10 to 20 percent of postpartum women globally, shaped by hormonal, psychological, and socio-environmental factors.
StatPearls (last updated January 2025) adds that up to 50 percent of perinatal depression cases remain undiagnosed, largely because of stigma and reluctance to disclose symptoms.
For couples, this means many are navigating the effects of postpartum depression on a marriage without a name for what is happening. Anger, withdrawal, loss of intimacy, and communication breakdown can set in before either partner fully understands the cause.
Kleiman and Wenzel describe marriages in this state as "suffocating," shaped by a depression that arrived just as couples expected joy. Tokens of Affection addresses the period after the acute phase passes, when couples are seeking, in the authors' words, "direction back to their previous levels of functioning and connectedness."
The 8 Tokens of Affection
The book's central framework consists of eight relationship qualities framed as "tokens" that couples can consciously offer each other. These are not communication exercises alone. The authors frame them as deliberate gestures on behalf of the relationship itself, grounded in marital therapy research.
1. Esteem: Recognizing and affirming a partner's worth during a period when self-worth is frequently depleted. Small, concrete acts of acknowledgment can interrupt cycles of self-doubt and withdrawal.
2. Collaboration: Approaching parenting and household responsibilities as a team. Shared effort reduces the isolation that often develops when one partner carries more than they can hold.
3. Compromise: Finding workable middle ground on decisions that carry emotional weight, from sleep schedules to childcare arrangements. Compromise preserves mutual respect when disagreement threatens to calcify into resentment.
4. Selflessness: Making consistent choices that prioritize the relationship over immediate frustration. This token does not require self-erasure; it requires attention to the partnership as a distinct entity that deserves care.
5. Sanctuary: Creating emotional safety within the couple's relationship so that both partners can be honest about what they are experiencing. Without safety, communication often defaults to performance or avoidance.
6. Expressing: Communicating feelings and needs directly rather than allowing them to accumulate resentment. The authors treat expression as a skill that requires practice, not a fixed trait a person either has or does not.
7. Tolerance: Extending patience during a period when both partners may be operating under significant and sustained stress. Tolerance here is not passivity; it is a considered choice to hold space for the other person's struggle.
8. Loyalty: Recommitting to the relationship's foundation when external pressures, fatigue, and conflict pull at its seams. Loyalty, in the book's framing, is an active orientation toward the partnership rather than a passive assumption.
Together, these eight tokens form a shared language for couples rebuilding after postpartum depression. The model is designed to be practical enough for daily use and grounded enough to hold in a clinical context.
What the Book Covers
Tokens of Affection moves through several thematic areas across its chapters. The book opens by examining the state of the marriage before and immediately after childbirth, then explores how depression disrupts the relationship's functioning. From there, it turns to strategies for reconnection and rebuilding communication, including an introduction to cognitive behavioral principles. The second half of the book introduces each of the eight tokens in depth, closing with a frank discussion of the challenges that can arise even as couples make meaningful progress.
Throughout, Kleiman and Wenzel balance clinical knowledge with real-world examples drawn from practice. CBT research on postpartum depression supports the therapeutic approaches the book draws on. Evidence reviewed by Charlie Health (2026) indicates that CBT helps people develop lasting coping skills and can improve interpersonal relationships alongside core depressive symptoms, with benefits that often persist well after formal treatment ends.
This book is not a substitute for professional treatment. If postpartum depression symptoms are present or affecting daily functioning, a qualified clinician should be consulted.
Praise for Tokens of Affection
"Postpartum depression knocks most couples off their feet, and Tokens of Affection serves as a solid grab bar for regaining balance. Written with humor, sensitivity, and remarkable insight, Kleiman and Wenzel have created a practical and effective roadmap for couples seeking enhanced connection and stability."
Margaret Howard, Ph.D., Director, Postpartum Depression Day Hospital at Women & Infants Hospital; Professor of Psychiatry and Human Behavior (Clinical), Warren Alpert Medical School of Brown University
"With the perfect blend of clinical experience and scientific knowledge, Karen Kleiman, with Amy Wenzel, has written an outstanding book that will teach you the skills you will need to stay focused on your relationship and successfully ride out this trying period of time."
Jonathan S. Abramowitz, Ph.D., Professor and Associate Chair of Psychology, University of North Carolina at Chapel Hill
"Tokens of Affection provides important information, real-world examples, and practical skills for improving communication, compromise, and marital satisfaction. This is a must-read for couples looking to reconnect and rediscover the strengths in their relationship after postpartum depression."
Pamela S. Wiegartz, Ph.D., Director, CBT Services and Training, Brigham and Women's Hospital; Assistant Professor of Psychology in Psychiatry, Harvard Medical School; Author, The Pregnancy and Postpartum Anxiety Workbook
"Based on years of clinical practice and solid research, Kleiman and Wenzel's practical, easy-to-read guide is a must-read for postpartum couples."
Shoshana Bennett, Ph.D., Former President, Postpartum Support International; Author, Postpartum Depression For Dummies
Related Books and Resources
Dr. Wenzel has authored and co-authored a range of books on perinatal mental health and evidence-based psychotherapy. The following titles address closely related areas:
Cognitive Behavioral Therapy for Perinatal Distress: a clinical text on CBT approaches for anxiety and depression during the perinatal period
Anxiety in Childbearing Women: addresses anxiety disorders during pregnancy and the postpartum period
The Oxford Handbook of Perinatal Psychology: a comprehensive scholarly reference on perinatal mental health
Dropping the Baby and Other Scary Thoughts, 2nd Edition: practical support for intrusive thoughts during pregnancy and new parenthood
If you are exploring evidence-based perinatal care or have questions about Dr. Wenzel's work, you are welcome to reach out through the contact page.
