The Pregnant Therapist: The Effect of a Negative Pregnancy Outcome on a Psychotherapy Patient

Abstract

In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27-31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician's life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist's pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.

Psychoanalytic psychotherapy and the pregnant therapist: a literature review

“…The 22 remaining articles were read in their entirety (Figure 1). The studies with adult patients show results in which the psychotherapist's pregnancy makes itself present in the setting in a marked way (Bienen, 1990;Chiaramonte, 1986;Cole, 1980;Diamond, 1992;Domash, 1984;Korenis & Billick, 2014;Korol, 1995;Napoli, 1999;Rosenthal, 1990;Stockman & Greenemrich, 1994;Tinsley & Mellman, 2003;Tonon, Romani & Grossi, 2012, Underwood & Underwood, 1976. They emphasize the impact of pregnancy on the patient and how the therapist realized this (Bienen, 1990;Dyson & King, 2008;Korenis & Billick, 2014;Korol, 1995;Stuart, 1997;Tinsley & Mellman, 2003, Tonon et al, 2012.…”

“…In many treatments, it is the first time that information appears about the real psychotherapist (Al-Mateen, 1991;Korenis & Billick, 2014;Korol, 1995;Stockman & Green-Emrich, 1994;Tonon et al, 2012). The studies with pregnant therapists, and with adult patients, discuss the professional limit between psychotherapist and patient, how both deal with this change and the reactions of the patients faced with the gestation (Al-Mateen, 1991;Bienen, 1990;Chiaramonte, 1986;Cole, 1980;Diamond, 1992;Dyson & King, 2008;Genende, 1988;Korenis & Billick, 2014;Korol, 1995;Stockman & Green-Emrich, 1994;Stuart, 1997;Rosenthal, 1990;Tinsley, 2000;Tinsley & Mellman, 2003). Some studies tell that the patients are more prone to ask the therapist personal questions, due to the pregnancy, and that the therapists tend to answer in a more honest and direct way (Al-Mateen, 1991;Genende, 1988;Korenis & Billick, 2014;Stockman & Green-Emrich, 1994;Tonon et al, 2012).…”

“…The patients tend to bring the therapists more presents during the gestation and the therapists tend to accept the presents (Stockman & Green-Emrich, 1994). Other studies discuss the consequences of the gradual physical changes in the psychotherapist (Al-Mateen, 1991;Korenis & Billick, 2014;Korol, 1995;Stuart, 1997;Tinsley, 2000).…”

“…Almost all the articles consulted are rich in clinical examples that present, in a clear way, the expressions and transferential manifestations in several cases attended to by the authoresses. Those studies describe that the patient's reactions, when faced with the therapist's pregnancy, can be complex and involve ambivalent thoughts and feelings (Bienen, 1990;Cole, 1980;Diamond, 1992;Korenis & Billick, 2014;Korol, 1995;Tinsley & Mellman, 2003;Underwood & Underwood, 1976). Feelings of jealousy, resentment, competitivity, as well as the discussions about having children , sexuality, happiness for the therapist and the desire of undergoing that experience (Diamond, 1992;Korol, 1995).…”

Psychodynamic Psychotherapy of a Child with Internalizing Symptoms: A Study of Outcomes

“…Alice's treatment was characterized by elements of death (mourning her father, the loss of her school) and of life (the therapist's pregnancy, overcoming the family). The therapeutic repercussions of the pregnancy of the therapist on psychodynamic treatment are well known (Korenis & Billick, ; Tonon, Romani & Grossi, ). Some studies (Simonis‐Gayed & Levin, ; Tonon et al ., ; Wolfe, ) report that such a pregnancy catalyses and facilitates aspects of the process; others describe difficulties that arise (Ashway, ; Bassen, ; Hacham‐Lynch, ; Korenis & Billick, ), such as the tendency not to interpret sadistic and hostile associations in the patients during this period, the feeling of guilt experienced by some therapists (owing to being more involved with themselves and by the imminent maternity leave) and the fear that the anger and aggression of the patients may harm the baby, generating blind spots in the therapeutic process.…”