I’ll never forget the response of, Annie, the first client I informed that I was pregnant with my first child. “Don’t you have enough?” she asked, clearly distressed. Huh? At first, I was mystified. I didn’t have any other children. Then I realized she was talking about herself. The oldest of 10 children, her experience with the arrival of new babies was that there was less and less attention and more and more responsibility for her.
My graduate training hadn’t prepared me for this situation so off I went to the library. (Yes, the library. This was 35 years ago; before the Internet changed our lives).
The few articles I found about the impact of therapist pregnancy on clients were from a psychoanalytic point of view and involved the concept of “transference.” Certainly that applied to Annie. But did it apply to all of the people I was seeing for therapy? There was a decided dearth of information back then.
I wish I could report that there has been a lot of progress. Unfortunately, the research on the impact of therapist pregnancy on client attitudes, behavior and progress is not much more plentiful now. Most of the available articles continue to be grounded in psychoanalytic theory.
For those of us whose training is from a different theoretical perspective (mine is Adlerian), the relationship with the therapist isn’t always seen as a useful metaphor. In solution-focused or brief therapy work, exploration of what looks like “transference” can derail the treatment.
My experience has been that client response is as unique as the client. Over the 10 year period during which I was adding my four children to my family, I calculate that I saw approximately 180 different clients while I was pregnant.
For most of my clients, the relationship with me was not the centerpiece of our time together.
Oh, they acknowledged the fact of my changing appearance and changing status as mother. They were appropriately interested in my welfare and were curious about the things most people are curious about when someone they know is expecting (gender? names?).
But they then returned to working on their anxiety or depression or their battles with their teens or disappointments in love and work. For most, going down the path of transference would have interrupted instead of enhanced treatment.
Transference or Not?
And then there were the clients who did respond to my pregnancy in ways that suggested that Freud was onto something with his idea of “transference. ”.They generally fell into the categories that follow. But, to add to the complexity of our thinking, other clients with a similar presentation would not have found an analysis of transference appropriate or helpful.
I therefore offer some examples of when talking about transference with my clients was helpful and when it was not. I do not intend to suggest that my experience usually applies. Rather, I am sharing anecdotes to help my younger female colleagues think about and perhaps prepare for the variety of client reactions to their pregnancies.
I’m sure there are those who will argue with some of the decisions my clients and I made in these cases. Please bear in mind that these are thumbnail sketches of on-going clients with sometimes complicated treatments. There is more to each of the stories than I can present here.
Borderline Personality Disorder: Those with a diagnosis of BPD were most likely to be reactive. As with other relationships, their relationship with a therapist is unstable at best. Your pregnancy is likely to raise fears of abandonment and precipitate acting out behaviors (no-shows, highly emotional sessions, accusations, etc.) to test whether you care enough to stick with them.
Annie, the client at the beginning of this article, was typical of the client with BPD. Over the months following the announcement of my pregnancy, she created crises, didn’t show up for appointments and regularly accused me of not caring enough or doing enough for her.
Apparently I passed enough of her tests and she was able to accept the transfer to a colleague in my office for while I was on leave.
Dependent Personality Disorder (or those who have a history of co-dependent relationships): Their relationship with you may be more dependent than you know. Those who are coming out of social isolation or who have let themselves become dependent on you for problem-solving may panic.
Terrie, a woman I’d been working with for some time to help her develop self-confidence, became highly anxious when she learned I was pregnant and would be taking a month long leave. It surfaced how much she had been moving her dependency from her partner to me.
This occurrence gave us an opportunity to work more productively as we talked about how to transfer her dependency on others to reliance on her own good judgment.
Clients with contentious relationships with mothers (or mother figures): I had my youngest child when I was 42. I was taken by surprise when a young client (age 25) said I was too young to be having children!
She had convinced herself that I wasn’t much older than she was. Flattering as it was that she would think I was almost 20 years younger, it showed us both that she hadn’t allowed herself to see me as close to her mother’s age, not hers. No, she wasn’t psychotic.
The problem that brought her into therapy was her troubled relationships with women at work. Her response to pregnant me opened up a whole new area about her relationship with her mom and with other women she saw as having authority.
Clients with a history of loss: A client who has suffered miscarriage, stillbirth or infertility may be triggered into new grief or be angry that you are able to have a child when she cannot. One of my clients whose last pregnancy had ended with stillbirth was very clear. “I wish you the best”, she said, “but I can’t keep seeing your while you are pregnant. I’m just not ready to be that close to it.”
She knew herself well enough to understand that being confronted every week with my growing belly was too much too soon.
It could be argued that she needed help with incomplete grieving. But that wasn’t the case for her. She and her husband had been forthrightly managing their grief. Her goals in treatment had to do with needing to be more assertive. She transferred to a cognitive behavior therapist who later told me she did well.
Another client wasn’t so self-aware or so measured in her response. She had been going through IVF to try to conceive. She was furious. Why was I able to get pregnant? It was unfair! Yes, the hormones she was taking probably contributed to her rage.
But she experienced my pregnancy as yet another assault on her feelings of inadequacy. Therapy gave her a safe place to express and work through her anxiety, anger, bitterness and grief that what she thought should be an easy part of womanhood had been denied to her.
The pregnant client: Pregnant clients also differ in response. Neisha, who I would describe as one of the “worried well,” delighted in the idea that were pregnant together.
Every week, she would begin the session with comparisons and happy chatter about our growing physical awkwardness. She wasn’t anxious. She wasn’t sabotaging her therapy. To her, we were part of a sisterhood that she found delightful.
She successfully continued and completed her therapy to deal with her conflicted feelings about having more education than her husband. When I run into her in town these days, she still refers to our “babies” (now 32 years old) as a mutual positive experience.
Not so another pregnant client. Joan was upset that her pregnancy hadn’t been planned. She was anxious about changes in her relationship with her husband and angry about the interruption in her career plans. Being in the room with an obviously pregnant therapist made it difficult for her to avoid talking about her own issues.
Fortunately, we were able to make constructive use of it but I would not have been surprised if she requested a transfer or terminated.
Mothers: Clients who are about the same age and happy as mothers may feel they have something new in common with you and be eager to chat about it. Those who find mothering difficult may share their complaints and warnings.
Older mothers may want to give you parenting advice. It’s all potential therapeutic material. Or not. I did my best to take the client’s lead about whether they just wanted to make some passing comments or whether they were introducing new material that would lead them to better self-understanding about dysfunctional patterns.
Jennifer was a poster child for transference issues. Her mother hadn’t liked being a mother and she didn’t either. Sometimes I found myself thrown into the role of disapproving and critical mother, sometimes into the role of her teen daughter who often let her know that she was a failure as a mom. Sensitive and smart, Jennifer was able to understand and work on the issues.
She took a recess during my month long leave. She came back to treatment to continue to work on being a different kind of mother for her daughter than she herself had had.
Contrast that with Kelly, a client I was treating when I was pregnant with child number four. Also a mother of four, she’d often start a session with a few minutes of friendly advice about the care and feeding of a big gang.
Then she’d return to working on the goals of her therapy. When asked what the advice-giving was about, she simply stated that sharing tips that can make life a little easier is just what women do for each other.
Caretakers: Some clients will see you as fragile and vulnerable. They want to engage in caretaking, asking how you are feeling, bringing you little presents, or offering to do things to make you more comfortable during sessions. Sometimes it’s an example of “transference” but not always. Sometimes the solicitousness is simply an expression of caring.
I’d been working with a Mike intermittently for a number of years while he dealt with his teenaged son’s drug habit. His expressions of support and caring while I was pregnant were not neurotic or born of anxiety. They were not an effort to do for me what he couldn’t do for his son. He was acting on his belief that men should not absent themselves from the cycle of life. He’d offer to do something for me (like get a glass of water), then get on with the goals of his therapy.
In contrast, Linda felt it would be unfair of her or even dangerous if she were to be intensely emotional around me. “How can I get angry when I might upset you?” she asked. “I don’t want to be the reason you miscarry.”
Further discussion helped us make sense of that idea. She had grown up with a mother who regularly warned her kids that any angry voices would give her a heart attack. Her transfer of old fears and concern to me led to some important therapeutic work.
Client Responses Will Be As Unique As They Are
Few graduate programs include a class or two in how to manage our clients’ responses to what is a common event in female therapists’ lives, our pregnancies. I found few studies that are helpful.
The male supervisor who had always been a wonderful resource for me about other issues couldn’t seem to relate to this one. Neither could my male office mate. My best information and support came from two wise older women therapists who were also mothers of multiple children.
“Your pregnancy may be the most important thing happening to you at this time but it isn’t necessarily so for your clients,” they said. “Consider each person in their uniqueness.” Good advice.
Pregnant career woman photo available from Shutterstock