Rosenthal (1990) described that the pregnant therapist is faced with issues about identity, integration of roles, maternal identification, and redefinition of important relationships. In some cases, the client views the pregnant therapist as a person for the first time. More specifically, the therapist may not have been previously viewed as multifaceted, with many roles such as therapist, mother, and having personal relationships outside of therapeutic work. In psychodynamic therapy, affective responses from both the therapist and client must be understood in order to provide effective treatment. The pregnant therapist must find the balance between professional and private life, while dealing with circumstances about how to integrate these two identities. Fallon and Brabender (2003) label this process as an identity crisis for the pregnant therapist, especially if this is the therapist’s first pregnancy. The identity crisis can have an impact on the therapist’s self-image, maturational development, and physical and psychological state. Furthermore, a self-image shift may occur as the pregnant therapist develops a new interest in herself and aligns with her own mother as a prototype paternal figure (Rubin, 1980).
The pregnant therapist may evoke intense feelings in the client, and in return may experience these intense feelings in response through countertransference. Countertransference occurs when positive and/or negative feelings are evoked in the therapist by the client (Frankland, 2013). A common theme found in most of the literature was feelings of guilt for the therapist. In the article by Rosenthal (1990), pregnant therapists reported being more aware of feelings of guilt toward their clients when encountering thoughts about discontinuing and separating from the client. The literature review showed that as the therapist’s maternity leave approached, clients became angry or engaged in acting out behaviors which lead to increased intensity of therapist’s guilt (Grossman, 1990; Rosenthal, 1990). According to Grossman (1990), some triggers for the guilt experienced by pregnant therapists was reportedly due to being less available to nurture clients, less flexibility in scheduling of appointment times, and physical vulnerability.
Baum’s (2006) research found similar themes of guilt amongst pregnant social work students completing their field training. Interviews conducted with 10 middle class social work students found reports of feelings of guilt. Guilt feelings stemmed from a reported lessened ability to concentrate on their clients in session, wanting to develop professionally, and also wanting to leave fieldwork in order to spend time with their baby once born. One participant in Baum’s (2006) study stated, “When my belly was jumping, it was a dilemma of whom to listen to” (p. 565). Likewise, interviewees expressed themes of using supervision time for therapeutic support through their pregnancy.
Supervision in the field of psychology is a time reserved for a trainee to receive feedback from another clinician about their work with clients, professional development, and personal development, typically their clinical supervisor (Watkins, 1998). Although literature is scant, Baum (2006) discusses the unique shift in supervision that occurs. Pregnant therapists reported to focusing more on personal development, rather than the typical review of work with clients and professional development. Utilizing supervision space in this manner increased feelings of guilt for those who inevitably transformed supervision sessions into personal therapeutic experiences in order to fulfill their own personal needs. Some of these personal needs, according to Baum (2006), included a desire to be cared for and guided; this is especially relevant for pregnant therapists who are experiencing their first pregnancy and thus may experience feelings of uncertainty about the many unknown aspects about motherhood. Accordingly, in addition to reviewing clients, it appears that supervisors may need to shift the focus of supervision in order to meet the needs of the pregnant supervisee and particularly to allow space for the supervisee to process emotional reactions to clients and the therapeutic process. However, this may lead to increased feelings of guilt for the pregnant therapist due to frequently utilizing the supervision space to focus on personal needs surrounding the pregnancy.
Other literature also suggests that feelings of anxiety, particularly about what the future may hold for them, is another common theme amongst pregnant therapists (Baum, 2006; Rubin, 1980; Schmidt, Fiorini, & Ramires, 2015). As one participant in Baum’s (2006) study stated,
I did not sleep because of thoughts of what I would do. I wanted so much to continue my studies and I was afraid [the baby] would be in the way… I was very ambivalent. It was very difficult to talk about this; anybody who hears it gets frightened, saying: You are pregnant, you should say thank you (p. 567).
In addition to guilt and anxiety, other themes that emerged among pregnant therapists were self-protectiveness, guilt about clients’ envy of pregnancy or inability to conceive, desire to avoid client hostility, and ambivalence about self-disclosure.
Countertransference of guilt and anxiety may hinder the therapist or cause the therapist to become hypervigilant, causing a deficit in the therapist’s ability to effectively work by misreading the presence or absence of reactions from clients about the pregnancy (Wedding & Corsini, 2014). A pregnant therapist’s guilt and anxiety around the pregnancy may impact her ability to disclose the pregnancy to the client in a timely fashion. Research by Dyson and King (2008) states that if the client has been unable to acknowledge the therapist’s pregnancy, or is in denial about the therapist’s pregnancy, there is a heightened risk that the therapist may collude with the denial of visible events. The therapist may, for example, deny her pregnancy, mirroring the client through countertransference. According to Dyson and King (2008), this is done by the therapist to avoid feelings of guilt and anxiety about how the client will respond to the news of the pregnancy out of fear that she or the client will become overwhelmed and potentially impact the therapist’s self-identification.
The self-identification of a pregnant therapist has been seen to impact the countertransference experience. Sachs (1986) investigated the countertransference experience and identity of pregnant therapists who self-identified as lesbian. According to Sachs (1986), a pregnant therapist who identifies as lesbian (or with another non-heterosexual label) can evoke myths about pregnancy for clients on an unconscious level. From Sachs’ (1986) personal experience as a lesbian pregnant therapist, she reported frequent questions from colleagues and clients of “How did you do it?” The pregnant lesbian therapist may also debunk stereotypes about lesbians, such as lesbians being masculine, disagree with traditional female roles, and/or carry no feelings for children (Sachs, 1986). Additionally, the pregnancy of a lesbian therapist may also go against.
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