The Pregnant Therapist: Transference and Countertransference: Part 1

This post, Part 1 of a series of posts about the identity of and reactions to the Pregnant Therapist, will focus on the topic: How Societal Attitudes and Assumptions About Pregnancy and Interfere with the Patient’s Transference Towards the Pregnant Therapist, the pregnant therapist’s unique counter transference, and the resulting Invasion of the Therapeutic Alliance and Therapy Session Itself.

Below is a useful definition of the term transference first used by Sigmund Freud. (I quote Wikipedia directly as this part of their entry on the topic is a good description.) Of course you can read more online about the term as well as about the counter transference of the therapist towards the patient

“In a therapy context, transference refers to redirection of a patient’s feelings for a significant person to the therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status. When Freud initially encountered transference in his therapy with patients, he felt it was an obstacle to treatment success. But what he learned was that the analysis of the transference was actually the work that needed to be done.[citation needed]”
(“citation needed” came from Wikipedia, not me. I may have to lift this citation but for now it’s a good description to use about the very specific and different transference that comes up with the pregnant therapist.)

1. The therapis’s body is usually what communicates her pregnancy to her patients. In many cases, patients pick up on feeling that their therapist is different in some way and take the risk of bringing it up directly in the session. During the first 3 months of pregnancy, if this happens, it can invade the therapist’s assumption of the secret she has even in her own personal life, if she is limiting the sharing of the news of her pregnancy. If the therapist has a miscarriage at any point in the pregnancy, another set of reactions is obviously triggered in the patient and the therapist. (This loss will be elaborated in in another post on this topic.)

In many cases, however, the patient notices the therapist’s growing “belly” later on in the pregnancy and asks the therapist directly (and sometimes indirectly through dreams or images) if she is pregnant. The only kind of transference this can be compared to is when a therapist is obviously sick or injured and her body tells the story. However, usually the patient is not so surprised if the therapist has suddenly cancelled a session and in the next session the patient can see that the therapist is sick or injured. However, with the pregnant therapist, the transformation of her body is usually not seen as a sickness but as a joyful event. There is an interesting time lag, especially in the case of female patients, in which a patient wonders, “Is she pregnant?” but waits a while to ask for fear of being told, No. The patient in such cases is sensitive to not wanting to insult the therapist if it turns out she has simply gained a lot of weight and is not pregnant. ( I have had patients who know I have a child ask me if I’m pregnant, not because of any visual difference in me but sometimes to express a feeling of abandonment or a sense that something secretive is going on with me, or even as a way to express that I seem to be less attentive.) With patients of all sizes who have experienced such situations themselves and felt wounded, there is a tentative aspect to asking the question. More will be addressed on this topic in another post…

The main point is that the therapist is put in an unusual position in which she cannot control the revealing of private information about something very personal to her patients. (This is of course in contrast to male therapists who are having a baby. Even if the expectant father reveals the news because he is taking a paternity leave, he has much more control over when and how and how much he decides to reveal to the patient.)

2. In terms of societal attitudes that infect or have a part in the patient’s’ transference to the therapist and the therapist’s counter transference, a big one is the idea or notion that any pregnant woman needs extra care taking. With it there is societal permission to invade the personal boundaries of the pregnant woman. (An obvious example is that of strangers asking a pregnant woman to feel her belly. This really does occur!) This can move towards even unconscious assumptions that the therapist is now fragile and even could be needy. There is also often a conscious or unconscious association of unpredictability, lack of consistency, and possibility of the therapist being in medical danger during the pregnancy and delivery. There is also sometimes a perceived possibility of the therapist dying or losing the baby at delivery or having a late miscarriage.

The patients who take on a care taker role thus will become somewhat hyper vigilant about trying to ascertain how the therapist is doing and wanting to some how take care of her. These patients often start the session with a check in which involves questioning the therapist about how she is feeling to alleviate their heightened anxiety before they are able to focus back on themselves. In society, the idea of taking care of the pregnant woman can be positive, negative or neutral. In NYC, the giving up of a subway seat is even an instruction paired with instruction to give a seat to disabled individuals, on a sign in each car. (Even this pairing expresses the attitude that the pregnant woman is weak or fragile. Of course there is some truth to this in terms of heightened exhaustion, difficulty standing in a moving train, feelings of nausea, etc., which are very real possibilities in pregnancy, but many pregnant women feel stronger than before and more aware of their surroundings.)

Other less positive often new experiences for any obviously pregnant woman include strangers’ bossy, intrusive negative reactions to seeing a pregnant person drinking alcohol or even coffee and obviously if she is smoking a cigarette. Thus, normal respect of one’s personal space is often invaded because our society sees it as ok to break the stranger “boundary” when a pregnant woman is involved. In New York City especially, which is known for its inhabitants respecting personal space and expecting the same treatment from others, this sudden infantilization of the pregnant woman is an odd and even traumatic experience for her, especially if this is her first successful pregnancy…

The other unusual aspect of the care taking role taken on by some patients is that some are unconsciously responding to the anticipated abandonment by the therapist when she will interrupt treatment to take a maternity leave. There is a high risk that for this particular “societal attitude” type if Caretaker transference is not recognized and explored, that the patient will wait until s/he finds out the therapist has had the baby and is healthy and able to return to work to themselves terminate with the therapist and take back “control” that they feel was taken away from them. No matter what the therapist does, some patients will feel the need to take control of the therapeutic process by leaving, and as a way to express anger at the therapist for abandoning the patient and prioritizing her baby over the patient’s well being. Even if the pregnant therapist processes these issues and feelings way in advance with her patient and has referrals for the patient to use to continue therapy if needed, sudden “revenge” termination can happen once the patient knows their therapist is healthy, still alive and no longer pregnant…

3. American society has coined a term “baby brain”, referring to a pregnant woman’s loss of some short term memory. Somehow that can translate to her being viewed as unpredictable, disorganized, overly preoccupied with her pregnancy, prone to impulsivity or somehow less sharp and responsive as a therapist, a loss of capacity to empathize or be present with the patient while there is a growing foetus in her body, which is indeed physically invading the session as her belly continues to grow. Patients who adopt this societal attitude are vigilant about observing their therapist closely to make sure she is really listening and giving her full attention to them as well as watching to see if she is able to match their normal expectations of her competence as a therapist, etc.

4. The opposite kind of transference that sometimes arises is linked to another societal view of the pregnant woman as some kind of idealized earth mama. For now, it is highly rare for a male to become pregnant (though not impossible for some transgendered individuals). There are many primitive perceptions and assumptions about the pregnant woman. Though they may involve idealizing and elevating her for being “special” in that she is actually growing a potential new human being in her body, these attitudes can take on a quite sexist or at essentialist quality. Being made special or seen as having some kind of magic power, even the positive wonder of how a new person is created in the female body, can result in the pregnant woman feeling weirdly objectified and idealized.

Go into any museum with “older” paintings in it, and the ones of mothers with babies, whether actual religious depictions or not, idealize the female pregnant form and the female with infant

I will end this post with the thought that being idealized and seen as a Major Archetypal Symbol coupled with all the expectations and attitudes about Motherhood in our culture can be quite a challenge and difficult experience for any pregnant woman or mother. This idea can become magnified in the therapy session…

To be continued…


2 thoughts on “The Pregnant Therapist: Transference and Countertransference: Part 1

  1. Wow this is really interesting. A therapist I had in one of my past group treatments became pregnant and ended up leaving so I can relate to some of these things you’ve written, or at least can see similarities in the things you’ve written to the way which other people in the group reacted at the time.


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