The Pregnant Therapist, Continued: The “Recognition” Session

Finding Out About The Pregnancy: “Intrusion” in the Therapeutic Space

This post got so longwinded, I’m not sure what to do with it, so I will edit a few paragraphs, and save the rest for another post continuing this longwinded “pregnant” topic! At least it won’t take 9 months to write about it…

You are pregnant and in your office with your patient. There are now 3 heartbeats in the room.  Now, jump ahead to your fifth month. If your patients haven’t “guessed” yet about your pregnancy, this is the time in which you will have a lot of “pregnancy recognition” sessions and a few sessions where you might actually inform your patient about the pregnancy and help him/her prepare for the upcoming changes, such as your maternity leave.

In one of the books I mentioned in my last post, the authors remarked that there are many ways your patient may let you know that they have become aware of your pregnancy besides direct verbal comments asking if you are pregnant, including dreams and images, even discussion of the patient wanting or not wanting to have his or her own baby.

Sometimes a patient, usually a woman, will wait a few sessions to see if your belly is getting bigger, as many women are sensitive to body image and don’t want to make a big “mistake” and find out you have gained weight for some reason and are not pregnant. I’m sure this happens sometimes, as I’ve had a few patients tell me they get asked if they are pregnant, sometimes by strangers, and are not. (Not always people who are overweight, but nonetheless, an odd unpleasant experience no matter what you look like…) Of course this can be very wounding to a person and most of our patients are very careful not to hurt our feelings, especially if they already know what it feels like…

(Confidentiality note: these “stories” are made to be not identifiable, as I do not supply any identifying information beyond gender of the patient. In some cases where the gender is not important, I have changed that, but given the nature of pregnancy, often the reactions are different in women versus men, as well as children, teenagers, adults, older adults, etc…)

So by around five months into my pregnancy, I had to have the inevitable “Recognition” session with each patient. Each person reacted completely differently.

One person had discussed noticing it with another patient, a friend of his whom he saw once in a while, and the two discussed it and decided the one who noticed would say something so he did. I don’t remember much of that session as he was fairly honest about his feelings and reactions. Then the friend came for her own session and got distracted by focusing on feeling bad that she didn’t notice, and her friend did. This may have been a convenient way to avoid the real topic, but I pointed out that I actually saw her “not noticing” as a good sign. Given certain issues around boundaries she was grappling with, I observed that it was great she was able to be so focused on herself.

One patient had a very interesting reaction. As a woman with mother issues (just like the rest of us, who doesn’t have mother issues!) that were unresolved. ambivalent and complicated, she was overly sensitive to my being pregnant and told me she was very concerned that her own negative energy would “hurt” both me and the “baby”,even though I reassured her that this was not the case. She simply did not believe it and was convinced she was right. While I was on my leave, she communicated to me that she could not come back to therapy knowing I was a new mother and explained as thoroughly as possible the issues this knowledge was triggering and not wanting to process them with me despite encouragement…This is an example of a patient who cannot be comfortable during but also after the pregnancy, as opposed to the majority of patients who do return to therapy with their now mother therapist. Quite a few young female patients openly admitted to feeling a discomfort in the sessions and being very aware of my body changing from week to week. One person expressed this through chronic lateness to the sessions and had no interest in exploring the connection to my pregnancy… Of course I supported all reactions, and once I knew the discomfort caused by my actual body changing, I was more sensitive than usual about checking in with people a few times in the session to see how they were feeling about it.

This reaction is related to the conscious and unconscious feeling many patients have that the now pregnant therapist is and will become more and more sel preoccupied and unable to be present and focused in the patient. Most children feel this way and show it non verbally. Having a younger sibling does not always mean a child is more comfortable with the therapist having a baby. The therapeutic space belongs to him or her and many children feel the therapist is going to be inattentive and absent. This reaction at any age can be very real in many ways. The pregnancy is a very real intrusion as well as a big or little distraction for both therapist and patient.

For me, as I contined to view my work with patients, despite the changes of pregnancy, I continued to see my work as a good distraction for me from focusing on the pregnancy and the inevitable birth of the child and shock of now having a real human to take care of… I could not avoid talking about it at relevant moments and accepting that it was very disturbing for some. Even the people who ignored it completely, were nonetheless deeply affected by the change in the therapeutic space, however, they ndicating that it was easier for them to “forget” about this intrusion and sort of get rid of the belly in order to avoid some kind of discomfort. Other therapists that I’ve talked to during their pregnancy have expressed that it was increasingly difficult to focus on and care about their patients, especially therapists at very difficult often traumatizing jobs, so this concern is very natural and needs to be addressed even if the therapist or especially if the therapist is colluding with those patients to try to ignore the inevitable change, that the therapist will be taking a leave, some short, some longer, and the patient has no control over the timing of it in their own life’s journey and their own progress/process in therapy. The return of the therapist is also not in the patients’ control. In private practice, there is usually trust that if the therapist says she will return in two months or three, she actually will; however, I have known a lot of therapists in all kinds of jobs who have been unsure of whether having the baby will cause them to decide not to return to their job, or to return briefly and terminate. In short term settings, the pregnant therapist usually has more emotionally laden issues with the rest of the staff, rather than the patients who may be at the site, such as a hospital, very briefly. These patients tend to be the least affected by the therapist’s pregnancy, although in many cases, people still have strong reactions and transference towards the pregnant therapist, more related to their own particular feelings about mothers and mothering… Thus, short term sites can actually allow for some interesting issues to emerge in therapy and art therapy groups when the pregnancy is addressed in a less personalized way. Discussions that would not normally occur may happen due to the pregnancy bringing up a lot of issues and feelings…

There is much more to say about the topic of “Recognition” and lack of it (thus the therapist’s inevitable “Announcement”. When in the session to tell the patient and how are another interesting focus to be further explored, as there are going to be people who simply do not say anything and even admit to waiting for you to tell them, as well as those mentioned above who probably are avoiding it altogether…

To be continued…

The Pregnant Therapist, Continued! Part 3: What Little Info Is Out There Still!

This is my third post on this topic. I am planning to put together some kind of workshop for therapists that will be about the very particular experiences in therapy for both therapist and patients regarding the pregnancy of the therapist. In my experience, there is very little preparation, actually maybe none, for the female therapist regarding how to manage the very unique experience of pregnancy, especially those experiencing it for the first time. In my personal experience, it was never discussed in my grad school program, although, actually, while I was in grad school, one of my classmates got pregnant and went to her internship during the beginning and middle of her pregnancy. She had her baby after we graduated, but I have some vague memories of her sharing some of her experience with us. At the time, pregnancy and babies were not in my radar or future plans, so I did not retain many memories of what her experience was like, besides that there was nothing in the curriculum about it, and besides one woman with teenage children, she was probably the only person in the class about to be a mom.

Anyway, I did find two helpful books that I read while pregnant. Both were not recently published. I don’t know where they are in my bookshelves, but I think they were the following two that I found on Amazon after a big search:

First one was published in 1994: The Therapist’s Pregnancy: Intrusion in the Analytic Space, by Sheri Fenster, Suzanne B. Phillips and Estelle R. G. Rapoport

The other one was: Awaiting the Therapist’s Baby: A Guide for Expectant Parent-Practitioners, by April E. Fallon and Virginia Brabender, published in 2002

A quick google search just now (2012!) did not produce much besides the first book mentioned and a short blog post on Psych Central: http://blogs.psychcentral.com/unplugged/2010/07/the-pregnant-therapist/

So this short post simply reveals that this is a very important topic for women therapists who are curious about the topic even if they are not sure they want a child, or thinking about becoming mothers, of actively trying to get pregnant, or pregnant right now and experiencing the “intrusion” in the “analytic space” or therapeutic space as I prefer to call it.

On the one hand, I am happy to have stumbled on a topic that is very relevant for therapists and patients of pregnant therapists, yet not a very popular topic that has been written about exhaustively. Seems like there is plenty to say about it, and not much that has been written since 2002, ten years ago! The first book which is probably more well known, is way out of date, as it was published almost twenty years ago!

In posting about this topic, I am curious to hear people’s experiences both as therapists and patients. In addition, since my pregnancy, I have worked with pregnant patients as well as patients who are thinking about having kids and for one reason or another know that I have been through it, and found that to be an interesting experience. I had one therapist patient who went through my pregnancy with me, came back after my maternity leave and then got pregnant and went through her pregnancy with me, leaving therapy to have her baby. I also have worked with patients who came to therapy due to the loss of miscarriage and seen some of them get pregnant and work with me through their pregnancy. I have also had patients who have gone through the experience of abortion and processed this experience with me, a whole different but very important topic as well, as it can be a lonely difficult experience in which the person needs a lot of support for various reasons, especially the often secrecy of this process, in which a woman often does not want her family to know and only tells a few people…

I have also since having my own child been a close witness to colleagues who have gotten pregnant and experienced the “before” and “after” of private practice, in which your caseload goes through a lot of upheaval in terms of patients who stay through your pregnancy and return after the birth, patients who leave in the midst of your pregnancy, and patients who stay up to your leave and then do not return. Of course, how a patient leaves therapy in the course of a pregnancy and birth can be very important, just as it is in general. Having someone process why they are leaving and terminate in a more healthy manner is very different from some abrupt terminations, and some that come with no communication whatsoever. By chance I had a few patients who were moving out of NY during the time when I was pregnant and left before I had the baby. The termination was the more natural kind with a lot of time to process the person’s leaving therapy due to moving and their feelings about leaving as well as feelings about “missing” the opportunity to work with me after the birth, which they were all curious and slightly sad about in addition to the other feelings around termination… One of my patients had been processing a lot about whether she wanted to be a mother or not and had a lot of ambivalence about it. She found it helpful to see me go through the pregnancy and share some of the experience with her before her move. She subsequently sent me a very nice package with a hand made gift for me and several baby gifts. In addition, she emailed me a couple of years later to share her announcement of her own pregnancy and the birth of her first baby. Of course this was especially meaningful and I was thankful to find out about her decision and happiness about becoming a mother…

So there are many aspects to this experience for both therapists and patients. I found it an odd synchronicity that for some odd reason, before my pregnancy in my private practice, I do not remember working with a mother although I may have had a few patients with kids that I forgot about; I do remember working with a father of teenage girls, with whom I did discuss parenting, especially the particular experience of being a father of teenage girls. I actually used my own experience as a teenager to reflect with him upon the particular challenges he was dealing with. Once I became a mother, I started working with more patients who were pregnant, trying to get pregnant as well as people who were already mothers.

Making Your Art Work Versus Showing It, A Common Struggle!

I just wrote this post and it vanished, so I’ll start again. This is another short post just to bring up some topics and questions, especially for artists and art therapists and those who identify as both.

Do you exhibit your work? If so, is it very sporadic or often? Where do you exhibit it? If you don’t, why not? Do you have gallery representation? Do you want to have your art out in the public eye? Do you sell your art work? Do you enjoy selling it? Are you attached to any of your art work, such that if you exhibited it, you would mark it as Not For Sale? Are you easily discouraged by the competition? Do you find yourself making lots of work as a way to procrastinate trying to show it? Do you every get blocks where it is hard to get yourself to make art? These questions are not easy to wrestle with for any artist, and often more frought with inner turmoil for us artists/art therapists…

For me, I’ve been an artist for way longer than an art therapist, even though I didn’t go to “art school” or major in Art. However, although my artist resume has a long list of exhibitions at various types of venues that I have shown my work, I find that in the last two years, I have not really exhibited it, beyond having it out for public view during the Tribeca studio tour: (http://www.toastartwalk.com/toastartwalk/Natasha_Shapiro.html)

I don’t have issues with getting attached to any of my art work, so that is not a road block for me. I admit that I get easily discouraged by rejection, and find it hard to hussle and market myself as an artist. I am currently working on these very issues, by writing about it here, and by actively trying to look for galleries and opportunities to show my work, that I normally don’t get out of my comfort zone to do… I have always been lucky in that I have no problem with blocks around making art. While I may have a block on a specific piece or idea, I always have two or three other things I’m working on, so I don’t notice getting blocked. However, I confess that I too find it very easy to procrastinate the marketing and selling end of things. For example, I got invited to be an artist on a great website called “Artiscle”, and it took me about a month to make a profile and get some work on it. I still need to post a lot more work on the site, as it is a great opportunity to not only sell work but rent it out.

I find myself making myself promises I do not keep. So it’s time to get on it, and work through all the things that get in the way of trying to succeed more as an artist! Share your struggles and triumphs in comments please!

Trusting Yourself in The Art Making Process

It is a struggle, making art often and trusting the process. At times I do not realize that I am very lucky as I have stumbled on something that is a kind of blueprint and I can keep going on and on, making one thing after another in a series. Once I have figured out the rules to it, I can follow them and keep generating more work, all variations on a theme I’ve stumbled on that is fueling me. It can last several years.

Recently, for the first time in years, I reached a strange place in my work. Suddenly I was unsure about my current “blueprint”, and not finishing things I started, feeling a bit distanced and getting a little bored with what I was doing. Maybe some of it was due to the detour on vacation of making necklaces and getting obsessed with beading…

I got in an interesting place, and I’m still there, struggling with the process…

To be continued soon. As well as the Pregnant Therapist Series. I haven’t forgotten about that!