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…
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