Psychotherapy and pregnancy

Abstract

It is suggested that psychotherapeutic treatment during pregnancy can help a disturbed woman achieve better integration of internal resources and self-representations, thereby preventing postnatal maternal distress. The need for psychotherapeutic intervention related to childbearing is discussed and some special features of psychotherapy with pregnant women are described, including common phase-related themes, unusual therapeutic structure, transference/counter-transference issues for both individual and group work. Key therapeutic situations are indicated by delineating three somewhat overlapping subgroups of women, who may be particularly at risk during pregnancy due to factors in their current or past experience which constitute stressors when interacting with resensitized areas of intrapsychic vulnerability.

Risk-indicators specified are: Conflicted pregnancies - including unplanned, untimely and ‘wrong’ (such as those resulting from incest or rape). Emotional sensitization - expectant mothers who for a variety of predisposing reasons (own or maternal obstetric history, previous stillbirth or neonatal loss) or neurotic disorders, are prone to emotional difficulties such as over-or undervaluation of foetus/baby, pregnancy and/or birth. Complicated pregnancies - examining some of the possible concurrent physical conditions (maternal illness, substance abuse or eating disorders, AIDS-imperilled babies, threatened miscarriage or maternal disability), life-events (bereavement, eviction, negative test results), socioeconomic difficulties (unemployment, housing problems, poor social support), emotionally impoverished marital relationship and unsupported women on their own.