Patients’ Pregnancies During Treatment: The Influence of the Analyst’s Psychology

Abstract

Psychoanalytic therapists are today far more aware of countertransference effects, intersubjectivity, and mutual influence. The area that has been explored least in this two-person appreciation of psychoanalytic process is the effect of the psychodynamics of the therapist in a wide sense—that is, how the therapist brings a whole psychology, with a wide array of potential transferences, to each treatment. Triggered by the unexpected announcement of a patient’s expecting a baby, the author reviewed his practice and found that a large portion of his women patients ages 30–45 had become pregnant during therapy or psychoanalysis. The particulars were varied: how much the patient wanted a baby, whether the treatment was psychotherapy or psychoanalysis, the patients’ personality structure. Was the analyst’s psychology a common factor? The paper presents three quite different case examples and examines whether and how the author’s developmental and inner experience of women, sexuality, pregnancy could have contributed to a dyadic process that, in turn, could lead to pregnancy. If such effects happen, then it is important to look beyond and behind “anonymity” and “neutrality,” as well as momentary countertransferences, to the real-life effects that we have in our treatments.

Notes

¹ A very rough review of my practice suggests that more than one third of the patients in the possible group got pregnant during treatment, and another third had a child subsequently (letting me know), for a total of two thirds of the total. My impression is also that this proportion increased to roughly half, as my practice continued, and I saw more women in the latter part of the child-bearing years (ages 30–45). As a baseline comparison, the average child-bearing rate for the age group 30–45 in recent years is 5.5%/year. If my treatment contacts averaged 5 years in length, the “control group” rate would be 28%. My patient population tended to be in the 35- to 45-year-old range, where the “control” rate would be 17%.

² In proposing to explore this thesis I am aware of my own concern about transgressive impulses or behavior, or the criticism of others. After all, ethical concerns about the analyst’s behavior are not limited to frank sexual activity (Jacobson, 2010). But on the other side, arguing for reporting the study here is the fact that the influence of the analyst’s personality is ubiquitous in analytic/psychotherapeutic practice. We are better off if we consider its possible clinical impacts. Excessive anxiety and self-protectiveness about analyst influence discourages examination, which then tends to be limited to after-the-fact inquests into extreme boundary-crossing (Burka, 2008; Celenza & Gabbard, 2003).

³ For a wonderful literary description of such an experience, see Flanery O’Connor’s (1952) story “My Oedipus Complex.”

⁴ Of course, I could have pressed the point, and then worked with this meaning if it emerged. But I am describing what did happen, not what could have been.

⁵ The many anecdotes of women who adopt and soon after become pregnant come to mind here.

Additional information

Notes on contributors

Richard Almond

Richard Almond, M.D., is a Training and Supervising Analyst, and faculty member of the San Francisco Center for Psychoanalysis; Adjunct Professor of Psychiatry and Behavioral Sciences, Stanford Medical School; and founding Chair of the Palo Alto Psychoanalytic Psychotherapy Training Program. He is the author, with Barbara Almond, M.D., of The Healing Narrative: Fictional Relationships and the Process of Psychological Change (Praeger, 1996).