The Pregnant Therapist: Caring for Yourself While Working With Clients

by Judith Gerber, PhD, and the Advisory Committee on Colleague Assistance

July 21, 2005 — Many psychologists continue their careers through their reproductive years. As a therapist you will want to prepare your clients for the fact of conception by anticipating the effect that visible pregnancy might have upon the therapeutic alliance. At the same time, it is important to take appropriate steps to care for yourself.

Regardless of theoretical orientation or treatment modality, sound clinical decision making will allow you as a professional psychologist to enjoy your new focus on parenting while attending to the client’s needs throughout the pregnancy (Fallon, 2003).

There are personal, professional and business concerns involved as the therapist begins to plan a family. It is beyond the scope of this article to address the many relevant issues in detail. A therapist who is planning a family generally needs to consider the following four issues:

• How and when will the clients be informed of the pregnancy?

• How will the therapist handle his or her clients’ reactions to this news?

• What will be the dates and length of the maternity leave?

• Who will manage the clients while the therapist is on leave? (Haber, 1992)

While the psychologist may be accustomed to presenting as a pre-pregnancy model of health and energy, she may be surprised to find this replaced by physical symptoms of nausea and fatigue during her work day. It is important to make adjustments in the work environment by:

• Communicating with your employer and colleagues about special needs during your pregnancy

• Attending to the creation of a comfortable and ergonomically supportive office environment, such as pillows or footstools.

• Adjusting the client schedule to incorporate stretch breaks, brief stress reduction exercises and nutritional requirements.

• Paying special attention to maintaining a professional presentation in attire as the pregnancy progresses and becomes visible. (Futa, 2002).

Pregnancy may stir intense feelings in clients. This may result partially from their feeling intense rivalry with the newly important being coming into their therapist’s life, and also from viewing their therapist as a sexual being. Observing their visibly pregnant therapist may be the first time clients have even considered that their therapist has a life outside the consulting room!

Such reactions may serve as a catalyst for change in treatment, perhaps helping the clients resolve issues of loss, sibling rivalry or oedipal conflict (Cullen-Drill, 1994). Further, the reactions may engender discussions regarding the length and course of treatment and perhaps motivate clients to maximize their time in treatment.

However, emotional changes in the therapist herself due to hormonal fluctuations of pregnancy, fatigue and a growing sense of vulnerability may reduce her functioning as a therapist. Impending parenthood may also cause emotional changes for male therapists, that could become problematic if left unaddressed (Guy, 1986).

It may be important that the psychologist enter her own psychotherapeutic treatment during this time so that she is able to distinguish her unresolved issues from those of her client. (This may similarly be the case for male therapists who are soon to become fathers.) Objectivity can be difficult to maintain during the heightened sensitivity of pregnancy. Regular supervisory sessions or peer consultation can also be helpful in identifying personal issues and maintaining appropriate boundaries within the therapeutic session.

Special challenges in interacting with clients might include:

• Personality-disordered patients who may vacillate between hostile and affectionate attitudes toward the pregnancy.

• Male patients who reveal sexual fantasies involving their female therapist.

• Female clients with a miscarriage history may experience renewed feelings of loss when the therapist reaches the gestational stage at which the client lost a pregnancy.

• Jealous patients who view an anticipated maternity leave as abandonment.

Careful planning of the maternity or paternity leave will allow the therapist to protect her or his privacy as well as help provide for appropriate continuity of client care. There are important continuity of care considerations and related legal and ethical issues that may be involved with pregnancy and taking leave from professional practice. Psychologists in this situation should seriously consider consulting with a knowledgeable attorney to ensure that they take appropriate steps related to continuity of client care.

A few practical pointers include:

• If a colleague will fill in for the therapist on leave, an early introduction of the colleague to the client is helpful.

• Introducing clients to the covering therapist early in the pregnancy can help facilitate a smooth transition. This may be especially important if coverage is needed earlier than expected due to circumstances such as an enforced bed rest during pregnancy, miscarriage or delivery complications which might delay return to work.

• If the therapist is not planning to return to practice following the pregnancy, transitioning clients to a new therapist well before the expected due date can provide ample time for the therapists to consult with one another about client treatment.

• Limiting acceptance of potential long term clients during initial pregnancy might be in the best interest of both psychologist and client.

Cullen-Drill, M. (1994) The Pregnant Therapist. Perspectives in Psychiatric Care, 30(4), 7-13.

Fallon, A. & Brabender, V. (2003). Awaiting the therapist’s baby; A guide for expectant parent-practitioners. Mahwah, NJ: Lawrence Erlbaum.

Futa, Kristine, (2002) The working pregnant psychologist. California Psychologist, March/April. http://cpaclasp.org/articles.

Gerson, B. (1994). An analyst’s pregnancy loss and its effects on treatment disruption and growth. Psychoanalytic dialogues, 4(1), 1-17.

Guy, J, Guy, M. & Liaboe, G. (1986).Therapeutic issues for both female and male psychotherapists. Psychotherapy: Theory, Research, Practice, Training, 23(2), 297-302.

Haber, S. (1993). Women in independent practice: Issues of pregnancy and motherhood. Psychotherapy in Private Practice, 11(3), 25-29.