Pregnancy in the Analyst

As more and more women pursue independent careers, they commonly choose to postpone childbearing until after they are established professionally. A result of this trend is the increasing frequency with which analysands must contend with the phenomenon of a pregnant analyst. Literature on the effects of a therapist's pregnancy is scant but instructive, focusing on the more common transference reactions of patients, the special challenges to the therapist's adaptability, and the assets and liabilities inherent in the loss of her capacity to approximate a “blank screen.” Most of it concerns hospital or clinic practice, not necessarily long-term outpatient psychoanalytic treatment.

In the course of my own career in private practice I have given birth twice, each time working until my due date and then breaking for six weeks. Some of my patients have thus endured one of my pregnancies, others two. Since it is probable that increasing numbers of female analysts will make choices like my own, to maintain a basically uninterrupted therapeutic career while juggling simultaneous parental responsibilities, I wanted to make a few additions to what has so far been said about pregnancy in the analyst. First, concerning transference reactions: I have encountered three frequent themes I have not seen discussed elsewhere. (Prior writers have rightly noted oedipal issues precipitated by the inescapable evidence of the analyst's sexuality, sibling rivalry themes, sudden regression to an early maternal transference, separation and rejection anxieties, and fantasies of rebirth by identification with the baby.)

1. Protectiveness. The analyst must be alert to the possibility that patients are withholding feelings or fantasies experienced as threatening – especially those involving anger and neediness – because they think that they would excessively burden the analyst at this sensitive time. Such protectiveness has been previously attributed to denial and projection, but additional sources of t