The Pregnant Therapist: Societal Attitudes and Assumptions About Pregnancy

September 14th, 2012 | Categories: Gender

In a recent post on her blog Art Therapy and Related Topics, Natasha Shapiro discusses the pregnant therapist and its impact on therapy for both the therapist and patient. In her first of a multi part post which is amended to be more non-therapist reader friendly and posted here, titled The Pregnant Therapist: Transference and Countertransference: Part 1, she provides TCS readers with a unique view into how stereotypes of pregnant women impact the work of a therapist.

The therapist’s body is usually what communicates her pregnancy to her patients. In many cases, patients pick up on feeling that their therapist is different in some way and take the risk of bringing it up directly in the session. During the first 3 months of pregnancy, if this happens, it can invade the therapist’s assumption of the secret she has even in her own personal life, if she is limiting the sharing of the news of her pregnancy. In many cases, however, the patient notices the therapists growing “belly” later on in the pregnancy and asks the therapist directly (and sometimes indirectly through dreams or images.) if she is pregnant.

The only kind of transference this can be compared to is when a therapist is obviously sick or injured and her body tells the story. However, usually the patient is not so surprised if the therapist has suddenly cancelled a session and in the next session the patient can see that the therapist is sick or injured. However, with the pregnant therapist, the transformation of her body is usually not seen as a sickness but as a joyful event.

There is an interesting time lag, especially in the case of female patients, in which a patient wonders, “Is she pregnant?” but waits a while to ask for fear of being told, No. The patient in such cases is sensitive to not wanting to insult the therapist if it turns out she has simply gained a lot of weight and is not pregnant. (There can be other reasons people ask their therapist she is pregnant when she is NOT! For example, I have had patients who know I have a child ask me if I’m pregnant, not because of any visual difference in me but sometimes to express a feeling of abandonment or a sense that something secretive is going on with me, or even as a way to express that I seem to be less attentive.)

The main point is that the pregnant therapist is put in an unusual position in which she cannot control the revealing of private information about something very personal to her patients. (We can contrast this to male therapists who are having a baby. Even if the expectant father reveals the news because he is taking a paternity leave, he has much more control over when and how and how much he decides to reveal to the patient.)

As a result of the pregnancy being revealed, however this occurs, societal attitudes can infect or have a part in the therapy experience.

A big societal attitude that is relevant here is the idea or notion that any pregnant woman needs extra care taking. With this idea, there is societal permission to invade the personal boundaries of the pregnant woman. (An obvious example is that of strangers asking a pregnant woman to feel her belly. This really does occur!) This can move towards even unconscious assumptions that the therapist is now fragile and even could be needy. There is also often a conscious or unconscious association of unpredictability, lack of consistency, and the possibility of the therapist being in medical danger during the pregnancy and delivery, and even the perceived possibility of the therapist dying or losing the baby at delivery or having a late miscarriage.

The patients who take on a care taker role will become somewhat hyper vigilant about trying to ascertain how the therapist is doing and wanting to somehow take care of her. These patients often start the session with a personal check-in, which involves questioning the therapist about how she is feeling to alleviate their heightened anxiety before they are able to focus back on themselves.

In society, the idea of taking care of the pregnant woman can be positive, negative or neutral.

In NYC, the giving up of a subway seat is even paired with the instruction to give a seat to disabled individuals on a sign in each car. This pairing expresses the attitude that the pregnant woman is in a special class often stereotyped as weak or fragile. (Of course there is some truth to this in terms of heightened exhaustion, difficulty standing in a moving train, feelings of nausea, and so forth, which are very real possibilities in pregnancy.)

Other less positive, and often new, intrusive experiences for any obviously pregnant woman includes a stranger’s bossy, insensitive and negative reactions to seeing a pregnant person drinking alcohol or even coffee and, obviously, if she is smoking a cigarette.

Thus, normal respect of one’s personal space is often invaded because our society sees it as ok to break the stranger “boundary” when a pregnant woman is involved.

In New York City, which is known for its inhabitants respecting personal space and expecting the same treatment from others, this infantilization of the pregnant woman is an odd, sudden, and even traumatic experience for her, especially if this is her first successful pregnancy.

There is a high risk that if this particular “societal attitude” type of what I call the “Caretaker” transference is not recognized and explored, then the patient will unconsciously respond to the anticipated abandonment by the therapist when she interrupts treatment to take a maternity leave.

In the cases where this occurs, the patient will wait until s/he finds out the therapist has had the baby, is healthy, and is able to return to work. Then the patient will suddenly terminate with the therapist in an attempt to regain control of the therapeutic process and as a way to express anger at the therapist for abandoning the patient and prioritizing her baby over the patient’s well being. Even if the pregnant therapist processes these issues and feelings in advance with her patient and has referrals for the patient to use to continue therapy if needed during the maternity leave, sudden “revenge” termination can still happen once the patient knows their therapist is healthy, still alive and no longer pregnant.

Another societal attitude that impacts the pregnant therapist is what in American society has coined as “baby brain.” This refers reality that a pregnant woman experiences a loss of some short term memory. It often becomes transformed into a kind of stereotype. It can translate to her being viewed as unpredictable, disorganized, overly preoccupied with her pregnancy, prone to impulsivity, and somehow less sharp and responsive as a therapist. While there is a growing fetus in her body, which is indeed physically invading the session as her belly continues to grow, the therapist may be viewed as having a loss of capacity to empathize or be present with the patient. Patients who adopt this societal attitude are vigilant about observing their therapist closely to make sure she is really listening, giving her full attention to the session, and matching their normal expectations of her competence as a therapist.

Yet anther societal attitude that is relevant here involves the societal view of the pregnant woman as some kind of idealized earth mama. (As, for now, it is highly rare for a male to become pregnant though not impossible for some transgendered individuals.) This stereotype involves many primitive perceptions and assumptions about the pregnant woman that can take on quite a sexist or essentialist quality though they may involve idealizing and elevating her for being “special” in that she is actually growing a potential new human being in her body. Being made special or being viewed as having some kind of magic power, even the positive wonder of how a new person is created in the female body, can result in the pregnant woman feeling weirdly objectified and idealized.

Art history reveals this reaction to pregnancy throughout time and cultures with iconic images of pregnancy and birth reproduced and, therefore, objectified ubiquitously. As a child, I was fortunate to be exposed at a young age to museums all over Europe and in Asia. I remember having a negative association to and dread of going to any European museum that voiced itself in the thought, “Oh no! Another Mary and baby Jesus picture, I’m sick of seeing them everywhere.” Also as a Jewish girl, I saw these images of maternity as something foreign being forced on me by the majority Christian society I was being brought up in. (Back then there were no days off from school for Jewish holidays.)

I will end this post with the thought that being idealized and seen as a Major Archetypal Symbol along with all the other societal attitudes (and expectations) about Motherhood in American culture can be quite a challenge and difficult experience for any pregnant woman and represent an additionally unique experience for the therapist.

Natasha Shapiro is a Licensed, Registered, Board Certified Art Therapist and Psychotherapist, as well as a Professional Visual Artist and an Advanced Reiki Practitioner. She authors the blog Art Therapy and Related Topics.

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