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A Patient’s Reaction to the Pregnant Therapist

In our book A WOmb of Her Own (Routledge, 2017)  author Meredith Darcy writes as follows:

Abby hated coming to therapy–she would tell me this often.  She explained that our time together was her most difficult time spent each week.  Abby much preferred her group therapy experience and often reminded me that she was only coming to individual treatment because it was mandatory.  She valued her interactions with this group—it was her primary social contact during the week.  I would speak with her group therapy leader several times throughout the year regarding Abby.  This therapist would often complain that Abby’s authoritative, directive, and critical style of communicating was alienating others in the group. She would often threaten, “If Abby doesn’t get with the program…!”  Abby would frequently discuss this therapist with me.  She often would remark upon her physique: her fit figure and toned arms.

The Therapist’s Fertility Treatments

Despite her palpable discomfort with individual psychotherapy, Abby began coming twice weekly about three years into her psychotherapy treatment.  Another change occurring this third year of Abby’s treatment, was that after several years of trying unsuccessfully to conceive a child, I began a series of IVF treatments. I was hopeful that this reproductive technology could finally make me the mother I had wanted to be.  I had always known I had wanted to become a mother, and like many women my age in metropolitan areas, I had put my education and career first, assuming that conceiving children in my mid-thirties would be a viable option.

Over the next two-year period, I went through five IVF cycles.  Out of those cycles, I became pregnant three times, and from those pregnancies, I had two early-term miscarriages and one full-term pregnancy.  During this personally challenging time, Abby was regularly coming to her two sessions weekly.  She seemed more committed to her treatment, willing to introspect, trusting the process and me.  Our connection seemed to be strengthening and growing.  Also during this time, Abby began to experience even greater anxiety and discomfort due to my changing body.  My breasts had grown considerably and I was looking much more like a woman and less like a “baby.”  As expected with the fertility treatment, and the requisite medications, I gained about 10 pounds.

Revealing the Pregnancy

“You’re gaining weight,” she confronted me, accusingly, after my second miscarriage.  We discussed her fantasies of my out of control eating, marital troubles, and depression.  She voiced her anger and anxiety about working with me–how could she trust me, come to me for help, knowing that I was so “out of control?”  I never told her explicitly about either miscarriage.  However, after repeatedly asking me, quite pointedly, “Why are you gaining weight?” and extensive exploration about her fantasies, I asked her if she really wanted to know why I had gained weight.  But she purposely changed topics.  Would I have told her?  I might have.

I told Abby about my third pregnancy at about twenty-two weeks, after blood tests and anatomy scan revealed a healthy baby boy.  She was relieved at first, having noticed more weight gain, but didn’t want to mention it (which seemed so unlike her!).  She expressed feeling hurt that I had not shared my news earlier, as “friends usually tell each other after three months.”  Although aware this label of “friend” was not an accurate depiction of our relationship, I chose not to interpret her need to keep me on equal (safe and comfortable) footing and see where it would take us.  All of my years of play therapy had taught me to “play” and accept—I wanted to encourage an openness, not derail what was being created in the room. Staying in the affective frame a patient needs can protect and positively impact those who’s emotional experience were chronically obliterated (Slochower, 2012).  When we would discuss my growing belly and subsequent leave, she would assure me it was fine for me to bring my baby boy into the office and she would hold him for me during her session.  She thought I should name him Ozzy.  I would smile and happily explore her fantasies with Momma, Abby and Ozzy; she would bounce him on her knee and take him to the park while I saw other patients.  She was part of our lives, and we were all together.

With our increased discussion regarding my growing body and exploration of her fantasies about our relationship, she had begun to have greater awareness and ability to articulate more feelings.  Abby began to describe the loneliness she would experience at night, triggering her binge eating.  She began discussing her feelings regarding her parents more honestly and would detail their interactions with greater depth and texture.  She began to experience and articulate feeling unloved and lonely.  I felt I was making headway, but was also insufficiently aware that our progress was perforating Abby’s carefully constructed armor.

The Patient’s Anger and Fear

Abby started to become increasingly more angry and frightened. “You’re huge!” she would regularly gasp, physically recoiling when I opened my office door to greet her.   She seemed to hate my growing body, much in the same way she hated her own and seemed to see my new “woman’s” body as soft and “bad” and my vulnerability as weakness.  Abby was having a hard time with my changing role, with seeing me as “mother.”  Here I was her “friend,” and now I was becoming a “mother.”  Abby’s criticisms of me were strikingly at odds with my own image of myself.  We were having such different emotional reactions—I felt like super mom, so maternal—loving my growing pregnant body, as well as Abby.

Pines (1988) writes no matter how pleasurable it may be for the therapist, the patient’s real reactions to this real event, is vitally important to treatment. There is a danger to the analytic process if the pregnant therapist’s own unconscious needs for mothering in her feminine role pull too much on the patient. This seems to bring a sense of urgency to the analytic process and an intensification of the transference, which facilitates further working through; the patient’s intense envy of the “life-giving mother” can be activated with regard to the present reality of the therapist’s life, and to her pregnancy, and to past feelings and experiences from childhood (Pines, 1988, p. 439)

She started complaining about “knowing” too much about me, and began lashing out at my “emotional openness.”  She became critical and accusatory of my “warmth” and “softness”, blaming me for not being “a good enough therapist”. She claimed that I had not maintained my professional boundaries: I had allowed her to “see me” and to “know me.”  This was now personal, too personal: not professional any longer.  She seemed scared and frightened. She said she could not imagine a male patient working with me, as I was too gentle, supportive and kind—not tough enough.  My maternity and these images of “loving” qualities were simultaneously triggering both longing and fear, causing her attack.

Pines, D. (1988). Psychoanalytic Quarterly, 57:435-440

Slochower, Joyce, 2014.  Holding and Psychoanalysis.  NY, NY Routledge.


A Patient’s Reaction to the Pregnant Therapist

Ellen Toronto, Ph.D.

Dr. Ellen Toronto is a licensed clinical psychologist/psychoanalyst in the state of Michigan.

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APA Reference
Toronto, E. (2019). A Patient’s Reaction to the Pregnant Therapist. Psych Central. Retrieved on July 11, 2020, from


Last updated: 21 Aug 2019
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