Brief Focal Psychotherapy with a Pregnant Woman Presenting with Nightmares of Killing Her Baby: A Case Study

Abstract

SummaryThis paper reports an 18 session treatment in brief focal psychotherapy of a case that presented with at least two major contra‐indications for this type of therapy: 1) childhood deprivation and 2) the danger of intensification of a depressed illness. This paper shows that the recent traumatic event, in this case a highly ambivalent pregnancy, can help to destabilize the armour of a defensive structure, and bring to the surface primitive fears and conflicts which cause severe symptomatology and distress but which become more accessible to the patient's awareness and more amenable to interpretation. The acuteness of the disturbance brought about by the traumatic event increased the patient's motivation and need for treatment, speeding up the therapeutic process. This brief psychotherapy shows the importance of the working through of the patient's intense hostility towards her mother and towards the therapist in the transference, if a solution of murderous feelings towards her baby are to be achieved. As far as technique is concerned, this paper shows that a thorough interpretation of the negative transference from the early stage of therapy, an unusual number of transference/parents interpretations and the working through of the patients's anger and grief about termination seemed to be essential factors correlated with a positive outcome.