INTRODUCTION

Abstract

The first paper on the subject of an analyst's pregnancy appeared more than 50 years ago, and was followed by a complete silence on the subject for the following 17 years. Slowly, a few substantial papers began to emerge, and there has been a gradual expansion in this area of the psychoanalytic literature particularly over the past 25 years, so that by now we have at least 60 papers on the subject, several chapters in books, and at least one complete book that I am aware of. There is of course a substantial separate literature on the subject of pregnancy itself, which is of direct relevance to an understanding of the subject of the analyst's pregnancy. In addition, the literature on special events in the course of therapy is pertinent to the subject too. I have limited my own review of the literature specifically to that related to the analyst's pregnancy but I have included all the references I could trace in the bibliography at the end of this issue. I have grouped the papers to some extent around key areas of interest as they emerge from the whole literature. In particular, I have noted that the earliest papers began to outline some generic responses to the analyst's pregnancy, ranging in intensity from supposedly minor turbulence in men to intense transference storms in women. The early papers seem to have regarded pregnancy solely as an interference in the treatment process. Later papers began to place more emphasis on the analyst's countertransference response and to acknowledge that the therapist herself is confronted at this time with issues involving her own identity, integration of new roles, maternal identification and redefinition of important relationships in her own life. At the same time she is having to find a way of functioning as an analyst in the face of intensified transference reactions. If the analyst can negotiate the challenges to her own pre-existing psychological equilibrium which pregnancy confronts her with, she will be better placed to address the stormy period in therapy which her pregnancy is likely to provoke in her patients, and some therapeutic gains can be made over this phase of the analysis. Later papers attempt to differentiate male from female responses to the pregnancy, and the demarcation is not surprisingly found to track psychosexual development along familiar gender lines. Examination of responses of homosexual patients, whether male or female, emphasizes the point. In addition, attempts to differentiate responses to the event according to the core psychopathology in the patient, confirm the pattern of anxieties and defences to be expected in particular configurations. A few papers examine the responses of patients to the therapist's pregnancy in different treatment modalities, and although there is some evidence to suggest that patients having group treatment are more likely to present with issues of sexual curiosity, sexual identity, or sibling rivalry, compared with patients in individual therapy, in the final analysis all patients confirm a core complex of fear of abandonment and feelings of loss of the fantasized exclusive mother-infant relationship. There is very little discussion in the literature on the impact of an analyst's absence due to unsuccessful pregnancies and it is postulated that this remains an area of great difficulty for the patient and the analyst, to the extent that it is almost obliterated. I can find only three papers on this topic. However, a few papers are published on the patients' responses to an analyst who has had two pregnancies. While this constitutes a particularly complex challenge to both patient and analyst, the overview suggests that there are additional therapeutic gains to be made in terms of working through, in the course of the second pregnancy. Numerous authors address the subject of the inevitable changes in technique that follow from the fact of the analyst's pregnancy. Some of these changes are felt to be directly related to the physical and psychological changes with which the therapist is confronted at this time, and by association so is her patient. The more these changes can be acknowledged by the therapist, within herself, the more likely it is that she will be able to continue to function as an analyst. It is also apparent that the role of the supervisor is of particular importance during and immediately following this life-changing event (Imber 1995, Goldberger et al. 2003) and this is described in some detail in these two recent papers.