NDJ:8 Elizabeth McKamy, MSW


My first pregnancy was the highlight of my life. Everything was touched by it, including a new and growing psychotherapy practice. Confidence swelled; thoughts ripened with energy, possibility, enthusiasm. As breasts enlarged and stomach expanded, I was fascinated with my patients’ reactions, the stirrings evoked in them, their various and poignant associations to my developing child.

While pregnant, I drafted a paper entitled “During and After a Therapist’s Pregnancy: Impact on her Practice.” It explored patients’ responses to body changes, transference issues, and enactments specific to planned maternity leave. It speculated about how a female therapist’s return to work following the birth of her baby might play out as the treatment partnership resumed. A pretty good paper, it was never published. As they say, “Sometimes things just don’t work out.” One patient explored losing her baby, years before, to adoption. She was able to yearn to hold that baby, embrace what she could not touch, and then release self-loathing that had so long accompanied her.

Another patient’s jealousy was triggered by the apparent fullness of my life. Sexually molested by a stepfather throughout childhood, she articulated a fantasy of sneaking into my back yard and stealing my baby one day. Beyond envy, she worked through issues of a childhood lost and violations perpetuated against her. She unblocked desires that had lodged beyond her reach for a very long time.

Remarkably, a twice-divorced man never recognized my pregnancy at all, even when my maternity leave start date went into one, then two weeks overdue! Affectively repressed in many ways, he described himself “a failure,” never completing or feeling completed in tasks or relationships. With many ways to consider his blindness to the obvious — defenses against recognizing sexuality, fear of attachment — I was astounded at his astonishment when called upon to “see” that I was expecting a baby.

So there we all were, late for a long-anticipated much-processed maternity leave. Patient coverage was set up, fantasies I might not want to return to work explored, concerns that my baby might replace my patients dutifully discussed. One patient worried if I would survive childbirth. Another recalled her own mother’s frightening post-partum depression following a younger sibling’s birth.

To a number, each of us was ripe and ready to transition from waiting for baby to a return to the usual parameters of pre-natal psychotherapy. In labor, finally, I was thrilled to leave word I’d be out of the office and resume practice in six weeks.

Well, as has been said, “Sometimes things just don’t work out.” My beautiful, full-term baby boy was stillborn early on a morning in May almost thirty five years ago. There are not words to express the utter emptiness, staggering disappointment, total and overwhelming sense of failure that arrives when one’s newborn baby is dead. There’s a head on collision, physically, spiritually and psychologically, between the strongest push of life and the emptiest pit of loss.

Six weeks at home were filled with grief, physical longing, and soul-shaking doubt about my competence regarding pretty much everything. How was I to return to my patients? How could I “hold it together?” What would I tell them? How could I possibly trust myself, or be trusted, to carry their treatment journeys further? I turned to Ann Morrow Lindberg and John Gunther, pained parents who had suffered child loss and written exquisitely about their experiences.

Reaching beyond myself, I realized that as I had been turned inside out by trauma and devastating disappointment, so had many of my patients in their lives. I considered that absolute despair is a holistic experience – body, mind, and soul. One’s core indeed “melts down,” “falls apart,” crazes like a ceramic piece under unbearable stress. It’s not so much what happens to us as that it has happened, shaken everything, and thus one knows one can never be the same again.

Such thoughts helped me get back to work. Rather than differentiate from my patients’ most painful experiences, I felt connections in comfortable, and comforting, ways previously unknown. I understood anxiety as a form of defense against real or imagined loss; anger, envy and blindness as protection against presumed disappointment. Gradually, I began to reform and function again. My caseload gave me a job to do. My patients, given simple honest answers, brought me solace. My stillborn baby gave me depth. One of these days I might try to publish a paper, “During and After a Therapist’s Pregnancy.”