The Value of Psychotherapy in Pregnancy (Especially in Certain Cases)

Pregnancy is a period in which the barriers between the different layers of the psyche soften; as M. Bydlowski (a French psychiatrist and psychoanalyst specializing in perinatal care) maintains, the pregnant woman has a greater "psychic transparency", meaning she is more inclined to let emerge, and to connect with, her history, not only present but also past, and with the key figures of her life.

Pregnancy in fact opens a breach into the woman's most remote past, since it reactivates experiences she went through not only in early childhood but also during intrauterine life. It is as if, in order to enter into feedback with her baby, the woman were unconsciously returning to her own intrauterine/infantile condition. Inevitably, however, this irruption of the past also brings back to the surface, reactivates, the conflicts that each woman, depending on her own history and psychic makeup, has experienced with greater or lesser intensity.

So while psychotherapy in pregnancy is an invaluable help for every woman, to prepare herself to be a mother, to manage to discharge and separate her own issues from the relationship with the baby, to prevent a build-up of tension that would otherwise inevitably tend to express itself through more or less severe symptoms, in certain cases it proves indispensable.

I am referring to women whose difficulties, rooted in a distant past, have already resurfaced at moments in their life before pregnancy; or to those who had kept them under control until the instinctual drive of this period brought them back to the surface, as happens to those who manifest psychological symptoms for the first time, symptoms that had never appeared before they became pregnant.

Psychotherapy (especially the analytic kind*) makes it possible to "channel" the affect that accompanies moods and memories once they are put into words, or the emotions felt when recalling certain situations, certain people, certain moments of one's life. Translating one's thoughts into words, giving voice to one's emotions, helps the affect flow out physiologically; if it remains blocked, encysted, it ends up creating symptoms.

In particular, resorting to psychotherapy should be not just advisable but indispensable (even though unfortunately not many gynecologists recommend it) for a woman under treatment with psychiatric medication who, at the start of a pregnancy (planned or not), must decide together with her doctor what to do: continue the treatment or suspend it, with the risk of a relapse that could also have consequences for the fetus. The choice, far from simple, can be a source of anxiety either way. Indeed, the fears typical of all pregnant women, of possibly giving birth to an "abnormal" baby, can be intensified by taking psychiatric medication. Sometimes the reassuring words of the psychiatrist, who knows from epidemiological studies on that particular drug that the teratogenic risk does not increase by taking it, are not enough to reassure the pregnant woman. On the other hand, however, even a pregnancy without medication is not free of risk, because of the possible relapses.

* This is a psychotherapeutic treatment based on psychoanalytic theory, but with a lower frequency and shorter duration of sessions.