"Pregnancy loss" is an umbrella term for the death of a conceptus, fetus, or neonate before the 21st day of life and affects a substantial number of women and their partners.
Numerous studies have documented the devastating effects of pregnancy loss on parents, particularly on the mother. Specifically, grief following a pregnancy loss is often chronic and severe and may extend for years, beyond the birth of a healthy baby.
Perinatal grief is often accompanied by symptoms of depression, anxiety, and trauma. Many of these women have lost faith in their bodies, in the world as a fair and predictable place, and in others as a source of support and comfort.
Some studies reveal the negative effects that a pregnancy loss may have on certain subsequent pregnancies, including heightened pregnancy-related anxiety, or the constant fear of another loss, prenatal depression, and prenatal attachment difficulties, all of which may extend to the post-partum period and impact the new mother's adjustment in this critical period and the mother-infant attachment relationship.
Despite the high rate of occurrence and distressing impact of pregnancy loss on parents, there is a noticeable lack of empirical research and clinical guidelines on psychotherapy for pregnancy loss.
The idea for a special section on psychotherapy for pregnancy loss in Psychotherapy was thus formed from the pressing need for more clinical and empirical literature in this area. The ultimate goal of this special section was to raise consciousness among psychotherapists regarding the unique psychotherapy needs of patients who have suffered a pregnancy loss and to provide practical suggestions for clinical practice with this population.
In this section, Wenzel (2017) describes how Cognitive-Behavioral Theory (CBT) can be used to understand the experience of pregnancy loss and how to apply three common CBT techniques — behavioral activation, cognitive restructuring, as well as mindfulness and acceptance — to help patients cope with feelings of self-criticism, depression, and anxiety following a loss, and to mitigate problematic behaviors of avoidance and social isolation.
Separately, from a continued bond/attachment theory perspective, O'Leary and Henke (2017) explores therapeutic interventions for parents pregnant after loss within a group setting. Therapeutic educational interventions are discussed to support the parent's continued bond to the deceased baby while also risking attachment to the new baby.
Jaffe (2017) uses a reproductive story framework to conceptualize and treat patients experiencing infertility and pregnancy loss. She offers suggestions on interventions to help patients grieve the loss of one or more pregnancies as well as the loss of their reproductive story as it was "supposed" to unfold, feel less responsible for how their stories went awry, and write a new and more positive ending to their reproductive story. Suggestions are offered for how to help couples work through disagreements that often arise during the course of infertility and pregnancy loss, as couples struggle to make major revisions to their reproductive story.
Diamond and Diamond (2017) pay special attention to the potential impact of reproductive trauma on the attachment relationship with the subsequent child. They delineate three interventions, aimed both at healing the parents themselves and at protecting attachment relationships with subsequent children: initially staying present-focused and engaging with the painful details of the loss experience; eliciting the reproductive story to identify and integrate past losses, and in its revision, to allow for hope and repair; and attending to both acknowledged and denied grief.
Lastly, Leon (2017) examines key therapeutic tasks and interventions for psychotherapy with parents who have terminated a wanted pregnancy because of a fetal anomaly (or are in the process of deciding whether to terminate the pregnancy). In his paper, the therapeutic tasks argued to be essential with these patients include absorbing the impact of learning about the anomaly, defining what or who has been lost, deciding whether to continue or terminate the pregnancy, and deciding who to tell what. It is suggested that when these tasks are performed within the context of an empathic therapeutic relationship then other therapeutic goals are believed to be met, including: empowerment, normalization, validation, and the processing of grief and trauma.
In Western society, pregnancy loss and the despair that follows typically occurs in the shadows, as it is neither acknowledged nor validated. In contrast, through acknowledging the loss as real and validating the parent's subjective experience, psychotherapy can shed light on the shadow of loss and help parents with the process of mourning.
Psychotherapy, December 2017
Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.