The pregnant therapist and the seriously disturbed patient: managing long-term psychotherapeutic treatment.

A therapist's pregnancy affects a broad range of issues in long-term psychotherapeutic treatment, yet the literature has understated the magnitude of the pregnancy's impact on sicker patients. Because of their illnesses and particularly their difficulty in tolerating loss, patients with serious personality disorders or psychotic illnesses are at high risk for increased dysfunction and destructive acting out during the therapist's pregnancy. Although these patients tend to be sensitive to any event in the therapist's life that symbolizes loss (such as a vacation), the pregnancy of a therapist is a more potent disruption.