The pregnant therapist: the effect of a negative pregnancy outcome on a psychotherapy patient.

In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27-31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician's life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist's pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.