Parenthood after reproductive loss: How psychotherapy can help with postpartum adjustment and parent-infant attachment.

Parenting after pregnancy loss is often complicated for people who have not effectively grieved the loss and worked through the trauma. Reproductive losses can trigger shame and self-doubt, damage the sense of self-as-parent, and inflict narcissistic injuries, which, in turn, may impede the resolution of grief. If not addressed, these unresolved feelings may be projected onto subsequent children, potentially disrupting attachment relationships and the child's sense of self. The reproductive story, a lifelong internal narrative that comprises the thoughts, feelings, and hopes about how parenting and adulthood will unfold, and forms the core of parental identity, can be used as a tool in helping parents understand the depth of their feelings, integrate current and past losses into the self, and resolve grief. The authors discuss 3 crucial aspects of intervention with parents who have had pregnancy losses, aimed both at healing the parents themselves and at protecting attachment relationships with subsequent children: (a) initially staying present-focused and engaging with the painful details of the loss experience, to normalize and validate the patient's grief and trauma, counteract shame, and begin repairing narcissistic injuries; (b) eliciting the reproductive story to identify and integrate past losses, and in its revision, to allow for hope and repair; and (c) attending to both acknowledged and denied grief. The challenges and satisfactions of working with this population and potential countertransference reactions are also discussed. (PsycINFO Database Record