Facing an Unanticipated Challenge

The demands of residency in any field are difficult. The challenges of pregnancy in the midst of a psychiatry residency are no exception.

The myriad challenges I faced, as I look back over the bulk of my outpatient year, were ones that I did not anticipate. Initially, my thoughts were about my pregnancy's impact on my fellow residents, preparing for the physical demands of call, and the inevitable delay in completing training requirements, but these worries quickly shifted to concern about the impact on my patients.

From early on in this period, questions about self-revelation and how I would respond to personal inquiries from patients circled constantly during appointments. I'm sure the self-consciousness and doubt imparted by a training program steeped in dynamic theory pervaded the room. Quite differently from male residents who become fathers during the course of training (or parents who choose to adopt or use surrogates), my personal life, my baby, was right there in the room—literally sitting there between me and my patients. I could not help but wonder, were they speculating about my marriage, my husband? Or even more anxiety provoking, were they thinking about my sex life?

My fellow NYU residents and I are expected to treat a variety of outpatients during our third year, from child, group, and family cases to a wide range of weekly therapy patients along the supportive-dynamic continuum.

One family case to which I was assigned, a couple who both had significant psychiatric histories and who were planning to get married and contemplating whether to start a family, had its challenges right from the start. How would a pregnant therapist be perceived to a couple struggling with such a life-changing decision themselves? It so happened that the woman of this couple wanted children more than the man did, and I struggled with feelings of guilt and pride about my own family simultaneously in our weekly sessions.

In group therapy I had the privilege of working in a largely supportive role with a group of chronically ill patients with mood and psychotic disorders. While I struggled with how much information about my pregnancy to share with the majority of my other patients, I found the questions I received in this group a sign of how well they were able to organize themselves around support for someone else. The potential complications of disclosure to the group seemed less daunting given my supportive role, but nonetheless elicited plenty of questions in supervision on this topic.

My child-psychiatry case proved even more difficult since efforts toward alliance building played such an important role in the beginning of our treatment relationship. This was a young girl struggling with attention-seeking behaviors and abandonment issues in her own family. As I prepared for maternity leave, I was concerned that she would conclude that I was about to abandon her as well! Did I owe her more information or more support than my other patients? Is there more innocence associated with personal questions from a 10-year-old? Luckily, I had outstanding supervision to help with these questions as they arose, and in the end I have managed to maintain the therapeutic alliance and use my experience to make her treatment more meaningful.

My understanding of ego defenses was furthered when a supportive-therapy patient who had been witness to my growing belly for months (and I neared the eight-month mark at this point) told me that he did not realize I was pregnant. Treating affect that is so strongly defended against is certainly not easy.

I'm still working through these challenges, and I suspect that even more will arise, but the opportunity my pregnancy provided for deeper understanding of my patients has been invaluable. Some of my patients have yet to return to treatment, and others have decompensated, but most have done surprisingly well, enabling us to start right where we left off.

I have to admit, I am somewhat jealous of other people in other professions, where pictures of babies are proudly displayed on desks and where sharing details and accomplishments of one's children does not complicate their work. I have managed to be content with quick glimpses at the carefully tucked-away photos I have hidden for those rare free moments. I was lucky enough to have an amazing amount of support from my peers and supervisors throughout this process, but for those with questions that remain and less support than they would like, perhaps creating more dialogue on this subject will make it a little bit easier. ▪