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. ▪