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Steiner, J. (2004). Foreword. Psychoanal. Psychother., 18(1):1-4.

(2004). Psychoanalytic Psychotherapy, 18(1):1-4

Papers

Foreword

John Steiner

A few years ago, at the Tavistock Clinic, a number of young therapists became pregnant at about the same time and began to meet regularly in order to discuss the impact of the pregnancy on their patients. I was fortunate to take part in the meetings of this group, which turned into a regular seminar where ideas were tested through the close examination of clinical material. Ultimately the members of the group began to write up their material as individual case reports, which were brought to the seminar for discussion and which now make up the various papers in this issue.

Several themes emerged repeatedly in the clinical material. Many of these had to do with the impact of the fact of the pregnancy on the patient and we were struck, for example, by how some patients seemed to be excessively slow to notice that the therapist was pregnant while others were highly observant and picked it up before it seemed to be apparent to anyone else. The pregnancy appeared as a ‘fact of life’ and the intrusion of this fact as a reality had a peculiar impact and seemed to repeat a trauma in a concrete form. All the therapists found it difficult to know how best to talk about the fact of the pregnancy to their patients. When they had not been pregnant they could explore the patient's phantasies of pregnancy with relative freedom, but now that the pregnancy was real and not a phantasy in the mind of the therapist, this became more difficult. Sometimes it seemed cruel not to mention something that was so obvious and which would have such an impact on the patient. All of the therapists took a significant period of maternity leave and this made it difficult for them to wait for the patient to take their own time to notice and discuss the pregnancy. This seemed to be an example of how the intrusion of a reality into the mind of the therapist inhibited the freedom to explore a phantasy.

Other features of the interaction with the patient made it apparent that the pregnancy had profound effects on the therapists. They had to negotiate the difficult conflict of a divided loyalty to their patients on the one hand and to their unborn child on the other. Sometimes this linked to more general conflicts about the wish to combine a professional and family life, which

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