Pregnancy:

Unraveling the impact of trauma on pregnancy is complicated because of its far reaching effects. I would initially adopt a practical approach and do a multi-level assessment, and depending on the outcomes, propose a program of intervention. I would work with my client to determine if she is safe at present. If she is not, I would assess the level of danger and ultimately, help ensure that she is or can become safe so that therapy can be successful.  Once my client is safe, or, if the source of traumatic stress is in the past, I can work with her to determine the nature of her distress and develop a treatment plan. I would propose treatment for traumatic stress, depression and/or anxiety, but I would, given the pregnancy:

• Place added emphasis on developing methods of physical relaxation to help prevent a spike in stress hormones, using anxiety focused techniques, to help her manage her stress level such that it is not interfering with her health and the health of her baby.
• Consider holistically her general approach to her health and the health of her unborn baby, whether her mental health is interfering with self care and nutrition, and whether she is resorting to substance or alcohol use to alleviate stress.
• Ask her permission to collaborate with a psychopharmacologist to determine if medication is warranted, what type, and how to monitor effectiveness and side effects.
• Adopt an “ecological” view and ensure that her environment, e.g., her relationship with a partner, her social supports, and her access to services are appropriate to support her in her pregnancy and if not, determine how each of these factors could be improved.
• Provide psychoeducation for family members if requested and when appropriate.

Early Parenting:

I also specialize in the impact of past and current interpersonal trauma and early attachment difficulties on parenting capacities, and assist my clients when these experiences interfere with being loving and supportive parents. My clients who have experienced abuse, or harsh or neglectful parenting, all of which are associated with very insecure attachment to caregivers, have expressed difficulty controlling their emotions with their children – from infants to teens. They may experience greater likelihood of experiencing PMADs, or perinatal Mood or Anxiety Disorders, and also wonder if they are in danger of repeating intergenerational patterns of harsh parenting, or of not being able to see their babies’ needs clearly or neglect them because of their own attachment problems. In a fascinating program of research, psychologists Miriam and Howard Steele found that mothers’ attachment style (i.e., security or insecurity), assessed before their babies were born, had a high concordance rate with their infants’ attachment type, when infant attachment was assessed at 18 months after birth.  This study provided evidence that a mother’s attachment style can influence infant attachment; as such it is vital to recognize potential problems in the early mother-infant relationship and intervene as soon as possible. In this case I would work with my client to:

• Assess the nature of her attachment patterns in her family of origin and whether they were secure or insecure.
• Help determine whether these patterns were causing her to “project” negative qualities that remind her of abusive or neglectful caregivers onto her baby, and separate her current life with her infant from her past.
• Determine if she was experiencing traumatic reminders which might cause some dissociative states, where she might behave differently than she would like with her infant, such as in an angry, frightened or avoidant way.
• Determine under what circumstances these things were more likely to happen and work with my client to alter them; I would also use trauma-focused techniques to identify triggers and develop alternate belief and feeling states.

“If we do not know how to transform and heal the wounds in ourselves, we may transmit them to our children and grandchildren.”

— Thich Nhat Hanh

Mothers who acknowledge that their past histories or current circumstances may impact their pregnancy and early parenting and seek help, are making a fundamental decision – to stop a potentially negative cycle and pave the way for a healthy and secure relationship going forward.