Emergence and resolution of ambivalence in expectant mothers.

Little has been written about the perceptions of expectant mothers with previous histories of psychiatric disturbance and their affective oscillations during pregnancy. This paper discusses the case of a 22-year-old primigravida with a history of schizoaffective disorder who was referred to our mother-infant psychotherapy service. Despite the patient's initial defensive style, she was asked to discuss several dreams that she had had since learning about her pregnancy. A wealth of information about the patient's unconscious ambivalence and destructive wishes toward her unborn infant emerged. The patient was also unable to engage in any predictive imagery about the future of her infant or to anticipate intuitively what the experience of mothering would be like. This paper reveals that pregnant women with a history of psychological disturbances often have highly aberrational fantasies and ambivalent impulses toward their unborn infant, and some of these fantasies threaten to manifest in the form of abusive behavior after the birth. Techniques for predicting how new mothers with previous psychiatric histories will interact with their infants after birth are outlined. It is hoped that this treatment may avert child abuse.