Psychotherapy during pregnancy: opportunities and challenges.

In this article, I emphasized the developmental receptivity of pregnant women to psychotherapeutic interventions. I selected four psychotherapy themes, illustrated with examples of brief, conflict-focused interventions with pregnant women and their families. The first theme that I discussed was conflicts over increased dependency needs, and I gave clinical examples of helping to express and to tolerate such needs. The second theme examined was narcissistic disturbances and pregnancy. I discussed both the impact of a burdening maternal ego ideal and the attempts to reestablish a narcissistic balance through pregnancy. In the third theme, reconciliative themes in pregnancy, I discussed the identificatory struggle with the mother's mother that is reactivated by pregnancy, both in renegotiating separation from her and in facing issues of rivalry. In the last theme, working through losses while giving life, I described a case of mourning during pregnancy. In the discussion, I examined various aspects of involving expectant fathers and other family members in treatment. Finally, I discussed various transference phenomena, including the fetus as a transference object, some aspects of the transference to the therapist, and the integration of different transference phenomena.