An investigation into perinatal psychotherapy as a treatment for first-time mothers with anxiety disorders

It is widely recognised that the perinatal period brings an increased risk of mental health problems for women, with more than one in ten women in the UK developing a mental disorder during pregnancy or within the first year of having a baby. Perinatal mental disorders are potentially far-reaching in terms of the negative impact they can have on the lives of childbearing women and the foetus or infant. For example a mother’s disturbed mood can have an adverse influence her child’s emotional development and psychosocial outcomes, and can affect the parent-infant relationship.
In the UK, perinatal treatment usually takes place on an outpatient basis although in extreme cases, for example where psychosis is diagnosed, a woman may be admitted to a psychiatric unit. In either case, sometimes the use of psychotropic medication may be needed. However, women’s fears about harm to their babies as a result of using psychotropic medication, plus concerns about their own possible dependency, mean that many women prefer psychological intervention to treat their perinatal mental disorder. Psychoanalytic psychotherapy is one type of psychological intervention used in the UK NHS in the treatment of perinatal disorders. However there tends to be little attention from research and literature on the role and effectiveness of psychoanalytic psychotherapy in working with mothers, and on the sorts of things that can lead to mental disorders in the perinatal period. Hence it is the aim of this study to explore these issues through a qualitative case study of three patients attending one outpatient perinatal service for psychotherapy treatment with a male therapist, specifically for anxiety disorders. Drawing on the material from the three individual case studies, the fear of being judged a bad mother is illuminated as each patient tries to adjust to the transition to motherhood when suffering from complex psychological conflicts. Observations are made of their conscious and unconscious identifications with the vulnerability and dependency of their babies and the interrelated anxiety arising when faced with the primary responsibility of care. A range of factors which have serious implications for the mothers feeling emotionally capable of being the primary caretaker come to light as the case studies unfold. Attention is paid to the transference in the patient-therapist relationship and the technical challenges for psychotherapeutic technique in relation to the gender dynamic. The case examples show a working through of psychological dilemmas in the setting of a perinatal service focussed on strengthening mother-baby relationships at risk of being damaged.