Matrescence as a Psychotherapist: Part II

Source: Photo by Bethany Beck on Unsplash

In our first article in this series which was written in collaboration with Chrissy Ellis, LCSW, PMH-C, we discussed the profound change we undergo during matrescence, or the physical, psychological, and emotional changes associated with the transition into motherhood. We also explored just how challenging it is to undergo this transition and be a parent while providing care as a psychotherapist. While this dual role is complex for us, it also prompts unique challenges for the clients we work with. These challenges can be both practical (scheduling changes, fear of decreased emotional availability from your therapist, fear that your therapist may not return from leave) and transferential. In this article, we will discuss both the transferential and countertransferential reactions and address the ways in which a strong therapeutic relationship can be a powerful source for healing old wounds.

Transference, or “the redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood” (Oxford Languages, n.d.) is bound to occur with at least some of your clients when your role as an expectant or new parent is discovered. Whether rooted in their past or not, your clients will all have some response. While the ideal response isn’t a client that says “ok” and moves on, this is not to say that we should look for clinical meanings in every reaction or assume that a client’s attachment history or their own issues are being projected. We must realize that we are, in fact, disrupting the therapeutic process and essentially asking for new terms of the relationship when clients don’t have a say in this process beyond electing to stop treatment. They are helpless in this way. Therefore, it’s understandable that some clients will become emotionally dysregulated on a continuum of severity and that there will be clients whose reactions may be more deeply rooted in their attachment, developmental, and trauma histories and who will be enacting something that resides deeper in their psyche. An example is the client who is annihilated by the news of your parental leave because you are the only stable person in their life. They may begin to act out or reenact cycles of abandonment from their family history in the face of this new threat.

Countertransference reactions include all of the perceptions, emotions, and responses to the therapeutic situation which are provoked by the client’s reactions and that emerge more directly from the therapist. Fallow and Brabender (2002) name some examples:

  • Professional confidence reconsideration: Feelings of incompetence might arise and you might find yourself either overcompensating or being consumed by self-doubt as a response. The blending of roles contributes to this experience. For example you might think, “Can I be both a competent mother and a competent therapist?” This can lead to a real developmental crisis, a denial of one’s physical state, anxiety and guilt about inadequacy, and sometimes even anger at those who have failed to make accommodations. If we cannot acknowledge our own identity crisis, we cannot help clients resolve theirs.
  • Discomfort with personal disclosure: While there is no optimal or perfect therapeutic response to clients’ questions, there are defining features of what and when is too much. The first is too much excitement on the part of the therapist, the second is role reversal with the client (seeking caregiving), and the third is motivated by guilt. Some discomfort can also come from a fear of invasion of privacy and an overall sense of exposure and vulnerability which are rarely part of the therapist’s role. Asking yourself if any of these prompt an urge to disclose can be helpful in guiding your behavior.
  • Issues of sexuality: Pregnancy makes visible assumptions about one’s sexual activity and perhaps even assumptions about one’s sexual orientation. We are now seen as a sexual being and there is the assumption that you have now had sex at least once. While there isn’t anything that can be done to hide one’s pregnancy and therefore assumptions about sexual activity, it can be helpful to simply be aware that an element of your sexuality is now in the therapy room.
  • Fear of client’s negative reactions: Being pregnant or postpartum can make it difficult to tolerate anger, aggression, hatred, or envy. We simply do not have as much bandwidth to deal with negative emotions and this is protective toward our developing or young child. As therapists, we’re supposed to be skilled at navigating these emotions and because of the lowered threshold to tolerate these emotions, there is potential to not pick up on and/or ignore certain negative emotions of our clients. Being aware of this can help you remain attuned and attentive to your client.

Given the risks for both the therapist and the client to have intense emotional reactions to the therapist’s matrescence, the work we do to establish and maintain trust and communication in the relationship is all that much more important. When we think about why expanding our own families might trigger these reactions in clients, it’s helpful to consider John Bowlby’s (1907-1990) attachment theory. Attachment is lasting psychological connectedness between human beings and attachment styles are expectations that people develop about relationships with others based on past relationships. Attachment styles can be context-specific and they can change over time. The four attachment styles: secure, anxious/preoccupied, avoidant/dismissive, and disorganized/fearful (McLeod, 2017), begin to develop in infancy. They continue to play out in relationships throughout our lives. A healthy therapeutic relationship can repair attachment wounds in the following ways:

  • Establishing safety
  • Learning/practicing emotional identification and expression
  • Clarifying what’s important
  • Learning, establishing, and maintaining healthy boundaries
  • Learning importance of self-care in relationships

While it might not be explicitly stated in every therapeutic relationship, these ingredients are a critical component of healing and growth. The therapist’s matrescence provides a unique opportunity to create a flexible holding space for your client, allowing them to move toward a secure attachment style. If you find yourself thinking that this all demands quite a bit from the therapist during an already vulnerable time, you are not wrong! In our next and final article in this series, we will focus on how to care for yourself during this process and how the concept of the “Good Enough Mother” applies to both our roles as parents and therapists.


Fallon, A., & Brabender, V. (2002). Awaiting the therapist’s baby: A guide for expectant parent-practitioners. Mahwah, NJ: Lawrence Erlbaum Associates

Mcleod, S. (n.d.). John Bowlby. Retrieved May 1, 2021, from website:

Oxford Languages. (n.d.). Oxford Languages dictionary. Retrieved July 15th, 2021, from