Psychotherapy for Pregnancy Loss: Applying Relationship Science to Clinical Practice

Cover
Psychotherapy for Pregnancy Loss
Copyright
Contents
Acknowledgments
1. Introduction
	Definitions
	Intended Audiences
	Trajectory of the Book
	Organization of Chapters
	The Background: Evidence-​Based Relationships and Responsiveness
	Meta-​Analysis: What, Why, and How?
	Putting the Task Force’s Conclusions and Recommendations into Action
2. Understanding and Treating Pregnancy Loss: Rates, Risk Factors, Symptomatology, and Implications for the Therapeutic Relationship and Treatment
	Rates and Risk Factors
	Symptomatology Associated with Pregnancy Loss
	Normal Versus Complicated Perinatal Grief: Diagnostic Features, Risk Factors, and Sociocultural Considerations
	Reflections on the Unique Aspects of Perinatal Grief
	How Attachment Theory Helps to Understand the Psychological Experience of Pregnancy Loss Grief: Implications for Treatment
	Psychological Treatment of Pregnancy Loss: A Symptomatic Versus Relational Focus
	Why Is the Relationship Important in Psychotherapy for Pregnancy Loss?
	Therapy Goals and Outcomes
	Conclusion
3. The Alliance in Individual and Couples Therapy for Pregnancy Loss
	Alliance: An Evidence-​Based Relationship Principle
	Characteristics That Facilitate the Alliance
	Clinical Application: The Alliance in Therapy for Pregnancy Loss
	Therapist–​Client Bond
	Agreement on Goals and Tasks of Therapy for Pregnancy Loss
	Common Challenges to Establishing and Maintaining a Strong Alliance
	Clinical Implications
4. Empathy in Psychotherapy for Pregnancy Loss: Undoing Aloneness, Healing Narcissistic Wounds, and Processing Trauma and Grief
	Empathy: An Evidence-​Based Relationship Principle
	Clinical Application: Empathic Goals and Interventions for Pregnancy Loss
	Empathy: The Undoing of Isolation and Aloneness
	Healing Narcissistic Wounds: Counteracting Shame and Restoring Self-​Esteem
	Processing Trauma and Grief: Healing and Growing from the Horror of Loss
	Common Challenges to Therapist Empathy in Psychotherapy for Pregnancy Loss
	Clinical Implications
5. Emotion in Psychotherapy for Pregnancy Loss: Mourning as an Affective-​Relational Process
	Emotional Expression: An Evidence-​Based Relationship Principle
	Productive and Unproductive Emotional Expression for Pregnancy Loss
	Clinical Application of Working with Emotion in Psychotherapy for Pregnancy Loss: Goals and Interventions
	Self-​Restructuring: Rebuilding Self-​Esteem as a Necessary Foundation for Emotion Work
	Emotional Soothing and Alliance Building
	Downregulating Inhibitory Affects and Relinquishing Defenses: Applying Malan’s Triangle of Conflict and of Person
	Deepening Primary Affective Experiencing and Expression
	Common Challenges to Emotion in Therapy for Pregnancy Loss: Personal Reflections
	Clinical Implications
6. Alliance Rupture and Repair Episodes in Psychotherapy for Pregnancy Loss: An Attachment Perspective
	Alliance Rupture and Repair: An Evidence-​Based Relationship Principle
	Strategies for Repair or Resolution of Alliance Ruptures
	Rupture and Repair: An Attachment Perspective
	Clinical Application: Rupture and Repair Themes in Therapy for Pregnancy Loss
	Ruptures Related to Shame and Inadequacy: Healing Narcissistic Wounds
	Ruptures Related to Societal Invalidation of Pregnancy Loss: Repairing Empathic Failures
	Ruptures as Reenactments of Past Attachment Experiences of Separation and Loss: Facilitating a Secure Attachment and the Grieving Process Through Repair
	Clinical Challenges
	Clinical Implications
7. Managing Countertransference in Psychotherapy for Pregnancy Loss
	Countertransference Management: An Evidence-​Based Relationship Principle
	Therapist Self-​Disclosure: Helpful Intervention or Countertransference Behavior?
	Immediacy
	The Client Role
	Common Countertransference Themes in Psychotherapy for Pregnancy Loss: Application to the Case of Hana
	When One of Us Is Not Like the Other: Transference and Countertransference Issues When the Therapist or Client Becomes Pregnant
	Countertransference Reactions to Trauma
	Clinical Challenges to Countertransference Management
	Clinical Implications
8. Client Attachment in Therapy for Recurrent Pregnancy Loss and Infertility: Theory, Research, and Clinical Guidelines
	Chapter Overview
	What Is Attachment Theory and How Can It Be Used as a Clinical Guide in Individual and Couples Therapy for Pregnancy Loss?
	How Does Attachment Relate to the Process and Outcome of Therapy: Attachment as an Evidence-​Based Therapist Responsiveness Principle
	Empirical Findings: Client Attachment and Therapy Outcome
	Empirical Findings: Client Attachment and the Therapy Process
	Coping with RPL and Infertility Through an Attachment Theory Lens
	Empirical Findings on RPL and Infertility Stress: An Attachment Trigger
	Summary and Next Steps
9. Relational Guidance on Therapist Responsiveness to Client Attachment in Individual and Couples Therapy for Recurrent Pregnancy Loss and Infertility
	Overview
	Identifying the More Anxious Client in Therapy for RPL and Infertility
	Relational Guidance for Anxious Clients Struggling with RPL and Infertility
	Identifying More Avoidant Clients Struggling with RPL and Infertility
	Relational Guidance for Avoidant Clients Struggling with RPL and Infertility
	Clinical Challenges to Therapist Responsiveness to Client Attachment
	Clinical Implications
10. Where Do We Go From Here? Future Research Directions, Training Recommendations, and Practice Implications
	Future Research Directions
	Training Recommendations
	Practice Implications
Appendix: Table A.1. Easy-​to-​Administer and Easy-​to-​Score Measures of Important Relationship Components That Can Be Used in Clinical Practice
References
Index