The therapeutic relationship is sacred. It is a relationship where we can safely process, disclose, and talk about our most shameful experiences with honesty, security, and love. And we as therapists can do this because, like you, we’ve been right where you are sitting. The facts of our circumstances may be different; in fact, they probably are. But I, like you, have experienced loss, grief, anxiety, shame, embarrassment, and the whole range of emotions we all desperately want to avoid. And in understanding that, the therapeutic relationship is further strengthened: I can trust that you have experienced pain, as I have.
I found comfort in a therapeutic relationship when I experienced my third pregnancy loss. And while my therapist did not disclose if she had experienced pregnancy loss herself, I understood that the plight of being a human being is to experience pain. As long as we are alive, we will feel pain. None of us are immune to it. My recurrent pregnancy loss was not the first pain I felt, nor will it be my last.
Often, therapists are drawn to the work they do when they identify a gap in therapeutic services. I find this especially true with clinicians working in the perinatal mental health world. Prior to my losses, I could not fathom the immense grief one can feel when they’ve lost a pregnancy. I also was blind to the enormous gap in therapeutic services available for those who have experienced birth trauma or pregnancy loss, until I experienced that lonely, isolating gap for myself. In fact, after my second loss, I had to ask my doctor for recommendations for a therapist who might specialize in pregnancy loss, and she gave me one referral. It was bad enough that a referral wasn’t simply offered to me, but then I was only given one option. And when I called that one option, she wasn’t accepting new clients.
It was in that moment that my focus began to change. I wanted to offer services for those who had also experienced pregnancy loss, and provide them with something that I so needed, but struggled to find. And while this is my primary motivator for doing this work, I don’t share it with my clients in session. I don’t have to. Instead, what I do is connect with you in empathy.
Empathy is the ability to feel what another person is feeling, by drawing on a personal experience that elicited a similar feeling. Empathy builds connection with others. And when we feel connected, our feelings of shame decrease. Shame is a powerful emotion that can lead us to shut down or retreat from others. It can cause us to lash out and get angry with others for no apparent reason. Shame isolates us when what we truly need is connection with others.
When my doctor first told me about my pregnancy loss, I began to cry in her office. Her response: “It’s OK, because you need three miscarriages for us to worry about it.” Disconnection. Shame. Isolation. In one sentence. It wasn’t OK, not for me. I wasn’t thinking about a third miscarriage. I was thinking about this baby, right now, who I lost. Which then led to me thinking, “if my doctor is right, then what’s wrong with me that I’m so sad about this baby?” That’s shame speaking!
When I told a friend of mine that I was having a miscarriage, she hugged me and said, “I’m so sorry. This is so hard.” Connection. Support. Empathy. And that support encouraged me to find a therapist, and continue connecting with others.
Empathy is a choice, and it’s one that many of us might choose to avoid. As a result, a lack of empathy (or, as clinicians say, empathic fails) can threaten our closest relationships. One empathic fail is when the listener doesn’t want to re-experience those unwanted feelings. I have a choice to join with you in your pain. It’s a vulnerable choice because I need the courage to “go there” with you.
Another empathic fail is when there is a power dynamic at play. This power dynamic can even exist in the therapeutic relationship. A client, who is experiencing a hardship, comes to the therapist, the perceived expert. Therapists, initially, take on the role of expert because when one is in crisis, one wants to know they are in good hands, that they will be well-taken care of. When we are hurting, we sometimes need that expert to tell us what our next steps should be. We don’t want to see someone who appears disheveled, uncertain, unfocused, or disconnected.
Sometimes, however, when one has an ongoing relationship with a therapist, that expert position can elicit feelings of shame and disconnection. I once had a client tell me, after recounting a harrowing experience with an ex-partner, “you probably have no idea what I’m talking about. You have your act together, and you never would have done something like this.” Right then, I recognized two things: the first was that my “expert” appearance had made the client feel disconnected from me, and the second was that I needed to drop that act.
How do we heal empathic fails? With empathy. Empathy is not saying, “you’ve had two pregnancy losses! Well, I’ve had three.” Rather, empathy says, “your pain is real. It’s so real, I don’t even know what to say in this moment.” Empathy sometimes isn’t even words; rather it’s a hug, a hand over your heart, or simply holding space for someone to cry, yell, or express their feelings. Empathy allows someone to drop down into an emotional pit with the support of another person. The other person climbs down there with you, but they have all of the tools to help you climb back out. I, as the therapist, go down into this pit with a rope, a jug of water, a flashlight, and a ladder. We can stay down there for as long as we need to, and return safely.
By connecting in empathy, you can now rest, knowing that you are in good hands. I have been where you have been, and I’ve done a lot of work to get here today. Your therapist has a history of trauma, struggle, broken relationships, heartbreaks, griefs, worries, anxieties. And that’s because we are human beings. You can trust that your therapist has either been in pain, is currently in pain, and will experience pain in the future. And all of this can be said without ever saying it.
There are amazing therapists out there to work with you! Your best resource for all perinatal mental health needs is the Postpartum Support International therapist directory: https://www.postpartum.net/get-help/provider-directory/. Here, you will find therapists in your area who specialize in pregnancy loss, birth trauma, termination for medical reasons, perinatal mood disorders, and a host of other perinatal mental health needs!