Navigating the Intersection of Work and Mental Health
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Working Better and Stressing Less

Ideas on work and mental health

When therapist grief shows up at work... sometimes you have to show it

In graduate school, we talk a lot about the ethics of self-disclosure (what you ought or ought not to tell your clients about yourself and your personal life). The general rule I follow is if the disclosure is for the benefit of the patient, it's ok. If the disclosure is for your own benefit, it's not ok. We usually have a lot of choice about how much our clients know about us but when it comes to some very visible things about ourselves or our health, we don't. I recently had an experience with a lot of forced disclosure and coming from a therapeutic tradition of very light disclosure, found myself thrust into the spotlight in my office in ways I wasn't accustomed to. Suddenly, I was put in a position where I sure that clients could see whether or not I practice personally what I preach as a professional. I want to tell you the story...

A month ago today, I had to tell my clients that I would not, in fact, be going on maternity leave in December. A lot of people have asked me if I regret telling people I was pregnant as early as I did, but I do not. First, I had to make modifications to my schedule to accommodate symptoms so disclosing was largely unavoidable without worrying folks that something else was wrong with me. Second, when I was last pregnant, I didn’t tell clients until midway through my pregnancy, only to find that Portland is such a small town, some had already found out through referring physicians, or friends of friends of friends. That seemed like a much worse outcome than telling folks earlier and having to take it back if something went wrong. And wrong it went.

A lot of clients have asked me how I’m doing and some have even probed into what the grief is like. I use a complex reflections to acknowledge their curiosity but get back to how it’s relevant to them because it’s not my therapy hour - it’s theirs. The truth is that I haven’t experienced much grief from losing that embryo. I truly and completely believe that our bodies are wise and that my body and the embryo knew that something was catastrophically wrong and did what it evolved to do. I don’t think that my experience is the only “right” way to process loss. I know my husband experienced the loss differently and his way is “right” too. My experience losing that particular pregnancy simply hasn’t been that sad. In fact, the day after I had a painless (but very expensive) surgery to tie up the loose ends from that pregnancy, I was full of energy and feeling “back to myself” after the first trimester fatigue and nausea I’d suffered in the weeks before.  

The grief for me has come from going back to the drawing board. It took us 3.5 years of reflection and contemplation to feel ready to try for a third child. Our second child, Malie, is intense in both wonderful and challenging ways. She needed more time to be a baby and to receive focused emotional care from us than her brother did. We were extremely ambivalent about trying for a third child and losing the pregnancy picked us up and dropped us back at the starting line of the decision-making process.

Three weeks after losing the pregnancy, Malie finished using diapers at night. We also passed along all of our baby things to someone close to us due the same month I was. The baby things took up almost our entire attic. Getting rid of the diapers and the equipment for caring for an infant (seriously how can such a small thing need so much stuff?!) was a literal and figurative weight off of us and left a large void where baby stuff used to be. How is it possible to be so relieved and feel so light yet so empty and sad at the same time?

Medical and biological realities also began to hit home. I will be at least 38 by the time any future child would be born and I’ve had two cesarean sections and one D&C (to complete the miscarriage). It’s likely that my uterus has scar tissue that makes it more dangerous to have another child. A growing national conversation about maternal mortality in the peripartum period has been loud for me as well. They had multiple units of blood on hand for my D&C procedure because apparently, it’s possible to bleed out from it. I didn’t need them but holy crap - blood transfusions?! What if I die in childbirth trying to have this third child that we want? I’m also just finally starting to get back into shape, hiking, walking, and doing yoga consistently for the first time since my two oldest children were born. I might actually get back to my pre-pregnancy fitness-level someday.  Do I want to put that off for another few years? If I do, will I suffer long-term consequences?

My kids are also starting to be really fun. I mean it’s not that babies and toddlers aren’t fun but they don’t appreciate the beauty of a hike, they can’t walk very far, and they really suck to travel with. I did take Malie with me to Japan when she was a baby but I came back saying “it was great but it was more of a trip than a vacation.” I did see beautiful things but I also was overwhelmed by caring for an infant by myself while traveling Japan. My kids are starting to make amazing observations about the world around them and they very nearly don’t need midday naps. Am I willing to subject them to the nap schedule of an eight month old who won’t sleep in the car seat or carrier? Will I miss out on some of their childhoods because I was in a fog of pregnancy, nursing, and the peripartum-near-depression that goes on for me from conception until my baby is two years old?

Yet, I also feel like “people” will be disappointed if we don’t try again. I know my parents will be disappointed. The kids say they’ll be disappointed. I’m sure my clients who knew I was pregnant will wonder “what ever happened to the third kid idea,” even if they never ask. I’m not a big fan of disappointing people. It’s uncomfortable.

As we struggle with relief and pain, emptiness and lightness, one life path or another, I’ve come to the conclusion that this is the first time I’ve had to acutely face my limited time on Earth. Statistically speaking, I probably have 42 years left to live, if all goes well. Perhaps I have 62 as a lot of ladies in my family die near the century mark. But either way, I’m approaching the end of my childbearing years. It’s now or never and I keep trying to consult my old-lady self to figure out what she’d tell me to do. There are two versions of her though: One version who tells me to go for it because the painful part of pregnancy, infancy, and toddlerhood go fast in big picture and another version that tells me that I can have many more adventures with my husband and two wonderful kids if I double down on making life fun for the four of us rather than diluting efforts on five. Approaching the mid-life mark, I can see why people say that “life starts at 40,” and I have so many hopes, dreams, and plans for my mid and late life that I couldn’t have imagined in my 20s, when my vision for life kind of stopped at having kids. Do I want to spend another two to four years pregnant and nursing (I’m 6 years in, already)?

In the end, I don’t know what we’ll decide. There’s no biological certainty to our decisions at this time and there may not be any until I actually hit menopause but I’m having a more and more difficult time imagining going through pregnancy again. The stakes with regard to my health are becoming higher and I’m not sure if I can shake the words, “Do you know your blood type? We like to have plenty of units of blood on hand for this procedure,” from my brain. I’m not in the same boat as the mom who had two low-risk vaginal deliveries. I’m a 38 year old with two c-sections and if my graying hair and wrinkling skin are any indication, my body isn’t as young or as strong as it was when my first two were born. I think if you’re going to see us with a baby in the future, it probably won’t be from my tummy… but we still don’t know if we’ll be taking those baby clothes back when our friends are through with them.

While I can't be certain of what we'll decide and why, I do feel like I've walked through this experience practicing what I preach. It's not comfortable or easy but it feels like a good process. 

Katie PlayfairComment