When talking is not enough.’ Pre- and Perinatal Psychotherapy: A Resource for Therapists

by Paul Bradley

“Birth memories, if not entirely explainable, have a way of forcing
themselves on us.”

(David B. Chamberlain, 1988: 97)

Introduction
Since Freud first charted the biographical psyche, modern day therapy has mapped the terrain, and has discovered an array of theories, insights, and methodologies. Yet as Joseph Campbell put it: “Freud was fishing while sitting on a whale” (1968: 59). While the biographical still holds dominion, it remains but one layer of the human psyche. The prenatal psyche precedes it. This article posits that the prenatal dimension is readily accessible and offers an in-depth and unique perspective to a client’s process.

Imagine that sitting in a room are a group of therapists. Each is asked to briefly summarise one aspect of their approach. one highlights that ‘bidden or unbidden, the spirit is always present’. Another alludes to the self-actualising tendency manifesting within the client. The third points to the existence of the transference. A fourth speaks of the client’s experience of the ‘here and now’. Each offers a different perspective, highlighting a specific dimension of the client’s process that from their point of view may be present. All are utilising a foundational element that forms the basis of their work.

Were a Pre- and Perinatal psychotherapist to enter the debate, he or she may start with the following observation that “nine months is a long time in one place” (noble, 1993: 25). Perhaps too long to be ignored?

To put this in perspective, consider anything in your adult lifetime that lasted at least nine months: a house lived in, a relationship, a job or new position at work. An undertaking of this duration is quite an experience at any stage of life and leaves more than just a passing memory. now consider the 270 or so days and nights spent in utero; that singular period of life when we are at our most vulnerable and sensitive, when our defenses are immature and inadequate. Can we really afford to say that psychologically this has no impact upon us? For a Pre- and Perinatal psychotherapist this experience in utero is the defining foundation for life and incurs a lasting impression on the developing psyche.

Definition of Pre- and Perinatal (PPN) Psychotherapy
Pre- and Perinatal psychotherapy (pre: before birth; perinatal: around birth) posits that the unborn child is a conscious, sentient and aware being, that learning and remembering takes place in the womb, and that early trauma memories impact later adult behaviors (Lyman, 2005; noble, 1993; Rank, 1929). The PPn literature cites that through trauma encountered in either or both womb and birth experiences, the vulnerable psyche of the prenate becomes imprinted. This imprinting is formative, enduring and can be recalled and remembered.

Definition of Birth Trauma
The PPN literature defines birth trauma as a shocking or traumatic event for prenates, such as:

• Unwanted pregnancy and pregnancy involving social shame or disgrace.
• Conception by force, harassment, manipulation or rape.
• Conception under the influence of drugs.
• Abortion: fantasy, plan, event or culmination.
• Intrauterine chemical and/or emotional toxicity (diets, medication, drugs, cigarette smoke, alcohol and strong negative emotions).
• Emotional, physical or sexual abuse of mothers and/or fathers during either or both pregnancy and birth.
• Pre- or perinatal twin loss.
• Accident, injury, illness or surgery to prenates or parents.
• Reluctant parenthood.
• Divorce or separation during pregnancy.
• Obstetrical medication and mechanical interventions.
• Birth complications such as maternal toxicity, cord compaction prolapse, oxygen deprivation, foetal distress.

Birth Memory
Memories of traumatic birth and womb experiences can arise spontaneously: during therapy sessions as flashbacks, through thoughts, feelings or images, while dreaming and through the recalling of dream imagery, in meditation and relaxation, through creativity, and during altered or regressed states of consciousness. Several authors (Castellino, 2000; Chamberlain, 1999a; Cheek, 1986; Emerson, 1989; Grof, 1975, 1985; Janov, 1983; Lake, 1981; Verny & Kelly, 1994) recount that clients in regression are able to recall and relive traumatic memories and experiences associated with birth. Medical and scientific research substantiates these findings and is now demonstrating what PPN practitioners have known for almost a century: early trauma can be remembered (Anand & Scalzo, 2000; Cordon et al., 2004).

William Emerson, one of the pioneers of PPN psychology, states five categories of research on pre- and perinatal memories (Emerson, 1999):

1. Appearance of spontaneous memories in natural settings:
Psychologically unaware people (including small children) who know nothing about Pre- and Perinatal psychology, spontaneously remember prenatal and birth experiences during their everyday lives.

2. Appearance of spontaneous memories in non-regression therapies:
Clients in non-regression therapies (i.e., therapists who do not invite clients to regress to early experiences and who usually invalidate the reality of pre- and perinatal memories) in fact have memories from pre- and perinatal periods. Such reports rule out the possibility that clients are responding to the biases of their practitioners.

3. Agreement with medical records and interviews:
Clients in regression-oriented therapies remember prenatal and birth trauma and shocks, and their memories are confirmed through either or both medical records and interviews with those that were present at the time.

4. Spontaneous resolution of symptoms:
Troublesome and lifelong symptoms of clients in regression therapies are resolved through cathartic regressions to birth and prenatal periods, confirming that experiences from these early times can be remembered, have life-long impacts and are resolvable.

5. Congruent memories of mothers and children:
Chamberlain (1988) compared the detailed birth memories of mothers and their children while they were independently regressed. Children were carefully selected, making sure they had no conscious birth memories and that parents had not told them anything about their births. More than 90% of the remembered details were identical.

How traumatic events become imprinted and remain within the prenatal psyche is still the subject of much discussion. Arthur Janov (1975, 1983) posits that traumatic events, which later embed as imprints, form part of implicit or unconscious memory. Janov further cites that therapy must include a conscious connection to one’s physiological imprint and “the physical and emotional reactions to that experience are vital to the healing process” (Janov, 1975: 340). This conscious connection to the early trauma and how this is supported is an integral and important part of the PPn psychotherapy approach.

PPN Psychotherapy and Trauma
Lyman (2005) defines PPN psychotherapy

as the treatment of the sequela of deeply imprinted events, because without intervention, unresolved early traumas have the potential to become maladaptive and repetitive patterns in adulthood (59).

Alison Hunter and Shirley Ward both state three parts for a primal trauma to be healed: emotional feeling, physical sensation and historical memory (Ward, 2014: 43). Hunter has named the importance of the “circuit breaker”, the defining insight or shift in consciousness that breaks the recycling birth trauma (A. Hunter, personal communication, 17 June 2007).

William Emerson (1999) states that pre- and perinatal trauma and shock have lasting and profound effects on personality and development and so require a specific range of treatment, guidelines and protocols. Emerson differentiates between shock and trauma sequela and the importance of avoiding re-traumatisation of the client. He further emphasises the essentials of empowering the client through resourcing and for the therapist to pay careful attention to pacing and disclosure.

Peter Levine (2011) defines a ‘Method for Transforming Trauma’ with key points, notably concerning safety and support of the client, utilising the techniques of pendulation and titration, discharge and regulation of high arousal states, engaging in self-regulation to restore equilibrium, and reorienting in the here and now.

Client Case Study

Birth is a transformative psychological event, a psychic pacemaker that unconsciously motivates our subsequent life. How we enter this world plays a crucial role in how we live in it.

(Verny & Weintraub, 2002: 70)

It is here, in the first three months or so in the womb, that we have encountered the origins of the main personality disorders and the psychosomatic stress conditions.

(Lake, 1981: 147)

The following offers a brief summary of a client’s case history over a number of sessions and records some of the key elements that were linked to her original birth trauma. Informed permission has been granted by the client for publishing both in journal and on the IAHIP website. All names, dates, some details and personal context have been changed to protect anonymity.

Please note that in recounting sessional work I am aware of my own limitations in attempting to convey, through words, the full extent and depth of the experiences of feeling, insight, ‘felt sense’ awareness and psychological connection encountered by this client.

‘Anne’ is a 39-year-old professional, single and employed in a large company. A relationship break-up along with increasing work stress prompted her to come to therapy. She was given my name by referral and she presented with the following issues:

1. Emotional fall-out from relationship breakup.
2. Work stress and related difficulties.
3. Feels she is too controlling in personal relationships.
4. Often has intense feelings of frustration.
5. Unsure regarding her career choice.

Another important factor in her presentation was her underlying birth type: she was induced, followed by an emergency caesarian section.

Anne’s journeys, through an understanding of her underlying birth process to the presenting issues and insights revealed, using a PPN psychotherapy approach, are as follows:

1. Emotional fall-out from relationship breakup
Anne’s birthday is in May. At the beginning of her second trimester her mother and father briefly separated. The month was December. Anne was, by her own admission, astonished when she realised the connection that her most recent relationship and also her first significant relationship as a young adult both terminated during the month of December. Anne decided to talk with her mother ‘Rita’ about her experience of being pregnant. She did not disclose that she was in therapy as she wanted her mother to talk spontaneously. Rita revealed that during that time of separation she was distraught. Anne got an immediate ‘felt’ sense realisation regarding the sense of responsibility she often feels towards her mother around Christmas, expressed as ‘when my mother feels down I always feel guilty’. Anne noted a sense of ‘something shifting or changing’ but she was not quite sure what. The following week Anne met her mother at a family outing and for the first time noted that she did not feel her usual sense of feeling ‘drained’. Anne began to feel a growing sense of lightness between herself and her mother.

2. Work stress and related difficulties
Anne describes her style of work as having difficulty ‘finishing’ things. She often ‘takes on’ too many projects and encounters pressures working to deadlines. She describes her career as ‘nothing really comes easy’ and she has to ‘work extremely hard’ for everything. Anne feels an underlying sense of never being satisfied.
The imprint of a ‘long, hard’ birth may constellate into different areas of life. If birth was difficult, then work and achievement may well turn out to be ‘arduous’ processes. Caesarian births may also pattern into life experiences and distinctive aspects of character and behaviour. For an infant, a caesarian birth may imprint as an interruption or abrupt termination. Anne’s issues around completion may be linked to her ‘unfinished birth’.

3. Feels she is too controlling in personal relationships
Anne recalled some of her personal relationships with men and admitted being ‘too controlling’. When we explored what it was like to have a male therapist, Anne said that initially she had great difficulty opening up to me. She felt panicky at times. She recalled that she ‘needed to know what I was doing’ and in earlier sessions she often insisted on wanting to know how therapy works, the ‘steps’ I would take and the ‘formula’ I would work to. She stated she didn’t know if she could consider ever ‘letting go’ in front of a man.

An exploration of Anne’s underlying birth process revealed that her sister had been born prematurely at home and in a conversation with her father he recalled the experience as being overwhelming. He told her he could not cope with another home birth happening again and so he was extremely anxious during the last few months prior to her birth. on the day Anne’s mother went into labour, her father had panic attacks to the extent that a relative had to drive her mother to hospital. Anne made a connection to her father’s anxiety: ‘Is it his panic I often feel?’ She also wondered about the sense of resentment she often feels towards her father at other times in life when he has had panic attacks. She feels his panic and anxiety is a ‘weakness’.

In reconnecting to her birth she felt her father ‘just wasn’t strong enough to be involved’. She then became aware of how she can sometimes negatively react to what she perceives as weaknesses in other men, especially with male colleagues.

Anne subsequently experienced a significant change in work. Previously she had spoken of her difficulty delegating, particularly to male employees and felt she had to ‘micro-manage’ in work. The change she noted was a sense of being more relaxed, of being more trusting; of letting others share the burden and carry the responsibility. overall she sensed a relaxed feeling of just letting go and a growing feeling she described as ‘a little more freedom and a little less duty’.

4. Often has intense feelings of frustration
Anne recalled moments in her life where she felt overwhelmed with frustration. She described these experiences as happening ‘often just out of the blue’. She also recalled a recurring dream. In the dream she feels stuck and while the dream’s scenes and places change, the overall themes are being stuck, rooted to the spot, unable to move. An intense feeling of ‘being held back’ then comes over her.

She decided to talk to her relative who had been present at her birth. Her relative revealed that the labour had been long and difficult. Anne’s relative overheard the midwife saying ‘this baby is stuck’. Eventually an emergency ensued which necessitated the caesarian section. Anne’s felt sense realisation about the recurring dreams was that they mirrored her experience of ‘being stuck’ in the birth canal.

5. Unsure regarding her career choice
Anne is employed in a large firm. For many years she has felt doubts about whether she is in the right career. Although she made the choice to pursue this particular career after finishing university she often feels distracted and unsettled, with thoughts of working in another profession.

Her mother Rita revealed what turned out to be a defining insight on her career choice: Anne was induced even though Rita had a feeling the baby wasn’t quite ready yet and she needed more time. When Anne asked why she was induced, Rita recalled that she overheard the medical staff saying that they were near the end of the shift and were making plans for a social event taking place that evening. one remarked: ‘It’s time this baby came out’. Anne had an immediate and distinct feeling that in birth ‘I didn’t have a choice’. This was a revelation to her and she was visibly taken aback at the implication. She then had a further realisation: ‘Having no choice, I cannot choose to do what I really want’. Anne then decided for the first time to take her full allocation of holidays that year and to use the time as ‘my freedom to explore choices’.

The limitations of space exclude a full account of this client’s process which took place via weekly sessions over a year. Yet what can be seen from the above is a glimpse at the way the prenatal psyche can open and reveal itself. of course only the client can truly say if those revelations are helping and whether the process is working or not. As therapists though we can at least get an inkling of the perspective that Pre-and Perinatal psychotherapy may offer.

Conclusion

In our lifetime we encounter three births; we are first born to our mother, our second birth is to our father, our third birth is our self. 

Anonymous

What is therapy if it’s not at the very least about this third birth? The ‘emergence’ of self, the ‘arrival’ of insight, of a ‘new’ way of seeing things, a ‘new’ level of awareness, a ‘coming into being’ are all an integral part of the therapeutic encounter. Yet all are birth themes. Seeing therapy as a ‘birthing’ process attunes us to what is already innate in the client, to being ‘midwife’ to the ‘emerging’ other. Clients can sense that level of attunement. For, silently, it permits. That permission is an invitation the pre- and perinatal psyche is already seeking.

Janov states that any ‘psychotherapy that uses words as the predominant mode of therapy cannot make profound change’ (2007: 17). our experiences in utero are, after all, ‘pre-verbal’ so words naturally are sometimes the least part of prenatal therapy. But the place ‘beyond words’ is indeed a very powerful place and as a resource it is a gift that truly keeps giving. Above all, this gift can be now accessed safely and gently.

It is said that the child is mother to the woman and father to the man. Yet the infant in utero is grandparent to them all.
That infant’s experience has built the foundations of our psyche. And that infant knows a thing or two about whales….

Paul Bradley is a Psychotherapist based in Maynooth, Co. Kildare.

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