Having a baby?

Fourteen years ago when clinical psychologist Lynn Bufka, PhD, was pregnant with her son, she used her near-daily morning sickness to connect with several clients who were dealing with severe social anxiety and fear of having a panic attack in a public setting and vomiting.

"I would put the trash can in between the two of us during the session and tell them, ‘I'm throwing up all the time right now' and it winds up not being a big deal," recalls Bufka, now assistant executive director for practice research and policy in APA's Practice Directorate.

"They were sort of taken aback at first, but it was the reality of my life at the time," she says.

While Bufka never actually lost her lunch with a client in the room, she did often munch on snacks in front of patients — something she'd never do outside of her pregnant state — when it was the only way to keep her nausea at bay.

The passage into and through pregnancy and new parenthood affects all aspects of a clinician's life, including her work with patients. No matter the therapist's theoretical orientation, she is faced with making decisions that aren't usually addressed in training or psychotherapy literature, such as the delicate task of communicating with clients about an impending maternity leave and managing a pregnancy's effect on the therapeutic alliance.

Bufka and others who have practiced through pregnancy offer this advice:

• Set boundaries. For many early career psychologists, pregnancy and new parenthood are the first time your career may need to take a backseat to your personal life — or at least get less of your attention. That's important for your new family's sake, suggest the results of a longitudinal study with 126 practicing psychologists. It found that the more hours a psychologist worked and the greater his or her emotional exhaustion, the poorer his or her family functioning (Professional Psychology: Research and Practice, October).

"Dealing with the complete exhaustion of the first trimester was really the beginning of my realizing that my work–life balance was already starting to shift," says Houston clinical psychologist Kay Hurlock Brumbaugh, PsyD, who had her first baby last March. "While maybe a couple of years ago I could be go-go-go — preparing presentations, working with clients, starting a new group therapy — I realized that might no longer be the case as this new chapter began in my life."

The months before a new baby arrives might be a good time to set stricter client rescheduling and late arrival policies, if you don't already have them in place. And as preparing the nursery and researching child-care options begin to take up more of your time, energy and mental capacity, do your best to set up a mental divide between home and work life as well, to help you stay focused on the task at hand, says Joshua Knox, PhD, a psychologist in the University of Houston's counseling and psychological services department. Before his daughter was born, he'd been providing intensive therapy for people with personality disorders.

"When we were expecting our daughter, my wife and I would often have a weekend all about buying baby gear, getting excited about our daughter's arrival, and it was really jarring to switch my mindset on Monday to then go into the clinic and work with people who had tough childhoods, and tough relationships with their parents," Knox says.

• Remember that one size doesn't fit all. Just as there's no one way to provide treatment to every client, there's also no one way to handle when and how to share your news with every client, says clinical psychologist April Fallon, PhD, co-author of the 2003 book "Awaiting the Therapist's Baby."

"It's very much an individual experience," Fallon says. "On the one end, you have the more analytic type of therapy … where not much at all is shared, maybe only that you're pregnant or that you had a baby boy or girl and the rest is left up to helping the patient deal with it, whereas psychologists in more supportive therapy roles may be willing to share more."

Before telling any clients you're expecting, it's important to think about where they are therapeutically in the relationship, as well as what their own experiences have been. For example, clients with a history of miscarriages or infertility may experience renewed feelings of loss as the therapist's belly continues to grow. Patients dealing with jealousy or rejection may view an anticipated maternity leave as abandonment.

"For most patients, a therapist's pregnancy is not going to be a big deal," Bufka says. "But it's important for clinicians to be sensitive to the fact that for some patients this will be a big deal, and to think through how best to handle things with them."

• Be flexible. Clinicians should also be accommodating when it comes to allowing clients to change their minds about their interim treatment plan several times as the clinician's due date approaches, says Heather Loffredo, PsyD, a clinical child psychologist in Silver Spring, Md., who had her second child in December.

"Some clients think they don't want to see anyone else [while you're on leave] and that they'll be OK managing without you for a while, but then as you get closer to the baby's due date, they either experience some anxiety around that or they hit a nice stride in therapy and they want to maintain it, so you really have to be flexible with your plan."

• Reach out. Get support from colleagues who have had children while in practice. Their advice can be particularly helpful if you have concerns about a client's reaction or behavior related to your pregnancy, Fallon says.

Also, early in your pregnancy, introduce your clients to the therapist who will be covering for you to help facilitate smooth continuity of care. This may be especially important if you need to leave your practice earlier than expected due to enforced bed rest, a premature birth or other complications.

If a client plans to just take a break from therapy while you're out, you may want to contact other professionals with whom the client may already have a rapport, rather than transferring to another clinician. "If a client already has a relationship with a school counselor or a psychiatrist or past therapist," Loffredo says, "ask if that person would be willing to check in with the client during your absence. That creates less of a loss for the client, but it definitely also takes more individualized planning."

• Build in nap time. Hormonal surges can leave pregnant women tired and — as Bufka experienced — nauseated for much of the day. Pay attention to your own needs and adjust your work environment, Fallon says. Adjust your client schedule to incorporate stretch breaks and snack times, and bring in pillows and a footstool to create a more comfortable and ergonomically supportive office space.

"If you can, build in the ability to take a nap during the day, and try not to see so many people late into the evening," Fallon says.

• Make it a learning experience. In many ways, your pregnancy and transition into maternity leave can be a great way to support a client's therapy, Bufka says.

"If the person is anxious about change, this is going to be a change," she says. "Use the experience to talk with clients about their plan, and help them see it as a chance to practice the skills and cognitive flexibility you've been working on in session."

• Ease back in. Loffredo recommends that therapists stop taking new clients a couple of months before their due date so that they don't feel inundated when they return from maternity leave. When they do come back, they should gradually build their client base back up as they adjust to the new lifestyle and the sleep deprivation that often comes with having an infant at home. Some therapists — for financial or other reasons — move quickly back into full-time work, while others keep their schedules lighter for a few months, or even a few years, to allow for more time at home with the baby.

Before you resume work, leave the baby under someone else's care and go into the office for a few hours to plan for your return, Fallon says. It's a good time to see what it feels like to be away from the baby, to check mail and email, and to evaluate your office's accommodations for pumping breast milk if you plan to do this once you return to work.

"Your brain is in a very different place than it was before you had the baby, and a lot of women describe this sense of their brain's just being mushy and not being able to think clearly about a lot of the issues that you need to think about as a clinician," Fallon says. "Doing one or two dry runs before you actually go back can really help smooth the transition back to work."

• Forgive yourself. As an expectant or new parent, it's important to give yourself a break every so often. You might feel stressed about whether you'll be able to keep your milk supply going once you return to work, for example, but don't beat yourself up over it, says Norma Ngo, PsyD, director of counseling and psychological services at the University of Houston.

"We perceive a lot of expectations placed on us as women, and some days may be better than others," Ngo says. "This is not a reflection of who you are as a mom or who you are as a professional."

Amy Novotney is a writer in Chicago.