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Hidden Grief: The Psychodynamic Unfolding of Infant Loss and the Path to Emotional Repair

Hidden Grief: The Psychodynamic Unfolding of Infant Loss and the Path to Emotional Repair


Baby's legs and feet resting on white sheets, with one foot gently clasped by both hands. Peaceful, soft lighting.

Introduction


I wanted to write something that is close to my heart and an area I think gets very little attention. Society often shuns the discussion and open realisation of infant loss both prebirth as a miscarriage, to post birth as a baby, infant and child. The birth of a baby occurs firstly in the mind of the parent (if it is planned of course) and even if not the child becomes a living breathing human in the minds of the parents as an idea and concept long before the actual birth. It seems maddening for me to think that early miscarriage and loss of a baby is often seen simply as a medical event, a missed opportunity that will come round again or simply a fact of life not to be discussed but to be moved on from.


I am aware it is however not so simple as I make it. Sometimes it can be a loss that is little thought about and moved on from and there are all sorts of grief reactions and life events that cause all sorts of feelings and responses. What seems to to be the challenge facing us is the way in which thinking about it together seems a struggle.


Death and dying has long been a taboo subject in many cultures (not all I might add) but if there is no room to talk about a loss then how are we helping and creating space for those that need it?


I will conitnue now with you safe in the knowledge that I am of the opinion that there is no 'one' experience of infant loss as any stage of the pregnancy from thought to adulthood but that I will and do provide space for it when it is needed. However it manifests.


Infant loss is one of the most profound and uniquely devastating experiences a parent can endure. The grief that follows is often hidden, complicated by societal silence and expectations that parents “move on.” I feel that Psychodynamic psychotherapy allows us to provide a crucial space where the layers of grief — emotional, somatic, and symbolic — can be gently explored and worked through. This article delves into how psychodynamic therapy supports healing after infant loss, highlighting recent research on somatic manifestations of grief and the therapeutic role of ritual and symbolic expression.... and perhaps some opinion based on my thoughts and feelings too.


The Complexity of Infant Loss Grief


Infant loss disrupts the expected life narrative in a deeply traumatic way. Unlike other losses, it often occurs in the earliest stages of attachment formation, complicating the mourning process. This can be, as I mensioned in the minds of the parents. Parents can experience feelings of isolation, guilt, and unspoken sorrow, often compounded by social pressures to suppress or deny their pain.

Ultrasound image of a fetus in 2nd-3rd trimester. Black and white with medical text details on right.

Psychodynamic theory helps us understand how this hidden grief can become unconsciously buried, manifesting through defensive mechanisms such as denial, repression, or somatisation. It also provides a framework for us, as therapists to hold and contain the emotional experience, fostering an environment where the individuals internal world can be safely unfolded and explored.


Somatic Expressions of Grief


Grief is also not purely an emotional experience; it frequently shows itself physically. Sillis, Claes, and Andriessen (2022) studied bereaved university students and found a significant correlation between intense grief and somatic symptoms such as chest pain, digestive disturbances, headaches, and fatigue. These physical symptoms often reflect the autonomic nervous system’s activation during prolonged grief and the body’s attempt to communicate distress when words fail. How often have we had last minute stomach upsets before an important event? or felt our heart race when we anticipate an exciting event?


In psychodynamic psychotherapy, attention to the body is crucial. Individuals may present with physical complaints that are, in essence, expressions of unprocessed grief. My attempt at attunement to these somatic signals allows for the integration of mind and body, facilitating a fuller mourning process and working through.


The Healing Power of Ritual and Symbolic Expression


Two hands, one dark-skinned and one light-skinned, grasp each other in a gesture of unity against a plain grey background. Black and white photo.

Rituals provide a vital therapeutic pathway in processing grief, especially after infant loss, where traditional social rituals may be absent or insufficient. A scoping review by Wojtkowiak, Lind, and Smid (2021) analyzed 22 studies of ritual-based interventions in grief therapy, including symbolic acts like writing letters to the deceased, creating farewell ceremonies, and engaging in dialogue with imagined representations of the lost infant.


These symbolic approaches are often embedded within psychodynamic work to help individuals articulate and contain often overwhelming emotions, providing structure to the chaotic experience of grief. The review highlights that incorporating ritual elements tends to correlate with reductions in grief severity and symptoms of trauma. Although I do not normally give active solutions to these feelings rather help the individual to feel, identify and choose what they may do with they find, I do think that listening and opening these avenues for individuals with a non-judgemental open space may facilitate this.


Psychodynamic Psychotherapy: Creating a Safe Space for Emotional Repair


My approach prioritizes the therapeutic relationship as a container for the individuals grief first and foremost. Through empathy, attunement, and interpretation, I beleive the individual can then explore unconscious material related to the loss, such as ambivalence, guilt, or unresolved conflicts openly without judgment.


Countertransference is also a significant consideration; therapists must remain aware of their emotional responses to clients’ grief to avoid enmeshment or avoidance. Barth (n.d.) offers insights on managing countertransference in grief work, emphasizing the importance of supervision and reflective practice to maintain therapeutic effectiveness. I do feel however that the therapists own experience and how this leaves them feeling in the moment 'although clearly not shared directly with the individual' can be a useful tool to think about but only with extreme caution to avoid further trauma.


A man in a blue sweater looks pensive, leaning forward with hands clasped. A woman takes notes on a clipboard in a bright, modern room.

Conclusion


Healing from infant loss is a complex journey involving emotional, somatic, and symbolic dimensions. One could also reframe 'healing' with 'acceptance' and living with the pain more skillfully. Psychodynamic psychotherapy’s depth and relational focus make it uniquely suited to support this process. By recognizing the physical manifestations of grief, incorporating ritual and symbolic thoughts and feelings, and maintaining a safe therapeutic alliance, psychodynamic therapists like me can, and do guide individuals toward emotional repair and finding peace within themselves.


If you have suffered a loss like this there is always somewhere to turn. The foundation for infant loss in the UK is a good resource to turn to and provides a list of practitioners specifically trained in this area along with lots of other resources. There is help if you need it. If this article has brought up difficult emotions that you are struggling to deal with then please do reach out to someone. Samaritans, A&E, Crisis services, GP's registered and experienced therapists like me, a friend, relative or support group that can provide support through this difficult time.


I offer a free 20 minute consultation so reaching out to see if I can offer something that may help is free and easy to set up, Just follow this link and book today


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