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Pregnancy--procreative process, the "placental paradigm," and perinatal therapy.

Based on extensive clinical experience with childbearing women, a metaphor is suggested depicting psychic reality during pregnancy as a "procreative container," constituted through three intertwining systems--physiological-placental, intrapsychic-familial and socioenvironmental. Psychohistorically predisposed thresholds of tolerance are proposed, with each woman manifesting varying degrees of "permeability" or "psychological immunity" to engagement in the process of emotional gestation. A model illustrates variations in affective quality, fixity, and intensity of preconscious maternal representations underpinning defensive structures. This "placental paradigm" charts seven permutations of the combination of herself as mother to her fantasized baby (in relation to split aspects of herself as baby to her archaic mother) and effects of these imagined dyads on the postnatal exchange. The paper concludes with an exposition of unique features of psychoanalytic treatment during pregnancy and postnatally, and the impact of the procreative psychic reality on patient and analyst.