Tips for EMDR Therapists Working with Perinatal Issues

Guest Blog Post by Mara Tesler Stein, Psy.D., PMH-C

The experience of perinatal loss and trauma isn’t just a medical crisis; it’s a family earthquake, shaking the very foundations of hope and expectation (Davis & Stein, 2004). We dream of a smooth conception, a simple pregnancy, and the joyful sound of a newborn’s first cry. But when things go sideways—when pregnancy becomes a labyrinth of complications, or when a baby arrives too soon, too sick, or not at all—those dreams feel like shards of glass underfoot, painfully sharp, and impossible to ignore. Even when birth goes according to plan, the postpartum period can unleash a tidal wave of depression, anxiety, or even psychosis that feels like a cruel joke. It’s not the journey anyone signed up for, especially for those who follow the rules, the checklists, and the well-meaning medical advice (Davis & Stein, 2004).

Instead of the blissful experience we envision, families find themselves thrust into an unexpected, unwanted reality—a membership in a club they never chose. Time splits into “before” and “after,” leaving them disoriented and longing to reclaim the innocence that vanished when their world shattered.

Building a family is a delicate dance, filled with both the potential for growth and the risk of deep wounds. The natural chaos of pregnancy, birth, and the postpartum phase can feel like a hurricane, especially for those with limited coping skills or those still carrying the weight of past traumas. And even the strongest among us can find ourselves stumbling when loss strikes. It’s a messy road, and sometimes “okay” does not feel like enough.

As clinicians, recognizing where these cracks form and why certain injuries are especially hard to bear can illuminate our path to healing—for everyone involved. We must understand that these issues are already lurking in our offices waiting to be acknowledged.

Here are nine things to remember that can help EMDR therapists when working with perinatal issues.

1. Your clients are already living this

You are likely already seeing perinatal clients. Even if you don’t specifically seek out perinatal-related issues, they are bound to cross your threshold. The heartbreak of infertility, miscarriage, and perinatal mood disorders is common—it is a silent epidemic. The chances are high that at least one of your clients carries this burden, or that someone close to them has felt its sting.

2. Ask the hard questions

Just like any trauma, shame can wrap itself tightly around people’s experiences, making them reluctant to share. It is’s our job to gently pry that shame loose, and ask about clients’ reproductive histories.

3. Observe the shifts in parental development

Parents and babies grow side by side, and our work requires us to be sensitive to this parallel journey. Pay attention to ruptures in parental development.

The EMDR Standard Protocol can do more than just stitch up acute wounds; it can help rebuild the emotional connective tissue that trauma has frayed. By focusing on resources—like emotional regulation and relational strength—we help parents re-establish their identities in this new landscape (Dworkin, 2005). This attentiveness allows us to tune into the universal themes of the perinatal period (Davis & Stein, 2004; Stein & Davis, 2022), guiding families toward healing.

4. Forget searching for new protocols

Instead, focus on how to conceptualize resource building and target selection. The Standard Protocol will usually meet your clients’ needs, as long as you guide them to the core memories that shape their suffering.

To support families, we should hone in on three central themes: Managing Emotions, Developing Parental Identity, and Navigating Relationships. Keeping an eye on the intersections of core trauma themes like vulnerability, guilt, shame, and belonging helps us pinpoint where the injuries lie.

Managing Emotions: Families facing perinatal crises often grapple with these themes. Helping them manage the tidal waves of emotion that crash over them requires grounding techniques that help them stay anchored in the present, even when it hurts.
Developing Parental Identity: Supporting a parent’s sense of self means helping them accept the reality of their situation, getting to know their baby, and breaking down barriers to connecting with them.
Navigating Relationships: Relationship dynamics start in the therapy room, where curiosity, humility, and attunement create a safe space. As parents navigate the shifting landscape of their relationships—with their baby, extended family, and themselves—they need our guidance.

5. Nurture the bond between parents and babies.

Nothing should come between them (Stein & Davis, 2022). As therapists, we hold the power to support this vital connection. We need to help parents build the networks that allow them to feel like parents, regardless of their baby’s situation. This means digging into the complexities of bonding and attachment, identifying pathogenic memories, and fostering adaptive connections.

6. Understand that bonding and attachment are not the same

Attachment reflects the relationship between parent and child, shaped by how attuned and responsive the parent is over time (Bowlby, 1978; Ainsworth, 1979). Bonding—the fierce devotion parents feel for their children—begins even before birth (Klaus & Kennell, 1976). When a baby is premature or sick, the expression of that bond can shift dramatically.

Rather than viewing these changes as problems, we should help parents recognize and honor their devotion, affirming that it matters deeply to both them and their baby.

7. Look for signs of parental bonding

Assume that bonding begins in pregnancy, even when trauma tries to muffle that connection. When a baby dies or needs intensive care, parents often feel like bystanders in their own story, battling feelings of inadequacy while longing to nurture. Help them see that their heartbreak and protectiveness are signs of love, even when expressed in unexpected ways.

When bonding feels disrupted—manifesting as avoidance or distraction—be attuned to the vulnerabilities that might be exacerbating the disconnect. Assess for perinatal mood disorders and guide them back to the present moment, helping them rediscover themselves and their baby.

Parents have already experienced too much loss. We must help them recognize the love and connection that persists, no matter its shape or form.

8. Don’t forget about fathers and non-gestational parents

Much of the focus on perinatal mental health tends to hover around mothers, leaving fathers and other parents in the shadows. No matter their biological ties, everyone deserves support as they navigate the terrain of love, loss, and trauma.

9. Perinatal mental health is a specialty

Just as you would not treat children without specialized training, you cannot effectively support the perinatal population without the right knowledge. Loving babies or being close to someone who’s endured loss doesn’t equip clinicians to handle these sensitive issues. Seek out the wealth of resources available in the perinatal mental health field, both within and beyond the EMDR community.

When you do, you’ll find yourself embraced by a growing network of perinatal specialists—clinicians committed to elevating the care provided to families weathering these storms. Join us in this vital work, and let’s lift each other up as we support these fragile yet resilient families.

Mara Tesler Stein, Psy.D., PMH-C is a clinical psychologist and EMDR consultant and trainer in the United States and Israel. She is the founder and director of The Touchstone Institute for Perinatal Training where she offers both foundational and advanced EMDR trainings which take deep dives into the intersections and applications of EMDR and perinatal mental health.

Dr. Tesler Stein is the editor of the forthcoming book, EMDR for Perinatal and Infant Mental Health (Springer, anticipated, 2026). She is the co-author (with Deborah Davis, Ph.D.) of Parenting Your Premature Baby and Child: The Emotional Journey (Fulcrum, 2004) and Intensive Parenting: Surviving the Journey Through the NICU (Fulcrum, 2013). She has also contributed book chapters in the areas of perinatal loss, EMDR treatment, and trauma focused psychological care for NICU families.

Her trauma work is grounded in her personal perinatal journey, which began 28 years ago taking her through infertility, twin pregnancy, prolonged hospital bedrest, the NICU, and years of raising NICU graduates. You can find her at www.touchstoneinstitute.org.

References

Ainsworth, M. S. (1979). Infant–mother attachment. American Psychologist, 34(10), 932–937. https://doi.org/10.1037/0003-066x.34.10.932

Bowlby, J. (1978). Attachment theory and its therapeutic implications. Adolescent Psychiatry, 6, 5–33.

Davis, D. L. & Stein, M. T. (2004). Parenting your premature baby and child: The emotional journey. Fulcrum Publishing.

Dworkin, M. (2005). EMDR and the relational imperative: The therapeutic relationship in EMDR treatment. Routledge. https://doi.org/10.4324/9780203955970

Henson, C., Truchot, D. & Canevello, A. (2020). What Promotes Post Traumatic Growth? A Systematic Review. European Journal of Trauma & Dissociation, 5(4), 100195. https://doi.org/10.1016/j.ejtd.2020.100195

Klaus, M. & Kennell, J. (1976). Maternal-Infant bonding. The C. V. Mosby Co.

Marazziti, D. & Stahl, S. M. (2020). The relevance of COVID‐19 pandemic to psychiatry. World Psychiatry, 19(2), 261–261. https://doi.org/10.1002/wps.20764

Stein, M. T. & Davis, D. L. (2022). Perinatal crisis and traumatic bereavement. In A. Dempsey, J. Cole & S. Saxton (Eds.), Behavioral health services with high-risk infants and families: Meeting the needs of patients, families, and providers in fetal, neonatal intensive care unit, and neonatal follow-up settings (p. 488). Oxford University Press.

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Tips for EMDR Therapists Working with Perinatal Issues