Errors in Clinical Treatment Surrounding Perinatal Grief

An Article Review

Markin, R. D. (2016). What clinicians miss about miscarriages: Clinical errors in the treatment of early term perinatal loss. Psychotherapy, 53(3), 347-353.

Find the original article here.

Spontaneous miscarriage is defined as the loss of a pregnancy before the 20th week of gestation and is the most frequent type of perinatal loss, occurring in approximately 10-25% of all pregnancies (American College of Obstetricians and Gynecologists, 2015) and frequently leads to symptoms of depression, anxiety, and traumatic grief reactions (Blackmore et al., 2011; Lee et al., 1996).

This article discussed clinical errors in the treatment of perinatal grief due to miscarriage(s), including: (a) minimizing or avoiding painful affects related to the miscarriage, (b) assuming grief is resolved upon a subsequent healthy pregnancy, and (c) failing to work through early unresolved losses that are reawakened by the loss of the pregnancy.

The author argued that these unintentional errors, typically committed by significant others in the patient’s life, are similarly made by well-intentioned clinicians due to a lack of knowledge about the psychological impact of miscarriage and, moreover, an unconscious avoidance of such a common yet distressing loss.

Background information relevant to each clinical error was briefly reviewed, followed by recommendations for a better approach to the situation and verbatim clinical exchanges. The author suggests that, in general, a better approach to treatment is based on the assumptions that: (a) miscarriage is often a traumatic loss in a woman’s life, and (b) the traumatic affect associated with the event should be approached, rather than avoided, within a safe affect regulating relationship with the therapist.

Rayna D. Markin, PhD, received her doctorate in Counseling Psychology from the University of Maryland, College Park and is currently an associate professor in counseling at Villanova University and a licensed psychologist with a private practice ( Her research and clinical work focus on psychotherapy from a relational-attachment perspective for individuals and couples coping with fertility struggles and pregnancy loss. She is the author of the new book Psychotherapy for Pregnancy Loss: Applying Relationship Science to Clinical Practice, and co-author of the book Attachment in Group Psychotherapy. Through her clinical writing and practice, Dr. Markin has developed an attachment-based experiential and trauma-informed approach to treating the psychological effects of pregnancy loss, as demonstrated in the new American Psychological Association (APA) Therapy Demonstration video on psychotherapy for pregnancy loss. Dr. Markin has over 40 published articles, books, and book chapters on the psychotherapy relationship and psychotherapy for pregnancy loss, recurrent pregnancy loss, pregnancies after loss, and fetal terminations due to genetic anomaly. She is associate editor of the APA journal Psychotherapy: Theory, Research, Practice, and Training. Dr. Markin is frequently interviewed in the media on topics related to pregnancy loss and infertility. She has held several leadership positions in Division 29 of the APA and served on the Third Interdivisional APA Task Force on evidence-based relationships and responsiveness.

Cite This Article

Markin, R. D. (2017, March). Errors in clinical treatment surrounding perinatal grief [Web article] [Review of the article What clinicians miss about miscarriages: Clinical errors in the treatment of early term perinatal loss, by R. D. Markin]. Retrieved from


American College of Obstetricians & Gynecologists. (2015, August). Early Pregnancy Loss: Frequently Asked Questions. Retrieved from

Blackmore, E. R., Côté-Arsenault, D., Tang, W., Glover, V., Evans, J., Golding, J., & O’Connor, T. G. (2011). Previous prenatal loss as a predictor of perinatal depression and anxiety. The British Journal of Psychiatry198(5), 373-378.

Lee, C., Slade, P., & Lygo, V. (1996). The influence of psychological debriefing on emotional adaptation in women following early miscarriage: a preliminary study. British Journal of Medical Psychology69(1), 47-58.


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