Many people that experience a miscarriage often suffer significant mental health challenges—often silently. Counselors are uniquely positioned to support this population to address the full scope of this type of loss.

The mental health impact of miscarriage can vary widely and include depression, anxiety, post-traumatic stress, isolation, relationship strain, and/or intimacy issues. It’s vital for counselors to understand both the individualized nature of this grief and the common emotional responses that may emerge.

To better equip counselors working with clients navigating miscarriage, we spoke with Claudia Bracey, MS, NCC, LPC,  at Therapeutic Counseling and Consulting.

Bracey emphasizes that many clients seek counseling only after the initial support from friends and family has waned. By this point, they’ve often heard well-intentioned but dismissive remarks like “just try again” or “at least you know you can get pregnant.”

“Grief after miscarriage doesn’t follow a timeline, and the pain of that loss may never fully disappear—even for clients who go on to have healthy pregnancies later,” says Bracey. “Therefore, my first priority is to create space for clients to grieve openly and without judgment.”

Bracey highlights the prevalence of self-blame, where clients question their actions or feel their body has failed them. Here, psychoeducation and statistics can be powerful tools.

“Gently challenging these thoughts while providing accurate information can help clients separate fact from fear and shame,” Bracey states. “Miscarriage is rarely the result of something the person did or didn’t do.”

Bracey combines unconditional positive regard with cognitive behavioral therapy (CBT) to help clients process their grief. Unconditional positive regard establishes a safe, empathetic space where clients feel deeply heard and accepted, while CBT supports clients in recognizing and reframing harmful thought patterns, especially those rooted in guilt or shame.

However, Bracey cautions against a rigid application of any single method.

“There’s no one-size-fits-all approach. Some clients may want validation and reassurance. Others may seek empowerment. The key is to meet them where they are.”

Research supports the importance of considering a pregnancy loss within a client’s individual social and psychological environment. A study by Shreffler et al. (2011) highlighted a “social constructionist approach” and found that a person’s distress after miscarriage was shaped by multiple factors, including their beliefs about parenthood, the planned nature of the pregnancy, their current desire for children, and the time since the loss.

Bracey advises to consider potential pitfalls within these individual contexts.

“Avoid minimizing statements like ‘at least . . .,’ which—though often meant to comfort—can invalidate a client’s pain and leave them feeling dismissed. Instead, it’s more helpful to simply acknowledge the grief and hold space.”

Clients with preexisting mental health conditions, such as depression, anxiety, PTSD, or trauma history, may experience more intense or prolonged grief. For these clients, Bracey recommends a trauma-informed, client-paced approach that incorporates their mental and emotional capacity.

“Their prior struggles don’t require a complete shift in therapeutic approach, but they do call for greater sensitivity and adaptability.”

One challenge Bracey personally highlights is working with clients who have experienced miscarriage while navigating her own pregnancy. She’s mindful not to disclose unless asked and keeps sessions client-centered to avoid causing unintentional harm.

Balancing validation with gentle encouragement is crucial as well, according to Bracey. Counselors may be tempted to foster hope too early or assume where a client “should” be in their healing. She reminds us that the “most respectful thing we can do is follow a client’s lead.”

Unfortunately, due to cultural silence and limited training, miscarriage is often under-addressed in counseling. Research has noted that that 1 in 4 pregnancies results in miscarriage, which means this issue is far from rare (Rogers et al., 2019). Counselors must be prepared to meet this grief with skill, empathy, and humility.

“None of us are perfect. We’ll make mistakes. However, if we stay client-centered and continue to learn, we can be a powerful part of their healing,” Bracey concludes.

Claudia Bracey, MS, NCC, LPC received a bachelor’s degree in psychology with a minor in Spanish from Virginia Tech and a master’s degree in rehabilitation and mental health counseling from Virginia Commonwealth University. She specializes in women’s health and perinatal counseling, and other specific women’s issues, at Therapeutic Counseling and Consulting in Richmond, VA.

Rogers, J. L., Crockett, J. E., & Suess, E. (2019). Miscarriage: An ecological examination. The Professional Counselor, 9(1), 51–66. https://doi.org/10.15241/jlr.9.1.51

Shreffler, K. M., Greil, A. L., & McQuillan, J. (2011). Pregnancy loss and distress among U.S. women. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 60(3), 342–355. https://doi.org/10.1111/j.1741-3729.2011.00647.x 

**Opinions and thoughts expressed in NBCC Visions Newsletter articles belong to the interviewees and do not necessarily reflect the opinions or practices of NBCC and Affiliates.