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Infertility - Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education addiction counselor CEUs

Section 1
Infertility Perspective (Part 1)

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Psychologist CE, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On this track, we will discuss belief systems about infertility.  This will include uncovering beliefs about infertility and fertility and locating the origins of these beliefs.

The "Plow" that Thrusts Itself
Infertility, the "plow" that thrusts itself through the couple’s psychological field, unearths many cognitive constructions, world views, assumptions, premises, narratives, attributions, and explanations that are related to various aspects of infertility.  These can collectively be called a couple’s "beliefs."

The couples’ beliefs that become a part of the experience of infertility are not necessarily conscious or easily articulated, yet are often assumed to be "truths," simply the way things are.  They may include very basic notions such as "Children and marriage go together," "Fertility and masculinity are the same," "Women who cannot bear children are not real women," "Men who carry the infertility factor are not real men," or "Adopted children are always a problem." 

Idiosyncratic beliefs might include such constructs as infertility proves "I’m different," "I’m undeserving," "I’m less manly or womanly than others," or that "Nothing ever comes easy for me and my family," or "Infertility is a sign that our union is flawed."

3 Steps to Approaching Infertility
My approach regarding helping couples deal with problematic and conflicting beliefs about infertility has three steps: 
-- 1. The first step is to help couples articulate their positions. 
-- 2. Secondly, I work with each partner to find when, where and how each view was learned and assimilated. 
-- 3. The focus can then shift toward the exploration of alternatives, that is, other ways that the couple can understand their experience of infertility. 

Within this expanded discussion, the couple’s universe of assumptions can widen and thereby yield a wider range of feelings, choices and actions.  I have found that there are basically three subdivisions of beliefs that tend to dominate the landscape of infertility.  Infertility itself, assumptions about maleness and femaleness and the meaning and value of children and parenting. 

On this track, we will discuss the first belief, concerning infertility itself.

2 Parts of Discussing Fertility

#1 Uncovering Beliefs about Fertility and Infertility
First, let’s discuss uncovering beliefs about fertility and infertility.  Fertility and infertility are likely to summon up associations about the masculinity and femininity of oneself and one’s partner.  Like other traumatic stressors in life, infertility taps into existential beliefs and world views.  Fertility tends to be viewed as confirmation of worth, the reward for a virtuous life, and the marker of normality.  Infertility, by contrast, is often linked with an opposite set of values, such as less manliness or womanliness, confirmation of abnormality or worthlessness, and punishment for past wrongs. 

Themes of retribution for past misconduct, evidence of intrinsic inferiority, lack of entitlement, cause for shame, and the curse of perpetual bad luck are often linked with infertility.  Clients often come to me saying such things as, "These kinds of things always happen to me," "Why me?  I don’t deserve this!"  Conversely, "Why not me?  I always fail, nothing in life ever comes easily for me," "Life sucks," "The world is unsafe," "I can’t do anything right!" and so forth.

In order to locate these beliefs, I tend to begin by asking a couple open-ended questions like "What does the diagnosis of infertility mean to you?"  Some couples can immediately list a number of assumptions that have plagued them since the infertility was first diagnosed.  Other couples, however, may feel embarrassed or ashamed of their seemingly absurd notions and may worry that the clinician will think their beliefs are "outdated," "stereotypical," or "irrational." 

Acknowledging this fear while asking more focused questions can be a more successful approach.  For example, I tend to preface the exploration of beliefs by saying, "Infertility is likely to stir up what may seem like totally fantastic, irrational thoughts and ideas.  It’s not uncommon for people facing infertility to have these thoughts.  Do these kinds of ideas occur to each of you?"

#2 Locating the Origins of These Beliefs
Second, let’s discuss locating the origins of beliefs about infertility.  Once the couple feels comfortable talking about their beliefs, I can then ask questions about how the etiology of these beliefs, or questions about how, when and why they think these beliefs were generated.  "Where do you think you learned that?" can be a useful question. 

These questions about deprivation allow people to step back from their experience of infertility and appreciate the cultural, familiar, and personal sources of their beliefs.  In so doing, couples may have sufficient distance to question the absoluteness of their assumptions, to critique them, and to entertain the possibility of changing them.

Seven Questions about Deprivation
Questions might include some of the following: 
-- 1. "Where do you think you learned this?" 
-- 2. "What are your ideas about how you came to think this?" 
-- 3. "Have thoughts like these surfaced at other stressful times in your life?  Or is there something special about infertility that evokes them?" 
-- 4. "What kinds of messages does society give us about fertility and infertility?" 
-- 5. "What ideas about infertility have you learned in your family?  Are there any stories about family members who have experienced infertility?" 
-- 6. "Is there some personal meaning that you attach to infertility?" 
-- 7. "How do you think being a man or woman affects the way you are looking at this?"

Such exploration can uncover problematic themes connected to the past.  When asked about what past or current experiences might be affecting the way in which they view the infertility and the choices they have made, some individuals can immediately locate the sources.

I asked Molly, age 36, about what had been most distressing to her about her infertility.  Molly stated, "I was born with a physical defect that was corrected with surgery…but I could never seem to reassure my parents or myself, for that matter, that I was as physically normal or sturdy as my siblings.  I felt if I could conceive and give birth to a child, I could finally prove that my body is normal.  That’s why I thought adoption, my husband’s first choice, was out of the question.  I prefer donor insemination, because that might give me the opportunity to demonstrate my physical normality."

Do you have a colleague who might benefit from hearing this track? 

On this track, we have discussed belief systems about infertility.  This has included uncovering beliefs about infertility and fertility and locating the origins of these beliefs.

On the next track, we will discuss two more beliefs about infertility.  These will include maleness and femaleness and children and parenting.

Peer-Reviewed Journal Article References:
Barbaro, N., Shackelford, T. K., Holub, A. M., Jeffery, A. J., Lopes, G. S., & Zeigler-Hill, V. (2019). Life history correlates of human (Homo sapiens) ejaculate quality. Journal of Comparative Psychology, 133(3), 294–300.

Casu, G., Zaia, V., Fernandes Martins, M. d. C., Parente Barbosa, C., & Gremigni, P. (2019). A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment. Journal of Family Psychology, 33(3), 315–326. 

Chazan, L., & Kushnir, T. (2019). Losses and gains of psychosocial resources: Effects on stress among women undergoing infertility treatments and participating in social network systems. Psychiatric Quarterly, 90(4), 717–732.

Darwiche, J., Favez, N., Maillard, F., Germond, M., Guex, P., Despland, J.-N., & de Roten, Y. (2013). Couples’ resolution of an infertility diagnosis before undergoing in vitro fertilization. Swiss Journal of Psychology, 72(2), 91–102. 

Flykt, M., Lindblom, J., Punamäki, R.-L., Poikkeus, P., Repokari, L., Unkila-Kallio, L., Vilska, S., Sinkkonen, J., Tiitinen, A., Almqvist, F., & Tulppala, M. (2011). Prenatal expectations in transition to parenthood: Former infertility and family dynamic considerations. Couple and Family Psychology: Research and Practice, 1(S), 31–44.

Jaffe, J. (2017). Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective. Psychotherapy, 54(4), 380–385. 

Online Continuing Education QUESTION 1
What are two steps to helping a couple deal with problematic and conflicting beliefs regarding infertility? To select and enter your answer go to CEU Test.

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