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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
Infertility continuing education MFT CEUs

Section 2
Infertility Perspective (Part 2)

CEU Question 2 | CEU Test | Table of Contents
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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

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

2 Beliefs about Infertility

#1 Maleness and Femaleness
First, let’s discuss common assumptions about maleness and femaleness.  Because there is a considerable body of research concerning the differences between how men and women respond and to and cope with the diagnosis and ordeal of infertility, we assume that although there may be hardwired differences between men and women, which may be difficult to alter, there are also gender-linked ideas that become a part of men’s and women’s socialization that may be more malleable. 

In order to avoid getting caught up in a debate about what is nature and what is nurture, we take the position that each perspective offers a way of understanding the differences that arise between men and women.

Have you found, as I have, that although men may appear to experience less distress, their actual distress may be closer to that of their partners’?  When content, rather than the extent of the distress is analyzed, men and women seem to have similar responses to the infertility in the areas of role failure, loss and reduced self-esteem, helplessness, guilt, inadequacy, and a focus on having a child and a willingness to go to great lengths to do so.  Over time, as men and women continue to struggle with infertility, differences between them tend to decrease.

I have found that discussion regarding gender-linked differences with couples can help them to understand each other.  I have also found that discussion can minimize conflicts that arise when one partner tries to impose his or her feelings and attitudes on the other.

Rigid Gender Stereotyping
However, I need to be careful not to make any rigid gender stereotyping.  Stereotyping can reinforce or even create barriers to a couple’s intimacy.  In addition to exploring each partner’s gender-related beliefs, I track how their beliefs were instilled and shaped over time.  Finally, I invite each to reexamine those beliefs to see whether they can be changed.

Ben and Cheryl had just learned that Cheryl would be unable to carry a pregnancy to term.  I asked, "Which one of you will feel saddest about not having the opportunity to experience a pregnancy?"  Ben stated, "I think I will…I’ve always wanted to see and feel our baby grow inside Cheryl…I’ve been fascinated with our friends’ pregnancies.  I think it’s such a miraculous process." 

Cheryl stated, "I hate to say this, even though I want a child more than anything else in the world.  If we have to have a baby without my experiencing pregnancy and childbirth, I’d feel just fine about it…I’ve always hated any kind of physical inconvenience and pain, and blood terrifies me.  I could easily do without it…Ben’s the one who’s always been excited about pregnancy and being there to see the baby born."

Toward the end of the session, Ben and Cheryl told me that asking questions not directed to one or the other partner in a gender-role played an important part in helping them to process their feelings about infertility.  These questions had an important effect on each of them and on their relationship.  Ben stated, "This allowed me to feel comfortable with my atypical attitude, and furthermore, I feel it’s helped Cheryl and I to accept the other’s ideas and feelings without assuming we were in any way abnormal."

#2 Children and Parenting
Second, let’s discuss the meaning and value to many couples regarding children and parenting.  A core set of beliefs evoked by the infertility experience concerns the meaning and value partners place on children and parenting.  Unlike most couples, who are never confronted with infertility, those who encounter infertility are likely to think carefully and deliberately about why they want to be parents and what children mean to them.  Because these ideas may change over time, it may be useful to revisit the subject of the meaning of children to the couple periodically throughout the course of treatment.

When I asked Chase, age 40, what his thoughts were regarding being a father, Chase stated, "I want to leave my mark on the future…I can’t imagine doing that without a genetically related child."  When Chase and his wife, Margo, age 38, learned that she could neither produce viable eggs, nor carry a baby to term, Chase believed he could never be a father, and became extremely depressed.

Margo, on the other hand, came from a family in which there were several relatives diagnosed with several mood disorders.  Margo stated, "My mom and my brother are chronically depressed and my family often refers to my mother and brother as their ‘morose and suicidal’ forebears.  When I was little, I loved visiting other peoples’ families and anybody else’s home was always cheerful compared to mine!" 

Margo had few reservations about adoption, and actually preferred not passing along her family’s genes, thereby placing a child at risk for depression.  However, because Chase was so depressed about not having a genetically related child, Margo had undergone several cycles of infertility treatments fearing that if she did not, Chase’s depression would worsen and become long-term like the depression in her family.

My discussions with Chase and Margo about of the value and meaning of children and parenting included beliefs in regard to genetic relationship, adoption, and life without children.  Because Chase and Margo’s chances of having a genetic relationship to a child would decline over time, we revisited the options of adoption and no children.  

11 Questions for Revisiting the Options
Here are eleven questions that I used in my sessions with Chase and Margo.  These questions are located on your reproducible client worksheet.
-- 1. "What are or were your ideas about being a mother or father?  What are your ideas about parenting together?" 
-- 2. "What do you see as the value of children?" 
-- 3. "What aspects of parenting matter most to you?" 
-- 4. "Is having a genetically related child associated with the way you see yourself as a man or woman?" 
-- 5. "What does the genetic relationship to your child mean to you?" 
-- 6. "Do you see a difference in how you might parent a genetically related child versus a child who was adopted?" 
-- 7. "How do you imagine you would see yourself if you were a parent of a child who was adopted?" 
-- 8. "What ideas do you have about adoptive families?" 
-- 9. "Have you ever considered what it would be like to choose to live a life without becoming a parent?" 
-- 10. "If you had or have only the option of adoption or a life without children, which would seem more fitting to you?"

Four Additional Questions
Once Chase and Margo had stated their beliefs, we could talk about how and when these beliefs were learned and thoughts about alternative ideas they might consider.  I asked Chase and Margo four additional questions:
-- 1. "Where do you think you learned this particular idea?" 
-- 2. "What ideas about children, parenting, adoption, and life without children did each of you bring from your families of origin?" 
-- 3. "Do you have family members or friends who have not had children or have adopted?"
-- 4. " What conclusions have you drawn from their experience?"

I asked Chase to think about whether there were other ways to "leave his mark on the future," and I asked Margo to think about whether Chase’s sadness could be viewed as anything other than a psychiatric problem.  Margo was able to distinguish between pathological depression and sadness as an expression of grief.  Margo was then able to acknowledge Chase’s feelings and comfort him.  Chase, for his part, began to see the value of passing on his life experiences and not necessarily his genetic make-up.

On this track, we have discussed two more beliefs about infertility.  These have included maleness and femaleness and children and parenting.

On the next track, we will discuss facilitating mourning.  This will include the "mourning ritual" technique, mourning and attachment, support systems and who knows what.

Peer-Reviewed Journal Article References:
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 2
What are two sets of beliefs about infertility that can be addressed with couples? To select and enter your answer go to CEU Test.

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