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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
On the last track, we discussed facilitating mourning. This included the "mourning ritual" technique, mourning and attachment and support systems.
Do you have a client who may be in the dawning or beginning phase of dealing with infertility?
On this track, we will discuss the dawning or beginning phase. This will include the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting. As you listen, think of your client. What behaviors does he or she display that may be characteristic of the dawning phase?
The dawning phase of infertility is characterized by a gradual awareness that there seems to be some difficulty achieving pregnancy.
#1 The Crisis and Trauma of Infertility
But after a few months of trying with no results, one of the partners may realize that it is not going as he or she expected. Couples may rationalize why it might be taking so long to conceive, concluding, for example, that their attempts did not coincide with ovulation. Some may turn to books and start charting their temperatures or begin using over-the-counter ovulation detection kits.
#2 Impact on the Couple’s Relationship
Differences between partners can quickly emerge over whether there is any reason to be concerned about getting pregnant. People may also get upset with the ways in which their partners are handling their anxiety. A partner with a more optimistic disposition, for example, may remain relatively untroubled until infertility has been confirmed, while his or her partner may be very worried.
When the anxiety of one partner is not shared by the other, the dynamic balance between worry and reassurance can tip. Polarizations may escalate as the worrier’s alarm leads the optimistic partner to reassure him or her so much that the worrier becomes apprehensive. Unintentionally, the comforter encourages the worrier to worry more, and the worrier induces the comforter to reassure still more forcefully.
#3 Bringing Up Infertility
By initiating these difficult discussions, the therapist helps the partners to clarify their positions and attitudes regarding childbearing, the relationship, sexuality, identity, and treatment discussions. I have found that when I raise the possibility of infertility with a couple, I sometimes need to guard against infusing the discussion with an urgency that the couple may not feel.
Have you found, as I have, that the introduction of a topic like children and infertility may produce repercussions within the couple, and between the couple and you? Clients may react angrily and question your right to intrude. Clearly, timing is key. I have found that there are situations in which I may discover that exploration of topics like infertility may not only put undue burden on the couple’s relationship, but may even prove to be counter-therapeutic. For example, if couples are in extreme distress or are unable to resolve major differences, it might be premature to raise the larger issues of children and fertility.
#4 Helpful Questions
Questions Regarding a Life without Children
#5 Attitudes about Parenting
Two questions that might help in broaching this subject include the following:
Examining ideas about reasons for wanting children can be useful in helping couples understand not only what they feel about having children, but why they feel as they do. In such an exploration, alternatives can emerge. For example, if parenting represents a way of giving meaning to one’s existence, what other ways might there be to achieve that goal?
Perhaps the desire for a child is driven by legacies of the family of origin such as a death and the fantasy of a replacement child, or current issues in the family such as wanting to bring forth a child for a dying relative. In such cases, would resolution of the family problem free the individual or couple to find another way of parenting. Clarifying such issues may help the couple to avoid some of the driven quality of the immersion phase of infertility and also pave the way for more open communication between them when the going gets tough.
On this track, we have discussed couple issues in the dawning phase. This has included the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting.
On the next track, we will discuss couple issues in the mobilization phase. These will include shock and disbelief, losses, communication gaps and problem solving versus expression of emotion.
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