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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
On the last track, we discussed couple issues in the mobilization phase. These included shock and disbelief, losses, communication gaps and problem solving versus expression of emotion.
On this track, we will discuss a therapeutic approach to mobilization. This will include externalizing the infertility, eliciting the story, evoking the future and curtailing the shame. As you listen, think of how you address your clients who are in the mobilization phase of infertility. How do your methods compare with those presented on this track?
Couples begin to experience significant distress during the mobilization phase, although it is not as intense as what usually occurs during the later immersion phase. Because couples are not yet submerged in the most stressful and time-consuming phase of medical treatment, therapists have a unique opportunity during mobilization to lay the groundwork for healthy patterns in the partner’s relationships with the medical system, their family and friends, and each other.
Couples in mobilization phase are more likely to come for therapy than couples in the dawning phase. The disconcerting diagnosis of infertility, decreased sexual pleasure, and the prospect of never having a genetically related baby place great stress on the relationship, and individual partners or couples may be troubled by the distressing feelings aroused by the meaning of infertility. During mobilization, marriages start to show the strain, and some couples begin to question whether they should remain married at all. This concern seems especially compelling for couples whose marriages are primarily predicated on having children together.
#1 Externalizing the Infertility
In particular, you may be able to help couples to externalize the infertility and thereby separate the infertility from their identity. One or both members of the couple may be thinking or saying, "I am, he is, she is or we are infertile." You can encourage your clients to shift this perception to "We are struggling with infertility or we are experiencing infertility." When provided with this perspective, couples are more able to hold onto the idea basic to most infertility treatment, that the infertility, not the relationship is the problem.
Even though the physical symptom resides within one partner, conceptualizing it as an external adversary helps the couple join together and regain the partnership that may have been lost. Danielle, age 35, and her husband Nat, age 40 had begun their journey through infertility with distance between them. Danielle stated, "When I thought of myself as defective, I just wanted to pull away. But when I saw infertility as our mutual enemy, we pulled together."
#2 Eliciting the Story
In hearing each partner’s story, I can begin to get an idea of when the stresses began to build, whether there was a particular procedure that precipitated the crisis, and what is unique in this couple’s reaction to the infertility experience. I can also begin to get an idea of the partners’ emotional states and the couple dynamics. For example, are they together in the process? Is only one partner worrying? Is only oneof them grieving about the miscarriages? I have found that this process helps me to join with the couple and understand their particular ordeal.
#3 Evoking the Future
It may be helpful for couples to take some time to consider the implications of their actions and to ask themselves how far they are willing to go in pursuing pregnancy. Asking these questions relatively early on may help prevent couples from rushing ahead into expensive and psychologically complex treatments and making poor choices. Questions regarding the meaning and value of children and parenting may be important to review at this time.
In addition, you might address the following two areas. First, you might address levels of intervention and second, you might address expenditures of time, money and effort. Opening up these discussions can enable couples to set some preliminary limits and to have a road map before they enter the daunting territory of the immersion phase.
Regarding levels of intervention, you might ask questions like:
Questions regarding expenditures of time, money, and effort might include:
#4 Curtailing Shame
Asking 4 Wide-Range Infertility Questions
It may be important for the client, in regard to the expectation of parenthood, to remember that his or her identity includes the expected future of him- or herself. When this future self is blocked, as in infertility or chronic illness, this affects the view of the current self. Once these destructive beliefs have been brought to light, you can help to minimize angry, painful, shameful legacies by addressing and reframing them.
2 Questions for Addressing Destructive Beliefs
On this track, we have discussed a therapeutic approach to mobilization. This has included externalizing the infertility, eliciting the story, evoking the future and curtailing the shame.
Management of the Infertile Couple: An Evidence-Based Protocol
- Kamel R. M. (2010). Management of the infertile couple: an evidence-based protocol. Reproductive biology and endocrinology : RB&E, 8, 21. doi:10.1186/1477-7827-8-21
On the next track, we will discuss couple issues in early and middle immersion phase. This will include the roller coaster of hope and despair, loss of innocence, miscarriages and secrecy and protection.
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