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

Section 14
Infertility Counseling

CEU Question 14 | CEU Test | Table of Contents
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed couple issues in the legacy phase.  These included lingering loss, patterns of protection, a changed sexual relationship and infertility as an identity.

On this track, we will discuss a therapeutic approach to legacy.  This will include latent feelings about infertility, a history of infertility, different legacies, revisiting belief systems and belated mourning.

In the legacy phase, couples rarely seek treatment because of past problems with infertility, as they are not likely to consider their current difficulties relevant to infertility.  Instead, they are likely to seek therapy for a variety of relational difficulties which may or may not be related to the couple’s past encounter with infertility.

5 Therapeutic Approaches to Legacy

#1 Latent Feelings
First, let’s discuss latent feelings about infertility.  I have found that often, couples are disturbed to find that the infertility is still affecting them, even years later.  If this is so, I tend to ask about he couple’s painful feelings related to the infertility, specifically about whether there have been special moments when these feelings are likely to occur.  Normalizing their lingering feelings of loss allows them to feel more comfortable when discussing infertility’s impact.  It may be helpful to probe each partner’s ability to communicate with the other when these painful feelings arise. 

The following four questions may be suggestive of how to explore this area: 

  1. Are there times you still think about the infertility?
  2. Do you share those moments with each other?
  3. When was the last time the two of you discussed the infertility?
  4. What worries do each of you have about sharing your feelings about the infertility?

#2 A History of Infertility
Second, as in earlier phases, when clients come to me in the legacy phase, I ask about a history of their infertility.  Couples may have endured a poor sexual relationship or conflicts in communication for years without connecting these problems to their failed attempts to get pregnant.  I use the following six questions to elicit a client’s history of infertility in the legacy phase.

  1. Was it your choice not to have children?
  2. Are you satisfied with the size of your family?
  3. Which one of you has been most disappointed with not having, or not having more, children?
  4. If infertility is the reason you have no children, or only one child, do you think it has had an impact on your relationship?  If so, how?
  5. Is there any part of the current problem that may be related to the infertility?
  6. Are there any positive changed in the relationship as a result of infertility?

#3 Different Legacies
Third, in addition to discussing the history of infertility, let’s discuss different possible legacies.  Because couples who have been unable to have children often take on a nurturing, mentoring role in their communities, I try to broach this possibility with couples who have been unable to satisfy these goals, using the following four questions: 

  1. Has the meaning and value of children changed for you because of the infertility experience?
  2. What about parenting was important to you?
  3. Have you been able to fill some of the needs in ways other than having children?
  4. When you talk about wanting to leave a lasting legacy, do you think it is worth exploring some other way of leaving your mark?

#4 Revisiting Belief Systems
Fourth, in addition to different legacies, let’s discuss revisiting belief systems with clients in the legacy phase.  As mentioned in track 1, infertility often gives rise to fatalistic world views such as "Bad things always happen to me."  In the legacy phase, these perspectives ay have become organizing principles, which can be reinforced by subsequent adversities.  I usually try to explore these world views with couples using the following seven questions.

  1. What ideas about infertility did you have as you were experiencing it?
  2. Have those changed since time has gone by?
  3. What would happen if you decided to let go of these ideas?
  4. Which of you would be most likely to let go?
  5. What would happen if you had a different idea?
  6. How might your life change?
  7. Did you have other kinds of ideas before the infertility?

Because the inability to reproduce can raise questions about one’s sexuality, potency, and attractiveness, it can be helpful to stress that although our culture conflates sexuality and fertility, the two are distinct.  Depending on the couple, you may decide that it is preferable to discuss sexual legacies in separate sessions.  I have found that this can be particularly applicable when discussing each partner’s feelings about the other. 

I use a couple of questions in either separate or joint sessions, including, "Do you see yourself as any less sexy as a woman or man because you were unable to produce a baby?  If so, where did you learn that?" and "Can you think of any advantage to figuring out how to see yourself as sexy even though you could not produce a child?"

#5 Belated Mourning
Fifth, in addition to revisiting belief systems, let’s discuss belated mourning for some couples.  Some people come from a background in which there was relative ease in talking about loss and death, whereas in other families, these subjects are taboo.  To assess whether couples have sufficiently dealt with the losses of infertility, you may want to open a discussion about the couple’s comfort with discussing and dealing with loss. 

Three questions that I use in such discussions include, "How have your families dealt with loss and expression of grief?" "How comfortable were your families in talking about death?" and "Do you think this pattern has influenced the way you handle your sad feelings?"

Exploring these issues not only reveals possible impediments to grieving, but it can also provide couples with an opportunity to mourn the losses of infertility together.  As in earlier phases, you might suggest that couples may wish to acknowledge their lost child more formally and mourn that loss.

On this track, we will discuss a therapeutic approach to legacy.  This has included latent feelings about infertility, a history of infertility, different legacies, revisiting belief systems and belated mourning.

An Introduction to Infertility Counseling: A Guide for Mental Health

- Peterson, B., Boivin, J., Norré, J., Smith, C., Thorn, P., & Wischmann, T. (2012). An introduction to infertility counseling: a guide for mental health and medical professionals. Journal of assisted reproduction and genetics, 29(3), 243–248. doi:10.1007/s10815-011-9701-y

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.

Galst, J. P. (2018). The elusive connection between stress and infertility: A research review with clinical implications. Journal of Psychotherapy Integration, 28(1), 1–13. 

Gibson, D. M. (2007). The relationship of infertility and death: Using the relational/cultural model of counseling in making meaning. The Humanistic Psychologist, 35(3), 275–289.

Online Continuing Education QUESTION 14
What are five therapeutic approaches to legacy? To select and enter your answer go to CEU Test.

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