The sense of extreme isolation in females can be a distressing time, during which they experience high levels of negative emotion and often feel unsupported and not understood. Here, counseling can be of great benefit, and a long-term counseling relationship may be of benefit throughout their journey, as and when they feel they need support. In addition, there are points which can be particularly difficult for females, where counseling can help. These include: the time around treatment e.g. immediately prior to, during and following, regardless of outcome; at critical points such as a miscarriage, anniversaries of due dates of lost pregnancies; when friends/family fall pregnant; and on being told treatment is not a viable option with their own eggs.
Following treatment, and regardless of whether they become mothers or not, females can experience a 'delayed' reaction in which they may be confronted with a host of issues that have been unresolved due to being on the 'treatment treadmill'. Counseling can play an important role in terms of minimizing or preventing this reaction, which may also have a negative affect on the bonding process with a child or children.
As mentioned above, many males do not necessarily have a desire or need to discuss their feelings with anyone, let alone a 'counselor', and may run in the opposite direction if it is suggested, particularly in cases of male-factor infertility. However, this reaction is not as straightforward as it appears. Many males who do access counseling will reflect that if they had known 'what counseling was' they would probably have gone for it sooner, particularly in cases of malefactor infertility. They also expressed their concerns about confidentiality -- that their partner might 'find out' how they really felt. This can act as a deterrent. Yet many males say they do feel the need to talk, in private, to someone outside of their relationship about the trauma of the experience but that they did not necessarily know how to find a counselor or what to expect when they got there. The good news is that BACP has made positive moves on this and I am getting more referrals from males via the BACP website.
Males who do access counseling, in addition to talking about their feelings, tend to want to gain some kind of understanding about infertility and its impact. This includes a desire to understand the medical diagnosis and procedures and what the female experiences emotionally and physically, so that they know how to help their partner. Males also have a desire for their partner to understand what they may be experiencing emotionally and psychologically so that they are not perceived as 'not caring' and 'being fine', when often they are not, despite outward appearances.
Couples can benefit from counseling at each stage of the infertility journey, chiefly through the facilitation of communication and understanding between them. In addition, couples can use counseling to help them deal with a number of specific issues as they arise -- such as decision-making around treatment options, miscarriages, failed cycles and when they achieve a pregnancy, for instance.
Limitations of counseling
Given the distressing nature of infertility, it is not surprising that many individuals and couples express a desire to receive psychological support. Yet what is perhaps surprising is that less than 25 percent tend to access it. There are the feelings of failure (females) and inadequacy (males) which contribute to the low uptake. But part of the explanation is that, unlike medical intervention, counseling cannot provide a 'solution' to the problem of infertility and so it is often not considered or offered. Furthermore, counseling often tends to focus on realistic goals and objectives, which clients do not always find useful, and some can find this counter productive -- for example 'Stephanie', who wrote an account of her experience of infertility and counseling in this journal last year. She found her long-term, male therapist helpful during the early stage of her journey. However, a few months into her treatment, she reflected that she was not getting her needs met - she needed 'an energy that would push her forward'. The focus was on how things would be if she did not become a mother, which was not what she wanted. At the time of treatment, couples feel a need to be optimistic and strong to cope with the rigorous demands of it. They are also likely to be full of hope for the outcome of the treatment cycle and their future. They may not wish to discuss the more bleak and painful options at this stage. Counselors working with this client group need to be aware of this and be able to work with clients in a way they find beneficial.
- Perkins, Jo; The psychological impact of infertility; Therapy Today; Oct 2006: Vol. 17; Issue 8
Reflection Exercise #4
The preceding section contained information
about counseling infertile clients. Write three
case study examples regarding how you might use the content of this section in
Online Continuing Education QUESTION
What emotion is commonly expressed by females and by males regarding their infertility? Record the letter of the correct answer the .