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

Section 6
Track #6 - How to Externalize Infertility & Curtail Shame

CEU Question 6 | CEU Answer Booklet | Table of Contents
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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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.

4 Parts of the Mobilization Phase

Share on Facebook #1 Externalizing the Infertility
First, let’s discuss externalizing the infertility.  If infertility is the first major crisis in the partners’ life together, they may soon discover their relationship’s weakest and strongest elements.  When undiscovered or underutilized assets seem overshadowed by problematic interpersonal dynamics, you can play a role in helping the partners locate and utilize their strengths while highlighting the particular stressors that are a part of coping with 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.”

Share on Facebook #2 Eliciting the Story
Second, let’s discuss eliciting the couple’s infertility story.  Hearing the couple’s story pays tribute to and validates the couple’s struggle.  Thus, telling the story can be a healing ritual in and of itself.  It may be helpful to begin with an open-ended invitation such as, “Tell me your story,” or “What have you been through?”  As with asking about someone’s surgery or experience of childbirth, people are usually eager to recount their experience with infertility.  Couples may begin tentatively, but as they recognize that you are familiar with the medical information they may begin to speak more freely.

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.

Share on Facebook #3 Evoking the Future
Third, in addition to externalizing the infertility and eliciting the couple’s infertility story, let’s discuss evoking the future.  Couples in mobilization tend to be action-oriented and optimistic.  Danielle had been so optimistic in planning for the success of her and her husband, she gave little thought to what would happen if they didn’t work.  Danielle stated, “I moved my office to my house so I could be home with the baby and the pregnancy and the whole thing.  And suddenly I was left with no prospect for a baby…sitting there, alone with my job in this big house!”

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:
-- 1. “What level of invasiveness are you willing to tolerate, and does your partner agree?” 
-- 2. “What reservations do each of you have, and how do you deal with these differences?”

Questions regarding expenditures of time, money, and effort might include:
-- 1. “Which of you feels more strongly about having children?  How long are you willing to keep trying?” 
-- 2. “Who is more worried about putting your savings at risk?” 
-- 3. “If you find infertility and its treatments very distressing, how much do you think you can tolerate?” 
-- 4. “Which of you would be the first to think about ending medical treatment?”

Share on Facebook #4 Curtailing Shame
Fourth, in addition to evoking the future, let’s discuss curtailing shame.  I can engage a couple in discussing ways of curtailing shame by reframing the meaning of infertility.  In this early intervention the clinician can sometimes limit the negative impact of infertility on each partner and the couple.  In order to explore these potentially important themes, you may find that you need to ask the couple for their thoughts on a wide range of infertility-related subjects. 

Asking 4 Wide-Range Infertility Questions
You might ask questions such as:
-- 1. “What different beliefs do you have regarding the carrier versus the non-carrier of infertility?” 
-- 2. “Which one of you feels more affected in your sense of being a woman or a man?” 
-- 3. “Who holds the stronger belief that one cannot be an adult without being a parent?” 
-- 4. “Which one of you feels more deprived when among family and friends?”

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
You might ask:
-- 1. “Would you see yourself differently if you saw infertility as bad luck instead of a sign that you are defective?” 
-- 2. “How would that different view affect the way you function in your marriage and in the world?”

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.

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.

Online Continuing Education QUESTION 6
What are four parts to a therapeutic approach to mobilization? To select and enter your answer go to CEU Answer Booklet.

 
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