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

Manual of Articles Sections 15 - 28
Section 15
Tell Me Your Story

CEU Question 15 | CEU Test | Table of Contents
Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

The Relational Model and its Applications in Treatment
Much of the existing research indicates that women often react to infertility by telling their stories to others, including telling their partners how they feel (Keystone & Kaffko, 1992; Williams et al., 1992). This sharing  infertility Infertility psychology continuing education of their stories through relationships with others seems to be a major resource for coping (Keystone & Kaffko, 1992; Williams et al., 1992). The Relational Model of development (Jordan, 1995) provides a useful context for understanding how and why women cope in this manner and thus can be used to facilitate women's adjustment to infertility.

Relational Model of Development
Jordan (1995) and other researchers at the Stone Center at Wellesley College have created a new model of women's development based on a relational perspective of human experience. Specifically, this model states that "women grow and/or develop in, through and toward relationship" (Jordan, 1995, p. 52). Through experiencing life as arising from a context of relationships, women are provided with a sense of connection to others (Miller, 1988). Therefore, women discover a sense of value and effectiveness in themselves (Miller, 1988). Miller (1986,1988) proposed that women-once they feel that initial sense of connection with others-will feel an increased sense of energy, have a more accurate view of themselves and others, feel empowered to act outside of their relationships because they are active within them, feel a greater sense of worth, and desire more connection. These relationships or "sense of connection" with others are the key to women's psychological well-being (Jordan, 1995). Relationships are "growth fostering," enhancing the psychological development of all individuals involved in mutual interactions (Miller, 1988; Miller & Stiver, 1997).

The Relational Model differs from other developmental theories that focus on the "growth fostering" of only one person in an interaction or on the nature and impact of psychological separations from others (Miller, 1988). In the context of the relational development perspective, the goal of development is for the person to build and increase their involvement in relationships, such that all individuals involved in the interactions will benefit (Miller, 1988). These relationships require both empathy and mutuality to be beneficial (Jordan, 1995; Miller, 1988; Miller & Stiver, 1997). In other words, empathy and mutuality in relationships are necessary for growth.

Empathy is a familiar concept of many counseling theories, especially in the counselor-client relationship. However, the creators of the Relational Model emphasize the use of empathy in a different manner. Empathy is modeled for clients through an examination of their relationships with others. The counselor models empathy for the client and learns self-empathy. An appreciation of ongoing interdependence of human beings is modeled in counseling and contradicts previous counseling theories that emphasize independence and self-reliance (Jordan, 1991). Furthermore, a process of mutual change and impact in the counselor and the client characterizes this treatment process. This mutual intersubjectivity means that all individuals in the counseling relationship risk something of themselves in the process and are changed and affected by each other. Therefore, they grow in and appreciate the strengths of relationships.

Empathy is a complex, cognitive-affective process of understanding and can potentially lead to a better understanding of self, others, and relationships (Jordan, 1997). Jordan (1997) believed that empathy "relies on an ability to tolerate the tension of opening to another's experience" (p. 344). In empathizing with others, one has to be able to perceive another's affective state, psychologically identify or join with that affective state, and gain some understanding about that person's constructed reality (Jordan, 1997). Empathy is the process of moving away from the self-centeredness of being for oneself to an understanding of the growth of self and others and an awareness of relationships with others (Jordan, 1997). In counseling, empathy has usually been regarded in terms of the counselor's empathy and its impact on the client (Jordan, 1995). In relational counseling, empathy decreases and eliminates the client's sense of isolation because the client is being responded to in her attempts to relate (Jordan, 1997). This experience of being responded to will increase the client's sense of connectedness and her own sense of being able to relate; therefore, the client will develop empathy for others and self-empathy in the therapeutic relationship. Eventually, one's self-esteem increases and the client is able to accurately request the need to be understood by others and the need to better understand others (Jordan, 1997). This leads to the client searching for relationships that offer the potential for their needs to be met, which are relationships that incorporate mutual empathy or mutuality.

Mutuality or mutual empathy, can be thought of as an extension of empathy. Mutuality is reciprocal empathy where one is empathizing and is also receiving empathy (Jordan, 1997). This can happen between two or more people at the same time. In general, the individuals involved are open to this happening, are emotionally available to others, and require emotional understanding in relationships (Jordan, 1995). When this empathy is mutual and is happening within the relationship, the process affirms the self, helps the self develop, and creates a "sense of self as part of a larger relational unit" (Jordan, 1995, p. 57).

Mutuality is also a part of the relational perspective for therapeutic relationships. In the therapeutic relationship, mutuality is represented by accurate mutual empathy, mutual responsiveness, and mutual respect for one another (Jordan, 1997). Mutuality conveys to the clients that the therapeutic relationship is one that will promote their psychological well-being and encourages the clients to explore the potential of valuing others as they are exploring and learning to value themselves. Attaining mutuality within the therapeutic relationship means that the counselor adheres to appropriate roles and boundaries, and it promotes the counselor's flexibility in appropriately relating personal experience and being open to being emotionally affected by the client's experience (Jordan, 1995). Relating to a client with a presence of control, power, and emotional detachment will impede this exploration process (Jordan, 1997).
- Gibson, Donna M., Myers, Jane E.; Gender and Infertility: A Relational Approach to Counseling Women: Journal of Counseling & Development: Fall 2000; Vol. 78, Issue 4

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 225 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about the Relational Model of Development. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Casu, G., Zaia, V., Fernandes Martins, M. d. C., Parente Barbosa, C., & Gremigni, P. (2019). A dyadic mediation study on social support, coping, and stress among couples starting fertility treatment. Journal of Family Psychology, 33(3), 315–326. 

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.

Tate, D. P., Patterson, C. J., & Levy, A. J. (2019). Predictors of parenting intentions among childless lesbian, gay, and heterosexual adults. Journal of Family Psychology, 33(2), 194–202.

Online Continuing Education QUESTION 15
What are the two traits that are necessary for growth in the Relational Model? Record the letter of the correct answer the CEU Test.

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