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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
On the last track, we discussed two more beliefs about infertility. These included maleness and femaleness as related to passing on a genetic legacy and mourning versus pathological depression.
How does your client cope with loss as a result of infertility? How do you respond to your client?
On this track, we will discuss facilitating mourning. This will include the "mourning ritual" technique, mourning and attachment as well as support systems. As you listen, compare your techniques you are currently using with those presented on this track.
As you are aware, loss is the motif of the couple’s encounter with infertility, and the kinds of losses are both tangible, such as failed medical protocols, miscarriages, still births. . .etc.. and intangible, such as experiencing a trouble-free pregnancy, having a genetically related child, as well as the anticipatory loss of not knowing whether they will ever have children.
Try to keep in mind that although loss is a fundamental aspect of the human condition, not merely a central experience of infertility, we are living in a culture that has difficulty dealing with issues of loss and mourning. Not only couples, but clinicians as well may have difficulty talking about grieving and loss.
By attending to the motif of loss, I try to help the couple identify and address their losses. At times, this may mean probing for the implicit or implied loss. When couples talk about, for example, not qualifying for or experiencing failure in regard to a treatment protocol, questions arise not only regarding loss but the nature of the loss often need to be asked.
3 Questions about Perceived Losses
I have found that partners’ ability to comfort each other about their losses improves over time. At first, many couples are awkward about expressing sadness in front of and/or receiving comfort from the other. This is especially true when infertility produces the first serious losses the couple has yet encountered.
This can be approached in a variety of ways. For example, each partner might be asked what he or she feels would be most comforting. For some, it may mean exploring beliefs associated with the expression of sadness, for example, assumptions about masculinity and not showing emotion. For others, a ritual may be an appropriate form of mourning
Technique: Mourning Ritual
In my experience, I have found that a couple is more likely to feel that creating a ritual sounds "too hokey" if I haven’t spent enough time in helping the couple to articulate their loss. If treated with importance and seriousness, the rationale for a mourning ritual makes emotional sense. Some couples arrive at inventive ways of mourning together without actually realizing they have created a mourning ritual.
Edward, age 35 and Shelley, age 34 had a "Bed and Chocolate Ritual." When Shelley got her period after an insemination, both of them came home from work and cuddled in bed with chocolate and a video. This ritual helped Edward and Shelley to get through another failed attempt.
I have found that some couples prefer to mark their losses with an in-session ritual, especially if I have understood their sadness and not shied away from their pain. In these instances, I am allowed by the couple to be a respectful mourner who amplifies the seriousness of the ritual.
Other couples prefer to perform their mourning ritual alone, although a discussion about how it will be executed may take place in the session. In these instances, the discussion of the ritual can activate or intensify the process of mourning. A later track will detail the mourning ritual one couple had developed of planting a pine tree for each miscarriage.
As Carol, age 43, put it, "I feel a profound sense of loss that we are not actually, physically, going to be able to make love and make a baby and that we’re not going to have this creature that our blood commingled in, our DNA commingled in. You know, I feel like somehow life cheated me out of something that I really, really wanted."
While this loss was one of many to mourn, the creation of and participation in mourning rituals can help partners to construct different kinds of attachments with each other. These empathetic bonds can have special significance and utility. Although they may not replace the unique union of parenthood, an intimate connection brought about through shared mourning can be vital in helping couples get through the anguish and sorrow of infertility. When this opportunity is missed, the effects on the couple’s relationship may be devastating.
Alice and Carl, both aged 48, had experienced long years of what they called a "nonmarried kind of marriage." They connected their gradual disaffection not only to their infertility, but to the fact that Alice mourned alone, at the time the infertility was diagnosed, after each treatment failure, and at various times throughout the years when feelings related to her losses were triggered.
Each time Alice pulled away from Carl to keep her mourning private, she stepped further and further away from her marriage. Carl was aware of her sadness and suspected that it stemmed from the infertility. However, Carl took Alice’s increasing distance as a signal that she did not want him to comfort her. Because Carl felt responsible for having urged Alice to end medical interventions, he was afraid that if he tried to step across Alice’s invisible wall to comfort her, she might use the occasion as an opportunity to reproach him.
Although some families or individual family members can be enormously supportive, many are likely to have limited understanding of the couple’s plight. Moreover, spending time with other families who have children can be extremely painful. Furthermore, if one partner finds solace in time spent with family and the other cannot tolerate family gatherings, conflicts may arise.
To address the issues of family and friends, I have worked with couples to find strategies for developing workable relationships during their struggle with infertility. These vary from couple to couple. Some may look at the kinds of boundaries that existed before the infertility and even evaluate whether these are still comfortable or whether a recalibration of private versus social life makes more sense now.
Other couples may want to alert family members to their "temporary crisis." Have you found, as I have, that relationships with significant family members are often reconfigured as a result of infertility? Would playing this track be beneficial during a future session?
On this track, we discussed facilitating mourning. This has included the "mourning ritual" technique, mourning and attachment and support systems.
On the next track, we will discuss couple issues in the dawning phase. This will include the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting.
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