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

Section 4
Trauma of Infertility

CEU Question 4 | CEU Test | Table of Contents
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed facilitating mourning. This included the "mourning ritual" technique, mourning and attachment and support systems.

Do you have a client who may be in the dawning or beginning phase of dealing with infertility? 

On this track, we will discuss the dawning or beginning 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.  As you listen, think of your client.  What behaviors does he or she display that may be characteristic of the dawning phase?

The dawning phase of infertility is characterized by a gradual awareness that there seems to be some difficulty achieving pregnancy. 

The Dawning Phase - 5 Parts

#1 The Crisis and Trauma of Infertility
First, let’s discuss the crisis and trauma of infertility.  Many couples fully expect to be able to get pregnant once they make the decision to do so.  Dawning or beginning awareness emerges slowly, accompanied by a moderate concern.  If they have no history of infertility or medical problems, and if the couple is under 40, they may presume that conception will occur with no difficulty. 

But after a few months of trying with no results, one of the partners may realize that it is not going as he or she expected.  Couples may rationalize why it might be taking so long to conceive, concluding, for example, that their attempts did not coincide with ovulation.  Some may turn to books and start charting their temperatures or begin using over-the-counter ovulation detection kits.

#2 Impact on the Couple’s Relationship
Second, let’s discuss the impact on the couple’s relationship.  Have you found, as I have, that partners often cycle through the various stages of the infertility experience at different times?  When the partners are out of synch, it can lead to tension and conflict in the relationship.  Other areas of conflict include differing styles of coping and gender differences.

Differences between partners can quickly emerge over whether there is any reason to be concerned about getting pregnant.  People may also get upset with the ways in which their partners are handling their anxiety.  A partner with a more optimistic disposition, for example, may remain relatively untroubled until infertility has been confirmed, while his or her partner may be very worried. 

When the anxiety of one partner is not shared by the other, the dynamic balance between worry and reassurance can tip.  Polarizations may escalate as the worrier’s alarm leads the optimistic partner to reassure him or her so much that the worrier becomes apprehensive.  Unintentionally, the comforter encourages the worrier to worry more, and the worrier induces the comforter to reassure still more forcefully.

#3 Bringing Up Infertility
Third, in addition to the crisis and trauma of infertility and the impact on the couple’s relationship, let’s discuss bringing up the subject of infertility.  When is it appropriate for to broach the subject of infertility with a client in a session?  You may want to ask for the client’s permission to discuss infertility, saying, for example, "Do you think you might want children some time in the future?" since couples often benefit from talking about topics they may have avoided. 

By initiating these difficult discussions, the therapist helps the partners to clarify their positions and attitudes regarding childbearing, the relationship, sexuality, identity, and treatment discussions.  I have found that when I raise the possibility of infertility with a couple, I sometimes need to guard against infusing the discussion with an urgency that the couple may not feel.

Have you found, as I have, that the introduction of a topic like children and infertility may produce repercussions within the couple, and between the couple and you?  Clients may react angrily and question your right to intrude.  Clearly, timing is key.  I have found that there are situations in which I may discover that exploration of topics like infertility may not only put undue burden on the couple’s relationship, but may even prove to be counter-therapeutic.  For example, if couples are in extreme distress or are unable to resolve major differences, it might be premature to raise the larger issues of children and fertility.

#4 Helpful Questions
Fourth, in addition bringing up infertility, let’s discuss helpful questions.  The following list of questions may help to initiate discussions between partners regarding children and infertility, topics that may have been ignored or avoided by the couple. 
-- "Have the two of you thought about if and when you want to have children?" 
-- "Have you always assumed that having children was not a matter of choice?" 
-- "As you are both interested in having children, when are you planning to get pregnant?" 
-- "Are either of you concerned about the possibility of infertility?" 
-- "Do either of you have any special medical conditions that cause you to worry about infertility?" 
-- "What do you know about how a woman’s age related to infertility?" 
-- "Have you discussed any of this with your gynecologist?  What has he or she said?" 
-- "Would you prefer to work out all your relational difficulties before having children, even if it puts your fertility at risk?  Or, would you rather risk having difficulties in your relationship, but have children?"

Questions Regarding a Life without Children
Some questions to ask regarding a life without children might include some of the following: 
-- "If you chose not to have children, how do you imagine it will affect your relationships with your family and friends?" 
-- "Which one of you might have the harder time not having children?" 
-- "If there are differences between you about these matters, how do you think you will resolve them?"

#5 Attitudes about Parenting
Fifth, in addition to helpful questions, let’s discuss attitudes about parenting.  It may also be useful to find out which attitudes toward parenting the partners have adopted from their particular families of origin and which from society, and whether they believe that being a parent confers a special, perhaps adult status, and that adulthood is defined by parenthood. 

Two questions that might help in broaching this subject include the following: 
-- 1. "Are there unresolved issues related to your family of origin, legacies from your own childhood that affect your wish to have children?" 
-- 2. "Is having a child a means of attaining status in your families and in society?"

Examining ideas about reasons for wanting children can be useful in helping couples understand not only what they feel about having children, but why they feel as they do.  In such an exploration, alternatives can emerge.  For example, if parenting represents a way of giving meaning to one’s existence, what other ways might there be to achieve that goal? 

Perhaps the desire for a child is driven by legacies of the family of origin such as a death and the fantasy of a replacement child, or current issues in the family such as wanting to bring forth a child for a dying relative.  In such cases, would resolution of the family problem free the individual or couple to find another way of parenting.  Clarifying such issues may help the couple to avoid some of the driven quality of the immersion phase of infertility and also pave the way for more open communication between them when the going gets tough.

On this track, we have discussed couple issues in the dawning phase.  This has included the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting.

On the next track, we will discuss couple issues in the mobilization phase.  These will include shock and disbelief, losses, communication gaps and problem solving versus expression of emotion.

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.

Jaffe, J. (2017). Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective. Psychotherapy, 54(4), 380–385. 

Quinn, G., Bleck, J., & Stern, M. (2020). A review of the psychosocial, ethical, and legal considerations for discussing fertility preservation with adolescent and young adult cancer patients. Clinical Practice in Pediatric Psychology, 8(1), 86–96.

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 4
What are five elements of the dawning phase? To select and enter your answer go to CEU Test.

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