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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
On the last track, we discussed couple issues in the dawning phase. These included the crisis and trauma of infertility, the impact on the couple’s relationship, bringing up infertility, helpful questions and attitudes about parenting.
On this 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. On the next track, we will discuss a therapeutic approach to the mobilization phase. As you listen, think of your client. Is he or she in the mobilization phase of coping with infertility?
During mobilization, couples shift into active gear and start to investigate medical assessment and treatment. Whether they start with a gynecologist or an infertility specialist, couples may investigate several clinics or doctors in their search for competence and comfort. A lot of medical tests may be initiated.
Although the diagnostic phase may be brief if the condition can be diagnosed quickly, as you are aware, it is sometimes drawn out for years. Often, as you have experienced with your clients, idiopathic infertility, or infertility in which no problem areas are found but there are repeated failures to conceive, is very distressing to couples.
During mobilization, partners may form enduring patterns of communication with the medical system, family and friends, and each other. These patterns will affect the couple’s experience in later phases. For some, this marks the beginning of ongoing distress, both individually, as with the onset of the infertile identity, and as a couple, with communication gaps and different coping styles.
#1 Shock and Disbelief
As with the diagnosis of cancer or some other life-threatening disease, couples may balk at the truth, denying the possibility and hoping to find out that it was all a dreadful mistake. For couples experiencing secondary infertility, the shock may be particularly severe. Having already borne a child, they are completely taken by surprise at finding that they are no longer fertile.
They may also blame their physicians for not warning them about the risks of infertility. But once couples realize that the process of having a child will be different than they had expected, they are faced with the first losses of infertility. These losses may be traumatic, and you may need to be alert for the significance of these losses with your client.
Four Kinds of Loss
Loss One - Control over Sex Life & Problem-Free Conception
In addition to anxiety and uncertainty undermining the couple’s sex life, their expectation of having a problem-free conception is thwarted. Perhaps their imagined conception, a private occasion, joyously undertaken with no worries, has been lost and replaced by a lot of medical exams, office procedures and unwelcome intrusions. This may precipitate feelings of sadness for the couple, although in the face of the hope that accompanies the mobilization stage, this loss may not be acknowledged.
Loss Two - Confidence in One's Body
Loss Three - Loss of Privacy & Intimacy
Loss Four - Loss of Full Adult Status
Anita, age 30, described to me a family wedding at which she and her husband were put at a table with the teenagers. Anita stated, "We’re older than many of my cousins who have children! Until we produce a kid, I doubt they will see me as an adult…Will they be putting us at the young adult table until we’re 60!? And then what?! At the old people’s table!"
#3 Communication Gaps
Because men may communicate less distress about being childless, women often conclude that men do not share the desire for a child. Unfortunately, when men appear calm about treatment failures, women may feel rejected, unsupported or weaker than their partners. For their part, men may be confused about how best to relate to and support their partners. Men may even accept their partner’s perception of them as unfeeling or less devoted to the idea of having a child.
Because men are socialized to regard menstruation, reproduction and infertility as "women’s problems," men may find it difficult to talk about the infertility. The degree of intimacy required for adequate discussions regarding medical plans necessitates an alteration in the couple’s relationship, one that both partners may at first find difficult.
#4 Problem-Solving vs. Expression of Emotion
The other partner may prefer a slower process, with ample time and opportunity to express him- or herself. Action-oriented partners may think that talking about feelings and expressing sadness is a waste of time an, indeed, may feel worse when they talk about their pain. On a practical level, this may become problematic if the action-oriented partner rushes into a precipitous decision that has long-term effects, not only for the other partner, but for the couple and any possible offspring as well. On an emotional level, the different coping styles can lead to feelings of isolation and disconnection between the partners.
Do you have a client like Anita? Might he or she benefit from hearing this track?
On this track, we have discussed couple issues in the mobilization phase. These have included shock and disbelief, losses, communication gaps and problem solving versus expression of emotion.
On the next 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.
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