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Infertility: Interventions for Shame, Mourning, and Feelings of Inferiority
On this track, we will discuss a therapeutic approach to early and middle immersion. This will include separate sessions, using metaphors, tracking losses and the "mourning a miscarriage" technique.
With the diagnosis of infertility and the increased involvement with the medical system, couples tend to experience heightened stress and anxiety and subsequently are most likely to come into therapy. Couples often fail to realize how profoundly their distress is affecting the marital relationship until the situation feels dire. The shifting extremes of hope and despair have a cumulative emotional effect on each partner and put great stress on the couple’s relationship. Couples eventually may become concerned that the marriage will no longer be able to tolerate the tribulations.
Sid, age 34, and Alicia, age 32, had been arguing for months before they came to see me. Sid stated, "Had we not been so focused on getting pregnant, we probably would have noticed the toll on our relationship much sooner." Alicia stated, "We started to question whether we could stay together, if we ever got to be parents. Then we knew we had let things go on for much too long."
In view of the powerful effects of infertility, I chose to delay any assessments of functioning or personality with Sid and Alicia. By the second or third session, Sid and Alicia were calmer and less distressed, and then I could assess them more accurately.
#1 Separate Sessions
Embedded in the sadness, there may be feelings of grief, anxiety, and anger. Feelings of defect, whether about the self or the partner, a sense of being less womanly, less manly, or less sexy, and fantasies of ending the relationship or having a baby with another person are common. Often, these ideas are so overwhelming that the partners may not feel they can discuss these feelings with the other.
I have found that one issue that frequently arises in separate sessions with men is that they feel as though they are not entitled to an equal voice in decision-making about infertility treatments. They feel they can support their partner’s ending treatment, but that they cannot ask her to continue with treatment because her body is the site of most procedures. As an offshoot of this thinking, men also may feel that they cannot discuss their feelings of helplessness with their partners.
In order to bring his voice into the couple sessions, I first try to normalize the man’s feelings by stating that such feelings are common in these situations, and then open up the possibility regarding him discussing his sense of powerlessness with his partner. The idea is not so much for the man to gain equal voice as it is for him to acknowledge his feelings.
'Future Questions' Intervention
#2 Using Metaphors
Here is how I used metaphors with Sid and Alicia
When Sid was diagnosed as being infertile, his wife, Alicia wanted to have a child using donor inseminations. In an individual session, I asked Alicia, "How included or excluded will Sid feel about having a child with donor sperm?" Alicia replied, "Sid feels excluded from everything. He uses this imagery that he’s a lone wolf on the tundra."
In a separate session with Sid, he talked to me about this lone wolf metaphor. I asked if he might be able to change the metaphor of the lone wolf to a more inclusive one. In a later session, Sid stated, "I want to be more active, more like a guardian protector role, so I thought about being an English sheepdog whose role is to guard the sheep." Would the use of metaphors be beneficial to a client you are current treating?
#3 Tracking Losses
Three Questions for Tracking Losses
Technique: Mourning a Miscarriage
Four Questions for Preparing for a Mourning Ritual
Sid and Alicia chose to plant three pine trees in their yard to commemorate their three miscarriages.
On this track, we have discussed a therapeutic approach to early and middle immersion. This has included separate sessions, using metaphors, tracking losses and the "mourning a miscarriage" technique.
On the next track, we will discuss late immersion phase, the donor decision. This will include genetic loss, egg donation as an "affair," sperm donation as "rape" and feeling like an impostor.
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