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Archive for the ‘Infertility Counseling’ Category

Frequently I get phone calls about whether a group or individual counseling would be appropriate.  And when is it time to get the support for infertility issues?

The sooner the better…as soon as you realize infertility might be an issue call around and get some support.  Unfortunately many of the clinics around do not mention how emotional and isolating infertility can be for a couple.  Usually they have resources if you ask for them, but most couples in the beginning don’t realize they need support.  What I typically see is the couple or individual who come to me after months and even years of battling infertility by themselves.  I realize treatments are expensive, but counseling should be considered as part of the package and journey.  Most of my clients wished they had gotten support sooner and feel not alone once they do get the support. Ironically, or not, most usually get pregnant within a few months of joining a group or getting individual counseling.

Group or individual?  I think this depends on you and the couple.  I think it is important for the couple to be seen either in a group or individually right away.  It is a couple’s issue not just the woman’s problem…unless you are of course doing this alone, which many women are these days.  Some people are uncomfortable in a group setting and need time to warm up to the idea of just sharing their story with a stranger. Or maybe they just have experienced a traumatic miscarriage and need individual time to process those feelings before entering a group setting. Those people should start with a therapist first.  The group experience is very powerful and healing. It offers something individual work cannot.  Try both is what I suggest, when appropriate.  Most groups are only a 4-6 session commitment and individual work is done on a per session basis.  Whatever you do definitely get support because infertility can be a lonely journey and it doesn’t have to be.

My group is Fridays in Oakland at 6:30 biweekly.  Half of the group just got pregnant on the same cycle!  So now we have some newcomers and I look forward to their good news in the next few months as well. That is how it works.  80% of the group gets pregnant eventually!

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What to expect from infertility counseling from me, whether it is in a group , individual, or through couples counseling.

Individuals and couples with infertility often contemplate whether to seek counseling.  Some approach this decision with ease, but many others have questions about what is involved in a counseling relationship. In today’s blog, I will offer an inside view on the beliefs that have guided my counseling experiences with my infertile clients.

In my own experience, my first contact with a client usually is in a telephone conversation. On the telephone I try to learn how the prospective client (almost always a woman) defines the problem(s) she wants to work on; what her partner’s feelings are about being involved in counseling; whether she or her partner has ever been involved in counseling before; at what stage of diagnosis/treatment they are; and where they are currently getting medical intervention. I then offer a bit of information about myself, including possible appointment times that I have available; fees and insurance coverage information; and my office location. I also ask whether she has any questions that she would like to ask me before we meet. Then we set a date and time for the appointment or when the next support group is that is appropriate for her to join. Not all clients are ready for a support group and not all groups are appropriate for everyone.  Some groups have a specific focus and others are more open format.

So here are some things that are typical of my first meeting with my new clients. It is not unusual for the person with whom I have spoken on the telephone to take the lead in introducing me to her partner and in saying something along the lines of “I think I’m going crazy!” or “I don’t know how much more stress I can take.” And my response to that introduction is usually to point to my nearby box of tissues and to say that being upset comes with the territory of infertility. I also try to work in something about the courage it takes to begin a relationship with a counselor, since getting help will involve talking about difficult issues.

I ask both of them if they are comfortable with my taking notes as we speak, since I want to be sure to remember accurately how they portray their situations. And then I say that in my experience, each of them may have their own unique “take” on their infertility, so I will be encouraging both of them to clarify for me the dimensions of this experience that are important to them. This also opens the door for them to see each other’s perspective and to learn how important it may be to keep both perspectives on the table. It is here that I say to the partner of the telephone caller how much I appreciate his/her coming to this meeting, and how much I believe that person’s presence can help all of us to move forward in working on the issues connected with their infertility.

With those introductory remarks, I remind all of us that we have work to do, that our session will end in “X” minutes (I meet with clients for 50 minute sessions), and I encourage them to tell me how they hope I can be of help. I am careful to have both members of the couple speak about their own perspectives and to summarize my impressions of what seem to be the most pressing issues. I am interested in knowing how the couple has already tried to address their challenges and what successes and difficulties they have encountered. That will more than fill up the first session, and probably will spill over into subsequent sessions as well. Before ending, I ask the couple how they are feeling about the time we spent together today, whether they would like to return and, if so, whether this is a good time for regular future appointments, and whether I can look forward to having both of them at subsequent sessions. I tell them that after a few sessions I should be able to give them some idea of how many meetings we may need in order to address their concerns, and I express my appreciation for their openness in sharing with me today the challenges they are facing. I ask if they have any questions for me, which I try to answer as succinctly as I can.

I do not think of myself as a therapist who lets my clients entirely drive the counseling process. I tend to be fairly interactive in offering feedback to clients on their skills and resources. I am respectful of the social work edict “Start where the client is and stay with him/her.” To me this means that I should be respectful of where my clients want to focus, but it doesn’t prevent me from testing whether they are ready to be pushed to new places. If they have had an infertility intervention for months that isn’t working, I am likely to push them to ask their physician to make a plan with them that includes how long to continue with one intervention before moving on to a different one. If they have spent many dollars and many years on infertility treatment, I may revisit an earlier statement that they won’t consider adoption or a surrogate, by asking if they would consider collecting information about either of their previously rejected options. If I see areas of difficulty on which they have not asked for my help, I may make an observation that such-and-such an issue seems to be an “elephant in the room,” and I am wondering whether there is a reason they haven’t felt ready to examine it. So, even as I try to stay apace with my clients’ issues, I also push and prod a bit, just to see whether new growth and resilience enables them to feel resilient enough to consider new directions. If not, I step back, and I am not surprised when, weeks later, they may raise the question of the proverbial elephant for future examination.

So, for those of you who are contemplating seeking counseling for any of your infertility issues, I hope that my own disclosures about the way I think of the counseling experience will help you in your own interactions with a therapist. Keep in mind that not everyone shares my perspective that client partners are the first choice when providing counseling, nor that the families of the couple may be the “elephants in the room,” nor that the therapist takes as active a role as I do, nor that assertive behavior with health care providers is a place for therapeutic intervention. But all therapists should be able to be clear with you about areas in which they can offer new knowledge and skills, how they observe confidentiality, and their comfort with the ever-so-present issues of loss and mis-communication.

Source: Connie Shapiro, PhD

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