This was a very special interview for me to conduct. Valorie Thomas my therapist as I went through infertility treatments, and someone that I give credit to for helping me eventually get pregnant. I wouldn’t have gotten through those years without her guidance and support.  In this interview, she says that one of the things someone should look when seeking help, is a therapist who can offer hope. She absolutely did this for me and I am forever grateful.
 
How did you first become interested in fertility counseling? 

My personal experience led to my interest in infertility counseling. This unexpected roller coaster ride led me to have a deep level of compassion and understanding for all those who travel the journey to creating a family. Being a therapist, I suppose was both a blessing and curse as I put unrealistic expectations on myself to be able to handle things better that the average person due to my training. When I became pregnant, I did my "therapist thing" like relaxation, meditation and focusing on creating healthy balance. I found out later, through formal training, that those things were actually all of the skills that contribute to riding the roller coaster smoothly. I discovered that everything I had been through had a purpose- my journey lead me to the other side of being able to be there for other people in a different way. It's almost as if everything I had been through was this journey to get me to the other side of being able to be there for other people in a different way. At that point I sought some additional training to hone in on that piece and found out the things that I was doing were the things that had been helpful to other people. I felt this challenge, so to speak, to help other people and to help them to understand that they're not by themselves, they're not alone, that there's help out there. Just to offer them hope.
 
Do you have a typical treatment process with your clients?
Every couple's experience is unique. People seek help at different places in their journey, so I focus on tailoring my approach to their specific needs. We begin by exploring what brought them to therapy "at this particular time".  I want to hear their journey. I listen to what it's been like for each of them and how this has impacted their relationship. I help them identify and express their feeling to each other, to "listen" to each other's experiences. We validate the fact that the feeling of loss they may be experiencing is REAL and they don't need to apologize for feeling the way that they do. I find that taking time to explore their journey, the couple is able to hear each other a little differently, sometimes for the first time. 

I also like to visit family of origin and understand a little bit about the families they come from, encouraging each of them to be able to listen to those stories, and some of the messages they've received about family and creating a family. Once I feel like the couple is moving together and I understand backgrounds and they come to understand each other, I ask what they hope to accomplish by coming in. Usually people come to the realization that they’re tired, they don't know which way to go and they just want to feel better. From there, I establish goals with them and look at increasing coping skills and start to introduce mind-body techniques that they can start working on and practice in between sessions. Although, I often begin with the couple, I work with the woman for most sessions after the intake, focusing on mind-body techniques and coping strategies. I see the couple together for some subsequent sessions as needed.

How would you describe your therapeutic approach?

It’s eclectic. I'm a systems therapist so I'm always looking at the system. When treating infertility, the couple is affected, the relationship is affected, as well as each of them individually, so I'm paying attention to the individual and the couple system at the same time. 

I am solution-focused, so I'm looking at identifying their strengths, using those strengths to be able to mobilize them to move forward and helping them make decisions and draw on the strengths of the couple, whether it be humor, creativity, planning, etc. I also draw on cognitive behavioral therapy. We take a look at some of their thought processes and irrational beliefs. Messages that they've received that maybe they don't believe in anymore but find that they're trying to hold themselves to a certain expectation. Maybe we need to revisit that message and say, "Is that something you embrace? What is that all about?" 
             
I also rely on narrative therapy. I think at some point it's looking at rewriting their story. They had an idea that it was going to be a certain way and maybe it's different now. How can we rewrite this in a more life-giving way? Again, depending on the issues, some of these approaches will be more appropriate than others. 

I also draw on symbolic experiential approaches to create rituals to be able to grieve, even grieve a missed opportunity and help them understand that it was real and that they were grieving their future, and that's why it's so painful.

Most importantly, I utilize a Mind/Body approach to treating infertility. Techniques such as relaxation, deep breathing, yoga, mind fullness, guided imagery and progressive muscle relaxation.

What do you find yourself saying to most clients? 

"You're on a journey to create a family." I want them to know it's an amazing journey and every journey is unique. "If you want a family you will create it. It may not be the way that you envisioned it, but you will create it."  I tell them to focus on taking the best care of themselves and their partner and that it will evolve and when it does all the pieces are going to fall into place and you'll know it was the perfect plan for your family. 
             
"Your pain is real, it's okay to grieve." I think couples need the validation that this is very difficult. That this is very painful and that they have the right to feel the way that they do. They're right to be angry and have these conflicted feelings and all these things that they're going through. I often say to them, "You're feeling a normal response to the stress of struggling to create your family and be kind to yourself. This is normal." 
             
"It's okay to feel different and cope differently than your partner." I'd say most couples are not on the same page and it's normal. I find normalizing the fact that they're NOT in the same place is a big stress off of them. I find that letting them know that it's okay to feel however they feel even though it's conflicted takes a weight off.
Are there any common issues that you find most clients face?
Loss is a big issue. Loss of self, loss through miscarriage or a failed attempt. Every time a pregnancy fails or a treatment fails they're grieving their future. So much of it is dealing with a loss that you have. Even loss of how you see yourself as a couple. Of how you see yourself when you're going through this. 
             
The other issue that comes up is when to take a break or whether to stop infertility treatment. Breaks are hard for a lot of people but sometimes couples are looking for "permission" or validation that it is OK to get off of the roller coaster for a while. Taking a planned break can serve to revitalize and renew their energy and rejuvenate their soul! Deciding to stop treatment altogether and move forward to consider other ways to create a family is also an issue that many couples face.

Do you give any guidance or recommendations regarding medical treatments? 

We can't really recommend medical treatment but I do encourage couples working with a physician to ask hard questions. I coach them in terms of communication about clarifying their thoughts about treatment and maybe formulating specific questions. I help couples clarify and narrow down what it is they want to say and how they want to ask it to the physician. Because you get in there and you forget what you were going to ask.

Is there anything you recommend people do between sessions?

Yes, I recommend a variety of different coping skills. It could be practicing effective communication between the couple, just asking them to expand what it is that we've done in a session.  It could also be helping them communicate to family members in a way that they're setting some boundaries. They might leave here and say, "Now I know what to do about that baby shower." In between sessions they're going to practice or go out and set some boundaries with family that they need to, that they want to, but have felt not very empowered to do because they feel like they don't have a right to do it. Some self-nurturing techniques. Journaling. I also tell couples, “this week you need to go out and have fun.” Plan a date. Limit infertility talk to a certain amount of time during the day. I ask them to focus on what they're enjoying and do more of those things. This is hard but you have other things, believe it or not. Even though you're occupied a hundred percent of the time it's not your whole life. It's a part of your life, it's impacting you, but there are other things that you can enjoy. 

What is your goal in your work with your clients?

Couples come in expressing they're feeling "out of control" and "stuck" most of the time. They're out of control, they feel like they just don't know what's going on. My goal is to put them back "in control" and to help them become "unstuck." They are in control of their treatment. They are in control of how they're going to create a family. I BELIEVE in them and offer HOPE. They WILL write their unique story.
             
What do you consider as a success story?

Each couple defines success. Maybe success for them is determining if they even want to begin an infertility treatment. Maybe it's wading through the ups and downs of the treatment. Maybe they've closed the door to having a biological child and they're ready to take a look at other options. They define what success is by what it is that they do here and how they get there and accomplish their goals. Success isn't always a take home baby. They really define what success is. It's different for every couple.

What advice can you offer somebody looking to seek therapy while going through treatments?

Reach out, you're not alone. Find someone you can connect with, someone that understands the process and can support you. Someone you feel is offering you HOPE.
Therapy is just a tool. You're going to use that tool in order to get where you want to get. I think looking for someone who validates your experience. Someone who can work with you where you're at, whatever pace you are going, and really meet you where you are at right then. I also think it's important the person have some additional training or expertise in infertility counseling.

Why do you think there's so much shame and secrecy surrounding infertility and miscarriage?
 
Several reasons come to mind. We live in a society that emphasizes success. No one wants to fail. Our body has failed us, and this does not feel good. We may begin to wonder if somehow we are responsible. If we did something or failed to do something that contributed to our infertility/pregnancy loss. It is just a natural feeling to question yourself even your relationship during these painful times.

Also creating a family is for the most part a biological urge that you have and it's also something that you may just grow up assuming will happen when you decide you are ready. You are supposed to be able to do this, right? It is the “ultimate experience of womanhood” we are told. Society expects it to some extent! When it doesn’t happen we are thrown off course and may begin to question our future. Things are not going as planned. This is something we may not want to talk about. It is very personal, after all creating a family is part of our identity and how we see ourselves as a woman.
​
The challenges of infertility may also provide an opportunity to revisit religious beliefs and messages from our family of origin that may get us “stuck”. We don't want people to think we have failed or that maybe, "Gosh, maybe I don't want to have a family, but my family has given me the message that that's when you become a success …when you have a baby…but I’m not sure I believe that now. How might they react if I decide not to create a family, or if we decide to do another round of invitro, or if we decide to adopt”.
It’s time to revisit these messages and clarify your thoughts as individuals and a couple.  

Maria T. Rothenburger, Ph.D., L.P.C. is the owner of and psychotherapist for Miracles Happen Fertility Center. Her skills and areas of expertise include therapy for those struggling to build families. Dr. Rothenburger is also a regular contributor to the podcast, “Beat Infertility,” where she shares her wisdom on the psychological aspects of infertility. If you struggle with infertility and read this interview, I think you will find someone who truly “gets it.” And her thoughts and advice are definitely worth remembering.
 
To contact Dr. Rothenburger, see the services she offers, and to read her blog, please visit: www.drmariarothenburger.com
 
How did you become interested in fertility counseling?
 
When I was dealing with infertility, I was hard pressed to find a therapist who really “got” me.  I would often hear those nails-on-a-chalkboard statements like, “Have you considered adoption?”  Or “How about relaxing? Have you tried that?”  One counselor literally said, “Man, I just look at my wife and she gets pregnant.”  It was one hundred percent disheartening and even more debilitating when I could not find a safe space to get some support.  After I came out of the darkness, I simply knew I had to use my knowledge and credentials to help others through this major life crisis.
 
How has your own experience with infertility affected your work with your clients?
 
I think it first has helped me with people in general.  I think I’m just a better human.  I will never ask anybody about their plans for the future (like asking newlyweds when the baby’s coming, or asking new partners when the wedding is).  I focus solely on the present and celebrate the joys that come from being Here and Now. With clients specifically, this is the first time I am “out” about any of my struggles.  I think it’s important for fertility clients to know that their therapist truly gets them.  I don’t share the minutiae of my experience, but clients know that I get them -- from the newly diagnosed to the infertility veterans -- just because they know I struggled, too.  It may also have something to do with knowing the infertility language.  Like, “Hey, were you able to BD on CD15 after your +OPK last week?  How was your EWCM, and was DH less cranky this time?”  Ha!  I don’t actually speak like that, but people appreciate that they don’t have to explain all of these things to me.
 
Do you have a typical treatment process with your patients?
 
Yes.  1) Do an intake.  2) Be where they are.  
 
There’s certainly more detail that goes into treatment, but everyone is so individual, I like to tailor treatment to that particular person.  I am what’s called a client-centered therapist, so I really practice empathy and unconditional positive regard.  I don’t care if someone fantasizes about throwing daggers at a pregnant woman, I’m there to offer empathy and positive regard.  
I also do fertility coaching, which is rather different from therapy.  I like to say it’s therapy’s best counterpart.  It’s for people who are already doing pretty okay through the process and just want to be the best they can in order to create the ultimate environment for a baby.  The coaching process is not treatment; rather it’s a way to fine-tune goals and be an accountability partner.  I find fertility clients in particular really like coaching, because they like to be in control and appreciate having goals to accomplish. Succinctly said, therapy focuses on healing from the emotional impact of infertility.  Coaching focuses on growing from the emotional impact of infertility.
 
How would you describe your therapeutic approach?
 
See above.  There’s a poem by the famous Sufi poet, Jalaluddin Rumi, that goes like this:
“Out beyond ideas of wrongdoing and rightdoing there is a field. I’ll meet you there.”
That’s me.
 
What do you find yourself saying to most clients?

“Give yourself a friggin’ break!”  I find fertility people to be super conscientious, bright, capable, and highly sensitive.  They do not want to step on toes, they do not want to harm relationships, they want to take care of everyone, and they will sacrifice their own happiness for that of others.  It’s why they make wonderful parents.  AND it’s why the struggle to conceive becomes so hard.  Have you ever heard the analogy of putting on your own oxygen mask in an airplane before helping others?  When struggling with fertility, it is imperative one heed that advice.  I often talk about practicing Radical Self-Compassion, and it is the number one thing by far I talk about with my clients.  
 
What do you consider a success story?
 
Someone who has left my office feeling more capable of peaceful moments than when they first came in.  And honestly, I’ve seen the most clients end up being parents who have found some element of peace in their life.  One need not banish stress or anxiety or even depression; one need only find ways to ameliorate those issues.  It’s the chronic negative emotions that hurt us the most, so when you’re able to find peace in some aspect of life (I don’t care if it’s something as small as how minty your breath is after using that new toothpaste), I consider it a success.  Add in a series of small successes and, voila!  Changed person.  Growth accomplished.
 
Do you give any guidance or recommendations regarding medical treatment?
 
Let’s face it, all of us IFers believe we should be honorary Reproductive Endocrinologists.  We know a lot of sh*t.  And once in awhile I will chat with clients about exploring medical options, but I leave the true discussion and medical planning to the people who are far more qualified than I on such decisions.  Whether it’s Western medicine, Eastern medicine, naturopathy, chiropractic, nutrition, or nothing at all, I leave it to other professionals to help my clients decipher a medical plan.  I help with the emotional issues around that plan.
 
Are there any common issues you see that most patients face?
 
The inability to let go.  I’ve just submitted a book proposal on this topic and hope to publish it soon.  People think that letting go is the same as giving up.  I struggled with this, too!  I could go on about this topic, but I’ll leave you with one analogy.  People think that being strong is being like an oak tree.  But a strong hurricane blows through, and that oak tree is likely to snap in two.  I encourage people to be more like a bamboo tree.  Its strength lies in its ability to let go, lay down as the hurricane blows through, and slowly creep back up once the hurricane passes.  The bamboo never gives up; it just moves with the wind.
 
Do you typically see couples? Or individuals?
 
I most often see individual women struggling with fertility issues.  I love seeing couples, though, too, because one partner often feels more isolated and more emotionally challenged than the other.  There are often interrelational issues due to the stress of infertility, so even if I am seeing an individual, I offer an occasional session with their partner if I find that it’s one of my client’s stressors.  
 
Any resources you'd recommend?

Holy cow, I don’t have enough room to list them all!  Here are top three: I have a blog (www.thinkfertilitycounseling.com)  that is chock full of stuff to read about from dealing with the emotional impact of infertility to transitioning to alternative options like ART (Assisted Reproductive Technology) or adoption.  I also get to be part of a lovely podcast called Beat Infertility (www.beatinfertility.co), which is packed with info on all kinds of infertility-related things from pros and laypeople alike.  Lastly, RESOLVE (www.resolve.org) is one of my favorite go-to resources, and they organize a Walk of Hope now every year in several locations across the states. Also, Brene Brown’s Ted Talk on Vulnerability is amazing!
 
What advice can you offer to someone looking to seek therapy while going through Infertility?
 
Probably one of the biggest issues I find with people coming to see me is that they’ve waited until they are absolutely broken before coming in.  They have the “I’ve got this” attitude, which is typically 100% fine.  The trouble comes when you practice “I’ve got this” when there’s a serious life crisis happening, and there’s nothing in place to relieve the intense despair and darkness.  If you are going through infertility, I recommend finding someone before you completely break down.  You will be taking care of yourself, you will receive some support, and you will walk away feeling more in control than had you tried to power through yourself.  
One super important note: Please practice vulnerability.  Therapy is one venue where you can be a crying, snotty mess, and you will not be judged.  Vulnerability is the way through grief and healing with a therapist - use it well.  
 
Why do you think there is often secrecy and shame surrounding Infertility and miscarriage?
 
Dang, this is a fantastic and rich question.  I could write an entire essay on it.  For now, I’ll keep it simple. As I’ve said previously, I feel like there’s this supposed prescription for life (you know: Find partner, get married, buy house, have 2.4 kids and a yellow lab), and I generally find IFers to be super conscientious and able to fly through many of these life accomplishments.  Many are professional people who love their work and have higher degrees and such.  So when infertility hits, and the same follow-the-rules prescription doesn’t work, we lose our minds.  There’s a great deal of shame in being able to do all of these amazing things with our lives, yet something as natural and “normal” as conception and carrying a baby to term is not our normal. Making matters worse, people don’t know how to talk about it.  IFers don’t know how to say, “I’m struggling, this isn’t working, I need help but I don’t know what.”  And non-IFers don’t know how to say, “This is really shitty.  I have no idea what to say right now, but I’m glad you told me.”  Instead the conversation looks like this: “I got my period today.” “Oh that’s too bad. You know, my best friend’s uncle’s girlfriend’s dog’s ex-owner knew this guy at a pawn shop whose daughter adopted then got pregnant with TWINS! Isn’t that amazing?!”   So, we walk around with our masks on.  We pretend we aren’t dying inside.  We continue to help others instead of ourselves, and we grow more bitter, more ashamed, and more secretive.  It’s 100% unnecessary.  Thankfully there are organizations and individuals out there who are willing to shed some light and education all over this bad boy we call infertility.  Crossing my fingers people get to talking with each other in a way that honors all.  
 
Anything you recommend someone should look for in a counselor?
 
Find someone who specializes.  Go to resolve.org and find a therapist in your area.  I am licensed in two states (soon to be three: NJ, OR, WA) and am able to do online counseling.  It’s fantastic and uber convenient!  So, even if you don’t find someone near you, there is a possibility that one will be open to doing online counseling, if that is appropriate or of interest to you.
Do NOT be afraid to fire your therapist!  I totally mean it.  If it is not a good fit, then find someone else (it took three tries myself).  I am personally never offended when someone finds I am not a good fit for them, but even if your therapist may be offended, it’s okay.  That’s their stuff, and it’s nothing you have to worry about.  Practice the Radical Self-Compassion I wrote about before, and get thee to someone who fits your needs. Stat!  
 
What are some things you recommend clients do or practice in between sessions?
 
If you know IFers, you know that we tend to be go-getters who can tackle any large project like a lion chasing a gazelle.  What I ask people to do on the daily, is to take a step back and consider tiny fertility habits.  Ask yourself, what is one tiny thing I can do today to feed my spirit, mind, and emotional wellness?  Maybe that is going for a walk, watching a trashy TV show, or reading a good book.  Perhaps it’s not doing something, like the dishes.  Wait, that’s me.  Regardless, ask yourself what you want that day and do it.  Why is that a fertility habit?  Because, every time you are “on,” every time you are doing something you have to do, every moment you try to control the universe, your body is in fight-or-flight mode, which effectively turns off your reproductive system.  What I’m asking you to do instead is be the lazy lion sitting in the shade of a giant tree on a vast African plain.  If all you can manage is 5 minutes, that’s all you can manage.  It’s called a tiny fertility habit, after all.  
 
What is your goal in your work with your clients?
 
The logistics vary depending on the type of service I’m providing, but overall here are my goals for clients:
When you look in the mirror, you recognize yourself again.  The pain and overwhelm of infertility has left you; being in the world doesn’t feel so dreadful and seeing baby stores or pregnant women is no longer like a stab to your fragile heart.  You can serenely walk by kids and pregnant bellies, and even gently smile.  If you feel envious, you know exactly what to do with it.  Your energy, vitality, and spark are all back.  The darkness is behind you, and you are able to recognize that the mindset of infertility is transformed; and you are transformed because of it.
You’re not fooled into thinking pregnancy or becoming a parent will transform your infertility mindset.  Infertility is a trauma; and you have learned that it is entirely possible to heal and even grow from your experience.  You are wiser, more flexible, and more capable than you’ve ever been.  Congratulations.
“
Even when you’re in the gutter, you have the option of looking up at the stars.”
-Dr. Wayne Dyer
​

Mandy Persaud is a licensed marriage and family therapist practicing in Orlando, Florida. In addition to working with individuals and families in private practice, Mandy has more than 15 years of experience in leadership development and organizational culture and has provided international leadership consultation and training for healthcare entities in the U.S., Hong Kong, Malaysia, and the Caribbean. Of particular focus for Mandy is infertility and assisted conceptions. She and her husband have personally traveled the road of infertility, including endometriosis, diminished ovarian reserve, and multiple failed IVFs, and had their first child via egg donation. This personal experience, coupled with her clinical expertise, makes her both a skilled and empathetic therapist for individuals and couples who are facing the challenges of building a family.
 
You can read more about Mandy and find her contact information here:
https://thebraveonestherapy.com/
 
How did you first become interested in infertility counseling?
 
Personal experience. I was going through my own journey and realized there weren't a lot of resources locally. Going through my own treatment, I was required by my RE to see a therapist. They said, "Here's a list of therapists. Choose off here." Being a therapist myself, I was looking forward to sitting down with someone who had an understanding of what my husband and I were going through and could help us discuss the delicate and very important decisions we were having to navigate together. I knew that was important. But I quickly realized there was a gap in resources in the area.  Grief and loss and coping skills are a huge part of infertility and infertility treatment, but there is just so much more. It’s crucial that the clinician understands that there are unique challenges to becoming a parent via “natural pregnancy” vs. IVF vs. becoming a parent via egg donation or sperm donation. They also need to be aware that the various paths to parenthood and all of the medical interventions present unique challenges to the couple.  
 
How has your own experience with infertility affected your work with your clients?
 
I think having gone through it helps me understand what clients need as they go through their own process. I don’t want them to have to waste time educating me on what they’re dealing with. I find it very important that I stay up-to-date on the nuances of different infertility diagnoses and how that relates to medical interventions and choices my clients have to make, and I stay up to date on best practices specific to infertility counseling. Once a client enters the world of infertility treatments, they are overloaded with information – test results, medical interventions, financial decisions (infertility is rarely covered by insurance in our state) – I want my clients to be able to trust that I am tracking with them on their unique situation so that we can use our time together to get to the heart of the matter – how all of this impacts their sense of self and their relationship. And helping them to find hope and joy in the journey and ultimately own their unique story.
 
Do you have a typical treatment process with your clients?
 
I start by getting an understanding of my client’s journey to date and help them to develop treatment goals. From there we move towards their goals through in-session exercises as well as some homework in between sessions. All of this is done in a very warm, casual, conversational way.
 
How would you describe your therapeutic approach?
 
Shame resilience theory guides the work that I do. It was developed by researcher and author Dr. Brene Brown in 2006. I am also certified in The Daring Way work, which is a highly experiential methodology based on the research of Dr. Brene Brown. In addition to working through the nuances specific to the challenges of infertility and infertility treatment, I work with clients in recognizing and accepting the vulnerability that is inherent in learning that something so fundamental to life is outside of their control. I also help them to embrace their journey and connect with others who are experiencing similar challenges. Infertility is experienced by 1 in 8 couples. That’s important for clients to understand. While it can feel like a very lonely journey, they are definitely not alone. And that is a critical piece of the healing process.
 
Do you have any guidance or recommendations regarding medical treatments?
 
I don't give any kind of guidance as far as what direction to go in because that really needs to be a conversation between the physician and the patient. What I will do is encourage clients to ask as many questions as they can. I see one of my roles as empowering them to have a voice in the process because it can feel like it gets out of their hands very quickly and that they are at the mercy of the “medical machine”. A lot of the work that I do is helping them to identify what questions and concerns they have, how to research their options so they can make informed decisions, and how to bring those questions to their physician.
 
Are there any common issues that you see most clients face?
 
A very common issue is the difference in a relationship, between the one who is going through treatment versus the one who isn't. The partner not being treated may feel the desire to support but not know how to do so and that can lead them to feeling frustrated or wanting to disengage emotionally. And then the partner going through treatments often feels at “fault” or misunderstood, or as if they’re taking things too seriously, or that they're having to constantly explain themselves. I work with couples to help them to share how they are experiencing this life event individually and help them to gain understanding of the other’s perspective so they can better work as a team towards their shared goal.
 
 
What advice can you offer someone looking to seek therapy while going through infertility?
 
I think first and foremost, with any therapy, they have to connect with the therapist that they’re with. All of the training or certifications or where the therapist went to school can be meaningless if the client is not feeling that connection. Research shows that the therapist-client connection is the biggest piece that impacts change. If they don't feel like they have that connection they shouldn’t be afraid to seek out another therapist. We're all trained to not take that personally and hopefully we all explain that in the very first session. People need to know that it’s ok to say, "Is there somebody else I can work with?” or, “I'm going look around because I'm just not feeling it." It doesn't even have to be a rational reason. If they're not connecting, they're not connecting. Secondly, I would just want to know about the therapist’s experience with infertility. They don't need to have gone through it personally to be a good therapist, but what they do need to be is to be up on the field. It’s constantly evolving.

Any resources you recommend?
 
There’s RESOLVE, which has a lot of information. I also tend to point clients towards groups that are online and forums. Mothering.com has a good, rich forum they can go into and it can be private. There are a lot of Facebook groups that are private too. I think that connecting with other people going through their specific experience is really important.
 
Why do think there's often secrecy and shame surrounding infertility and miscarriage?
 
I think because it's a biological process that we expect will just happen. When people find themselves in a position where they can't get pregnant or they can’t keep a pregnancy and they’re doing everything right, I think it really hits at the heart of a lot of peoples’ sense of self and purpose in life. So much of our purpose in life is tied around building our family. When that becomes an issue and they don't hear anybody else talking about it, it just gets drilled deeper and deeper down. That's why awareness is so important, because when people start speaking about what it is that they're going through, the shame can't handle that light.
 
What is your goal in your work with your clients?
 
My goal, first and foremost, is their goal. To support them on their journey. That's really what they come to me looking for. It's so all-encompassing and that's really when people are calling me. They usually have spent a fair amount of time trying to handle it on their own and then they get to that place where it's seeping into all areas of their life. I want to help them to move through the process. Help them learn coping skills. How to take care of themselves. How to still have fun and enjoy life while they're going through this because that's such an important piece that gets lost. We laugh a lot less. We're not as silly and playful. When those pieces are missing it compounds the problem.
 
Anything you recommend they do between sessions?
 
Gratitude journaling. The research behind it is so solid in helping us to have resilience for any kind of challenges that we're going through. It really rewires our brain. It helps us to scan our environment to see what's going right rather than to scan our environment to what's going wrong. That's one of the first things that I have every client do- buy a special journal, something that they enjoy writing in. They don't have to write long sentences or paragraphs or anything deep. They just have to keep track of what they were grateful for every single day. Because it helps, again, with building resilience in any challenge but especially in infertility.
 
What is your favorite thing about working with your clients?
 
I think it's the relief that I see. That they express verbally but that I can even see physically change throughout the session. Coming in they have their body language, the heaviness, the sadness. To see them as they walk out lighter and ready to reengage with life. To me the sessions are a sort of refueling, so that they can go back out into the world and do what they need to do. Because they have life to live. They've got jobs. Sometimes they have kids that they're raising at the same time while they're going through treatments to have a second child and clients need to have that sense of a place that's just for them. And when they leave they have that sense of relief, and then we do it all again the next session.

​What do you consider a success story?
 
I think it's when they've reached their goal. That goal being parenthood for the vast majority. I think that's really it. However they come to that place. A lot of clients have to explore a lot of different options before they get there. And then, once they are able to achieve pregnancy, or begin the adoption process, or make the decision for surrogacy or however it is they choose to add to their family - they start feeling secure enough to disengage from therapy. Eventually they start to believe it's actually going to happen. They've moved past all the fears of what's going to take place. That hope has been restored and a sense of peace and normalcy has been restored.

Sharon N. Covington, LCSW-C is a Board Certified Diplomat in Clinical Social Work, with over 40 years' experience as an adult psychotherapist and over 40 years working in reproductive medicine, providing highly specialized infertility counseling services. In addition to her private practice, Mrs. Covington is the Director of Psychological Support Services at Shady Grove Fertility, helping start the largest fertility practice in the country almost 25 years ago. Please read more about Mrs. Covington and her internationally-recognized work at the links below:
http://www.covingtontherapy.com/
http://covingtonandhafkin.com/
https://www.shadygrovefertility.com/

How did you become interested in fertility counseling?

I was a therapist doing individual, couple, and group adult psychotherapy, and like many people who end up being drawn to this field, I had my own experience with reproductive loss. I had two early premature births and lost both babies. One at 20 weeks, one at 22 weeks. I also had a miscarriage between the birth of my oldest daughter and my middle child, my son. And then his was a very high risk pregnancy. He was born premature, but he's absolutely fine today, a father himself.
 
When I went through those kinds of losses, there were no support groups. There were no resources. This was close to 40 years ago. There wasn't really anything about it, and as a therapist, I was experiencing these profound feelings and emotions. The grief was very different than other grief I had experienced in my life. I was searching out what I could find and I ended up starting a support group in the Washington area called M.I.S. (Miscarriage, Infant death and Stillbirth). As a result of that, I went around speaking to hospitals, and different organizations about pregnancy loss and the kinds of interventions that really needed to take place. It was out of the passion of my own experience that I did that.
 
Subsequently, I ended up meeting a doctor who had heard me talk, an OB/GYN. He said, “I do lot of infertility work and I really think that the emotional piece gets kind of forgotten in all this. Would you be interested in moving your psychotherapy practice into my OB/GYN office?” I did that, and then we slowly started an infertility practice and what has evolved into our practice Shady Grove Fertility. It started with one other doctor and myself, and now it's a practice of 40 physicians. I have 8 psychologists and social workers that work for me. We have probably 800 employees in the practice, so it's grown dramatically. It came from the pathos of my personal experience, and the passion of the work evolved from there. It certainly is a vocation in some way. I feel very passionate about the work, and while I would never want to repeat that experience, it's brought me into doing work that I absolutely love, and I certainly believe and hope that I've been able to help others as a result of that.
 
Do you have a typical treatment process with your patients? 
 
I do have an assessment process. First, I want to hear what's bringing them in. What's going on in their life. Sometimes it might just be a one-time appointment-they're in a crisis, or they need some very specific work related to their infertility treatment or something like that. Other times there's a lot going on in their life, so I go through an assessment process. The first session, I hear what's brought them in-the presenting problem. Then I do some history taking. I explain to people that this step is really important in doing counseling and therapy because they wouldn't go into their physician, and he or she start treating them without getting any history on them. It's the same thing in this experience because everybody brings a history into the infertility or reproductive loss. That history can have a profound affect on the way they experience it. So, we do some history taking, and then we come up with a plan. Usually it's about a three or four session process. After I've done all of that I will give them some very specific feedback on where I see things are with them, and what my recommendations are about what will help them get to the place that they want. Then we come up with specific goals that we both agree upon. I ask them to really be thinking about what it is that they want help with, and how they want things to look when they would walk out the door and say goodbye to me one day. I give them feedback based on what those goals are.
 
How would you describe your therapeutic approach?
 
Eclectic. I was trained in a more psychoanalytic approach early on in my career, and I certainly still use that theoretical foundation. That tends to be more in my longer-term therapy patients, but in doing this kind of work, it's very eclectic. The cognitive behavioral techniques, the relational issues, the mind/body things that can help people adjust, or crisis intervention. Just a whole host of different things. It depends very much on what people are presenting with.
 
Is there something you find yourself saying to most patients?
 
I think I tend to normalize the experience a lot. People come in often feeling very alone, very overwhelmed. They have heard of people having infertility problems but they think that happens to other people, not them. They see themselves as different from others. I think I do a lot of normalization of the kinds of things that they're feeling and experiencing and help them put it within a context. People are often sitting there, suffering with the thoughts, “will I ever have a family?” or “will I ever have a child?”  Something I say that people find very hopeful, and something that I really believe is, that if they want to be a mom or a dad, or
parents at the end of all of this, they will be. I promise them that. It just may not be in the way that they initially thought it would be, but at the end of all of it, it will be very much their child. The idea of being able to hold hope for people when they're feeling hopeless is quite helpful.
                                               
Are there any common issues that you see that most patients face?
                                               
I think, certainly, the sense of anguish, grief and loss over something that most people never expect they're going to face. We spend most of our lives trying not to get pregnant, and even though people know infertility is an issue, they never really expect it's going to happen to them, or a pregnancy loss too. You may know people who have miscarriages, but you never really think it's going to happen to you. I think that's a very common issue, the anguish, grief and loss. Also, the sense of isolation. I think the sense of shame and stigma is a very common feeling. A sense of feeling different than others. Feeling a lot of angst because of feeling like their body has failed them in some very fundamental way.
 
Based on that vein of thinking, why do you think there's so much secrecy and shame 
surrounding infertility and miscarriage?
 
It’s like Victorian sex: nice people don't do it. Nice people don't talk about it, because it's reproductively related. I think that people don't really talk about it in these sorts of ways. I think also because it's is so related to who we are as a man or a woman. The very sense of our biological self- that if you acknowledge these kinds of feelings or issues that somehow it verifies the fact that something is wrong with you.
 
Do you give any guidance or recommendations regarding medical treatment?
 
Well, I'm not a physician so I don't give medical advice. What I often do is raise questions, because of the background and knowledge that I have. People are talking about their treatment, and if there are some things that I know are kind of typically done, and aren't being done, I may raise the questions and I will encourage them to go back and talk to their doctor. Sometimes even pretty basic stuff that can be missed, like vitamin D deficiency. We're learning more about that. Have they had that checked out? Have they had a regular physical? Just raising the questions that help them go back to their healthcare providers to have those things looked in to. I really think that this is a team approach that we take, that we all kind of have different perspectives. Sometimes I can raise a question that someone else hasn't thought about, and vice versa.
 
Are there any resources that you recommend?
 
I have a whole bag of resources. We actually have a wellness center at Shady Grove where there's acupuncture, there's nutrition, there's massage. I have a whole bag of tricks related to book lists, resource lists. We've developed these within our practice: internet resources; book that we've reviewed; websites that we think are good. When I'm working with people I might suggest certain apps for their phone, like mind, body related apps for working on certain things. Other professionals in the community too, of resources that I may know about. Sometimes we may need to consider medication, or at least getting a medication evaluation, a psychotropic medication. There are many different kinds of resources that I draw upon.
 
What advice can you offer to someone looking to seek therapy while going through infertility?
 
Well, a couple of things. One is, don't wait until there's a big problem. I think that an ounce of prevention is worth a pound of cure, and if they look upon therapy or counseling as a resource and support as they go through it, it can really help tremendously and prevent problems down the road. The second thing is, see someone who has had training and experience in the area of infertility, reproductive health, reproductive loss. There's a lot of therapists out there who are very, very good. Excellent individual, couples therapists, but if they haven't had training in this highly specialized area, then you're going to spend a lot of your time educating them not only about what you're going through medically, but also what you're going through emotionally. Luckily today there are more people who are out there that have this background and training, and places to go to look for people in this area. I’d suggest they go to the ASRM website, and look in the mental health professional group section, as well as Resolve, or Pathways to
Parenthood to find people who are working in this area.
 
Do you typically see couples and individuals? Or individuals? Or a mix of both?
 
I do all, but I encourage them to come in as a couple. Because whoever may be experiencing the problem, or experiencing the feeling from the infertility greater, it's still a couple's issue. They need to use it as an opportunity to learn and grow from the experience. Particularly if a woman calls and then the partners is excluded. Men are pushed out of the process in so many ways, and can really feel marginalized in it, so I think it can be very helpful to kind of take that approach right from the beginning. That being said, sometimes people say, oh I really want to come in by myself, and then maybe my partner come in later. I'm fine with doing that too. Again, I take a more open kind of approach where I will see a couple together. I will see them individually. I look upon the marriage and the relationship as the client as opposed to the two individuals.
 
What would you say is your goal in your therapy practice with your clients, with patients, or couples, or individuals?
 
It really depends on what their goal is. It shouldn't be my goal, it should be their goal. What it is they're wanting to get out of this work. I tell them, “I work for you. You have hired me to help you, but I work for you. It really needs to be your goal.” For many people, it's that they want to be able to have a baby. I can't promise them that. I can't do that, but I can certainly help them with their feelings, and what they're going through, and learning how to manage and cope with the feelings, and learning how to make peace with the things that are going on around them. It's really up to them to develop what the goal is. To help them deal with uncertainties-the whole experience of infertility is so much uncertainty, to help them find ways to deal with that.
                                               
Do you recommend they do anything between your sessions? 
 
Yes, I do give homework assignments. There are specific things I will give people depending on what the situation is. Sometimes with a couple it will just be ways to help them talk and having them do exercises at home. If they've had a miscarriage or pregnancy loss, we may do specific things around grieving. It's very individualized.
 
What do you consider a success story?
 
I consider a success story what my clients consider a success story. Do I wish that everybody has the baby that they wish for? Of course I do, but it doesn't always work out that way. What I really hope is that they can find some peace and resolution at the end of all of this experience, and they can leave my office feeling good and strong and resilient again, after many having very beaten down by the process.
​