Interview: Mandy Persaud, MS, LMFT

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.