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.”
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