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:
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.