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.