Integrated Therapies for the Emotional Issues of Infertility By Barbara Blitzer, MSW

If you’re reading this article, you know full well that infertility is a condition that affects all aspects of one’s life.  A simple trip to the store can become an emotional ordeal.  Scheduling medical appointments while keeping up with a demanding job, wondering if sex will ever be the way it used to be, attending a family event full of children or unwelcome questions, navigating friendships when everyone else seems to be pregnant or talking about children, planning a vacation around treatments, and managing finances—all of this and more can be difficult.  The daily fabric of life — the structure of comfort, predictability, and community — can be torn asunder. I call this the breadth of infertility, its incredibly far-reaching range.  It is this list that is frequently cited in discussions of the stressors of infertility.

Infertility also has depth.  It reaches deeply into the soul, threatening some of our most dearly held dreams assumptions and beliefs. Some are left feeling broken, cast out, less than whole. Spiritual beliefs can be challenged and a general feeling of optimism upended. It is no wonder that feelings of isolation, low self-esteem, anger, envy, and depression are common.

But while there is a great deal of commonality in the experience of infertility, there is also great variety.  In fertility groups I lead, heads often nod as people recognize their own experience in the experience of others.  Yet, infertility happens to people, and not all people are the same.  Each individual has a unique history, a unique set of priorities, and a unique way of handling stress. 

The Emotional Complexity of Infertility

Emotionally, infertility is a complex issue. It reaches deeply into our hearts.  It is a condition to be managed, treated and overcome.  It calls upon us to make decisions, to maintain hope repeatedly in the face of setbacks, to define our priorities, and to find the best way to build a family.  Infertility is also a wound.  To heal, to cope as well as possible, to hold on to what is best and most true in ourselves, we need to know our own hearts.  What is it that is making this most difficult?  How does this leave me feeling about myself?  How do I feel with friends, family, coworkers, my spouse?  Are these feelings old or new?  How do I react to this trying situation?  Do I face it with optimism or despair?  How do I manage disappointment?  Does this experience make my marriage stronger or weaker?  Can I share my deepest feelings with my spouse?
While most of us think we know our own hearts and could easily answer the above questions, it is also true that nobody is 100% aware of the deep feelings and unresolved wounds that may lie beneath the surface.  It is also true that over time and with growth and reflection, our answers can change.
We need to go beyond the easy answer that “I am stressed” to an understanding of what makes us stressed and what to do with it.  For all of life’s challenges, we need to know how to stay in touch with our truth as we experience situations.

The Mind-Body Connection

Infertility also is a decidedly mindbody issue.  Mindbody is used here in the broadest sense, acknowledging that whatever is happening in the mind is having an impact on what is happening in the body, and conversely, whatever is happening in the body will affect the mind.  Infertility patients in treatment can attest to the effects of certain hormones on their emotional well-being.  Stress, something experienced in abundance by most fertility patients, can, in and of itself, create profound changes in the body.  Practically, mindbody therapies can encompass all techniques and practices which acknowledge and address this reciprocal mindbody relationship.  While many people think of mindbody approaches as stress reduction and cognitive restructuring, in this broader definition, mindbody techniques can also include such therapeutic approaches as EMDR, EFT, hypnosis, imagery and visualization, prayer, meditation, emotional release work, art, movement, and body work.
Given the complexity and range of the infertility experience emotionally, an integrated approach to infertility counseling can be beneficial.  A therapist who uses an integrated approach can help each individual assess her own strengths and weakness and, drawing from a range of approaches, craft an individualized program for that individual.  Your program may include some or all of these goals: healing old hurts, bolstering self-esteem, strategizing about the best way to handle relationships, learning skilled relationship behavior, and incorporating mindbody techniques both to heal and to reduce stress.
Let’s look now at some examples of clients and how there needs were met.

Case Studies

Janet is a 38-year-old woman with an excellent job and a stable marriage.  She says that she has always known that if she applied herself, things would work out.  She went to good schools, did well, and has created a satisfying life for herself–except for the fact that she has been trying to conceive for two years, has had two unsuccessful IUIs and two unsuccessful IVFs.  Her infertility is unexplained.  She’s finding herself sad a lot. She feels somewhat alienated from her husband who doesn’t understand why she is so upset. She is avoiding her many friends with children, hasn’t taken a vacation in a long time due to her treatment schedule, and has placed a purchase of a new home on hold until she and her husband can figure out the extent and outcome of the treatments. She dreads the next pregnancy announcement and can’t stand family gatherings, which are filled with children.  She feels her parents are more interested in spending time with her sister who has three children, the only grandchildren. She has lost interest in much of what she used to enjoy and feels she is going through the motions of living rather than being present to life.  Her mother tells her to relax and her friends ask why she doesn’t just adopt–something that she is not ready to consider. 
And now consider Gail.  Gail has created a good life for herself as an adult.  She also has unexplained infertility and has been trying for two years.  Unlike Janet, she has not always felt she could get what she wanted.  Her early life was difficult, filled with disappointments. There was a lot going on in her family that she couldn’t really talk about.  Her father was in the military so she moved a lot.  She often feels just a little bit different, not sure she really belongs or fits in. She persevered and decided, like Janet, that if she just tried hard enough she could get what she wants.  After all, she had.  Until now.
Going through infertility means being stressed to some extent.  Figuring out what exactly is making it hard requires some work to uncover feelings, make connections with our past hurts, and to understand how they affect us in the present situation.  It requires good boundaries, an ability to know what is owed to others and what is not.  It requires good self-esteem–knowing that even if our bodies are not doing what we would hope and expect, we are still worthwhile people. It also it takes relationship skills–knowing how to talk to others who are close to us about what we really feel and knowing how to fend off unwelcome comments and inquiries.  It requires an ability to make decisions about treatment, finances, and when to say, enough is enough.  And it requires an ability to soothe and calm oneself.

Peeling the Onion

Uncovering who we are and what is important to us is like peeling away the layers of an onion.  We think we know what we’re made of, but layer after layer, we find there is more.  In working with the emotional aspect of infertility, it’s important to know what our vulnerabilities from the past are so that they don’t make an already difficult situation more difficult.  An integrated approach to therapy that incorporates mindbody techniques with talk can be invaluable.  In getting to know patients and in helping them get to know themselves better, I often use drawing, imagery, breathing techniques, and sometimes even movement to help uncover thoughts and emotions.  Sometimes we use the empty chair technique, allowing both sad, angry, and happy feelings to flow while addressing a person imagined to be in that empty chair.  Sometimes we write letters to infertility, that unwelcome stranger that took up residence with us, or have a dialogue with infertility as though it were a person.  I encourage people who are so inclined to keep a journal so that they have a safe and predictable place to express and explore thoughts and feelings.  All of this, in combination with talk, encouragement and support, can help peel that onion and lead us back to the heart.  It can help release and relieve old pain. It can reduce stress and confusion.
Sometimes as we peel, we find an issue from the past that lingers emotionally, adding salt to the wound of infertility.  Gail, having had to keep secrets about her family throughout her childhood, was particularly troubled by who to tell and who not to tell about her fertility issues.  She was also worried about how people would react to her and her child were she to use a donor or to adopt.  To her, although she didn’t realize it at first, infertility was tantamount to a shameful secret.  It made her feel different and once again she had to relive those familiar feelings of not fitting in.  She began to wonder if all her efforts to right her once troubled life were worth it.  It seemed that bad things were destined to get her in the end.
Once we are able to identify old issues and their impact on current ones, we can begin to heal the past and become free in the present.  When we react in the present, while carrying an emotional load from the past, we tend to distort, overreact, get confused, or simply suffer more than necessary.  Sometimes talking–just connecting the dots, understanding and making some decisions in light of the new insight–can make all the difference.  Often we can work to clear the past using approaches that are appropriate for the issue.  We might use EMDR, a technique that helps us access memory and association by use of bilateral eye movements, to correct any negative feelings or beliefs we incorrectly hold about ourselves based on past hurts.  We may use EFT, or emotional freedom technique, to restore balance to the energy system in the body.  We may use imagery, visualization, and affirmation to create a happier stronger, more self- accepting self.  We may work with cognitive techniques to challenge and replace negative thoughts with more positive and realistic ones. 
Healing some of the old wounds makes it easier to use other mind body techniques to reduce stress.  Stress is what happens to us when we are thrown out of balance with ourselves, when we are distressed.  For example, Gail’s history could make it harder for her to get support, to be with others, or to make the best decisions about family building.  What a shame to reject a potential family member because an undigested issue from the past makes us feel second best! When the burden of shame is lifted, Gail no longer reacts strongly to the thought of sharing her fertility issues with close and trusted friends.  She is able to evaluate the pros and cons of donor egg and adoption without a secret burden she didn’t even realize she had.  She is creating less self-generated internal stress than she was before. 
When we feel good about ourselves, capable and lovable, it becomes easier to advocate for ourselves in relationships.  We have rights to privacy, to decide whether sharing with someone is in our best interests or not.  We become more able to stay away from that baby shower when it feels too overwhelming and to honor that decision or, on the other hand, to go when we feel it is manageable and important. We deal with our physicians more effectively, knowing how we want to be treated and feeling comfortable advocating for ourselves or changing practices when necessary.  We can figure out when we are the problem and when we’re not.  We become more available for learning and strategizing in the present.

Building Relationship Skills

Part of dealing with the emotional aspects of infertility involves learning skilled interpersonal behavior both in our intimate partner relationships and with friends and coworkers.  It can be immensely helpful to have some therapy sessions with a spouse and learn specific techniques for safely sharing those deeper feelings.  All too often women are longing to be understood, held, empathized with, while men, trying to support their wives, try to fix the situation.  It is often difficult for men when they are unable to relieve their wife’s suffering.  And frequently, in a therapy session, it is possible for husbands to share the anxieties that they may have been keeping to themselves.  Most of us did not observe skilled, intimate behavior at home.  This then becomes an opportunity to learn techniques that can be taken home and that offer the possibility of a closer, happier marriage. Infertility places a burden on a marriage.  Knowing how to communicate well from a deep emotional place can help determine whether the experience of infertility weakens or strengthens the marriage.

Reducing the Stress

Stress reduction skills also are important.  They give the mind and the body a break, allowing the hormones to flow properly and allowing us to be in balance emotionally and physically.  Everything that allows us to reduce stress is a stress-reducing technique, whether it is healing old wounds and releasing energy that has been pent up, communicating effectively, making good choices, having realistic but optimistic and flexible thinking, or being part of a medical practice in which we feel as much at ease as possible.  When we think of mind/body and stress reduction, however, most people think of meditation and mediation-based techniques, such as breathing techniques, yoga, and soothing imagery.  These are all wonderful and can be used during or after a therapy session or during a procedure as a way to calm and center or in anticipation of getting results or making an important treatment decision.  Simple biofeedback which measures hand temperature can be learned and practiced at home to indicate that the imagery is in fact allowing the body to move into a relaxation mode as indicated by the dilating blood vessels which allow the hands to warm.

Addressing Spiritual Beliefs and Expectations

Since infertility can be difficult, it also can challenge spiritual beliefs.  I’ve prayed and my prayers have not been answered.  I’m mad at God.  Maybe I think I’m being punished for my past mistakes.  Maybe, because something is wrong with me, God doesn’t want me to have a child.  Mindbody techniques and emotional healing can bring us closer to our hearts and our own, very personal answers, regardless of what belief system we identify with.
Infertility is a passing crisis, but it doesn’t feel like one at the time.  Some people worry that its legacy will be with them forever and that they may never find happiness.  For most, the issues resolve, one way or the other, and a family is created.  Depending upon how we handle the challenges of infertility, we enter the parenting years with ourselves more or less whole and healthy.  We owe it to the future children to handle this time wisely.  It is possible to come through the infertility experience wiser, more skilled and more loving then before.  As one client recently said to me, “I came to you because I wanted a child.  I now have a child and I have myself as well.”
Barbara Blitzer MSW, LCSW-C
Barbara Blitzer has integrated her knowledge of mindbody approaches with contemporary psychotherapy to create a complete approach to healing.  Her own experiences with GYN disorders led her to focus on infertility.  She has served as a faculty member of The Center for MindBody Medicine in Washington, DC, training health care professionals to integrate mind body techniques in their practices Barbara has worked with Resolve conducting mindbody groups and serving on the board of the DC chapter as Complementary and Alternative Medicine Resource.  Barbara’s work with infertility has been noted in the Washingtion Post and and Washington Woman. She has lectured throughout the DC area on the topics of stress reduction ,women’s health and infertility.
Barbara attended University of Wisconsin, American University and Catholic University School of Social Services. She went on to do advanced training in mindbody medicine, couples counseling and Eriksonian Hypnosis, EMDR and EFT(Emotional Freedom Technique) She has studied with Alice Domar, Ph.d and been certified to conduct PAIRS groups for relationship skills.

Specializing in Integrative Psychotherapy for Infertility

Washingtion,DC metro area


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