Thursday, January 27, 2011

Infertility: How to find a good psychotherapist

The decision to begin therapy usually has a backdrop that can include stress, unhappiness, unfilled hopes and interpersonal difficulties. If infertility is at the source of the stress, there may be additional components: fertile friends and siblings; juggling employment and treatment; monthly feelings of failure; difficulty communicating (verbally and sexually) with your partner and, perhaps, the experience of mourning one or more pregnancy losses. Finding a therapist who can be helpful along all of these dimensions can feel like a huge challenge. So, in the spirit of good problem-solving, let's see how we can approach this creatively.

I am writing this particular blog now, because in my December 31st blog heralding the beginning of the new year I cautioned all readers to take care of themselves emotionally. For some this will mean gathering comfort from friends and family, and for others it could mean seeking a therapist who can help you feel empowered by sorting through the various components of your emotional distress. In my recent book When You're Not Expecting, I devote an entire chapter ("Another Shoulder to Lean On") to finding emotional sources of support. Today's blog will focus on finding a therapist.

If you are beginning this search already in the throes of emotional misery, be aware that you may need to expect some delays as you identify a therapist who feels like a good choice. The therapist may have a waiting list, may not be covered by your insurance, may have a schedule that conflicts with yours, or may have an office that requires more travel than is ideal. So let's begin with how you can initiate your search.

Most of my clients and infertile acquaintances have found that word-of-mouth in their own community often serves them very well. Good therapists acquire good reputations for all the right reasons, and your initial inquiry should include whether or not the recommended therapist has experience counseling infertile clients. Someone with this background is ideal, since s/he will probably be familiar with treatments, side effects, parenting options and resources, and will save you the time of explaining your infertility issues in much detail. If you are currently being seen at an infertility clinic, be sure to ask whether the clinic employs a mental health professional for its patients. But if infertility is not a familiar issue for a recommended therapist in your community, don't despair. Here are some of the most important areas of expertise for a therapist: couple communication, grief counseling, family dynamics, depression and decision-making. Those areas are ones in which many couples with infertility need help, and along the way you can educate the therapist about the particular aspects of your infertility that are important.

So let's imagine that trusted friends, infertile acquaintances and family have not come through for you with names of therapists to consider. Some other resources could include your county Mental Health Association, the social worker at your local hospital, a local RESOLVE representative, your ob-gyn, a mental health specialist at a nearby fertility clinic or your religious leader. You also can contact RESOLVE (the national infertility association) at for names of therapists and leaders of support groups in your area. You are likely to be given names of social workers, psychologists, pastoral counselors and marriage and family therapists from these resources.

Once you have several names, it will be up to you to contact the therapist and ask for an appointment. What barriers might you encounter? You should expect the therapist to ask that you and your partner both attend the first meeting, so be sure to have two datebooks in front of you when you have this first conversation. You will be asked to describe your situation briefly, so be prepared to do this, and to ask the therapist whether s/he works with clients using the areas of expertise I mentioned above. If your prospective therapist has a full caseload of clients and offers to put you on a waiting list, you should ask how long it is likely to be before you could be seen (or, better yet, ask whether you could be fit in for an introductory appointment so you at least can determine whether you feel comfortable in conversations with this particular therapist). If the wait seems too long, or if a visit reveals that the chemistry is just not right, ask the therapist to suggest names of other therapists in the community. This process can take a while, but it is time well spent.

Another potential barrier is insurance coverage for the therapist's services. Find out in your initial telephone conversation with your own health insurance carrier what therapists are covered, and begin by contacting them. But if you find, for whatever reasons, that insurance is a problem, you have several options. One option is to ask to be seen by a therapist at your local mental health clinic or at your local family counseling agency (both may have sliding fee scales). Some therapists in private practice also have sliding fee scales. Another option is to look carefully at your savings and decide whether you can afford to pay out of pocket for these expenses. A last option is to seek a financial gift or an interest free loan from loving family members.

In terms of therapists whose schedules are a challenge or whose offices are difficult to reach, those issues are likely to be ones where you will need to adjust your life once you have decided that seeking therapy is an important priority. You can request a more convenient time if one becomes available, but the inconvenience of distance is a challenge. Occasionally a therapist might be open to a Skype session or a conference telephone call, but this is likely to be the exception rather than the rule.

So, the take-away message of this blog is that finding a therapist can take time and energy, but there are very clear pathways to follow in this quest for emotional support. And with this emotional support, hopefully you and your partner will feel increasingly energized and resilient as you face together the months ahead.

Wednesday, January 19, 2011

Sharing infertility news: How to reach some decisions with your partner.

From the moment you suspect the word infertility could apply to you, there is an emotional pause as you struggle with how open you will be with your apprehensions. As months pass, as diagnostic tests or pregnancy losses increase your anxiety, the questions still loom: whether or how to take others into your confidence on this very personal matter.

So what are the questions you and your partner will need to consider? Together you have undoubtedly spent hours discussing how both of you are viewing the news you are receiving from medical professionals, from your own collection of information, and possibly from local infertility support group members. But the big question you both need to be clear on is how open to be about your news and with whom. Each of you needs to be respectful of the other's wish for privacy, which initially may include no sharing of any news, and eventually is likely to include what news is acceptable to share. As you discuss this issue with your partner, you will want to focus on why it would be helpful to you if both of you could consider a certain perspective, and why you, in particular are, feeling a strong need to move forward in a new direction. This puts the positive framework of "problem solving" on the discussion, rather than the more negative dimensions of power struggles or selfishness.

So here are some considerations for both of you. Chances are that once a piece of information is shared, it will be shared broadly, even if you have asked your confidante to keep it private. This happens in several ways. Your confidante, with all sincere wishes for your emotional welfare, may want to create a small group of supportive others, alerting them perhaps to only a small piece of the information you have shared, and in the process arousing further curiosity ("I don't think it's just PMS that makes Janet so upset every time she gets her period."). Another possibility is that your confidante may feel somewhat overwhelmed to have learned the information you have shared, and may feel the need for help with the anxiety the news creates ("I'm feeling so helpless since Suzanne told me she is being tested for infertility -- I wish there were some way I could help her."). And then, there's always the possibility that your confidente is a bit of a gossip girl and thinks she will become the center of attention as she shares even a small bit of your news ("I never imagined that infertility is what is making Katie so edgy these days -- what? you didn't know? well, here's what she told me....") So whether it is concern for your welfare or a disregard for your request for privacy, the news will pass among friends and family members once you have begun to share it, no matter with what expectations of discretion you may have.

That brings us to the next question of how you and your partner can come to agreement on what to share, now that you know the word ultimately will circulate to a circle of family and friends. You might begin by asking yourselves what are your own issues of privacy. Is there some stigma associated with thinking of yourselves as infertile? Are you concerned that curious loved ones will pry further to learn more information than you want to divulge? Do you want to avoid well-meaning advice from folks who are not knowledgeable about the medical aspects of your infertility?

Whatever your issues of privacy may be, you both can probably find ways to deflect inappropriate remarks or to correct misinformation. What may require further effort on your parts is the question of stigma. These days, with infertility being so much in the news, affecting so many well-known celebrities, and being heralded for medical breakthroughs, stigma has much less power than in the late 1900's. So rather than focusing on stigma, you both could consider discussing how you think others may view you differently if they hear your news -- chances are you'll arrive at the conclusion that others will be concerned about how they can help, will share information about acquaintances in their lives who have grapplied with infertility or pregnancy loss, and will want to have some sense about how much you want to talk further about your infertility.

So one major effort you and your partner need to make is how you want to present your news so that you'll minimize intrusive behavior of others while creating compassion for the challenging times ahead for both of you. You'll probably want to decide how much initial news to share and, as you offer medical information, you'll probably also want to offer suggestions for how others can help. This can range from "I'll appreciate some extra thoughtfulness if I tell you I've just gotten my period" to "feel free to ask us about how things are going, and if we don't mention our infertility, then it means either there's nothing new to report or we're not in the mood to discuss it right then." This leaves open the door for ongoing conversations at whatever time those offers would meet your needs.

The topic of sharing infertility information is multi-faceted, and in today's blog I have tried to address some of the most challenging aspects. In my recent book When You're Not Expecting, I devote a fair amount of attention to the issue of how/when/whether to share, and there is a reason for this. The burden of infertility easily can become too heavy for a couple to keep to themselves. It crowds your conversations, it intrudes constantly, it makes you feel "stuck," and it can make you feel emotionally isolated and barricaded. Being able to share information can create a sense of broad support, concern and compassion (okay, so it also can create some unwanted intrusions, but that goes with the territory of having people concerned about you). So I hope this blog will help you and your partner to open discussions about how to begin (or continue) sharing infertility information in a way that generates the emotional support that is so important as you face the ongoing challenges of infertility and pregnancy loss.