Storm clouds are coming: Ways to help couples reconstruct the crisis of infertility

This paper examines the crisis of infertility; takes into account several theoretical considerations, exploring the socially constructed cultural-historical definitions of infertility and the definitions and meanings which flow from these constructions; the family life cycle Stressors which influence the couple's psychological reaction; and the mourning and grieving process of infertility. Therapeutic interventions using a constructivist theoretical framework are presented. By assisting the couple to reconstruct the crisis of infertility, over a period of time, family therapists can help couples to visualize a future in which the fertility problem plays a minor role.Steven Dobkin, MA, holds a master's degree in marriage and family counseling from Hofstra University.     

An Infertility Primer for Family Therapists: II. Working with Couples Who Struggle with Infertility

The distress of infertility and its medical treatments are profound, and the effects reverberate in each partner, the couple dyad, and the couple's relationships with family, friends, and medical systems. Yet family therapists, like others in our society, are often uninformed or misinformed about the experience of infertility. While the legacies of infertility may be painful and enduring, they often remain unspoken, and hence may be overlooked in standard interviews. This article describes the experiences of couples struggling with infertility, most of whom have sought medical intervention, and it provides treatment interventions for guiding couples through this difficult and often uncharted terrain. Case vignettes derived from 2 years of this clinical research study are included.     

A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Psychological and relationship changes of couples undergoing an infertility investigation: Some implications for counsellors

The emotional and psychological aspects of the experience of infertility have been largely ignored by researchers. A study was accordingly undertaken of 43 infertile couples who were undergoing medical investigation of their fertility problems. Preliminary analysis of the data suggests that the infertility investigation was most stressful for the participants at the time of the initial medical interview, and that distress was greater for those who were themselves identified as having an organic fertility problem. A substantial number of the men and women involved indicated a need for the provision of psychological counselling services. The nature of the most appropriate forms of such help is explored.     

GENDER'S ROLE IN RESPONSES TO INFERTILITY

Infertility is a major life stressor that affects approximately 10% of U.S. married couples. Infertile women and men have reported experiencing depression, helplessness, and marital strain. Given U.S. society's emphasis on women's role as mothers, it has been suggested that women's lives are more disrupted by infertility than those of men. This hypothesis was supported in a survey of 185 infertile couples and 90 presumed fertile couples. Infertile wives, as compared to their husbands, perceived their fertility problem as more stressful, felt more responsible for and in control of their infertility, and engaged in more problem-focused coping. Infertile husbands experienced more home life stress and lower home life performance than did their wives. These differences were not found for presumed fertile couples. Both infertile and presumed fertile wives experienced more depression, more sexual dissatisfaction, and lower self-esteem than did their husbands. Theoretical and counseling implications of these findings are discussed.     

Infertility as boundary ambiguity: one theoretical perspective

Infertility as a life event can be understood from a number of conceptual perspectives: a developmental crisis, a grief reaction, a disruption of marital contracts and roles, a crisis of identity, sexuality, and/or values, or a challenge of decision-making processes. Stress theory and the construct of boundary ambiguity can augment the understanding of the crisis of infertility by providing a different approach and unique perspective. It is the hypothesis of this article that the involuntarily childless couple may experience infertility as a stress of boundary ambiguity, that is, not knowing who is in and who is out of the family system. As infertile couples attempt to make the transition to parenthood they may experience the child they wish to have as a family member who is psychologically present but physically absent.     

Characteristics of the Biopsychosocial Crisis of Infertility

As many as 5 to 12 million individuals of childbearing age in the United States may now be infertile. For couples who wish to conceive but cannot do so, discovery of physical infertility, coupled with strong expectations about conceiving and raising children, sets the stage for a complex series of reactions labeled here as the crisis of infertility. Infertile couples frequently struggle with strong feelings, ranging from disbelief and denial to isolation, guilt, and grief. Problems coping with infertility are worsened by physical and psychological stresses accompanying medical procedures. The marital relationship may be severely tested as well. For many individuals, the infertility crisis is resolved with virtually no support from anyone. With empathy and understanding, counselors can help infertile individuals to work through this crisis productively.     

Therapists' Perspectives on Working with Interracial Couples

SUMMARY

This paper is based on interviews with seven marriage and family therapists (AAMFT Clinical Members) on their experiences of providing therapy to interracial couples in the course of their private practices. The interviews were conducted by the author as part of a masters thesis project. Interracial couples may frequently present for therapy with a variety of generic couples' issues and concerns. However, therapists often find that underlying these more generic concerns are issues related to the ethnic, racial, and cultural differences that the partners bring to the relationship. This paper focuses on the historical context of intermarriage, specific concerns and issues that interracial couples experience in their relationships, and on the experiences of therapists providing therapeutic services to this diverse and challenging client population.     

Themes of Hope and Healing: Infertile Couples' Experiences of Adoption

Using a qualitative approach, the authors explored the experiences of becoming parents through adoption after unsuccessful infertility treatments. During in‐depth narrative interviews, 39 infertile couples shared their stories of how they determined that adoption was an acceptable parenting option, the vicissitudes of the adoption process, and their experiences of becoming adoptive parents. Phenomenological analysis of these data revealed 3 overarching themes. These findings are discussed in terms of their implications for counselors who work with infertile couples considering adoption, clients engaged in the adoption process, and those who have recently made the transition to parenthood through adoption.     

Infertility, “Experientially Oriented” Couples Therapy and Subsequent Pregnancy

SUMMARY

Four couples who had been diagnosed as clinically infertile were seen in experientially oriented couples therapy. Each couple conceived a baby shortly after a particularly powerful session. These ' sessions are described. The commonality across these sessions involved opening up the clients' inner experiencing and enabling these clients to actualize and integrate whatever was deeper within. The conventional biomedical and psychoanalytic approaches to infertility are described. The experiential model provides an alternative way to understand the timing of pregnancy or lack thereof. It also offers a holistic approach to working with infertile couples.     

Negotiated nonmonogamy and male couples

One issue that has the potential to confound family or couples therapists working with male couples is the issue of nonmonogamy. For many therapists, sexual nonexclusivity challenges fundamental clinical assumptions that "affairs," or extra-relationship sex or romantic involvements, are symptoms of troubled relationships and are always a form of "sexual acting out." This article explores the issue of sexual exclusivity and nonexclusivity within male couples. In order to achieve both clinical and cultural competency in work with male couples, therapists need to challenge their cultural biases regarding monogamy.     

Roles and Role Conflict of Women in Infertile Couples

This study explored the experience of role conflict for women in infertile couples. The infertile group consisted of 29 women who, with their husbands, were beginning an infertility program; comparison group subjects were 29 married women with no history of inability to conceive. Each subject completed self-report instruments measuring role conceptions and expectations, the experience of role conflict, and occupational commitment. Each husband also reported his role expectations for his ideal woman. Also, a semi-structured interview was conducted with each infertile subject. Compared to the control group, the infertile group's role conceptions were more traditional; they reported less role conflict of various kinds, and they showed greater occupational commitment. They did not differ significantly on degree of wife-husband role discrepancy, or on mother's occupational commitment. These findings lead to an understanding of infertility as part of an interactional system for dealing with potentially intolerable sources of role conflict.     

The meaning of treatments for infertility: cognitive determinants and structure

Infertility is a life crisis for which modern technologies suggest solutions that themselves are stressful. The purpose of the present study was to determine how treatments for infertility are perceived, and the cognitive structure underlying their perception. Fifty women undergoing in vitro fertilization and 50 fertile women recorded their perceptions of 10 infertility treatments on 15 dimensions. Intergroup comparisons showed that patients generally perceived the treatments more positively than nonpatients, and differences in perceptions focused on female-centered treatments rather than on male-centered and donor-involved treatments. Fertile women tended to be more concerned with the risks to the fetus, whereas infertile patients tended to be more concerned with the social exposure of the treatments. Cluster analysis revealed that patients' conceptions of infertility treatments were organized according to the most salient features of the procedures being applied, whereas fertile women's were organized according to the cause of infertility. The significance of these findings for providing care for infertile couples is discussed.     

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples’ adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross‐sectional study, a total of 134 participants (67 couples with infertility) completed self‐report questionnaires assessing infertility‐related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.     

Strategies for Counseling Infertile Couples

Approximately one in six couples experience problems with their fertility in terms of conceiving and/or carrying a viable pregnancy to term. The infertile couple's need for counseling and support has been emphasized consistently in the literature. This article presents specific intervention strategies that may serve to reinforce the infertility experience as an opportunity for personal and marital growth.     

Benefits and Challenges of Dual-Earning: Perspectives of Successful Couples

The purpose of this study was to discover the benefits and challenges derived from the dual-earner lifestyle for couples who successfully balance family and work. The data for the study are part of a larger data set drawn primarily from in-depth interviews with 47 couples. While the intent of the overall project was to discover the adaptive strategies that these couples utilized at home and work to successfully balance family and work, this paper focuses specifically on the couples’ perceived benefits and challenges of dual earning. Many therapists harbor negative and stereotypical assumptions of the quality of dual-earner family life and appear to believe there are inevitable and significant challenges that are intrinsic to the dual-earner family arrangement (Haddock & Bowling, 2001), but the findings of this study are helpful in providing a more balanced, informed view of the possibilities of this family arrangement.     

Cohesion and adaptability among individuals under treatment for infertility

The objective of this study was to evaluate cohesion and adaptability as relationship patterns of individuals in the presence or absence of infertility. Infertile subjects (20 men and 26 women, age 29.9 yr., SD = 3.8), and 100 fertile individuals (52 men and 48 women, age 29.5 yr., SD = 3.6) were included in this cross-sectional study conducted in Brazil. Subjects were married for the first time and had no children. The pattern of relationship (cohesion and adaptability) was assessed on the Family Adaptability and Cohesion Evaluation Scale (FACES III). Subjects were also interviewed and the interviews tape-recorded and analyzed by independent and blinded senior psychiatrists. The concepts of cohesion and adaptability did not differentiate infertile couples from fertile ones. Further, the recorded interviews also resulted in heterogeneous. nonconcordant judgments. These results lead to two conclusions: that awareness of infertility is not present in the population studied or that it is present but the magnitude of its effect is quite small and that FACES III and the interview focus on adaptability and cohesion are not sensitive enough to measure the difficulties in these couples' relationships. This leads us to reflect on the type of psychiatric support available to infertile couples.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

Understanding autism: how family therapists can support parents of children with autism spectrum disorders

The number of children diagnosed with an Autism Spectrum Disorder has increased dramatically in the last 20 years. Parents of children with autism experience a variety of chronic and acute stressors that can erode marital satisfaction and family functioning. Family therapists are well-suited to help parents stay connected to each other as they create a "new normal." However, family therapists need updated information about autism, and they need to understand how family therapy can help parents of children with autism. Because having a child with autism affects multiple domains of family life, this paper explores how family therapists can utilize an integrative approach with parents, enabling them to flexibly work with the domains of action, meaning, and emotion.