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Couple Counseling and Therapy for the Unfulfilled Desire for a Child — The Two-Step Approach of the "Heidelberg Infertility Consultation Service"
... Kada govorimo o kovoditeljskom paru, članovi mogu biti istog ili sličnog iskustva, psihoterapijske orijentacije, mogu podeliti uloge tako da je jedan dominantan, a drugi više u svojstvu posmatrača/ pomagača ili pak nastupati ravnopravno. Ono što je preporučljivo za svaku grupu parova, a posebno kada se radi o grupi parova koji se suočavaju sa neplodnošću, gde muškarci i žene imaju različite strategije suočavanja sa ovim problemom (Donarelli et al., 2012), jeste da voditeljski par čine muškarac i žena (Wischmann et al., 2002). Naravno, jasno je da ovo nije uvek izvodljivo, pogotovo imajući u vidu činjenicu da je među psiholozima puno više pripadnica ženskog pola. ...
... Razlog tome je osećaj ovih parova da nisu sposobni da izađu iz rolerkostera koji se pokreće i da njegova brzina zapravo daje osećaj izostanka kontrole, što je slučaj i sa suočavanjem sa neplodnošću. Ovaj osećaj kod parova dovodi do emocionalne krize, za koju je važno da bude prepoznata od strane savetnika -voditelja programa (Wischmann et al., 2002). Tema vezana za emocionalne reakcije koje su se javljale tokom suočavanja podeljena je na dva susreta, pri čemu se na prvom od njih, kako je navedeno, bavimo onima koje su se javljale po saznanju o neplodnosti, dok je tema narednog susreta definisana kroz emocije, misli i ponašanja koja su se javljala u kasnijim fazama tokom suočavanja. ...
... Tema vezana za emocionalne reakcije koje su se javljale tokom suočavanja podeljena je na dva susreta, pri čemu se na prvom od njih, kako je navedeno, bavimo onima koje su se javljale po saznanju o neplodnosti, dok je tema narednog susreta definisana kroz emocije, misli i ponašanja koja su se javljala u kasnijim fazama tokom suočavanja. Važno je naglasiti da, dok god postoji želja za detetom, postoji i ovaj osećaj, i da parovi mogu da smanje brzinu, ali da ne mogu u potpunosti da savladaju rolerkoster (Wischmann et al., 2002). Upravo ova činjenica, kao i rezultati istraživanja koji ukazuju na to da su ženama razgovor i podrška u ovom domenu najpotrebniji , bili su razlog za ovu podelu i detaljnije bavljenje emocijama, mislima i strategijama kroz dva susreta 3PS programa. ...
Neplodnost predstavlja ozbiljan problem savremenog čoveka koji osim pojedinca i para, pogađa i društvo u celini. Može se reći da je neplodnost globalni bio-psiho-socijalni problem, sa trendom porasta. Ozbiljnost i učestalost ovog problema ilustruje činjenica da Svetska zdravstvena organizacija (World health organisation – WHO) rangira neplodnost kao peti najveći uzročnik invaliditeta među svetskom populacijom mlađom od šezdeset godina. Svi statistički pokazatelji učestalosti neplodnosti različitih organizacija (WHO, UCLA Health, CDC, United Nations Population Fund)1 su u najmanju ruku zabrinjavajući. Uzroci neplodnosti su brojni, od čega najveći procenat pripada medicinskim uzrocima. Međutim, porast stope neplodnosti u najvećoj meri se dovodi u vezu sa odlaganjem roditeljstva i zasnivanjem porodice u poznijim godinama. Većina izveštaja o prosečnoj starosti žena na području Evrope i Amerike u trenutku rađanja prvog deteta pokazuje trend porasta i iznosi oko dvadeset devet godina (EUROSTAT, National Center for Family & Marriage Research, The Human Fertility Database). Ova pojava se dovodi u vezu sa značajnim demografskim i društvenim promenama poslednjih godina dvadesetog veka, koje su značajno izmenile stil života muškaraca i žena. Obrazovanje postaje dostupnije ženama, one ulaze na tržište rada, postaju finansijski samostalne, angažuju se na radnim pozicijama koje su do početka ovog veka isključivo bile dodeljivane muškarcima. Veća kvalifikovanost i radna kompetentnost žena uz dostupnost kontracepcije vode ka odlaganju roditeljstva, a samim tim i do povećanja reproduktivne disfunkcije povezane sa starenjem kod muškaraca i žena.
... At least the social surroundings might be negatively affected. As Wischmann and coworkers point out [19], social pressure can lead to a defensive approach so that neither friends nor parents are informed of the wish for a child or about the medical infertility treatment the couple is undergoing. As described by Wischmann and Thorn [18], psychosomatic research postulated for decades that women suffer considerably more from infertility than their male partners. ...
... On the basic mood scale, the self-assessments of men and women are very close together, whereas the partner images are positioned toward the carefreeness pole of the scale for the men (as seen by the women) and toward the depressive pole for the women (as seen by the men). As Van den Broeck and colleagues [6] point out, it can be helpful to visualize this polarization pattern (or "role allocation") [19] in couples counseling to normalize its occurrence and to "allow" more flexibility in the allocation of roles. Otherwise the woman may want to talk about her pain and sadness, whereas her partner may feel helpless and withdrawn, resulting in polarization and isolation of both partners at a time where both partners need each other most in their infertility crisis. ...
... As Wischmann et al. point out [19], it is necessary to consider both unconscious areas of the wish for a child (e.g., fantasies and dreams) and the consciously expressed motives and expectations of the couples. After years of infertility treatment, ambivalent feelings linked to the wish for a child or the medical treatment may barely be perceived by the couple as a consequence of their coping attempts. ...
The experience of infertility and its medical treatment is for most couples an emotional challenging life crisis. For a successful coping with this crisis, it is essential to use only effective coping strategies. These are mainly active-confronting and meaning-based coping strategies, whereas avoidance coping strategies usually increase the personal and marital stress of both partners. In this chapter some typical issues in the relationship between health care professional and the infertile couples will be described. One important didactical goal will be to increase the knowledge on favorable coping strategies in infertility and how to address these coping strategies adequately as an Ob/Gyn-professional.
... Infertility is clinically described as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse [1], affecting 9-15% of couples worldwide [2]. Research widely recognized that infertility is a distressing experience [3][4][5] that may significantly affect perceived levels of quality of life (QoL) [6][7][8][9][10][11] and psychological health [12][13][14][15], and implies attempts of re-definition by searching for causes and meanings to re-establish personal control and satisfactory (QoL) [16][17][18]. ...
... Nevertheless, according to previous research on couple counseling and therapy with infertile patients [17], the couple's biographical background may also have a significant impact on the perception and definition of the current infertility experience at individual, relational and social level. Indeed, previous research highlighted that the adaptation process to an aversive event consists of appraisals of both primary control (i.e., appraisal of possibilities to modify the situation to reduce its negative impact) and secondary control (i.e., appraisals of possibilities to modify the appraisal of circumstances to promote adaptation to them). ...
... Infertility is clinically described as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse [1], affecting 9-15% of couples worldwide [2]. Research widely recognized that infertility is a distressing experience [3][4][5] that may significantly affect perceived levels of quality of life (QoL) [6][7][8][9][10][11] and psychological health [12][13][14][15], and implies attempts of re-definition by searching for causes and meanings to re-establish personal control and satisfactory (QoL) [16][17][18]. ...
... Nevertheless, according to previous research on couple counseling and therapy with infertile patients [17], the couple's biographical background may also have a significant impact on the perception and definition of the current infertility experience at individual, relational and social level. Indeed, previous research highlighted that the adaptation process to an aversive event consists of appraisals of both primary control (i.e., appraisal of possibilities to modify the situation to reduce its negative impact) and secondary control (i.e., appraisals of possibilities to modify the appraisal of circumstances to promote adaptation to them). ...
Background:
Research highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients' perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple's dyadic adjustment.
Methods:
A questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples' lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple's dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL.
Conclusions:
Data provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples' resources to define counselling interventions with women attending infertility treatments.
... Infertility affects both men and women psychologically and emotionally, although they may respond differently (9)(10)(11). These psychological impacts may have a long or short-term effect on life satisfaction but it is evident that the diagnosis of infertility, treatment process, and acceptance has shown to have a major cause of loss in QoL (12)(13)(14)(15)(16). ...
Introduction: FertiQoL questionnaire was developed and validated in 2011. It has been widely used and translated into many languages to measure QoL among infertile individuals. The use of translated psychometric tools is often subjected to cross-cultural variations. The objective of this study is to assess the psychometric properties of the Malaysian FertiQoL. Methods: A study was conducted among attendees of a public infertility clinic. Demographic details were collected and respondents answered the Malaysian FertiQoL. The questionnaire consists of 34 items. Factor analysis and internal consistency were analysed using SPSS v24. Results: Data from 175 respondents were analysed. Mean age is 32.1 ±3.8 SD with 56.6% female and 43.4% male. KMO index were 0.826 and significant Bartlett's test for sphericity. For Treatment domain, factor loadings for items T2 and T5 were < 0.32 but for all other items were acceptable between 0.32-0.80 with no cross loadings and Cronbach alpha for environment (0.717) and tolerability (0.660). For Core items, Q4, Q6 and Q14 loaded onto different domains and Q19 had poor factor loading. All other items were acceptable. Cronbach alpha for specific domains were emotional (0.788) mind-body (0.829), relational (0.639) and social (0.666). Cronbach alpha for emotional, relational, social improved to 0.857, 0.643 and 0.732 if Q4, Q6 and Q14 were omitted respectively. Conclusion: The study identified six items that affected the psychometric validity of the questionnaire and maybe explained by language or cross-cultural reasons. However, the Malaysian FertiQoL can still be useful to measure QoL in those with infertility.
... The subject matter addressed in infertility counseling has been widely discussed (Boivin & Kentenich, 2002;Covington & Burns, 2006;Van den Broeck et al., 2010;Wischmann, Stammer, Gerhard, & Verres, 2002). The following is an outline of typical elements: ...
Over the last few decades in Europe, both the number of unintentionally childless couples and the frequency of treatment with assisted reproduction techniques (ART) have been constantly increasing. With a view to assessing the psychosocial aspects of infertility and infertility therapy, section “Infertility and Assisted Reproduction – Basic Facts and Figures” provides basic information on the frequency of infertility and the subjective response to it in women and men, on the potentialities and risks of assisted reproduction and its psychological impact, and on long-term developments following successful/unsuccessful treatment. Section “Psychological Interventions for Infertile Couples” outlines practical examples of subject matter usefully addressed in counseling and psychological interventions for women and men with an unfulfilled desire for a child. The chapter closes with an outlook on the future challenges facing psychosocial infertility counseling, challenges posed mainly by the headlong progress of reproductive medicine.
... In neueren psychologischen Ansätzen wird der Kinderwunsch als Zusammenfassung verschiedener mehr oder weniger bewusster Motive zu Schwangerschaft, Geburt und Elternschaft gekennzeichnet, welche durch biologische und intrapsychische Voraussetzungen der Person sowie durch Sozialisation und gesellschaftliche Normen determiniert werden (Mittag & Jagenow, 1985;Gloger-Tippelt et al., 1993;Beutel, 2002;Stammer et al., 2002). Vielfach wird davon ausgegangen, dass diese Aspekte sowohl bejahenden als auch verneinenden Charakter haben und der Kinderwunsch damit ambivalent ausgeprägt ist. ...
This report gives an overview about certain aspects of modern reproductive medicine. The following issues are prioritised: development of medical facilities, people’s knowledge on reproductive medicine, appraisal of chances and risks, psychological aspects of involuntary childlessness, stresses and strains during IVFtreatment, ethical consequences of these medical procedures. Furthermore interactions between demographic and medical developments are analysed as well as resulting psychological and sociological perspectives. Previous research results present both a lack of knowledge towards reproductive medical treatments and disproportionate expectations and hope toward treatment-outcome. Very often expensive and complex methods are practiced to fulfil the child wish, but mental and social aspects remain unconsidered. So the motto “a child at any cost” on the part of many involuntary childless couples as well as of some fertility doctors poses a glaring contradiction to insufficient counselling in practice prior to, during and after the treatment.
Zusammenfassung
Der vorliegende Artikel soll einen Überblick über verschiedene Aspekte der modernen Reproduktionsmedizin ermöglichen. Auf folgende Schwerpunkte wird deshalb genauer eingegangen: Entwicklung der medizinischen Möglichkeiten, Wissen in der Bevölkerung, Einschätzung von Chancen und Gefahren, psychologische Aspekte der Kinderlosigkeit, Belastungen während einer IVF-Behandlung, ethisch-moralische Konsequenzen der Verfahren. Darüber hinaus werden Zusammenhänge zwischen demographischer und medizinischer Entwicklung sowie die sich daraus ergebenden spezifischen psychologischen und soziologischen Perspektiven aufgezeigt. Die bisherigen Forschungsergebnisse zeigen nicht nur ein Mangel an Wissen bzgl. fortpflanzungsmedizinischer Aspekte, sondern auch übertrieben große, zum Teil unberechtigte, Hoffnungen hinsichtlich der Wirksamkeit der reproduktionsmedizinischen Verfahren. Oftmals werden hochaufwändige und kostenintensive Verfahren eingesetzt, um den (langen) Wunsch nach einem Kind zu erfüllen, allerdings ohne psychischen und sozialen Wirkfaktoren Rechnung zu tragen. Somit steht die Devise "ein Kind um jeden Preis" seitens vieler Paare und aber auch Reproduktionsmediziner im krassen Gegensatz zu mangelnder Beratung vor, während und nach einer Behandlung.
The unfulfilled desire for children is a significant problem worldwide. The psychological effects of this development are usually underestimated, while the myth of “psychogenic infertility” stubbornly persists. This article first provides an overview of the basic facts on the subject before highlighting the psychological effects of both the diagnosis of infertility and the therapeutic options. Psychological aspects of “third-party” reproduction and further developments after childbirth or without a child are discussed, followed by a brief outline of the general and specific subject matter addressed in infertility counselling. The article concludes with reflections on the possible psychological consequences of further medical developments in this area.
Many life events or circumstances produce psychological imbalance through the severe emotional discomfort that human individuals experience. In recent decades, infertility has received increasing attention due to the implications it has for the functioning of infertile couples as well as for society. Undertaking treatment for infertility is a stressful experience marked by lengthy and invasive medical procedures, high financial cost, and relatively low success rates. Today, with the continued rapid advances in the assisted reproductive technologies, there is a much clearer recognition of the psychosocial issues that may arise over the course of treatment for infertile patients/couples as well as the critical role played in their management by mental health professionals. This review of the literature will present an overview of relevant psychosocial aspects related to infertility and its medical treatment. The findings of the studies that have dealt with the psychological factors of infertility will be reviewed. We will also highlight the consequences that this medical problem has in terms of the psychosocial functioning of couples experiencing the unpleasant experience of infertility. Special attention will be paid to the relationship between psychological stress and infertility. The impact that infertility has on the life of a romantic couple and gender differences in the subjective experience of infertility will also be addressed.
A large body of literature has emerged over the past four decades which highlights the need to address emotional needs in infertility and integrates psychological services within routine fertility care. Evidenced-based guidelines in most countries propagate that the mental health expert (MHP) plays a vital role as a team member in reducing the impact of infertility on the lives of patients, across all stages of treatment. In accordance with these global developments, inclusion of psychosocial care in fertility treatments is an upcoming trend in our nation. This review article brings forth the traditional role of MHP in infertility, compares patient-centered care with counseling, and elaborates on the guidelines on determinants of patient needs and suitability for structured psychological interventions. It also highlights the evidence-based studies on the application of psychotherapy in infertility.
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