COUNSELLING: DEPRESSION, ANXIETY, GRIEF
Stages of grief in infertility
By Francine Blanchet, MBACP,(Accred.) MA, BA, Adv Dip Couns. AMBICA (Accred)
The issues that face those with infertility problems may include any number of emotional responses including fear that they are “not normal”, loss of self-esteem and/or a sense that they are not in control of the direction of their lives. They may also face existential anxieties regarding the purpose of their lives – “What am I here for?” or, “How do I now define myself in the world?”. A fear that stretches ahead of them with no children to occupy their time and energy. They may ask themselves, “What do I do with my life if they are no children?”
People who receive a diagnostic of infertility typically respond with shock and denial. It can take time before one can accept the reality of their situation. The refusal is normally a state that does not last long, it is a state of shock. One cannot work their head around the situation and accept the medical position that there is something wrong, especially if the couple had dreams about having a child and a family.
The couple now need to deal with the loss — the loss of the dream, the loss of an imagined future, the loss of being unable to procreate, the loss of being a biological parent. The anger can be distributed widely including being irrational with staff and colleagues at work and even exhibiting irritation with everybody at the infertility clinic. They can say that those who are trying to help are incompetent, didn’t do enough, that they have not proven themselves. The client is not conscious of that. They believe they are in their right to complain and to react the way they do. It is also difficult when they are through this stage and the couple are trying to understand each other’s grief. Nobody mourns in the same way so instead of helping each other, they can be pushing each other away.
Fences are erected and there is a desire sometimes to hurt each other because of the hurt the client is experiencing. It is a complex emotion and sometimes we just need to react to this in a sensitive way.
This is when the client wants to exert control over the situation. In their mind there is a process of give and take. “If I could get pregnant just once, I promise I would be the best parent ever. I only ask for one child and I will start to give my time to some charities”. Or just getting pregnant to know how it feels. It is a very painful process when it does not work, because the bargaining never works. The couple can revert to anger very easily.
Over time many couples find that they begin to despair of achieving their goal of having their own biological child. An infertile person may become depressed. It might be overwhelming as they face the possibility that the child they were striving to have may never be.
When the couple confronts their fears of being childless, the anxiety and the tension can increase.
It is important to distinguish between sadness as a healthy response to a major shift in one’s self-image and sense of one’s place in the world, which requires recognition, time and understanding to work through, as opposed to depression which is a more sustained response. Depression needs long-term management to resolve. (Stuck grief will be discussed later).
The loss attached to childlessness may include loss of faith, loss of power, loss of dreams in the future and loss of sexuality and intimacy. Then for the male, it is the loss of self-image (virility) and for the women, not being a true “woman” and being able to fulfil that function properly. The couple feels they have failed the basic task, having a family.
This can be defined at the point which the person has accepted the reality of the loss and then are able to put energy into the present and to start to plan for the future. It can emerge at any stage of the infertility treatment or management process. Couples may come to accept that they will never have a child and feel able, even eager to move forward to a new life without children. They come to an acceptance of their infertility and feel ready to consider the option of donated sperms or ovaries to help them to have a child within their relationship. The infertile couple needs to accept that they will not have the imagined child of the relationship and be ready to incorporate a different to way of creating a family.
At this time the person or the couple will have grieved the loss of their fertility, as well as the loss of their biological child. They will be prepared to move on with renewed energy to the acceptance of a child through adoption or gamete donation. Acceptance may be indicated to take up a treatment option that previously had been unacceptable to them.
What is there to do?
Worden’s four tasks of mourning:
- Acknowledge the reality of the situation – it is important after having experienced denial that the loss is fully acknowledged. The client may discount the significance of the loss, the infertile person may search for another diagnostic or may be unable to let go of a scan picture of the implanted embryo.
- Work through the pain of grief – some people will not allow themselves to feel at all and focus on the next treatment. One of the aims of grief counselling is to help facilitate people through this difficult task so they don’t carry the pain throughout their life. Sooner or later, some of those who avoid all conscious grieving, break down – usually with some form of depression. The unseen nature of infertility means that it is all the more easy for those around them to discount their pain and to try to point out all the positive sides of child free living, at the time where the couple needs to feel that they are allowed to cry, rage and feel the pain of this enormous blow to their sense of themselves, their hope and their aspirations.
- Adjust to the environment – this is the last part of the acceptation.
- Emotionally relocate and move on with life – reinvent their life without children and take pleasure and meaning in the world where their own biological children are missing.
Egan helping model:
Firstly, exploration: taking time to look at what is there – resources, passion and hobbies to be built upon those so to help for a new meaning.
The second stage is new understanding: there is hope and after the bereavement and the sadness, some actions can be taken.
Finally, action: start with taking care of the body, possibly exercising, eating well and meeting friends.