Devastating mental health consequences sometimes unfold due to unfortunate circumstances. Combined with limited coping skills, life can quickly spiral out of control if proper help is not received. Infertility, defined as a failure to conceive naturally after 12 months of repeated, and unprotected sexual intercourse, negatively affects marital or sexual satisfaction, and psychosocial well-being (Luk & Luke, 2015). Multiple studies report infertility to increase risk for emotional imbalance (WHO, 2002), and women tend to feel more stress than infertile men, considering themselves a failure in their responsibility to reproduce and inadequate as a woman if they are incapable of perpetuating the family line (Luk & Luke, 2015). The cognitive behavioral counseling approach is supported by research to help individuals and couples move beyond the heartaches, and find renewed satisfaction in life.
The most common answer to problems with infertility is IVF, or medically assisted techniques to improve a couple’s potential for conception. However, seeking fertility treatments may prove detrimental to one’s psychological well-being. Namely, because the process is expensive, time consuming, and worst of all, not guaranteed to work (Luk, & Luke, 2015). Lack of success turns into shame, severe depression, and resorting to dysfunctional coping mechanisms. Depression and anxiety tend to be leading culprits for emotional drain, and research is inconsistent regarding the overall quality of life impact. However, women report numerous symptoms while dealing with infertility, including sleep disturbances, elevated anxiety, reduced concentration and interest in usual activities, weight fluctuations, feeling socially isolated, guilt, pessimism, and suicidal tendencies (Ramamurthi, et al., 2016). Additionally, cultural effects can increase problems, especially in family systems in which in-laws have influence over marital relationships (Luck, & Loke, 2015). Husbands, and the commitment to a couples relationship is significant predictor in the couples ability to handle the infertility crisis, and supporting each other through the experience may serve to bring the couple closer and strengthen their relationship (Luk, & Luke, 2015). Research shows that individuals with greater self-confidence, and self-esteem report less significant symptoms of anxiety and depression, and tend to utilize more successful coping methods. Reframing, a technique to define threatening events in more manageable ways, is one of the most useful tools, and correlates positively with couples adjustment, and decreased anxiety and depression symptoms (Myers & Wark, 1996). On the other hand, passive appraisal, or simply avoiding and denying the issues in hopes the threatening event will disappear, results in the opposite effect for couples.
A cognitive behavioral treatment approach may prove highly effective for individuals, and couples seeking help for issues stemming from infertility. Cognitive Behavioral Marital Therapy (CBMT), which views marital distress as a function of unsatisfactory behavior exchanges between spouses, is an effective treatment for relationship problems (Myers & Wark, 1996). Likewise, a cognitive behavioral approach can be tailored to fit the needs of couples experiencing an infertility crisis. The cognitive behavioral approach is comprehensive, and effective for a variety of issues, and works to identify and counteract automatic thoughts (Myers & Wark, 1996). The technique also proves ample for addressing decision-making and emotional needs through emphasis on communication skills. Using a cognitive behavioral approach, counselors need to help clients pinpoint four targeted goals:
1) Identify and evaluate appraisals concerning infertility and marriage, 2) Redirect efforts toward sources of satisfaction other than children, 3) Communication and problem-solving techniques to facilitate expression of emotions, needs, and resolution to the infertility crisis, 4) Improving the couples sexual relationship (Myers & Wark, 1996).
For total emotional success, couples must agree to an ultimate resolution. This means setting an agenda for each goal, with a start and end date. For example, when attempting IVF, the couple must have an end date for a decided outcome so they do not continue into a state of helpless despair. If adoption becomes a goal following unsuccessful attempts at conception, it must be acknowledged that adoption will not completely end feelings of emptiness, and the couple needs to accept missing out on the experience of pregnancy, childbirth, and other experiences that may have occurred prior to adoption. Couples are likely to feel some level of hurt long past treatment, but should expect renewed emotional strength, confidence, and the capacity to manage their well-being with beneficial coping skills. Couples can find success and accomplishment in many other areas of life, and marital satisfaction is possible for couples facing infertility. This author recommends couples seek counseling early in their struggles to conceive, and before attempting fertility treatments. A counselor can help the couple set goals, learn coping skills, and gain emotional preparedness for one of life’s most unfortunate circumstances.
Luk, B. H., & Loke, A. Y. (2015). The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review. Journal Of Sex & Marital Therapy, 41(6), 610-625. doi:10.1080/0092623X.2014.958789
Myers, L. B., & Wark, L. (1996). Psychotherapy for infertility: A cognitive-behavioral approach for couples. American Journal Of Family Therapy, 24(1), 9.
Ramamurthi, R., Kavitha, G., Pounraj, D., & Rajarajeswari, S. (2016). Psychological impact and coping strategies among women with infertility – A hospital based cross sectional study. International Archives Of Integrated Medicine, 3(2), 114-118.
World Health Organization, 2002. Gender and mental health. Retrieved from: http://apps.who.int/iris/bitstream/10665/68884/1/a85573.pdf
Dustin Choate, LPC