In Session: Psychotherapy in Practice最新文献

Pregnancy loss following assisted conception confronts couples with grief, anger, self-doubt, and questions about the measures they have taken in order to conceive. Each of these issues is intensified when a couple suffers additional pregnancy losses. Couples find themselves in the paradoxical situation of simultaneously seeking and fearing conception. This article describes and illustrates how the use of advanced reproductive technology—and specifically, the close monitoring of early pregnancy—alters the experience of early pregnancy loss. The case example highlights the challenges that a couple experiencing prolonged infertility and repeat pregnancy loss bring to clinical practice. © 1996 John Wiley & Sons, Inc.

This article focuses on a set of disagreements that a couple experienced while pursuing infertility treatment. Aspects of conflict that are unique to this case and others that are common to most cases involving infertility are discussed. The thrust of the article is that conflict is an inevitable aspect of infertility, rather than the symptom of a troubled marriage. A therapist must understand the situational factors contributing to the conflict and help the couple learn to resolve it. Intervention procedures are noted that can help ameliorate infertility-related conflict. © 1996 John Wiley & Sons, Inc.

Infertility frequently has a profound and long-lasting psychological impact on individuals and couples attempting to conceive. The psychological responses to infertility vary, but typically include loss of self-esteem, depression, anger, and guilt. Psychotherapy, although not a cure for infertility, can help couples cope with the pain and emotional distress that infertility may cause. This article describes common responses to infertility and includes a case illustration of the psychological impact of infertility. Mahlstedt's (1985) theory of infertility as a series of losses is used to provide a theoretical framework for understanding and structuring psychotherapeutic interventions for both immediate and long-term reactions. © 1996 John Wiley & Sons, Inc.

Research has strongly suggested that infertility is an organic problem. Recently, studies have indicated that, indeed, stress may contribute to some cases of infertility. Stress management and relaxation training show promise in decreasing psychological distress in infertile women, as well as the potential for increasing conception rates. A behavioral medicine group treatment program for infertile women was started in 1987, which is described and illustrated in this article. Participants demonstrate significant decreases in all measured areas of psychological distress, as well as a 34% conception rate. Because the majority of infertile women who attend behavioral sessions experience significant psychological relief, and some may experience increased conception rates, it is suggested that such psychological interventions be offered to all infertile women. © 1996 John Wiley & Sons, Inc.

Infertility can be an extremely psychologically stressful experience. Seeking social support, through disclosure and discussion of the infertility to friends and family can be helpful to many infertile couples. When a couple is undergoing the assisted reproductive technologies (ARTs) including third-party reproduction, disclosure can have both a positive and negative impact on the couple. Disclosure about the use of donor sperm, donor egg, or a gestational carrier may lead to disapproval from others and/or reveal information a couple would prefer to keep private. Alternatively, disclosure can provide the couple with important social support and understanding from others. This article reviews the issues of privacy and disclosure, specifically focusing on a case illustration of a couple deciding whether to disclose their use of anonymous sperm donation. The role of the mental health professional as a facilitator in this process is emphasized. © 1996 John Wiley & Sons, Inc.

As infertility treatment continues to provide more options to couples and individuals who wish to conceive, the decision of when to end treatment falls increasingly on the patient rather than the physician. Often this decision is made more difficult by conflicting emotions and information received by the individual or couple. The pressure to continue treatment may be perceived as coming from partners, parents, cultural expectations, or medical professionals. When a couple or individual decides to end treatment, it may be to go on to alternative parenthood options such as adoption, surrogacy, or donor gametes. Conversely, the decision to end infertility treatment may result in the difficult decision to live child-free. Regardless of what course the couple elects to follow, the actual decision to stop is ultimately bound up in the individual's ability to relinquish the hope and dream of having his or her own genetic child. © 1996 John Wiley & Sons, Inc.

Infertility can significantly stress a couple relationship in a myriad of ways. Men and women have different ways of coping with infertility and, at times, one or the other partner feels insufficiently understood or supported. Issues of coercion, communication, financial allocation, and empathic failure are common. Furthermore, marital and sexual constriction often occurs, both during the months (or years) of infertility intervention, and when the infertility crisis has apparently been successfully resolved. This article addresses these issues and illustrates them with a case example involving both primary and second infertility. It is noted that empathic, effective individual and couple therapy can be an important resource in dealing with both the immediate and long-term aftermath of infertility on sexual and marital functioning. © 1996 John Wiley & Sons, Inc.