Infertility, including the inability to carry a pregnancy to term, can deeply affect the emotional and psychological well being of women.
Fertility, in our culture and others, stands for productivity, growth, and continuity. For most people, reproduction is a basic expectation of life, and to have a child is to continue the human life cycle. It is the renewal of life; it is a type of immortality. Because fertility and childbearing are deeply rooted in our psyches and in our culture, the inability to have a child can be a powerful threat to identity. Specifically, the experience of infertility is often defined as a “life crisis.” Its impact on self-image, marital and sexual relationships, and relationship with family and friends is significant. To become a parent is regarded by many as the most significant rite of passage into adulthood. As such, infertility brings with it many real or potential losses: the loss of self-esteem, the loss of a dream, the loss of close relationships, financial losses, and the loss of a sense of self as a healthy sexual being.
Society places a high premium on family, and women have traditionally assumed the roles of giving birth and nurturing children. A number of studies suggest that women exhibit more emotional distress related to infertility than men (who also experience male-factor infertility stress). Depression, anxiety, anger, and guilt are common psychological responses to infertility. These conditions can be exacerbated as patients feel unable to predict or control treatment outcomes.
Infertility, as well as habitual pregnancy loss, touches people deeply. It threatens their identity as capable adults, and can have significant ongoing psychological effects. Addressing the psychological components of infertility can not only help individuals and couples in developing more effective coping strategies, but can also help them make important decisions about treatment as well as other parenting options.
Anxiety and Depression During Pregnancy
Pregnancy can be a period of emotional well-being, but for some women it can be just the opposite: research shows that depression is one of the most common complications of pregnancy. Women with pre-existing mental health diagnoses are at particular risk of relapsing during pregnancy or postpartum. Family history of depression, lack of social support, and unplanned pregnancy are also risk factors for depression during pregnancy. Infertility treatment resulting in pregnancy has also been shown to be related to increased anxiety during pregnancy.
If you have already been treated for a mental illness or feel that you are at risk for developing one, consultation with a licensed psychologist who specializes in reproductive women’s mental health can help you cope and put you on the path to wellness for both during and after your pregnancy.
Postpartum Support for Depression and Anxiety
The postpartum period (after pregnancy) is another time when women are vulnerable to depression and/or relapse of previous mental health illness. Although many women experience passing feelings of “baby blues” in the 3-14 days after giving birth, about 10 to 20 percent of women become clinically depressed. A common symptom of postpartum depression is anxiety. Women may worry that they are not doing a good enough job in caring for the baby, or feeling overwhelmed, and mourning how their life used to be before their baby arrived. These symptoms can worsen to the point of impairing a woman’s ability to care for herself or the baby. The postparum transition can be very rough on mental wellness. I work with new and experienced mothers during what I like to call “the fourth trimester” (which often lasts much longer than 3 months postpartum, sometimes years), however long you need support services. Recovery is within reach.
Women and men all ages don’t understand what keeps them from having the relationship they want. They may spend time in relationships that are not beneficial to them, want to improve their current relationship, date aimlessly or not date at all. Often, women do not realize the power they have in a relationship. They may feel helpless to improve aspects of the relationship that are not working.
Symptoms of depression and anxiety are often associated with relationship difficulties. It may be difficult to determine which came first – the pattern of intermittent depression, or the difficulty with relationships.
Therapy can help you build skills in emotional tolerance and communication, identify relationship pitfalls, understand the influence of personal history, clarify their relationship needs and ameliorate depressive symptoms.
Couples counseling can improve communication and help strengthen the foundation of your relationship. Through research-proven success techniques (primarlily from Dr. Gottman), my job is to help you and your partner connect, rekindle what you may be worried is lost, and help you move forward in our relationship with confidence and research-proven tools to keep in your toolbelt. Many relationships need a “tune-up” now and then, it’s not abnormal or shameful at all.
Sexuality is a complex interplay of emotional and physical factors. Women at any age can struggle with issues of sexuality, from basic concerns about intimacy to sexual dysfunction. Women are often hesitant to discuss their concerns about sexuality with their physicians.
Sex therapy often begins with an educational phase, as a person’s uncomfortable feelings may be due to needing more information on the subject. Literature on sexuality and closed facebook groups can help with this, in addition to counseling. Secondly, there is the “permission” stage of sex therapy counseling, which involves resolving insecurities/questions about whether or not it is ok to feel the way you do or want what you want. In this stage it is important to realize that there is a *very* wide spectrum or degrees of interest in sex.
Finally, the process of unpacking one’s sexual history (even if you hadn’t had sex until your spouse, ever since you were a kid you likely received messages about sex and positive/negative attributions about it). A history of abuse is critical to disclose to your therapist for progress to be made, as trauma impacts one’s sex life, even if it happened decades ago. If one has not had an abusive sexual past, writing down one’s sex history for deeper insight and mindfulness can be therapeutic before counseling begins, or to share with your partner if you feel they are a safe person and you want to communicate this history to them for greater understanding (be cautious, however, as this is a very vulnerable act and you must be sure you can trust them).
Sexual disorders (as diagnosed in the DSM-V) can occur at the desire, orgasm, or resolution phase. Inorgasmia (inability to experience orgasm) is quite common in women, most studies report 1 in 3 women have trouble reaching orgasm during sex, and as many as 80% have difficulty reaching orgasm through intercourse alone. Vaginismus (pain during intercourse) is also common. If you are experiencing these and they are interfering with your life, counseling can help.
Parenting and Child Behavior Assessments
Now that you have your bundle of joy, becoming a new parent can be very challenging. Whether it is your first, or your older children are having a hard time adjusting to the new arrival, counseling support can be helpful to anyone feeling overwhelmed. Very practical tools from a psychologist can help you diagnose problems and implement new strategies, and monitor them over time for results.
I was trained in Massachusetts as a Postdoctoral Fellow to conduct In-Home Behavioral Assessments for children and families. I offer these services to clients, whether in person or by satellite. Such an assessment includes multiple interviews to pinpoint the problematic behavior in your child you wish to change (up to 4 target behaviors), and then multiple observations either in person for local clients, or via (supervised by you) skype/facetime/webcam monitoring of your child’s everyday activities to observe the behavior and the setting in which it occurs. This report, customized to your child, will provide all the parenting support you’ll need. I will also interview your child, depending on age. Once I have collected this data, I will write a 5-8 page Child Assessment Report detailing a plan to stop these problem behaviors, with specific tools and research-proven methods to improve your child’s specific behaviors. Included will be 3 follow-up sessions to monitor continuing behavior and adjust the behavioral assessment accordingly as your child progresses.
I am also trained to provide intelligence testing, neuropsychological testing, as well as assessment for learning disorders, Autism Spectrum, and ADHD–for children, adolescents, and adults.
Spirituality can provide deep and satisfying meaning in individual’s and couple’s lives. It is quite normal for adults to progress through “stages of faith” and question certain aspects of their religious upbringing. I help people unpack what they’ve grown up with spiritually, what they would like to keep with them, what they feel they are ready to let go of based on what currently brings them joy vs. pain, and how to move forward given what you are sorting through: in your personal life, your relationships, your extended family, friends, and community. Adjusting to a faith transition (some refer to it as a faith expansion, faith crisis, others an exodus) can be very stressful, decisions don’t have to be made right away. I believe authenticity and carving out a meaningful life based on those values you hold dear is key to a good life.
Faith transitions can rock the foundations of a couple’s relationship, if one or both are re-examining their religion. An individual’s relationship to their faith community can also be helpful to talk about in therapy for those undergoing a faith transition. Such a life transition is common but can lead to distressing symptoms (akin to an adjustment disorder), that therapy (either couples or individual sessions) can alleviate. You don’t have to go through a faith transition alone.
Career and Family Balancing
Work and family conflict stems from combining multiple responsibilities and roles, such as parent, partner, individual and employee. While some distress navigating multiple roles is natural, those experiencing prolonged or persistent distress is that interferes with functioning may benefit from treatment.
Trouble balancing all this is not generally labeled as a specific disorder, probably because it manifests so differently across individuals depending on their circumstances and resources. For example, some women experience distress while attempting to set clear boundaries between their work and their family roles, feeling somehow inadequate and shortchanged in both arenas. Others may struggle emotionally in their roles as spouse or mother, unsure of their own identity outside of a caretaking role. And still others may feel preoccupied with work or financial concerns that impact their family choices.
No matter how work and family conflict manifests, women in significant conflict are likely to experience some symptoms of either depression or anxiety, such as low or anxious mood, difficulty making decisions, sleep disturbances, poor concentration, procrastination, restlessness, and irritability.
Effective treatment that you’ll receive focuses on symptoms of anxiety and depression, and helps optimize experience in both work and family situations. Coping and assertiveness skills training are usually beneficial too. Focused, shorter-term therapies such as cognitive behavioral therapy may be successful treatment approaches for this type of conflict while longer-term dynamic treatments may help to address underlying issues that lead to assumptions about if you feel you’re “not good enough” or are assuming a role that you feel was pressed upon you from cultural, religious, or family expectations.