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Micro-video: The Trauma of Infertility and Pregnancy Loss: Helping Our Patients Heal

Presenters: Janet Jaffe, Ph.D., Center for Reproductive Psychology; Julie Bindeman, Psy.D., Integrative Therapy of Greater Washington; and Karen Hall, Ph.D., Center for Infertility Counseling and Support

TRANSCRIPT

Hello, I’m Janet Jaffe, clinical psychologist from the Center for Reproductive Psychology in San Diego. I will be discussing the trauma of infertility and pregnancy loss, for both intended parents and surrogates, and provide some clinical techniques to treat trauma. At this time I’d like to acknowledge and thank my two colleagues: Dr. Karen Hall, who added her expertise on surrogates, and Dr. Julie Bindeman, who focused on EMDR.

While many reproductive patients fit the PTSD diagnosis, the definition of trauma can be broadened to include the disintegration of expectations, assumptions, hopes and dreams. When core beliefs of how the world is and how the world should be are disrupted, the very meaning of life can feel threatened. This is important because by the time reproductive patients reach our office – whether a mental health or medical facility – they are likely experiencing grief, depression, and anxiety, and may be having difficulties functioning in every day life.

The concept of the Reproductive Story captures core beliefs and assumptions about pregnancy and parenthood. Our stories about being a parent begin in childhood and develop into a major part of adult identity.

What are some of the core elements of the reproductive story? First and foremost, we believe that it will be easy. All we need to do is stop birth control and it will happen. Other people have difficulty, but not me because I’m healthy and strong. Another core belief is that if I work hard at something, I succeed. The conclusion then, if I don’t succeed, is that I must have done something to deserve this, and self-blame is paramount.

For most, a reproductive trauma is a huge blow to their sense of self. The extent of their reaction is related to the degree of deviation the story has taken, and what it means in the context of their life, culture, and history.

Because most surrogates do not feel maternal attachment to the fetus they carry, the trauma is about the loss of connection with the intended parents. The surrogate’s story, about providing a “gift,” abruptly ends.

Many surrogates have never experienced a pregnancy loss and assume they are invincible when it comes to reproduction. A loss can leave them confused about their previous assumptions about their health and their body.

Their loss is often minimized and misunderstood. They may be hesitant to discuss feelings of guilt, self-blame, and shame, and are left feeling isolated. This can feel like much more than they bargained for and can leave them with stress responses similar to PTSD.

We are now going to shift gears and talk about some treatment modalities.

EMDR, which stands for Eye Movement Desensitization and Reprocessing, is a well-documented treatment for PTSD.

EMDR posits that psychopathology is due to maladaptive or incomplete processing of traumatic life experiences. EMDR targets past experiences, current triggers, and future potential challenges, and facilitates the resumption of normal information processing and integration.

Because of it’s potential to work rapidly, EMDR is often proclaimed to be “magic”. It is not. Skeptics have compared it to snake oil or voodoo; however, EMDR has over 30 years of evidence that supports its efficacy. In essence, EMDR can interrupt the trauma loop a patient might be stuck in and enables them to call on constructive coping strategies.

Cognitive and narrative therapies are also effective in helping people get ‘unstuck’.

Cognitive therapy directly challenges peoples’ assumptions and core beliefs. As previously discussed, people tend to blame themselves if a traumatic reproductive event occurs. Even if there is evidence to the contrary, many feel better blaming themselves rather than having no explanation. Gently challenging their false beliefs and replacing them with logical evidence can be helpful in reducing their guilt.

An important part of healing and grief work is the ability to tell one’s story again and again. With each telling, the sense of isolation and shame can diminish, the pain literally has a place to go – out into the world - as it gets validated as real.

The reproductive story allows patients to ‘try on’ different endings. Although they’re in the middle of their story, they can imagine a variety of ways the story may conclude and take back a sense of control.

Out of loss, there is gain. Posttraumatic growth is positive change that occurs in the aftermath of a challenging life event. People experience newfound gratitude for the everyday, a not-taking-things-for-granted attitude.

From clinical experience, I have seen reproductive patients grow in extraordinary ways whether they are able to have children or not. Many want to “give back” as a result of their experience. One couple made memory boxes for other patients at the hospital where their daughter was born still; another took to Facebook to educate the community about what to say and what not to say when someone is dealing with infertility.

As people balance feelings of loss with a sense of growth, the strength that emerges is distinct. Knowing they can get through it increases one’s resiliency. A new core belief can develop: I am a person who is tough, hardy and can handle just about anything!

This has been a concise overview of reproductive trauma and its treatment. For more information, please feel free to contact me at: doctorjanetj@gmail.com. Thank you!

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