“Good practice in infertility clinics encompasses more than medical care. Clinics need to be prepared to take into account and deal with the psychosocial issues that confront couples who use their services.”
Guidelines for Counselling in Infertility. European Society for Human Reproduction and Embryology (ESHRE)1
Infertility consultations differ from other medical consultations in several ways. It’s probably useful to define a few of these before proceeding.
Alleviate suffering associated with infertility
Firstly, the central focus of the initial consultation is an unfulfilled goal in life. The denial of the biological and psycho-social need to procreate. So, the usual emphasis in medical consultations to diagnose and treat is modulated to define and alleviate suffering associated with infertility.
Secondly, the solution to the problem generally involves cycles of repeated treatments that have margins of success and failure. This, by its nature is a long process, which creates unique emotional stress; often accompanied by disappointment and even desperation.
Treatment has implications
Another important consideration is that the treatment has implications on the life of the patient, their partners and close relatives. The patient’s ability to cope with the psychological and emotional effects of treatment have to be considered with each new treatment.
Finally, the exercise aims to create a third person, the yearned-for child. Yet the child is not represented in person, so essential issues must include the best interests of the child. Such as the family environment and potential conflicts of interest between the wishes of the patient and the needs of the non-existent child.
To sum up, the main differences between the IVF consultation and other health care consultation are:
- The focus on an unfulfilled life goal.
- The length of treatment and the cycles of success and failure, which impinge on the patient’s emotional wellbeing.
- The impact of treatment on the personal lives of the patient and their significant others.
- The need to consider a third person who is not in attendance – the unborn child.
From a tactical point of view, it is number 2, which can be considered as most important. Because consideration of it allows a skilled counsellor to build a psycho-social scaffold around each step of treatment and cycles.
But what do we mean by psychosocial care in the IVF setting?
Generally, it is helpful to consider two aspects:
- Patient-centred care: this is the psychosocial care provided as part of routine services at the clinic. Patient-centred care is expected from all members of the clinic team at all times
- Counselling: this involves the use of psychological interventions based on specific theoretical frameworks. Counselling is typically delivered by someone having received training in the mental health professions.
Patient centred care
Think of the psychosocial process at each stage of therapy. Beginning with the initiation of the patient relationship and ending with the outcome and evaluation of a given treatment. Each step in the cycle can be broken down into four dimensions:
– The purpose: the psycho-social reason for the encounter. The psycho-social purpose of the first meeting with patients might be to to provide a helpful and competent environment.
– The objectives: these follow from the purpose. The objectives following on from the purpose might be to ensure that patients feel understood, respected and reassured.
– The issues: these are the barriers to the objectives. Some typical issues encountered in a first meeting are that patients aren’t allowed to overcome feelings of embarrassment and shame.
– Communication skills: at every stage of the process good communication skills are required. They encompass everything from remembering who the patient is, right through to detecting that patients are unable to express negative feelings.
IVF health care professionals play an important part in ensuring that psychosocial care is integrated into patient care through their relationships to the patient. Depending on past training, health care professionals – particularly nurses – can also be involved in the counselling of infertility patients, though for the most part clinics will refer patients to trained counsellors for this aspect of their treatment experience.
In order to obtain a good standard of patient centred psycho-social care it goes without saying that health care professionals in the IVF clinic setting should have good communication skills and a basic knowledge of counselling.
Counselling, as opposed to patient-centred psychosocial care, aims to address the extraordinary, unique specific needs of some patients.
The type of counselling depends on the patient and the treatment choice, but will usually involves the following:
- Information and implication counselling: ensuring that that individuals understand the different psychosocial issues involved in their treatment choice
- Therapeutic counselling: understanding the emotional consequences of childlessness or treatment failure.
One of the main differences, of necessity, between patient-centred psycho-social care and counselling is the counsellor’s level of training. The counsellor is generally working at a higher primary-focussed level than a healthcare professional who is providing psycho-social care as an adjunct to medical therapy.
As a minimum, counsellors should have received training in one of the mental health professions as well as training in the medical aspects of reproduction.
To sum up, let’s refer again to the ESHRE guidelines:
“Good practice in infertility clinics encompasses more than medical care. A more holistic approach to patient care is believed to improve health outcomes, increase patient and team satisfaction, reduce negative psychosocial reactions and help patients better come to terms with their experiences.”
Neil Madden, Editor
The Fertility Hub
- J. Boivin, T.C. Appleton, P. Baetens, J. Baron, J. Bitzer, E. Corrigan, K.R. Daniels, J. Darwish, D. Guerra-Diaz, M. Hammar et al. 2001. Guidelines for counselling in infertility: outline version. Human Reproduction, Volume 16, Issue 6, June 2001, Pages 1301–1304