Last week I talked about counselling ART patients, but who are the patients that most benefit from this?
An academic review reveals three groups of patients who might benefit from counselling during ART therapy:
- Highly stressed patients
- Those who require third-party services such as surrogacy or donation services
- Patients with unique social circumstances such as single women, gay or lesbian couples.
Let’s take a look at these groups.
Highly stressed patients
In general practice counselling highly stressed patients make up the majority of consultations. However, this is not the case in ART counselling, where only 20% are considered to be highly stressed.
Stress in these 20% of patients can manifest as depression or anxiety. These patients often describe themselves as being overwhelmed and unable to cope. The counselling strategy for these patients depends on two things.
Personal characteristics of the patient that place them at risk of high stress. These can include Type A personalities who are time-conscious, deadline-driven and competitive. This group also have a predisposition to anxiety or depression. They may have a history of prescriptions for these conditions or symptoms of them such as insomnia.
Identifying the cause of distress. This could be treatment-related, such as IVF cycle failure, fear of medical procedures themselves or fear of procedure failure. It can also be related to circumstances like peer pressure or financial worry. However, special circumstances like the implication of a multiple pregnancy should be considered.
Patients who require third-party services
These are patients who require surrogacy, donated eggs or donated sperm in order to achieve their dream of parenthood. The introduction of a third party causes unique stresses and emotional issues that require additional counselling.
Counselling strategies in these cases might include:
- Help couples come to terms with the implications of third-party reproduction
- Ensure the emotional wellbeing of the parent who will not be biologically related to the child
- Discuss the legal, medical, religious and cultural considerations
- Discuss the effect of donation on the donor’s family
- Counsel on secrecy/openness towards the future child
- Address the potential lack of support some patients may encounter
- Clarify the role of any known donor/surrogate in the future life of the child
- Couples donating embryos should resolve their feelings about the embryos
- Patients need to evaluate the fact that hereto unknown siblings of the future child may exist
- Evaluate reasons for needing surrogacy, and evaluate motives of surrogate
- Discuss legal issues
- Prepare the patient for potential long wait in egg-sharing programmes
- Counsel on the high drop-out risk in voluntary egg donation schemes and the potential lack of choice.
Patients with unique social circumstances
These are patients who seek fertility services because of their social status rather than for medical reasons. For instance, single and lesbian women who require sperm donation services, and gay men needing surrogacy services. These patients face issues that are specific to social infertility and require counselling that is in tune with their specific objectives.
Counselling strategies for such patients might include:
Lesbian couples
- Strategies on how to integrate the child into the family/social environment
- Discuss assignment of parental roles between the couple
- Discuss the position of the non-biological mother
- Determine the legal status of the child and non-biological mother
- Consider the consequences of the absence of a father in the future development of the child.
Single women
- Assess the mental/social wellbeing of the potential mother
- Help the patient come to terms with the fact that a loving partner will not be present to help them in their desire for parenthood
- Discuss the social and economic considerations of being a single parent
- Potentially the effect of becoming a mother at an older age than usual.
Gay men
- Strategies on how to integrate the child into the family/social environment
- Discuss parental role allocations
- Discuss role and legalities of surrogate mother
- Consider consequences of the absence of a mother in the future development of the child.
These are not all encompassing and just provide a snapshot of some of the issues that might be discussed in these circumstances. Of course, in reality, although these three groups of patients can be discrete it is better to think of them as a Venn Diagram with the potential for their populations to cross over into each other’s spheres.
Experienced counsellors will be adept at recognising where their particular patients fit in the Venn Diagram. You can appropriate strategies and techniques to match the requirements of each individual patient.
Neil Madden, Editor
The Fertility Hub
References
J Boivin et al. 2001.Guidelines for counselling in infertility: outline version. Human Reproduction Vol.16, No.6 pp. 1301–1304, 2001
