Insights from Emotionally Focused Couples Therapy to Help Couples Who Are Going Through Infertility Treatment.
Infertility and the rigors of infertility treatment are stressful and exhausting emotionally and physically. They take a toll on each member of a couple individually as well as on the relationship. This is not just a feeling, but a well-documented reality. According to researchers Hassani et. al., “Infertility creates major and prolonged stress for couples” (2010).
This stress mixed with the heightened emotions of infertility can lead to conflict. Couples may experience anger and resentment towards one another, sometimes wishing the process of conceiving could be easier or different. Often couples experience guilt and shame about their inability to conceive. These emotions cause communication to break down between the partners which results in arguments and avoidance. And maybe I don’t need to tell you, these negative emotions and strained connection may be counterproductive to their efforts to conceive.
In addition to stress, there are a host of effects of infertility that can sometimes get lost in the doctors’ visits and awkward family conversations. Here are examples of some common social and emotional effects of infertility:
- Undermined sense of womanhood
or manhood (Najafi, 2014)
- I’m not a real woman or man if I can’t have a child
- Sense of guilt
- I can’t provide a child for my partner/myself
- Undermined self-esteem (Hassani, 2010)
- Anxiety and Depression (Pash, 2016)
- Poor marital adjustment
- The couple has lost some degree of affection, relationship satisfaction, and connection, and sees an increase in conflicts
- Sexual relationship affected
Gender Differences in How Couples Experience Infertility:
Despite those common effects of infertility mentioned above, men and women experience infertility differently. In general, men and women respond differently to stress. Men tend toward the “fight or flight” response of either solving the problem or distancing from the negative emotions. Women are more likely to “tend or befriend” and talk through their emotions or reach out for support. These differences in response create the perfect conditions for conflict. Here are a few key differences that may be helpful to keep in mind if you and your partner are struggling with infertility.
1.Research shows women are more affected then men (or women are suffering more)
In some studies, women report more stress from infertility than do men who were also surveyed. More than 50% of the women reported that infertility was “the worst thing that has happened” to them. Women’s reported stress was comparable to having a terminal illness or suffering the loss of a loved one (Domar 1992).
Additionally, the woman (or the childbearing partner) is the one who receives the majority of the infertility treatments, regardless of the source of the infertility issue. These treatments are demanding physically and emotionally, involve disrupted schedules to attend appointments, various painful shots and procedures, and side effects of artificially increased hormones and other medications.
2. Motherhood is often central to a woman’s identity
Biologically, some women may feel a stronger need to have a child than men. But, biology aside, motherhood is also a central identity role in our society. Among other pressures toward motherhood, women are often questioned about when they will have children. Pregnancy itself is often viewed as a developmental milestone for a woman to feel she’s had the “complete” experience of womanhood and having a baby a desire that she and her family and friends may have cultivated from a young age.
On the male or non-childbearing side of the equation, it may be that it’s easier for the other partner to get satisfaction from work and career alone, and they are less likely to be bothered by strangers about whether and when they plan to have children.
3. Different coping styles
Most women talk about issues and are more emotional and expressive than their male counterparts (Hussani, 2010). Men tend to be problem solvers and prefer to process things in more quiet or problem solving ways without necessarily talking them through. This difference in coping style can be misinterpreted as indifference around the infertility and couple’s wish to have a child.
When different coping styles aren’t recognized or understood, it can lead to relationship problems like distancing and conflict. Each partner requires support and empathy while going through infertility treatment, and permission to cope differently. The experience is much more manageable when taken on as a team.
Jane was diagnosed with endometriosis. She knew she would have problems conceiving, and soon after she married John, she pursued infertility treatment. Due to the severity of her condition, the couple started with IVF right away.
Jane schedule was quickly filled with appointments at the fertility clinic. Frequent absences for medical monitoring began to affect her work, but she kept her worries about the IVF and her work to herself. Deep inside, she felt guilty that it was her fault that they needed to go through IVF. She blamed herself that her husband could not have children. At times, she would melt down and cry. She did not feel entitled to talk about her struggles with her husband because it was too painful to talk about the infertility being “her fault.” She was withdrawing and hiding her pain. Her husband did not know what was going on with his wife, but he was very hopeful and optimistic about the success of IVF.
They were already mismatched in their emotions—he was positive while she was fearful and sad. They could not talk about that. They hid their pain and sadness to themselves.
When IVF didn’t work out, Jane was devastated. She cried and cried. John, concerned about his wife’s sadness, tried to cheer her up. He was also sad but felt that as a husband he needed to be strong and be positive for his wife. He did not share his sadness with her and acted as a problem solver and fixer. He offered solutions: they could try again, they could adopt… John did not know how to join his wife in her grief, so she felt devastated and alone.
What she needed was a hug. Jane also needed John to see her pain. Instead, she sensed that it was too hard for John to see her so sad, so she hid her pain even more. They started drifting away from each other when underneath they wanted to be together and have a family.
How to Deal with These Differences in a Productive Way:
In emotionally focused therapy (EFT), created by Dr. Sue Johnson, couples learn how to deal with these differences in a productive way. These three strategies inspired by Johnson’s “steps to forgiveness,” help safeguard the relationship so that it can weather the stress and high emotions of infertility (Johnson, 2008).
1. Clearly express yourself
Articulate your feelings and be clear and specific. Saying, “I’m stressed” isn’t helpful when everyone is constantly feeling stress. You have to go deep, to the dark and vulnerable part, and express how you feel. Tell your partner about your pain in the simplest way you can. Try to focus on your pain and what caused it and stay away from attacking and blaming. How did you feel when you learned you might not be able to conceive? Or when you had your first IVF treatment, or your last? What did you need from your partner in that moment? What do you need from them now?
Here are some examples of how to talk about your inner hurt in a useful way:
- “ I’m afraid I will never get pregnant.”
- “I’m angry at my friends that got pregnant easily.”
2. Be present with your partner
It’s easy to drift away from your partner amid the demands of everyday life but taking the time to be present with your partner and in your relationship is a counterbalance to the busy pace of life and the stress of infertility. It’s crucial to make time for just each other, with no distractions and no technology.
Be available and responsive to your partner’s needs.
If you are the partner that is not going through fertility treatment, most often male, hear your partner’s complaints. Don’t offer suggestions. When you acknowledge the pain, hearing and validating her sadness or her hurt, you will increase your emotional connection and it will show her clearly that you care.
3. Lean on each other
Approach infertility as a team. Be supportive of your partner, and remember to approach the stress, the schedule changes, the doctors’ appointments, the everything, as a unit. You’re in this together, so make an effort to tackle it together.
Research from disastrous events like 9/11 shows that survivors who had someone to rely on for connection and support in the months that followed healed more easily from the trauma (Johnson, 2008). Infertility can be a trauma for the individual and for the relationship. And the strain of infertility can remain in the relationship many years. Leaning on each other and working to strengthen your connection will help both of you find healing.
Research Proven Methods with Positive Effects on Couples Going Through Infertility
Emotionally Focused Couples Therapy (EFT) has significant positive effect on marital adjustment in everything from communication, to affection, to reduced anxiety and depression (Najafi, 2015). In fact, EFT has been shown to be more effective in reducing anxiety and depression than medication (Soltani, 2014).
Couples that received EFT are more affectionate with each other, happier in their relationship, and overall more “in sync with each other.” Correspondingly, they also report better communication and an improved sex life. After receiving EFT, couples were stronger overall, better able to support each other, and were more motivated to continue with infertility treatment (Najafi, 2015).
If you are currently going through infertility and find yourself struggling, you may benefit from an EFT-trained couples therapist who also specializes in infertility. Dr. Irena offers in-person couples therapy for those who live in Houston and online therapy for those who live in Texas and New York.
Call (281)267-1742 or email [email protected] for a free 10-minute phone consultation.
1.Domar Alice, Alexis Broome, Patricia C. Zuttermeister, Machelle Seibel, Richard Friedman: The prevalence and predictability of depression in infertility woman. Fertility and Sterility (1992), Vol. 58, Issue 6, p1158–1163Johnson, S. (2008). Hold Me Tight. New York, NY: Little, Brown Spark
2.Najafi, M., Soleimani, A.A., Ahmadi, Kh., Javidi, N., & Hoseini Kamkar, E. (2015). The effectiveness of emotionally focused therapy on enhancing marital adjustment and quality of life among infertile couples with marital conflicts. International Journal of Fertility and Sterility, 9(2), 238-246.
3.Pasch, LA, Holley GR: Addressing the Needs of Infertility Patients and their partners, Are they informed of and do they use mental health services? Fertility and Sterility (2016)106:209-15
4.Soltani, M., Shairi, M.R., Roshan, R., & Rahimi, C. (2014). The impact of emotionally focused therapy on emotional distress in infertile couples. International Journal of Fertility and Sterility,