The Many Faces of Grief in Infertility

“There is a unique pain that comes from preparing a place in your heart for a child that never comes.” ~David Platt

Ever since she could remember, Jenny’s dream was to be a mother. She fantasized about cuddling infants, chasing toddlers at the park, kept a list of names she liked for future children, and subconsciously observed mothers she admired–taking note of things she wanted to integrate into her own parenting. Fast-forward 20 years: She was in another doctor’s office receiving yet another negative pregnancy test. She and her husband were delivered the news: They were up against infertility and would need specialized treatments in order to have children.

Infertility affects 15 million people in the U.S. annually. These individuals and couples ride the roller coaster of hope and disappointment each month in an emotional quest to start a family. They grieve the loss of a “normal” pregnancy” and have to face the mental, relational, and financial issues that accompany infertility. As April 21–27 is National Infertility Awareness Week, I want to dedicate a blog post to the education and awareness of this widespread struggle.

Simply stated, infertility is the inability to conceive children. You may be surprised to learn that infertility affects women and men equally. It can be caused by a number of things including advanced maternal age, ovulation disorders, blockage of the fallopian tubes, other women’s health issues like uterine fibroids and endometrial polyps, or male factors that affect the sperm (like low sperm count or mobility, or abnormal sperm). The American Society of Reproductive Medicine recommends that women under 35 begin infertility test only after trying to conceive unsuccessfully for 12 months, or six months if the woman is over 35. It is completely normal for that pregnancy test to not read positive after a month or two trying; remember it may take several months to conceive. Many couples find that they are more relaxed when trying to conceive if they believe that everything is normal.

Luckily, there are several options available nowadays for infertility treatment. These options include: 1) education to make the most informed choices; 2) medication to encourage egg development or ovulation; 3) intrauterine insemination (IUI), where sperm is placed into uterine cavity to promote easier penetration with eggs; 4) In Vitro Fertilization (IVF), where eggs are collected and then fertilized by sperm outside the body; 5) third party reproduction like sperm or egg donation, embryo donation, or gestational surrogacy; 6) surgery to correct an abnormality; and 7) adoption.

In addition to affecting the body, infertility takes a toll on the mind and mental health of those experiencing it. Parenthood is one of the most anticipated transitions in adult life for both men and women; anger, stress, depression, grief, and anxiety are common responses to infertility. Couples experience stigma, sense of loss, and diminished self-esteem in the wake of their infertility. In couples struggling with infertility, women show higher levels of distress than their male partners; however, men’s responses to infertility closely approximates the intensity of women’s responses when infertility is attributed to a male factor. Both men and women can experience grief, loss of identity and feel defective and incompetent.

The infertility journey can wreak havoc on even the strongest relationships. Many couples experiencing infertility report marital problems including disconnection, frustration and even sexual dysfunction. Because infertility brings feelings of grief and mourning, it may take time for either individual (or both) to even consider other options in the quest to start a family. Furthermore, infertility can cause social isolation from peers who are blessed with normal, healthy pregnancies. They likely will not understanding that their friends are literally grieving the loss of a healthy pregnancy and unborn children. Even the closest friends may struggle to relate to the infertility experience and offer unwelcomed platitudes like, “It will just happen.”

Infertility can lead to financial strain. Insurance coverage varies by state and by plan, but often requires hefty out-of-pocket payments. Many couples spend thousands of dollars on specialist consults, medications, and assisted reproductive technology like IUI and IVF. These multiple appointments can put strain on employment as well. This understandably causes great stress on individuals and couples.

The reality is that infertility takes a severe toll on the mental health, relationship quality, and financial situation of those experiencing it. Thankfully, awareness is increasing and help is more readily available. There are support groups and cognitive behavioral group psychotherapy groups–both of which have been found to decrease stress and mood symptoms and increase fertility rates. There is also medication for those struggling with mental health issues amidst the infertility journey.

Lastly, and perhaps most importantly, mental health treatment is available. For those facing infertility, therapy is not just an option; I consider it to be a necessity. Infertility is a life-altering journey that requires strength and resilience to address the mental health, relational and grief issues that may arise along the way. Outfitted with the right tools and a strong mental health foundation, you will be well-prepared to weather the emotional turmoil that can accompany infertility and its treatment. Please do not hesitate to reach out with questions or schedule a session with me at your earliest convenience. I am here for you!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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When Your Consent is Taken Away

“Our lives begin to end the day we become silent about things that matter.” ~Martin Luther King Jr.

Almost a year and a half ago, Alyssa Milano posted on Twitter: “If you’ve been sexually harassed or assaulted write ‘me too’ as a reply to this tweet.” 24 hours later, there were more than 500,000 responses. 12 months later, the hashtag was estimated to have been tweeted over 18 million times. The #MeToo movement has caught people’s attention worldwide, yet sexual assault continues to be a difficult topic. Although uncomfortable to discuss, it is prevalent and life-altering, and worthy of our attention and dialogue. I write this post in line with April’s Sexual Assault Awareness Month campaign to raise public awareness about sexual violence and to educate communities on how to prevent it.

In my initial research for this blog post, I found some staggering statistics I would like to include:

  • Approximately eight out of 10 sexual assaults are committed by someone known to the victim
  • More than half of female victims of rape reported being raped by an intimate partner and 40.8% by an acquaintance.
  • A forcible rape occurs every 6.2 minutes within the United States.
  • Nearly 1 in 5 women (18.3%) and 1 in 71 men (1.4%) have been raped at some time in their lives
  • Most female victims of completed rape (79.6%) experienced their first rape before the age of 25, and 42.2% before the age of 18.
  • More than 1 in 4 male victims of completed rape (27.8%) experienced their first rape when they were 10 years of age or younger.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

Let’s discuss the basics of sexual assault. The term “sexual assault” refers to sexual contact or behavior that occurs without explicit consent of the victim. Some examples of sexual assault include attempted rape; fondling or unwanted sexual touching; forcing a victim to perform sexual acts; penetration of the victim’s body; sexual intercourse against a person’s will; forcible sodomy (anal or oral sex against a person’s will); forcible object penetration; marital rape; sexual contact with minors, whether consensual or not; incest; or any unwanted or coerced sexual contact.

Sexual assault can happen to anyone of any age, gender, race, and socioeconomic background. It can happen at any time or place. Assailants may be strangers, acquaintances, friends, or family members, and they may use violence, threats, coercion, manipulation, or other forms of pressure or deception to commit sexual assault.

Not all sexual assault is rape, but rape is one of the more well-known forms of sexual assault,. For its Uniform Crime Reports, the FBI defines rape as “penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” This can be done in one of three ways; the first is called a “blitz” sexual assault, which is when a perpetrator quickly and brutally assaults the victim with no prior contact, often at night in public.  The second is called “contact sexual assault”, and is when a perpetrator tries to gain their victim’s trust by flirting, luring the victim to their car, or otherwise trying to coerce the victim into a situation where the sexual assault will occur. The third type of rape is a home invasion sexual assault–when a stranger breaks into the victim’s home to commit the assault.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

The distinguishing line between sexual assault and consensual sexual activity is just that: CONSENT. Consent is a voluntary, sober, enthusiastic, informed, mutual, honest and verbal agreement. It is an active agreement that cannot be coerced. Consent is a process which must be asked for every step of the way. Consent is never implied and cannot be assumed, even in a relationship; simply dating a person does not give the right to sexual interactions. Legally, an intoxicated person cannot give consent!

Survivors of sexual assault often blame themselves for somehow behaving in a way that encouraged the perpetrator. When your consent is forcefully taken away, it is not your fault. I cannot possibly stress this enough: The victim is never to blame for the actions of the perpetrator! In my experience as a clinician, guilt is a feeling that each victim experiences during his/her healing process. Because of this, it is essential that victims get the appropriate and necessary treatment from a licensed, experienced therapist. I have treated numerous clients who have experienced sexual assault, and am equipped to help you or your loved one along this difficult yet beautiful path to healing. It is possible, and I am here for you. Please contact me today or click here to schedule a session.

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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The Direct Path to Happy Relationships

“Be direct. Be clear. Don’t worry about being correct. Worry about being real.” ~Jill Telford

Who can relate to the episode of That 70’s Show when Jackie is trying to get Kelso to do something, so she goes radio silent and expects him to figure it out? Of course he has no idea what she wants, and he actually goes the other direction–instead of getting closer to her to see what is wrong, he backs off, thinking things between them are great! She is left feeling frustrated because he did not magically figure out what she wanted, and this little tiff requires words in order to be sorted out.

In seeing this acted out, it is obvious that Jackie’s methods are comical and ineffective at best. However, it is not uncommon for this type of behavior to be employed in relationships outside of the 1970s. When you want or need something from your partner, what do you do? Do you sulk, whine, or pull back from the relationship as your way of indicating you need to be heard? Or do you speak up and directly voice your needs? Jackie’s type-of-response is referred to as “indirect support seeking” behavior and has a strong correlation to low self esteem. Ironically, such behavior elicits rejection–the exact thing Jackie’s type is trying to avoid! If this is something you do in your relationships, I imagine you are wondering…is there a better way to get what I need?

The answer is yes!

What I am about to say might sound too simple to be possible, but there is a way, and that way is by simply being direct. By saying what you need or think.

I have a close friend who I never have to worry if she is mad or if I offended her because she will tell me. She has taken the lead with being authentic, and has shown me how advantageous it is to have real, honest relationships. She says what she feels, thinks, and needs. It has created an incredible level of trust and openness in our relationship. Being direct removes so much anxiety and promotes closeness and trust. This can be done in any type of relationship!

Being direct and assertive involves being honest and genuine while remaining appropriate, diplomatic and respectful of yourself and others. It is not passive (being a doormat or a wimp), passive-aggressive (indirect communication, like not returning calls or emails hoping somebody gets the hint), or aggressive (being hostile and rude.) Being direct requires courage–the courage to be vulnerable and real.  It might be difficult to be direct when you tell someone you love them (or do not love them), when you need to confront someone about a problem, when you need to give difficult feedback, fire someone, say “no” to anything at all, or a host of other scenarios. In short, it is safe to say that you are likely to come under fire of potentially uncomfortable situations each day. Will you respond directly?

The following are suggestions for being more direct in your important relationships:

  • Consider the feelings you are holding inside and make your words match those feelings.
  • Before speaking, take Shirdi Sai Baba’s advice and ask yourself first, “Is it kind? Is it necessary? Is it true?” This will help you keep your ego in check and stop you from saying destructive things out of anger.
  • Keep it simple. Concise, clear, and brief is always better.
  • Speak in terms of “I” rather than “you” (“I need more physical affection” rather than, “You don’t show me enough affection”).
  • Focus on the behavior, rather than the person (“I need you to let me know when you are running late” rather than, “You are inconsiderate for making we wait”).
  • Avoid “always” and “never.” These superlatives are often unfair and untrue.
  • Avoid triangulation by speaking directly to the source.
  • Choose to love yourself by saying, “no” as needed. Know your limits!
  • Say it face to face. Do not express important sentiments or needs over text or email. Phone is okay, but in person is best. This will help prevent miscommunications.

Being direct is a skill that needs to be practiced and developed, but it can be done! Once understood, it will improve all of your important relationships. Indirect support seeking behaviors will nearly always leave you feeling rejected, alone, and misunderstood. Avoid this altogether by learning to say what you mean and meaning what you say. Be direct! I can speak from personal experience and say that communicating directly is liberating. It is the best way to get what you want or need out of all of your relationships. Communication is key in relationship satisfaction; if you need help communicating to the important people in your life, please do not hesitate to schedule a session. My door is always open!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Personality and Social Psychology Bulletin: “Low Self-Esteem Predicts Indirect Support Seeking and Its Relationship Consequences in Intimate Relationships”

Alcohol Anonymous: Strength in Numbers

Alcoholics Anonymous

“When I stopped living in the problem and began living in the answer, the problem went away.”

~ Alcoholics Anonymous

According to the 2015 National Survey on Drug Use and Health, 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime. While it may not lead to an addiction for some, it does for others. Alcohol has touched all of our lives in one way or another, whether it is personally or through someone we care about. Because April is Alcohol Awareness month, I want to dedicate a post to one of the most helpful, renowned support groups for those working to overcome an addiction to alcohol: Alcoholics Anonymous.

WHAT IS ALCOHOLICS ANONYMOUS (AA)?

Alcoholics Anonymous is an international group of men and women who have had or are working to conquer a drinking problem. AA is open to all races, politically neutral, self-supporting, and is available almost everywhere. There are no age or education requirements, and membership is open to anyone who wants to do something about his or her drinking problem.

HOW DID AA START?

Alcoholics Anonymous was founded by Bill Wilson and Dr. Bob Smith, who were both recovering alcoholics. In 1935, Alcoholics Anonymous began as a community-based fellowship which encouraged sobriety for other recovering alcoholics. These two men developed the 12 steps to aid their attendees, and later introduced the 12 traditions to help further define the group’s purpose and achieve continuity for AA groups across the country (and later around the globe). AA paved the way for other support groups; today Narcotics Anonymous, Gamblers Anonymous, and Overeaters Anonymous are just three of the many groups that have modeled themselves after the AA meeting concept.

WHAT ARE THE MAIN TENETS OF AA?

The original steps are still intact and many former addicts credit the group with helping them through recovery. The 12 steps that govern all AA group meetings are presented in linear fashion, but participants see them as an ongoing circle. The following steps may be revisited until the recovering addict is comfortable in that stage of their recovery process:

  1. Admit powerless over alcohol
  2. Accept that a higher power, in whatever form, will restore your sanity
  3. Make a decision to turn your will and life over to a higher power
  4. Take a moral inventory of yourself
  5. Admit to a higher power, another human, and yourself the nature of your wrongdoings
  6. Accept that a higher power will remove your character defects
  7. Humbly request the higher power remove your shortcomings
  8. List people you hurt during your addiction and be willing to make amends
  9. Make amends to those people unless it would harm them
  10. Continue to take a personal inventory, and when you’re wrong, admit it
  11. Use prayer and meditation to connect with the higher power
  12. Carry the message of AA to other alcoholics and continue to practice the principles of the 12 steps in your daily life

DOES AA WORK?

Because AA is anonymous, some members of the group do not participate in studies since it could breach anonymity. Many want their participation in AA to remain unidentified, in line with the group’s original intention. Additionally, participants might not want to admit to relapse. A New York Times article stated that AA claims that up to 75% of its members stay abstinent.  Alcoholics Anonymous’ Big Book touts about a 50% success rate, stating that another 25% remain sober after some relapses. Though it is difficult to know just how effective it is, it is safe to say that many people have been helped by regularly attending AA. Just how effective depends on the participant.

CAN AA WORK FOR THOSE WHO DON’T BELIEVE IN GOD?

The first time I read through the twelve steps, I was surprised how often God was referred to. While the faith-based program of AA may be effective for some, it does not work for everyone — particularly those who do not subscribe to God as a higher power.  Might I offer a solution: AA founder, Bill Wilson, encountered the term “higher power” in the book, Varieties of Religious Experience, by William James. In this book, James offers many examples from Christian traditions, as well as non-Christian examples. One of the best examples of “higher and friendly power” is borrowed from Henry David Thoreau walking in the midst at Walden Pond feeling a sense of connection to pine needles. He cited other examples of a “higher power” to potentially include moral principles, patriotism, civic engagement, and even a higher or better self. Therefore, the term “higher power” does not have to be a faith-based term and thus varies from participant to participant.

You could go to an AA meeting in Los Angeles, London or Lima and each one would be carried out in a similar fashion. This is because the steps and traditions of Alcoholics Anonymous are the foundation for every meeting. In each meeting, members will get to know one another, discuss progress and relapses, and support each other through sponsor programs. Although it can be difficult going to an AA meeting with complete strangers and admitting to such a personal issue, it is the only place where every participant knows exactly how you feel. They have been where you are and can support you in your journey. That is powerful. To quote AA literature: “The feeling of having shared in a common peril is one element in the powerful cement which binds us.”  This instantaneous bond cultivates a unique feeling of community and understanding that is incredibly helpful to those recovering from alcohol addiction.

The only real way to find out if Alcoholics Anonymous can help you is to give it a try. See for yourself if you think the help and support from others struggling with the same problem can help you stay sober. As Alcoholics Anonymous has no dues or fees, you have nothing to lose in choosing to visit a few meetings. I strongly encourage it. Call now at 877-600-9205 or go online and use a meeting finder to find a meeting in your area. Click here if you are local to the Dallas/Ft. Worth area and could benefit from community resources. In like manner, if you feel you could use professional help, I invite you to contact me today or schedule a session to begin your journey toward recovery. I am here to help you along the uphill road of addiction recovery!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

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