Donor Conception Network - Articles
Counselling around donor conception:
Paul Crowther “What is Counselling For?”
Two experienced counsellors Jenny Dunlop and Paul Crowther gave talks to the DC Network meeting in September. This is an edited version of Paul's talk at the DCN meeting in September.
Paul has been a couple counsellor with Relate since 1994. He was an infertility counsellor for nearly four years at CARE Fertility in Manchester. He is on the Executive Committee of British Infertility Counselling Association and is Editor of the Journal of Fertility Counselling.
Introduction
I will base this talk on my personal experience, I hope to de-mystify the subject, and stimulate thought about the process.
So what is counselling for?
1. To help couples and individuals (sometimes families) to look at issues they are facing, or may face.
2. To provide a) structure, space and clarity to the process, b) non-judgemental empathy c) a sense of hope.
3. help people make sense of the fertility treatment process eg dealing with the decision to end treatment.
4.providing the an clinic “alarm system” to ensure the procedure desired by the clients is ethically appropriate.
What is counselling not for? It is not for giving advice, though the giving of information and suggesting where to seek further advice is perfectly sound practice. Also, it is not there to judge clients as people, or parents. I stress this aspect because it judgements often seems to pervade clients’ thinking - having somehow to justify why they want children, or why they want a particular procedure, or why they “should” or “shouldn’t” be thinking certain thoughts.
The challenge of ‘one session’ counselling.
Many clients who come for implications counselling have been “sent” and rarely expect or want, to come for more than one session. “Counselling is mandatory, I’m afraid,” is the way a consultant might put it. No wonder some clients see counselling as a judgement or assessment – perhaps a hurdle to further treatment.
Even those who come of their own volition for support may want only one session. I do my best to help them in that hour if that is all they need, and I never try to keep clients engaged in counselling longer than they choose to.
In the first part of the session I allow the client to tell their story, as they see it, so that whatever discussion ensues, it arises from their perception of their experience.
Although the client’s story is bound to have a medical element,
I try to get away from the medical context, The medical model (ie an illness, a diagnosis and a cure) is very different to counselling, which works along the lines of exploration and understanding leading to change.
The profoundness of infertility counselling
Infertility counselling is always profound. There is often a theme of multiple loss: loss of autonomy in the face of increasing medicalisation of infertility; loss of a “free” sexual relationship, loss of certainty in the future, to name but three. It’s like “count your blessings” in reverse: I call it “count your losses.”
Another constant theme is the unfairness of life, Anger is often around. So are sadness, grief, envy, guilt, hope, fear and confusion.
Sometimes it is enough just to name and acknowledge the presence of these difficult themes – in some cases the feelings can be complicated or blocked by events or attitudes. It is then that clients can most benefit from more counseling sessions.
Couple Dynamics
How a couple interact is an essential aspect of any counselling session. I try to allow both partners a voice – especially where one “talks” for the other. Another common problem which brings people to counselling may be that the two partners are grieving at different speeds and in different ways. There is no right or wrong way to grieve, but infertility can intensify the differences. Communication, which works well in normal times, may be inadequate to express the range of expression of pain, sadness, depression and all the effects of the emotional “roller-coaster”. Indeed whole ways of coping for a couple – which work well in normal times - can be stretched to breaking point, and many relationships do not survive. Those that do – and these are generally the ones we see - are often much stronger as a result.
Counselling Men
Olivia she suggested I say something about being a male infertility counsellor and counselling men. So here are some of my personal thoughts on this.
Men are often more logical than women. They have a tendency to keep their feelings inside, to bottle them up, under stress. Often they let the woman “do” emotion for them. Because their emotions are not displayed on the outside, there is often an assumption that they have no feelings – they may even believe this themselves.
Often men will adopt more linear thinking. For instance, lack of success in trying for a baby throws up a problem, and a linear problem-solver looks for a solution. They try this and that, to try and solve it, but as time passes the inability to “do” anything can have a highly debilitating effect on such types.
Women may approach the same situation with a more lateral processes. Under sustained stress the two different approaches can lead to a very confused couple!
Implications counselling
Most clients are very focused on the immediate problem of having a baby. Implications counselling is an attempt to get them to look into the future. A client cannot know exactly how they will feel in certain scenarios, but asking the question “what if?” can help put them connect with implications and possibilities they have thought about.
Showing clients the DCN “My story” picture-book about how a donor conceived child is born can have a powerful effect on a couple, when they confront the reality of what could happen.
For donors, the equivalent reality moment comes when they complete the HFEA Register “Green Form” on which they write a goodwill message and a “Pen Portrait” of themselves.
Conclusion
It is hard to draw any clear strands together after a rapid journey through such a complex area as counselling, but if I had a few messages to leave you with it would be these:
1. Don’t be afraid of counselling (even a male counsellor!) we only want to help.
2. I believe no clients leave the counselling room quite the same as when they came in. If I didn’t believe that counselling, even in one hour, could make a difference to people and ultimately to their children, I would not be doing it.
Editors note: Both Jenny and Paul sought to clarify some of the key issues and principles of counselling – those which are consistent for all clients. I hope that specific issues relating to single women, same-sex couples and will be the subject of future articles and/or talks.
