The images are everywhere. The perfect little family, in a magazine article, on a sitcom, or peering out from every celebrity Twitter post. But for up to 15 percent of couples, those images are a reminder of just how difficult it can be to start a family of their own. From infertility to failed in vitro fertilization attempts to the loss of a pregnancy, many couples find themselves struggling with reproductive issues in a world where everyone seems to have a child or three by their side.
For these people, said Carla Contarino, Ph.D, a clinical psychologist with a practice in Rochester, NH, and for those who have difficulties with postpartum adjustment issues, the value of therapy is that it can help them to move forward, cope with grief, make decisions about their options and find balance.
As a sub-specialty to her general practice, Contarino helps women and men with issues of infertility and traumatic birth experiences or pregnancy losses along with postpartum adjustment problems.
She also works with people on overcoming fears and anxiety during pregnancy and childbirth and offers psychological consultation around in vitro fertilization and evaluations for potential gestational carrier candidates.
Contarino spoke with New England Psychologist’s Catherine Robertson Souter about her work, suggestions on what to look for when working with women or couples, and her goals for bringing her expertise to a wider audience.
I understand you plan to shift your practice towards working primarily with reproductive issues. Why did you choose to work in this field?
I began a general private practice in 1989. Sometime in the early 90s, I began to see women coming in with reproductive medical issues who had associated depression and anxiety.
Then, in my personal life, I had friends and family who were dealing with their own infertility, issues of adoption, and using in vitro fertilization (IVF) so I started trying to research whatever I could.
The field was very sparse in the early 1990s. I read what books I could find and joined the American Society for Reproductive Medicine (ASRM), took courses there, went to conferences and was mentored.
Are there a lot of people doing what you do?
There are a lot more younger professionals, women mostly, that I can see in my area now. When I first decided to do it, there were not a lot of us. There was maybe one social worker in Portsmouth and a woman down in the Boston area.
But I think it has grown in part because the whole field of fertility treatment is much more known, more utilized. Women are not as quiet about it as they used to be so there are a lot more supports out there.
What are the needs in this area?
There is a lot of depression and anxiety, associated with feelings of isolation, inadequacy, loneliness, guilt and shame, intimacy issues, and even social isolation.
Women who have lost a pregnancy or a baby don’t want to go to a baby shower. They don’t want to see their co-worker’s infant and then there is the self-criticism that ‘I should be able to be happy for this woman and I am really struggling with why I am not.’
So, I try to work with them through those normal reactive feelings and help them with more self-compassion as well as more self-care.
With childbirth, there are a lot of obsessive thinking and actions. SIDS is a very anxiety-producing situation for moms. So often they won’t sleep and that becomes a sort of cascade biochemically for them; they are not only fatigued because of getting up for nursing but then they are checking on the baby repeatedly though the night and not getting any sleep.
In cultures where the mother is mothered postpartum, we see very limited postpartum adjustment issues because she is taken care of, the house is taken care of, the baby is taken care of. The family is there so she can sleep and rebuild the biochemical resources to emotionally deal with all the changes she is dealing with.
How do we change the culture? Most women I know do try to do it all, clean the house and get groceries and entertain visitors when they have babies.
I think we are seeing changes. Even in the OB office, they are working to build social networks, with mom’s groups, etc. They do a lot of talking to women and partners before the baby is born around who can come in and vacuum and teaching them to ask for help. If your mother-in-law is going to come in and wants to be entertained, well, let’s wait to see her until husband is home.
Do you also work with adoption?
I don’t directly except maybe with post IVF failures or if someone has decided not to go on to IVF, I will help them with the decision about whether to adopt. One of my clients was struggling to adopt for two years and went through two failed adoptions and that is psychologically very similar because it is the repeated loss.
A loss is a loss.
And it doesn’t matter if they have other children. That is one of the myths; people feel that if you have other children, why is this loss so important?
They also feel totally invalidated when people say, “well, you are pregnant now so all should be well, why are you still upset?” People struggle so hard to support their loved ones and they just want them to feel better and don’t recognize that it is a long-term process.
Our culture struggles to talk to people about death and especially about a lost pregnancy or an infant death. People don’t know what to say and what they do say often hurts so it complicates the grief process.
I try to help them learn to live with the loss. It is not that they get over it. They have to find a place in their psyche, “Where do I put this? Where is this child in our family history? How am I going to honor this child for myself?”
I do a lot of education around it and normalizing it. I tell people, “You will be 95 years old and still going to feel some loss around this and that is normal.”
Do you work only with women?
No, but with grief work, I have noticed gender differences. If I do have men come in, they come in for a short time and then the woman will continue on. And then she worries that there something wrong with her because she is not over it and is he over the loss? I work on helping them understand that they may each manage their grief in different ways.
For those psychologists who do not specialize in this area, are there questions they should be asking?
I think, for any client who is of child-bearing age, a psychological assessment should inquire about reproductive life history to see if there have been traumatic births, if there are any postpartum adjustment issues, or any fertility difficulties.
Infertility dramatically affects a couples’ intimacy life. I would hope couples’ therapists understand the specific nature of what a couple is going through in their journey towards parenting. There is a lot of guilt and shame and self-blame with infertility.
Since you are moving towards working primarily with reproductive issues, do you have plans for increasing your reach?
I guess one of the things I am hoping for myself to figure out is how to bring more men in for getting psychological support. Men have infertility too and men lose these children too and men tend not to come in for psychotherapy for that.
I have no idea how to do it yet but it is something I’d like to figure out, a way to help open this up as a resource for men as well.
Catherine Robertson Souter is a freelance writer and social media agent based in New Hampshire. A contributor to New England Psychologist since its inception, she previously wrote for Massachusetts Psychologist among other media outlets.