Ambivalence--its role in decision making in infertiity treatment

Individuals in infertility treatment are often faced with difficult and life-changing decisions. Usually, there is no "right" option involved in these decisions. No one but you can decide, for instance, if you should keep going in treatment or if you should call it quits. Or if you should change RE's, or try a different clinic. Or if you feel comfortable with using an egg or sperm donor, and if so, how you feel about the disclosure of your future child's genetic origins. Or if you should start to pursue and adoption, and if so what type...the list of big decisions goes on and on. For almost all of these decisions, your choices, although they will be limited by your medical and financial circumstances, will be primarily based on your subjective preferences.

Figuring out your subjective preferences, however, may not be so easy. These situations are usually very complicated and involve emotions from many aspects of your life. Further, many of the types of decisions listed above are "workarounds". Already, they involve feelings about the loss of being unable to have a baby without treatment. So naturally, these types of decisions are going to bring up some negative feelings--even if, in the end, they are going to be the "right" option for you.


On the other hand, sometimes our negative reactions are telling us that an option would not be the right thing for us to do. It can be tricky to sort out when we are just experiencing "predictable" ambivalence, and when we should make rule out an option based on our negative feelings. In this post, I'll discuss some of the distinguishing features of the two types of negative feelings.

Ambivalence

in graduate school, a former supervisor once told me, "ambivalence is the hallmark of mental health." At the time, I gave him the same puzzled look that I now routinely get when I say this during a session with a client. But with the benefit of time and experience, I increasingly understand the wisdom of his statement. To be able to be conscious of and tolerate, at the same time, both positive and negative feelings about a person or situation (e.g., ambivalence), and still be able to function successfully, requires psychological maturity and sophistication.

When it comes to the types of decisions that come up in infertility treatment, ambivalence is practically a given. Even so, many of my clients have been concerned when they experienced negative feelings about a family building option,especially initially. They have worried that this means they shouldn't even consider the option, even if it may be the most practical or probable solution. In fact, in my work, if I hear a client express uniformly positive feelings about issues such as the ones listed above, I usually become concerned. My worry is that they aren't consciously dealing with some important feelings--and this might cause them problems in the future.

As an illustrative example, I would not expect someone to be thrilled upon deciding to use a gestational carrier, especially during their initial considerations. So feeling okay about the decision of using a gestational carrier might look something like, "I'm sad that I won't be able to myself be pregnant with my child, but I'm happy that I will be able to become a parent to a newborn". Tolerating feelings of disappointment, loss and perhaps envy along with the excitement of the pregnancy and anticipation of becoming a parent--that's the cost of doing business in this situation.

When no means no

There are times, however, when your negative feelings are telling you something important--that you are fundamentally uncomfortable with the option before you. This will look different than the types of ambivalent feelings I described above. One difference is that in ambivalence, the intensity of the negative feelings tends to lessen over time. Once you start grieving the losses these decisions involve, the benefits of the decision seem more prominent. However, if your negative feelings are telling you that this is not the right decision for you, they tend to remain present, and even increase in intensity--until you respond to them.

Another way to distinguishing factor between the two sets of negative feelings is how you feel after making the decision. I have observed this difference many times in both myself and my clients. If you have made the right decision for yourself, you will tend to feel a sense of resolve and peace mixed in with all of the anxiety the situation produces. Although you are aware of the downsides involved in your choice, you still fundamentally feel that no matter what the outcome, this decision is the best for your current situation.

On the other hand, if you continue to have consistent feelings of unease, repetitive nagging doubts, or continued intense negative emotions, you probably need to take a step back and reexamine your decision. It may be that you have decided to do something (or, as many times is the case, not to do something) that really isn't right for you. The good news is that even though you may have to change course, you can use these feelings to help guide you to a decision that does feel more in line with what works best for you in your life.