This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Wednesday, June 20, 2012

Infertility treatment and the Type A Personality, Part 2: feelings of failure

In an earlier post, I discussed some of the issues that can occur when a person with a "type A" personality style experiences infertility. In this blog post, I would like to focus on one particular aspect of that experience; namely, the emotional experience of treatment failure. Failure is endemic to infertility and infertility treatment, as the failure to produce a viable pregnancy starts the whole process.
 By the time a person with Type A personality typically gets diagnosed with infertility, they have already been deluged with feelings of failure. Failure to get or stay pregnant is distressing to everyone, no matter their personality style. However, it seems to be particularly stressful for those of us who are more on the type A side of things. To me, this is best expressed by this equation:
 Type A personality + treatment failure = uncomfortable recognition of lack of control.

 One of the biggest motivations for being type A, e.g., worried about the details, anxious about potential obstacles, is that it can provide a faux sense of control. Someone with a more laid-back approach to things may have a basic belief that although things are out of their control, they will work out well in the end. This is not so for people with The A personality style. Simply put, they do not feel lucky. Not only do they not feel lucky with infertility, they do not feel lucky in any aspects of their lives. The underlying assumption is that the world is not a safe place.

It's pretty uncomfortable walking around being anxious and worried about the future all of the time. Thus, if you have this basic belief, you will need to develop a psychological strategy for minimizing these feelings. That's where a type A personality style, with its emphasis on working hard to manage all the details, can come in very handy. You can get so busy organizing, planning and working that you can put your feelings of anxiety about the world out of consciousness.

 The Type A strategy of managing anxiety is usually adaptive in most situations. However, in a situation like infertility treatment, where success or failure usually rest on several factors beyond anyone's control, it all falls apart. A treatment failure isn't just a profound disappointment; it is also an example of the person's worst fear come true. It is a concrete reminder that no matter how hard they might try, bad things happen--and thus, the world is not safe.

Add in some fertility drugs tweaking the emotions, financial stress, and a few insensitive comments from friends and family, and you've got a recipe for the perfect storm in terms of creating an emotional meltdown. Sound familiar? I know I myself have been in that play several times before.

 Although it is painful and unsettling to realize that we feel unlucky and unsafe, there are some advantages to doing so. In reality, your situation is no better or worse off than it was before. The primary loss is actually the fantasy that you had some sort of omnipotent control in the first place. By letting go of this fantasy, you may be able to paradoxically relax a bit more--if it's not all in your power, it can't be all your fault, right? Also, by acknowledging that your fear that you are always unlucky of that the world is always unsafe, you can also realize the ways in which your fears aren't accurate. In reality, a person can't always be unlucky, and not every situation is unsafe. This can allow you to respond more specifically and helpfully to the threats of a given situation, saving your energy for the things that matter most. 

Friday, June 8, 2012

Infertility treatment and the disaster plan: or, another defense of negative thinking

I remember  the moment like it was yesterday; the moment I decided to quit infertility treatment (although, glutton for punishment that I am, I would return two more times).  Another IVF had failed, and the diagnostic explanations as to why were becoming increasingly sinister.  I had a break at work and was agitated, so much so that I couldn't sit still.  I paced back and forth in my office, back and forth, wondering what to do next.  Giving up treatment felt like such a loss, an admission that I couldn't make a baby, and  yet, staying in treatment felt completely hopeless.  I had no confidence anymore in my  body.  I felt so much loss and frustration that things had worked out this way.  And just at the moment when I felt these things most intensely, I felt some sort of shift in myself, a new voice in my head, and I found myself telling myself that although I couldn't get pregnant, I couldn't be unhappy all of the time anymore.  I had to spend my time doing something that I had some hope of being good at, and I felt that I could be a good parent to an adopted child, someone who needed a family just as much as I needed to be a mother.

That was the moment when everything changed for me, and resulted in us joining our eldest daughter five months later. It's all very dramatic sounding, isn't it?  But the truth is that this moment was actually the product of many moments before that, moments that allowed me to reach the clarity of this decision.  Those prior moments were spent constructing my disaster plan, a plan that I could implement if things didn't work out with my first plan of infertility treatment. 

When I recommend that clients create a disaster plan for themselves, I am sometimes not met with enthusiasm.   The truth is that for a therapist, I am actually not that "comforting" of a person to be around.  My way of reassuring myself  has always been to imagine and plan for the worst case scenario.  If I have a concrete plan for surviving that situation, I feel calmer, and I'm more able to focus on the situation at hand.   More than once, I have had  clients react negatively to this line of thinking, for they didn't find considering the worst-case scenario to be comforting at  all, but rather extremely anxiety-provoking.  At these times I am usually asked why I am bringing negativity into the situation.  Wouldn't it be better if I just focused on a positive outcome?

Perhaps it would be better to just focus on a positive outcome, but I know myself well enough to know that I'm not capable of pulling that off.  But more than that, I think that there is great utility in a disaster plan. Having a concrete plan of what you would do if things go badly not only gives you a plan of action, it also aids in decision making and helps you emotionally prepare for the event that things don't your way.

For instance, for me, when I was going through treatment and things were looking increasingly bleak, I started researching all of my options, and in detail.  I learned about surrogacy, and I learned about adoption.  As I considered these options and gained more knowledge, I began to realize how I felt about myself in either of these situations.  In so doing, I decided to focus more on adoption, and then began learning about the different options in the adoption world.  I sent off for information from adoption agencies, signed up for listservs, read message boards, and tried to become literate--fast--in the adoption world.  Some of my family and friends thought I had gone off the deep end.  My IVF treatment was still proceeding, and we didn't know how that would end.  But I felt compelled to keep up with researching and planning.  Pretty soon, my husband and I had decided on a detailed specific plan of action that we would take regarding adoption, including the agencies we would use, if our last treatment failed.

Thus, when I was pacing back in forth in my office that day, I already had a detailed, concrete picture in my mind of what I needed to do should we decide to adopt.  And I think the importance of that detailed picture cannot be overemphasized.  It's basically impossible to feel clarity about an undefined, abstract option.  Everything is so hazy and undefined--how can you possibly know how you really would feel about it?  Having a detailed plan that you can visualize and implement immediately if necessary helps you make a better, more realistic decision.

In addition, the emotional clarity I felt in that moment in my office was the result of gradually working through my feelings about adoption as I read, researched, and talked to others about it.  Instead of jumping in all at once, I had time to imagine myself in various situations.   When the decision was finally at hand, the shock value had gone out of the equation, and I could just focus on what was best for my husband and myself.

Another benefit of the pre-prepared disaster plan; I didn't have to figure all this stuff out when I was terribly upset, when my cognitive functioning is not at its best.  I  just had to plug away at the steps I had already outlined.  This allowed me to keep going, and not lose time while I processed my feelings regarding ending infertility treatment.
Of course, some disasters cannot be planned for, and the best-made plans may not pan out in actuality.  But if you are in the midst of infertility treatment and things are not looking very positive for the outcome, I would encourage you to give serious thought and time to developing an alternate plan of action.  You might decide to try a different type of treatment, get a second opinion, or go to a different clinic.  You might consider third-party reproduction as an option, or decide that adoption is a path you might take.  Once you decide on a direction, learn as much as you can about that direction as possible, so that if you should need to go that way, you've already got a very detailed map to follow.

Although I did end up using my disaster plan, I am happy to report that in doing so, I soon realized that my new path was anything but a disaster.  Although there were many challenges along the way, they were ones I  could handle.  The paper chase of adoption was a breeze compared to infertility treatment.  For example, though couldn't get my body to cooperate in IVF, it turned out I could assemble our homestudy documents with alacrity, and wade through bureaucratic red tape with efficiency.  In so many ways, adopting our daughter was an amazing experience that I will always cherish, even though it began as my disaster plan.