SPECIAL INTEREST GROUP ‘PSYCHOLOGY AND COUNSELLING’
Contributors and affiliations
Dr. Timothy C. APPLETON Independent Fertility Counsellor, Affiliate Lecturer Department of Obstetrics and Gynaecology, Cambridge University, United Kingdom Mrs. Patricia BAETENS Psychologist, Centre for Reproductive Medicine, Academic Hospital, Dutch-speaking Free University of Brussels, Brussels, Belgium Mrs. Judith BARON Counsellor, Midland Fertility Services, Birmingham, United Kingdom Prof. Dr. Johannes BITZER Gynaecologist and Psychotherapist, University Frauenklinik, Lausanne, Switzerland Dr. Jacky BOIVIN Psychologist and Lecturer, School of Psychology, Cardiff University, Cardiff, United Kingdom Mrs. Elizabeth CORRIGAN Business manager and Nursing director, Centre for Reproductive Medicine, University of Bristol, Bristol, United Kingdom Dr. Ken R. DANIELS Sociologist and Associate Professor, Department of Social Work, University of Canterbury, Christchurch, New Zealand Dipl.-Psych. Joelle DARWISH Psychologist and Psychotherapist, Service de Psychiatrie de Liaison, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Dra. Diana GUERRA DIAZ Psychologist, Servicio Medicina Psicosomatica, Instituto Universitario Dexeus, Barcelona, Spain Mrs. Margaretha HAMMAR Nurse, Fertilitetscentrum, Carlanderska sjukhemmet, Göteberg, Sweden
Prof. Dr. Heribert KENTENICH Gynecologist and Psychotherapist, DRK Frauenklinik, Berlin, Germany Dr. Alexina McWHINNIE Medical and Psychiatric Social Worker, Counsellor and Senior Research Fellow, University of Dundee, Dundee, Scotland Prof. Dr. B. STRAUSS Psychologist and psychotherapist, Department of Medical Psychology, Friedrich-Schiller-University of Jena, Jena, Germany Petra THORN Social Worker, Social Therapist, Family Therapist, in private practice, Moerfelden, Germany and Affiliated Lecturer, Department of Social Work, Protestant University of Applied Sciences Darmstadt, Germany Dr. Dipl. Psych. Tewes WISCHMANN Clinical psychologist and psychotherapist, Department of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
Fundamental issues in counselling
Counselling within infertility
Who should counsel?
Who is likely to need counselling?
The role of the physician in counselling
Counselling in infertility treatment
Special questions in counselling
Pregnancy after infertility treatment
Facing the end of medical treatment
Patients in migration
Special topics (third-party reproduction)
Reproductive services with lesbian couples
Reproductive services with single women without partners
Additional types of psychosocial services
Written psychosocial information and telephone counselling
Professionally facilitated group work
1. INTRODUCTION Heribert Kentenich
The desire for a child is a result of individual development. It does not exist from birth but usually increases as time passes.
The wish for a child is not only a deeply felt need originating from individual instincts. It also depends on:
the development of individual personality,
individual biographical changes,
interpersonal processes between partners and
These psychosocial factors moderate the wish for a child. If the wish is not fulfilled and an infertility problem becomes apparent, this may result in a narcissistic wound that diminishes selfconfidence. Hopelessness may arise. The patients may express feelings of guilt. There may be desperation and grief. The problem of infertility becomes a problem within the relationship of the partners (Menning, 1980; Golombok, 1992; Möller & Fallström, 1991).
During the last two decades great advances have been made in the field of assisted reproductive technology (ART). Treatments such as in-vitro fertilisation (IVF) and microinjection (ICSI) have given new hope to many infertile patients.
There is a danger that the emotional impact of infertility is neglected and that the problem is reduced to a biological or medical one.
However, in addition to the necessary medical procedures, one should also focus on the patients’ psychosocial and emotional needs by
giving information and ensuring it is processed,
support counselling and/or
Caring for the emotional needs of the patient demands continuity and should not be treated as a single event.
The information-giving and counselling of the patient takes place both in the general practice and in the fertility clinic. The teams consist of more medically orientated members such as nurses, doctors, biologists, embryologists and lab technicians, and of more psychosocially orientated members such as counsellors, psychologists or psychiatrists. The individual processes and interpersonal dynamics within the different groups in the team should be recognised.
These Guidelines have been set up in order to provide a framework for counselling in infertility. We are aware that counselling is dependent upon the legal, ethical and cultural background of every country. Therefore these Guidelines are not strict rules or fixed regulations. They are based on the current best practice and are a proposal for a counselling framework as an official paper of the European Society of Human Reproduction and Embryology (ESHRE).