Motherhood, Fertility & Mental Health.

For any woman the journey to motherhood can be overwhelming, emotional, and fraught with unknowns. For some however, the journey may involve incredibly difficult challenges and experiences: fertility worries, infertility, IVF, miscarriage, loss. To navigate this path, with all the hopes, dreams, anxiety, stress, loss, grief, stress and sadness is both incredibly brave, and at times devastatingly heartbreaking.

The impact on mental health for women going along this fertility journey can be immense. The journey can be long and lonely, even when surrounded by the most loving support. It can be filled with hope, love, joy and strength, but also anxiety, frustrations, doubt, worry, anger, sadness, guilt, shame, sadness, envy, stress, panic, fear, grief and loss. In its dark times it can bring negative thinking and self-criticism, and (unjustly) a sense of failure or loss of hope.

Every woman’s journey toward motherhood is different, and the impact on mental health is unique for each person, influenced by many elements both before and during the motherhood journey. And whilst there is inevitably a degree of (difficulty but ultimately manageable) negative emotions and negative thinking that impacts every person along the journey, when the anxiety, or the sadness, the stress, the anger, the grief, begins to become pervasive, becoming more and more present and impacts on more areas of life, or on the ability to continue to navigate the motherhood journey, then it may be helpful to look toward therapy interventions to help.

Therapy within the motherhood journey may take many forms. Counselling, CBT, ACT, EMDR, Psychodynamic Psychotherapy are some of the many forms of therapy available. Whilst these types of therapies can vary based on the skills, training and approaches of the therapist, there is typically a standard approach you may expect of each intervention as outlined below. However, it is often noted that with any therapy it is often the relationship with the therapist, and the ability to engage with them and feel heard and supported that is often most crucial in the sense of success of therapy.

When searching for therapy there are different professionals offering therapy including Counsellors, Clinical Psychologists, CBT Therapists, and Psychotherapists. Some professionals may have trained in a variety of approaches (for example a Clinical Psychologist may have trained in CBT, Psychodynamic approaches, ACT, EMDR, Mindfulness etc) and so it is important to find out about the training a person has undertaken and the ethos of their approach to ensure you feel this meets your needs. It is also important to note that choosing the type of therapy is also a personal decision, based on what approach seems right for you, as well as understanding which approach may best suit the difficulties you are experiencing.

Counselling typically involves sitting with a counsellor and having the time and space to talk about and reflect on your thoughts and feelings about what you have been through or are going through. These sessions are typically supportive and containing, with a focus on listening and reflecting what is being said and felt. The number of sessions may vary for what you feel you need, from a brief 6 sessions to a longer number as agreed. (Please note for this approach and the others below, NHS offered therapy will likely have more time limits due to resources whilst private interventions may offer more scope for ongoing work if needed, however do check your local NHS services who can offer fantastic therapists and interventions to support you).
CBT is Cognitive Behavioural Therapy. This is more of an active, structured approach to therapy. 6 – 12 sessions may initially be suggested but more may be useful. Cognitive refers to our cognitions (our thoughts) and the therapy makes the links between how we think about situations happening to us, our feelings or emotions, (anxiety, panic, sadness), how our body feels physically (physical symptoms such as tension, heart racing, stomach churning), and how this affects our behaviour (avoidance, withdrawal, overeating, etc). CBT mainly focuses on the here and now and day to day life, and you work together with your therapist to develop strategies to manage negative thoughts, emotions, physical symptoms and unhelpful behaviour patterns. You will have “homework” to go away and complete in between sessions, and it will be very collaborative and supported as you work together towards your goals.
ACT (Acceptance and Commitment Therapy) is a somewhat newer approach than CBT, that focuses on what your values are in your life, what is important to you, and what you can do to help yourself move forward toward living a meaningful valued life, whilst learning to mindfully acknowledge and live with, (whilst reducing the power and impact of), the difficult thoughts, feelings and experiences you may be going through. This approach draws a lot on mindfulness which is a very useful approach in itself, the ability to be in the moment and not be caught up in our thoughts and feelings to the detriment of our mood, wellbeing, and ability to focus on life happening around us.
EMDR is Eye Movement Desensitisation Reprocessing. This approach has been developed for over 20 years but is recently becoming more known. It was originally developed for PTSD but can effectively be used for many different mental health difficulties, often where a trauma, difficult experience or memory is present. Whilst similar to other therapies in enabling you to explore your thoughts, feelings, memories, and the physical symptoms these evoke, EMDR achieves this through a process of eye movements or hand taps that stimulate the left and right sides of the brain and results in the difficult memories, thoughts and feelings being reprocessed in such a way that they no longer have an impact as memories or in day to day life. For some this therapy can sound a little strange at first and it is not a process of hypnosis. This can however be an incredibly powerful, unique and fast-moving therapy. Sessions again may vary from 6-20 etc as required.
Psychodynamic Psychotherapy – this is a longer-term therapy, that can typically span over a year or more, although there are shorter term interventions that have been developed. This therapy may focus more on drawing links, patterns and interpretations between current experiences and early childhood experiences, relationships or the unconscious mind. Typically more long term/ intense and in depth than the therapies above, this therapy may give more chance to analyse yourself at a deeper level.

So, for those of you on the journey toward motherhood through fertility challenges, who may be feeling the stress or the overwhelming nature of this intense and brave journey, please do think about finding therapy support if needed. As a therapist I am always inspired by the strength of the people who come to see me, through some of the most difficult times in their lives. Therapy can be life changing, and enriching and supportive, which is entirely deserving of every person on the journey to motherhood.

Dr Emma Cotterill

Chartered Clinical Psychologist

Empower Psychology

www.empowerpsychology.co.uk

Useful Links:

Counselling and Psychotherapy:

https://www.bacp.co.uk/

https://www.bacp.co.uk/about-therapy/types-of-therapy/

CBT

https://www.babcp.com/Default.aspx

https://www.mind.org.uk/media/17708241/cbt-2017.pdf

EMDR: