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Does support counselling help reduce Stress and Anxiety?

The aim of this paper is to give you an outline of what is meant by counselling generally, how counselling may help in the context of infertility and what we should expect when you contact or are referred to a counsellor, whether this is in a licensed clinic or outside of one. I shall also use some case material to illustrate where, when and how seeing a counsellor can be helpful.

To begin, what do we mean by the term ‘counselling’?

The dictionary gives the following definition:
Counsel: advise (person to do); give advice to (person) professionally on social problems etc.; recommend (thing)

When the term is used by doctors and nurses for example, it usually means information giving and advice. It involves giving expert advice, using good communication skills and should lead to the empowerment of patients. It is good medical practice.

However, counselling offered by a professional counsellor/therapist is definitely NOT about advice giving. Rather counselling seeks to provide an environment in which ‘talking’ can bring relief, lessen the sense of aloneness that often accompanies personal crises and offers support to help you find your own answers to your problems. Counselling respects confidentiality, individuality and a person's responsibility to make his or her own decisions. It provides you with a safe place in which to explore your feelings without being judged. Counselling can also help you and your partner if you have one to ‘hear’ and understand each other's feelings at a time when your relationship may be under a great deal of strain.

The British Association for Counselling and Psychotherapy have this to say about counselling:

‘Emotional problems don't go away by ignoring them and we suppress them at our cost: migraine, headaches, backache, low energy, tension, stress, constant grumpiness, depressed feelings or fits of irrational temper – the likelihood is that most of us will recognise something in this list! It is natural and healthy to seek help when we can't sort things out on our own. In the old days we might have gone to the local priest or minister, family doctor or a favourite aunt. Now with communities split up and everyone leading busier lives, these characters have faded from the scene or, although understanding, simply don't have the time to offer. Counsellors are in many respects, filling that gap.’

Differences in theoretical approaches

Sometimes people ask what is the difference between counselling and other ‘talking therapies’. This is not always easy to answer as therapists themselves will often debate the finer points that distinguish one therapy from another. However, the Department of Health publishes a useful booklet called ‘Choosing Talking Therapies’ (2001) which provides some basic definitions including the following:

‘Counselling is different from psychotherapy and psychoanalysis. The latter two tend to assume deep disturbances rooted in the client's past, particularly in their childhood relationships. Counselling in contrast starts from the idea of addressing the immediate issues in people's lives (such as infertility) and provides an opportunity to explore the associated feelings.’

Remember that choosing a particular kind of counselling or psychotherapy is far less important than choosing the right person – a therapist who you feel comfortable with. Research studies have shown that different kinds of counselling and psychotherapy can be equally effective. The key factors for success are

The skill of the therapist
Whether you feel comfortable with them
Your own level of motivation

Why might you consider counselling in relation to your fertility issues?

Having a child is a major life event for anybody and when this is proving difficult to achieve, it can feel like a major life crisis. What should be a normal life stage, for some anticipated since young adulthood or even his or her own childhood, now seems almost unattainable. Life may begin to revolve around medical interventions – hospital and clinic appointments, investigations, diagnoses, treatments and outcomes. All of these can trigger intense feelings such as:

Anxiety
Anger
Guilt
Sadness
Devastation
Despair

Treatment itself may bring up issues or experiences from the past you have thought to be forgotten or ‘left behind’.

What does counselling offer?

A professional and confidential service in which you have the opportunity to talk to someone who is

Separate from other areas of your life
Independent of any treatment decision or procedure
Informed about the medical and technological procedures as well as the legal, social and psychological aspects of infertility and treatment
Available to listen in a specific way
Will not judge you

What were your initial feelings about any form of counselling before you attended?

I used to imagine lying on a couch talking to a stranger. I couldn't understand how anyone could tell someone their feelings
I was very wary, I thought that I might be judged or that whatever I spoke about would be repeated
I've never considered myself the sort of person who would ever need counselling, as I am usually quite relaxed and in control, but on receiving my letter about IUI, I became extremely depressed and anxious and needed someone to talk my fears through with

How can counselling help?

Whatever your difficulties at whatever stage of your investigations, treatment or endings, a professional counsellor is someone who will help you to:

Make sense of how you are feeling
Explore and clarify your thoughts and concerns
Understand your reactions and find ways of coping
Identify choices and make decisions (about treatment options, including whether to use medical interventions, when to start treatment and when to stop)
Consider the implications of specific procedures
Come to terms with treatment not being successful, available or possible at all
Celebrate with you and support you in adjusting to pregnancy
Plan your future with or without children

With what can counselling help?

Loss of confidence and self esteem
Loss of control over your life and sense of direction
Feelings of isolation, sense of failure as a man or woman (as partner, husband, wife, son, daughter)
Difficulties in communicating with partner, family, friends, colleagues and significant others
Tensions within couple relationships including sexual tensions
Living with uncertainty
Other health concerns
Endings

What, if anything, do you feel you achieved from counselling?

I feel I achieved and am still achieving an unburdening of a little of my pain. I have been helped towards seeing things in a more positive light and identifying action I can take to regain control of a situation which feels very alienating
It helped us to release our anger and fears and to relax more about the situation we were in. Having someone who understood what we were going through was an enormous relief
I'm not sure whether counselling helped the treatment but I think it helped me cope with the unhappiness of being childless

What is the context of infertility counselling in the UK?

The HFE Act 1990, s3, gave clear statutory recognition to counselling in licensed centres
The HFEA Code of Practice 8th edition clearly identifies counselling as a distinct and separate area of expertise in clinics
‘Counselling is expected to be provided only by a qualified counsellor… and is expected to be independent of the clinical decision making process’ HFEA Code of Practice 8th ed para 7.7
Counselling is expected to be clearly distinguished from:

Information which is to be provided to all relevant parties
The normal relationship between clinical staff and the potential donor or seeker of storage or treatment (including the giving of professional advice)
The process of assessing individuals and deciding whether to accept them for treatment

What forms of counselling should be available at your treatment centre?

Treatment implications counselling
Donor-assisted conception implications counselling
Support counselling
Therapeutic counselling
Genetic counselling (may be provided by the centre's own counselling service or via referral to a specialist genetic counsellor or both)

Counselling – how, where and when?

Each licensed centre must offer counselling and provide verbal and written information on how to access the service
You may wish to research the counselling service offered prior to selecting a treatment centre – see the HFEA Clinic Directory for further information www.hfea.gov.uk
Some counsellors offer sessions within the centre, some work off site
Wherever the counsellor is based, you should be able to contact him/her directly without going through the centre's main appointment system, if this is what you prefer
Some, though not many, centres charge a separate fee for counselling – make sure you have full details before you commit yourself
Counselling services should be available at any time before, during and after any treatment or consultation
You may wish to attend with your partner (if you have one) or alone – discuss this with the counsellor
You may feel that one session will be sufficient or you may agree a number of sessions with your counsellor – there should be a clear arrangement which is regularly reviewed together
You should be able to access counselling at as many stages of your involvement with the centre as you feel necessary (including after your involvement has ceased)

Counselling – outside licensed centres

Although the majority of infertility counsellors appear to practice within licensed centres, some of these counsellors also provide counselling privately and some practise completely independently.

BICA (British Infertility Counselling Association) maintains a referral list of infertility counsellors which you can access via their website www.bica.net or by phoning their Information Line on 0114 2631448
BACP (British Association for Counselling and Psychotherapy) publishes a list of counsellors region by region on their website – www.counselling.co.uk Some of these counsellors may express an interest and expertise in fertility issues
UKCP (UK Council of Psychotherapy) as BACP – see www.psychotherapy.org or BCP (British Confederation of Psychotherapists www.bcp.org.uk
Many GP practices now offer a counselling service or will be able to refer you on to a suitably qualified therapist

10 Rules for choosing a counsellor (outside licensed centres)

Make sure he or she is registered with a professional body such as BACP, BICA (British Infertility counselling association) UKRC (United Kingdom register of Counsellors), UKPC or a chartered member of the BPS (British Psychological Society). If in doubt, ask about his/her qualifications and check these with the relevant professional body
Make sure there is a complaints and disciplinary procedure and he/she is working according to a professional code of ethics
Ask for an initial two-way assessment session – remember, this is going to be an important relationship and it is worth waiting to find the right counsellor for you
If you feel very uncomfortable with a counsellor, trust this instinct
Sort out any payment arrangements at the outset
Establish a contract – how long will you see this counsellor for, what will the review arrangements be, what are the cancellation fees if any?
Talk to the counsellor – you can say anything you want!
Be thoughtful and quiet if you want
Bear in mind that counselling is rarely very easy
Expect changes not miracles

Additionally, in the context of infertility, you may wish to ask about his/her relevant infertility counselling experience.

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