How to Keep Infertility from Destroying your Marriage

Infertility places extraordinary stress on a marriage. In addition to the medical challenges associated with infertility there are numerous emotional and relationship challenges that develop as a result of infertility. Unfortunately, very few physicians educate couples about the emotional aspects of infertility or about how infertility treatment can impact a marriage. Many couples aren’t even aware that their relationship is deteriorating until it reaches a breaking point.

When couples begin trying to conceive, they do so with the hope and expectation that becoming pregnant will take some time but that it will eventually happen. The first shock occurs when conception fails to occur in the time frame they and their doctors have set (usually a year). At this point, one or both partners becomes worried. Typically, this is when the couple seeks medical consultation.

A diagnosis of infertility is usually unexpected and almost always disappointing. Infertility introduces greater uncertainty into the family planning process. Once a couple has been diagnosed as infertile, they are usually referred to an infertility specialist who recommends a course of treatment. While treatment is stressful for both partners, there is a qualitative difference in the type of stress each partner experiences.

Women often develop anxiety around their menstrual cycles. Each month they experience guarded anticipation. If their menses occurs, they become disappointed and even more anxious about their prospects for becoming pregnant. This often places stress on the husband who also experiences anticipation and disappointment alongside his wife. However, in addition to coping with his own feelings, husbands witness and struggle to cope with their wife’s increasing anxiety and disappointment.

This recurrent cycle of anticipation and disappointment can wreak havoc on a relationship. It’s not uncommon for women to become somewhat controlling about having sex during ovulation. They may be irritated or demanding towards their partner if he’s unavailable at the appropriate time.

Men may begin to experience anxiety related to having sex. The feeling that they have to perform on demand and under pressure, can effect their ability to obtain or maintain an erection. This may further frustrate the woman who may respond to this perceived obstacle by becoming angry or accusatory. This introduces an undercurrent of anger, resentment and anxiety between the partners. These are not optimal conditions for maintaining a good sexual relationship, let alone a good emotional relationship.

In addition to the above relationship dynamics, infertility treatment is expensive. Spouses are not always in agreement about how long to pursue treatment, how much to spend on it, the kinds of interventions to pursue or the alternative of adoption or not having children at all if the treatment fails.

Last but certainly not least, infertility is physically uncomfortable and sometimes painful for women. Hormonal changes can exacerbate moodiness. The longer treatment proceeds without success, the greater the level of anxiety and disappointment experienced by one or both partners.

One of the alternatives to the increasingly charged spiral I’ve described above is for couples – especially women – to try to move away from the monthly focus on their menstrual cycles. A longer term view that places the health of the marriage in the forefront can work to keep a marriage healthy and insure regular sexual contact.

It is important for couples not to allow their entire relationship to become focused on procreation. Regular date nights, romantic weekends and other “baby free” zones of relating are an important balance to the often intense process of trying to have a child. It’s also a good idea  to decide on a time line for pursuing treatment. Otherwise the process may feel endless which can be quite discouraging.

It is advisable to create family alternatives that take into account the possibility that treatment may not be successful. This may include adoption, becoming more involved in the lives of the children that already exist in your extended family, or deciding not to have children at all. If this last option becomes the one you choose, the two of you may need to develop specific plans for how you want your life to evolve.

Some times couples whose relationships have deteriorated during the process of infertility treatment, decide to place procreation on the back burner while they concentrate on rebuilding their relationship. While this may feel like a setback, it may also be necessary.

The best strategy for dealing with infertility is for both of you to make your relationship the priority. Remember - there can be no family without the two of you!

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Johanna Nauraine is a psychotherapist in private practice. She specializes in premarital, marital and divorce therapy, infertility, addictions and career coaching. Read her relationship articles at: http://johannascouch.com

Breaking Your Engagement Requires Bravery!

If you are thinking about breaking your engagement – be prepared for a chorus of confusion and disapproval from the important people in your life. One of my readers asked, “Why is a broken engagement seen as worse than a divorce?” Good question!

Unfortunately, friends and family typically respond to the person who’s not sure about following through with their marriage -- as “just having cold feet.” This perspective minimizes the importance or legitimacy of that person’s feelings.

It’s not uncommon for friends and relatives to try to shush or suppress the doubting person’s fears. Often they fail to explore this person’s reservations. They mistakenly assume the person’s “second thoughts” or last minute “jitters” are normal and temporary.

I believe there are social taboos against breaking an engagement.  We admire engaged couples. They symbolize our romantic hopes, dreams and expectations. There is something in all of us that hopes, “these two will make it.” We project our own unmet hopes and expectations on the newly engaged person. If that person begins to experience serious reservations about getting married, their fears stir up our own feelings and hopes about marriage coupled with the disappointing awareness that many marriages don’t work

In addition, social status accrues from being engaged. Friends and family admire the prospective bride’s ring. They get involved and excited about planning showers. They anticipate looking for dresses, shopping for flowers, etc. It’s not uncommon for the wedding to become more important than the marriage!

The engaged person who begins to have reservations about moving ahead with the wedding usually worries that they will disappoint not just their romantic partner but their friends and family. Sadly and often accurately, they anticipate a lack of support or anger from these people regarding the money and time spent preparing for the wedding.

Many brides and grooms know, prior to their wedding that their relationship is in trouble. Some seek premarital therapy hoping to improve their relationship. However, many of these couples enter therapy after they’ve begun planning their wedding. Not often but occasionally I’ve recommended that couples in troubled relationships wait to marry until they are on firmer ground. These couples usually ignore my suggestion – mostly because their wedding plans are already in the works.

Weddings tend to take on a life of their own. Couples typically feel once the “train has left the station” there’s no going back. Unfortunately, I often see these couples for therapy shortly after their wedding or a year later when their relationship is in even deeper trouble.

Every relationship has challenges but two people who are thinking about getting married should be able to make major decisions in a manner which both feel good about. They should both feel comfortable and happy with their physical relationship. Each should be able to count on the other emotionally, especially during illness or crisis. There should be a good capacity for resolving problems and communicating openly. If any of these elements are missing, they need to be worked on prior to getting married.

The most common causes for breaking an engagement are:

1)   One or both have been ambivalent about the relationship for a long time but felt pressured into getting engaged by their partner’s expectations, coercion or ultimatums, by the norms in their peer group or by their families.

2)  One of both realize they got engaged for the wrong reason, .e.g it seemed like the right time in life to get married, the woman got pregnant, one partner was facing visa problems which could be solved by getting married, someone needed health insurance which the other had through work, it was an impulsive decision fueled by alcohol.

3)   The relationship has been problematic for some time but one or both realize getting married won’t magically make the relationship better.

4)   There’s a big fight and one breaks off the engagement and walks out.

5)   One partner meets someone they love more.

6)   Neither feels their needs for closeness, affection, intimacy or understanding are being met.

7)   One partner experiences the other as unreliable when it comes to money, emotional availability or support.

8)   The engaged person observes behavior in their partner that seriously concerns them. This might include drinking, partying, spending money, or engaging in infidelity.

9)   One partner feels the other is too involved with their family of origin.

10) A couple who has gotten engaged during a long distance relationship, move to the same city and  begin to experience difficulties.

11) One of the partner’s realizes they don’t love the other enough to want to marry them.

This list is by no means comprehensive but it’s a pretty good starting point.

It’s my belief that couples should feel married before they get married. Ideally, there should be sufficient closeness and satisfaction with the relationship that getting married feels more like an afterthought – the period at the end of the sentence, the icing on the cake. Too many couples mistakenly think getting married will take their relationship to a new level of closeness. In a good relationship this is certainly true. But in a troubled relationship, marriage often amplifies the problems that already exist.

Marriage is complex. There are many opportunities for a relationship to veer off course. If either one or both of you have any reservations about getting married, sort them out ahead of time. If you’ve made efforts to work out the problems in your relationship and this has not been successful – think again. If you’re meant to be together – you will be. Take time to develop your relationship to a point where getting married feels natural and right.

If you are seriously considering ending your engagement, get support from friends and family. Tell them why you are feeling the way you are. Don’t compromise on what’s best for you. Be brave. Your friends and family are not going to live in your marriage – you are. Marriage more than any other relationship has the capacity to impact your day-to-day happiness. Make sure your relationship is one you believe in for the long haul.

Johanna Nauraine is a psychotherapist in private practice. She specializes in premarital, marital and divorce therapy, infertility, addictions and career coaching. Read her relationship articles on her blogs at: Chicago Psychotherapy.

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Marriage Maintenance: The Weekly Summit

Two career couples often find themselves so busy they have little time for each other and their relationship. One of several outcomes seems to derive from this lack of quality time together.

It’s not uncommon for small issues to build up and become big ones. This can lead to resentment or to explosive encounters where one or both dump everything they’ve been upset about. (See my article, Fair Fighting). Neither of these is a productive method for resolving conflict and both can lead to distance in the relationship.

Emotional closeness is essential to the survival of a long term relationship. Busy couples need to develop habits that contribute to maintaining closeness.

One suggestion I often make to couples is that they hold a weekly summit. The weekly summit is an opportunity for each partner to communicate with the other about experiences that occurred in their relationship during the week. I recommend the following format.

Guidelines for The Weekly Summit

1.      Choose a quiet time and place for your conversation.

2.      Turn off all forms of media and remove distractions.

3.      Sit in a comfortable place facing each other.

4.      Assume an attitude of respectful openness.

5.      Only one person speaks at a time.

6.      The speaker has the floor until they are completely finished with their three positive comments and their three negative comments.

7.      The listener listens without interrupting.

8.      The listener maintains an attitude of open curiosity no matter what the speaker is saying.

9.      The speaker begins by mentioning 3 things they appreciate about the other’s behavior during the week.

10.  The speaker follows up their appreciation by making three complaints or requests for change or improvement in the other’s behavior.

11.  The listener should acknowledge each positive statement after it’s made and each negative statement after it’s made.

12.  The listener should respond to the other’s request for change by agreeing to what’s been asked or by proposing an alternative.

13.  Once both people have had a chance to state their positives and negatives and once agreement has been reached concerning the requested changes, the summit is over.

The weekly summit does not need to be lengthy. In fact, it shouldn’t take a lot of time. However, making a regular practice of conducting this meeting will help maintain and sustain emotional closeness in your relationship.

Copyright Johanna Nauraine, 2011

To read more articles on marriage, visit my blogs at: Chicago Psychotherapy.

Premarital Counseling Builds Healthier Marriages

Engaged couples who are happy together may not see the relevance of premarital counseling. However, those couples who have an easy courtship are often least prepared for the challenges of married life. In contrast, couples who experience problems during courtship usually develop patterns for resolving their differences. Unfortunately, these patterns are often dysfunctional.

Couples are often referred for premarital counseling by the clergy who will be officiating at their wedding. These couples usually enroll in a premarital counseling workshop or seminar offered through their church or synagogue. Others seek out public workshops to learn about marriage. These workshops offer an introductory exploration of common marital issues such as money, sex, in-laws, household responsibilities, religious beliefs, etc.

However, after more than thirty years of treating couples in all stages of relationship, I’ve concluded that emotional and psychological knowledge of one another is a necessary prerequisite for successful marriage. Conflicts about money, sex, child rearing, infidelity and a host of other issues are often symptoms of deeper individual or marital problems. Good premarital counseling and psychotherapy addresses both the symptoms and the underlying causes of these difficulties.

Good premarital counseling is a fully engaging experience. It requires each person to examine and address their own issues and to expand their thinking and actions in order to accommodate their partner’s needs and feelings. The best premarital counseling and psychotherapy builds relational competence. It helps couples learn to communicate effectively, acquire skills in conflict resolution, deepen intimacy, build empathy, strengthen emotional bonds and establish a strong foundation for the future. In addition, good premarital counseling helps each person develop greater self awareness and a deeper emotional understanding of their partner. It also helps couples gain insight into their relationship’s dynamics and improves their ability to work with these dynamics to build and preserve emotional intimacy and the long term health of their relationship.

Psychological and emotional understanding of one another at a deep level takes time. This is not something that can be accomplished in a weekend or multi-week group seminar. Unfortunately, many couples are unwilling to engage in this work until after they have started to experience problems. By then it is much more difficult to alter the patterns of interaction that have been established in the relationship. In addition, there may be serious problems with trust based on disappointing experiences.

The best time to begin premarital counseling is as soon as you and your partner know you want to get married. Most couples seek premarital counseling prior to and during their engagement. Many continue to be involved in counseling and psychotherapy through the first year of marriage. This is the optimal approach as there are many changes that occur in the months leading up to and through the first year of marriage.

It takes bravery to be willing to examine yourself, your partner and your relationship. There is always the risk that you will uncover something you can’t accept or don’t want to live with. You may discover that your values, lifestyle preferences or interactional dynamics are too difficult to navigate. But you may also fall more deeply in love with your partner. You may appreciate them more. You may develop greater empathy and compassion and respect for their individuality. And you may experience greater confidence in your ability to be good partners to one another.

Marriage is a complex relationship that deserves careful thought and reflection. The quality of your marriage has the power to impact your day-to-day happiness and the happiness of your children. While there are no guarantees, premarital counseling and psychotherapy are the best safeguards I know for building and preserving a healthy marriage.

Copyright Johanna Nauraine, 2010

Johanna Nauraine is a psychotherapist in private practice. She specializes in premarital, marital and divorce therapy, infertility, addictions and career coaching. Read her relationship articles at: http://johannascouch.com/

REPRINT RIGHTS Statement: This article is free for republishing by visitors provided the Author Bio and Copyright is retained and the author's website link remains active.

Long Distance Relationships - Love Across the Miles

Long distance dating relationships and long distance marriages are increasingly common. However, physical distance poses certain risks to these relationships. In my more than thirty years of experience as a psychotherapist, I’ve concluded that these risks vary in quality and meaning depending on the stage of the relationship.

Among dating couples, the greatest risk posed by physical distance is the honeymoon quality that characterizes their periods of togetherness. These relationships are frequently passionate and intense due to the constant cycle of separation and reunion. The limited exposure to one another often results in the partners having an idealized experience of on another, that is, they see each other when they’re at their best.

In my experience, the greatest risk associated with long distance dating is that a couple will decide to marry during the honeymoon phase. When this happens, neither has sufficient knowledge of the other, because they haven’t experienced one another across a spectrum of life experiences.

When long distance daters get engaged, one partner usually relocates to the same city as the other. This often sets off a period of adjustment because they have greater exposure to on another. The honeymoon phase usually gives way to a more realistic phase. If the partners decide to move in together, their involvement with each other is amplified. Certain issues need to be addressed including: division of household responsibilities, detailed discussions and decisions about finances, the development of a shared social life, and perhaps greater involvement with or separation from one or both partner’s family of origin.

A couple’s ability to problem-solve together usually becomes more apparent during this more realistic stage of the relationship. If they experience difficulties, one of three responses tends to prevail: they seek premarital counseling, they continue with plans to marry despite the problems, or the relationship dissolves. In my experience, many premarital couples move forward with plans to marry despite the fact that they are experiencing significant problems. The greatest risk among couples who move from long distance dating to getting engaged is that the excitement about their marriage plans take precedence over learning how to successfully negotiate the problems they encounter in this realistic stage of the relationship.

Long distance marriages typically occur after a couple has lived together for some period of time. The separation is usually due to one partner’s career. Physical distance places several unique stresses on a marriage. First of all, the bulk of household and child care responsibilities fall to one partner. This partner may grow resentful or envy the freedom and seeming glamour of the commuting partner’s life. They may also feel insecure if their partner is going to be working closely with members of the opposite sex.

Spouses in long distance marriages often feel lonely, especially because they’ve grown accustomed to living together. While the lure of sexual novelty is no different for married couples living apart than it is for those living together, physical distance may make these marriages more susceptible to infidelity. The distance makes it easier to hide an affair. There may also be a greater likelihood of one partner falling in love since it’s virtually impossible to sustain emotional intimacy in a relationship during extended periods of absence.

In order for long distance romantic relationships of any kind to work, a couple needs to communicate with one another frequently and make plans to see each other regularly. The more frequent the visits and the longer the time they spend with each other – the better. Also, prior to marriage, a couple should plan to live in the same city if at all possible. Most importantly, they need to move from the honeymoon phase to the realistic phase of relating and they need to be sure they are able to successfully navigate the real life problems that emerge during this stage.

For married couples who live apart – the same holds true. Frequent contact by phone and in person is essential to keeping a marriage alive. It is the day-in, day-out quality of marriage that leads to emotional depth and intimacy. While absence can make the heart grow fonder, it can also lead to indifference.

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Chicago Psychotherapy: Tips for Consumers

Chicago is a city with thousands of psychotherapists. Finding a good one can be daunting. Consumers often have little idea about what to look for when seeking a therapist. This article provides guidelines that will help clients navigate the complex landscape of Chicago psychotherapy.

Within Chicago there are a number of schools that offer degrees in psychiatry, psychology and social work. These three degrees are the best recognized and most widely known within the Chicago psychotherapy community. The University of Illinois, Loyola University, The University of Chicago and Northwestern University offer programs that are highly regarded and that rigorously screen applicants to their programs. Graduates finish these programs with one of several degrees. Psychiatrists have an M.D., psychologists usually have a PhD. and social workers have an M.A. or M.S.W.

Clients who are looking for a therapist should ask where the therapist received their degree. Unfortunately, there are more and more online degree programs that require no supervised internships and offer students no clinical supervision. While graduates of these programs have paper credentials, they do not have the necessary clinical experience or supervision to be psychotherapists.

It’s also important for clients to ask how long someone has been in practice. Psychotherapy is an art and a science. The longer someone has been providing psychotherapy, the greater the likelihood that they will be skilled at their craft.

Clients are often encouraged to look for a therapist with whom they ‘have a good fit.’ However, this doesn’t mean just finding someone who’s a likeable person. Most therapists are nice people but not all therapists are skilled at what they do. Clients should look for someone they like AND who they trust in terms of their level of experience and skill. Skill is something that can be readily determined. It doesn’t take long to know whether a therapist understands you and the challenges you’re facing problem and has some idea about how to help you address your issues.

Choosing a therapist in your insurance network shouldn’t be the only criteria for deciding which therapist to see. In the Chicago psychotherapy community, the most experienced therapists are often out-of-network providers. These therapists frequently have a sliding scale in order to accommodate those clients who aren’t able to pay their full fee but who would like to work with them.

Therapists have many different approaches to working with people. Some are focused mostly on reducing a client’s symptoms – e.g. eliminating conflict in a relationship or reducing anxiety.  This therapy tends to be short term and the relationship between the client and the therapist is secondary to reducing the symptoms the client came in with.

Other therapists have a focus on personal growth and change. This type of therapy tends to be deeper and longer lasting. Therapists with this type of focus tend to develop relationships with clients who come to see them off and on for many years.

Over the past twenty years, the Chicago psychotherapy community has experienced a radical shift. This shift coincides with the proliferation of managed care and insurance panels. Presently, there is a much greater emphasis on short term psychotherapy and symptom reduction. The client-therapist relationship has a secondary role and those therapists who provide the deepest work and highest quality treatment are increasingly difficult to find.

It is important to be clear about your expectations for psychotherapy and to communicate this to your provider. This tends to lead to greater satisfaction with therapy.

Johanna
http://www.johannascouch.com/