Therapy and Pregnancy Loss

As some of you may know, October is Pregnancy and Infant Loss Awareness Month. With 20% of pregnancies ending in miscarriage and 16% of people trying to conceive struggling with infertility in some way, this is an important topic and one that's very close to our hearts.

I (Caroline) am one of the co-founders of The 16 Percent, an organization dedicated to sharing stories of infertility and pregnancy loss, in an attempt to destigmatize this, and help people going through this feel less alone. In honour of this month, we’ve decided to link our two missions and talk about how therapy can be an essential part of grieving a loss and moving forward, whatever that may look like.

I spoke with Caitlin Beukema, a social worker/psychotherapist at The Healing Collective about therapy and pregnancy loss.

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In a general way, what can therapy do for someone dealing with infertility/loss?

Infertility in particular is unique in that month after month, there are ups and downs. Hope and loss are in rotation, and the grief from this can intensify. If pregnancy doesn’t appear possible, there is the loss of the dream, the expectation of carrying a baby. Similarly, with miscarriage or stillbirth, the loss is multifold. Loss of a baby, loss of a life unknown, loss of the self-concept of a parent, or the couple as a family, and so on.

In both cases, the grief felt by those experiencing infertility and pregnancy loss can be described as disenfranchised grief. This refers to people who feel that their grief cannot be openly acknowledged, publicly mourned or socially accepted

It’s generally seen as different from those mourning the loss of a loved one who died later on in life. The grief revolves around many loses, as mentioned earlier, and it occurs because, despite no physical presence, the psychological and emotional presence is very real. Although more and more people are starting to speak openly about infertility and pregnancy loss, often friends and family members, though well-meaning, may say things that end up being hurtful; things like “it wasn’t meant to be”, or “at least you already have one”. So, in addition to being a place of healing, therapy for someone experiencing a loss or dealing with the challenges of infertility can be a place of acknowledgement.

Having a space to feel that acknowledgment is so vital to healing. Therapy can help you to understand the culture of grief we live in and how contradictory it is from what the grieving person actually experiences and knows to be true. It can be a place of acknowledgement for something that is generally not easily spoken about, a refuge to feel all the big, messy and ever-fluctuating feelings. Therapy can help normalize and validate those feelings, and help you to navigate and cope with them in your daily life.

How do you know it’s time for therapeutic intervention after a loss?

This is highly individual, but some indicators that it would be a good time to talk to someone would be:

  • Feeling alone; a lack of support from friends and family, lack of support to acknowledge the loss
  • Difficulty managing at work or daily activities
  • Difficulty in one’s relationship as each partner may be navigating their grief differently
  • Any feelings of shame or guilt surrounding the loss
  • Any behavioural changes, ongoing or persistent changes in mood, sleep, and appetite may also be indicators that it would be a good time to see a therapist.

This is sort of a general question, but a good here too. How do you find the right therapist? What are some key questions to ask before meeting?

First and foremost is the relationship between yourself and the therapist- it lies at the heart of therapy and is central to a successful healing journey. For this reason, many therapists will offer a free consultation- take them up on it! You can get a good sense of how the therapist works by doing this, and gives you a chance to ask the questions you need to decide if you’d like to move forward with an appointment. That leads us to the questions you might like to ask… I’d recommend clarifying to yourself what it is you are looking for. What would you like to work on, and why now? Try to understand if you have any particular expectations from your therapist, and what, if any, modalities you might prefer. There is so much information available online, so take some time to research these things. You can also ask the therapist to describe their approach; what does a session look like? Finally how did it feel when you spoke to them during the consultation? Did you feel heard, did you feel comfortable? Don’t forget to listen to your intuition when making this decision.  

What are some helpful therapeutic methods or techniques that people who are dealing with loss and/or infertility should discuss with their therapist?

It really depends on the person and what is needed. With loss specifically; there really is no one way to grieve, and so the modalities used would depend on the client, and the therapist may draw various techniques from a wide range. Mindfulness techniques, or narrative techniques come to mind as being useful. Your therapist will likely keep in mind various grief theories to help conceptualize the treatment. There’s this old and somewhat lasting theory that grief follows a certain path of emotions- denial, anger, etc. You may have heard of this concept, though it’s been known for some time that rather than a linear path it’s more of a rollercoaster; navigating a new normal of ups and downs. Your therapist will help you ride that rollercoaster, normalizing and validating your experience, and help you to find more and more moments of balance and peace. Often, it’s about holding both absence and presence together in the mind.

In therapy, you’ll learn to understand and recognize the wide range of emotions and various ways you can cope with them. A really nice technique that I like to encourage clients to use are rituals. They can be small- like taking a moment, lighting a candle and thinking of the loss with your partner or family, or larger such as organizing a memorial. Tapping into various creative outlets can be super healing… music, art, cooking, or even spending time in nature. Finally, a good grief therapist will also be able to distinguish grief from trauma, which can get in the way of working through the grief.

Loss and/or infertility can often create rifts in relationships; both with a spouse and with friends and family (particularly those who are pregnant or have babies). What are some strategies (besides seeing a therapist) that can help people keep their relationships intact when everything seems to be falling apart?

This can be so so tough. On a personal level, I remember how alone I felt after my first miscarriage. I was surrounded by friends and colleagues that seemingly had no trouble achieving and maintaining their pregnancies. There was shock and anger- why didn’t I know how often this happens?

Since we don’t talk enough about loss or infertility openly in our culture, not many people know how to offer support. I think it’s really important to tune into oneself, to be mindful of the different emotions that can arise and to be aware of how to honour these emotions. Part of this means learning how to ask for what you need, and often it’s about deciding where to spend your energy. If you are struggling with infertility and your friends talk only about their pregnancies or their new baby, perhaps it’s a good idea to consider some boundaries for the time being. This could look like declining that invitation to the baby shower, (you really don’t have to go!) avoiding spaces that are typically full of strollers, or even asking your friends if they could be mindful of the conversations they involve you in.It doesn’t mean you aren’t happy for them, it just may be a little more difficult to fully live in their joy.

Working with a therapist can help to clarify some of these things, help you to attune to your own emotions and articulate your needs. Journaling/writing can also be a great way to process emotions and uncover your needs. When we are able to sit with what is happening, allow it to be, as it is --whether it be the pain of infertility or the pain of loss-- we can better help ourselves to survive and manage inside of that pain.

How can therapy help people strike a manageable balance between grief and hope, in cases where another pregnancy is the goal?

This is a really good question, and I think that grief and hope can definitely live together. Therapy can help you recognize that both need to exist. It can help you get to a place where you know simultaneously that you’ve experienced something tragic, AND you still desire moving forward, or trying again. There will be moments of living fully with the grief, the knowledge of the loss and its impacts on your life. There will also be moments of planning for the future. This happens more easily once the grief has been acknowledged. Grief doesn’t end, but it does become more manageable. Give yourself time, talk about it as much as you can or need to. There will be ups and downs; there will be triggers (like seeing friends with their babies), but if you honour your emotions, it will get easier. Eventually, the story will be integrated into your life. It’s your story… not the one you would have chosen, but it’s yours. The more accepted this becomes, the more space you create for thinking about the future…whatever it may hold. Hope is uplifting, it’s integral, and above all, hope is survival.

Thank you Caitlin!

If you’d like to learn more about The 16 Percent, you can visit us on Facebook, or on our website, the16percent.ca.

 

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