Great news for our local infertility community!
Salt Lake City will be the home of the Utah Infertility Resource Center. I am heading up the clinical aspect of UIRC as the Clinical Director and I'm excited about what's in store. Join us for an opening night celebration and ribbon cutting event on Saturday, March 5th.
UIRC has conducted a survey to better understand the needs of local Utahns experiencing infertility. We wanted to ensure that our services address the needs of our community. After reviewing the data I wrote up an article summarizing it. Read on to learn more about specific emotional aspects unique to Utah.
Infertility in Utah: A Unique Experience
Ashley and Jake both grew up in Utah, married young at age 23, graduated from college, began their careers and dreamed of a future with multiple children. A year after their wedding, they began trying to conceive. Month after heartbreaking month, the pregnancy tests were negative. Pregnancy announcements from friends and family started getting harder to celebrate. Reality began to set in, and with it came the realization that they would need to seek medical help in order to grow their family. Jake felt like less of a man due to infertility and didn’t share his experience with anyone. Ashley felt like less of a woman, because she had always imagined herself as a mother. She began to sink into a dark depression, feeling like she was losing sight of her lifelong dream of motherhood. Friends and family meant well, but a once exciting question now stung. When would they start a family? Four years, many invasive treatments, a failed adoption and thousands of dollars later, Ashley and Jake remain childless. Ashley and Jake’s story is not uncommon. They are among the 1 in 8 couples that struggle with infertility.
Individuals in every corner of the world experience infertility, but A Utahn struggling with infertility is likely to experience some unique complicating factors. As with any experience, infertility is colored by a person’s culture, beliefs, community values, and the like. For example, a woman suffering from infertility in Manhattan may have different experiences, levels of support or feelings about infertility than those experiencing infertility here in Utah. Interestingly, close to 5% of all pregnancies in Utah result from some form of fertility treatment. The Centers for Disease Control recently released birth statistics from a number of states and Utah scored at the top of the list: a higher percentage of Utah residents receive fertility treatment than in the other states included in the study. How are Utahns experiencing infertility? Which emotional aspects are related to our local culture and which are not? One local nonprofit wanted to know more.
The Utah Infertility Resource Center (UIRC), a newly-established non-profit dedicated to supporting those with infertility, has gathered data from local respondents by posting a survey among various infertility, parenting after infertility, and adoption online support groups. UIRC compiled the data from 152 respondents (97% of whom were women) which reviewed age, income, length of time trying to conceive, infertility treatments, symptoms of grief, depression, anxiety, and resources individuals relied on for support. Of the respondents 55% have children (the majority have one child) and 45% do not have children. Of those with children, 35% had children who were conceived with no medical intervention, 31% had children through IVF (In-Vitro Fertilization), 24% had adopted infants, 19% had children with the help of fertility medication, 10% had participated in foster care adoptions, and 7% had children resulting from IUI (Intrauterine Insemination). Almost half of those surveyed reported experiencing miscarriage, stillbirth or loss of child. The median time trying to conceive was three-four years.
Interestingly, 85% of respondents reported that Utah’s family-focused culture influenced their infertility journey. Although respondents did not report specifically how it had impacted their experience, respondents may feel increased pressure to have a family or have a large family. The average age nationally of when a woman delivers her first child is 26. Utah’s average is slightly younger, 25.1. Woman aging into their 30s may feel “left behind” by peers or siblings. Utah also has the highest fertility rate in the nation, that is, 2.6 children for every one mother, meaning that Utah families are the largest in the country. Living in a state with these statistics and being the outlier undoubtedly has an emotional impact on couples who are experiencing infertility. It is also likely that couples are seeking fertility treatment earlier (in their 20s and 30s) whereas couples in larger metropolitan areas where the cultural expectations differ, are likely seeking fertility treatment later (40s).
What Infertility Feels Like
UIRC was interested to know how respondents experienced the emotional side of infertility. A common theme was isolation. Many respondents reported that they didn’t share their infertility diagnosis or treatment with anyone for the first several months. When they were diagnosed, one-third of respondents didn’t know anyone who had struggled with infertility; and half of respondents waited two years or more to reach out to others who were also suffering from infertility. Respondents reported their most common emotions as sadness followed by frustration, anger, emptiness, hopelessness, depression, fear and despair. The majority of respondents reported extreme anxiety. We know from broader studies that women experiencing infertility have significant levels of distress, equivalent to those facing life-threatening diseases such as cancer. Consider that 75% of local respondents reported that infertility was the most upsetting event of their life!
Barriers to Treatment
It is clear that the experience of infertility has an emotional impact on couples. UIRC was interested to explore barriers to creating a family. UIRC found some interesting trends, many of which are likely true of individuals across the country. Respondents reported cost as the most significant barrier to accessing infertility treatment. Infertility treatment is, for the most part, not covered by insurance, and couples are often left to cover the costs on their own. Local respondents with an average annual income of $60,000, reported spending an average of $10,000 to $15,000 on fertility treatments. The cost of treatment is a serious problem and impediment for most.
Respondents reported feelings of grief and loss as the second largest barrier to infertility treatment. The emotional toll often leaves couples stifled, either unable to make a decision or emotionally overwhelmed by the options.
Reaching out for Support
Many respondents were unsure where to seek support services for infertility, such as support groups or individual counseling. More than half were interested in attending a support group, but weren’t aware of one in their area. And, although many had considered individual therapy, cost continued to be a barrier. Many couples found support in online fertility-focused support groups. Finding support for any emotional obstacle is useful but perhaps--and the research seems to suggest--seeking support concerning infertility could also improve pregnancy outcomes. A study completed by Alice D. Domar, a psychologist at Beth Israel Deaconess Medical Center in Boston and director of mind-body services at Boston IVF, concluded that women who were taught stress-reduction techniques, such as mindfulness-based meditation or cognitive restructuring, had improved outcomes related to conception. Dr. Domar notes “there’s something about practicing relaxation techniques or being with other women who understand what you’re going through, probably a combination of everything, that makes a difference. It isn’t just about relaxing.” Dr. Domar further explains that “in some cases her symptoms and prognosis improve” when “you treat a woman’s mind as well as her body.” Regardless, “almost without exception she feels better and can cope more effectively with her condition.”
UIRC is using the foregoing and other data to develop programs to support those who experience infertility. These programs include support groups, sliding fee scale therapy, informational events, community awareness and advocacy. UIRC is excited to bridge the gap of services for those struggling to build their families. Utah couples like Ashley and Jake will now have greater access to education and support for the mental, emotional, and social effects of infertility. UIRC’s Opening Night Celebration on March 5, 2016 will introduce Utahns to local resources and support services for those experiencing infertility.
The next round of my Infertility Support Group is starting February 16, 2016. I love this group, really love it, it's magical.
I watch women instantly find a sisterhood among others who are dealing with infertility, women share their fears, hopes and vulnerabilities. I watch clients experience being heard, and understood. During the first session, I watch as strangers shake their head in agreement with one another as stories are shared. It's like having a mirror to validate your own experience, you see that you aren't crazy, you aren't a mess.
These small groups of women build solid relationships, they keep in touch, and go on to attend one another's baby showers.
I am so lucky that I get to create the space for all this to happen. Join us!
Finding Peace: Infertility Support Group
Join a small group of women in discussion about the impact of infertility. Open to women on any part of the infertility journey including: considering treatment, fertility treatment, third-party reproduction and those moving towards adoption. We will utilize art therapy modalities, journaling, mind/body awareness, all in a supportive setting. Led by Whitney Barrell, LCSW therapist, with both personal and clinical expertise in infertility counseling.
When: Tuesday Evenings: February 16th-March 22nd 7:00-8:30pm
Where: Whitney Barrell’s Office
1308s. 1700e. #209 SLC, Utah 84108
Why: Because it feels good to be in a group of women who "get” what you are dealing with.
Want to know what to expect? Read a journal entry from a woman in a previous group.
***Feel free to call with questions about the group, or to see if it would be a good fit for you.
Developing Confidence or self-esteem is often a topic in sessions with teens. In a developmental stage where they are forming their identity, values and becoming more and more aware of the complexity of human relationships it's a topic we often circle back to. But, as a therapist I find it's a slippery one, a concept that doesn't lend itself to explanation. This video, along with it's practical tips is well done. Take a look, for yourself, or for your teen.
Lesson made in partnership with the Always #LikeAGirl campaign, animation by Kozmonot Animation Studio.
Introducing our new parenting series: Beyond the Birds and the Bees: Discussing Healthy Sexuality with your child.
I am very, very excited to announce a collaboration a colleague and I have been working feverishly on. Shannon Hickman is a fellow clinical therapist who specilizes in sex therapy. In her private practice she treats couples dealing with a myriad of issues related to sex, intimacy and their implications.
Shannon and I are both new mothers. We starting talking about how important it is to us that our girls feel comfortable in their bodies, think about and experience sex without shame and get their information from us (rather than rumors and school yard pals). So, we started digging into the research about how to ensure this happens. Lucky for you, we've distilled all of this down into a parenting series that we're offering to parents who feel as passionate about this issue as we do.
We plan to discuss how our own thoughts about sexuality have the tendency to bias our discussion with our kids, we will talk about age- appropriate sexual development, break down the nitty gritty on just how to share information about sex and cover any other questions you can conjure up. It's going to be a great time, join us.
If you're interested in a little taste, check out the KSL article we wrote to give you an idea of where were headed.
Beyond the Birds and the Bees: Discussing Healthy sexuality with your child.
By Shannon Hickman, LCSW and Whitney Barrell, LCSW
First published by KSL July 29, 2015
Most parents tend to dread, or at least feel intimidated by, having “the talk” with their child. There are a myriad of resources discussing what topics to introduce at which age, and what is characterized as normal sexual development. The National Child Traumatic Stress Network offers a comprehensive outline of healthy sexual development.
But, what we’d like to offer is a broader view of this “talk,” and some factors to consider. Parents typically think of the “talk” as discussing sexual intercourse in a framework of how children are conceived. Rather than just focusing on the mechanics of how babies are born, consider broadening the discussion based on the child’s age and ability to understand concepts. No one knows your child better than you do, and as parents, your deep love and connection to your child makes you the best person to talk with them about sex. Before talking with your child about sex, think through your own values about the role of sex in a relationship, healthy sexuality, what you want your child to understand about their body, and how you want them to feel about their body and their sexuality. Think back to your own experience when learning about sex and intimate relationships and how your parents or others discussed this topic with you. Are there important values or standards that you want to impress upon your child? Consider the biological, emotional, social, relational and spiritual aspects of sex and how your beliefs and values fit into these areas. Was the way your parents shared this information with you successful? Is there something you’d like to do differently?
Often children grow up viewing sex as a physical gratification rather than equating it to love and fulfillment. It is important to remember this is not a one time conversation. It is an ongoing topic of discussion and the more open the child can be, the more support a parent can provide in helping to positively shape their child’s sexuality. With our children being bombarded daily in the media with sex and sexual images, it is more important than ever to help them to develop healthy attitudes about their bodies and sexuality.
Identifying your own beliefs and attitudes about sex ahead of time will allow you to work through some of your own anxieties prior to having the discussion with your child. We as adults have often developed unhealthy attitudes about our bodies and sex that may affect the way we communicate with our child during discussions about these topics.
Most parents feel a degree of anxiety in discussing sex with their children. Examine what makes you anxious: is it talking about a private topic; is it that you don’t feel prepared? Keep in mind that the tone or level of anxiety will convey more about how you feel about the topic than the actual content you share. If you want to exude acceptance and openness, make sure your face, and body positioning also conveys this. Plan out what you’d like to tell your child and choose words that feel comfortable for you.
Using everyday life to bring up topics of sex and sexuality are typically the best way to proceed. If you see something on TV with your child that feels like a “teachable moment,” take it. You might ask, “what do you think about all of that?” Focus on what questions they are asking. If your child asks “where did I come from?” He may just be asking which hospital he was born in? Clarify the specific question, then answer it as succinctly as possible. Follow up with “did I answer your question?” Follow their lead. Also consider the importance of strengthening your relationship through special times and activities that promote heartfelt sharing and connection.
Young children are concrete thinkers. Metaphors tend to complicate things. If you are talking about specific body parts or functions of body parts, be as direct as you can, while also keeping in mind the child's developmental stage. It is helpful to use the appropriate names for body parts. This helps the child to begin to understand they do not have to be ashamed or embarrassed about any part of their body. This approach will begin to set the foundation for positive body image and healthy sexuality.
-It’s not one talk, it’s many.
Rather than sitting down with your child once they reach puberty to talk with them about sex, consider starting early and building on the depth and complexity of this topic. Identify an end goal. Parents may want their child to grow into an adult who is capable of an intimate relationship without feeling ashamed. If this is your goal, work backwards, expounding on experiences and discussions to support your goal. Consider the use of tools such as age appropriate books to help guide you in your discussions.
Shannon Hickman, LCSW is a trained sex therapist. Whitney Barrell, LCSW specializes in child therapy. Together they are leading a parenting series on how to talk with your child about healthy sexuality.
"The world is so big, so complicated, so replete with marvels and surprises that it takes years for most people to begin to notice that it is, also, irretrievably broken. We call this period of research “childhood."
There follows a program of renewed inquiry, often involuntary, into the nature and effects of mortality, entropy, heartbreak, violence, failure, cowardice, duplicity, cruelty, and grief; the researcher learns their histories, and their bitter lessons, by heart. Along the way, he or she discovers that the world has been broken for as long as anyone can remember, and struggles to reconcile this fact with the ache of cosmic nostalgia that arises, from time to time, in the researcher’s heart: an intimation of vanished glory, of lost wholeness, a memory of the world unbroken. We call the moment at which this ache first arises “adolescence.” The feeling haunts people all their lives.
Everyone, sooner or later, gets a thorough schooling in brokenness. The question becomes: What to do with the pieces? Some people hunker down atop the local pile of ruins and make do, Bedouin tending their goats in the shade of shattered giants. Others set about breaking what remains of the world into bits ever smaller and more jagged, kicking through the rubble like kids running through piles of leaves. And some people, passing among the scattered pieces of that great overturned jigsaw puzzle, start to pick up a piece here, a piece there, with a vague yet irresistible notion that perhaps something might be done about putting the thing back together again..."
Words by Michael Chabon. Full article: http://www.nybooks.com/blogs/nyrblog/2013/jan/31/wes-anderson-worlds/
Beyond the Birds and the Bees
Parent Education Series
Sex. Wondering how to discuss it with your children? Wondering how your own experiences are shaping the conversations with your child? Want to know what is normal, healthy sexual development and when to be concerned? Want to ensure that sex doesn't become shameful or embarrassing? Do you want your child to talk to you first? No one knows your child better than you do, and as parents, your deep love and connection to your child makes you the best person for the job.
Join us! Shannon Hickman, LCSW a trained sex therapist, will be sharing her expertise on healthy sexuality. Whitney Barrell, LCSW who specializes in child therapy, will focus on child development and the use of parent-child relationship to foster healthy development.
Who: Parents of children ages 3-17
When: Monday July 13th AND Monday July 20th 7:00pm-8:30 pm.
Cost: $200 per couple/individual
Where: South Valley Therapy
8537 S. Redwood Road, Suite A, West Jordan, UT 84088
Click HERE to sign up.
Shannon Hickman, LCSW holds a Master's Degree of Social Work from Rutger's University and has a private practice in Taylorsville, Utah where she specializes in couples counseling and sex therapy. As a trained sex therapist she is able to help with a variety of concerns related to sexuality and intimacy.
Whitney Barrell, LCSW holds a Masters of Social Work degree from the University of Utah and maintains a private practice in the Salt Lake City, Utah. She works mainly with young children and their families on mental health issues and is focused on and improving family relationships.
Parenting is the most demanding job we’ve got.
Most parents aren’t making deliberate decisions about what skills they need to possess to be the best parent; rather they are ensuring teeth are brushed, homework is done, and talking with children about their ideas and goals — which turn out to be important parenting skills.
Parenting absorbs us; it’s hard to get an objective look around.
We don’t often rely on science to guide our parenting decisions. It’s more likely that we consider the type of parents our parents were, and either duplicate the parts we felt were effective, or turn the other direction entirely.
Women talk with their girlfriends about discipline or choosing a good school. Men trade stories about their children and their relationship with them. We ask the pediatrician, and we notice the skills other parents utilize at the park and we integrate them into our routine. We Google. We read parenting books. And when we’ve done all of that, we realize how much contradiction exists.
Dr. Robert Epstein has done the legwork for us. He’s compiled a list of 10 parenting competencies that are predictive of good outcomes. In this case, good outcomes for children are defined as a child's success, health and happiness, as well as the quality of the relationship between parent and child.
Eleven parenting experts evaluated the 10 competencies identified, and data was collected from over 2,000 parents who identified both the outcomes of their children (health, happiness, success) and how closely they parented related to the 10 competencies.
Using this data, Epstein ranked what competencies had the most impact down to which had the least:
Love and affection
Love and affection tops the list. The one-on-one time we spend supporting our child has a direct impact on his or her degree of happiness, health and success. Parents are powerful.
Stress management and relationship skills
Interestingly, competencies ranked No. 2 (stress management) and No. 3 (relationship skills) are factors that don't involve our child directly. How a parent manages stress and the skill he or she possess in relating to other adults aren't typically considered parenting skills. But, as we see from where they rank, are factors of high importance.
Mothers and fathers in healthy and satisfying marriages are more engaged in their roles as parents and have more positive attitudes toward their children. Frequent and intense conflict, on the other hand, is associated with unresponsive and insensitive parenting.–Urban Institute
Stress management is a measure of how well a parent manages his or her stress. If a parent can rely on healthy ways to minimize stress, he or she is more accessible to the children and has more time for love and affection.
This finding dovetails with what we know about maternal depression and its impact on children. When mothers are depressed when their children are young, they may be fighting to manage basic care-giving tasks (food, hygiene, etc) and don't have the energy for important bonding that takes place early on. Regardless of a child's age acting as a role model by caring for yourself, will pay off for the entire family.
Relationship skills reference a parent's ability to communicate and compromise, whether he or she is parenting in the same household or co-parenting due to divorce or separation. Children show improved outcomes when parents are able to speak kindly to one another and model healthy relationship skills. Prolonged exposure to high conflict between parents has an impact on children's psychosocial development.
Research by the Urban Institute goes further, reporting, "Mothers and fathers in healthy and satisfying marriages are more engaged in their roles as parents and have more positive attitudes toward their children. Frequent and intense conflict, on the other hand, is associated with unresponsive and insensitive parenting."
Life skills are another domain where parents have a degree of control. Epstein defines life skills as one's "ability to provide for your child, have a steady income and a plan for the future." As we can see, many of these competencies are intertwined. Those who are financially stable have one less thing to worry about and one less stress to manage.
Behavior management is likely the competency most fuzzy for parents. There are myriad opinions on the best way to diffuse conflict with our child, or ensure that he or she complies with our requests. Recently, advances in neurosciencehave shed some light on this topic. We know that when a child is hyper- or hypo-aroused, he or she is unable to participate in problem-solving or skill-building.
The good news is, despite all the contradiction in how to best discipline our child the approach we use isn't as important as it may feel. Besides, this competency falls in the lower third of the list.
Religion makes a surprising appearance on the parenting skills list. One theory is parents who support or encourage spiritual development may be a part of a broader religious community that provides support for the family spiritually and informally, and that leads to improved outcomes.
Figuring it all out
Parenting often feels sandwiched between guilt and shame. Being a parent seems to be a very public display of one's skills and abilities when this isn't the case. All parents, regardless of outside circumstances, desire for their children to be happy and healthy. How we progress toward that goal is determined by our history, values, experiences and opportunity.
Among this list of 10, there is undoubtedly a place where we "have it down." If one is interested in testing where he or she falls among the 10 competencies, Epstein's website has a skills test that will assesses a person's strengths and provide feedback.
First published by KSL on May 24, 2015.
The Finding Peace Infertility group has just wrapped up it's first rotation. It was incredible. A group of five women who didn't know one another at the beginning of the 6 weeks formed honest, genuine, vulnerable relationships with one another. The group members shared their intimate thoughts, feelings of intense loss and were met with support and open arms.
Throughout the group participants journaled, used art therapy to create a visual representation of how infertility feels, their goals and accomplishments, and most importantly, found a space where they didn't feel alone. (Current group info here.)
One of the journaling assignments was related to how infertility affects the relationship with ones spouse. I requested that the group write a letter to their spouse about how infertility has impacted them. And, one participant blew us away, a wicked smart women full of love and compassion shared her letter, and there wasn't a dry eye in the room. So, in honor of Infertility Awareness Week, and with her permission, I'd love to share her letter with you. Maybe you can relate.
A letter to my husband,
Infertility has beat me up. It has drawn blood and left me battered and bruised.
When I was younger I had a plan that I was going to be married and starting a family by 23. It was always something that I wanted but never happened, and you know I'd never settle.
When I married you at 30 I thought it was finally my turn. You know I wanted kids right away, but I had to wait- we needed to finish law school, then we needed to move, take the bar, get jobs, get better jobs. By the time we said "fuck it" and gave up trying to be ready, I thought again, this is finally it. Month after month, year after year, disappointment set in. After the miscarriage in December, it happened. I lost hope. I am defeated, broken, sad.
I know you must feel something too, but when you try to comfort me by agreeing that infertility sucks or that you know how I feel- I am surprised. I feel as if I am telling a friend my woes and I expect sympathy, but not understanding. I often times forget you are on this journey with me. I don't know if that is because you don't often share your feelings on the subject because I am so consumed with mine, or that I don't listen.
I want to though, I want to listen to you and be excited about the future with you. I want us to be the "Spokane us." We were broke, unemployed, childless, and without a clue to what we would do next, but we were happy, and in love, and excited about possibilities.
I think more than anything I want, I need, action. I am so sick of saying everything and doing nothing. Let's do our frozen transfer, let's adopt, let's move, let's change careers or take the bar again. I don't want to wait anymore. I want to live the very precious lives we've been given. Life is so short and I don't want to spend it waiting. I want to LIVE IT with you. I want to TRY with you. I love you.