Group therapy is a process used to treat problems of personality, life experiences, and difficulties in daily living; it may range in duration from very brief (a session or few) to long-term (years); it can vary in focus from education to self-analysis; and can occur in a variety of settings, from hospitals, clinics, and private offices of mental health professionals to businesses and schools. Group therapy is one of the various treatment modalities traditionally and successfully used by infertility counselors.
The factors and its application to infertility group work include:
INSTILLATION OF HOPE
Hope combined with a conviction and confidence in treatment modality, brings people into therapy and keeps them there, enabling the therapeutic process to occur. Hope is the elixir of infertility treatment. Like many self-help groups, infertility groups use personal testimonials that can offer inspiration for successfully managing the stresses and strains of infertility and treatment. Hope is offered by the infertility counselor’s conviction in the efficacy of group treatment, as well as group members’ experiences as both providers and recipients of hope and encouragement in the achievement of their goals (i.e., improved quality of life, coping skills, diminished anxiety and depression).
Individuals usually enter group therapy with the belief that their painful struggles with infertility are unique and their self-perception damaged by feelings of stigma and isolation. Interactions with group members facilitate universality through the realization that others have similar feelings and experiences – often a member’s first experience of feeling truly understood and accepted. Group therapy provides universality through normalizing the feelings of infertility, providing an arena for catharsis, and acceptance by others grappling with infertility, the demands of treatment, and decisions about family-building.
Another curative factor of groups is the sharing of information through exchange of information among group members, didactic instruction, and/or educational process regarding medical and/or psychological issues relevant to infertility. Typically, infertility-specific groups impart information about the medical and emotional aspects of impaired fertility that is integral to the therapeutic process. The psycho educational component may involve learning new skills (e.g., cognitive-behavioral techniques), highlighting the power of knowledge, and helping infertile individuals gain a greater sense of control.
In therapy groups, individuals receive through giving, not only by participating in the group process but also via the intrinsic act of giving. Group members offer support, sharing, reassurances, suggestions, insight, and other gentle acts of kindness and generosity of spirit that facilitate the healing of others as well as their own healing, boosting self-esteem, and confidence. All too often, the wisdom and the experiences of the infertility group members are more beneficial and therapeutic than that of the infertility counselor.
THE CORRECTIVE RECAPITULATION OF THE PRIMARY FAMILY GROUP
Frequently individuals entering an infertility group have family-of-origin issues that can significantly impact behavior, reactions, and roles in the group, as the group can resemble or be experienced as the family-of-origin. Because infertility is a multi generational family system crisis, family issues often emerge particularly around issues of grief, emotional support, and envy jealousy family pregnancies. However, family-of-origin issues in infertility-specific groups may be less relevant because group members are more invested in future relationships (e.g., ‘wished-for’ child) than reworking past family relationships. Nonetheless, groups often provide the warm, supportive, and understanding ‘chosen family’ that their family-of-origin cannot.
DEVELOPMENT OF SOCIALIZING TECHNIQUES
Learning skills that help one interact appropriately with others (i.e., social skills) is another curative factor of groups. Infertility groups frequently help members learn how to deal with issues that come up with family, friends, work, clinic staff, and other relationships over the course of treatment. Members often help each other by providing suggestions, feedback, or role-playing opportunities (e.g., practice) to help manage difficult interpersonal situations and/or conflicts with the fertile world or treatment team.
Sometimes referred to as ‘spectator therapy,’ groups provide social learning opportunities by allowing group members to observe and imitate the healthy behaviors of the therapist and other group members. The group allows members to ‘try on’ new behaviors in a safe environment and in a manner not usually available in other therapies. Members often talk about using some of the behaviors they have seen or heard other group members use when dealing with difficult situations or relationships.
Group is a social microcosm in which members obtaining sight into themselves, their relationship with others, and how they interact with others. As such, it is a corrective emotional experience offered in a psycho socially safe relationship. Infertility-specific groups can be particularly helpful arenas for interpersonal learning opportunities and healing because infertility is socially isolating and stigmatizing.
It is a complex process of solidarity, fundamental to group therapy, in which individual members become attached to the group and develop a sense of ‘we-ness’ or ‘group-ness.’ Infertility-specifc groups typically vary in their degree of cohesiveness for a variety of reasons including group structure, type, and frequency of group meetings. However, the universal experience of involuntary childlessness typically contributes to strong feelings of cohesion.
It is the process of expression of strong emotion or affect and, while a curative factor, is not a primary therapeutic goal of group therapy. Nevertheless, infertility-specific groups usually provide a strong cathartic experience for most members, which is both healing and hopeful. The facilitation of catharsis by the infertility counselor may be through deliberate techniques (e.g., guided imagery) or group members may relate a particularly painful experience within the group that facilitates catharsis, exorcising the pain of infertility or the infertility experience.