Subscribe in a readerPreparing for In Vitro Fertilization: Emotional Considerations
Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.
For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.
The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.
The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.
The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.
Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.
Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.
IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. Continue reading ‘Preparing for In Vitro Fertilization: Emotional Considerations’
Adult Day Care Centers
Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff
Today, family caregivers have options to choose from when they need assistance or respite. And, highly trained and experienced social workers are available to help caregivers sort through the range of available options. Below is a brief description of some of the caregiving services commonly available.
Adult Day Care
The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.
How Do Adult Day Care Centers Operate?
These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.
Assisted Living
Assistive Technology
Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”
Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
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When The Soldier Doesn’t Return: The Needs of American Families of Downed Warriors In Iraq
Note: All names have been changed to protect confidentiality.
By L.B. (LeslieBeth) Wish, Ed.D, MSS
Introduction
Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”
When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”
“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.
These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.
Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.
Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?
Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.
Current Issues of Some American Military Families
At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.
Fear of Being “Found Out”
Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.
Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
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My Child Has ADHD: Now What?
If you find that your child does, indeed have ADHD, it’s important to educate yourself as much as possible. There are numerous books on the subject. Consulting with a mental health professional to help you with the many challenges ADHD can present, is invaluable. Finding support by attending local groups such as CHADD (Children and Adults with Attention Deficit Disorder) also are immensely helpful in not only learning more about ADHD, but also to connect with other families who are struggling.
- What are the risks vs benefits?
- What side effects might I observe?
- Which medications will work best for my child?
- What options do I have if I don’t want to use medications for my child?
- How will I know if the medications are working?
For more information visit www.helpstartshere.org.
Bullying Behaviors
From About Schools and Communities - HelpStartsHere.org
Reviewed by NASW Office of Social Work Specialty Practice Staff and Center for Workforce Studies Staff
Studies show that between 15-25 percent of U.S. students are bullied with some frequency. Bullies use aggressive behavior to show that they have power over another student. Bullying may be physical, involving hitting or punching; verbal, such as teasing or name calling; or psychological, involving social exclusion or spreading rumors about another child. Boys most often use name calling and teasing, while girls are more likely to socially exclude other girls. Youth with disabilities or special needs, and those who are gay or bisexual are at a higher risk of being bullied then other children.
Bullying is not just an unpleasant passage of childhood. Not only does it often interfere with school work, but bullied children are more likely to feel depressed, lonely, and anxious, and to think about suicide. It is common for bullied children to pretend to be ill or skip school to avoid their tormentor.
Middle school and high school students among the sexual minority may be the most vulnerable to victimization from school bullies. A 2001 survey found that 83 percent of gay, lesbian, bisexual, and transgender (GLBT) students experienced verbal, physical, or sexual harassment and assault at school, according to the National Mental Health and Education Center.
A majority of GLBT students feel unsafe at school because of their sexual orientation. As a result, nearly 30 percent drop out of school, and the rates of suicidal ideation, attempts, and suicide by sexual minority students are two to three times higher than for heterosexual youth.
Students may not tell their parents that they are being bullied because they are embarrassed, ashamed, or afraid. If you suspect that your child is a victim, ask questions about what has happened, where the bullying occurred, and how your child responded. Do not ask your child to ignore bullies or encourage retaliation, which may only escalate the problem.
Contact the school principal, social worker, or your child’s teacher and describe the problem. Ask school authorities to talk with other adults who interact with your child to find out if they have witnessed any bullying behavior. Many school districts omit sexual orientation from anti-bullying programs, so parents of GLBT students may suggest that the sexuality issue is addressed and that school activities are available to all students, regardless of sexual orientation. School social workers can act as advocates for students who are victimized and identify a support network of caring adults.
Finally, encourage your child to make friends with students in the classroom or outside of the school environment. Children can become more resistant to bullying when they develop confidence and other positive attributes.
Related Articles
Historias de la Vida Auténtica sobre la Pena y la Pérdida: Niños y pena
Jonathan tenía seis años cuando murió en 1988. La trabajadora social Mary Lee Carroll, LCSW lo acompañó como voluntaria de hospice. El trabajo que ella hizo con él, y su espíritu inspiraron a la Sra. Carroll a desarrollar un programa de duelo pediátrico para un hospice en Conneticut. En 1994, el Júnior League de Waterbury hizo un donativo a la organización para patrocinar el Campamento Jonathan. En 1999 el Campamento Jonathan fue incorporado y ya no depende de ninguna organización. El Campamento apoya a las necesidades de las personas en duelo de Conneticut en la región de Watertown. Cada verano, el Campamento Jonathan patrocina un campamento diurno de una semana para niños que están en proceso de duelo por la muerte de una persona significativa en sus vidas. A continuación ofrecemos una lista de comentarios acerca del duelo y de tener una pena hechos por los niños que asistieron al programa de apoyo de una semana en julio del 2005.
Además del apoyo que se da a niños y jóvenes durante una semana experiencial en el verano; el Campamento Jonathan ofrece grupos de apoyo durante todo el año para niños y padres, y sólo para niños y jóvenes. En noviembre de cada año, la organización también lleva a cabo un retiro para mujeres en duelo. El Campamento Jonathan, dirigido por un equipo de orientadores pediátricos en duelo, terapeutas y voluntarios entrenados, ofrece apoyo terapéutico individual o en grupo tanto a niños como a adultos en duelo. Los orientadores utilizan terapias creativas para contactar las emociones, como terapias de movimiento, arte, poesía y psicodrama para procesar el duelo y enfrentarlo de manera más exitosa. Hay otros programas disponibles en el país parecidos al Campamento Jonathan y, a menudo, son gratis para familias como la de ustedes. Si sabe usted de un Campamento así y lo recomendaría, por favor contáctenos a la siguiente dirección de correo electrónico: info@childrenshospice.org. Estamos haciendo una lista de Campamentos para que las familias puedan elegir entre ellos y la publicaremos en esta página de Internet. |
Disclaimer: The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
Media, Technology, and Psychotherapy
By Alyson Mischel, LCSW
Introduction
Historically, social workers are trained to work with the populations most in need of assistance. They practice in prisons, with drug users, the severely mentally ill, batterers and domestic violence victims, and with HIV positive clients. But, increasingly, social workers have private practices and treat people who can afford to pay for traditional 50 minute psychotherapy sessions. Regardless of the brand of social work practiced, or the population served, social workers can rely on concepts of media psychology to serve their clients.
Most everyone watches television, listens to the radio, or reads some form of printed press on a daily basis. Media is the 21st century’s glue – it’s what connects us and makes a Wall Street banker able to relate to a struggling waiter in Los Angeles. As a consumer who may communicate with a therapist online, or have a therapist use television and film as case studies, it’s important to understand the following basic concepts of media psychology and how they relate to psychotherapy.
Telemedicine
Telemedicine is the delivery of medical and/or psychological services at a distance with the use of technology like telephones or web-based systems. Treatment via telemedicine could involve two medical professionals talking over the telephone in real time about a case and also the use of satellite equipment allowing a doctor in California to evaluate, diagnose, and treat, a patient in Brazil.
The focus of telemedicine is largely consultative, which is why there is a growing trend toward online, synchronous psychotherapy. Some psychotherapists offer online and telephone counseling services for marriage, depression, parenting, family, and grief issues. The International Society for Mental Health Online, the National Association of Social Workers and the American Psychological Association have issued statements about telephone counseling. Understanding how telemedicine works is essential for consumers since psychotherapists increasing use e-mail and the Internet to provide services.
Cinematherapy
Cinematherapy is the use of film as a metaphor to bring about positive growth in psychotherapy clients. Watching television and films may be a catalyst for healing and change. Movies can be “windows” to the unconscious in the same way that dreams and fantasies are. Watching films allows clients to become consciously aware, resulting in gained insight and emotional release. Cinematherapy works best in the tradition of Systems Theory and Cognitive Behavioral Therapy, which are the treatment modalities used by most social workers. Films may help clients become aware of their irrational beliefs and poor coping mechanisms. Cinematherapy is another tool like stories, myths, and fables, that psychotherapists use to treat their clients.
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To read more from Alyson Mischel visit www.alysonmischel.com
A positive, compassionate, and enthusiastic personality, Alyson Mischel brings a special brand of empathy to her psychotherapy and life coaching work. Alyson combines her education and clinical training with her own experiences, and has developed a common sense approach for addressing life’s challenges. Alyson is a lecturer at the USC School of Social Work, and serves as a consultant for UCLA’s Educational Leadership Program, a doctoral program of education. She was formerly a clinical supervisor for the Los Angeles County Department of Mental Health. Alyson has counseled hundreds of people in the areas of career, relationships, health, and finances. A graduate of Stanford University, the University of Southern California, and a licensed clinical social worker, Alyson has been studying and practicing since 1998.
Advance Care Planning
Reviewed by NASW Office of Social Work Specialty Practice Staff
Introduction
Families plan and prepare for major life events: attending college, getting married, having a baby, and retiring at the end of a career. However, few plan for events such as how we would want our health care delivered if we become very ill.
Or some people may be adamant about not going into a nursing home but they fail to plan for securing long-term care insurance, home modifications, or having someone to advocate for them if they cannot communicate. Rarely do we think that far head.
These are decisions that we all should be thinking about. They should be documented so that our family members, health care providers, etc. will know our wishes for our care.
In generations past, people who were terminally ill remained at home, dying quickly from infectious diseases or accidents. Today, with the deluge of new medicines and technologies, we have become a “death denying” society, in which death is an enemy that must be beaten at all costs. We focus on fighting death rather than preparing for its inevitability.
Who Needs Advance Care Planning?
Every adult can benefit from Advance Care Planning. Planning is particularly important for those who are terminally ill. Research shows that people suffering from chronic illness also benefit from advance care planning. Even healthy people should consider their wishes for end-of-life care and discuss their decisions with family members or professionals, before a health care crisis occurs.
Because an accident or serious illness can happen suddenly, and at any time, thinking about this topic when you are capable of making decisions is important. Sharing these decisions with your family helps to ease their burden and reduce their uncertainty if they ever have to make health care decisions on your behalf.
What Are the Benefits of Advance Care Planning?
Studies funded by the Agency for Healthcare Research and Quality (AHRQ) have shown that people who talked with their family, physician, or others about their preferences for end-of-life care had less fear and anxiety, felt more in control of their own medical care, and believed their doctor had a better understanding of their wishes. Other potential benefits of advance care planning according to the National Institutes of Health include:
- Decreased personal worry
- Decreased feelings of helplessness and guilt for the family
- Decreased implementation of costly, specialized medical interventions
- Decreased overall health care costs
Smoking and Other Forms of Tobacco Dependence
Ms. Linda Guhe, MSW, LCSW
The History of Tobacco and Health in America
Tobacco has been around since ancient times and it has been significant throughout American history. When Christopher Columbus discovered America in 1492 he also discovered smoking tobacco. Tobacco proved to be quite appealing to those early explorers. As a result, tobacco from America spread to other parts of the world. Tobacco was first grown commercially in America in the early 1600s. In the 1800s, the revenue from taxed tobacco helped finance the Civil War. In the early 1900s, RJ Reynolds began producing and selling the first brand-name cigarette, Camel.
While popular and appealing, tobacco use has led to serious health problems in the United States and world-wide. Today, approximately 25 percent of Americans smoke. Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 people each year. The number of Americans using smokeless tobacco ranges from two percent to 9 percent. Financial costs of treating tobacco-related illnesses in the US are more than 50 billion dollars a year.
Health Care Providers and Tobacco Dependence
It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community. However, because of an increasing awareness in recent years of the physical dangers to health, along with financial burden for society, tobacco has been gaining more attention in public health education and research. For example, the federal government is focussing on the problem with its Healthy People 2010 initiative. Among the government’s health objectives for the years 2000 through 2010 is a campaign to promote the cessation of tobacco use.
There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals. As a result, in comparison to experts in other kinds of disorders, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.
Money became available to fund tobacco dependence research as a result of the financial settlement of lawsuits filed against the tobacco companies by 46 states in 1994 and 1995. The lawsuits were filed in response to financial burdens experienced by states in treating tobacco-related illnesses. Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and the states that filed the lawsuit has helped fund, draw interest to, and generate tobacco research.
Because of an increase in research in the last several years, we now have a better understanding of tobacco. We now know that tobacco products contain both (1) harmful toxins that damage health and (2) nicotine, which is a powerful addictive drug. Research has also led to the development of evidence-based methods of tobacco cessation treatments. As a result, the number of specialists in tobacco and the treatment of tobacco addiction have been increasing.
Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking, and for offering tobacco cessation treatment. In addition, there are multiple agencies providing information to the public on smoking and tobacco addiction, and help for quitting.
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Adoption by Gay and Lesbian Adults and Couples
By Stephen Erich, PhD, LCSW
Introduction
The numbers of gay and lesbian adults and couples who are adopting children is increasing dramatically; at the same time, the number of adoption agencies willing to place children with gay and lesbian adults and couples is also increasing notably. What does this mean for children in need of healthy family environments? What does the research tell us about families with gay or lesbian parents, including those created through adoption?
First, a little background information about children awaiting adoption and the size of the adopter pool (parents interested in adopting). The number of children not living with their biological parents is at unacceptably high levels. Research suggests that there were 542,000 children in foster care in the United States in 2001 and as many as one third of these children may be eligible for adoption.
Many gay and lesbian adults and couples are interested in adopting children. However, discrimination has made it difficult for gay and lesbian adults and couples to complete the adoption process (Brodzinsky, 2003). Excluding gays and lesbians as potential adopters is not only discriminatory but it limits the number of potential adults available to adopt the thousands of children eligible for adoption.
Research on Families With Gay and Lesbian Parents
Although it is not commonly known, the research regarding parenting by gays and lesbians is very positive. The following list shows the important findings from research on families with gay and lesbian parents:
- Lesbian mothers have been found comparable to heterosexual mothers in their desire to be parents (Kirkpatrick, Smith, & Roy, 1981; Lewin & Lyons, 1982; Osterweil, 1991).
- Lesbian mothers have been found comparable to heterosexual mothers in their warmth toward children (Golombok, Tasker, & Murray, 1997).
- Lesbian mothers have been found comparable to heterosexual mothers in their parental behaviors (Harris & Turner, 1986).
- Lesbian couples have been found equal to or superior to heterosexual couples in dividing responsibility for chores equally, in financial cooperation, decision-making, relationship satisfaction and emotional expression (Brewaeys, Ponjaert, Van Hall, & Golombok, 1997; Chan, Brooks, Raboy, & Patterson, 1998).
- Gay fathers have been found comparable to heterosexual fathers in involvement with their children, intimacy with their children, provision of recreation, encouragement of autonomy, problem-solving and parental satisfaction, but superior in the way they respond to child needs, and communication of reasons for appropriate behavior (Bigner & Jacobsen, 1989a; 1989b; 1992; Peterson, Butts & Deville, 2000).
- Gay and lesbian couples value and desire commitment in relationships to the same extent that heterosexual couples do (Kurdek, 1995; Peplau, Veniegas, & Campbell, 1996)
- Children raised by gay and lesbian parents have no apparent adjustment problems that have been found to be related to their parent’s sexual orientation (Chan, Raboy, & Patterson, 1998; Flaks, et al., 1995; Patterson, 1994; 1997).
- In comparison to children raised by heterosexual parents, children raised by gay and lesbian parents have been found comparable in intelligence, behaviors, moral development, and peer relationships (Allen & Burrell, 1996; Falk, 1994; Flaks, et al, 1995; Tasker & Golombok, 1995; 1997).
Research on Children Adopted by Gay and Lesbian Adults
There is a limited number of studies involving children adopted by gay and lesbian adults and couples but once again the results are very positive. Continue reading ‘Adoption by Gay and Lesbian Adults and Couples’