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Identifying and Transforming Infertility/Adoption Stress

Mark Gorkin, LICSW

Drawing on his experience as a RESOLVE Conference Keynote Speaker, the Stress Doc identifies key sources of infertility treatment and adoption stress. The article also illustrates interactive exercises and therapeutic concepts that were enthusiastically embraced by conference attendees.

Identifying and Transforming Infertility/Adoption Stress Venting, Sharing and Laughing as a Conference Community

This Spring I had the opportunity to be the Keynote Speaker for the RESOLVE of Maryland and the RESOLVE of the Washington Metropolitan Area 2005 Conference - Road to Resolution: Adoption and Infertility. The title of my one-hour opening presentation: Practicing Safe Stress: Transforming Infertility Related Stress through Interactive & Motivational Humor. Both by interviewing some RESOLVE members before the presentation and especially by observing the interactive sharing during the program I discovered the obvious: for individuals and couples the infertility treatment and/or adoption process generates STRESS! (And this uncomfortable reality is only compounded by the fact that stress may well be an obstacle to conception.)

To help find the pass in the impasse, first I will note some key stressors in the treatment/adoption process. Then I'll describe several key program exercises, therapeutic concepts and strategic interventions that were enthusiastically embraced by participants. Hopefully, our mutual learning and sharing will also help you Practice Safe Stress!

Here are "Four Broad Stress Issues":

1. Health/Lifestyle. A significant source of tension is the actual body changes due to the treatment process. And there may be physically disruptive side effects from the medication. In addition, there's the uncertainty captured by such questions as, "Should I exercise and/or diet or not?" And last, but certainly not least, there's the challenge of scheduling sexual relations.

2. Psychological/Existential. In this process, of course, there can be a cycle of hopefulness at the onset of treatment followed by disappointment if not depression if the therapeutic regimen is not (initially) successful. How long does one persevere? And surely the vagaries or missteps of an (international) adoption process can generate its own highs and lows and "stay the course" woes.

For many (especially the "older" couple), the inability to give birth to a biologically healthy child can evoke an overt or chronically gnawing sense of a "lost dream." Now a period of mourning is the life cycle task; grief work bypassed can culminate in an ongoing state of cynicism and/or melancholy.

And infertility can leave all parties wondering, if not engaging in self-doubt or self-blame, "Is there something 'wrong' with me?" "Did I do something (in my life, in my past behaviors or choices) to bring this on?"

3. Family. And the aforementioned self-doubt can contribute to a sense of shame that often induces a secretive pattern of behavior with family and friends. Of course, in our genetically conscious society, a couple may withhold "bad news" to spare others pain or possible self-recrimination. Alas, such coping behavior often becomes a pressure cooker. Not only is there a sense of isolation, but also the couple may take out their frustrations on each other.

4. Finances. Both infertility treatment and adoption can be expensive and time-consuming undertakings. (And we all know the old saw about time and money.) And when the medical insurance doesn't cover higher technology procedures, this can surely add insult to injury.

While the above is only a sample sketch of the many possible pressures, let's proceed to draw on key aspects of the keynote experience in order to illustrate Tools and Techniques for Transforming Infertility/Adoption Stress:

1. Acknowledge Stress Smoke Signals. The warm-up exercise divided the audience into clusters of five or six. The "Three 'B' Stress Barometer" task: to generate a group list that answers the question, "How does your Brain, Body and Behavior let you know when you are under STRESS?" The lists and the laughter flowed easily. Several groups read their lineup. My response to such common stress items as problematic sleeping and eating was to illustrate their multifaceted nature. For the former, "Aren't there some days when you just don't want to get up and out of the covers? Yet aren't there some folks who know all the best buys on ebay and QVC Home Shopping channel at three in the morning?"

Or with eating, by a show of hands, "How many occasionally eat to numb that anxious edge in the stomach?" After seeing a large contingent, I would ask, "Do any folks lose their appetite and eat less when stressed?" With the smaller showing, my immediate response to the entire audience: "And we hate these people don't we!" Knowing and stress-reducing laughter predictably followed.

The animated group exchange spoke volumes: everyone could relate and commiserate. The laughter revealed the value of letting down the "always be strong (or silent) in public" mask. (A Stress Doc maxim: Strong silent types get a lot more ulcers than Oscars!) Clearly, a little bit of intimate sharing and risk-taking can be significantly stress relieving. In fact, several of the RESLOLVE officers sketched a sobering contrast to this group sharing involving the Saturday morning ritual in the infertility treatment doctor's office: couples sitting in silence, seemingly walled off from each other.

Especially with folks who too have walked in those foot-blistering and bunion-bruising shoes, this "all too human" sharing encourages a beginning empathic connection, perhaps laying the groundwork for closeness.

2. Practice a Three-Step Burnout Prevention/Recovery Regimen. After the "Three 'B'" warm-up, I briefly outlined the "Four Stages of Burnout": 1) Mental, Physical and Emotional Exhaustion, 2) Shame and Doubt, 3) Cynicism and Callousness and 4) Failure, Helplessness and Crisis. (For the "Ffour Stages" article, email As is customary, some heaviness enveloped the auditorium. To help manage the mood I used a professional and personal perspective for presenting the Three Burnout Recovery Steps:

A. Good Grief. After my own academic burnout experience, I needed some time off to recover from serious spells of dizziness and some depression. And I needed time to grieve the loss of a creative dissertation concept, one that for several years was a vital part of my identity. Alas, the thesis topic (based on a mystical-like experience in psychoanalysis; definitely another story) was off the academic wall. And letting go of a dream is painful. One must grapple with shock and denial, sadness and fear, helplessness and rage. However, if one has the courage and the support to do this mourning, eventually there is a new day of reckoning: "I don't like what has happened, but how do I make the best of it?" or "What are the new options to explore?" Actually, for me there was a silver lining: I became an expert on stress and burnout!

B. Four "R"s of Rejuvenation.

1) Running. With the backing of you doctor, consider an exercise regimen - brisk walking or jogging, biking, swimming, etc. Not only are there cardiovascular, endurance and endorphin (a mood-enhancing chemical) benefits, but when feeling uncertain and vulnerable, when everything seems up in the air, exercise helps you feel grounded. There's a beginning and an end point. Thirty to forty minutes of non-stop, large muscle movement becomes a "success ritual" yielding a tangible sense of accomplishment and control.

2) Reading. Read books or watch TV sitcoms or movies that tickle your funny bone. Under prolonged stress and moodiness, you can lose your sense of humor. For me, Calvin and Hobbes and rereading The Catcher in the Rye were definitely part of my therapeutic routine. And hearty laughter has been likened to inner jogging, as it too releases those mood-uplifting chemicals.

3) Retreating. Once my heaviness started lifting, I needed to reflect on how my needs, expectations, hard-headedness and some long-standing self-esteem issues had contributed to my demise as a doctoral student. But this soul searching also helped me realize that there was more to this tumultuous dissertation process than getting a doctorate. While my attempt at being creative didn't fly in an academic setting, an identity was truly forged: creative expression would forever drive my future career/life path.

4) Writing. I began to write about my experience, although initially my focus was on two burnt out attorneys in my therapy practice. However, my personal motivation was transparent. And I was on to something. Research indicates that writing about psychological issues from an expressive/emotive perspective as well as with an analytic eye has stress relieving value.

C. Transition to Passion. After a burnout episode and these rejuvenating steps, it's vital to ask, "What is real and what really feels like me?" "What actions or directions will help the life juices flow again?" Sometimes you must let go of a "been there, done that" one too many times path. Sometimes it's recovering vital pats of a past self (or former interests) that have been lying dormant. For some a Sabbatical is needed after a prolonged "erosive spiral" experience. Whatever the new or renewed path, the purposeful and passionate challenge is to steadily "Rebuild the Fire."

3. Discussion and Drawing Exercise. The final exercise returned us to the group sharing of the Three "B" warm-up. Now the question posed: "What are the sources of stress and conflict going through an infertility treatment or adoption process?" Again the audience was divided into small groups. The groups had about ten minutes for discussion. Then with large easel paper and colored markers in hand, these evolving teams were challenged (also in ten minutes) to come up with a group picture - a stress icon or storyboard, perhaps a Dilbert-like cartoon - that, through a unified theme, captures the individual stress perspectives. For clarification purposes, I cited examples of sinking ships and sharks circling in the water drawn by US Navy personnel.

This "D & D" exercise was truly "out-'rage'-ous." The groups discovered the power of team brainstorming and visual imagery to transform sources of stress and frustration into playful and passionate exaggeration. (I reassure folks that there is no need to get anxious about drawing: stick figures are fine and "I'm a graduate of the Institute for the Graphically-Impaired.")

In addition to releasing terrific energy, everyone was able to contribute ideas and images. Through emotional disclosure and expression people realized they were not alone; almost are in a similar boat (whether it's cruising or speeding along or sometimes feeling like your boat is on the verge of sinking). Even if only momentary, participants stepped back from their day-to-day pressures, poked fun at external "stress carriers" and laughed at their own flaws and foibles.

Upon completion of the drawing segment, we turned the auditorium into an art gallery; everyone walked around enjoying the groups' poignant or silly but always vivid visual metaphors. And finally, several teams presented their pictures to the collective. By the close of the program there was a definite sense of community and synergy: through emotional connection and team creation our whole was truly greater than the sum of the parts.

Closing Summary

The focus of this article has been tools and techniques for recognizing and transforming infertility treatment and adoption stress. The first section identified four broad stress factors: 1) Health/Lifestyle, 2) Psychological/Existential, 3) Family and 4) Finances. Drawing on my RESOLVE conference program, the second segment has highlighted strategic exercises and learning concepts:

1) Acknowledge Stress Smoke Signals
2) Practice a Three-Step Burnout Recovery/Prevention Regimen
3) Engage in a Group Discussion and Drawing Exercise.

Hopefully, I've illustrated how by developing a burnout recovery/stress prevention regimen and by sharing and playing with peers you can release tension, while gaining new and enriched perspective both day-to-day and for the life journey. So, are you ready to…Practice Safe Stress?

Mark Gorkin, LICSW, "The Stress Doc" ™, is a psychotherapist and "Motivational Humorist" whose Interactive Keynotes and Kickoffs draw wide and "amazing" acclaim - from Fortune 100s and Federal Agencies to around the world with Celebrity Cruise Lines. An OD/Team Building Consultant, Mark is the author of Practice Safe Stress: Healing and Laughing in the Face of Stress, Burnout & Depression and of The Four Faces of Anger: Transforming Anger, Rage, and Conflict Into Inspiring Attitude and Behavior. Also, the Doc is AOL's "Online Psychohumorist" ™ running his weekly "Shrink Rap ™ and Group Chat." See his award winning, USA Today Online "HotSite" -- (cited as a workplace resource by National Public Radio (NPR). Finally, Mark is an advisor to The Bright Side ™ -- -- a multi-award winning mental health resource. Email for his monthly newsletter showcased on For more info on the Doc's speaking and training programs and products, email or call 202-232-8662.