#NIAW: Clinical Psychologist Dr. Shara Brofman on Infertility, Resiliency, and Re-Imagining Paths to Parenthood

The “emotional rollercoaster” that we hear about for those trying to conceive is something that Clinical Psychologist Dr. Shara Brofman is all too familiar with. To shed light on the taboo topic of infertility for National Infertility Awareness Week, we sit down with Dr. Brofman In today’s blog to talk about her work specializing on the perinatal period. We talk about when it’s time to get help, the resiliency of the human spirit, and how she can help women and couples navigate the stormy waters of infertility. Thoughtful, reflective, and incredibly insightful, Dr. Brofman is an invaluable resource to so many women on this journey.

Find her at her website.

How did you find your way to perinatal and reproductive psychology? 

I have spent most of the past (almost!) 14 years developing clinical and research expertise in reproductive (fertility and infertility) and perinatal (pregnancy, birth, and the postpartum time period) mental health. I had always had an interest in these topics, but, thinking I might become a child psychologist, I studied Child Development in college. After graduation, I worked as a case manager for children with special needs at a non-profit organization in New York City before becoming a clinical research coordinator at Columbia University Medical Center. There, I worked on research studies exploring mood disorders and stress during pregnancy. It was a wonderful role to be able to have; I worked closely with research participants (pregnant women and infants) over time, supporting and understanding their experiences in the context of stress. Many people describe research as feeling abstract, but clinical research, especially when you get to form relationships with the most important people involved in it, can be really meaningful. And case management, of course, is also humbling and rewarding, and builds meaningful relationships. 

I found, in both of my jobs supporting children and families, that I was often in a role of, and drawn to, supporting adults and parents. It is helpful to keep a developmental perspective in mind: babies become children, who become adolescents, who become adults, who often have babies and raise them – etc. So, in graduate school, although I studied a variety of topics and worked in various clinical settings, I chose to write my dissertation on psychology and reproductive medicine, and then eventually to pursue a specialization in this field. 

What was your training like? 

Four years of undergraduate work (Tufts University), three years of working in the field, five years of combined course work, research, and clinical work in my doctoral program (Rutgers University), and then a sixth year of a postdoctoral fellowship in adult outpatient psychology before earning my license to practice psychology. The following year, I completed certifications in perinatal mental health from Postpartum Support International and the Postpartum Stress Center. I’ve been doing full-time clinical work and teaching for almost six years now. This was a lot of work! But I met many wonderful people along the way, and really enjoyed my training experiences and helping people. Importantly, I also had ongoing support from colleagues and mentors. 

Can you define your methodology and approach?

Emphasizing individual strengths and personal goals, I help people to engage in self-observation and exploration, to feel less overwhelmed and stuck, and to improve healthy coping, relationships, and quality of life. I incorporate warmth, humor, and a realistic perspective in my work. I combine psychodynamic, cognitive-behavioral, mindfulness, relaxation, and related approaches in exploring which therapeutic strategies will be most helpful for the unique needs of the person.

How can therapy support women and couples going through infertility and fertility treatments, such as ART? What are most patients looking for when they come to you?

People often seek therapy when something has not gone as expected, and reproductive life transitions can be a major source of stress. People have often experienced significant stress, trauma. and loss, which can also bring up past trauma and loss. They may have a range of feelings, which may include anger, envy, sadness, grief, anxiety, hopelessness, or other experiences. In my work, I help people to find paths forward, sometimes in the midst of uncertainty or crisis. A path may not be the one someone has imagined, and it may involve a sense of loss. And, at the same time, it may also be possible, and meaningful. Often, my work also includes a collaborative discussion to answer questions and concerns about which experiences during this time are to be expected, and which may need additional therapeutic support. Importantly, I focus on how to highlight existing individual, family, and community strengths (like MyNestwell!) to gain support and reduce stress.

What is a first session with you like for those coming with fertility concerns?

In a first therapy session, I gather information about what support someone needs and discuss their history, as well as individual strengths and goals. Then, we work together to discuss what will be most helpful. My approach is professional, but at times also relatively informal and collaborative. I like to keep it real in conversation. People also sometimes want to talk about concerns other than fertility – which is fine! 

Sometimes, I meet with people in a context that may not be for ongoing therapy, so this work may only be for a few sessions, or may have different goals. For example, I meet with intended parents, gamete donors, and gestational carriers for psychoeducational consultations related to third-party reproduction. I also provide education and guidance in helping parents to navigate conversations with children about having built their families via ART and third-party reproduction. I support people who may be going through ART treatments in the context of genetic disease or cancer, and I meet with people pursuing or considering medical or elective fertility preservation, e.g. egg freezing.

How many sessions does it typically take to experience results — and what are “results” when looking at therapy and counseling for infertility?

This really does vary person to person. Some people are hoping to find relief from symptoms of stress, depression, anxiety, or other challenging issues, or they may hope to work through a particular concern or question. They might feel ready to end therapy after just a few sessions. Others may wish to stay for weekly appointments for a few months, and others wish to continue more long-term to explore ongoing concerns. And, it can depend what’s going on with family building and cycles. Goals and experiences can also change over time. I also may work with someone for a short period of time (e.g. maybe a few months), after which they feel ready to end, but they may then return at a later point for additional support during a different time, or for a different issue. So, that’s also OK! And that approach can be helpful to many people. 

What should someone who is looking for fertility support from a therapist ask to see if they are a good fit?

In general, I absolutely recommend speaking via phone or meeting with a therapist to see if the conversation feels comfortable and helpful, and, importantly that you feel your unique experience is being heard and reflected. It is also important to review therapists’ credentials. Many providers state that they specialize or have experience with a particular subject, but the depth and breadth of their clinical experience and training credentials are also important. I have been a member of the American Society for Reproductive Medicine and its Mental Health Professional Group since 2011. Most of us have pursued specialized training and/or attend conferences and meetings regularly. We also stay connected to scientific journals and medical updates, which is another way to ensure expertise in this field. 

What do you say to those who are on the fence about therapy and may be hesitant because they’ve “tried all the things” and nothing seems to work.

Make sure to mention this concern to a therapist in your first phone call or meeting! Be honest. I always find this really helpful to know. I usually ask – what has helped or not helped in the past? This question is very useful in figuring out next steps and possibilities together so that you can feel better, and feel that you have tools moving forward. 

In this new age of Covid-19, how are you supporting patients? What are the primary concerns you are addressing right now?

Given COVID-19, I moved my work to be entirely virtual in mid-March of this year. So, for now, appointments are all via a secure telehealth (videoconferencing) platform. People often seek therapy with concerns about the unknown and uncertainty, and this pandemic is really amplifying this stress for many people, especially around family building. Unfortunately, many people are also navigating uncertainty around paused, cancelled, or postponed fertility treatments, and I am providing support around this very difficult and often stressful experience. 

What’s a rewarding day at the office look like?

Somehow, even in times of deep sorrow and grief, there can also be moments of relief, calm, and even laughter and humor. At the risk of sounding cheesy, we really are resilient, and we can move through loss and stress – even move forward “with” it, as a colleague of mine would say. It is rewarding to help people find strength and meaning for the future, even if the story may not look exactly as someone imagined it. 

Photo credit: Smitten Chickens

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