Involuntary Childlessness (eBook)

Table of Contents 6
Foreword 8
Preface 10
I. Introduction to the Subject 14
Psychological and Psychosomatic Aspects of Involuntary Childlessness: State of Research at the End of the 1990’ s 16
Introduction 16
1 Psychological Characteristics of Infertile Women, Men, and Couples 17
2 The Influence of Stress on Fertility 19
3 Psychosocial Stresses Connected with a Fertility Disorder 21
4 Psychological Stress in the Context of Reproductive Medical Treatments 22
5 Gender Differences in the Stress Experienced Due to a Fertility Disorder 26
6 Aspects of the Relationships of Involuntarily Childless Couples 29
7 Further Developments 30
Psychological Diagnosis, Counseling, and Psychotherapy in Fertility Medicine – An Overview 32
Introduction 32
1 The Tasks and Goals of Psychological Diagnosis and Intervention in Fertility Medicine 33
2 Effects of Psychological Care 44
3 Outlook 46
Primary Medical Care of Infertile Couples – Limitations and Opportunities 48
1 Target Population 48
2 Background 48
3 Content and Goals of Primary Medical Care in Relation to the Wish to Conceive 49
4 Specific Aspects of Diagnosis in Family Practice 50
5 Approach 50
6 Special Problem Configurations in Patients Wishing to Conceive 58
7 Implications for Practice 60
The Unfulfilled Desire for a Child of Oriental Couples – Infertility Counseling and Treatment of Turkish Immigrants in Germany 64
1 Introduction 64
2 The Psychosocial Situation of Turkish Immigrants in Germany 65
3 Special Features and Difficulties in Gynecological Care 67
4 The Unfulfilled Desire for a Child 69
5 Conclusions 71
6 Indications for Practice 71
II. Specific Counseling and Therapy Approaches 74
Psychological Therapy in Idiopathic Infertility: A Stress Reduction Approach 76
1 Indications, Target Population, Motivation, and Selection 76
2 Reasons for the Development of the Program 77
3 Content and Goals 80
4 Distinctive Features of the Diagnosis 81
5 Treatment 83
6 Advantages and Disadvantages, Contraindications 90
7 Results and Effects 90
8 Implications for Practice 91
Focal Counseling for Women and Couples with an Unfulfilled Desire for a Child:A Three Step Model 92
1 Indications, Target Population, Motivation, and Selection 92
2 Reasons for the Development of the Program and Theoretical Background 95
3 Content and Goals 97
4 Distinctive Features of the Diagnostic Process 98
5 Treatment 100
6 Effects of the Counseling 112
7 Implications for Practice 115
Solution-Focused Counseling for Involuntarily Childless Couples 118
1 Indication and Target Population 118
2 Reasons for the Development of the Program and Theoretical Background 119
3 Goal of the Couple Counseling 120
4 Setting, Diagnosis and Evaluation 120
5 Treatment Model 121
6 Advantages and Disadvantages, Contraindications 130
7 Results and Effects 131
8 Summary and Implications for Practice 137
Couple Counseling and Therapy for the Unfulfilled Desire for a Child – The Two-Step Approach of the “Heidelberg Infertility Consultation Service” 140
Introduction 140
1 The Two-Session Couple Counseling 141
2 Ten-Session Couple Therapy 151
3 Advantages, Disadvantages, and Contraindications 160
4 Effects of Couple Counseling and Therapy by the “ Heidelberg Infertility Consultation Service” 160
5 Implications for Practice 161
The Relationship of Research and Practice in Fertility Medicine 164
1 The Implementation of Psychosomatic Research Projects in Reproductive Medical Institutions 165
2 Transference of Research Results to Clinical Practice 166
Bibliography 168
List of Authors 184
III. Appendices 186
Practical Therapy in Sterility – A Manual for Gynecologists from a Psychosomatic Point of View 188
Introduction 188
1 The Wish for a Child 189
2 The Problem of Sterility – The Case History 189
3 Initial Interview with the Gynecologist 190
4 Diagnostic Phase 191
5 Contraindications Against Medical Therapy in Sterility 192
6 Focusing on Psychological Aspects 193
7 What is a Treatment Success? 194
8 Problems in Care 196
9 Key Questions 197
References 200
List of Contact Addresses for Organizations 202

The Unfulfilled Desire for a Child of Oriental Couples – Infertility Counseling and Treatment of Turkish Immigrants in Germany (p. 51-52)

Lucia Gacinski, Emine Yüksel, and Heribert Kentenich

1 Introduction

In the discussion of appropriate medical and psychosocial care, the consideration of the ethnic and sociocultural marked attitudes, and expectations of the patients are of great significance.

In the Federal Republic of Germany, the Turkish population represents the largest immigrant group, numbering around two million people. They usually live in big cities and population centers. Since birth rates are higher among Turkish immigrants than among German women, institutions of obstetrics and gynecology are frequented more by Turkish people. Sterility consultations are also in increasing demand by Turkish couples.

This chapter focuses on the counseling and treatment of Turkish couples with a desire for children, as they often present particular problems for clinicians. Due to sociocultural conditions related to origin and immigration, the meaning of an unfulfilled wish for children is different and more complicated for Turkish couples than for German couples. It is often not easy for therapists to comprehend the specific form of the foreign couple’s desire for a child. Frequently there are also language comprehension problems, so that communication with the couples is impeded. Even when comprehension of the language is good, misunderstandings can arise from differing sociocultural contexts.

In order to overcome these problems and to develop an adequate approach for counseling, diagnosis and therapy, a closer consideration of the psychosocial situation, the specific motivation for a child and the medical idiosyncrasies of this patient group is helpful. Knowledge of the respective legal residency status is imperative, as absorption of the costs of treatment and the length of stay of the patients in Germany are dependent on these basic conditions. These conditions will only be examined in the following text, if they are meaningful for the understanding of the psychosocial situation of the patients.

2 The Psychosocial Situation of Turkish Immigrants in Germany

- The first generation of immigrants:
The large majority of Turkish people in Germany originally came from rural, unindustrialized regions of Turkey, where Islamic-patriarchal societal norms and values predominated. They came in the first phase of immigration in order to insure the subsistence of their family and to enable its social advancement. As a rule, through their continuing stay in the Federal Republic, they were able to improve their economic situation, but not their social status in comparison with their situation in the country of origin. In terms of employment, income, education and living situation, immigrants are usually living in more deprived circumstances. Meanwhile, this first generation of immigrants is increasingly reaching retirement age. The dream of returning to their homeland after retirement is very common, but seldom actually realized. The older generation is compelled to stay in the country of immigration because their descendants live in Germany and because of infirmity or sickness.

- The second generation of immigrants:
The children of the first generation came as children to Germany or were born here. At least a part of their time at school was spent in Germany, so that, in most cases, there is a good understanding of the German language. The second generation has to confront the problems of differing social values and norms. They experience transcultural upheaval, and have to struggle with the question of their cultural identity.

- Third generation:
This generation grows up in Germany, and also face the problem of differing values, as well as the question of identity. Language difficulties are rarely present because they have learned the German language as children whilst attending kindergartens and schools. However, there are certain family situations in which third generation children enter school without any knowledge of German, and consequently are disadvantaged in their educational opportunities.

- "Extended" second generation of immigrants:
Members of this group are born in Turkey and marry a Turkish partner who is already living in Germany. They know little about the German language, do not hold a work permit, and their residency permit is restricted in its length. Their lack of employment limits their contact with the German population.