Involuntary Childlessness: Psychological Assessment, Counseling, and Psychotherapy. (Book Reviews).

Editor: Bernhard Strauss

Publisher: Hogrefe & Huber, 2002

The treatment of infertility has been expanding rapidly over the past 20 years as advances in reproductive medicine have enabled couples to have children. While the progress in the medical realm has been rapid, the progress in the provision of psychologic care for these couples has not progressed. This book is a compilation of research and recommendations from a federal research initiative in Germany to improve the diagnosis and treatment of infertility related to psychologic problems. The book focuses on the psychologic aspects of infertility research and the application of research findings to the clinical setting. It is divided into two sections: (1) general introduction, literature review, and (2) specific counseling and therapy approaches.

In the first section, the first chapter reviews the existing psychologic studies related to infertility, the psychologic characteristics of infertile men and women, the bidirectional effect of stress on infertility, gender differences in reaction to infertility and the impact of infertility on the relationship between partners. The review of the literature is thorough, but the authors' bias toward a psychogenic cause for infertility comes through at times.

The second chapter focuses on the use of psychologic interventions with couples undergoing infertility treatment. The authors believe that all couples should receive supportive counseling as they receive medical treatment for infertility. They review the few existing studies examining the impact of psychologic counseling on infertility treatment and do a good job of differentiating between improving a patient's psychologic well-being versus trying to improve pregnancy success rates as a result of psychologic interventions. One of the most important points in this chapter, which is frequently overlooked by physicians, is the provision of psychologic follow-up care to couples who have been unsuccessful in treatment. The discussion of treatment failure is often difficult for patients and physicians alike. The information provided in this section is very useful. Other topics in this section include the provision of infertility treatment in a primary care setting and infertility counseling among Turkish immigrants in Germany which may be of some interest to a small group of readers.

The second section of the book focuses or specific therapeutic intervention strategies The chapters in this section are detailed descriptions of clinical research of psychother-apeutic approaches to use in individual or couples' counseling. In general, the theoretical background information is explained clearly. These chapters use case material effectively to describe the points being made. Treatment plans are specific and often include session by session accounts of the intervention. For this reason, the book would be a valuable resource for the practicing therapist. These chapters may provide more detail than the gynecologist or reproductive endocrinologist is looking for.

The best part of the book for the physician is at the end; the first section of the Appendix. It is entitled, Practical Therapy in Sterility -- A Manual for Gynecologists From a Psychosomatic Point of View. Contained in this section is basic information in an easy to read format on the psychologic aspects of infertility treatment and issues that the physician should be aware of as he or she is in consultation with their patients. Every doctor who treats infertility patients should read these 10 pages to be reminded of the difficult emotional issues that influence infertility treatment. Particularly useful sections are those addressing how one defines treatment success and transference/countertransference to the reproductive health professional.

While many providers do not have the time to conduct interviews as thoroughly as recommended in the book, heightened awareness of the psychologic issues described by the authors may make the time they have available with the patient more useful.