Fertility and Hypnosis by David Kraft
‘The longer a couple have been trying to conceive, the less likely they are to conceive’
Dr Françoise Shenfield
From a viewpoint as a hypno-psychotherapist, list and explain the reasons why this might be the case. Devise an action plan for assisting your client.
(2500-3000 words)
by
David Kraft
Submitted in partial fulfilment of the requirements
of easibirthing
Certified Hypnotic Fertility Practitioner Qualification (CHFP)
NCHP Hypnosis for Fertility Practitioners’ Course Assessment Paper
LONDON, UNITED KINGDOM
2012
Approximately 3.5 million couples in the UK experience problems with infertility and, although some women go on to becoming pregnant, others do not. For many men and women, the process of ‘becoming pregnant’ can be an extremely stressful and time-consuming experience (Brand, Roos and Van der Merwe, 1982). Many couples tell their friends that they have decided to ‘try for a baby’ and this immediately adds additional pressure on both individuals. After a period of time, often the couple begin to fear that they will never have a baby, and this can lead to feelings of guilt. For example, men fear that they are inadequate because they might not be producing adequate semen—adequate enough, certainly, to maintain and transport the sperm. This may also cause the man to stop or reduce sexual contact with his partner. If oligospermia is diagnosed, then males often feel that there is no hope for them whatsoever. However, it is important to note, that some men who have a low sperm count are still able to produce an adequate sperm specimen in controlled conditions during ICI or after washing has taken place. Women also feel guilty that they have let themselves down, as well as their partner. As they continue to ‘try to get pregnant’, often they develop obsessions about having sexual intercourse at certain times of their cycle—often between day 10 and 14. Some women buy ‘herbal remedies to increase libido or to assist fertilization and spend all day worrying about having a baby. Others, insist that their partners have sex with them regularly, or as soon as the man gets home from work, and, as a result, some men feel that
they are reproducing machines rather than boyfriends. Furthermore, it is important to be relaxed during intercourse in order to have an orgasm as this can help fertility—particularly because, during orgasm, the contraction causes the cervix to dip down towards the vagina. As time passes, these obsessional behaviours develop still further, and a woman’s life becomes preoccupied with having a baby. This is often accompanied by a great deal of sadness and isolation.
In fact, the emotional impact of this can be severe. Some women develop gastrointestinal problems or depression; others blame their partners and try to find someone else. Further, as stress levels continue to grow and develop it makes it more unlikely for them to conceive (Domar, 2009). On top of this, women in their thirties feel that their ‘clock is ticking’ and this can add further pressure to the process; this is worse for women who are aged 35 to 40. Although some women go at lengths to solve this problem, in the first instance, the general practitioner is probably the first point of call. When visiting one’s GP, it is important to consider the following components which may affect one’s ability to become pregnant. The following list has been adapted from Mustard’s (2012) work on fertility:
1 Alcohol consumption—although this does not affect sperm count, it can affect female’s ability to get pregnant; it can also can lead to miscarriage
2 Smoking—this can reduce oestrogen and progesterone levels
3 Caffeine—large amounts of caffeine (over four cups a day) can delay the time it takes to conceive
4 Body weight—obesity can affect libido and reduce optimum hormonal functioning
5 Stress—when stress occurs within the autonomic nervous system, the reproductive hormone prolactin is over produced if one is stressed, and this can affect ovulation
6 Tight underwear (males)—men are advised to wear loose underwear so that the scrotum remains at a constant temperature; constraint can also reduce sperm count to some extent
7 Prescribed drug use and recreational drug use—prescribed drug use needs to be monitored because some drugs have side effects; recreational drug use is not advised
8 Nutrition—it is important to maintain a normal diet and to take in vitamins—particularly vitamin A and B6; one should also make sure that one does not have a calcium or zinc deficiency
9 Exercise—a healthy body will help the reproductive system to work efficiently—this is important for both men and women
Your GP might take a series of blood tests in order to assess thyroid function and prolactin levels. However, many women find that they undertake various tests at the hospital or with their GP—for example laparoscopy, hysterosalpingography or hysteroscopy—before their partner has been tested and that they spent a significant amount of time asking their partner to get a semen test. In fact, this can be done easily at home: there are many home testing kits which assess sperm count and the motility of the sperm. And, also at home, there are ovulation predictor kits that can be used. However, the more women have these tests, the more they fear that they have a biological problem—for instance, endometriosis, pelvic inflammatory disease, a hormone imbalance, an abnormality of the uterus, polycystic ovarian syndrome, an ovulation disorder or hydrosalpinx—and that they will never be able to get pregnant: indeed, this unconscious block has negative effects on the body right down to the cellular level.
There are a number of fertility drugs on the market, and women tend, after a period of time, to investigate these before enrolling on an IVF programme. In a natural cycle, the follicle stimulating hormone and luteinising hormone help to make the eggs in the ovaries mature (Mustard, 2012). If a couple decides to go the IVF route there is a waiting list, and most of the tests above need to be undertaken before IVF is considered as an option. However, the waiting and the IVF cycle itself can be exhausting and frustrating and often this can lead to mood swings, hot flushes and painful ovaries; in addition, this can affect quality of life in general.
For many couples, being unable to ‘get pregnant’ can have a huge impact on the relationship, and often it is the woman that seeks help from a psychotherapist, although this is still unfortunately rare. Indeed, most women go to their GP and then to a specialist, and yet there are some that realize that the problem could be related to their overall psychological well-being. It is important that we, as hypno-psychotherapists, or psychotherapists that use hypnosis as an adjunct to treatment, help clients to feel at ease as soon as they begin therapy and to challenge many of their negative ruminations at the start of therapy. Many women have already read articles on the internet and have done a fair amount of research: as a result, they begin to worry and, as these worries grow stronger, they convince themselves that there is something very wrong and fear that they will never be able to conceive.
A useful approach to use is a technique that can be called the ‘hall of learning’. This technique can be divided into three parts: (1): induction using 10-1 deepener, brief progressive muscle relaxation (PMR) (Wolpe, 1958), and a visualization of the colours of the rainbow; (2) visualization and experiential exploration of the hall of learning; and (3) preparation of successful conception of a baby. The following is an example of how this technique may be used (after the induction), and is an adaptation of the technique described by Sharon Mustard (2012).
And as you enter your hall of learning…I wonder how soon it will be before you notice all your limiting and negative thoughts disappearing… as you learn new theories and philosophies your expectations grow stronger and stronger..and with each step you take you learn more and more what you need to do to effect change for you and your body…As you enter the healing room, with each step you take, you move closer to the control centre of your unconscious…and you notice all the colours around the room..what colours might they be?…Can you remember a time in which you saw some wonderfully relaxing colours that made you feel comforted and in the perfect position to learn and re-learn to be relaxed…and when you are ready, just allow yourself to sit on a comfy chair and move the knobs and gauges on your console in your control room…feeling yourself become more and more calm,, setting your breathing to the right level and your heart beat to 60…Just feel all the muscles around your uterus easing into a deep relaxation, releasing any unnecessary nervous tension…And as you continue to relax…I would like to thank your unconscious mind for its full and undivided attention and for its ability always and already to conceive, and for the wonderful job it has done and will do in supporting the growth and development of your reproductive system…and the time is right for you to enter a new phase of its life…to become a parent…to direct your muscles into areas of the body…to release and relax..making everything the right climate so that an egg can fertilize…
For men, the therapist can use imagery to help him to feel pleasant and soothing sensations towards to testes, seeing a consistent and 24 hour process of sperm production being ‘manufactured efficiently’. The man can then experience the sperm developing safely in the testes and that, when they are ready, the sperm can travel down the sperm ducts into a nurturing liquid which keeps them safe ready for travel. For the woman, after this process (described above), it is quite helpful to visualize having a baby using age progression, and this should be done before disengagement. Post hypnotic suggestions can also be used to suggest support and growth and creating a natural environment for conception.
In fact, the process of progressive muscle relaxation (Wolpe, 1958) in itself can be very helpful for women: some individuals can be extremely tense when they first come for treatment, and this technique, although time consuming, can be highly effective in reducing stress levels, and helping the uterus and pelvic floor to be relaxed. One can also focus on the body—uterus, fallopian tubes and cervix—to enhance the efficacy of this work. This can be set up as follows—again, this is derived from Mustard’s (2012) approach to fertility:
As this wonderful warm wave of relaxation continue to grow and develop all the way down your body…I wonder if you can imagine it developing and spreading all the way down to your uterus, fallopian tubes, cervix…bathing you in a golden light…allowing a natural process of development and healing to continue…whatever needs to be repaired will be repaired… and whatever will flourish will flourish..ready for this special journey ahead…
In some cases, however, it is important to investigate any secondary gains individuals might have in not getting pregnant—for example, many women fear childbirth and/or pregnancy, losing one’s free time or becoming fat. In some more complicated instances, a female might resist sexual intercourse or block having an orgasm because of an unconscious desire to punish the partner or men in general, and this is often to do with past trauma—for example, an abortion or rape. Bereavement may also play a significant role in reducing chances of having a baby, and these will all need to be addressed in the psychotherapy. In all cases, it is important to use hypnosis to enhance the support given in the psychotherapy, and not to use it inappropriately. For example, it is important to do a great deal of listening in the first few sessions, while devising an appropriate therapeutic programme; this should be combined with support and an unconditional positive regard.
Indeed, resistance can take on many forms and have a huge effect on the body. Ibbotson (2012) uses a technique which is particularly helpful for PTSD and this can utilized here to help individuals who resist treatment for infertility. The main premise of this approach is that there are some mechanisms which are resistant to change, and yet they are stopping the person from getting pregnant or leading a normal life. However, by letting go of these obstacles (Mustard, 2012), mechanisms which served their purpose at one time, but are no longer useful, one can move on in life and reduce negative thinking and behaviours. An example of this is as follows:
And as you enter a wood…just take three deep breaths…and each time you breathe out, you notice how relaxed you are becoming more and more…just let go…and this wood can be a wood you know or an imaginary wood…or a mixture of both…and I wonder what you can see in this wood…notice what sounds there are around you…or smells…and as you continue to walk, you decide that there is something you need to get rid of…perhaps a feeling or a memory…or a behaviour…and you notice some dead leaves by a tree…and, although they served a purpose in the past…they do not serve a purpose now…and, when you are ready…you can allow yourself to just discard those leaves…and you know which ones they are…just take your time to discard those unnecessary leaves…as many leaves as you want…and watch the leaves fall on the ground…and land wherever they land…and you feel good and pleased to be rid of this thing or things…and, when you are ready to move on, then continue on your walk…
Another useful technique, also described by Mustard (2012), is one which is often used in the treatment of panic disorder and phobic anxiety, and this where the client meets the older, wiser self (Milne, 1988; Degun-Mather, 2001; Brann, 2012). In the hypnosis, the older, wiser self comforts and advises the younger self in what to do, and this can be combined with a matching metaphor(Lankton and Lankton, 1983) in which the protagonist reaches his or her goal. Indeed, during the hypnosis, the therapist would be advised to reduce negative self talk—for instance ‘catastrophisation’, magnification of details, personalization, fallacy of fairness or over-generalizing (Mustard, 2012)—and to utilize the matching metaphor to effect a change for the patient’s desired future (DeShazer, 1988; Iverson, Gergen and Fairbanks, 2005).
Solution-focussed therapists (DeShazer, 1988; Lankton, 2004) often use a goal-directed approach, and perhaps this is one of the essential components to Mustard’s (2012) programme for fertility. She points out that is helpful for patients to believe that they are going to get pregnant rather than consistently using the term ‘try’, and she emphasizes that feeling infertile can lead to a sense that one has lost control. She reiterates this point in her goals for treatment: this form of therapy should help both women and men to re-establish control of their lives and to enjoy both sensual and sexual intimacy in the bedroom. Of course, all individuals will have their own goals for therapy (the central one being that they want to become pregnant or fertilize their partner); however, Mustard (2012) makes the following suggestions as guidelines:
1To pursue fertility treatment (naturally or with IVF) without feeling that your life has been taken over
2 To be able to talk to your partner to address his or her needs as well as your own
3 To reduce stress and maximize your ability naturally to conceive
4 To have a life outside any problems with regard to infertility
5 To gain control of your life in general
We cannot guarantee that our clients will become pregnant, but the work that we do, if we follow these guidelines, can help increase the success rate. In addition, by working on reducing stress and by reducing cortisol levels in the body, therapists can work in conjunction with specialists in the field to increase the chances of conceiving naturally. The use of hypnosis in treatment is cost effective and, unlike IVF and fertility drugs (for example CLOMID), has no side effects. It is recommended that general practitioners should consider hypnosis as an adjunct to the treatment of infertility in both men and women.
Word Count: 2, 642
References
Brand, HJ, Roos, SS. and Van der Merwe, AB (1982), Psychological stress and infertility. Part 1: Psychophysiological reaction patterns. British Journal of Medical Psychology, 55: 379–384.
Brann L (2012). Phobias. In Les Brann, Jacky Owens and Ann Williamson (Eds) The Handbook of Contemporary Clinical Hypnosis: Theory and Practice (pp211-227). Wiley-Blackwell: Chichester.
Degun-Mather M (2001). The value of hypnosis in the treatment of chronic PTSD with dissociative fugues in a war veteran. Contemporary Hypnosis, 18 (1): 4-13.
De Shazer S (1988). Investigating solutions in brief therapy. New York: Norton & Co.
Domar, A (2009). Conquering Fertility. London: Penguin Books.
Ibbotson G (2012, March 10). ‘Treating PTSD using imagery’. Psychotherapy Advanced module at the National College of Hypnosis and Psychotherapy, London.
Iverson RR, Gergen KJ & Fairbanks II RP (2005). Assessment and social construction: conflict or co-creation? British Journal of Social Work, 35: 1-20.
Lankton, SR & Lankton, CH (1983). The Answer Within: a Clinical Framework of Ericksonian Hypnotherapy. New York: Bruner/Mazel.
Lankton SR (2004). Assembling Ericksonian Therapy: the Collected Papers of Stephen Lankton, Vol 1: 1985-2002. Phoenix, Arizona: Zeig, Tucker & Theisen.
Milne G (1988). Hypnosis in the treatment of single phobia and complex agoraphobia: a series of case studies. Australian Journal of Clinical and Experimental Hypnosis, 16 (1): 53-65.
Mustard, S (2012, September 29-30). Conference at the National College of Hypnosis and Psychotherapy. ‘Hypnosis for Fertility’, London.
Wolpe, J (1958). Psychotherapy by Reciprocal Inhibition. Stanford: StanfordUniversity Press.