How Existential Psychotherapy might help men struggling with male factor infertility and particularly with azoospermia
I have recently been very concerned about the psychological impact to men who blame themselves for the infertile state, and therefore I have been working with Orlando Taylor, who has been sitting in on my clinics, because I think that the technique of existential psychotherapy may be very helpful to many of the people and couples whom I see, but particularly the men. So this resume comes from Orlando after he had sat in on a day’s consultations and has reflected upon what he observed.
I spent the day with Jonathan Ramsay in his clinic and was therefore able to observe, and sometimes to talk with, the couples whom he was seeing. The overriding problem as I see it, and indeed as the patient sees it, is that they are suffering from a preordained condition (in this case male infertility) and the world is not offering any answers. I had a sense of this when observing the patients in JR’s clinic: there is something about their infertility which just does not make sense. Of course, JR can take them through the science (which he does with warmth and clarity) and hopefully he may have some potential solutions, but beyond this there still exists an underlying desire for some kind of deeper explanation.
This was particularly noticeable with the final man we saw, who was wrapped up in a circular intellectual conversation, searching for an answer that did not really exist. He looked pained and the question which he seemed to really want an answer to was ‘why me?’. Crucially, our psychologists tell us that this situation should not leave us in despair or hopelessness, but rather in accepting it and remaining lucid, or aware of what is happening, we can still live a full and happy life.
In therapy, I can sit with people and help them not only to accept their situation but to continue embracing it, and therefore all that the rest of their life has to offer – ‘to live and create in the very midst of the desert’.
Purpose
Purpose, which psychotherapists formulate as meaning for which we live, can be crucial for a fulfilling life. As one psychologist, Nietzsche, puts it, if we process our ‘why’ of life, we can put up with almost any ‘how’.
It strikes me that having a child is a core purpose for so many people, both men and women, so what are you left with if this purpose is called into question? Whilst the aim is for these couples to do everything in their power to conceive, it is important that they are reminded that they exist with purpose and meaning outside of that journey. When the quest to become a parent becomes your sole purpose, I wonder what impact this might have on a man and his relationship. At least two couples at JR’s clinic reported a loss of libido, describing feeling nervous that the obsession with conception might in fact be impacting their ability to conceive.
In therapy, exploring one’s purpose and identity outside of the fertility journey could have a profound impact on helping people retain their sense of self, hopefully reducing stress and improving relationships. The body and mind are of course linked and, as JR has told me, reducing cortisol levels increases one’s chance of conception.
Uncertainty
Humans are terrible with the uncertain. We move immediately to categorise, to diagnose and to make sense of the whole picture. What is immensely difficult about the fertility journey is that it is dripping with uncertainty. Where JR was brilliant was in his laying out the clear facts of the situation – no false hopes, no half-truths. However, what no one can do is to tell them with 100% certainty that they are going to conceive, and this uncertainty must be exhausting. One man JR spoke to on the phone had various theories as to what might be going on. So too did the last man he saw. They were trying to make certain the uncertain.
It strikes me that infertility is a battle with uncertainty and, like the ‘absurd’, having somebody sit in that uncertainty with you is a gift. The support I can offer through therapy while somebody is completely unsure of their future could be vitally important for their wellbeing and, who knows, might even help them on their fertility journey.
These are just a few thoughts of the psychotherapist Orlando Taylor, who has been sitting in with me. We are going to share a few experiences in the clinics over the next few weeks, because I hope that in the future we will be able to work more closely together to try to resolve some of the unhappiness and ‘dis-ease’ that surrounds so many of my patients’ quest for positive fertility outcomes.
So I wish all of you the best, and let us look forward to the future and try and help you through all aspects of your difficulties.
