By David J. Diamond, PhD

SDGPS is honored to welcome Kelly Boyd-Bragadeste, Psy.D. as our speaker on June 8, 2001 at 11:30 AM at Sharp Mesa Vista Hospital. Dr. Bragadeste will present on group therapy with post-partum women. Dr. Bragadeste’s presentation is based on her work in the Center for Reproductive Psychology directed by David J. Diamond, PhD, Martha O. Diamond, PhD and Janet Jaffe, PhD. Dr. Bragadeste will discuss issues related specifically to group and post-partum issues. The Center for Reproductive Psychology deals with the psychological issues encountered when reproduction does not proceed as expected.

Reproduction is one of the most fundamental of human activities, something at the core of life itself. Whether or not we have a child, feelings about parenthood and procreation are central to the identities of human beings. Beginning in early childhood, we carry within us dreams, hopes, plans and expectations about what it will be like to have a child. At the Center for Reproductive Psychology, we have come to call this line of development, the reproductive story. Often the story remains unconscious, and unfolds naturally as we make and enact the decisions of our life. When there is a disruption to this process however, when we confront obstacles in the path to parenthood, we experience a profound trauma and multiple levels of loss. Reproductive trauma subjects people not only to the loss of the experience of pregnancy and parenthood, but to the loss of our story, of having things go the way we had dreamed and expected. Infertility, miscarriage, premature birth, postpartum depression, or any other disruption in the reproductive process are traumas in the true sense of the word—overwhelming either physically, emotionally or both, and outside the realm of normal human experience and ability to cope. In coming to terms with the painful reality and what it means to them, patients must not only mourn their losses, but work through the trauma in order to avoid long-lasting damage to their identities and sense of themselves as healthy adults.

Under normal, healthy conditions, people often view their children as positive, narcissistic extensions of themselves; as such, a reproductive problem can be experienced as a devastating narcissistic injury. The sense of failure associated with infertility and other reproductive trauma can, in fact, trigger a massive blow to a person's self-esteem. One may question: What's wrong with me? Everyone else can do it, why can't I? Why is my body not working as it should? They are struggling, in fact, with a multitude of losses: loss of a fantasized child, loss perhaps of an actual child, loss of being a parent, loss of self-esteem associated with feeling healthy and competent, loss of control, loss of feeling normal. In addition, there has been a disruption in their developmental progress as adults, and they may feel excluded from social groups and peers who are having children. These losses are intensified by the fact that they may trigger other painful or unresolved losses from the past.

In assessing and treating patients who have had reproductive losses it is important to recognize the range of emotions they may feel. These include feelings of failure, loss of control, anger, sadness, grief, and narcissistic wounding. People may experience marital stress or difficulties at work or with family and friends. The mourning of reproductive loss is complicated by the fact that these losses are often intangible. There is no store of memories from which to draw comfort, there are no rituals by which to gain closure. Other people often do not provide the validation and support that is so much a part of the mourning of a loved one; indeed, others may not even be aware of what has happened because reproduction is such a private experience.

The treatment of patients who have experienced reproductive trauma can be compromised by our natural wishes to comfort and reassure (i.e. "you're young, you can have another," "it was meant to be"). It is imperative to recognize, however, that such "comfort" may invalidate the patient's very real distress, and leave them feeling that they have failed even in mourning when they do not feel comforted. One approach that we have found useful in helping patients work through their grief is the notion of the story; that each of them has their own reproductive story with an as yet unwritten ending. If patients can recognize their stories and be open to a range of endings, it may help them grieve their loss and work through the trauma.