Infertility and Bowen's Systematic Family Therapy Approach

Abstract

This study focuses on the psychological consequences of infertility, using Bowen's Systematic Family Therapy as a conceptual framework. Infertility is often characterized as a profound and intricate life challenge that profoundly affects an individual's emotional health. Research has underscored the psychological ramifications linked to this condition, including feelings of grief, heightened anxiety, depression, and diminished self-worth. Historically, early research linked infertility to psychological defenses against pregnancy, but advancements in medical technology have since refuted the psychogenic hypothesis, emphasizing biomedical factors. Nevertheless, the psychological ramifications remain substantial, necessitating a nuanced approach to therapy. Bowen's Systematic Family Therapy offers valuable insights through its eight key concepts, including differentiation of self, family projection process, and multigenerational transmission. These concepts help in understanding the intricate emotional dynamics and stress patterns within the family unit affected by infertility. Studies suggest that family therapy can mitigate emotional distress, improve marital satisfaction, and facilitate communication among family members. Despite the limited direct research on Bowen's Systematic Family Therapy and infertility, existing literature underscores the importance of integrated therapeutic approaches that consider emotional and relational contexts. Future research should focus on expanding the application of family therapy models in infertility treatment, developing comprehensive support mechanisms, and addressing the psychological needs of both individuals and their extended families. This holistic perspective is essential for fostering resilience and emotional well-being in families facing infertility.

Keywords

• Infertility
• Bowen
• psychotherapy

İnfertilite ve Bowen Sistemik Aile Terapisi Yaklaşımı

Abstract

Bu çalışma, infertilitenin psikolojik sonuçlarına odaklanmakta olup, kavramsal bir çerçeve olarak Bowen'ın Sistematik Aile Terapisi'ni kullanmaktadır. İnfertilite, duygusal refahı önemli ölçüde etkileyen travmatik ve karmaşık bir yaşam krizi olarak tanımlanmış olup, literatür, yas, kaygı, depresyon ve düşük özsaygı gibi ilişkili psikolojik sorunları vurgulamaktadır. Öncül araştırmalar infertiliteyi gebelikle ilgili psikolojik savunmalarla ilişkilendirmiştir, ancak tıbbi teknolojideki ilerlemeler sonrasında psikojenik hipotezden uzaklaşılmış ve biyomedikal faktörler vurgulamıştır. Bununla birlikte, psikolojik çıktılar önemini korumakta ve terapide incelikli bir yaklaşım gerektirmektedir. Bowen'ın Sistematik Aile Terapisi, benliğin ayrışması, aile yansıtma süreci ve kuşaklar arası aktarım gibi sekiz temel kavramıyla değerli içgörüler sunmaktadır. Bu kavramlar, infertilite sorunuyla etkilenen aile birimindeki karmaşık duygusal dinamikleri ve stres desenlerini anlamada yardımcı olmaktadır. Çalışmalar, aile terapisinin duygusal sıkıntıları hafifletebileceğini, evlilik memnuniyetini artırabileceğini ve aile üyeleri arasındaki iletişimi kolaylaştırabileceğini öne sürmektedir. İnfertilite ve Bowen'un Sistematik Aile Terapisi üzerine sınırlı doğrudan araştırma olmasına rağmen, mevcut literatür, duygusal ve ilişkisel bağlamları dikkate alan bütünsel terapötik yaklaşımların önemini vurgulamaktadır. Gelecek araştırmalar, aile terapisi modellerinin infertilite tedavisinde uygulanmasının genişletilmesine, kapsamlı destek mekanizmalarının geliştirilmesine ve hem bireylerin hem de geniş ailelerinin psikolojik ihtiyaçlarının ele alınmasına odaklanmalıdır. Bu bütünsel bakış açısı, infertilite ile karşı karşıya olan ailelerde dayanıklılığı ve duygusal refahı teşvik etmek için önemlidir.

Keywords

• İnfertilite
• Bowen Sistematik Aile Terapisi
• psikoterapi

References

1. Beal AEM (2008) Intimacy, affective communication patterns and sibling position in marital dyads: Based on a systems approach to sibling position (Doctoral dissertation) Utah, Brigham Young University.
2. Bekaroğlu E (2018) İnfertilite tedavisinin psikolojik etkileri ve tedavi sürecindeki psikolojik müdahaleler. Klinik Psikoloji Dergisi, 2:153-159.
3. Benedek T (1952) Infertility as a psychosomatic defense. Fertil Steril, 3:527-541.
4. Blyth E, Moore R (2001) Involuntary childlessness and stigma. In Stigma and Social Exclusion in Healthcare (Eds C Carlisle, T Mason, C Watkins, E Whitehead):235-243. London, Routledge.
5. Bodin M, Käll L (2020) Is it an issue before it’s a problem? Investigating men’s talk about fertility. Sociol Health Illn, 42:1611-1625.
6. Boivin J, Gameiro S (2015) Evolution of psychology and counseling in infertility. Fertil Steril, 104: 251-259.
7. Bowen M (1966) The use of family theory in clinical practice. Compr Psychiatry, 7: 345-374.
8. Bowen M (1985) Family Therapy in Clinical Practice. Oxford, Jason Aronson.

9. Bowen M, Papero DV (2023) Triangles and the scale of differentiation of self: Notes for a 1970 videotape lecture series on family systems theory produced at the medical college of Virginia. Family Systems, 18:43-65.
10. Brand HJ (1989) The influence of sex differences on the acceptance of infertility. J Reprod Infant Psychol, 7:129-131.
11. Brigance CA, Cottone RR (2023) Addressing infertility through family therapy: An emotionally-focused family therapy approach. Contemp Fam Ther, 45:437-449.
12. Baldur-Felskov B, Kjaer SK, Albieri V, Steding-Jessen M, Kjaer T, Johansen C et al. (2013) Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study, Hum Reprod, 28:683–690,
13. Burns LH, Covington SN (2006) Psychology of infertility. In Infertility Counseling: A Comprehensive Handbook for Clinicians, 2nd ed. (Eds SN Covington, LH Burns):1-19. New York, Cambridge University Press.
14. Calatrava M, Martins MV, Schweer-Collins M, Duch-Ceballos C, Rodríguez-González M (2022) Differentiation of self: A scoping review of Bowen Family Systems Theory’s core construct. Clin Psychol Rev, 91:1-13.
15. Ceja A, Gasbarrini MF (2019) Multigenerational transmission process in Bowen Therapy. In Encyclopedia of Couple and Family Therapy (Eds J Lebow, A Chambers, D Breunlin):1-4. Cham, Springer.
16. Comella PA (2011) Observing emotional functioning in human relationship systems: Lessons from Murray Bowen's writings. In Bringing Systems Thinking to Life: Expanding the Horizons for Bowen Family Systems Theory (Eds OC Bregman, CM White):3-30. New York, Routledge.
17. Cousineau TM, Domar AD (2007) Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol, 21:293-308.
18. Cousins A, Freizinger M, Duffy ME, Gregas M, Wolfe, BE (2015) Self‐report of eating disorder symptoms among women with and without infertility. J Obstet Gynecol Neonatal Nurs, 44:380-388.
19. Crossno MA (2011) Bowen family systems theory. In Marriage and Family Therapy (Eds L Metcalf):39-64. New York, Springer.
20. Darolia S, Ghosh D (2022) Importance of personality factors in determining the psychological consequences of infertility: A systematic review. Health Educ Behav, 49:708-723.
21. Deyhoul N, Mohamaddoost T, Hosseini M (2017) Infertility-related risk factors: A systematic review. International Journal of Women’s Health and Reproduction Sciences, 5:24-29.
22. Diamond RM (2019) Infertility and pregnancy loss in couple and family therapy. In Encyclopedia of Couple and Family Therapy (Eds JL Lebow, AL Chambers, DC Breunlin):1475-1479. Cham, Springer.
23. Edelmann RJ, Connolly KJ (2000) Gender differences in response to infertility and infertility investigations: Real or illusory. Br J Health Psychol, 5:365-375.
24. El Kissi Y, Romdhane AB, Hidar S, Bannour S, Idrissi KA, Khairi H et al. (2013) General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: A comparative study between men and women. Eur J Obstet Gynecol Reprod Biol, 167:185-189.
25. Engler N (2009) The psychological impact of infertility and its treatment. Harv Ment Health Lett, 25:1-3.
26. Ergin RN, Polat A, Kars B, Öztekin D, Sofuoğlu K, Çalışkan E (2018) Social stigma and familial attitudes related to infertility. Turk J Obstet Gynecol, 15:46–49.
27. Fassino S, Piero A, Boggio S, Piccioni V, Garzaro L (2002) Anxiety, depression and anger suppression in infertile couples: A controlled study. Hum Reprod, 17:2986-2994.
28. Fisher JR, Hammarberg K (2012) Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research. Asian J Androl, 14:121-129.
29. Frances-Fischer JE, Lightsey OR (2003) Parenthood after primary infertility. Fam J, 11:117-128.
30. Galhardo A, Pinto-Gouveia J, Cunha M, Matos M (2011) The impact of shame and self-judgment on psychopathology in infertile patients, Hum Reprod, 26:2408-2414.
31. Greil AL (1997) Infertility and psychological distress: A critical review of the literature. Soc Sci Med, 45:1679-1704.
32. Greil AL, Slauson-Blevins K, McQuillan J (2010) The experience of infertility: A review of recent literature. Sociol Health Illn, 32:140-162.
33. Harrison V (2003) Reproduction and emotional cutoff. In Emotional Cutoff: Bowen Family Systems Theory Perspectives (Eds P Titelman):245-272. New York, Routledge.
34. Hasanpoor-Azghdy SB, Simbar M, Vedadhir A (2015) The social consequences of infertility among Iranian women: A qualitative study. Int J Fertil Steril, 8:409–420.
35. Humeniuk E, Pucek W, Wdowiak A, Filip M, Bojar I, Wdowiak A (2023) Supporting the treatment of infertility using psychological methods. Ann Agric Environ Med, 30:581–586.
36. Hynie M, Burns LH (2006) Cross-cultural isues in infertility counseling. In Infertility Counseling: A Comprehensive Handbook for Clinicians, 2nd ed. (Eds SN Covington, LH Burns):1-19. New York, Cambridge University Press.
37. Jafarzadeh‑Kenarsari F, Ghahiri A, Zargham‑Boroujeni A, Hbibi M (2015) Exploration of the counseling needs of infertile couples: A qualitative study. Iran J Nurs Midwifery Res, 20:552-559.
38. Jaffe J (2017) Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective. Psychotherapy, 54:380-385.
39. Joja OD, Dinu D, Paun D (2015) Psychological aspects of male infertility: An overview. Procedia Soc Behav Sci, 187:359-363.
40. Keyhan M (2018) Medical family therapy and infertility: Referral practices of infertility physicians and their views of the biopsychosocial impact of infertility treatments on patients (Unpublished master dissertation) Texas, Texas Woman's University.
41. Lafarge C, Fox P (2012) The role of beliefs about infertility on psychological adjustment: A systematic review. VISTAS: Education, Economy and Community, 2:7-17.
42. Masoumi SZ, Parsa P, Kalhori F, Mohagheghi H, Mohammadi Y (2019) What psychiatric interventions are used for anxiety disorders in infertile couples? A systematic review study. Iran J Psychiatry, 14:160-170.
43. McQuillan J, Greil AL, White L, Jacob MC (2003) Frustrated fertility: Infertility and psychological distress among women. J Marriage Fam, 65:1007-1018.
44. Mikesell SG, Stohner M (1995) Infertility and pregnancy loss: The role of the family consultant. In Integrating Family Therapy: Handbook of Family Psychology and Systems Theory, (Eds RH Mikesell, D Lusterman, SH McDaniel):421-436. Washington, American Psychological Association.
45. Modarres M, Abunasri M, Alhani F, Ebrahimi E (2022) The effectiveness of implementing family-centered empowerment model on irrational thoughts of Iranian infertile women: A randomized clinical trial. J Caring Sci, 11: 224-231.
46. Morosow K, Kolk M (2020) How does birth order and number of siblings affect fertility? A within-family comparison using Swedish register data. Eur J Popul, 36:197-233.
47. Möller A, Fallström K (1991) Psychological factors in the etiology of infertility: A longitudinal study. J Psychosom Obstet Gynaecol, 12:13-26.
48. Nachtigall RD, Becker G, Wozny M (1992) The effects of gender-specific diagnosis on men’s and women’s response to infertility. Fertil Steril, 57:113-121.
49. Onat G, Beji NK (2012a) Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples. Eur J Obstet Gynecol Reprod Biol, 165:243-248.
50. Onat G, Beji NK (2012b) Marital relationship and quality of life among couples with infertility. Sex Disabil, 30:39-52.
51. Palha AP, Lourenço MF (2011) Psychological and cross-cultural aspects of infertility and human sexuality. In Sexual Dysfunction: Beyond the Brain-Body Connection (Eds R Balon):164-183. Basel, Karger.
52. Peterson BD, Newton CR, Rosen KH (2003) Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples. Fam Process, 42:59-70.
53. Pitta P (2019) Complicated loss, grieving, and infertility: Assimilative family therapy. In Integrative Couple and Family Therapies: Treatment Models for Complex Clinical Issues (Eds PJ Pitta, CC Datchi):25-46. Washington, American Psychological Association.
54. Podolska M, Bidzan M (2011) Infertility as a psychological problem. Ginekol Pol. 82:44-49.
55. Popovic M (2018) Bowen family systems theory. In Marriage and Family Therapy, 2nd ed. (Eds L Metcalf):43-70. New York, Springer.
56. Ramezanzadeh F, Aghssa MM, Abedinia N, Zayeri F, Khanafshar N, Shariat M et al. (2004) A survey of relationship between anxiety, depression and duration of infertility. BMC Womens Health, 4:9.
57. Samman SK, Frick, HA, Dansby Olufowote RA (2022) Medical family therapy with diverse populations part I: Interracial couples navigating infertility, racialized pregnancy, and pregnancy loss. International Journal of Systemic Therapy, 33:227-249.
58. Seymenler S, Siyez DM (2018) Infertilite psikolojik danışmanlığı. Psikiyatride Güncel Yaklaşımlar, 10:186-197.
59. Shapiro SA (1988) Psychological consequences of infertility. In Critical Psychophysical Passages in the Life of a Woman (Eds J Offerman-Zuckerberg):269-289. New York, Springer.
60. Simionescu G, Doroftei B, Maftei R, Obreja B, Anton E, Grab D et al.(2021) The complex relationship between infertility and psychological distress. Exp Ther Med, 21:306.
61. Starc A, Trampuš M, Pavan Jukić D, Rotim C, Jukić T, Polona Mivšek A (2019) Infertility and sexual dysfunctions: A systematic literature review. Acta Clin Croat, 58:508–515.
62. Teskereci G (2010) İnfertilite tedavisi gören çiftlerde yaşam tarzının, yaşam kalitesine etkisi (Yüksek lisans tezi) Antalya, Akdeniz Üniversitesi.
63. The Bowen Center for the Study of the Family (2023) Nuclear family emotional process. https://www.thebowencenter.org/nuclear-family-emotional-process (Accessed 29.11.2023)
64. Thorn P (2009) Understanding infertility: Psychological and social considerations from a counselling perspective. Int J Fertil Steril, 3:48-51.
65. Titelman P (2003) Emotional cutoff in Bowen family systems theory: An overview. In Emotional Cutoff: Bowen Family Systems Theory Perspectives (Eds P Titelman):9-66. New York, Routledge.
66. Ullah A, Ashraf H, Tariq M, Aziz SZ, Zubair S, Sikandar KUR, Ali N, Shakoor A, Nisar M (2021) Battling the invisible infertility agony: A case study of infertile women in Khyber Pakhtunkhwa-Pakistan. J Ethn Cult Stud, 8:89–105.
67. van Balen F (2009) Infertility and culture: Explanations, implications and dilemmas. In Marginalized Reproduction: Ethnicity, Infertility and Reproductive Technologies (Eds L. Culley, N Hudson, F van Rooij):34-48. London, Routledge.
68. van Balen F, Inhorn, MC (2002) Introduction: Interpreting infertility: A view from the social sciences. In Infertility Around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies (Eds F van Balen, MC Inhorn):3-32. Berkley, University of California
69. Whiteford LM & Gonzalez L (1995) Stigma: The hidden burden of infertility. Soc Sci Med, 40:27-36.
70. Winek JL (2009) Systemic Family Therapy: From Theory to Practice. Thousand Oaks, NJ,Sage.
71. Wischmann T, Schilling K, Toth B, Rösner S, Strowitzki T, Wohlfarth K et al. (2014) Sexuality, self-esteem and partnership quality in infertile women and men. Geburtshilfe und Frauenheilkund, 74:759-763.
72. WHO (2023) Infertility Prevalence Estimates, 1990-2021. Geneva, World Health Organization
73. Wright J, Duchesne C, Sabourin S, Bissonnette F, Benoit J, Girard Y (1991) Psychosocial distress and infertility: Men and women respond differently. Fertil Steril, 55:100-108.
74. Yli-Kuha AN, Gissler M, Klemetti R, Luoto R, Koivisto E, Hemminki E (2010) Psychiatric disorders leading to hospitalization before and after infertility treatments. Hum Reprod, 25:2018–2023.
75. Zouari A, Hammami F, Ellouze S, Turki M, Jenhani R, Chibani M, Gharchem R et al. (2021) Impact of male infertility on self-esteem. Eur Psychiatry, 64(Suppl 1):S547.