This essay was written by Carole Lieber Wilkins, Licensed Marriage and Family Therapist in private practice in West Los Angeles. A specialist in the field of reproductive medicine, adoption and family building options since 1986, she became a founding member of Resolve of Greater Los Angeles in 1987 and served on the Board of Directors in various positions for the next 14 years.
Carole is first and foremost a mother via egg donation and adoption. Carole is also an active member of The Mental Health Professional Group (MHPG) which is a part of ASRM. This group is a multidisciplinary group that formed in 1985 with the full support of the American Society for Reproductive Medicine (ASRM). Its mission is to promote scientific understanding of the psychological, social, and emotional perspectives of infertility patients
During a discussion about the roles therapists fulfill with intended parents during DE cycles Carole took the time to write an essay talking about what exactly that role is. - Marna Gatlin
I have been meeting with patients pursuing gamete donation, embryo donation, and surrogacy for many, many years. I don't call them, nor do I consider them to be evaluations or assessments, despite the fact that the clinics do tell patients they need a “psychological evaluation” before proceeding. My attempt to educate clinic staff has not been successful in changing their language, thus, patients often come in defensive and angry. I attempt to put them at ease immediately by telling them the meeting is not an evaluation and it is not my job to decide whether or not they are worthy of becoming parents. Their response is visceral. Shoulders drop, faces relax, and they breathe. Then we can proceed.
I tell patients I see my role as educative in two ways: to talk about the ways in which building a family thru gamete donation is DIFFERENT from having a family the easy and inexpensive way; and to play the role of child advocate.
I tell patients that I try to represent the only person in the family building equation who has no vote, but is the sole reason for the endeavor—the unborn child. The children resulting from all the procedures have no voice in how it all happens, (as no children have a vote in how they are conceived.)
I try to put a spin on what we DO know about how individuals feel who come into families thru donor conception, surrogacy, etc., regardless of the single/married, gay/straight constellation of the family.
We DO know some things that make healthy families and we DO know now from studies of DE and DS offspring how people feel about their means of conception and all that goes with it.
We DO know that it is normal and common for people to grieve the loss of a genetic link to an offspring.
We DO know how most infertility patients feel after being in treatment for a period of time.
Many have recently written about “the brave new world” we are involved in, but I wonder when it will stop being a brave new world. Yes, the stakes keep getting higher as technology tests our ethical boundaries of what can be done, but should it be done. However, surrogacy is now 30 years old. Donor sperm has been around forever and the first child born thru egg donation is now 27. Many people now have “children” through gamete donation who haven’t been children in a long time. In fact, some parents through gamete donation are now grandparents. It’s not that new and we DO know many things to be true.
With some exceptions, the report I send to a doctor reflects the discussion of the many complex issues that accompany complicated family building. Gamete donation families are special needs families, as are adoptive families, and many other kinds of families. This requires unique preparation and knowledge. Special needs are not bad; they’re just special, aka “a little extra.” I call it parenting plus. These families have all the stuff “regular” families have, with a healthy dose of EXTRA.
Even in a brief consultation, we can get a rough idea of whether there is psychopathology (vs. neurosis, thank goodness, or surely most of us would have never become parents), substance or spousal abuse or other issues that would make us significantly concerned about bringing a child into the household. In those cases, I recommend further counseling or whatever is needed. But most of the time, I think, our patients are as unqualified to parent as anyone off the street, only now, because they have been required to see us, they are much better educated about certain aspects of family building and parenting.
When patients leave my office, I hope they have more questions than when they walked in.
I hope they are thinking about gamete donation differently than when they resentfully made the appt. (if required by physician).
I hope they no longer think gamete donation is no big deal.
I hope they are thinking about what it would be like to grow up in a home where your parents didn’t have enough respect to tell the truth about who you are, or where parents were too scared to tell the truth.
I hope they think about the fact that it won’t matter what other people say about gamete donation as long as they as parents are fierce protectors and advocates for the family they created and how they created it, thereby claiming children as one’s own.
I hope my patients leave my office knowing that infertility is a lifelong disease that goes into remission for long periods of time, and then springs up again at the least expected moments.
I hope my patients leave my office armed with the response to the dreaded exclamation
“I don’t have to listen to you because you’re not my real mother!!”
I want them to leave my office having shifted from being terrified their kid will someday say that to them, to looking forward to it because they are prepared and ready to help guide their child through the muddy waters of trying to figure out who they actually are.
All that in an hour? We do what we can with what little we are given.