Alisa Hafkin, LCSW

Most of us have had a friend who has had some emotional crisis.  Hopefully family and friends (like you) have helped them find ways to maintain their life and receive assistance sorting out their stressful issues.  Many times those closest to the person in crisis feel helpless because they just do not know what to do.  Here are five great ways to help your friend get through to the other side.

1. Just go out for a walk.  Have you noticed the power of being outside?  Here in NYC it can be hard to really commune with nature, but being out in the fresh air and looking up at the sky can really help a person who is struggling.  Depending on how they are doing you can go to Central Park, the zoo, the High Line, or walk around the quiet of Battery Park early on a Sunday morning. Let them guide the discussion and direction or just accompany them in their silence.  Remind them of hope, their own strength and that you are there for them.
2. Cook a meal.  When I work with post-partum moms here in the city, there can sometimes be no better help than a home cooked meal.  Find out what the like to eat, if there are any dietary restrictions, and of course if they have any favorites.  Not a gourmet chef yourself, well then splurge and order from their favorite restaurant!
3. Take their kids for a few hours or an overnight.  If your friend or loved one is struggling, they need some rest, and usually taking care of children leaves no time to reflect or have a quiet mind.  Make plans to take their children so they can get the alone time they need.
4. Give them space.  You may feel the need to be a constant voice and fill your friend or loved one with the hope that activity and companionship will make them feel better.  While it is true some people do not want to be left alone, others crave space and solitude.  Of course, we do not want to see those who are struggling spend all day in bed, but they may need some time on the sofa watching a great movie by themselves.
5. Do not try to solve their problems, in fact that can make matters far worse.  You can not just cheer up a depressed person if their relationship has ended.  If a friend is in debt, money may not be their only problem.  If they regularly feel overwhelmed do not swoop in and take over their to-do list.  Again, offer support but do not try to save them.

Many of my patients here in New York City suffer with depression and/or anxiety.  Sometimes they feel as if they have no one to talk to, so just knowing you are there for them can make all the difference in the world.

As we make our way through June we are closing in on the half way point of 2015.  Did you set a list of personal things to do and have not made much progress?  Do you need a bit of encouragement  to get moving through your goals?  It can be a bit overwhelming.  I understand.  When we work, live, play and sometimes just try to keep our head above water in this fantastic city of ours, moving forward can be a challenge.

I have worked with clients in my NYC office who tell me it is frightening to think of actually achieving the goal.  I get it, it may seem a bit unusual and contrary to a regular line of thinking.  But the truth is, once you achieve a goal, what is next?  As long as that goal is in sight, you still have hope. Are you ready to step up and then do even more?  It can be scary to think that you could actually get your act together.  Then what would happen?

So what should you do if you are looking to accomplish some goals?

1. Write down what you want to do.  There is a certain power in the written word.  Seeing your goals in black and white (could be up on a screen) can have a profound effect on you.
2. Make sure your goals are obtainable.  For instance, if you want to be able to run a marathon in the next 30 days, that might not be reasonable if you have yet to walk around the block.
3. Determine some manageable steps by setting smaller goals to meet and celebrate when accomplished.

I have a friend who sets 90 day goals.  This seems to be a good number for her.  Her goals are always significant and they lead to bigger steps in her life. Most importantly, she has found that the her 90 day time frame is a perfect measurement tool that enables her to obtain her goals.  Using her system she increased her business, paid off a car, lost weight, and toned up her arms.

So why do I write about goals?  Goals can keep you on track to building your life.  When you are moving forward working toward certain accomplishments you will find that other pieces will fall into place.  Also, when you are working on goals, professional and personal, you will find there is little time for you to get complacent.

Modern science has reached a stage within the area of reproductive medicine, that challenges practitioners and their clients to face many ethical considerations when moving forward in the quest to have a child. The limited options that were available to individuals and couples 25 years ago did not create the kind of ethical dilemmas we face today. No one would have predicted that a child could potentially have five parents: the intended mother, the intended father, the egg donor, the sperm donor and the gestational carrier. That concept, during the early years of assisted reproductive technology, would have been considered science fiction and today it is just one of the magical advances individuals and couples have to choose from.

Some of the other leaps in assisted reproductive technology include having a child for a woman over the age of 50 with the use of egg donation, homosexual and lesbian individuals and couples having children through egg donation and surrogacy and having a child after death with the use of frozen sperm or eggs. These concepts are in use today and require in depth consideration of the considerable ramifications that can affect a much wider circle than just the individual or couple using assisted reproductive technology.

We first begin by identifying the reason/s for infertility as that determines the direction and individual or couple needs to take in order to have a child. Depending on the options available, and there are many, we then look at viability, practicality and then identify if there is an ethical dilemma. An example of this may occur when a woman diagnosed with infertility wants to use an egg from another family member such as a sister, niece or cousin. It may seem selfless and logical to implement this decision but there may be hidden issues that could cause potential harm. The donor may feel coerced or guilty or there may be financial incentives, all of which need to be explored before any further steps are taken. Another example is when a prospective parent is of an advanced age, increasing the potential that a parent will die while the child is still young. Looking beyond the immediate need to have a child to a future that may be compromised is a way to incorporate ethics in to the assisted reproductive arena.

The next step involves gathering as much information as possible about the situation at hand so as to make an informed and ethical decision. Using the in-family egg donation example above, a practitioner needs to help the parties involved make the best decision for themselves, the donor and the child. The practitioner can help shed some light on to concepts that were not previously considered such as, will the donor have a say in decisions about the child? Will the parents insist that the conditions under which the child was conceived be kept secret? What are the ramifications of offering money for egg donation to someone in financial need? As this information is gathered, the parties involved have the opportunity to look at and understand that they may or may not be making the best ethical decision for themselves, their family or their child.

After information is gathered and all parties understand the complexities of the situation, options are then identified with the goal that everyone can agree on the best path to take. For couples, one partner may be rooted in one ideology while the other wants to try something different. For individuals, it is important to focus on finding a viable and dependable support system that fosters the long term emotional and physical health of both parent and child.

There are so many things to consider with the use of assisted reproductive technology and being open to the scientific options as well as the ethical dilemmas, enables the potential for more holistic choices. Once all the options are explored, it is then time to make the decision to move forward and sometimes that means opting to remain childless. There is no way to predict the long term outcome of a decision fraught with challenging ethical issues but without consideration of those issues, there is certainly more potential for long term harm.

Ending infertility treatment is one of the most gut wrenching decisions an individual or couple has to make. Some of the reasons for ending treatment include multiple unsuccessful outcomes, emotional toll, financial drain and pregnancy. After many years of treatment, patients may feel a deep sense of intimacy with their medical team and leaving the circle of security can produce feelings of loss. The road toward becoming pregnant is long for a patient diagnosed with infertility and it may be a shock to actually become pregnant and then leave what has become so familiar. Pregnancy opens up other dimensions that include physical and psychological changes, confronting the reality of achieving what has been longed for, attachment to the baby and preparing for parenting.

Prior to the advent of assisted reproductive technology, women and men struggling with infertility had no choice but to accept that they would not have a genetically related child. There were no available options to enhance fertility or prolong the period of trying to get pregnant if normal sexual intercourse did not produce a pregnancy. Technological advances to assist in reproduction have elongated the time that women have to attempt getting pregnant and new methods are constantly being researched and tested. As long as there is the potential for something new to be tried, patients are willing to keep going.

For infertility patients, the drive to become pregnant takes on a life of its own and many patients will pursue their desired outcome for as long as they believe there is any chance of hope. Patients who are more unwilling or unable to face alternative family building options have the most difficult time ending fertility treatment. One has to be educated about the chances of success when beginning treatment and then draw on that information when it comes time to make a decision to stop. Emotional energy becomes a limited resource after multiple failed attempts and so the decision to end treatment may come from not wanting to experience the emotional pain of another failed cycle. Lack of additional resources and the pressure on marital/partnership and extended family relationships and the need to move on are other reasons why patients elect to end treatment.

People diagnosed with infertility experience grief and an altered sense of self over not being able to conceive a child in a normal way. When faced with having to stop infertility treatment, that grief is compounded by the loss of hope of ever having a child. Stopping treatment requires facing that loss and mourning the child that will not be. This is an essential step in moving forward with either adoption or a life without children.

When patients become pregnant after infertility, they may be surprised by some of the thoughts and emotions that can arise including ambivalence, fluctuating/opposing states of mind, isolation, fear and loss. Pregnancy after infertility treatment is different than a normal pregnancy in that there may be complications associated with advanced maternal age, multiple pregnancy and issues uncovered during infertility treatment. Pregnancy, after infertility treatment, does not automatically dispel feelings of anxiety and depression. After a protracted period of trying to get pregnant, the event itself is sudden and patients are thrust in to a completely new world. Fears abound about the health of the baby and mother and it is not uncommon for prospective parents to be hyper vigilant about changes going on in the woman’s body. The desire to get pregnant after months and years of trying is profoundly intense and when it occurs, it may not be the ideal that was wished for.

Parenting after infertility treatment presents challenges that differ from parenting after a normal and uncomplicated conception and pregnancy. Patients who have gone through many cycles of infertility treatments often make a bargain with themselves to be perfect parents, if they could only just get pregnant. This bargain leaves parents vulnerable to self-criticism and negative personal judgment when the trials and tribulations of being a parent arise. Parents may find that because they worked so hard to have their child, that now everything must be perfect and they cannot complain. Parents may find that their experience sets them apart from being a normal parent in that they cannot allow themselves to have normal feelings or they tell themselves “I should be so happy and grateful” even though they are angry, tired and frustrated.

There are many challenges associated with ending fertility treatment, the best of which is the desired outcome of pregnancy. When pregnancy does not occur after a protracted period and it is made clear that there is little or no chance of conception, patients need to make a decision to move on to other options such as adoption, having a non genetically related child through surrogacy or remain childless. The tasks that follow after infertility treatment has ended include processing the period of infertility including during the course of a pregnancy. Pregnancy after infertility can be a volatile and frightening time and special consideration needs to be given to address these fears. Parenting after infertility is a life long process of reconciling what had to take place in order to have a child while working to normalize each stage of development as the child grows.

When I work with clients here in New York City, we start off by sorting through the many different feelings and emotions they are experiencing.  Sometimes clients feel overwhelmed by life, others feel sad about a recent loss, and there is often confusion about what next steps to take. Clients may also feel ashamed that they cannot handle their problems and difficult emotions on their own.

As a therapist, I have a gentle approach to walking clients through this sorting process, starting with uncovering the blocks that have kept them stuck. Opening up and taking a risk allows clients to take ownership of the process and feel empowered at each step.

What does it mean to take ownership of your feelings? Ownership of feelings means that you, and you alone are responsible for the way that you feel on a daily basis.  Sure, there are outside forces that contribute to your mood, but they way you think and then internalize about external forces is within your control.

While our work together is an in-depth experience of your individual feelings, here are a few ways to start rethinking the way you handle your feelings and start to move towards ownership.

1. Realize your own power with regard to your feelings.  You may have heard the phrase “take your power back.”  The feeling of power over your emotions can be quite, well…powerful, if you are struggling to move forward in life.
2. Make a commitment to find the silver lining in the situation.  Did you ever meet a person who could “make lemonade out of lemons?”  They can take any situation:  infertility, illness, death, unemployment, divorce and look at the good and understand the growth that can come from their circumstances. While there are certainly times when you feel sad, I believe that personal growth is around the corner of any difficult situation.
3. Write things down.  Your journal can be one of the most powerful tools of transformation.  I have clients who write long paragraphs, some who only make lists, and ones who draw the stressors of life in a big interconnected graph.
4. Do not blame anyone or anything, least of all yourself. Move yourself out of the habit of blaming toward acceptance for what is.  For instance, if you are having problems conceiving a child, do not look at the infertility and blame the stress from your career, or the fact that you may have “waited to long” as that will only lead to more stress.
5. Pat yourself on the back.  Doing this work is difficult.  Taking time to shift the way you think about your current circumstances can cause a bit of upset.  Do not worry, I am here to help you.

Each of these steps can be difficult to walk through and I applaud you for taking the first few steps.  Owning your feelings can be a very powerful experience and can lead to great healing.  Once you begin to start moving towards ownership of your feelings you will experience a feeling of great relief.  Knowing you have the power to change the way you think about the external and internal forces in your life can be the catalyst for our work together.