published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

This exploratory-descriptive study, using multiple case studies, investigated the self-esteem, coping and psychology of infertility of a sample of individuals who have received infertility treatment at a privately managed health care unit. Infertility is a complex condition associated with the inability to conceive a child, frequently manifesting itself as a result of various biological factors. A literature review indicated that being on Artificial Reproductive Technology (ART) treatment significantly increases the stress in an individual. In an attempt to gain insight into the way patients undergoing infertility treatment find the strength to complete their treatment cycles, and to endure and overcome the pressures associated therewith, in order to continue their lives – in spite of a negative treatment/pregnancy result, the researcher found it necessary to investigate the self-esteem, coping and the psychology of patients undergoing infertility treatment. An exploratory descriptive research design was used and the participants were chosen by means of a non-probability purposive sampling procedure. The participants were given a package of questionnaires to complete under the supervision of the group facilitator and researcher, prior to, as well as after the intervention. The assessment consisted of a biographical questionnaire and two standardised paper and pencil measures. The participants’ self-esteem was explored using James Battle’s (1981) Culture-Free Self-Esteem Inventory; while the coping resources were explored using Hammer and Marting’s (1988) Coping Resource Inventory (CRI). Although these data were not analysable, due to the small sample size, it was utilised in a qualitative manner to support the findings from the qualitative data. The data were also gathered from the participants via a psychological intervention programme in the format of three focus group sessions. All the qualitative results were analysed, according to Tesch’s model of content analysis. The general finding was that the period of infertility treatment is experienced as both difficult and challenging by individuals, and that there is immense healing in the sharing of one’s narrative with other infertility patients. It also surfaced that selfesteem, especially one’s feelings of worth, is most affected by a diagnosis of infertility, as well as by going through the roller coaster of the emotions associated with the treatment and monthly cycle of infertility. It was evident from the narratives told by the participants that every domain of one’s self-esteem is affected by a diagnosis of infertility, and that the biggest challenge in maintaining a positive selfesteem seemed to be in finding a balance between one’s real self and one’s ideal self. Furthermore, this study found that the challenge related to coping for the participants in this study was to present a coherent life narrative to the ‘world’, despite intense feelings of being misunderstood by others, and being faced with the discourse of infertility, as part of one’s life script. The main coping responses utilized by participants included the re-channelling of one’s focus, using denial, seeking out familial and social support, bargaining with God, and nurturing hope and faith that this journey of infertility is merely just a journey and not a destination, with the destination that of being blessed with a biological child of one’s own.

M.A. (Social Work) / This research deals with the structuring, empirical testing and finalising of a model for the evaluation of the degree to which adoptive parents have accepted their infertility. The practice model provides guidelines for the assessment of the extent of acceptance of infertility on the part of prospective adoptive parents. Guidelines are also given for the provision of assistance to infertile couples within the boundaries of social care. This study does not pretend to provide the ultimate solution to the question of evaluation, but serves only as a social work orientated set of guidelines for evaluation ...

Thesis (MA)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The primary purpose of the present study was to create a profile of the psychological aspects presented by infertility patients of both genders before the commencement of each new phase of clinical intervention. The researched variables were constructed in such a way that negative as well as positive aspects of each patient involved would be reflected. The negative variables, which were classified as risk factors, included depression, anxiety, general mental health and the presence or absence of happiness. The positive variables (protective factors) included variables concerning resilience, namely life-contentment and general psychological well-being. General psychological wellbeing included specific aspects, such as self-acceptance, autonomy, positive relationships with others, purpose in life, environmental mastery and personal growth. The cognitive aspects (thought processes) included variables, such as hope and intrusive thoughts. In the present study intrusive thoughts referred specifically to distraction, social control, worry, punishment, and reappraisal. The secondary purpose was to ascertain whether these variables would be able to indicate to which degree a diagnosis of infertility could have a positive or negative effect on a person, could possibly lead to emotional problems, and how the person should be treated optimally during treatment. The psychological aspects present in men and women were also compared to give the therapist/physician a better understanding of gender differences. A descriptive research design was used. In this cross-sectional study, one-off survey research was executed in order to evaluate the infertility patients before the start of infertility intervention. The measuring instruments were six self-report questionnaires and a demographic questionnaire. The 116 participants, (87 women and 29 men) completed the following self-report questionnaires: “General Health Questionnaire” (GHQ28), “Oxford Happiness Questionnaire” (OHQ), “State of Hope Scale” (SHS), “Thought Control Questionnaire” (TCQ), “Satisfaction With Life Scale” (SWLS), and the “Ryff Psychological Well-Being Scale” (Ryff PWB). The study implies that the diagnosis of infertility can be made using the biopsychosocial model and the psychosocial resilience model to account for medical well-being as framework. Due to the complexity of infertility, specific phases of infertility should not be emphasised and risk factors solely attended to. Infertility should be regarded more globally. The present study reflected that before treatment was started, the home-plan/ovulation-induction group (HP/OI) (1) was more at risk concerning depression and anxiety; (2) uncontrolled thoughts of worry and anxiety were present concomitantly, and (3) there was a risk concerning protective factors. The intracytoplasmic sperm-injection/in vitro-fertilisation group (ICSI/IVF) was at risk regarding anxiety and intrusive thoughts. The artificial-insemination group (AI) possibly had unrealistic expectations before the commencement of the first treatment and risk factors (thought-control processes and protective factors) tested disproportionately high. It could thus be said that the specific cause of infertility well may influence psychological aspects before treatment starts. Infertility should be diagnosed in totality, taking into account the biological as well as the psychological aspects of the infertility patient. To be able to present an optimal diagnosis of infertility and to optimise a prognosis, patients have to be psychologically evaluated before treatment is started. This opens the field to further research with larger samples and particular attention paid to thought-control processes, protective factors and causes of infertility. / AFRIKAANSE OPSOMMING: Die primêre doel van die onderhawige ondersoek was om ’n profiel saam te stel van die sielkundige aspekte teenwoordig by beide geslagte infertiliteitspasiënte voor die aanvang van elke nuwe fase van kliniese intervensie. Die veranderlikes wat ondersoek is, is só saamgestel dat ’n profiel van negatiewe sowel as positiewe aspekte van elke betrokke pasiënt weergegee kon word. Die negatiewe veranderlikes wat as risikofaktore geklassifiseer is, sluit in depressie, angs, algemene geestesgesondheid en die teenwoordigheid, al dan nie, van geluk. Die positiewe veranderlikes (beskermende faktore) sluit in veerkragtigheidsveranderlikes, naamlik lewenstevredenheid en algemene sielkundige welstand. Algemene sielkundige welstand het spesifieke aspekte ingesluit, soos selfaanvaarding, selfstandigheid, positiewe verhoudings met ander, lewensdoel, omgewingsvaardigheid en persoonlike groei. Die kognitiewe aspekte (gedagteprosesse) sluit in veranderlikes soos hoop en indringende gedagtes. Indringende gedagtes verwys in die onderhawige ondersoek spesifiek na afleiding, sosiale beheer, bekommernis, straf en herevaluering. Die sekondêre doelstelling was om te bepaal of hierdie veranderlikes ’n aanduiding sou kon gee in watter mate ’n infertiliteitsdiagnose ’n persoon negatief of positief kan beïnvloed, tot moontlike emosionele probleme kan lei en hoe die persoon optimaal tydens behandeling hanteer behoort te word. Die sielkundige aspekte van mans en vroue is ook vergelyk sodat die sielkundige/geneesheer ’n beter begrip van die behandeling ten opsigte van geslagsverskille kan hê. ’n Beskrywende navorsingsontwerp is gebruik. In hierdie dwarssnitondersoek is van ’n eenmalige opnameondersoek-metode gebruik gemaak om die infertiliteitspasiënte by die aanvang van infertiliteitsintervensie te evalueer. Die meetinstrumente was ses selfbeskrywingsvraelyste en ’n demografiese vraelys. Die 116 deelnemers (87 vroue en 29 mans) het die volgende selfbeskrywingsvraelyste ingevul: General Health Questionnaire (GHQ28), Oxford Happiness Questionnaire (OHQ), State of Hope Scale (SHS), Thought Control Questionnaire (TCQ), Satisfaction With Life Scale (SWLS) en die Ryff Psychological WellBeing Scale (Ryff PWB). Uit die resultate kan afgelei word dat die diagnose van infertiliteit wel vanuit die raamwerk van die biopsigososiale-model en die psigososiale veerkragtigheidsmodel wat mediese welstand verklaar, gemaak kan word. Weens die kompleksiteit van infertiliteit kan daar egter nie net op sekere infertiliteitsfases klem gelê word en net op risikofaktore gelet word nie. Dit is belangrik dat daar meer globaal/holisties na infertiliteit gekyk word. In die onderhawige ondersoek is bevind dat die tuisplan-/ovulasie-induksie-groep (TP/OI) voor die aanvang van behandeling (1) ’n risiko vir depressie en angs geloop het; (2) daar gepaardgaande ongekontroleerde bekommernis- en strafgedagtes aanwesig was en (3) ’n risiko betreffende beskermende faktore. Die intrasitoplasmiese-sperminspuiting-/in-vitrobevrugtingsgroep (ICSI/IVB) was ’n risikogroep vir angs en indringende gedagtes. Die kunsmatige-inseminasie-groep (KI) het moontlik onrealistiese verwagtings voor die aanvang van die eerste behandeling getoon en risikofaktore (gedagtebeheerprosesse en beskermende faktore) was buite verhouding hoog. Daar kan dus gesê word dat die tipe oorsaak van infertiliteit wel sielkundige aspekte by die aanvang van behandeling beïnvloed. Infertiliteit moet omvattend gediagnoseer word, met inagneming van die infertiliteitspasiënt se biologiese én sielkundige aspekte. Om ’n optimale diagnose te kan maak en ’n prognose te optimeer, behoort infertiliteitspasiënte ook sielkundig geëvalueer word voor die aanvang van behandeling. Verdere ondersoeke word aanbeveel met groter steekproewe en besondere aandag aan gedagtebeheerprosesse, beskermende faktore en infertiliteitsoorsake.

The study explored the narratives of three adoptive couples. The participants were selected using criterion based convenience and snowball sampling. The adoptive couples’ data was captured through written narratives and/or individual or joint semi-structured interviews. The data was then analysed by means of thematic analysis conducted from the perspective of second order cybernetics. The results note the participants’ experiences of their infertility threatened their functioning as a couple. However, this threat to the couples’ functioning was limited by the adoptions through two means. First, the adoptions limited the couples’ communication about their infertility. Second, the adoptions allowed the couples to continue functioning as a couple dedicated to the goal of becoming parents. Differences between the participant couples’ experiences surrounded their interactions with social workers; their selection of support structures; their interaction with external systems; as well as their anxiety towards the individuation of the adopted child. / Psychology / M.A. (Clinical Psychology)

Thesis (MA (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: In all or most cultures, the experience of infertility has the potential to threaten the well-being of individuals and relationships. The marital relationship of couples experiencing infertility might be impacted negatively by infertility-related stress. This study aimed primarily to examine the nature of the relationship between perceived infertility-related stress, experienced by husbands and wives in infertile couples, and four specific aspects of the marital relationship. In addition, it was examined whether there were significant differences in four specific aspects of the marital relationship between infertile couples at the onset of different types of infertility treatment, and a pregnant control group. This cross-sectional, baseline study utilised standardised self-report questionnaires to make onceoff assessments of infertility-related stress and four specific aspects of the marital relationship: communication, satisfaction with the sexual relationship, intimacy, and marital adjustment. The demographic characteristics of the participants were also recorded. A total of 84 women and 32 men from two infertility clinics in the Western Cape (N = 116) were studied. From calculating Pearson correlation coefficients, highly significant correlations (p < .001) were found between infertility-related stress and all aspects of the marital relationship as measured in this study. Multiple regression analyses revealed communication as an important predictor of aspects of the marital relationship, in addition to infertility-related stress as a predictor. ANOVAs revealed no significant differences in specific aspects of the marital relationship between the infertile groups and the pregnant control group. The findings suggest that high levels of infertility-related stress might be detrimental to the wellbeing of the marital relationship of couples experiencing infertility. In addition, the importance of communication as a buffer against the potential negative effects of infertility-related stress was emphasised. Future research should incorporate a longitudinal design and investigate the nature of the relationship between infertility-related stress and the marital relationship. / AFRIKAANSE OPSOMMING: Infertiliteit word in alle of die meeste kulture beskou as ’n krisis wat die welstand van individue en verhoudings kan bedreig. Die huweliksverhouding van pare wat infertiliteit ervaar kan negatief beïnvloed word deur infertiliteitsverwante stres. Die primêre doelstelling van hierdie ondersoek was om die aard van die verhouding tussen waargenome infertiliteitsverwante stres, soos ervaar deur die mans en vroue in infertiele pare, en vier spesifieke aspekte van die huweliksverhouding te ondersoek. Bykomend is daar ook ondersoek of daar beduidende verskille voorgekom het in vier spesifieke aspekte van die huweliksverhouding tussen infertiele pare aan die begin van verskillende tipes van infertiliteitsbehandeling en ‘n swanger kontrolegroep. Hierdie deursnee-, basislyn ondersoek het van gestandaardiseerde selfrapporteringsvraelyste gebruik gemaak ten einde eenmalige assesserings te doen van infertiliteitsverwante stres en vier spesifieke aspekte van die huweliksverhouding: kommunikasie, tevredenheid met die seksuele verhouding, intimiteit, en huweliksaanpassing. Demografiese besonderhede van die deelnemers is ook ingesamel en aangeteken. In totaal het 84 vrouens en 32 mans (N = 116) van twee infertiliteitsklinieke in die Wes-Kaap aan die ondersoek deelgeneem. Met die berekening van Pearson korrelasiekoëffisiënte is hoogs beduidende korrelasies (p < .001) gevind tussen infertiliteitsverwante stres en die vier gemete aspekte van die huweliksverhouding. Op grond van meervoudige regressieontledings het kommunikasie na vore gekom as ‘n belangrike voorspeller van aspekte van die huweliksverhouding, bykomend tot infertiliteitsverwante stres. ANOVA’s het geen beduidende verskille in spesifieke aspekte van die huweliksverhouding tussen infertiele groepe en die swanger kontrolegroep getoon nie. Die bevindinge dui daarop dat hoë vlakke van infertiliteitsverwante stres nadelig kan wees vir die huweliksverhouding van pare wat infertiliteit ondervind. Daarbenewens moet die belangrikheid van kommunikasie as ‘n buffer teen die potensiële negatiewe gevolge van infertiliteitsverwante stres beklemtoon word. Toekomstige navorsing sal baat by ’n longitudinale ontwerp en daar behoort voortgegaan te word met ondersoeke na die verband tussen infertiliteitsverwante stres en die huweliksverhouding.

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

The study explored the narratives of three adoptive couples. The participants were selected using criterion based convenience and snowball sampling. The adoptive couples’ data was captured through written narratives and/or individual or joint semi-structured interviews. The data was then analysed by means of thematic analysis conducted from the perspective of second order cybernetics. The results note the participants’ experiences of their infertility threatened their functioning as a couple. However, this threat to the couples’ functioning was limited by the adoptions through two means. First, the adoptions limited the couples’ communication about their infertility. Second, the adoptions allowed the couples to continue functioning as a couple dedicated to the goal of becoming parents. Differences between the participant couples’ experiences surrounded their interactions with social workers; their selection of support structures; their interaction with external systems; as well as their anxiety towards the individuation of the adopted child. / Psychology / M.A. (Clinical Psychology)

A presente pesquisa teve como objetivo geral compreender a experiência de homens que vivenciam a infertilidade. E, especificamente, enfocou interpretações da masculinidade e infertilidade, contextualizando-as na contemporaneidade; apresentou a perspectiva fenomenológica existencial como possibilidade para tematizar o fenômeno do corpo enquanto expressão da existência; bem como descreveu e compreendeu a experiência de homens, na condição de inférteis, os quais procuram o serviço de Reprodução Humana Assistida do Instituto de Medicina Integral de Pernambuco IMIP. De natureza qualitativa, esta investigação está afinada à perspectiva fenomenológica hermenêutica, privilegiando a compreensão interpretativa fundada na Hermenêutica Filosófica de Gadamer, vinculada às compreensões ontológicas heideggerianas. Para acesso à experiência foi escolhida a narrativa, colhida tanto dos colaboradores, quanto dos registros feitos no diário de bordo da pesquisadora, a partir da sua inserção no lócus da pesquisa. Os relatos dos colaboradores apontaram para dificuldades vividas durante a tentativa de métodos de Reprodução Assistida, as quais levaram a experiências de desconforto, bem como de desesperança frente a burocracia e morosidade dos serviços. Aproximando-se desta via compreensiva, a possibilidade de procriação artificial foi revelada com certa estranheza, ressaltando a supervalorização da parentalidade biológica. Em tal cenário, os interlocutores narraram sua vivência frente aos procedimentos técnicos/médicos, desvelando de um lado a utilidade da técnica no projeto parental e, de outro, o seu domínio na hegemonia do discurso científico, bem como na compreensão do corpo masculino como matéria-prima a ser explorada e aperfeiçoada. / The present research had the aim to understand the experience of infertile men. Specifically, it focused on masculinity and infertility interpretations, contextualizing them in contemporaneity; it also presented an existential phenomenological perspective as a possibility to thematize the body phenomenon as an expression of existence; as well as it described and understood the experience of infertile men who searched for the Assisted Human Reproduction service from the Institute of Integral Medicine of Pernambuco IMIP. This investigation is of qualitative nature, linked to the hermeneutic phenomenological perspective that privileges Gadamers Philosophical Hermeneutic and Heideggerian ontological comprehensions. Narratives from collaborators and from the researchers field journal were used in order to access such experience. Collaborators reports pointed to difficulties during the attempt for Assisted Reproduction methods, which led to uncomfortable experiences, as well as a lack of hope face to the services bureaucracy and slowness. The possibility of artificial procreation was revealed with certain awkwardness, with highlights to the over-valorization of biological parenthood. In such scenario, interlocutors narrated what they have lived regarding technical/medical procedures, unveiling, on one side, the utility of the technique for the parental project and, on the other side, the domain of scientific discourse, as well as the comprehension of mens bodies as raw material to be explored and improved.