Loginova O. I.
(Article is published in its short version)
One of the most serious problems for the married couple is the impossibility to have children.
Absence of children in wedlock can be caused by various reasons. In some cases the family consciously does not want to have children. In the other cases the family wants children but cannot have them.
Reasons can vary: both of the social nature, for example, no housing, financial difficulties, career, study at the universities, and of the psychological nature. These include unreadiness of the spouses to be parents and have responsibility for the new life, women’s fears of the pregnancy.
In the other cases spouses want to have children but for the disease of one of the partners or any sexual dysfunctions the family cannot have children.
Often enough the impossibility to have children leads to the relations between the spouses step-by-step starting to become worse which often results in family disruption.
At that often the spouse whose infertility has been confirmed has a feeling of guilt and lowering of the self-feeling. Another spouse may have a feeling of anger. Spouses may feel disappointment, hopelessness, uneasiness, distress. The mutual recriminations appear, psychosexual disorders arise, the family conflicts become more often. It is especially acutely seen if one of the spouses entered into the marriage with the exact purpose – to have a child or by means of the child to strengthen the family.
1.1. Psychological factors of the infertility
Infertility means inability to have the posterity .
Diagnosis «infertility», according to Grubyakova Yu.V. , is made by the doctor in case all efforts to become pregnant during 2 years of the continuous sexual life turn to be unsuccessful. If numerous attempts by a woman end with miscarriage, this is also deemed to be the symptom of the infertility.
Both men and women can infertile.
According to the latest data infertility  is registered in 8 % of couples, it seriously influences the men and women, causes depression, anxiety, lowers the self-feeling, raises the feelings of guilt and shame (more often in women), negatively impacts the marital relations, especially the sexual ones. Infertility leads to re-estimation of the life plans and social roles.
On the other hand, K. Khorni wrote , we can witness the tendency to give the psychogenic factors too much sense. The followers of this point of view are inclined to see in them the main source of not only more or less obvious functional disorders like pseudopregnancy, vaginism, frigidity, menstrual disorders; besides they say that there is bass for recognition of the psychological influence to be the source of such diseases and disorders like preterm delivery or delayed labor, infertility etc.
The number of late marriages and, accordingly, late births which are eventful for the life of children (after 35-year-old age of at least one of spouses, the probability of the deviations in the child critically increases) is growing.
According to WHO data  the reason for the infertile marriage in 40-50 % of cases is pathology of reproductive system equally both of men, and women, and in 5-10 % - the pathology is detected in both spouses.
Barren family is the family, in which the spouses have no children throughout 8-10 years.
L. B.Schneider  classifies the barren marriage in two types:
1. Deliberately barren marriage;
2. Compelled barren marriage.
Deliberately barren marriage
Deliberately barren marriage, according to L. B. Schneider  is when the healthy young people can, but do not want to have children.
The modern marriage is more focused on satisfaction of needs in intimate and informal.
From the L. B.Schneider's  point of view, it is necessary to distinguish the need of the individual itself for children, and intra-family (joint – of the husband and wife) need for children.
The researchers of the negative motivation  (focused against children) found out that among the reasons preventing the delivery of the first-born only four ones are actual: for women – their wish to live «for themselves» and unsuccessful relations with the husband. Men say that they had "no time", or explain absence of the children with financial difficulties. In addition to the mentioned above the physiological reasons (pregnancy does not occur, bad health) can be added. Another, equally used by men and women motive, is the unsatisfactory housing conditions – the reason which, appeared to be connected with the general dissatisfaction with the marriage.
R. Richardson states (quot. in ): «When the sole children form a married couple, they quite often decide not to have children.
Authors in family psychology: Eidemiller E.G., Dobryakov I.V., Nikolskaya I.M. think  that there are several reasons the men and woman are guided with, when deliberately make decision to conceive the child, but only one of them is the core one. At that the reasons of a woman and a man can be different. There are constructive reasons promoting the strengthening of the family, personal growth of the spouses, successful birth and development of the child, and destructive reasons, leading to reverse results.
In case of refusal from having children, Schneider L.B. wrote , the married couple shows not the limited need for children, but their aspiration to satisfy some other social and psychological needs.
Besides, the birth of the child is an act of assuming by the parents (by father and mother together) the whole responsibility for his destiny. Not every modern married couple can assume such responsibility. Not every married couple (husband and wife) is psychologically ready to the birth and education of children.
The ideology of barren families, according to L.B.Schneider , is based on such argument:
- Children disturb the marital relations;
- Children disturb the social activity.
Meanwhile such barren families, especially women, suffer condemnation from the people around when they are said that no one can live without children.
The compelled barren marriage, from the point of view of Schneider L.B. , is connected with the poor health of one of spouses, infertility, miscarriage, traumas, etc.
One of the reasons for female and male infertility is the stress.
O.Lineva and V.Pavlov , referring to definition by WHO, wrote, «infertile marriage is the marriage in which, despite the regular sexual life without contraceptives, the wife has no pregnancy within a year provided that spouses are of childbearing age».
Grubyakova Yu.V. says  that experts can diagnose 23 reasons of infertility for women and over 15 – in men. According to her opinion nearly each 2nd married couple has several reasons impeding the conception. One of the infertility reasons is the psychological factor.
T.Pozdeeva  believes that psychological infertility is a kind of protection against any negative factor. In this connection they allocate three groups of infertile women.
The first group – psychological infertility can cease during medical examination when the woman understands that she is healthy and able to have children.
The second group - infertility is caused by any external factors. For example, the couple does not have house. Or one of spouses is engaged with career. This motivation interrupts aspiration to conception.
The third group – the most serious – the absence of children is the result of deep psychological traumas of the childhood. This includes raping, and he fact that the woman was born as a result of undesirable pregnancy.
The author traces the connection between undesirable pregnancies of the mother with psychological infertility of her daughter during the childbearing period. The undesired child, in her opinion, has a latent or obvious aggression in relation to the mother. Such child is born with the feeling of uselessness and guilt. Already being intrauterine the child felt that he is not wanted and loved.
The girl transmits subsequently the endured negative emotions on herself, is afraid to give birth, because can hate her children too.
Grace Craig and Don Bokum  wrote that in the USA about 50 % of pregnancies are unplanned. The information on pregnancy is often perceived not with happiness but with horror as it occurs at the inconvenient moment. It is connected with the break in work, career, study, pleasant pastime and causes the tightness in finances. Sometimes the future mother represents her child being physically abnormal, weakened or awful, or such one who one day brings the strongest afflictions and harm to the whole family. The future fathers sometimes think the same.
Grubyakova J.V.  thinks that to find out the reasons for infertility the data on character of the sexual function (presence of libido, orgasm etc.) have the important value. Now there is no common opinion on the role of sex life in female infertility. It is known that pregnancy can occur in the frigid women. However if we consider the libido and especially the orgasm as a releaser for activation of the reproduction system we can assume that the change of them can cause infertility.
According to the researches, held by Karen Khorni , some women suffer the frigidity the roots of which stretch from the childhood and are connected with the mutual relations with mother. In each case of frigidity it was accompanied with the other mental factors which can influence the functional disorders.
First of all it is a question of fears concerning the masturbation, able to affect both the mental attitudes and the corporal processes. The special form they often have in women is a fear that their genitals are physically damaged due to the masturbation.
Further Khorni informs us that «fears can have also such form: having damaged myself, I can never have the child». Patients who were treated by Khorni, often said that having children looks for them like the deal causing disgust, and they are never going to have them.
For the other women the pregnancy represents the special form of satisfaction. For them it is important not to have the child, to nurse and caress it, but the idea of pregnancy in itself, idea of carrying the child in the body.
Some women have a fear of death during the delivery.
Myers D writes  that in the 60s of the last century in vitro scientists conducted researches and photographed more than 10000 sexual "cycles" of the volunteers, agreed to participate in researches. William Masters and Virginia Johnson for the scientific purposes observed of muscle contraction in the whole body during the orgasm in examined couples. After long researches, they came to a conclusion that excitation and orgasm at the woman promotes the fertilization, helping to move the man's semen in the uterus for semen reception. The orgasm at the woman, hence, not only strengthens the sexual contact that is essential for the natural reproduction, but also promotes the movement of the discharged semen.
The doctors know for long that fact that the strong worries can change the work of reproductive system up to its full stop .
There is such notion as the stressful dysfunction of ovaries, psychogenic infertility. When the woman being under the constant stress cannot conceive the child. And it does not matter what such tension is connected with. It can be loads in the office and at home, worries for close people. And even the strong desire to have the child, can also become the tension reason. Comprehension of the own childlessness and inferiority in itself is the strongest stress for the woman. Under the influence of the strong stress the motility of uterine tubes decreases, there are changes in ovaries and uterus neck. The higher centers of the brain are also affected which provokes the hormonal changes sharply reducing the probability of conception  .
The psychotherapist V.Sinelnikov  puts forward the hypothesis of infertility. He thinks, «that if the woman has infertility, it means, her subconscious mind has such behavior which destroys the soul of the future child. The subconscious mind of the infertile woman has the program of destruction of children»
The strong subconscious aggression against the men can be another reason of infertility, according to the author. This can be strong insult, jealousy, hatred, contempt. The fear and resistance to the vital process, uncertainty about the future can also cause infertility. While the subconscious mind lacks the readiness for delivery of the child, there will be problems with fertilization. And sometimes one of the reasons is the fear to become ugly, unattractive, to spoil the shapes and the breast form.
From the point of view of the author as soon as the woman makes the revaluation of values, she can become pregnant and have healthy posterity.
The infertility reason is a series of factors :
1. Immature, sensitive, fastidious women, childish capricious;
2. aggressive-dominant women, not agreeing to recognize their feminity;
3. mother like – i.e. the ones who feel that they cannot copy the husband in the children and consequently transfer the maternal instinct on care of them;
4. women devoting their life to ideological or other emotional interests.
E.S.Ford (quote for ) after psychoanalytical talks with a group of the women suffering infertility, came to the conclusion that any of the women, suffering infertility, actually does not want to have children. In his opinion, all of them have the conscious desire to become pregnant caused by neurotic motives. Besides, the majority of them distinguishes with the hostile attitude to the own mother, or aggressively imitates the role of the man.
Even before conception, during planning of the child-bearing the family often needs the consultation of the psychologist .
The wish to have the child can arise in connection with various motives. They can be constructive and destructive. Destructive motives can interfere the carrying process of the child.
According to Bern (quot for ), «the situation of conception of the human being can strongly influence his destiny». Directly the situation of conception was suggested by him to be called «the rudimentary set». The attitude of the man and woman to the intimate life is reflected on their relation to the child.
Having conducted research of the scientific literature in the field of the barren marriage, we can make the following conclusions:
- barren marriage can be compelled and deliberate.
- Deliberate barren marriage as a rule is connected with the social reasons or when spouses want to live for themselves.
- The compelled barren marriage, is a consequence of some psychological reasons or weak motivation to have children. More often the psychological reasons of infertility are not realized by spouses.
1.2. PHYSIOLOGICAL PROBLEMS OF INFERTILITY
From the point of view of the psychotherapist from the Center of the family planning and reproduction, Tatyana Pozdeeva , the infertility problem can be not only of the psychological, but also of the physiological character.
In marriage men appear to be unable to give the posterity in 40 % cases. In case of man's infertility the situation in the family can be more intense since it is treated much more difficultly.
From the point of view of Grubyakova J.V. , the congenital or acquired endocrine disturbances, the infectious diseases suffered in the childhood, the venereal diseases received by sexual way are the reason of man's infertility.
The main causes of the female infertility are also the most various disturbances in the organism. The reason of primary infertility is organic changes of genitals, endocrine disturbances, abortion consequences, venereal diseases.
The compelled barren marriage is a strong ordeal for both spouses. Many scientists give the stress 5 % of the reasons of infertility .
Married couple, having learned about impossibility to have children through medical indications, feels the strong shock.
As Eidemiller E.G.  notes, the childlessness for the woman who married only for in marriage to give birth to the child, and then found out that her spouse cannot have children, will lead to more catastrophic results, than for the woman who married for love.
Scientists, investigating the psychological factors of infertility paid attention to the certain cycle of worries.
So, Svyatskevich I.Yu. , in the dissertation work writes: «the emotional state of the spouses being in the infertile marriage, changes eventually and passes a series of stages:
- surprise / shock
- grief / depression
- acceptance / adaptation.
According to the author of the work, «similar feelings arise in each one who can face the infertility problem though the order and sequence of stages can not be kept».
The same emotional state is typical in case deaths of the loved person or suffering the loss at divorce.
R.Kochyunas , gives the same scheme of emotional feelings when describing the process of grief, using the model of Kubler Ross. She assumes the alternating of stages:
In certain cases the surviving persons have a feeling of guilt in front of the died person. The woman who made abortion or lost the child in 1pregnancy can have the same feelings.
At divorce the spouses pass the same stages: negations, embitterment, stage of negotiations, adaptation stage.
Svyatskevich I.Yu. , in scientific work «Social and psychological aspects of self-perception and self-appraisal of women in infertile marriage», basing on the researches of the Russian and foreign authors, describes the psychological consequences of infertility.
We can carry to them:
- Lowering the self-appraisal, self-esteem of the person;
- Changes in marital relations and satisfaction marriage;
- Changes in sexual sphere;
- Syndrome of pregnancy expectation
The childless couple has strong emotional reactions:
- grief / depression;
- shame, confusion;
- sense of guilt;
The women may have the psychological disorders:
- obsession thoughts;
- hysterical semiology;
In rare cases - the schizoid semiology.
Childless couple after numerous attempts to conceive the child and having faced a series of problems, comes for consultation to the psychologist.
The psychologist finds out the problems of the married couple, and then in accordance with the shown problem, builds consultation process, developing together with the family the further steps for resolution of the problem.
If infertility was connected with the psychological factors which led to the family-sexual disharmony it is necessary to think of restoration of the sexual harmony and to undertake the corresponding steps.
Removal of the tension using the techniques of relaxations during the sexual contacts will allow the spouses to be relaxed and further they have a chance to conceive the child.
If is impossible to conceive the child through the medical indications then together with the married couple they should study several variants:
1. Correcting the life goals;
2. Adoption of the child.
Thus, basing on the researches held by domestic and foreign scientists, we can make certain conclusions:
- One of the infertility reasons is connected with the psychological factors, in the absence of any physiological diseases;
- Connection of infertility with psychological factors in some cases is not seen by the spouses;
- Comprehension of this interrelation is possible only after consultation with the skilled psychologist-counselor;
- The impossibility to have children influences the mutual relations between the spouses, resulting in some cases in sexual dysfunction which in complex may lead quite often to divorce.
WAYS OF RESOLUTION OF THE PROBLEM
At counseling the married couple we need to resolve three primary goals :
1. to define what the problem consists in;
2. to find the state which the husband and the wife want to reach, and to choose the direction for changes (what to do? In what direction to move?);
3. to help spouses to get over there ( how to make it?).
The psychological problem, according to T. V.Rumyantseva , is a demonstration of the subjective reality of the person, reflection of the features of his internal picture of the world, what causes anxiety, psychological discomfort or suffering.
«The problem, с from the point of view of Petrushin S.V. (quot. for ), – is not what is happening to the person, and how he treats it. The psychological problem consists not in the situation, but in the way this person takes it».
As a rule, the psychological problem is not completely realized by the client and connected with any unsatisfied (more often forbidden) wishes or with the difficulties in finding the most comprehensible ways to satisfy them.
According to G.S.Abramova (quot. for ), the client expresses the various content of the problem in the following way:
- «I want, but I can not»,
- «I am not like the others»,
- «I feel, but I do not know» etc.
According to S.V.Petrushina's figurative representation (quote for ), we can speak of the «two-layer nature of the problem. Layers of the psychological problem are understood as the wishes, therefore in each problem we can see at least two wishes. The first wish – «I Want» is realized by the person but as the person cannot carry it out, so we can assume existence of another extra mental wish – « may nothing change». That is why when working on the problem of the client, the counselor finds out collision of his several wishes:"constructive" one and reflects aspiration to changes, and "destructive" one that reflects fear of the changes and keeps the existing state of affairs.
From the point of view of E. V. Emelyanova  making the decision means to make a choice from several possibilities. And the choice always exists. Each person at least has two variants in each of three possibilities:
1. to keep everything as it is, or to change something;
2. to change the behavior, habits, views, set or to change circumstances in which the problem arose;
3. If it is impossible to change the circumstances then it is definitely possible to change the attitude towards the circumstances, that is to accept them:
- as a necessary reality,
- as a lesson which has to be passed,
- as the catalyst of the intrapersonal resources and abilities,
- as something positive contained in what is now perceived as negative.
Problems which often enough arise in the childless couple:
- the strong motivation to have children;
- sex problems, dissatisfaction of one of the spouses with another in this sphere and their mutual inability to get normal sex relations ;
- absence of warmth in relations of spouses, deficiency of intimacy and confidentiality, dialogue problems [8.];
- acceptance of the fact on impossibility to have children according to the medical indications and as the consequence the change of the life purposes;
- the steps undertaken for adoption of the child.
The strong wish to have children can influence the disorder of sexual sphere. Sex from pleasure turns into work since the pair tries to have the sexual contact only when it is needed for conception of the child, thus without having emotional splashes.
Constant analyses and other medical measures reduce the sexual attraction and strengthen the corporal tension. This cycle repeats every month. Belief - hope - expectation - disappointment. This cycle can be called incomplete Gestalt.
From the point of view of F.Perlz , the most interesting and important feature of Gestalt is its dynamics – need of the strong Gestalt for end. The best name for the incomplete Gestalt is the unfinished situation. One of the elementary examples of the incomplete situation is illness. Illness can end with recovery, death or organism reorganization.
If the person became almost blind, the author writes, he will make huge efforts to keep or improve the remaining part of his vision. The situation constantly remains incomplete. He is more and more absorbed by it.
Once he became completely blind, the situation usually changes in the dramatic manner. He gets used with the futility of the hopes.
In the eyes of his relatives he appears to be the cripple, but he himself becomes different. Now he is an organism without eyes. Changes of the corresponding nature as Perlz thinks, happen for the best.
The same can be said of the childless couples. The woman constantly wants to become pregnant. Makes huge efforts on the psychological level. Hopes and waits. For her this is also an incomplete situation. But when she precisely understands that she has no chance to give birth to the child the situation ends. And the family searches for the other ways for resolution of the problem.
IF SPOUSES DECIDED TO ADOPT THE CHILD
One of the important steps for counseling concerning the adoption is granting of the information to spouses . The counselor expresses the opinion, answers questions of the childless couple and informs them on different aspects of the discussed problem. Sometimes it is very important to grant the information during the counseling as the clients quite often ask questions which are hiding the worries of the clients about the future.
S.A. Vekilova writes , adoption relations are psychologically difficult. The spouses, unable to have children because of infertility, become adoptive parents. The parent motivation of such pair should be very strong. But despite the strong motivation, some adoptive parents facing these or those difficulties in communication with the adopted children, refuse from these children which leads to the great psychological trauma both for the adopted children, and adoptive parents.
In conversation with the childless couple first of all it is necessary to find out the force of the motivation for adoption.
To make discussion with the spouses and to tell what difficulties one can face during the education of the adopted child.
To discuss in what case to tell or not to tell to the child about his adoption. If to tell, at what age it is better to do. How to communicate this to the child not to make the mental trauma.
D.Vinnikott  believes that the adopted child should be told by the parents as soon as possible truth about adoption. The main reason consists in that sooner or later the children learn truth. For the adopted child the most bad thing is the unexpected news heard from other people.
From the point of view of D.Vinnikotta each family should choose itself the way how to communicate this news. It can be in the form of preparation of the child with the help of a fairy tale, or story which is similar to the story of the child. Or to pay attention of the child that the other families also have adopted children.
One of key rules: the news should be gradual.
As the scientist wrote, often parents feel disappointment only because they were not told from the very beginning about possible difficulties in education of the adopted child.
Having studied the scientific literature of domestic and foreign authors on the matter: «Psychological problems of childless couples and physiological problems of infertility», we can make the conclusions:
1. The literature review showed that at the consciousness level the childless spouses want to have children, but at the unconscious level they do not want it for these or those reasons.
2. The reasons lying in the unconscious level should be worked through by the spouses together with the psychologist-counselor.
3. In case of the syndrome "pregnancy expectation» there is a psychological and physical tension that reduces probability for conception of the child.
4. Each person possesses internal resources which can be detected by means of the psychologist-counselor and are used for resolution of the problem.
Thus, the task of the psychologist-counselor consists in the following:
1. Revealing of the true problem of the client and help in comprehension of it;
2. help to spouses in correction of the purposes;
3. establishment of the steps on realization of the purposes;
4. in case of impossibility to conceive the child for medical indications and in case of the decision of the spouses to adopt the child in the best way to inform them on all difficulties connected with this question;
5. in case of the psychological and physiological tensions of the married couple to teach them the techniques for relaxation.
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