Beyond the bereavement model: the significance of depression for infertility counselling.

Counselling in reproductive medicine has tended to focus on bereavement theory as the primary model of understanding and practice. This has meant that the experience of infertility has principally been conceptualized as a process with definable stages, leading smoothly, in time, to resolution and acceptance. This paper suggests that, whilst this is a valuable theory of the psychological and emotional components of infertility, it is also important to consider depression as a particularly significant aspect, independent of its being seen as a stage in the mourning process. The paper outlines an understanding of depression and gives case illustrations of the significance of depression for some people with infertility problems. The evidence for the prevalence of depression amongst those with impaired fertility and the various areas of personal functioning which might be affected are considered. Cognitive therapy has come to be widely accepted as an important approach to treating depression. The theoretical and research evidence for the efficacy of cognitive therapy is discussed, and how it might be applied in the context of infertility counselling.