APPENDIX 82
Supplementary memorandum from the British
Infertility Counselling Association
INTRODUCTION
The British Infertility Counselling Association
were pleased to have the opportunity to give oral evidence to
the Select Committee on 10th November 2004, represented by Mrs
Sheila Pike and Dr Jim Monach. We would wish to re-emphasise our
earlier submission, however the questioning and further reflection
after that meeting suggested certain matters which merit restatement
or clarification. In addition, we are appending an article written
by JM as part of the discussion of the British Fertility Society,
Royal College of Obstetricians and Gynaecologists, Association
of Clinical Embryologists and BICA in contributing to the implementation
of a National Service Framework for Infertility Services in the
UK and also a presentation upon which the paper drew.
EFFECTIVENESS OF
COUNSELLING
The questions of the Committee and some later
evidence suggested a limited awareness of the literature that
supports the effectiveness of counselling. The appended article
reviews the difficulties in accumulating this evidence [including
poor financial support, ethical considerations, history of poor
designs, limited professional commitment to research etc]. There
is current valuable evidence that has led the Department of Health
to conclude:
[there is] evidence of counselling effectiveness
in mixed anxiety or depression; most effective when used with
specific client groups . . . psychological therapies have benefit
in a range of somatic complaints including gynaecological problems"
[Department of Health Treatment choice in psychological therapies
and counselling: evidence based clinical practice guideline, 2001]
"In both mild and moderate depression,
psychological treatments specifically focused on depression [such
as problem-solving therapy, brief cognitive behavioural therapy
and counselling] . . . should be considered." [NICE Guideline
on management of depression in primary and secondary care, 2004]
Counsellors are often qualified in both generic
and these more specific modalities of counselling.
Whilst not all infertility patients will become
depressed, there is abundant evidence that significant numbers
will, especially during and after unsuccessful treatment. The
evidence is available that depression and anxiety are problems
with which counselling may be effective; infertility patients
are known to present excess episodes of such difficulties. The
lack of many rigorous studies which have brought the two together
is not evidence that counselling is not effective. The research
counselling community I am sure would wish to conduct such specific
studies if financial support were forthcoming.
Sexual and relationship problems are also widespread
amongst those seeking infertility treatment. Counselling has a
well-established credibility in working with such problems, although
they share the problem of limited robust studies [cf AE Bergin
and SL Garfield Eds [1994] "Handbook of Psychotherapy and
Behaviour Change"].
Not all patients will have a clinical level
of depression or anxiety, but most will experience a certain level
of such feelings. Working with a counsellor having the skills
to intervene with those more seriously affected will enhance the
value of their input. However the issue of effectiveness should
not undermine what is known about the reported popularity of counselling.
MANDATORY COUNSELLING
There was understandable concern generated by
the use of this term. BICA's view is that it is perhaps more helpful
to see this as a matter of clinics strongly encouraging certain
groups of patients to seek counselling [those with apparent high
levels of anxiety/depression or a history of these conditions,
those undergoing PGD or especially difficult procedures eg having
undergone repeated treatment failure, or protracted treatment
regimens]. Counselling might be a requirement in the case of those
embarking on donor gamete treatment, surrogacy or egg sharing
because of the highly complicated emotional and child care issues
raised, especially in a context of identifiable donation after
April 2005.
The offer of counselling should always be as
a part of the normal routine of the clinic as emphasised in the
HFEA Code of Practice. Counselling can play a very important part
in ensuring the "informed consent" of all parties to
difficult treatment, especially in ways that are clearly distinct
from those responsible for providing the treatment. This is the
element of independence that we feel is vital, rather than separation
from the multidisciplinary infertility team. BICA sees the counsellor
as an integrated member of the team—not independent.
BICA sees infertility counselling as part of
the increasingly important development of preventative measures
in other areas of medicine eg oncology. BICA is concerned for
counselling to be seen as promoting psychological health rather
than dealing with illness. Counselling offers particular opportunities
for:
— Developing stress management techniques.
— Modelling effective communication.
— Resolving past issues eg previous
losses such as terminations and miscarriages, trauma, child abuse,
psychosexual issues etc.
STATUS OF
COUNSELLING
The title of "counsellor" will become
reserved in law as a part of the Health Professions Council in
2007-08. In anticipation of this, counselling organisations including
BICA are looking at the possibility of establishing a voluntary
register of accredited counsellors. BICA has moved along this
road already in relation to a specialist, higher level award for
infertility counsellors.
ROLE OF
COUNSELLING
Counsellors, having a professionally trained
facility in communication, can play an important role in ensuring
that ethnic minority patients and those not having English as
a first language are able to play a full and fully informed part
in their treatment.
Counsellors look forward to clarifying the distinction
between their role and that of assessment. Whilst some counsellors
may appropriately assess patients for "Welfare of the Child"
purposes, this would only be on the clear understanding that this
role would be separated from a role as counsellor. Wherever possible,
a counsellor would not offer counselling to a patient/s of whom
they would make an assessment; certainly not as part of one session.
It is normal and preferable for different personnel to offer counselling
and undertake an assessment. BICA looks forward to the Welfare
of the Child requirements and procedures being clarified both
in the work of the Select Committee and in the current HFEA review.
This paper has not sought to repeat material
from the earlier paper. It is hoped that this additional contribution
focuses attention on issues that we did not have an opportunity
to address orally or were raised by the Committee.
We remain anxious to assist the Committee in
any way that might be deemed helpful in their work.
January 2005
| 
