Making Family Planning Decisions In Couples Counseling

In our NYC couples therapy practice, it feels like an understatement to describe family planning as a big decision for couples. Whether deciding to have kids (or not), trying to have a baby with your partner, dealing with the uncertainty of a surprise pregnancy, or deciding to adopt or go through fertility treatments, family planning can feel overwhelming and scary. It can bring up larger worries and anxieties in the relationship about finances, changes in the relationship dynamic, bodies, infertility, sex, etc.

Couples Only Recently Gained So Many Family Planning Choices

It should be acknowledged that only relatively recently have couples had so many options in family planning. To make or not make a baby is largely one most couples control. It’s also important to highlight that these are historically gendered issues. Women, in particular, often have had very little choice. Contraception and abortion have changed that and access to safe options for both is essential.

Deciding Whether or Not To Have Children

With decisions around whether or not to have children, we wish there was a sort of pro/con formula–some technique to guide couples in couples therapy through the decision. In our practice, we’ve never sat with a couple struggling with a decision where we didn’t need to examine the very question of what we mean by decisions, what counts as resolved and how to understand these decisions in the sense of a timeline. Decisions done well demand a return to our first principles: What are you doing in the world? Who do you want to be? Why are you together?

A decision isn’t a process of seeing into the future and finding the absolute right choice. It’s a declaration and a commitment to do X and all the things that follow from X. Quite a lot follows with kids, but a lot also follows from not having kids. Once you and your partner decide, there’s no fence sitting. Regret and conflict are fine, but they must be separated from action.

There are definitive, clarifying reasons to have a kid–one can create a series of compelling reasons that are sufficient to go forward. That being said, there are a lot of bad reasons to have a kid too such as wanting someone to take care of you, to feel like you’ve done your life right, to validate a relationship or to keep a partner from leaving. In couples therapy, we help each partner both sort out their own opinion and better understand their reasoning.

Dealing With Cultural And Family Expectations

It almost goes without saying that often families, friends and other loved ones can put pressure on couples to have children. In general, culture, family, friends and people in our environment influence our thinking about how we live our lives. Sometimes these influences are very clear, while others might come as a surprise.

In our couples therapy practice, we look at the question of how much and what kind of influences these players both have and ought to have in your decision to have a child. We help couples see themselves and their relationship as separate from these influences. Influenced by them, yes, but not beholden to them. By properly locating these influences as coming from a source, couples can decide with more clarity to what extent they want to build a family consistent with these values or to make a choice that goes against these expectations. It allows couples to make a more conscious, free choice.

Maintaining Great Sex While Trying To Have A Baby

Great sex is most often pointless–playful and even, silly. For many couples, deciding to have a baby means “pulling the goalie” and going about business as usual, perhaps with a bit of extra effort. When conception is difficult, though, it brings stress into bed. Will we or won’t we? What’s the best method? Are we doing it enough?

Practically speaking, we encourage couples in couples therapy to take breaks from focused sex or in vitro treatments, to have a sense of humor and play and to be creative. It can be easy to fall into the trap of thinking that sex is merely for procreation and, in these cases, fun, connection and play can get lost.

Deciding To Keep The Baby

If a couple experiences an unexpected pregnancy, both partners need to be willing to ask very uncomfortable questions–both moral questions and questions about the fitness of the relationship. Is it an option to not keep the baby? What are the emotional consequences? Can we foresee them?  What does it mean to explore these questions together–not as abstractions but as harsh realities?

This, of course, can be compounded when there is concern over birth defects. The intense emotionality of this can make it much more complicated to work through the decision. Like any difficult decision, much of the work in couples therapy is creating an opportunity where the fear, pain and uncertainty can be controlled enough to allow for space to explore the issue.

Adoption and Fertility Treatments

The challenge of wanting children and not being able to conceive is incredibly challenging. For couples unable to have children, many couples look to adoption or fertility treatments. It is, however, important to note that adoption doesn’t always follow in this circumstances. Couples can decide to adopt independent of their ability to have kids.

While the choice to adopt or go through fertility treatments comes with a different set of considerations and concerns, both involve navigating stressful, invasive and often exhausting appointments, procedures and bureaucracy. One important piece with both fertility treatment and adoption for couples is to articulate how far each partner is willing to go. There is uncertainty in each process and fear can become its own driver. Is it ok to set a time limit, a number of attempts or a dollar amount after which you aren’t willing to go further? What if you (or your partner) change your mind? It’s important to find ways to hold onto your sanity and the intimacy of your relationship, while being poked and prodded (and spending thousands of dollars on legal or medical fees).

The couples therapist’s role in these decisions is a key asset–your therapist is closely connected to the rationale and feelings related to a decision, but notably lacks a stake in the outcome. Your couples therapist is removed from the intense emotional experience. Being one step removed can allow the therapist to raise practical considerations, even in the context of a deeply emotional issue and help hold onto a couple’s commitments about these limits.