Exit counseling

Abstract

A referral for counseling—including exit counseling—is intended to improve the patient's quality of life, provide education, and improve couple and individual functioning. The patient must feel relaxed and trust the therapist—and so must the medical professional. Currently, the vast majority of counseling for infertile couples focuses on patients (1) entering treatment; (2) having difficulty coping with medical treatments; (3) with pre-existing mental health problems; and (4) considering third party reproduction. Exit counseling is not as common an arena of infertility counseling, but one that is receiving increasing attention. Patients should consider ending treatment when (1) their therapeutic options have been exhausted; (2) their resources have depleted (or near depleted); (3) other aspects of the couples life are adversely affected; (4) there is evidence of poor quality of life; (5) there is a serious illness and/or condition jeopardizing health of one or both partners; and/or (6) advancing age and increasing difficulty achieving pregnancy. Whether exit counseling is provided by medical caregivers or mental health professionals, the circumstances of the counseling are fundamental. Some clinics require exit counseling for all patients, thereby minimizing stigma and providing support and education regardless of whether the patient is pregnant or ending treatment without a successful pregnancy. By contrast, exit counseling may be the result of treatment failure or other patient circumstances, such as patient request for counseling to provide assistance with making the transition to non-treatment or decision-making. A summary of therapeutic interventions will be provided as well as an overview of To Whom, When, and How to refer for exit counseling.