Knocked Up Podcast - Understanding Fertility Counselling with Suellen Peak
What to expect from a fertility counselling session
Understanding Fertility Counselling with Suellen Peak
In Victoria, in order to access assisted reproductive technologies there is a mandatory counselling component. The concept of supportive counselling can be daunting if it isn't something that has been tried before. In this conversation with Suellen Peak, Senior Fertility Counsellor at Life Fertility Clinic Melbourne, we discuss what to expect and how we can benefit from this session.
Suellen Peak has a Masters Qualified Positive Psychology Practitioner and Accredited Mental Health Social Worker with over 20 years of clinical experience. Over the course of her career, Suellen has worked with diverse groups of people, in a variety of settings that include community organizations, not for profit agencies, and public and private health care settings. For the past 15 years, Suellen has specialized in counselling patients to navigate infertility and assisted reproductive technologies. She has a particular interest in Wellbeing Science, and fuses mindbody practices with the evidence base interventions from the field of positive psychology, neuroscience and psychology to help people to cultivate their full potential. Suellen is a full member of the Australia and New Zealand Infertility Counsellors Association and is a licensed Mental Health First Aid Trainer. Suellen is happiest riding around on her scooter Ruby, baking in the kitchen and travelling the world.
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
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Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Women's Health Melbourne is an innovative, holistic fertility and women's health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals. Our handpicked expert team provides the ultimate care experience for our patients. Reach us at women'shealthmelbourne.com.au and follow us at women's health melbourne and @doctorraelialew. Hello, and welcome back to Knocked Up, the podcast about fertility and women's health.
Jordi Morrison: You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI fertility specialist. Today, we are joined by Suellen Peake, the senior fertility counsellor at Life Fertility Clinic Melbourne. Suellen is a master's qualified positive psychology practitioner and accredited mental health social worker with over twenty years of clinical experience. For the past fifteen years, Suellen has specialised in counselling patients to navigate infertility and assisted reproductive technologies. Welcome to Knocked Up Suellen Peak.
Suellen Peake: Thank you for joining us.
Jordi Morrison: Thank you so much for having me. It's lovely to be here.
Suellen Peake: Suellen, we've been really excited to record this episode together with you, and we're also incredibly excited to work together with you at Women's Health Melbourne and Life Fertility Clinic Melbourne.
Jordi Morrison: Oh, thank you so much. I can't tell you what a joy it's actually to be here and to be working with this incredible team as well. So I feel very privileged and very lucky.
Dr Raelia Lew: Suellen, you're a senior infertility counsellor, an Anzeka counsellor. Can you tell us, firstly, what was your journey like on your way to this career and a little bit about yourself? And also, what is an Anzeka counsellor?
Suellen Peake: My journey, towards or into infertility counselling wasn't straightforward, actually. So my background, straddles two fields. One is psychology and the other is social work. As a a profession or as a professional body, I'm actually an accredited mental health social worker. So I've gone on to do additional training in social work, which allows me to work in the same manner as a psychologist under mental health plans, in the with the general public. I later went on, to study, my master's in positive psychology because I have a real interest in balancing, I guess, the science of psychology that's often been deficit based into how do we start to build what's right with people, but how do we build well-being? Because often we know that once we help people to move through a stage of illness or mental illness, we get them sort of back to baseline. But then how do we keep building and how do we make things better? So positive psychology has really given me a bit of a balance. But to answer your question, my pathway was really quite unique, and I actually started in high risk youth work. I was out there in the community supporting young people who were really having a number of challenges. I then found my way actually into the HIV and AIDS community, and, it was incredibly passionate work for me, and I was working in hospital settings at the time. I loved that work, but I was really hungry to learn more, and I really loved the counselling work. And so that's when I started to sort of specialise in the counselling work. And you know how sometimes the universe looks after you? There was an ad in the paper to apply for a fertility counselling job. And so I thought, I'm not sure that I can do this. I've got an interest in it. And when I applied for the job, it just so happened that the job was actually looking to bring together a counselling role with a new project, which is supporting serodiscordant, people who were HIV positive, with a partner who was not, to try and help them have families without passing forward, the HIV virus. And at that moment, I just thought, this is my job. And, I remember thinking, I really, really want to work in this space. So that's how I entered into infertility work. And then from there, Ralia, what actually happens is ANZICA, which is the Australian New Zealand Infertility Councils Association, is an overarching body. And so we become registered by doing some steps, obviously, in professional development and some training to make sure that we've got some competencies around that work as well. And so stepped into that and became an In Zica counsellor many, many years ago. I think it's 15. Am I allowed to say that out loud? Can we edit that bit actually? And ultimately, yeah, I've been doing this work ever since. So it's now fifteen years actually, in infertility work and fertility counselling.
Jordi Morrison: And what's your role now?
Suellen Peake: Yeah. So it's a senior counsellor's role at the moment. And, essentially what that entails is a whole depth and breadth of work on the patient journey. And I really love that about working in the fertility field is because I might have a touch point right at the very beginning, which is often mandatory counselling when patients step in and they're making that first transition from, I guess, natural conception into the world of assisted reproduction. So I get to see that right at the very beginning. And then it might be around supporting people at the different stages and different milestones of their treatment as well. So, ultimately, we offer supportive counselling, which might be around, as I said, that milestone, but also being able to support people around other decision making moments in their treatment. So we talk a lot about implications counselling actually in the field of fertility counselling because there's lots of decisions to be made. There's lots of moments where you might, as a couple or as an individual, need to digest what's going on and how do you keep moving forward and sitting with some of the ethical and moral and also personal decisions that sometimes you need a sounding board for that. And that's really where I think counselling comes into its own. It's offering you that really safe space to sit, to digest, to think, to wonder, to ponder. And I think when when we've got those combinations right, we're doing a really good job in counselling.
Dr Raelia Lew: I think you're right. Infertility and fertility medicine is complicated, and it's often the same patients who have blows and difficult times in fertility treatment that ultimately reach success and their goals of having a family. But it can be a straightforward journey for some and a rocky road for others. How counselling can make a difference for people going through fertility treatment?
Suellen Peake: Oh, such a I'm really passionate about this area, and I think it makes a difference by helping people to navigate those highs and lows that you talked about just then, Ralia, that for for when things go really well, we often have that upward lift, we feel good, and it's energising. But when we actually navigate a challenging result, an unexpected result, sometimes it can really come out of left field. And so ultimately what happens then is our brain does its natural process of starting to move into the negative. It has a very strong negative bias, not because of what's wrong with us, but because what's right with us. Our brain is trying to protect us. And so ultimately, it will get into that sort of more pessimistic, more negative space. And certainly, I think that's really the role of counselling is to help not only bring those thoughts to consciousness, but also to then what we would do is that metacognition is starting to look at how we're thinking about our thinking. And when we start to do that, we can really start to unpack that sometimes we just accept our thoughts as being true and correct. And then what it actually does is sets about this really strong emotional reaction and then, of course, behaviours because of those emotions. And so really this is the essence of CBT training, actually, that we teach people to explore their thoughts, how those thoughts impact their emotions, how emotions then impact our behaviours and actions. And I think in counselling, unpacking that with people and really just getting, as I said before, people to slow down and think about their thinking and then think about some strategies that can actually help them navigate those highs and lows because we know they're part of the journey.
Dr Raelia Lew: I think that's amazing. And it's really important to recognise that when people go through different struggles in life, fertility being merely one of them, we go through them as whole humans. It's not about our body parts. It's not about our disease state. It's our life experience. And it's not just about the medical. It's also about how we face our challenges and how we cope with our treatments. And I think looking after somebody's mental health is really important in terms of getting them to their desired outcome. Because if you're unable to continue on the path that you must tread to get you to your outcome, whether that's phrasing your eggs, whether it's going through emergency fertility preservation after receiving a cancer diagnosis, whether it's choosing to undertake fertility treatments in the face of infertility that nobody actually really wants to do. It's nobody's choice to face infertility. Keeping it together and supporting you as a person and as a whole person is critical to your well-being and also to your success.
Suellen Peake: Absolutely. I think that's such a beautiful way of reminding all of us that we are a whole human and it's a mind body experience and whatever our body is experiencing, our mind is experienced at the same time and vice versa. So just being really aware of that and bringing that more to consciousness, I do think this is where, we can really help people to buffer the highs and the lows, particularly the lows as well. Because, again, part of what sometimes I will teach is not to or, to help people to temper expectations as well so that it helps us then to have a buffering if if the result doesn't quite go our way. And we do this a lot when we're looking at fertility often a lot of people or egg freezing, I should say as well a lot of women will want to come in and do one cycle and move on. And, of course, that would be our hope, but sometimes it takes a couple of cycles too. And so often work with some of our patients around how can they start to think about multiple ways to get to a number that feels successful for them, even if that might be one or two or three treatments down the track as well. So we work with the brain to give multiple pathways, and that's really where psychological agility and psychological agility and flexibility really comes in. When we sort of hold on to it's gotta be one way, we know that we can sometimes find a sense of more suffering or challenge because we expected it to go a particular way, and suddenly we're kind of blindsided by a result that we we didn't actually, think about before.
Dr Raelia Lew: So, Ella, we go back quite a long way. You had days at Memorial Women's Hospital in Melbourne. You've worked in lots of different areas and also have such a wealth of experience within fertility counselling at different clinics in different scenarios. Can you tell us being integral to the development of our mental health program at Life Fertility Clinic Melbourne, how is life different for you?
Suellen Peake: Oh, wow. First and foremost, it's such a beautiful boutique experience. And, again, I think there's a real personalisation around the care and support, getting to know individual nurses and doctors and then people on administration and even behind the scenes in our labs. I think that makes it far more personalised as well. And and I certainly know as an employee as well, that's far more enjoyable to be part of a the rich fabric of a team like that too. I think the other part for me, which is really why it's so appealing to me as a counsellor, is being able to really step into the journey, with with our patients and offering them mental health support under a mental health care plan and saying, I'm here for the journey, rather than just one touch point, you're in and you're out. And at the end of the day, what often really supports us is continuity of care. We know that in so many different parts of the health care system that when we build, a story and an experience with somebody, we feel held, we feel contained, we feel safer, we feel more soothed. And that's really, what I wanna be able to create by being here as a counsellor. And so that we can say, okay. We were along your journey, and it might have been the last three years, and we were we saw you through your first and maybe your second pregnancy. And so we we become part of their fabric as well. And I guess that's the broader families in it. And I always love this idea that we become part of people's scaffolding of care, and we all need that because we all get the wobbles. And sometimes knowing that that scaffolding is really gonna hold us and contain us, and that's what I'm really enjoying at Life Fertility Clinic.
Jordi Morrison: You've mentioned about continuity of of care and how patients may need more more than one touch point. Something we get asked about a lot is about why is this mandatory, and what are the mandatory requirements? I guess for those of us that don't know this, what what is involved and what's required?
Suellen Peake: Absolutely. It's an interesting question, and I think for many people, it's so important to know what they're gonna be stepping into when they come into mandatory counselling. The reason that it exists, it's unique to Victorian legislation. So it's part of our legislation in Victoria. If you stepped out over the state borders, you would not be required to do required to do mandatory counselling. However, I always say to patients, I'd love to turn that negative if you have to be here into a positive. And because what I think it allows us to do is to have that moment, as I said earlier, let's slow down. Let's talk about how you're digesting this information, how you're actually feeling about stepping into assisted reproduction. And I also spend some time talking with patients about grief because there's a grief step. When we shift from natural conception and all of the beliefs and, hopes that we have in the natural world, and then we have to sort of shift gear, we know that there's a grieving process in that transition as well. So I think there's an element in that mandatory counselling where we can actually just honour some of the feelings that might not have already been talked about. But principally in that session, we cover off prescribed matters, and that's dictated by our legislation. It sounds a little bit sinister, but actually what it is, it's, again, slowing down to ask the patient whether they've had an opportunity to talk with their doctor and they understand their treatment, whether they've got any further questions about their treatment, or whether, they really are understanding some of the risks and challenges that might be involved as well. So here, we're kind of having a touch point around, are they in a position of really being able to give informed consent? And then once we, get through, I guess, those prescribed matters, we open up to say, are there other questions? And so the way I use that session is I might also talk about fitting IVF treatment or assisted reproductive treatment into their busy schedules. Let's be honest. We are all incredibly busy, and so fitting this in can create other stress points for people. So we might talk about how you're gonna manage work and have you got a strategy to manage, how you might talk about this with family, friends, and colleagues as well. So we spend a bit of time there talking about that. For other patients, they might actually wanna talk about how they'll talk about it with their families because they've got lots of pressure around people asking them about when are you getting pregnant and are you trying and all those sorts of things. So we'll use that session to talk about those strategies as well. But the two typical things that I will always do in that session is, make sure that patients are leaving with a strategy around how to manage their two week wait in their, IVF or assisted reproductive journey and how to plan for the pregnancy result as well because it is one of the most, challenging components to navigate, those two elements.
Jordi Morrison: Suellen, you touched on the reactions of others and the discussion with others in our lives about fertility treatment. To all our listeners out there, have you got some advice about how to handle the people in our lives, how to communicate and how to protect ourselves from, I guess, unwanted communication during fertility treatment?
Suellen Peake: Absolutely. I think it's such a great question. And there will be a little caveat here, which is, of course, there is no one size fits all, and we all have very, very different needs and experiences both culturally, and within our families of origins as well. So I think that's a really important caveat. But generally speaking, I think there's a couple things that can support people, and I really love this first concept and idea. And it comes not from me. It's from a researcher that I absolutely adore, and it's Brene Brown. And she talks about the fact that our story is a privilege and that we we should absolutely make sure that as we are sharing our story, that the others that are hearing it are qualified to hear that story. And so what she's really talking about there is to make sure that we, know that our story will be held and supported. And there are some people within our systems that are not always good with information. We've all got someone in our life where we say, oh, we're not gonna say that in their presence because everybody else will know. So this is kind of that indicator of making sure that we're telling our story to people that we know are gonna hold it very, very supportively and that they can set some boundaries around what is shared beyond that moment of sharing as well. Now that might be only one or two people in some people's lives, and that's absolutely okay. I think the other thing is really elevating values. I talk a lot about this with patients is that sometimes in defence, we might say when we're asked about whether we're having children or what we're doing, we actually deny that we we desire or want to have children. We might say, oh, we're not trying, or, hey. It's not on the table at the moment when actually they've been very actively trying. So elevating a value here can help us to find a way to respond. And part of that might be saying things like, we really want children or I really desire children. I'm I'm going to do everything that I can to make that happen. And so there, we elevate ourselves, and we actually also are able to support our own need and inner need as well. So that's certainly one way that I would encourage people to think about sharing, information with others. Other times, we we need to use humour, particularly with some of our, more intrusive family and friends who might ask us, you know, how's it all going and those sorts of things. And sometimes we just simply need to say really humorous things like, we tried three times last night, and we'll let you know how it goes. And so whilst that is not necessarily a response that most people feel really comfortable in doing, what it actually does is it allows the other person to go, oh, I've kind of overstepped the mark there, actually. It wasn't a response I was anticipating. And so humour can actually work incredibly well too. So keep in mind, as I say all these, some will land, some don't because everybody's got their own different needs and repertoire of strengths, and challenges with working with this. But the very last thing that I think is so incredibly important is setting boundaries. And boundaries might be, particularly if we've shared information with others, might be about saying things like, thank you, family. We we're gonna let you know that we are doing assisted reproduction at this time. We would like to be the ones that volunteer the information, so please don't ask us about it at this time or let us lead the way. So setting those types of boundaries can be incredibly helpful, but it also allows you to loop back to the boundary if somebody breaches that as well by saying, hey. Remember, we actually said we would be the ones that volunteer or or provide that information. So, actually, we're gonna stick to that same formula too. So lots of different techniques here. And, again, noticing that we have to practice, but we also have to work out what works for us because we've all got different, strategies that seem more aligned with our values or our strengths as well.
Jordi Morrison: You mentioned earlier about how we like to take the negativity out of the mandatory counselling. But there was there's obviously some reluctance for some patients to come and see you. How do you find they are when they leave the session?
Suellen Peake: Generally speaking, I'd like to believe that patients leave saying that was actually really useful. And to me, that's when I know I've done a really good job and turned that negative into a positive and, being able to talk with people about some of those strategies that can support their journey. And, one of the things that I didn't say before is part of the mandatory counselling is to also talk through future decision making, and that's usually where people will find it most value valuable because we're projecting way into the future. We are talking about if, IVF were creating embryos, we talk about what's the storage limits on embryos, what else might be some of the decisions that you might make if you're not going to use all of those embryos, and also we talk about posthumous use of embryos, being if one party is deceased, what is their positioning on on, providing an opportunity for their partner to go ahead and use that embryo at a later time. And so that is a very different conversation to how it might look on paper in a consent form. And so, really, in a session, that's where I hope people are leaving saying that was actually really helpful. Because when we read something, it doesn't always come to life, if that makes sense. But when we talk it through, we can talk about the nuance. We can talk about how it lands for us, but also where it creates moments of discomfort too, and that's really a rich conversation. So if nothing else in the session, I think that's a really incredibly important component, and people generally leave saying that was helpful.
Dr Raelia Lew: I agree. I can give you direct feedback, Swell, in that lots of my patients, countless patients, have told me how valuable the session that you provide is for them and how much they enjoyed it despite it being mandated. And I can say that as a fertility doctor, I hope I cover a lot of ground in appointments, but my appointments with my patients are about identifying and solving their medical concerns and and fertility concerns and problems, and I hope I explain those elements to them really well, what treatment is gonna be the best for them, how that treatment is going to happen, and all of the potential risks and benefits of those treatment choices. But I I don't tell tend to talk to them about what might happen if they have embryos in the freezer and something happens to their partner. So I think what we do together as a team really fills out the whole substance of what we're trying to achieve through assisted reproductive treatments, not just what we're doing right now to try and help our patients have a baby either immediately or in the future, but also what are the ramifications of our choices and what are the implications of the technology we choose to use. So I think working as a team is so cool. And I also think it's really amazing that our patients can meet with someone as knowledgeable and kind and supportive as you are, Suellen, to help ensure that their fertility treatment and their journey is as supported on a personal level as possible. So I I would like to just really thank you so much for the work you do with my patients. It's it's really very appreciated.
Suellen Peake: Oh, thank you so much. I feel a little bit gushy at the moment, but that's really lovely. And I really love this work, and I love working with this team, and I'm incredibly passionate about it. I always say to my patients, This is what gets me up and out of bed every day, is to be a service. It's why we choose this type of work and to know that it can really make the difference for some people in terms of what I would call endurance to treatment. It can be really hard to stick in there sometimes, especially in the face of uncertainty. And isn't that just the definition of courage in and of itself is facing something that's uncertain and that is just so, so courageous? But I also think, you know, as you mentioned before, Ralia, we all have a really important role, and there's lots of different touch points with different people in the clinic. There's lots going behind the scenes, and they all those people in the labs and our embryologists and our science, they're all in there, also really batting for the clients as well and the patients. But I do also think there is a place for the medical story and then and the medical, process, and then there's a place for this emotional and psychological process and and that story too. And sometimes they're quite different. And I often, you know, when I'm working with someone through supportive counselling, I might ask a little bit about what's been the medical story. And then I say, can I okay? Thanks for that. Now tell me about the the emotional story. And then we get a very, very different kind of story that evolves. There's a place for everything as well, and it really does complement each other.
Jordi Morrison: Thank you, Ralia, and thank you, Suellen. That was so insightful. It really gave a great understanding to what patients can expect to experience from their sessions with you.
Suellen Peake: Oh, thank you so much for having me, and I really hope that for anyone listening that perhaps this has made it a little less overwhelming, made it a little bit more inviting to step into the space of counselling.
Dr Raelia Lew: Such a pleasure.
Jordi Morrison: To support Knocked Up, leave us a review or recommend to a friend. Join us on Instagram at @knockeduppodcast and join Raelia at @doctorraelialew, and email us your questions to podcast@womenshealthmelbourne.com.au.