Telehealth Certification Institute

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TeleTherapy for Infertility, Birth Trauma, and Reproductive Loss

Millions of Americans are impacted by infertility, birth trauma, and reproductive loss. Black women are more likely to be diagnosed with infertility but are less likely to seek treatment, according to Dr. Kristy Christopher-Holloway, director of New Vision Counseling Center, in Douglasville, Georgia, and an expert on the mental health impacts of infertility. In an interview with Raymond Barrett, CEO of the Telehealth Certification Institute, Dr. Christopher-Holloway discussed how telehealth is helping expand her practice in the midst of the COVID-19 pandemic.

Dr. Christopher-Holloway says about 20% of the U.S. population is impacted by an infertility diagnosis every year. Black women are about 1.5 times more likely to experience the diagnosis of infertility, but they typically will seek help or treatment for the diagnosis at lesser rates.

Her current research includes perinatal mental health and infertility. “We know that this is an under-researched population area, and when there is no research we cannot do an effective treatment.”

Christopher-Holloway said studying this population is very important to her – to make sure that the mental health impact of infertility of Black women and Black couples is being researched.

She said that 1 in 7 women will experience a perinatal mood and anxiety disorder (and 1 in 10 men), but Black women are about two times less likely to get treatment for a postpartum or perinatal mood and anxiety disorder.

Christopher-Holloway said that infertility and miscarriage bring an ambiguous loss where the parents are not even sure how to grieve. She tells clients they are “grieving the future” – all of the birthday parties, visits with friends, late-night feedings, the pitter-patter of little feet, and all of those things that they thought would happen.

That connection [to the child] starts for many people if they know they want to be a parent, even before conception. Then once they do conceive, that attachment is there. If a person is asked, “How many children do you have?” Do you count the ones you lost? What if there were multiples, like twins or triplets, and one didn’t make it?

Parents have to give themselves permission to grieve or to acknowledge the loss, in a society that sometimes views it very differently.

It wasn’t until her own pregnancy with twins almost six years ago that Christopher-Holloway made the shift to telehealth. 

“The bigger I got, and the slower I moved getting to the office, I knew it was time to make that shift and transition [to telehealth] and still be able to do the work that I love.”

Fast-forward to 2020 when COVID-19 hits and therapists had no choice but to do telehealth. She said it took a while for her staff and their clients to get used to change.

“Our clients needed to get used to telehealth, and get used to doing telehealth in the midst of trying to teach their own children, be away from work, work from home.”

She said there were technology issues at first – choppy internet and overloaded video platforms, but now her office is serving clients all around Georgia rather than just three to four counties near her office in Douglasville, Georgia.

Telehealth has worked so well that Christopher-Holloway has decided not to fully reopen her office to in-person sessions this year. 

“All of the therapists [in her practice] said, “You know my clients have gotten used to it. I feel better. I've seen an increase in my caseload because now people aren't concerned about needing to battle traffic to get to the office.”

One of her clinicians has even switched to a night shift to see clients who need later hours. 

“So we've seen the increase...we've seen our clients get more used to it.”

Christopher-Holloway said there are still issues, like not being able to get a stable internet connection. But now her staff has a backup plan, and they just call the client on the phone.

She said that telehealth is here to stay for her practice, even after the pandemic ends.

“It's actually been working out really well to the point where we decided that whenever we do open back up and return to some type of normalcy, we will still maintain some virtual days, and have providers that are solely just virtual.”

Some clients still want to return to in-person therapy.

“Maybe they don't feel safe, or feel like they have a secure enough area in their home to do the sessions,” she said. “Sometimes people come to therapy to get away from all of that other stuff and so that therapy office was their outlet.”

She has worked to help telehealth clients find a safe zone. For instance, some clients do their sessions from a store parking lot. 

But she thinks there is now a good mixture of those who are okay with remaining virtual and those who are ready to get back to the office. She’s working to safely accommodate the clients who do want in-person sessions.

Christopher-Holloway is also trying to help her team and herself develop self-care plans for the pandemic.

“For me, I had to literally shut down my computer, not just close the laptop. I have to cut it off because I know me, I'll come back [and say], oh let me go look at this email real quick.”

She would also encourage clients to reclaim their “me time” and take breaks while working at home including lunch breaks.

“We’re seven months into [COVID-19]. We're all tired. We're done. It's like those first few months you're like “okay, yeah, yeah.” But now our bodies and our minds have been in this

crisis this trauma mode for seven months, and it's not like we can see the light at the end of the tunnel.”

She is keeping tabs on her staff via text and they are having group consultations via video conference. They share laughs and memes. 

“They know when all of this is over we're having a big party...we're having a big celebration.”

As a leader, she said she genuinely cares for the well-being of her team members and they’ve talked about pandemic fatigue. 

“What happens with the clients can definitely also happen with us as we're trying to navigate how to do this. I've had people say, ‘I haven't had a hug since March.’”

Her advice to other therapists?

  • If it's a group practice, stay in constant communication with your team. Help your team get the tools they need to be successful in their job.
  • For solo practitioners, make sure you're still connecting with other colleagues.
  • For all therapists, we're in this together so we need to be healthy; when we return to the “real world” – or some type of normalcy  – we still want to be well and in business.

By: Amanda Barnett, LPC, NBCC, MS, EDS