Dr. Aimee: Thank you both for being here.
Dr. Dana McQueen: Thank you.
Stefanie Bonnell: Thank you for having us.
Dr. Dana McQueen: Stefanie, would introduce yourself a little bit more and tell us a little bit about yourself?
Stefanie Bonnell: Sure. Thank you. Thank you so much, Dr. Aimee and Dr. McQueen for including me. I just feel so honored to be included with such a distinguished group of women, so thank you.
As you mentioned in my introduction, I am a licensed clinical social worker. My passion really is working with women and couples who have experienced fertility challenges on their road to building a family. I was drawn to this population because of my own struggles with fertility. Keeping with the theme of this week, I experienced the heartbreak of recurrent miscarriages and years of unexplained infertility. I call myself a two-time IVF survivor. I have the receipts, the battle scars, and a really beautiful baby girl to prove it.
Anybody who knows me knows that I say all the time experience equals perspective. I really lean into this when I work with my clients. You both get it, I get it. I’ve walked a similar path. I am hugely fulfilled in my work supporting women at all stages of their fertility journey. To me, it gives my story meaning, it gives me purpose to be able to give back.
Dr. Dana McQueen: How do women know it’s time to make an appointment with a therapist? Obviously, it’s hard to experience miscarriage and there’s a normal grieving process that goes with it. But how do you know you should see a therapist to talk about it?
Stefanie Bonnell: As a therapist, I think everybody should have a therapist. When I was struggling with my own fertility issues, I just had no idea that someone like me even existed, much less an entire practice of really amazing women like the ones that I am surrounded by at Nurture Therapy. When I look back at my years of struggle, it just makes me sad that I had no idea that there were people out there who were not only clinically trained but practitioners who were just like me, who walk the walk, and who could have supported me through that entire experience.
As we all know, miscarriage is incredibly isolating, it’s confusing, it’s devastating, it can turn your entire world upside down. It causes strain on friendships, your work, relationships, it takes a toll on even the strongest of marriages. Having the support of a therapist during the healing process gives someone a chance to express their emotions freely in a safe space where they can grieve and they can feel exactly the way they want to feel without any fear of judgment.
Sometimes, I think there is healing in just knowing that the person sitting across from you — in this case, a therapist — really gets it. They’re not trying to fix it. They aren’t trying to tell you to be positive or saying at least you can get pregnant. That has to be the most cringe-worthy statement ever to say to someone who has just lost a baby. A therapist can be with you, they can hold your hand (virtually, right now) and say, “This sucks,” right there with you.
Dr. Dana McQueen: How often will patients see you? Is it a weekly thing, is it once a month, or when they get pregnant they make an appointment?
Stefanie Bonnell: It really varies. I always say I’m guided by them. So often I will see a client for the first time, and I usually recommend for someone to see me weekly for a little while. Then it kind of depends on what’s happening in the process. Sometimes people then scale back to doing biweekly or once a month. I have clients that I’ve seen weekly for months and months, and I love that, but that’s not for everybody. Sometimes I see people for a long time and then I feel like they get better, and that’s great, so maybe they just check in with me every now and then when they need a little boost.
Dr. Aimee: I think sometimes just getting to that first visit is really hard for people, because they don’t realize that they need you. Then they finally meet you and, like you said, it’s like I can’t believe I didn’t know you were out there. For people who are thinking about seeing you, what can they expect at that first visit?
Stefanie Bonnell: Sure. I also say all the time that there’s a saying about the heaviest weight in the gym is the front door, and I feel the same way with therapy. The hardest part is sending an email, making a phone call, or maybe in some cases it’s just finding who is out there. Like I said, I just had no idea that someone like me was around, but there’s a whole practice of us at Nurture.
During the first consultation, it’s all about gaining trust and building rapport. It’s an opportunity for me to learn as much about the client as I can, as they’re willing to share. For my clients, it’s an opportunity for them to figure out, “Do I even like this person? Do I want to spend an hour of my week with them? Do I feel comfortable sharing the most intimate pieces of my life with this person?”
For a lot of women, their fertility story is super complicated. We know that. It’s been a roller coaster of emotions. Oftentimes, for years. A lot of times, it’s been pretty damn lonely. In that first consultation, actually for most of the sessions, I just spend a lot of time listening. Really listening. Giving them the space to share exactly what it is, feel exactly the way they need to feel in that moment.
For some women, they’ve never even been able to share their story, even with the person that they share a bedroom with. They don’t know the deepest darkest. It’s my role to just hold space for them at that moment.
Dr. Aimee: I think I’ll be putting that on a t-shirt, “The heaviest weight in the gym is the front door.” That’s pretty powerful.
Dr. Dana McQueen: I’ve heard you talk about this idea of ambiguous loss before. Truthfully, I hadn’t really heard the term. If you could explain what it means to have ambiguous loss versus a sort of more tangible loss, I guess that would be the first question. What does that mean? And then how do you manage these ambiguous losses?
Stefanie Bonnell: Ambiguous loss is something that I’m really passionate about, we work with ambiguous loss, so thank you for giving me the chance to share about this.
Ambiguous loss is a concept or a theoretical premise coined by a woman, a psychotherapist and a researcher named Pauline Boss. Ambiguous loss is different from traditional grief. With ambiguous loss there’s no possibility of resolution or closure, so therefore it winds up becoming what we call complicated grief, and that results from a chaotic and unbelievably painful situation. It’s typical, we expect that complicated grief will last for years. It can last for years.
Let’s take for example the events from this past weekend around the death of Prince Phillip. There was a community that rallied around the Queen. Her family came together. People from all over the globe rallied to support her. There was discussion about his life, there was celebration. Here’s what is most important; there was the ritual of closure with the burial of his casket.
Then let’s take for example a miscarriage. Often there are no answers to the loss. There’s no ritual. There’s really no celebration. Very few people even feel comfortable talking about miscarriage. Again, even the person that you share a home with, they feel uncomfortable. There’s often a lack of community, people are so isolated in their grief.
Then that grief shows up, say on the anniversary of their due date, attending their best friend’s baby shower, or even seeing a birth announcement as they scroll through social media. As humans, we long for some kind of control when we lose someone. That’s why burials, headstones, memorials are really important to our healing. People who experience ambiguous loss still need this. Closure is a great word when you’re talking about real estate or a major business deal. It’s a terrible word when it comes to grief and human relationships.
Here’s the key piece about ambiguous loss. Once you love someone or even the psychological presence of someone that you’ve never met, you always love them. You can’t turn it off. You can’t put closure on it. Ambiguous loss in the framework of our discussion refers to the psychological presence with physical absence.
I guess an even better way to understand this might be how we fall in love with that baby the minute we see those two pink lines. We make plans. We dream. We pick colors for a nursery. The psychological presence of that baby doesn’t go away just because its heart is no longer beating.
Dr. Aimee: I feel like there should be applause because that was so beautiful.
Stefanie Bonnell: Oh my gosh. Thank you.
Dr. Aimee: Literally every single person who is going to be listening to this that has suffered through what you described can totally relate to that. Tell me more. How do you start to process ambiguous loss and make it more tangible? Can you talk us through that?
Stefanie Bonnell: For sure. We can’t cope with a problem until we know what the problem is. Right? With ambiguous loss, once people have a name for it, once people make the connection that this is what they’re experiencing, they almost have what Oprah would call an a-ha moment, they have some clarity. I hear them breathe a big sigh of relief.
The goal of ambiguous loss is transformation, where people no longer blame themselves for the loss. Do any of us know a single woman who experienced miscarriage that didn’t blame themselves to some degree or at least question their part? So, our goal with this transformation is to reduce or eliminate the blame that they place on themselves so that they can somehow assign it meaning. Hopefully, she can then live or function for the rest of her life without too much stress.
One way to make ambiguous loss a little more tangible is to understand it in a way of paradoxical thinking. The only way to live with ambiguous loss is to hold two opposing ideas in your mind at the same time; hope and grief. That’s a really difficult task. We like finite answers. Once you put this kind of frame on it, people feel a little bit more at ease. This might be the closest thing to something tangible that we get.
We don’t like pain. We don’t like suffering. We want to cure it, we want to fix it, get over it, move on. That’s what has made our society great, it’s bolstered so much of our medical advancement. But now and then, like in the case of a miscarriage, there aren’t answers. We’re faced with problems that don’t have a perfect fix. Then this concept of holding two opposing ideas — hope and grief — at the same time can really be useful.
Viktor Frankl, who wrote Man’s Search for Meaning, wrote all about ambiguous loss through his horrific experiences in a concentration camp. He documented violence, loss, and ambiguity. He also insisted that meaning can be found through this. He says so beautifully, “Without meaning there is no hope and without hope there is no meaning.”
One of the ways that Pauline Boss talks about building resilience with ambiguous loss is to find new hope. In the example of a miscarriage, that new hope may come from just having the courage to try again. Another cycle. Another round of IVF. Maybe even exploring other options.
Dr. Dana McQueen: Are there specific coping strategies that women can use or couples us to combat the anxiety that comes with getting pregnant again or the depression that comes with having another loss?
Stefanie Bonnell: Yes. Again, we come from a culture of mastery, problem solving, problem fixing. We want to fix it and we want to move on. Elisabeth Kübler-Ross intended the five stages of grief. You may have heard of her, she made history by writing about the five stages of grief. Denial, anger, bargaining, depression, acceptance. But she wrote those for people who were dying, not even their families.
New research today doesn’t recommend stages at all. We know that they’re not linear. We know that human beings can live with grief, they don’t have to get over it, they can occasionally be sad. They can have good days and they can have really crappy days. It’s up and down. They don’t need to completely get over it.
So, we’re talking about something that’s nonsensical. If something is without logic or without meaning, as miscarriage is, we can leave it right there. We don’t have to give it meaning to make it okay. We can find meaning in other areas and let that be just good enough.
One coping strategy that I do talk with my clients about is finding situations where we can make meaning out of the ambiguous loss. Sometimes that meaning comes from participating in research. Maybe it comes from advocacy. Telling your story to the person across the room from you, a therapist. Writing a blog. Becoming a therapist that focuses on fertility, miscarriage, and loss. All of these things help us find meaning to our story.
I don’t like to use the word acceptance, but I do think that we can aim to be comfortable with that which we can’t solve.
Dr. Aimee: How do partners get involved, what can they do to support a woman who has had a miscarriage?
Stefanie Bonnell: I definitely get partners involved, especially to the degree that they want to be. Fertility challenges and miscarriage is incredibly confusing, especially for couples, and especially the partner.
In my experience, and what I often hear from clients, is that the partner understandably just wants to fix it. They want to make it better, they want to close it up, they want to put it away and be done. They just want the individual to feel better. What winds up happening is that there’s a disconnection between their communication and their grieving process. As an individual or as a couple, we have to find ways to just be able to live with the loss, whether it’s clear, like Prince Phillip, or ambiguous, like a miscarriage.
It’s okay to grieve with your partner. It can be really uncomfortable to grieve with anyone. We can sit with that and really just say, “I’m sorry.” The best thing you can say is just, “I’m so sorry.” We don’t have to fix it. We don’t have to make it better. Just simply saying “I’m sorry.”
The other piece that I think is really important for a partner is to acknowledge the loss. Acknowledge the baby. Remember, we’re honoring the psychological presence even in the physical absence.
Let me give you another example. It’s almost Mother’s Day, which has to be one of the toughest, if not the most difficult day for a woman who has experienced a miscarriage. For a lot of those women, that will be a day that they’ll want to crawl into bed, pull the covers over their head, and forget that the day is happening.
Some coaching that I like to give my clients that they can maybe then pass on to a partner, or if a partner has joined us in the session, I tell them to tell their partner how important the day is. A lot of the time the partner has no idea, and they can’t read our minds. It’s uncomfortable to bring it up. I tell my clients, I coach them, tell your partner how important this day is. Maybe it’s with flowers or a really sweet card, breakfast in bed, a weekend away, whatever it is, I don’t know. Something so that the couple can plan together, they can honor the day and the baby that they lost.
Remember that these kinds of rituals are what help us to make meaning. They help us to find that new hope that builds resilience. That then helps us to live with both hope and grief, and that’s the only way we can live with ambiguous loss.
Dr. Dana McQueen: How do women know, or how do couples know they’re ready to try again? Should they wait a certain amount of time after a miscarriage? I think medically I’d say it’s fine to try again right away, but it’s hard for me to know if they are ready emotionally to try again, if it’s going to be too traumatic to try again.
Stefanie Bonnell: That’s really client-dependent. I think some of my clients are ready just to move on. I think the biggest piece that I hear from my clients is the deafening sound, the tick-tock of the clock. We can’t look past that. Right? If the tick-tock of the clock is that deafening and they feel ready, then I say go for it.
I have other clients who it’s not as deafening, the tick-tock of the clock. It feels like a pause is healthy for themselves, for their relationship, for their process in moving forward.
Dr. Aimee: Thank you, Stefanie, for joining us. Where can we find out more about you, where can people find you if they want to see you for therapy?
Stefanie Bonnell: They can connect with me on my Instagram, @Stefanie.Bonnell.LCSW. They can follow us on the Nurture Therapy Instagram, @Nurture_Therapy. Our website is Nurture-Therapy.com.
Dr. Dana McQueen: My patients have had a really easy time making appointments with you guys over at Nurture Therapy. The patients are able to do a lot of the visits via telemedicine now, which has been great.
Stefanie Bonnell: Yes.
Dr. Aimee: Do you see people that are out of state as well, or is it just in-state?
Stefanie Bonnell: Right now, we’re seeing clients who are just based in Illinois. One, if not more, of our practitioners are licensed in Minnesota, so we can take clients from Minnesota as well. And New York.
Dr. Aimee: Thank you again. Thanks guys. I appreciate you.
Stefanie Bonnell: Thank you so much.
Dr. Dana McQueen: Thank you so much for coming on.
Dr. Aimee: Thank you, Dana. Thank you, Stefanie.
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