Supporting neurodivergent women during IVF treatment (with Liz Bancroft)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to the Mental Web podcast, the podcast about working in mental health for early career mental health workers. I'm your host, Bronwyn Milkins, and today we are talking about supporting neurodivergent people undergoing IVF.

[00:00:18] Bronwyn: For many neurodivergent clients, IVF isn't just a medical journey, it's an all-consuming, physical, emotional, and cognitive challenge. As mental health workers, we might not realize just how much sensory overload, executive functioning demands, and medical trauma can impact this process. In this episode, we'll unpack the unique needs of neurodivergent people navigating fertility treatment, and explore how we can offer trauma informed neurodiversity affirming support. Here to help us out is our guest, Liz Bancroft. Hi Liz.

[00:00:51] Liz: Hi. Thank you for having me.

[00:00:53] Bronwyn: Pleasure. So can you please tell listeners who you are and what your non-work passion is?

[00:00:59] Liz: Sure. Uh, so I'm Liz Bancroft. I'm a clinical and counseling psychologist, uh, trauma therapist, IVF veteran and proud, late diagnosed autistic woman. Um, I have a special interest in working with trauma, um, neurodivergence, and reproductive mental health as well.

[00:01:19] Liz: Outside of work, I'm a mom to a neurodivergent toddler, and a neurodivergent husband. Um, and when I'm not chasing either of them or juggling clinical life, you'll probably find me scouring the internet for interior design inspo for my next renovation project, or, you know, fine tuning my cooking skills.

[00:01:40] Bronwyn: I have to say your background is beautiful, like the interior of wherever you are is quite nicely designed. Is that you?

[00:01:47] Liz: Yes. Oh, this is actually converted from my toddler's nursery now into my recording studio, so yes.

[00:01:55] Bronwyn: It's very nicely crafted. Listeners, I wish you could see it. We're not doing video yet, but you have to imagine it looks beautiful.

[00:02:03] Bronwyn: So I think the first thing that I wanted to go over with you is what IVF is and what might prompt someone to undergo IVF because people might not be familiar with it at all.

[00:02:13] Liz: Yeah, so IVF or in vitro fertilization, it's a complex fertility treatment essentially where eggs and sperm are combined outside of the body to create embryos, which are then transferred into the uterus. So it's one of many assisted reproductive technologies that people can undergo if they've been trying to conceive and struggling for between six and 12 months, and people might pursue it for lots of reasons. So you might have blocked tubes, endometriosis, uh, polycystic ovarian syndrome, male factor infertility, age related factors, or sometimes just unexplained infertility. It's also used by solo parents and the LGBTQA plus families who need support to conceive because of social factors.

[00:03:08] Bronwyn: Great. And do you happen to know like how common it is or how many people undergo IVF every year?

[00:03:14] Liz: So at the moment, uh, the research, the statistics, official statistics are one in six couples, uh, undergo assisted reproductive technology. Uh, more recently they're saying it's now becoming closer to one in five.

[00:03:28] Bronwyn: Wow, I didn't realize it was so common. I guess the big question is how did you become interested in this area and in particular, supporting neurodivergent people undergoing IVF?

[00:03:39] Liz: So obviously it started personally, I went through IVF myself, uh, for six years as a un- undiagnosed autistic woman at the time. So I didn't find out until 12 months after my son was born. And so when I reflect back, it was the sensory overload, the emotional rollercoaster, uh, the lack of clear communication, all of that was incredibly tough, and it showed me how unprepared our health system is for people like me.

[00:04:12] Liz: And then professionally, I'd been working with neurodivergent and trauma impacted clients for years, and I realized that IVF was triggering the same survival responses that I see in complex trauma. And so there was a massive gap in the support that I could offer that, uh, infertility counselors were offering, um, and I knew that I could help fill that gap.

[00:04:37] Bronwyn: It's interesting to hear you say that you saw clients undergoing IVF, they were having similar reactions to clients who have experienced complex trauma. Um, I, I wonder if maybe the impact of IVF, you feel it's minimized or, or dismissed.

[00:04:53] Liz: Very much so. I think I read a study, this is old research, but they sort of compared the, uh, the psychological burden as being as intense as somebody who's going through cancer treatment. Now, you... that just speaks to how difficult it is. But when you are comparing apples with oranges, you know, somebody who is potentially heading towards death versus somebody who's just trying to create their family, um, I think it's very easy for society to minimize and dismiss the psychological burden of that experience.

[00:05:31] Bronwyn: Totally, and I guess like IVF is often framed as just a medical issue like you. And, and for me, I'm outside, I'm not a parent, I'm outside of this. So coming from an outsider perspective for me, I would hope that, I guess you'd be treated with dignity and respect throughout that medical process, but I guess I would see it as a medical process. But what you're suggesting is that it's much more than that, that it's a really whole body, whole life stress event.

[00:05:56] Bronwyn: Could you just unpack what that means, and I guess why it's important for early career mental health workers to understand?

[00:06:03] Liz: Yeah, absolutely. Most people think of IVF as a medical procedure, as you said, you know, like a slightly fancier pap smear with a baby at the end.

[00:06:14] Bronwyn: Yeah.

[00:06:15] Liz: Right. Um, but IVF isn't just medical, so it affects your, not only your body, but your identity, your finances, your relationships, your schedule, essentially your entire life. You know, it's weeks, months. Unfortunately, in my circumstances, it was 13 years of uncertainty, physical invasions, emotional highs and lows, and often grief as well. And so for our clients, especially those with trauma histories and with neurodivergent brains, IVF is a sustained state of threat. It's not just stress, you know, it's a full body, full brain experience. It's sensory overwhelm, it's decision fatigue, it's executive dysfunction, it's emotional whiplash, and all wrapped in vague instructions and fluorescent lighting,

[00:07:15] Bronwyn: Wow, yeah.

[00:07:18] Liz: It's not just science, it's, you know, navigating a medical maze whilst trying not to melt down in the waiting room. And so if we ignore that, we risk retraumatizing and invalidating our clients.

[00:07:31] Bronwyn: And that's a huge risk. Like we don't wanna do that. We don't wanna cause harm to our, our clients by re-traumatizing them and increasing their stress through an already difficult process.

[00:07:40] Bronwyn: And is the year, years long journey, is that a typical IVF journey or is there a typical IVF journey or is it different?

[00:07:49] Liz: Uh, it's, it's different for everyone and depending on factors like the, the cause of your infertility in the first place, um, your, uh, medical history, um, your, even your emotional wellbeing.

[00:08:04] Liz: So, statistically on average to get, um, some type of, uh, positive outcome from infertility treatment, they suggest that you need to undergo at least three rounds of IVF to be somewhat successful. Um, so the first round is generally a write off. It's just seeing how your body responds to all the medications and to the protocol and then after that they fine tune and, and tweak it, uh, to get closer to a better result.

[00:08:34] Liz: Now from the research we also know that psychological burden is the number one reason why people drop out of infertility treatment. Not because it's physically not gonna work, but because emotionally they just can't handle the process itself. And so what I've found is, I have a lot of one-on-one clients who have come to me after trying treatment and dropping out, um, and then we do the therapeutic work and it gives them the capacity to then be able to go back and undergo more rounds of treatment and become, hopefully successful.

[00:09:15] Bronwyn: So one of the things that stood out to me in what you were saying was the uncertainty, because I think early career psychs and mental health workers will be really familiar with uncertainty because we tend to see a lot of clients with anxiety and we know how much uncertainty can impact you. And I guess I just wanted to pull that out because if I think of the impacts of uncertainty, I've seen it in people, it's really all consuming and it's very detrimental and then adding on top all the other things you mentioned, I can only imagine how difficult this process may be and how much we need to pay attention to it as mental health professionals.

[00:09:48] Liz: Yeah, and it, I find that when you're dealing with presentations like uncertainty the ability to tolerate it, uh, can be impacted by lots of factors. Um, but I always formulate from a trauma-informed perspective. So the likelihood is, is that our ability to tolerate or not tolerate uncertainty well is likely come from experience. Um, and when I find that I include trauma work when working with these clients, if we can desensitize and reprocess those experiences of uncertainty whilst also building in, uh, future hope and capacity of being able to tolerate uncertainty, tolerate lack of control, uh, manage okay, and see themselves functioning on top of all of this uh, rather than just focusing on strategies, which I find often hit and miss, you know, when some experience is pushing back and you give somebody a strategy, it's like pushing shit uphill. You know, there is a force constantly pushing back. And so I think that's why the, the trauma-informed aspect of this work is essential, uh, because you get greater outcomes and more long-term change when you embed trauma work into this type of presentation.

[00:11:18] Bronwyn: I mean, it also sounds like it's very affirming of their actual experiences as well, because it is an uncertain process, like you do not know. So it would feel inappropriate to me to kind of try and, air quote, challenge those cognitions and be like, oh, it's okay, like, um, how uncertain is that? Maybe we should break it down into the actual numbers and then you can feel better about that and having the data, it's like it is a full body emotional experience. It is uncertain. So the trauma from perspective sounds just, it just sounds right.

[00:11:50] Bronwyn: And I wonder as well, could you share with us how navigating uncertainty might be, uh, more difficult for some people who are neurodivergent?

[00:11:59] Liz: Yeah, well, particularly for our autistic presentations, maybe less or so for our ADHDers, who kind of have a, uh, I guess a natural ability to sometimes lean into the chaos. Um, as an autistic woman myself, the, the lack of predictability, the lack of control, was the biggest, um, discombobulating factor, I guess a, a part of all of this, um, it adds that extra layer of chronic stress on top of what is already an acutely stressful experience.

[00:12:38] Liz: The biggest takeaway from that is newer research indicates that when you are sitting with chronic stress throughout treatment, uh, it's suggested that it can actually negatively impact on your treatment outcomes, particularly at keystone times such as egg collection and embryo implantation.

[00:13:02] Bronwyn: Yeah, I was thinking that as you were speaking. I was like, all that stress can't be good for the process as well.

[00:13:08] Liz: No. And, and for years we've been gaslit into being told by, uh, these medical systems that stress will not affect your outcomes. You know, they didn't want women to feel guilty for understandably, feeling stressed during this process. Uh, but there's a difference between a normal level of stress that the situation warrants and a much more heightened stress response. And I suppose as a system, once you acknowledge that stress does play an influential factor into outcomes, you then kind of have to do something about it. Uh, and I think that's where the shortfall is in the system at the moment.

[00:13:49] Bronwyn: Yeah, absolutely. And I guess that brings us to people's relationships with healthcare workers as well. So many neurodivergent clients might already have complex relationships with healthcare workers before they undergo IVF. Like medical gaslighting is a real thing. There's lots of research behind it. We have lots of voices telling us that they are gaslit about their symptoms, about their pain. And could you just walk us through what relationship neurodivergent people might have with the healthcare system and how IVF might amplify the negative experiences they've already had?

[00:14:23] Liz: Yeah, so look, neurodivergent clients often experience things like dismissal, miscommunication, and lack of adaption in healthcare settings. So that's particularly true for autistic women and women with ADHD. Because IVF clinics can be chaotic. You know, they give you really unclear instructions. You, you go to your first appointment with your, obstetrician, uh, gynecologist and the appointment is rushed and they're reading your notes for the first time ever in front of you like you are just another number. Uh, the sensory overwhelm of sitting in the waiting rooms while waiting for those appointments. Uh, and then the constant unpredictability as well.

[00:15:06] Liz: So the flow in effect is that clients in these situations might mask, they might shut down, or they might feel forced to advocate when they're at their most vulnerable. And so as mental health workers, we need to validate those experiences and help create a bridge. So whether it's practical strategies like planning scripts, uh, on how to communicate with your fertility clinic. Or how to prepare for your appointments, having an understanding of what to expect, um, and what you might need to do to make special accommodations for yourself when the system won't do that for you.

[00:15:49] Liz: Having the opportunity to debrief afterwards, uh, and then tailoring our therapeutic interventions so that we can address, for example, any maladaptive coping strategies that we already have that are becoming activated, um, as part of this process. Dealing with barriers to emotional regulation, distress tolerance, uh, and building assertive communication skills as well.

[00:16:14] Bronwyn: Yeah. How do you do that in an affirming way? Because part of me is thinking like, I guess this is, this is my little angry part, and I'm like, they should communicate better. They should adapt to the person, like they're the professional. And so, there's a part of me chucking a little tantrum over here. And then I heard you mention like, okay, we can also be assertive. And I'm like, I, there's a part of me that's like, okay, I agree with that as well. Like we can always advocate for ourselves. How do you help people in like a way that feels affirming and safe?

[00:16:42] Liz: So it's a, it's again, a, a very complex, uh, way 'cause I nev, I always work from a neuro affirming approach. So I never encourage clients to mask unless it's not safe to do so, um, or to change their communication style, just to fit the narrative of what the neurotypical community deems is the right way to communicate.

[00:17:07] Liz: But what you can do is you can sort of lean into your natural communication style, but just, uh, be more transparent about your preferences. So, you know, an assertive, affirming way of communicating your clinic would be giving them a heads up that this is the way that I like to communicate.

[00:17:25] Liz: Uh, for example, it might be you're going into your first appointment and, rather than furiously trying to write down notes to remember everything that's been said. 'cause you're being bombarded with information, which is, you know, peaking your stress levels, uh, it might be that you ask, can I just record our conversation? So I can go back and, and listen to it later, and I can be present in the moment and, you know, just pick out the bits and pieces I need at the time. Or, uh, if my partner can't make it, can I at least call them and have them on speaker phone so somebody else is sort of maybe picking up and shooting into stuff that I'm not able to attend to right now.

[00:18:06] Liz: You know, there's, there's ways around it. It might be, look, don't take offense, but I am really bad at eye contact. You know, and just normalizing it, because again, it, this is not going to impact on your, on the medical side in any way, shape or form. This just comes down to personal preference. So the, the assertive communication skills come down to feeling comfortable and having the capacity, uh, to ask for our needs to be met in a validating way, rather than forcing ourself to, uh, respond or behave in a way that is unnatural for us.

[00:18:44] Bronwyn: And I guess that's where somebody like you can come into the picture and support people with this. I'm just imagining that some people may have had negative experiences with healthcare workers in the past, and they've asked for their needs only to be told that they're being silly or dismissing those needs . So you would be helping people to, I guess, work with that and help them be able to express those needs again and hoping that we can, we can make this work.

[00:19:12] Liz: Yes. So it might be about doing more therapeutic work. You know, having, say I'll use a lot of EMDR and having a a, a, installing a positive future template of us confidently being able to ask for our needs to be met and feeling confident, genuinely, uh, in doing that, rather than going in, you know, big bag of nerves, anticipating the worst that's gonna happen because our experience tells us that that's probably the case as well.

[00:19:43] Liz: it would also be if you get pushback, not necessarily taking no for an answer and feeling like, well, well, that's it. I've done as much as I can. Uh, it would be then coming back and, and us formulating a plan to say, okay, how do we get, how do we move the needle a little bit further? So for example, it might be going down the firmer route of then quoting, federal and state legislation, uh, around, you know, what do things like, I think I was looking this up, um, just before we started, I, I've only referenced WA but you know, I, I'm very good at, at writing strongly worded letters to organizations in, um, advocacy work for clients. In fact, I kind of like it.

[00:20:32] Bronwyn: Me too. It's like, I'm like, I'm a well educated woman. I'm gonna use this.

[00:20:36] Liz: Yes, yes. So, you know, I would be writing a, a letter, um, formulating the argument that things like, for example, the Disability Discrimination Act of 1992, prohibits discrimination on the grounds of disability, which encompasses neurological conditions in various areas. And so medical services like infertility treatments are gonna fall under this category. So the act will mandate that service providers make reasonable adjustments to accommodate individuals with disabilities, and that ensures equitable access to services. And failure to do so can actually constitute unlawful discrimination, you know, and we have similar cases in, you know, there's state laws in Victoria and WA that, you know, also support a similar argument as well.

[00:21:28] Liz: So it would be about pointing those out to fertility clinics as well, that this is not just. Us being as autistic women often get labeled high maintenance, uh, difficult, bossy, uh, those type of labels, that this is actually, um, a relevant, and important need and, and also using the science and the data to support that. Just saying you want me to have a successful outcome as much as you want it for yourself and your statistics. And so the best way to do that, to help me reduce my stress is to provide these additional supports and accommodations that are not unreasonable.

[00:22:09] Bronwyn: Yeah, totally. And it's so good having somebody external to help with that, like yourself. I'm just thinking that people can feel so helpless in this process. I've heard from people that it's like, the doctor told me this, and they're the professional, who am I to question them? They're the expert, so I'll just do what they say. And you can feel quite helpless. But then hearing you quote the Disability Discrimination Act, it's like, oh no. We deserve to, to have good healthcare and we don't have to accept necessarily things that don't feel right for us.

[00:22:37] Liz: Yeah, and, and your Doctor may be the expert on infertility treatments, but you are the expert on you. You know, you've had 30, 35, 40 plus years of knowing you and your body, and so this has to be just like therapy, a collaborative approach. You know, we can't expect, uh, or we can't allow professionals to sit on pedestals and act as these all knowing powerful beings, when really to get effective results, whether it's in therapy or whether it's in medical care, you have to work collaboratively with each other and most clinics, and most doctors will be open to that.

[00:23:17] Bronwyn: Yeah.

[00:23:18] Liz: I think that the difficulty is, is that a lot of clinics operate under the assumption that women are well educated, well-informed of their rights, and they will ask for their needs to be met as and when required, but they don't understand the, the complexities and the nuances of, uh, how people, whether they're neurodivergent, whether they have trauma histories, really struggle to do that. It, It needs to be spoken upfront, normalized, so that people can do that straight from the beginning.

[00:23:53] Bronwyn: Yeah. And particularly like you said earlier, if somebody's feeling overwhelmed and they're in shut down or they're masking, um, they might not be able to tell a provider what their needs are. Um, they're, they're too busy trying to regulate themselves and their body is too busy, uh, I guess shutting down. So it is even more important to be able to make it explicit and make it upfront like, what are your needs? How can I help?

[00:24:15] Liz: Exactly. Yeah. And, and then, and probably have negotiated those from the very beginning in a place of being regulated. So in the instance where you, you are not regulated, that your provider can kind of have some insight or has knowledge about you already that indicates, okay, this is what we've agreed to do in these circumstances. And so they will then know how to respond in a way that is more affirming as well. And, and that will help them feel, uh, more useful, um, and more willing, uh, to do those accommodations that so many of us require.

[00:24:50] Bronwyn: Mm. As we're talking, I'm really realizing that the work that you do, well, tell me if I'm correct, maybe I'm realizing incorrectly, but I'm thinking that this is much more than supporting women like psychologically, emotionally. It's a whole paradigm shift in, I guess, how we interact in the health system. What do you think?

[00:25:09] Liz: Yes, a, a big part of my work and, and why I'm, uh, doing the scary thing as a psychologist, which we often find very difficult to do, which is to put ourselves out there and, and have a voice and, um, and doing all of this media and PR... for me, the starting point is around education and advocacy, uh, because I can help individual clients change one-on-one, but this needs to be a huge shift in the system.

[00:25:41] Liz: And it became evident to me when I went to the Fertility Society of Australia and New Zealand start training back in March last year, which is where all their new starters, nurses, doctors, et cetera, uh, meet to be trained as they enter the system. And out of a two day training, they had only one and a half hour presentation on mental health at the very end of the second day when half the delegates had already left for early flights. Uh, and then when the Q and A panel came on afterwards, one of been only one of three psychologists in the room I raised the question, you know, you've talked a lot about, uh, gender affirming and sexuality affirming care as part of your treatment processes, which is great, but what are you doing for the neurodivergent community? And the question back to me was, what is that?

[00:26:39] Bronwyn: Ah, wow. That speaks volumes, doesn't it?

[00:26:41] Liz: That speaks volumes. And, and so, and that, and that's when they confirmed this assumption is that we believe women will ask for their needs to be met if and when required. We don't need to make any special accommodations was the response that I got.

[00:26:56] Bronwyn: What do you think of that? What do you think of that response? Did the rage bubble up inside of you?

[00:27:02] Liz: The rage bubbled up inside of me. Um, obviously I didn't, I was regulated in front of my professional colleagues, but it was...

[00:27:10] Bronwyn: ...your response!

[00:27:12] Liz: It was the starting point of going to, you know what, if you're not going to, uh, do it off your own bat, then. I am going to do something about it. And, and, and that's where the starting point for this program, um, came about, uh, was how do I change the system, you know, overall.

[00:27:32] Bronwyn: And is this something that you wish that you had when you were going through IVF as well?

[00:27:37] Liz: Again, the, the premise of this program, sitting in that two day training, I heard a number of things that I wasn't informed about throughout any part of my six years of dealing with three different, um, fertility clinics. And so these are some of the things that I actually teach, uh, participants in my IVF coaching program that I'm in the midst of creating at the moment, is all of the information that I wasn't told.

[00:28:05] Liz: And I've already seen benefits to some of that with my one-on-one clients. Um, so for example, uh, the idea, and again, for this to sound familiar, you kind of have to be embedded in the fertility space. But there it was something simple like one of the presenters recommended that when you go to have your embryo implanted, that you ask for the embryologist to plunge the syringe, rather than your doctor.

[00:28:35] Liz: So you are, you're sitting there in stirrups, uh, with an ultrasound, uh, with a catheter in, um, and they're about to take this giant syringe and, and, uh, plant your embryo into your uterus, um, for, hopefully for pregnancy, and most of the time, the doctor will have the syringe passed from the embryologist who's taken it from the lab, from the petri dish, check that it's all there, ready to go, passes it over and the doctor puts it into the right spot in the uterus.

[00:29:06] Liz: Um, so that seems all above board, but as this specialist was saying, embryologists are the ones that deal with embryos day in, day out across that five day period as it's developing. And so they are the only ones who really know how much pressure an embryo can tolerate, uh, when plunging a syringe. And so it would be better practice to get the embryologist to do the plunging to, you know, re- reduce the risk of damage to that embryo.

[00:29:38] Liz: And so I, I told this, uh, to clients and, and some of the responses I get are, oh, I couldn't tell a doctor how to do their job. You know, I can't. Right? I can't suggest that that, you know, like, it just seems impossible to them to challenge, um, the idea or ask for a special accommodation like that.

[00:29:58] Bronwyn: I can totally understand that you're in such a vulnerable position, like, and even outside of that, for me, I would be like, that is the height of rudeness to think that I could tell somebody like, you shouldn't do this because apparently that person knows more than you.

[00:30:12] Liz: Yeah. And so, but it's not telling them you shouldn't do this or you can't, it's would you be open to... I've heard that, blah, blah, blah, blah, blah. So we can use more gentle language around it. I mean, I, I struggle with that as an autistic woman. I'm pretty direct and to the point.

[00:30:29] Liz: But what clients actually do is they take that education and they pre-negotiate it. So before they go into, they have a discussion with their doctor and say, hey, how would you feel, um, if I asked for the embryologist to plunge the syringe instead of you, would you be okay with that? You know, I've heard from this person, blah, blah, blah, that it might actually improve outcomes. The worst they can say is no, right?

[00:30:52] Bronwyn: Yeah, no, it's so good that you're there, I guess, from the insider perspective, and I guess that's something we don't draw in a lot as psychologists. I guess we're taught to leave our lived experiences at the door most of the time, and I guess we have very strict rules around disclosure, which I completely understand, which is important to make sure that disclosures are beneficial for the client, that they're therapeutic for the client and not unnecessarily, I guess, burden them with personal information that's not relevant to them.

[00:31:18] Bronwyn: And I just wondered how you navigated that, like bringing your lived experience into this. Was that hard for you?

[00:31:24] Liz: Yes, yes. It was very, very hard. Um, I'm somebody who hates getting in trouble, and I am very black and white and very much a rule follower.

[00:31:34] Bronwyn: Yep.

[00:31:35] Liz: So the idea of self-disclosing when as psychologists we're taught that it's a bit of a, uh, eth-, well, not a bit of it ethical, no, no. But I, I. I always read, and, and, and you'll see this with our new, um, code of competencies that AHPRA are bringing in in December coming up, is that if you, it's not cut and dry, right? So some of the, the benefits of, of self-disclosing, uh, your personal experience; one, it's promoting psychological wellbeing of the community that you're working in. So as long as you are doing it ethically and it enhances public understanding of mental health, um, whether it's, you know, IVF, neurodivergence, or whatever it is to reduce stigma, we're actually working to the code where we're asked to participate in efforts to promote the psychological wellbeing of the community.

[00:32:32] Liz: You know, it also enhances credibility and accessibility, you know, so us being authentic offers real world relevance, particularly for neurodivergent individuals and women navigating fertility treatments. So it helps Breaks this kind of ivory tower stereotype of psychology, especially when lived experience informs culturally reflective and trauma-informed practice. And so then we are meeting the code reference that we need to respect diverse cultures and beliefs and gender identities and sexualities and experiences of all people.

[00:33:07] Liz: Then, you know, our ability to educate the public and the potential clients using evidence-based, peer reviewed knowledge and personal insight, that combo is golden. You know, as long as it's accurate and as long as it's avoiding overgeneralizing. So we don't want to... as long as we're making informed comments using contemporary peer reviewed research findings that demonstrate our experience and expertise, I think having the blend is, is essential.

[00:33:37] Liz: And then by being open, the self-disclosure helps shift the culture of psychology to be more human, more diverse, more relatable, and in line with our profession's movement towards person centered and inclusive models.

[00:33:51] Liz: These were all the things I weighed up, um, and, and get supervision on regularly. And I even got legal advice on, um, from, uh, people who have worked within AHPRA before. And yes, there are some risks with our self-disclosure. You know, risk of blurred boundaries, you know, dual relationships and perceived conflicts, client misunderstandings about our roles and our own personal risk of vulnerability and burnout.

[00:34:16] Liz: But, I think overall the benefits well outweigh the risks, and as long as we continue to work within our scope of expertise, we are doing self-disclosure that is informed with intention. It's not for catharsis. And we use our support systems and our supervision and we maintain clarity about our professional role and our boundaries, it shows that we're working with a high level of professional insight, um, and I think it's of benefit to everyone, um, to provide self-disclosure in this way.

[00:34:51] Bronwyn: Yeah, totally. You said that so well, it's really clear that you've given this a lot of thought and a lot of reflection.

[00:34:57] Liz: Yes, I've had to.

[00:34:59] Bronwyn: Yeah, but it's so true as well. Like I guess coming back to how we were talking about this paradigm shift in trauma informed care, we want to reduce that power differential and we also want to see the people that we're working with as humans, not as numbers like they wanna be seen. And that's something I heard in your story as well, like you just felt that you were another number to medical professionals, but you wanna be seen as an individual. You wanna be heard with your needs. So I feel like, yeah. Self-disclosure in the way that you're using it comes under trauma-informed care.

[00:35:31] Liz: Yeah.

[00:35:32] Bronwyn: Yeah.

[00:35:32] Liz: Yeah, I would agree. And, and I think I've become a better therapist, uh, over time with the more flexible I've been with my self-disclosure compared to how I was in my very early co- career, which is where I was very rigid and very like, oh, I can't do any self-disclosure. And it's like, it was like very black and white about it.

[00:35:53] Liz: And it wasn't until I leaned into self disclosures that were purposeful, um, and intentional that, you know, my private practice work really blossomed and, you know, now I have a, you know, really thriving private practice that I'm very well sought after because of my unique style, um, that uses a touch of that personality along with being really professional and boundaried at the same time.

[00:36:19] Bronwyn: I totally relate to you on like the early, uh, career, fear of self-disclosure. I remember going to my supervisor very guiltily early in my career. It would've been like the first six months of practice. And I was working with kids and I said to my supervisor, I told a child today what my favorite color was. I feel so bad, like self-disclosure. And he's like, it's okay to tell the child your, your favorite color.

[00:36:43] Liz: Yeah, yeah.

[00:36:44] Bronwyn: But it's like, that's how, like, that's how fearful I was.

[00:36:47] Liz: I know, I know. And then like even, um, like if I use a really, um, high risk example would be when I was, I was going through my fertility treatments for six years. So, uh, of course Murphy's Law, synchronicity of the world says that I would inevitably land with a couple of clients going through similar things.

[00:37:07] Liz: But I, I, I've had clients come in where they're at particularly difficult places in their treatment, um, and mine is lined up at the exact same time and we are feeling the exact same thing in the room at that moment. And for me to put this kind of detached protector, uh, slash therapist role on in that moment would, would just be really inauthentic and, and, and would be very obvious in the room, like, I sometimes leaned in to what I was experiencing that lined up with the clients at the same time. And in some way we would, not making it about me, but we were allowed to feel the emotion together. And so I would cry with clients at the same time and, you know, things like that. And I would go away and talk about it and be like, oh, did I overstep the mark, and, um, but at, at the end of the day, each client got much more benefit out of it that it, it did in terms of potential harm.

[00:38:10] Liz: And so it's, it's having the confidence and I, I guess it comes with clinical experience of, of starting with the disclosures around my favorite color. And then slowly working up from there. Um, you know, even me identifying as some-, you know, somebody who's autistic, um, has been a huge shift, um, with lots of complexity in terms of how I personally feel about it, uh, over the last year. Um, it's only just in the last four months that I've been making this public.

[00:38:43] Bronwyn: Wow. How's that been for you?

[00:38:45] Liz: Great!

[00:38:46] Bronwyn: Good!

[00:38:47] Liz: I thought, I thought it was going to be, um, you know, nerve wracking. And I always thought I would be constantly looking over my shoulder thinking, oh, apro are gonna come after me for, um, but I think there's been some real trailblazers in this area. Um, and I'm part of a, you know, a really supportive, um, group of neuro affirming and neurodivergent clinicians, and I, and I look at them with awe about how open they've been about their diagnoses and, and see how it's only just sort of made things, uh, in this space in terms of advocacy work for the better. Um, and so that gave me the confidence, uh, to come out with this myself.

[00:39:28] Bronwyn: Yeah. No, that's amazing. I'm so glad it's been a good experience for you. And I agree, there's been such a groundswell of neurodivergent practitioners who are really paving the way for neurodivergent affirming care, and that includes recognizing that ourselves, we are human. Um, we're not robots and we've got complex, we are complex humans.

[00:39:46] Liz: Yes.

[00:39:47] Bronwyn: Yeah.

[00:39:47] Liz: And, and I think people like that about us as well. Like, we're, again, we're not in our ivory tower acting like we're all perfect, we're just as complex as everyone else. Um, the difference is, is that, you know, I, I always tell clients, I never give them anything in terms of, uh, therapy recommendations or, uh, skills or whatever it is that I have not tried myself. And so I think as, as long as it's been well tested and well researched, um, and, and we can show the, the benefits of that, then by all means share.

[00:40:24] Bronwyn: That's really cool. Thanks for that. I think that will really help some listeners who are yeah, reflecting and churning over at their own experiences. I know I've got a lot of neurodivergent listeners as well. Hi everyone. Um, but yeah, so I think that would be helpful. Thank you.

[00:40:36] Bronwyn: I just wanted to move on to your coaching framework. So you've created Hope Affirm Thrive, and it's a coaching framework for neurodivergent, uh, friendly trauma, informed fertility support. I guess we've talked about the gaps in traditional fertility counseling that led you to develop this approach, but could you just tell us a bit about the framework itself and how's it going?

[00:40:55] Liz: So it's still in the early stages. It's taken me the last 12 months just to, uh, one, develop the program, but the issue has been around marketing, um, and education and advocacy as well. Uh, so I obviously do this work one-on-one and it's always quite successful. It's just how do I get it out to the masses, in terms of, one, in a group format and to trying to educate women that prioritizing, um, their mental health is just as important as preparing their body, um, for IVF as well. And, and that's been the hurdle. You know, it's very expensive treatment and the idea of somebody needing to put more time and money and energy into just something else when, you know, a working woman loses 28 hours of work hours per month on average, going through infertility treatment. So to throw in one-on-one therapy in there as well is just, you know, too much, which I totally get.

[00:42:02] Liz: And so traditional fertility counseling, um, has often been this one size fits all. You know, it's um, clinicians that work in clinics couple of days a week during business hours. The, the therapy is usually only sought after or during a crisis. Um, and that, at that point it tends to focus on emotional validation and psychoeducation, but it, it misses the opportunity for, uh, practical scaffolding. Sensory regulation, system navigation, uh, and processing of acute and chronic stress responses that are triggered or exacerbated by past trauma. And those fertility counseling, um, clinics, they, I feel rarely center on the neurodivergent experience as well, unless you've got a clinician who obviously works in the space.

[00:42:56] Liz: So, I wanted to offer something that felt clear and structured and skill building and affirming where clients could feel empowered, not overwhelmed, and not judged, but they could also do it in a way that was accessible around work and the 6:00 AM blood tests and the multiple scans and, you know, all of the other obligations that are required for this process too.

[00:43:25] Bronwyn: Yeah, no, it sounds like an amazing thing and as you're talking, the thing that I'm thinking of is like, wow, I wish that this was embedded in the fertility clinics, like mental health support, or I wish there was like funding for it. It just sounds so important.

[00:43:37] Liz: That is my end game. I, I actually said that. I did a ABC, I spoke to an ABC reporting yesterday for an interview around this topic. So there will be an article coming out hopefully in the coming weeks. Um, but the end message I said is that my end goal is I want to see a program like this embedded into every IVF clinic in the country, 'cause I think it needs to be standard practice.

[00:44:01] Liz: It's a long way to go. Uh, I've only just started approaching infertility clinics around this and, and it will be the fact that one, it will cost them money to, to do so. And so I need to have data that supports that, um, this is worth doing. And that for an initial outlay of cost to the clinics, it's actually gonna result in not only benefit to their patients, but you know, greater successes maybe. Um, you know, more value for money in terms of having to do less rounds or, or dropping out and starting again, you know, those types of things. So it's a win-win for all. Uh, but I need the data to support it so early days.

[00:44:39] Bronwyn: And it's such a, yeah, early days, but what a worthy thing to do. Um, yeah, no, I, I fully support that. I'll look out for the ABC article, and I'll make sure I link it in the show notes as well.

[00:44:50] Liz: Thank you.

[00:44:51] Bronwyn: No worries. I wanted to ask you about some key do's and don'ts for supporting neurodivergent clients during IVF. Um, so just for our early career mental health workers, could you share some of the most important ones that mental health workers should keep in mind?

[00:45:05] Liz: Yes. Okay. So I guess first of all would be, um, education. Now obviously you don't need to be an expert in this space, but having some idea of the statistics, um, prevalence rates, you know, uh, the, the, the process in general, uh, those types of things. And, and, and there's usually some really good PD around where we can get sort of glimmers of this stuff. So you don't need to go deep dive into it, but it's good to have an overall understanding of what it involves, and, and so when you're talking to clients, it's not just kind of, uh, blindly nodding along, going, yeah, I have no idea what this is, but okay, sounds tough.

[00:45:49] Liz: Um, I guess beyond that, some of the key dos, um, for supporting any client through this process, neurodivergent or not, is just about approaching it with curiosity, flexibility and respect, um, for how their brains and their bodies are navigating the stress. So it's believing the distress first, even if they appear fine or highly articulate, you know, 'cause masking is common if you're neurodivergent, especially in medical settings.

[00:46:20] Liz: I guess the, the, the second thing would be using clear and concrete communication. So avoiding vague reassurances, like, oh, just stay positive, or, or the common one is if somebody has a, a, you know, pregnancy that they lose, it's like, well, at least you can fall pregnant, uh.

[00:46:37] Bronwyn: Oh. Cringe.

[00:46:39] Liz: Those really cringe, toxic positivity things that we get. Um, so you wanna use and validate the full spectrum of emotions, you know, hope all the way down to heartbreak, and the fact that the two can kind of coexist together at any point in time.

[00:46:54] Liz: And then it's about normalizing the grief response as well, but doing so even before a cycle begins. So, you know, fertility grief is often chronic and invisible and deeply enfranchised, and so I always like to educate clients on the likelihood that that is gonna happen before it happens, uh, so that when they do experience it, it's not a complete shock to the system and we are already part the way there of, uh, how they're going to work through, uh, some of this grief response.

[00:47:28] Liz: And then it's like things like helping plan for unpredictability. So if you've got clients who's struggling with, you know, dis- executive dysfunction aspects, um, it might be creating visual calendars, what if plans. You know, including recovery time after their appointments. Uh, it might be helping support, uh, informed consent and, and boundary settings. So role playing, writing out scripts like, um, being able to say to doctors, I need a moment, or Can I have that in writing? Or can I record this conversation? Um, getting 'em to feel confident about that and understanding their patient rights as well, uh, and that it's okay to ask them for those things.

[00:48:10] Liz: Um, then it might be encouraging self-tracking in neurodivergent friendly ways. So there's a lot to track in IVF, lots of medications and timings and stuff, so things like getting 'em to track symptoms, um, you know, helping them use apps or, or diaries or calendars. Um, having them prep- pre-prepare notes for their appointments so it reduces the need to mask when they go into the clinics and have their appointments.

[00:48:37] Liz: It might be helping them affirm different family structures and identities. So IVF isn't just for partnered cis hetero white women, right? And our neurodivergent clients are often the solo parents by choice or queer or culturally diverse, and they're gonna face added stigma that we need to be able to support them through.

[00:49:02] Liz: And then it'll be about fostering, uh, psychological flexibility as well. So helping clients stay connected to their values even when the outcome is uncertain, and, and that's the heart of neuro affirming practice and trauma informed work. It's staying rooted while everything else is in chaos.

[00:49:20] Liz: And apart from, if you know, not already considering doing, uh, trauma informed therapies, I highly, highly, highly recommend that every therapist, uh, train at some point in trauma informed work, particularly things like EMDR, um, because, you know, for example, statistically there's a, um, correlation that if you've had a previous sexual assault, um, you are twice as more likely to have a miscarriage. And so, again, we can't say sexual assaults cause miscarriages later on... uh, but you have to think about it from a, uh, nervous system point of view, and the activation of trauma when you are having a, for example, trans vaginal ultrasound and you've got sexual assault trauma, what the body is potentially doing in that moment.

[00:50:11] Liz: And so I always recommend trauma, uh, processing work prior to things like this, because again, it's preventative. You're going to prevent things like reproductive trauma, which, uh, the statistics show, you know, neurotypical, uh, people about 15%, but if you're an autistic woman, 94% end up with reproductive trauma. So it's almost a guarantee, right? And so if we can prevent that, um, then, you know, I would be recommending that straight off the bat.

[00:50:43] Liz: And then the, the things to not say, you know, like the, just relax the, you know, think positive, you know, anything that's minimizing. Um, you know, this is not a mindset issue. This is a nervous system issue. Um, not assuming coping strategies that are pathological. Um, so if somebody is a hyper organized spreadsheeter, that was me.

[00:51:06] Bronwyn: Yep.

[00:51:07] Liz: Not, uh, not seeing that as pathological or problematic. Um, you know, that's adaptive self-regulation.

[00:51:15] Bronwyn: Yeah, I love a good spreadsheet. Um, but, you know, I'm neuro divergent too, but, but like, but even if you're not neurodivergent, compliment them on their spreadsheet skills.

[00:51:23] Liz: I know. Um, not pushing clients to stay hopeful at all costs is an important one as well. So hope isn't sustainable without a space for fear and doubt and grief too. Just not assuming access or privilege. So IVF is expensive. It's exhausting, um, and not always inclusive. Um, so be mindful of those intersectional stresses as well.

[00:51:47] Liz: Although, on a positive note, I don't know how true this is, but I just read an article today, an exclusive that, um, suggests that the federal government have just committed to Medicare funding for solo parents by choice and members of the queer community because they're adjusting the definition of infertility beyond medical to now include social as well.

[00:52:12] Liz: So in terms of, yeah, so if, if it is true, that was from, I think the, um, I can't remember which news I, I I was googling. Is this, is this not common factor today? No. It's only one news article. So, uh, it might be on its way in the next couple of hours. But yes, access and privilege, we may be seeing improvements there.

[00:52:32] Liz: Um, and then the last don't is, is don't gloss over the trauma as well. So, as I said, for many IVF echoes, medical trauma, sexual assaults, powerlessness, loss, um, and that needs space, not a silver lining.

[00:52:48] Bronwyn: Uh, totally. Yeah. It takes, um, I, I totally agree with the need to be trauma informed and trained in that because I think, um, you know, I know for early career psychs, particularly thinking about my own training, uh, cognitive behavioral therapy was the first training that we got, and I don't think that that teaches us well, how to sit with clients in difficult emotions.

[00:53:07] Bronwyn: I think it teaches us to jump straight to labeling cognitive distortions and how we might go about linking that to rules and your history, which I, I don't, I, I really like CBT as a therapy, um, but I think there's also value in sitting with clients in difficult emotions and not trying to silver liner, which I think is a hard skill to learn, but a necessary one.

[00:53:27] Liz: Yes, absolutely. I mean, I was lucky enough to be trained initially as a counseling psychologist rather than a clinical, so we didn't have the same experience of, of CBT being, um, our primary form of therapy. We had lots of psychodynamic psychotherapy and existential therapy. And, um, when we trained, we were using not vignettes, we were using our personal experience. So in some way we've been primed to self disclose, um, from the very beginning. And yeah, I think that's given me a helping hand, um, in being able to be a little bit more flexible and collaborative and integrative in my therapy approaches as well.

[00:54:07] Liz: So I'd say, yeah, train widely. Go beyond CBT and, and, and make it your own. Like, don't do a manualized approach because it's trying to fit a square peg into a round hole. Every client needs their own individualized treatment plan.

[00:54:22] Bronwyn: Yeah, 100%. Liz, thank you so much for coming on the podcast today. I'm just really blown away by how articulate and invested and the, it's very clear that you've done so much work in building up your coaching practice and in this space and using your own experiences effectively. So thank you. What do you hope listeners will take away from our conversation today? So if nothing else, what do you want them to remember?

[00:54:46] Liz: I guess for a practical point of view, I, I, um, there's been some concern, well, I've had, as I've been advocating for this program, I've had some defensive responses in the, the public eye already from people thinking that this is trying to take over the role of, um, infertility, uh, psychologists that I'm saying they're doing a terrible job and, you know, all of this type of thing. Um, and, and that's not the case.

[00:55:12] Liz: So, you know, I want people to just have an understanding that, you know, therapy is where we explore the deeper stuff. You know, trauma, attachment, long-term patterns, it's clinical, it's diagnostic. Coaching, I'm not stepping on anyone's toes. This is skills focused, goal orientated, flexible. It's where we get practical, you know, like how do we just get through the next week appointment without melting down type of help.

[00:55:36] Liz: And so the two work beautifully together. You know, so coaching can complement one-on-one therapy by filling the gap between sessions, um, giving more peer orientated support as well. Um, particularly for people who, who are mild to moderate in terms of their symptoms and their struggles, and don't meet full diagnostic criteria for things. So from a, a practical point of view, I want people to understand that, um, that they can do both.

[00:56:03] Liz: And then I guess overall I want, well, I hope listeners feel more confident in supporting neurodivergent clients through any complex medical journey, even those beyond IVF, you know, and you don't have to be an expert in this space, but you just have to be able to be curious, uh, validating and adaptable. And, and that can make a huge difference.

[00:56:27] Liz: And I, I hope more early career psychs see how informed and neuro affirming work isn't a niche. It's just good clinical care. So the best gift that you can give a client doing IVF, is just believing their reality, adapting to their brain, remembering that fertility trauma isn't just sadness, it's medical trauma, it's grief, it's sensory overwhelm, and it's existential crisis all rolled into one. And we can't fix it, but we can walk beside them in it.

[00:57:04] Bronwyn: That's such a beautiful sentiment. Liz, I've really enjoyed this conversation. Thank you so much for coming on the Mental Work podcast today for us.

[00:57:11] Bronwyn: Listeners, if you found this episode valuable, please follow mental work on your podcast app rate and review the show and share it with somebody who might benefit from it. It's the best way to get the podcast out there if you just put it into their ears and make sure they listen to it.

[00:57:24] Bronwyn: That's a wrap. Thanks for listening to Mental Work. I'm Bronwyn Milkins. Have a good one, and catch you next time. Bye.