This chapter addresses the role, and importance, of individual counseling and psychotherapy in providing psychological assistance and support to patients who are struggling with infertility and loss. Depression and anxiety are the two most frequent emotional sequelae of the infertility experience.The chapter therefore speaks not only to what factors contribute to making fertility counselors effective in their work, but also addresses specific treatment approaches that can yield positive outcomes in working with this unique population. These approaches include psychodynamic psychotherapy, cognitive–behavioral therapy (including dialectical behavior therapy and trauma-focused therapy), and supportive counseling. A brief history and description of each approach is presented in addition to a discussion of ways in which these psychotherapeutic treatments can be effective in working with fertility patients. Each of these approaches can be longer term or time-limited, often depending on the needs and preferences of the patient.The chapter also emphasizes the importance of appropriate professional mental health training as well as an understanding of the unique medical treatments that are an inherent part of the personal experiences of fertility patients. A strong therapeutic alliance is critical to effective individual treatment, and each psychotherapy approach provides strategies for assisting individuals who are emotionally challenged by infertility.

Telemental health (TMH) is an exciting modality which makes it possible to provide services when it is inconvenient, untenable or impossible to work from one’s professional office. It offers professionals the ability to provide services from flexible locations and for clients to access services from locations that are convenient to them. For fertility counselors, TMH provides potential solutions for the challenges of accessibility for clients who live far from clinics, as well as third-party arrangements such as known donors and gestational surrogacy arrangements. TMH requires significant changes from in-person practice and entails some risks and cautions. Licensing laws, insurance issues, technology failures, privacy concerns, and distortions in transmission all impact the quality and utility of TMH. There is a significant learning curve for fertility counselors to become proficient in TMH and its particular requirements and procedures.Specific training in TMH facilitates this learning and enables fertility counselors to practice effectively and ethically. TMH is best used by professionals who approach this modality thoughtfully and who are knowledgeable about the practice, the ethics and the laws pertaining to it.

This chapter will explore ways to address spirituality in fertility counseling, offer clinicians guidance on how to understand the degree of spirituality or religiosity in their clients’ lives, and address how or if it is related to the challenges of infertility. The authors explore the views and positions of the major world religions with regards to options for couples who are exploring the use of assisted reproductive technology (ART) to achieve family building. Guidelines for the assessment of spirituality with clients in counseling are provided, as well as examples of interventions for use in psychotherapy. This chapter should be read along with the corresponding chapter in the Case Studies volume.