不妊治療による心理的負担を理解する

専門分野を教えてください。

臨床心理学、特に女性や大学生を対象としたメンタルヘルスを専門としています。中でも、生殖や不妊に悩む女性の心理的健康をテーマに、体外受精をはじめとする生殖補助医療、いわゆる不妊治療によって生じる心理的な負担について研究しています。生殖心理学という先行研究もまだ少ない領域です。また、キンダーカウンセラーとして、幼稚園での子育て支援にも携わっています。

不妊治療に着目されたきっかけは何だったのでしょうか。

晩婚化・晩産化を背景に、日本では約14人に1人の子どもが生殖補助医療によって誕生しています。しかし、不妊治療は女性にとって心身だけでなく、経済的、時間的な負担が多く、治療を頑張ったからといって必ず出産に至るわけではありません。
　実際、臨床でのカウンセリングだけでなく、自分のまわりにも不妊治療でつらい思いをしている方がたくさんいました。そこでリサーチしてみたところ、この領域に取り組む心理士はまだ少なく、また十分な研究も進んでいない。しかし、心理的なケアが必要とされている分野なのでは、と感じたことがきっかけです。
　不妊治療中の患者様は、クリニックの医療スタッフやカウンセラーに相談することで、心理的なサポートを受けることが可能かもしれませんが、治療を断念した方は、もうクリニックに通うことはできず、子育て支援団体等に繋がることもできません。また、治療と仕事との両立が困難で、離職せざるを得ないケースもあり、治療前の生活に戻ることができない方も多く存在します。
　子どもを授かることができず、仕事、お金、時間など多くのものを失い「思い描いていた人生と違う人生を生きる」という事実に直面した時、新たな生き方を見出す過程において、心理的支援の必要性を強く感じました。こういった方々が今の自分自身の人生をどのように感じているのか、その心理を理解することは、治療中あるいは治療終結後の支援に生かせるのでは、と考えています。

Understanding the psychological burden of fertility treatment

What is your area of expertise?

I specialize in clinical psychology, particularly in regard to the mental health of women and university students. Among other topics, I am studying the psychological health of women who are struggling with reproduction and infertility, and the psychological burden caused by assisted reproductive medical treatments, including in-vitro fertilization, that is to say, so-called fertility treatments. Reproductive psychology is an area in which there is still little prior research. As a Kinder Counselor, I am also involved in providing support for childcare in kindergartens.

What made you decide to focus on fertility treatment?

Against a background of late marriages and late childbearing, approximately one in 14 children in Japan is born with the help of assisted reproductive technology. However, fertility treatment is not only a huge physical and mental burden on women but is also financially costly and time-consuming.
　In fact, there were many people around me who were having difficulties with fertility treatment, in addition to those I encountered through clinical counseling. Therefore, I looked into the situation and found that there are still few psychologists working in this area, and not enough research has been done to date. However, I felt that this was an area where improvements in psychological care were needed.
　Patients undergoing fertility treatment may be able to receive psychological support by consulting with the clinic's medical staff and counselors, but those who have given up on treatment are no longer able to attend the clinic or connect with child-rearing support groups and other similar services. In some cases, they have to leave their jobs due to difficulties in balancing their treatment and work, and many are unable to return to their pre-treatment lives.
　Being faced not only with the fact that they could not have children, but also that they have lost their jobs, money, time, and many other things, and are now "living a life different from the one they had envisioned," many feel a strong need for psychological support in the process of finding new ways of living. I believe that building an understanding of how these people feel about their lives with regard to this process can be used to support them both during and after treatment.

治療中のサポートが人生観に影響

実際に調査されていかがでしたか。

不妊治療経験のある女性を対象に、子どものいない人生をどのようにとらえているのか調査したところ、4因子が見出されました。「①子のない人生の拒絶と悲嘆」、「②他者や社会への貢献意欲」、「③自己の人生への自信」、「④ありのままの人生の受容」の4つです。分析の結果、治療終結後の人生への向き合い方は、各因子に影響を与える大きな要因として、親や友人、特に配偶者のサポートの有無が深く関わっており、治療中にサポートがあった場合は人生を前向きにとらえ、逆になかった場合は悲観的にとらえる傾向が示されました。（表1・表2）

影響を及ぼす要因は他にもあるのでしょうか。

治療終結を決断した理由もそうです。不妊治療は出産に至るか、自ら子どもをあきらめる決断をするか、当然ながらどちらかでしか終わることはありません。納得して治療を終結したか、後悔が残っているかによって、その後の人生に対する向き合い方も異なります。治療にかかる費用は高額のため、経済的な要因で治療を断念した場合は特に、否定的な思いが高まることが示されています。ただし、2022年4月から人工授精等の一般不妊治療、体外受精・顕微授精等の生殖補助医療も保険適用となりましたので、今後変化があるのではと注視しています。
　この他にも治療時に生じたさまざまな事象が、治療終結後10年先の心理状況にまで影響を及ぼすことが調査で明らかになりました。今後は別尺度を取り入れながら、治療中の方や治療を終えてもなお苦しむ方々に少しでも役立つ知見を得たいと思っています。

Support during treatment affects outlook on life

How is the research progressing?

When women who had experienced fertility treatment were surveyed about how they viewed life without children, four factors were found. These factors are: 1) rejection and grieving for a life without children, 2) willingness to contribute to others and society, 3) confidence in one's own life, and 4) acceptance of life as it is. The results of the analysis showed that the presence or absence of support from parents, friends, and especially spouses was a major influence on these factors. Furthermore, the participants tended to view life positively if they had support during treatment, and pessimistically if they did not.

Are there other factors that influence this?

The same is true when a decision is made to terminate treatment. Infertility treatment can result in either childbirth or the woman's decision to give up on having a child. Depending on whether a patient has accepted the termination of this treatment or whether she still has regrets will strongly alter her attitude toward life afterward. Negative feelings increase due to the high cost of treatment. This is especially true when financial factors have led to the abandonment of treatment. However, since general infertility treatment such as artificial insemination and assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection will be covered by insurance from April 2022, we are watching for any changes that this may cause in the future. 　Research has shown that various other events that occur during treatment can affect the psychological condition of the person concerned as much as 10 years after the conclusion of treatment. In the future, I would like to incorporate other measures to gain useful knowledge for those who are undergoing treatment and for those who still suffer psychologically after treatment has ended.

目指すのは「誰かの役に立つ研究」

先生の論文は、学会で優秀論文賞を受賞されました。

今回の調査結果をまとめた論文「不妊治療経験がある女性の子どものない人生の捉え方」は、日本生殖心理学会で優秀論文賞をいただくことができました。このテーマの必要性を学会でも評価してもらえたと思うと、さらに発展的な研究に取り組むモチベーションとなりました。
　私が取り組んでいるのは「人の心を扱う」分野ですので、誰かの役に立つ研究であるよう常に意識しています。「自分の助けになった」と言ってくださる方が1人でもいるなら、研究者として大きな喜びと、やりがいを感じます。将来的には女性の生殖に関することを含め、子どもがいる方もいない方も、女性が生き生きと自分らしく生きていける社会の実現に向けて、私たちの心理支援技術を生かせるよう、研究を続けていきたいですね。

The goal is "to conduct research that is useful to others."

Your paper received Best Paper Award at an academic conference.

The paper "How Women Who Have Undergone Infertility Treatment Perceive Lives Without Children," which summarized the results of this research, received the Best Paper Award from the Japan Society for Reproductive Psychology. The acknowledgment of the need for this theme at this conference motivated me to undertake further developmental research.
　Since the field I work in "deals with the human mind," I am always conscious that my research should be of use to others. As a researcher, I feel great joy and satisfaction if even one person says, "your work helped me." In the future, I would like to continue my research so that these psychological support techniques can be used to help realize a society in which women, with or without children, can live their lives to the fullest in all aspects, including in relation to female reproduction.

心理職養成スキルを蓄積した研究科

所属の心理学研究科について教えてください。

心理学と心理臨床学の2つの専攻があり、心理臨床学専攻では、公認心理師の受験資格が得られる科目を用意しています。心の悩みを抱える方に心理的アセスメントや心理面接などの支援ができるよう、研究と実務の両面での専門教育を行っています。多くの公認心理師等の心理専門職を輩出しており、特に関西・大阪の心理業界では、本学卒業生がとても多く活躍しています。

学生や若者たちへのメッセージをお願いします。

私自身も関西大学文学部の出身で、大学院へ進み、心理相談室のカウンセラーや非常勤講師などを経て、30年以上も関西大学にいます。本学は心理職養成に長年尽力してきた大学ですので、カリキュラムや実習には教員の工夫やスキルが蓄積され充実した内容になっています。
　また、研究科付属の心理臨床センターは、地域に開かれたカウンセリング施設で、キャンパスから独立した場所にあることが特徴ですが、この規模での大学施設はなかなかありません。学生たちが勉強するには最高の環境が整っています。心理学に興味があり、心理職を志す方たちと、ぜひ一緒に学びたいですね。

A graduate school that has accumulated psychologist training skills

Please tell us about your graduate school of psychology.

There are two majors available to take: Psychology and Clinical Psychology. The Clinical Psychology major offers courses that qualify students to take the Certified Psychologist examination. We provide professional education in both research and practice so that we can provide psychological assessment, psychological interviewing, and other forms of support to those with mental health concerns. The university has produced many licensed psychologists and other psychology professionals, and many of its graduates are active in the psychology industry, particularly in the Kansai and Osaka areas.

What is your message to students and young people?

I myself am a graduate of Kansai University's Faculty of Letters. After graduating I went on to graduate school, worked as a counselor in the Student Counseling Room, and then as a part-time lecturer. This means that I have been at Kansai University for more than 30 years. As a university that has long been dedicated to the training of psychologists, our curriculum and practical training are enriched by the accumulated ingenuity and skills of our faculty.
　In addition, the Psychological Service & Counseling Center, attached to the graduate school, is a counseling facility that is open to the community and independent of the campus. It is hard to find university facilities on a scale equivalent to this. This provides a great environment in which students can study. I would love to learn together with others who are interested in psychology and aspire to become psychologists.