Finding a niche: Reproductive psychology

Julie Bindeman, PsyD, graduated from the George Washington University and is the co-owner of Integrative Therapy of Greater Washington in Rockville, MD. Her specialty is Reproductive Psychology, where she actively writes, lectures, and presents.  She has been on several committees serving the Mental Health Professional Group of the American Society for Reproductive Medicine and she served as a Board Member of the Maryland Psychological Association for over 10 years. Dr. Bindeman is a member of multiple organizations focused on Maternal Mental Health and was appointed by the Governor of Maryland to serve on the Maternal Mental Health Task Force.

Hannah Calkins: It might seem pretty straightforward, but starting a family can be incredibly complex. For one, people’s reproductive hopes, expectations, choices and challenges are deeply tied to their values and their sense of identity, and they’re also influenced by cultural, religious, and political factors. Furthermore, assisted reproductive technology, or ART, is rapidly expanding the parameters of possibility for LGBTQ+ couples and couples struggling to conceive—and while this is exciting, with these new options come new ethical dilemmas.

And, all this is before you even consider the particular grief and trauma of infertility or pregnancy loss, or how any of these things can also interact with emotional and physical health.

So how might someone navigate all these complexities? Well, they might see a reproductive psychologist like Dr. Julie Bindeman. In this episode of Progress Notes, I speak with Dr. Bindeman about her work, and about how reproductive psychology is an exciting, multidisciplinary niche that comes with unique rewards and unique challenges.

Julie Bindeman: My name is Dr. Julie Bindeman, and I am a reproductive psychologist. I’m the co-owner and co-director of the practice Integrative Therapy of Greater Washington, which is located outside of Washington, D.C., in the suburbs of Rockville, Maryland.

Hannah Calkins: Dr. Bindeman sees clients at all phases of their reproductive lives, from pre-conception to the postpartum period.

Julie Bindeman: I deal with people who might want to get off any kind of psychotropic medication in order to attempt pregnancy. I work with people who might have a history of mood issues and that comes up again during pregnancy or postpartum. I work with people who are struggling to conceive and are managing infertility, whether that is, just, they’re not getting pregnant or whether they’re using assisted reproductive technologies. I also work with people who have various kinds of birth trauma. I work with people who have pregnancy losses and neonatal losses.

Hannah Calkins: Dr. Bindeman found her way to this specialty through two paths.

Julie Bindeman: My journey was kind of twofold. The one part that guided me here is while I was in grad school I was working with some pregnant people while they were in high school and helping to guide them through pregnancy and postpartum, which was interesting, given it wasn’t an experience I had had at that time. And also what really guided me in graduate school was this idea around identity formation and identity construction, and I was looking at through the lens of an adolescent, but as I’ve done more work in reproductive psychology, I realized that the identity one has as a parent is a very complex time, and a time where a lot of identity has to be reconfigured—kind of similarly to adolescence, where a lot of one’s identity needs to be reconfigured and really thought about.

Hannah Calkins: Additionally, Dr. Bindeman later had her own experiences with postpartum issues, secondary infertility and recurrent pregnancy losses.

Julie Bindeman: That then sparked my interest in recognizing the need that we don’t talk about this. We don’t have language for it, we don’t have a grief construct for it, and that’s a really important piece.

Hannah Calkins: Inspired, she sought additional training and mentoring in the field. Now, she is a member of the American Society of Reproductive Medicine, where she continues to receive training.

Julie Bindeman: So this has not just become the place where I landed, but it is a passion of mine.

Hannah Calkins: Reproductive psychology has some similarities to other specialties under the health psychology umbrella. One similarity is that Dr. Bindeman offers consultations, sort of—but not exactly—like another psychologist might evaluate a candidate for an organ transplant or for bariatric surgery.

(And—an apology to our listeners—we had some difficulties with this part of the audio, so it will temporarily sound a little different here.)

Julie Bindeman: So there are some similarities in that we are perceived as a gatekeeper, and I really hate that perception, because what I say to clients that come in for consultations is that it is not my role to determine whether or not you are fit to parent. That’s not what my job is. But what my job is, is to make sure that you are going into this process eyes wide open, that you are aware of the nuances when you have a donor-conceived child, that you’re aware of decisions you might have to make.

Hannah Calkins: Unlike other health-adjacent psychologists, many of Dr. Bindeman’s consultation clients are a self-selecting group. Most often, they’re couples using assisted reproductive technology, or ART, because of infertility issues, or because they’re an LGBTQ+ couple. That said, Dr. Bindeman says that anyone who is considering having children can benefit from a consultation with their partner.

Julie Bindeman: When you’re in an ART evaluation, a lot of the things we’re talking about can apply to any pregnancy. So talking about, what might it be like if you were to spontaneously conceive multiples, and do you know what the impact would be on a person who is pregnant with multiples, and what the impact could potentially be on the babies you’re pregnant with? And what happens if there is some kind of genetic anomaly that gets discovered?

So, not only are they getting a lot of medical information, they have to process it, and they have to figure out, hey, based upon my own moral beliefs, my ethical beliefs, my religious beliefs, and my partner’s beliefs in all those spheres, where do we come, what kind of decision might we make around this?

Hannah Calkins: Another important component of Dr. Bindeman’s work is counseling people who are experiencing infertility, or who are grieving a pregnancy or neonatal loss.

Julie Bindeman: People need support during this. And what’s really hard is, in their daily lives when they just see pregnant people all around them, it can feel very isolating and feel very difficult in terms of finding support. So for lots of my clients who don’t feel comfortable talking to other people about this, my office is the only refuge they have.

Hannah Calkins: Reproductive psychology also differs from other health-adjacent psychology specialties because it deals with issues and experiences that are intensely personal, and yet also uniquely influenced by external factors—like science, politics, technology and religion.

Julie Bindeman: I love it! It keeps things so interesting. I get to talk to people about their spiritual beliefs, and I get to talk about how that is different from their religious beliefs, and really work with people to realize how their thoughts and beliefs don’t have to be stagnant. They can evolve—they don’t have to evolve, but that they can. And being on the forefront of what is next on the technological frontier is also so exciting and scary, too.

Hannah Calkins: That technological frontier might include things like uterine transplants that allow people to carry healthy pregnancies, or the eventual possibility of an ex-utero pregnancy. It also might include navigating things that are less technologically revolutionary but are still personally and ethically complicated—for instance, encountering your donor-conceived child’s relatives on a commercial DNA testing website.

Julie Bindeman: These issues, they’re not going away, and they’re just going to get more complex, especially as technology evolves. And the ethical questions about, just because we can, does that mean we should? So that’s really interesting, too, because that’s juxtaposed with the reality of what I see, which are people that are in such deep pain. And so they’re not necessarily thinking about, “just because we can, does that mean we should”; they’re thinking about, “I just want a baby by any means necessary.” And so that interaction too is really exciting.

Hannah Calkins: So not only does Dr. Bindeman need to be up-to-date on all technological advancements, she needs to be able to link them to her clients’ emotional experiences.

Julie Bindeman: One of the ways that I tend to think anyway, is I think a lot in analogy and metaphor. So that helps as a translation piece where I can come up with different analogies and metaphors and we can talk about it, we can look at options.

Hannah Calkins: For example, if a person is considering using genetic material from a donor not related to them and is having a hard time wrapping their head around that, Dr. Bindeman might talk about pets, and how people accept responsibility for their animals and love them intensely despite there being no genetic relationship between them.

Another rapidly shifting frontier of pregnancy and parenthood—where technology may or may not play a role—is gender.

Julie Bindeman: What’s great is that this intersection where gender is now being understood as more fluid, I can only imagine I’m going to be seeing more and more people that are, have a transgender identity or consider themselves nonbinary. So, yes, I need the competency to be able to work with all people. I’ve tried to really be conscientious about my language and look at it as a pregnant person versus a woman who is pregnant.

Hannah Calkins: This is just one of the many competencies that Dr. Bindeman needs to stay up on. Reproductive psychology is truly a multidisciplinary specialty.

Julie Bindeman: I’m really lucky to be a member of the American Society of Reproductive Medicine. They’ve done a really good job of making sure that reproductive endocrinologists, and embryologists, and lawyers, and nurses, and genetic counselors, and psychologists, all have a place to dialogue. Because we all have different lenses into some very similar kinds of issues.

Hannah Calkins: Public education and advocacy are also important parts of Dr. Bindeman’s professional identity as a reproductive psychologist.

Julie Bindeman: One, I just like teaching. Being able to educate people to give them good information because the internet is filled with bad information. I feel like it’s my duty to provide information that has been vetted in some way and that is useful and helpful. The other way I come to this too is that I’m a reproductive justice patient advocate. As I mentioned, I had my own story, and in my reproductive journey, we had two pregnancies that we had to end prematurely. I had the experience of not being able to have the kind of procedure that I preferred to have because of what was going on within our culture, and having to figure out, what was that going to look like. And that’s a horrible place to be when already your dreams have been devastated. So, one of the things that I’ve done is, I’ve testified in front of Congress, I’ve testified in different state legislatures, I’ve gone to countless congressional and senatorial offices telling any senator or staffer or congressperson, what my story has been.

Hannah Calkins: That personal connection that Dr. Bindeman has to her work is part of what makes it so rewarding.

Julie Bindeman: I tend to get pretty close to the people I work with. I tend to see them whether it’s been a pregnancy loss or whether it’s been a struggle with infertility, and what is so rewarding is having them come in with that baby that was so difficult to bring to the world. It’s sort of that sense of my small part that I played. And some of my clients, when I mention that it’s just a small part, they’re like, “No, it wasn’t!” And that’s really nice and validating to hear too. But knowing of the children in this world who may not have been there…that’s a really awesome, gratifying kind of thing.

Hannah Calkins: But there are also significant challenges.

Julie Bindeman: I think the challenge is that I hear really sad, heartbreaking stories, and I hear them all day, every day. And what keeps me going with it is knowing that I can be helpful and that I can change it for a person, but also what’s hard is that that work is not always quick. And I know people that, when they come into my office and they want relief, because the feelings they’re managing are so crushing, that it makes sense that they want relief. And not being able to give it to them in that kind of instantaneous type of way.

Hannah Calkins: For this reason, Dr. Bindeman says that colleagues who are considering entering the field should be prepared for some particularly difficult aspects of this work.

Julie Bindeman: This is a field where it’s really easy to have compassion fatigue, it’s very easy to have burnout. Know that if you are of reproductive age, this is challenging. Whether you have a journey or not, this becomes very challenging work, because you know too much, and pregnancy becomes seen very differently when you have a lot of knowledge versus when you are pregnant and you don’t necessarily have the knowledge of all the different things that can happen.

Hannah Calkins: That said, if you’re passionate about the field, that passion will keep you going. This is in addition to good self-care practices, and, importantly, joining a community of like-minded colleagues.

Julie Bindeman: I would certainly encourage people to get lots of training, that just having your doctorate or whatever kind of degree you have is woefully inadequate to do this work. It’s pretty highly specialized work. There’s a great community of mental health professionals that work within reproductive psychology and they’re great. They are a lifeline to me. And I’m so lucky that not only do I get to call them colleagues, but many of them I get to call my friends.

Hannah Calkins: Ultimately, practicing reproductive psychology is an opportunity to practice at the rich, dynamic junction of health, science, technology, politics and culture. It also allows practitioners to explore a particularly profound intersection of the mind and the body.

Julie Bindeman: I wouldn’t even know how to separate mind and body when it comes to reproductive health, because our reproductive dreams are so linked to what our bodies can do or can’t do in terms of reaching those dreams.

Hannah Calkins: Learn more about Dr. Bindeman and her practice at greaterwashingtontherapy.com. You can also follow her on Twitter @drjulieb.

This episode was produced by me, Hannah Calkins, with help from Jewel Edwards-Ashman. Our theme music is “Cradle Rock” by Blue Dot Sessions. Keep tabs on the practice of psychology by subscribing to Progress Notes on iTunes or on Google Play. Thanks for listening!