Ongoing Counseling Or As Needed Counseling

Ongoing counseling - boundaries holding hands

There are essentially two types of counseling available on a surrogacy journey.  One is ongoing counseling, and the other is ‘As Needed’ Counseling.  Both have been used for thousands of surrogacy pregnancies in many different countries, including Australia, Canada, the United Kingdom, and the United States of America.  This Article will look at both types of counseling.


Journey Counseling


Journey or ongoing counseling refers to the early involvement of a counselor in the process.  This could be when the counselor screens the surrogate or is brought in before a pregnancy takes place. The counselor communicates with all parties throughout the pregnancy and for a period following it.  The services provided often extend to both the intended parents and the surrogate. The key role of the counselor is to support all involved parties through counseling, ensuring the process stays on track. By anticipating potential disagreements and proposing proactive resolutions, matters can be discussed before they escalate into actual conflicts. The counselor aims to foster a collaborative environment among all parties. The role of the counselor is to guide, encourage, educate, teach good communication, provide resources, put in safeguards, manage expectations, and act more like a journey coach.


Having a journey counselor involved before a pregnancy is achieved provides the advantage of established familiarity with everyone involved.  Continuity is certainly beneficial for all parties, and this can be attained by having the same counselor who conducted the initial interview with both the surrogate and the intended parent(s).  Conducting the intake interview allows the counselor to understand each person’s thoughts, desires, hopes, and concerns and be privy to all discussions.


One of the advantages of ongoing counseling is the counselor’s ability to establish and maintain boundaries between all parties throughout the journey. This is crucial to ensure that those previously unfamiliar with each other can navigate this evolving journey comfortably.  It helps to prevent the parties from exhausting one another during the year or more that they will be working together.


A journey counselor can also step in as needed to relay information that either party may need time to process.  Some information may not best be served if communicated in the heat of the moment.   An example would be when a surrogate decides not to continue with an embryo transfer five days before scheduled because her son becomes seriously ill.  Normally, the intended parents may feel betrayed or let down by her.  They may have spent years on infertility treatments, miscarriage, and losses, and finally, they are within a hair’s breadth of a pregnancy.  They have spent time, emotion, and money on getting to this point, and now all is lost to them.  It is better for a trained counselor to deliver this news to them.  Of course, they have the right to be angry and let down, and they may want to voice their frustration, but the surrogate does not need to hear these raw emotions.  The surrogate may have agonized over what to do.  She does not want to disappoint her lovely, intended parents, but her family needs her.  The surrogate may be devastated as her dream of helping someone suddenly evaporates.  She will likely feel scared and overwhelmed by her family’s health crisis.

Ongoing counseling - boundaries

A journey counselor knows the personality of those involved and their family situations.  The counselor can also quickly step into a situation and offer guidance in case of a miscarriage, failed cycle, or stillbirth.


Intimate knowledge of the parties also allows a counselor to listen for mood changes, changes in expectations, and the quality of contact.  The counselor has the skills to fill in information when something is overlooked.   In addition, they can guide everyone through prenatal testing and birth plans.  Here they can offer advice, stimulate more communication, and offer research or resources.


As the parties build trust in the counselor, they become more open to suggestions, recommendations, and conversations.  The parties need to have built trust in the counselor to allow advice to be accepted or real change to be made.



As Needed Counseling


As Needed Counseling is, as the name describes, counseling services are available when requested.  Intended parents frequently consult with a counselor before embarking on a surrogacy journey.  If there are problems or situations, they can book a session to discuss things. 


With some agencies, the surrogate is screened by a counselor only, and that counselor may make themselves available for future calls if needed.  Frequently, agencies will offer a case coordinator or case manager who assumes the role of a counselor.   The parties can contact their case manager or coordinator to discuss issues and request help.  The cost of the case manager or coordinator is included in the agency’s fees.


A downside to ‘As needed’ counseling is that when someone realizes that they are in a difficult situation – where they admit to needing outside counseling, the damage is usually beyond repair in the short time a pregnancy permits.  Some may wrongly believe the situation will correct itself or diminish in importance with time, or the other side will “get over it.”  A surrogacy pregnancy is often a highly emotional journey, and rarely does anyone “get over it,” instead, the emotional conflict escalates to where communication between the parties simply ceases.




A counselor offers therapeutic support and coaching to assist the surrogate and intended parent(s) in managing stress, redirecting disruptive emotions, adjusting expectations, and setting personal and journey-related goals. The role of counseling is particularly key to this process.  Nobody wants the surrogate to suffer emotional harm due to her generous decision to assist someone in starting a family.  A counselor can reduce the likelihood of emotional distress and ensure the surrogate exits the surrogacy process with a positive perspective; they can also help to maintain a healthy relationship between all parties.  Without such guidance, avoidable issues such as delayed signing of legal documents by the surrogate, leading to retaliatory actions like bill non-payment by the intended parent, can cause discord.


Whether the decision is for ongoing or as-needed counseling, the primary takeaway is the invaluable role of a counselor.  It is advisable that the surrogacy contract includes a provision detailing the number of sessions a surrogate is entitled to attend and who will be responsible for covering the costs of these sessions.


Author: Karen Synesiou, Infertility Portal, Inc.