The mere scientific term, “psychological evaluation” may conjure up feelings of fear and
apprehension to anyone yet alone a potential surrogate who has selflessly decided to assist
intended parents in realizing their dream of creating and building a family. However, when a
woman does indeed decide to become a surrogate, it is necessary that she undergoes, what the
surrogacy industry calls, a psychological evaluation. The psychological evaluation with a
surrogate can usually take approximately two hours and it involves a personality questionnaire
that a Licensed Marriage and Family Therapist (LMFT) is trained to administer and score. Once
this session is completed, the therapist makes a recommendation to the agency about whether
the surrogate is a good candidate, whether she should wait a year or two or whether she is not
a good candidate for surrogacy based on some concerns that may arise in the interview.
Licensed Marriage and Family Therapist, Clark S. Marshall, has created a profound impact on
the surrogacy industry today due to his sincere and empathetic discernment while working with
potential gestational carriers, women who want to be egg donors and even interviewing and
supporting intended parents: “I really enjoy the work. I feel that my job is to help these women,
or these intended parents, be well prepared and well informed with what they are about to do.
Surrogacy is not always lovely, easy, beautiful and seamless. There can be a lot of
complications, medically, emotionally, logistically and legally. I need to make sure that these
women are well prepared for that, but I feel that I can do it in a way that they can feel safe and
not overwhelmed and they can take on these challenges”.
Clark discovered a niche in his chosen area of psychology whereby he could help to dispel the
fear that surrogates typically face in an evaluation: “When I first started considering doing this
for work, I was reading these blogs, Facebook and social media posts and I was reading about
how the surrogates were so damaged and traumatized by their psych evaluation. It just broke
my heart because I thought who on earth is out there scaring these women as a mental health
approach to an assessment? The primary objective of all therapists everywhere is to “Do No
Harm”. That is the number one Standard of Care for all therapists and to hear that surrogates
have left these assessments in tears, feeling judged or criticized. That’s really what motivated
me. I thought I could do this work differently and I feel like it’s working”.
It is abundantly clear that his method does indeed work as evidenced when surrogates provide
feedback upon completion of their psychological evaluation. Clark is able to immediately dispel
any fear resulting in surrogates discovering that their preconceived apprehension was
unfounded. Instead, surrogates encounter a therapist who is there to ensure that they are truly
supported: “What to expect is to know that we are curious about them. We are not being
judgmental; we are coming from an empathetic or a concerned space. Are you well supported
by friends and family members? Are you going to be able to emotionally survive a miscarriage
at 21 weeks? What’s that going to be like for you? What’s it going to be like once you start
showing yet you know that the baby is not viable and your appointment for the DNC is not until
next Thursday? So, there is a series of topics that are very important for us to talk about, and I
feel it’s important for surrogates to know that I am on their side. I am not actively looking for
things to disqualify them. I feel like the better I get to know them, the better I can support
them. I approach it as if they are good to go unless they prove to me that they are not. Perhaps,
they’re in between houses, in the middle of a divorce, they struggle to keep a job, they’re miles
and miles away from their closest friend or family member. These are all the types of issues
that may come up and may lead to the decision that a surrogate may need to wait a year or two
before becoming a surrogate”.
Clark initially entertained the idea of working with surrogates when he sat beside a woman on
an airplane who simply asked him what he did for a living. The woman in question owned a
surrogacy agency. Clark recalls how this trip changed his life: “I’m very personable and from
that one-hour airplane ride, sitting next to this woman, my life changed forever. She walked me
through the process. I took all the appropriate trainings, I pursued my own supervision and my
own training about the assessment tools, I joined all the appropriate associations. I’m not shy
so I made phone calls, I asked questions, I made friends and found people to be very
supportive. The word about my availability and my skill set spread and now I get referrals from
about 5 or 6 different agencies on the West Coast”.
Building candid and honest relationships with agencies is paramount to a therapist being able
to establish a genuine rapport with potential surrogates. Taking this into consideration, Clark
prefers the agencies that are “deeply involved in the surrogate’s wellbeing” appreciating the
agencies that value their surrogate’s mental health: “I feel that I perform one very specific and
very important piece of this enormous puzzle. I can tell when a surrogate is well supported by
their agency. They have had all their questions answered, when they are well prepared, when
they feel well supported by their agency, because when they come to me, they’re not nervous.
Their questions are very different than if an agency just plucks them off the internet and sends
them directly to me and I’m expected to answer all the logistics such as when do I have to take
shots and when do I get my first paycheck? Those are not questions for a therapist, so those
questions tell me that this agency has not well supported this woman. This agency has not
prepped their surrogates for what to expect”.
It is extremely important that the agency prepare surrogates to make sure that they know what
to expect from a psychological evaluation. Clark is not shy to convey to agencies that a
psychological evaluation is very much like a job interview: “You need to show up on time, you
need to confirm your appointment, you need to read all the instructions that are sent to you.
Again, I used to do these in person but now everything is online, so I send surrogates
information in advance. How to log in to the video portal? How to confirm your appointment?
How to sign all the electronic consent forms? So, my evaluation starts from the minute I call or
text these potential surrogates. How quickly do they respond? Do they need to change their
appointments at the last minute? How complex are their lives? How readily available do they
show up to an assessment? Many times, they need their partners to be available. Their partners
need to sit there with them and answer questions and be engaged and be supportive. It’s also
challenging for some women who have young children. Who is going to watch the children
while they are having this interview? How supportive is their family when they are doing this?
Did grandma agree to watch their kids so they could do this interview? Did a neighbour agree to
help? How do they follow the instructions? Did their sister agree to help? None of that makes a
surrogate ineligible, whether they have childcare available or not, but it’s the way in which they
deal with our appointment. If scheduling an appointment with me is difficult, then how are you
going to go fly across the country for four days for transfer? What will happen if you are going
to have to be on bedrest? Before I even do their assessment, I’ve already got a pretty good idea
of their support system”.
Research shows how stress can negatively impact a woman’s ability to get pregnant and stay
pregnant leading to the successful birth of a healthy and happy baby. It’s very important for
agencies to prioritise their surrogate’s mental health because stress can impact them physically.
A surrogate can follow all the rules, take all the required medications but if the support is not
available, it can be difficult and burdensome. Clark works with agencies to ensure that as a
team, they can face any challenges together. Clark is not only dedicated to building rapport
with surrogates within the initial minutes of their psychological evaluation, but he is also
committed to offering care throughout their pregnancy so that they feel empowered and
fulfilled. His personal approach, his care and compassion shown towards women choosing to
become surrogates renders him a respected standout in his field.