Abortion is a controversial subject in virtually any culture from moral, religious, personal beliefs and medical views of what is right, wrong and the rights of women. In this post I will try to show the approach extracted from a psychotherapeutic perspective as to how a woman could be assisted in making decisions about her very own well-being, the life span of the developing fetus, the non-public and social impact of that decision on her behalf life, her family and her relationships. We will also cover briefly and in context the thought of termination, of experiencing an unplanned miscarriage and sudden infant death including infanticide of children in an additional paper to be published.
Introduction
The first proof an abortion goes back to an Egyptian Ebers Papyrus in 1550 BC that depicted the techniques used for relieving the women of the unborn child. (1) Various accounts ever sold going back more than 100 years discussing abortion whether accepted or not and the penalties of killing an unborn child (often inflicted on the women for disobeying her husband in losing her baby) can be seen – this is simply not a modern medical choice but a historical phenomenon showing that abortion was an issue from the very beginning as controversial and difficult topic to discuss.
In modern days the problem across cultures still rages on with particularly polarised religious and moralistic viewpoints in regards to what is right, what is allowed and what is viewed as wrong (an offence) it is under this pressure and social umbrella that women have to come to terms with the decision of whether once they discover they are pregnant how exactly to decide whether they should terminate of not.
Psychotherapy itself makes no judgemental issue regarding the rights and wrongs of abortion although individual therapists may have strong religious or moral views of this issue. Where the therapist does have a conflict of judgement they ought to clearly remove themselves from the problem of counselling a woman or handful of an abortion choice and really should leave the matter to more professional therapists that the stand by position their non-judgemental stance in therapeutic situations. Any psychoanalyst who allows her or his personal prejudices in to the therapy room should you should think about a big change of profession or at the very least declare that their professionalism is tainted by their own belief system. In saying this one should also declare their personal beliefs whether in the pro-life camp or the absolve to decide camp.
In the beginning of a therapy session boundaries and objectivity ought to be set from the beginning with your client (patient) letting her or them know the limitations of your service and the difficulty in coming to a any decision that feels emotionally completely right. In my practice I set the boundary of who makes the decision to abort of not. I ensure it is abundantly clear that the ultimate say is in the hands of the pregnant woman only. That her partner, medical advisers, counsellors, members of the family are just secondary considerations to her very own well-being and decision. This sense of responsibility is essential in the emotional recovery of deciding to go ahead having an abortion. Later she cannot look to other people as forcing her, influencing her or elsewhere persuading her to just do it when she had not been sure. She must accept it is her decision and her final responsibility to go ahead or not. The reason why that is important is that following the event she must be emotionally clear that she made the very best decision for herself.
The Therapeutic Process
In the initial session it is best to establish the term of the pregnancy so far. (2) This gives you then a timetable for the decision process. Different countries and cultures have different times limits for when an abortion is still possible medically. Around the globe this can vary from eight to twelve weeks with variations from country to country. Therefore the obstetrician has determined she is 6 weeks pregnant in a twelve week system you have at least five weeks to decide (although a decision to really have the abortion ought to be made as soon as possible as procedures change on how the abortion is carried out medically). Once this timetable is set up it has two effects, one determines the quantity of sessions the therapeutic process can be bought out, and two a particular pressure on the woman to come to an early resolution in what she wants to do.
Once this is established the woman seeking counselling about an abortion ought to be encouraged to speak her mind about her fears, doubts and concerns about seeking an abortion to begin with. Once she’s vented her view (which maybe quite confused at this stage) you can reflect back again to her what she stated where her feelings and reasons for the abortion. It’s also advisable to establish why she actually is having doubts concerning the abortion, such as guilt, personal beliefs, practical considerations, fear of loss, inability to possess a child in the foreseeable future (real or not), the effect on her personal relationships with partner, husband, friends and family. It is always useful to have a whiteboard in a therapy office as this can help to list and clarify for the woman a visual cues to her dilemma. Later is can also act as a advantages and disadvantages list on her behalf to again give clarity her known reasons for an against getting the abortion. This first session if very practical in setting the scene for further psychoanalytical discussions. In addition, it helps the therapist to get insight into the main issues the client maybe coping with psychologically. At the end of the hour it is just a good idea to give a homework assignment to be emailed back to the therapist prior to the next session. Usually this is usually a one page biography of her life with the initial paragraph dealing with her very own parents, family and upbringing, the next her developing years and any significant events and finally a brief paragraph on the here and now situation. The reason of one page only is that it can help the client to focus only on the important issues. This biography may then be analysed by linguistic analysis and reflected back the clients at the next session. Exactly why is it important to discuss her background and upbringing? From a psychoanalyst viewpoint her history can reveal a lot about her mental conflict over her decision for an abortion today. For example a highly religious upbringing, poor parenting, abuse in childhood, sibling relationships, previous personal relationships, prior abortions or sexual history. Any of these areas could possibly be impacting on her current inability to see clearly what her own choices should be in the moment.
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In the next session it is advisable to ask your client what her thoughts had been about the clarification procedure for the first session, then if time, proceed through and reflect from her biography what issues arose when she wrote it, what thoughts had she about her past influencing the existing situation? Also the therapist can reflect what they saw in the biography that struck them as significant and have for the clients clarification and reflections. All of this is to enable the client through psychoanalysis to possess insight to their own character shaped by past events and help with a clearer understanding of the reasons on her behalf emotional considerations in her decision making process now. Right now a clear idea should emerge about her main thoughts and position of her decision to get an abortion. She might not have made up her mind completely yet but is certainly getting a better idea of the decision that faces her.