Abortion is really a controversial subject in any culture from moral, religious, personal beliefs and medical views of what’s right, wrong and the rights of women. In this posting I will try to show the approach extracted from a psychotherapeutic point of view as to how a woman could be assisted in making decisions about her own well-being, the life of the unborn baby, the non-public and social impact of this decision on her life, her family and her relationships. We will also cover briefly and in context the idea of termination, of having an unplanned miscarriage and sudden infant death including infanticide of children in a further paper to be published.
Introduction
The first evidence of 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 ladies 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 a concern from the very beginning as controversial and difficult topic to discuss.
In modern days the issue across cultures still rages on with particularly polarised religious and moralistic viewpoints in regards to what is right, what is allowed and what’s viewed as wrong (an offence) it really is under this pressure and social umbrella that women have to come to terms with the decision of whether once they discover they’re pregnant how exactly to decide if they should terminate of not.
Psychotherapy itself makes no judgemental issue regarding the rights and wrongs of abortion although individual therapists could have strong religious or moral views of the topic. Where the therapist does have a conflict of judgement they ought to clearly remove themselves from the situation of counselling a female or couple 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 their personal prejudices into the therapy room should you should think about a change of profession or at 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 start of a therapy session boundaries and objectivity should be set from the beginning with the client (patient) letting her or them know the limitations of one’s service and the issue in arriving at a any decision that feels emotionally completely right. In my practice I set the boundary of who makes your choice to abort of not. I ensure it is abundantly clear that the final say is in the hands of the pregnant woman only. That her partner, medical advisers, counsellors, family are only secondary considerations to her own well-being and decision. This sense of responsibility is essential in the emotional recovery of deciding to just do it having an abortion. Later she cannot look to anyone else as forcing her, influencing her or elsewhere persuading her to go ahead when she was not sure. She must accept it really is her decision and her final responsibility to go ahead or not. The reason that is important is that after the event she should be emotionally clear that she made the best decision for herself.
The Therapeutic Process
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In the initial session it is advisable to establish the term of the pregnancy up to now. (2) This gives you then a timetable for the decision process. Different countries and cultures have differing times limits for when an abortion continues to be possible medically. Around the globe this can change from eight to twelve weeks with variations from country to country. Therefore if the obstetrician has determined she is 6 weeks pregnant in a twelve week system you have at the very least five weeks to choose (although a decision to have the abortion ought to be made immediately as procedures change on what the abortion is carried out medically). Once this timetable is established it has two effects, one determines the amount of sessions the therapeutic process can be bought out, and two a particular strain on the woman to come to an early resolution about what she really wants to do.
Once this is established the woman seeking counselling about an abortion should 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 time) you can reflect back again to her what she stated where her feelings and known reasons for the abortion. It’s also advisable to establish why she is having doubts about the abortion, such as for example guilt, personal beliefs, practical considerations, fear of loss, inability to possess a child down the road (real or not), the impact on her personal relationships with partner, husband, family and friends. It is always beneficial to have a whiteboard in a therapy office as this can help to list and clarify for the girl 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 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 in to the main issues your client maybe dealing with psychologically. At the end of the hour it is a good idea to provide a homework assignment to be emailed back again to the therapist prior to the next session. Usually it is 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 lastly a brief paragraph on the here and today situation. The reason of one page only is that it helps the client to target only on the important issues. This biography may then be analysed by linguistic analysis and reflected back the clients at the second session. Why is it important to talk about her background and upbringing? From a psychoanalyst viewpoint her history can tell us a lot about her mental conflict over her decision for an abortion today. For instance an extremely religious upbringing, poor parenting, abuse in childhood, sibling relationships, previous personal relationships, prior abortions or sexual history. Any of these areas could be impacting on her current inability to see clearly what her own choices should be in the moment.
In the next session it is advisable to ask the 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 ask 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 knowledge of the reasons for her emotional considerations in her decision making process now. By now an obvious idea should emerge about her main thoughts and position of her decision to get an abortion. She may not have composed her mind completely yet but is obviously getting a better idea of the choice that faces her.