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 what sort of woman could be assisted in making decisions about her own well-being, the life of the developing fetus, the personal 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 experiencing an unplanned miscarriage and sudden infant death including infanticide of children in a further paper to be published.
Introduction
The first proof an abortion dates 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 hundreds of 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 not a modern medical choice but a historical phenomenon showing that abortion was a concern from the beginning as controversial and difficult topic to go over.
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 seen as wrong (an offence) it really is under this pressure and social umbrella that women have to comprehend the decision of whether after they discover they’re pregnant how to decide if they should terminate of not.
Psychotherapy itself makes no judgemental issue as to the rights and wrongs of abortion although individual therapists may have strong religious or moral views of this issue. Where the therapist has a conflict of judgement they ought to clearly remove themselves from the problem of counselling a female 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 his / her 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 very own belief system. In saying that one also needs to 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 right from the start with the client (patient) letting her or them know the limitations of one’s service and the difficulty in arriving at 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 make it abundantly clear that the final 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 otherwise persuading her to go ahead when she was not 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 up to now. (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. All over the world this can change 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 choose (although a decision to have the abortion should be made immediately as procedures change on what the abortion is completed medically). Once this timetable is established it has two effects, one determines how much sessions the therapeutic process could be taken over, and two a certain pressure on the woman to come quickly to an early resolution about what she wants to do.
Once that 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 Is Abortion legal in Turkey vented her view (which maybe quite confused at this stage) you can reflect back to her what she stated where her feelings and reasons for the abortion. You should also establish why she is having doubts about the abortion, such as guilt, personal beliefs, practical considerations, fear of loss, inability to have a child later on (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 may also act as a advantages and disadvantages list on her behalf to again give clarity her known reasons for an against having the abortion. This first session if very practical in setting the scene for further psychoanalytical discussions. It also helps the therapist to gain insight into the main issues the client maybe dealing with psychologically. At the end of the hour it is just a good idea to provide a homework assignment to be emailed back again to the therapist before the next session. Usually this can be a one page biography of her life with the initial paragraph dealing with her own parents, family and upbringing, the next her developing years and any significant events and lastly a short paragraph on the here and today situation. The reason of one page only is that it helps the client to focus only on the important issues. This biography can then be analysed by linguistic analysis and reflected back the customers at the second session. Exactly why is it important to discuss her background and upbringing? From a psychoanalyst point of view her history can tell us a lot about her mental conflict over her decision for an abortion today. For example an extremely religious upbringing, poor parenting, abuse in childhood, sibling relationships, previous personal relationships, prior abortions or sexual history. These areas could be impacting on her current inability to see clearly what her very own choices should be in the moment.
In the next session it is advisable to ask the client what her thoughts have been about the clarification procedure for the first session, then if time, go through and reflect from her biography what issues arose when she wrote it, what thoughts had she about her past influencing the current 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 this is to enable your client through psychoanalysis to have insight into 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 an obvious idea should emerge about her main thoughts and position of her decision to seek an abortion. She may not have composed her mind completely yet but is certainly getting a better notion of the choice that faces her.
