ARTICLES

"Would You Like Me to Take You to the Clinic?"

HOW NOT TO COUNSEL A POST-ABORTION CLIENT

Jenny was an attractive blue-eyed brunette who came into my office with great hesitation. "I came to you because my best friend said you really helped her, but I'm not sure I want a male therapist," she said. "I'm more comfortable with a woman, but my last therapist was a woman who changed my life, and not for the better."

Here is Jenny's story, minus my therapist interjections:

"I'm 30 years old next month. When I was 20 I became pregnant by this jerk who basically told me that there's no way he was willing to settle down and be a family man. But I still cared for him. I thought that if I went along with his pressuring for an abortion that we would get along better and that he would see that I really loved him. I went to the abortion clinic alone. He found excuses why he couldn't go. I had the 'procedure,' but I knew I had just taken the life of my child. I couldn't stop that hurting inside...."

"My life would never be 'normal' again. After the abortion, our relationship seemed to slip into nothingness. I didn't have him, I didn't have my baby, I didn't have anything. I didn't even want to live....

"The pain has never gone away. I don't know what is 'normal' anymore. My family noticed a definite change in me right away and kept telling me to snap out of it. The trouble is, they didn't know -- they still don't -- that 'it' was an abortion. Nobody knows. I knew after that experience of having an abortion that I could never go through that again.

"I tried losing myself in pursuing my college degree. Shortly after leaving college, I started dating this guy seriously. Even though I wasn't planning on getting sexually involved, I did. I made sure I was protected, so how on earth could I get pregnant again? When I told my boyfriend, he was sad for me, but his attitude was that our relationship wasn't serious enough for marriage. I agreed...I didn't want to move home, but...I did.

"I hated the thought of telling my parents, because I knew what I would get from them. But I also knew that I couldn't go through with another abortion. My mom cried. My dad was silent and withdrawn. I was humiliated; I had let them down. The one thing my mom always said to us when we went out dating was, 'Don't come home pregnant....' I hated my dad's withdrawn attitude as much as I hated my mom's verbal attacks."

Jenny spoke at length about what it was like to stay in her parents' house and endure their anger and disappointment. "But in spite of my being an embarrassment to them, to have their unwed pregnant daughter move home, I knew they loved me and I felt in time they would come around. I also knew their anger at me was because they were scared for me....I was scared for me.

"By the middle of the third month I was getting used to the idea and feeling of pregnancy. My mom was showing little signs of acceptance and my dad was beginning to lessen up on the silent treatment. Then, in my fourth month, I miscarried.

"I felt empty. I felt sorrow. I felt relieved. I felt fear. Was God punishing me? Would I ever be able to have children?

"For the next six years I devoted my time and energy to my career. I dated casually without involvement. I wasn't really interested in male relationships, even though some very nice men pursued me. Then last year I met this really nice guy named Robert. He was tender and caring....We moved in together....He would bring up the subject of marriage but, he said, 'not yet.'

"I was on the Pill and figured I was safe. Well, guess what. How could this happen to me again? I took a home pregnancy test three times and still couldn't believe it. I went to my doctor, who confirmed it.

"It took me a week before I could find the courage to tell Robert I was pregnant with his child. I must have known what his reaction would be. He was annoyed and said, 'I thought you were protecting yourself. You know I wasn't planning on this for some time, certainly not this soon.' When he proposed abortion as the 'only way out,' I told him that was out of the question. He insisted, I insisted....There was no way I could tell my parents again. I also knew there was no way I could endure another abortion. I had sacrificed my first child for the hope of happiness with a man, and I had lost my second child. I couldn't sacrifice another.

"Finally Robert turned on me and screamed, 'You need to see a shrink!' I'd never told my parents about my first pregnancy and I didn't tell Robert, either. I felt like he wouldn't accept me with that kind of past. He did know about the miscarriage and the pain from that loss. I felt like I was going crazy. I decided to seek counseling.

"I felt only a woman therapist would understand what had happened to me. I knew there was no way I could disclose my life to a male therapist. At first the therapist I chose seemed to understand, and even helped me through some role-playing to improve my relationship with Robert. But after the fourth session, something wasn't feeling right in my gut. She knew by the first session that my past ten years have been haunted by the memory of my abortion, and that there was no way I could live through another one. She seemed to understand my predicament. So why was I becoming guarded?

"It dawned on me that she was protecting Robert, not me. It was the things she said: 'He's really scared.' 'He's really not ready to settle down.' 'This doesn't appear to be the right time for a baby in your relationship with Robert.' 'It's decision-making time for you.' 'What is more important to you at this time, your relationship with Robert or losing that by having this baby?' What will happen to you and your career, a career you've worked hard for these past years, if you have this baby?' 'What will this do to your relationship with your parents?' 'Have you thought about the possibility that maybe you're stronger than you think you are, and that deep down you realize life would be simpler without a child in your life right now?'

"She asked a lot of questions like these, and each one began to feel like a pin in my stomach. At the end of the fourth session she said, 'You said you hated having to go to the abortion clinic by yourself last time. If you want someone to go with you to the clinic, I'll take you. Would you like me to take you?'

"I said no and left her office. I felt sick. I was feeling as crazy and even more confused than when I first came into her office." Two weeks later, without Robert and without her fired therapist, Jenny had an abortion.

When she came to me, Jenny was angry at the therapist for "protecting him" and "adding to my confusion." She was angry at the therapist for treating her predicament as a basic grief-and-loss issue, "without disclosing her own biases, especially since she knew of my definitive stance concerning any possibility of abortion." She was angry at the therapist for "not revealing and reviewing with me any other options that were available, such as single parenting or adoption." She was angry at the therapist for "not referring me to someone else, like a priest." (She had disclosed in therapy that she had left the Catholic Church after her first abortion.) Mostly, she was angry at herself for her fear and ultimate weakness.

Jenny needed that anger to avoid spiraling down into depression. Her guilt and shame, coupled with her grief and loss, was too much. In such a situation, one frequently looks for an outlet, someone else to focus blame on. In the short-run, this side-stepping of one's own guilt and shame can help maintain a sense of sanity.

This is not to say Jenny's anger at her therapist wasn't legitimate. Allow me for a moment some therapist jargon. Jenny had gone to the woman therapist with a sharply ego-dystonic problem. "Dystonic" is anything that is unacceptable to the ego. The typical human psychological reaction is to prevent things that are overwhelmingly hurtful or that go against the natural tendencies of a person's ego from even reaching the ego for its consideration.

An ego-syntonic situation is the opposite. "Syntonic" refers to the acceptability of ideas or impulses to the ego, which receives them as compatible with its principles. Say for instance Jenny had come into the therapist's office and said, "I had an abortion ten years ago but it's not a problem for me." The therapist is then under no obligation to pursue the subject, since it presents no conflict.

But Jenny's position was emphatic: "My first abortion ruined my life, there's no way I can do it again -- it would kill me." When confronted with a situation so obviously ego-dystonic, the therapist is obliged to address it as one of the main goals of therapy. For the therapist to side-step this problem shows poor judgment and unethical treatment. But to offer to facilitate an action that would exacerbate the psychological problem -- as this therapist did -- is not only grossly unethical, it may be grounds for a civil lawsuit by the client.

Jenny is suffering from what some may refer to as genuine or existential guilt. This means: I have committed an act that violates my way of believing and living. I have done something wrong. This produces tension where the psyche or personality is not in harmony with itself nor its environment. This is to be distinguished from neurotic or false guilt, where a person feels guilt for something that is truly not of his or her doing. Jenny admits that she, and not her therapist or Robert or anyone else, is the "owner" of her decisions.

As a family therapist in San Diego, I am finding that the issue of abortion in interrelational conflicts is often the key or "presenting" problem. Any therapist who sees abortion as only a "grief and loss" issue is missing the mark. A grief-and-loss-only strategy on the part of the therapist could result in the therapy being psychologically injurious, especially if the client exhibits post-traumatic symptoms as Jenny did to her therapist.

For an increasing number of people like Jenny, there is shame and guilt attached to the grief and loss. These too must be addressed and worked through in order to prevent a further breakdown in mental health stability resulting in deeper depression with possible suicidal ideations, along with future relational difficulties. The processing of the "total pain" can facilitate wholeness which brings the client back to a place of mental, physical, and spiritual stability.

After four months of therapy, Jenny is making strong headway against the anger she has toward herself and others. Coming from her Catholicism, Jenny is working hard to accept God's forgiveness and to forgive herself, which is often more difficult. Because of her Catholic upbringing, I referred her to a Catholic women's workshop: Rachel's Hope, Healing and Reconciliation Workshops for Post-Abortive Women. (This is a San Diego-based program directed and facilitated by my wife Rosemary, a licensed nurse with master's degrees in both marriage, family and child counseling and pastoral counseling.) Had Jenny been from another Christian denomination, or even non-churched, I would have made other group referrals to help remove her from her isolation.

I apologized to Jenny -- on behalf of the profession of therapists -- for the betrayal that led her to me. Tearfully, she accepted. *

Jim Benefield can be reached at Post Office Box 17363, San Diego, CA 92177, phone 619-581-0952.