Abortion is a controversial subject in any culture from moral, religious, personal beliefs and medical views of what is right, wrong and the rights of women. In this posting I will make an effort to show the approach taken from a psychotherapeutic perspective as to what sort of woman can be assisted to make decisions about her own well-being, the life span of the unborn baby, the personal and social impact of that decision on her behalf 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 an additional paper to be published.
The first evidence of 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 in history going back hundreds of 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) is seen – this is simply not today’s 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 seen as wrong (an offence) it really is under this pressure and social umbrella that women have to comprehend the decision of whether once they discover they’re pregnant how exactly to decide whether they should terminate of not.
Psychotherapy itself makes no judgemental issue as to 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 should clearly remove themselves from the problem of counselling a woman or handful of an abortion choice and really should leave the problem to more professional therapists that the stand by position their non-judgemental stance in therapeutic situations. Any psychoanalyst who allows his or her personal prejudices into the therapy room should seriously consider a big change of profession or at the very 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 coming to a any decision that feels emotionally completely right. In my own practice I usually 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, members of the family are just secondary considerations to her very own well-being and decision. This sense of responsibility is very important in the emotional recovery of deciding to go ahead with 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 that is important is that following the event she must be emotionally clear that she made the best decision for herself.
The Therapeutic Process
In the initial session it is best to establish the word of the pregnancy up to now. (2) This gives you then a timetable for your choice process. Different countries and cultures have different times limits for when an abortion continues to be possible medically. Around the world this can change from eight to twelve weeks with variations from country to country. Therefore the obstetrician has determined she actually is 6 weeks pregnant in a twelve week system you have at the very least five weeks to choose (although a decision to really have the abortion ought to be made immediately as procedures change on how the abortion is completed medically). Once this timetable is set up it has two effects, one determines the number of sessions the therapeutic process can be taken over, and two a particular strain on the woman to come to an early resolution in what she wants to do.
Once this is established the girl 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 has vented her view (which maybe quite confused at this stage) it is possible to reflect back 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 guilt, personal beliefs, practical considerations, concern with loss, inability to possess a child in the foreseeable future (real or not), the impact 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 girl a visual cues to her dilemma. Later is can also act as a pros and cons 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 your client maybe coping with psychologically. At Abortion in Istanbul Turkey of the hour this can be a good idea to give a homework assignment to be emailed back to the therapist prior to the next session. Usually this 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 short paragraph on the here and now situation. The reason of 1 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. Exactly why is it important to talk about her background and upbringing? From a psychoanalyst perspective her history can reveal a whole 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 possibly be impacting on her current inability to see clearly what her own choices ought to 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, 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 customers clarification and reflections. All this is to enable the client through psychoanalysis to have 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 seek an abortion. She may not have made up her mind completely yet but is certainly getting a better notion of the choice that faces her.