Unplanned pregnancies and abortion counselling: Some thoughts on unconscious motivations

Abstract

My experience of abortion counselling¹ over ten years has shown me the importance of understanding the unconscious dynamics behind an unplanned and unwanted pregnancy. Unless these dynamics are made conscious and understood, the experience of abortion may have to be repeated again and again. Both becoming pregnant and having an abortion often involve unconscious conflicts and fantasies originating in a woman's early development and reflecting her relationship with her mother. These may be acted out via an unplanned pregnancy and decision to have an abortion. The central task of abortion counselling is to address and make links with the unconscious processes, and in particular help the pregnant woman recognize and acknowledge her ambivalent feelings. In this way the counselling makes use of the opportunity to reflect provided by the crisis situation of the pregnancy.     

Emotional sequelae of abortion: implications for clinical practice

For women in therapy who have had abortions, an exploration of the context and aftermath of each abortion has been suggested. This inquiry should include: characteristics of the woman herself before and at the time of the abortion, the nature of the interpersonal and cultural milieu at the time, characteristics of the medical environment and procedure, and any events subsequent to the abortion that may evoke regrets about the earlier decision.
Whether or not such an inquiry results in the identification of unresolved issues surrounding the abortion, it is likely to enhance one's general understanding of the client. Exploring a woman's decision to have an abortion can bring into relief developmental and family issues, relationship conflicts, and her aspirations for education, work, and family. A woman's approach to establishing and asserting her priorities and values in making difficult personal decisions becomes clear as does her ability to tolerate and resolve the ambivalence inherent in making difficult decisions.
In psychotherapy, it is important to understand and address those aspects of experience that women have difficulty resolving. Hence, the emphasis on categories of experience that may have a negative impact on a woman's emotional well-being after abortion. Nevertheless, the clinician should remember that even women who report negative post-abortion sequelae overwhelmingly report that they feel that the decision was the right one for them. Having ambivalent feelings to resolve does not necessarily mean that one has made a wrong choice, only that one has made an emotionally significant choice with far-reaching personal implications, in a sociocultural environment that reinforces the ambivalence inherent in such decisions.     

Rachel's Story: A Transpersonal Experience

This article presents a case study in which a client's transpersonal/religious/spiritual experience facilitated the achievement of her counseling goal. Through the paranormal experience, she resolved several of her conflicts, including a new appreciation of the church from which she had become estranged.     

Divorced women's sexual and contraceptive issues

This work attempts to answer the question: could divorce create a feeling of alienation in women which causes one to feel vulnerable and detached and thus making sexual decision-making and planning difficult? When a women is married her sexuality is taken for granted because she is expected to have children; however, after a divorce, she must face many of the conflicts she felt as a young single woman. Guilt, planning contraceptive use, and coming to terms with her sexual behavior all present themselves again. 1 factor that must be considered is that contraceptive use is always assumed to be the function of the married women. Very little research has gone into the contraceptive use habits of unmarried women. This is primarily due to the societal assumption that unmarried woman don't have sex. This work contains the clinical observation of the author in which 28% of 459 prenatal patients were interviewed specifically because they were divorced. The conclusion is that divorced women are being neglected by the health care profession and are in great need of contraceptive counseling. This work primarily discusses a study done to expand and examine the conclusions of the clinical research. The study consisted of 101 sexually active, legally divorced, single women between the ages of 18-44 and physiologically capable of becoming pregnant. 53 of these women had experienced post-divorce pregnancies. Each woman was interviewed and given 3 standard tests: the Rosenberg Self-Acceptance Scale, the Snyder's Self-Monitoring Scale and Beckham's Coping Strategies Scale. The conclusion of the author is that divorce and its associated psychological problems may temporarily or permanently affect one's thoughts, feelings, and life course. Sexual and contraceptive use decision-making are both directly both directly affected by these changes. Some divorced women may be experiencing inadequate self-esteem, identity, and self-awareness.     

Mother and child. A psychobiographical portrait of Mary Cassatt

The noted American impressionist, Mary Cassatt is remembered for her intimate portrayal of women, children, and the mother-child relationship. In this paper I have attempted to highlight some of the psychological forces impinging upon the artist, feeling that the artist's work is highly overdetermined. Mention was made of some of the difficulties that a psychobiographical study engenders. Nevertheless, it is hoped that such a study leads to enhanced understanding and appreciation of the artist, her work, and her rich inner world. An examination of the artist's life indicates that difficulties in the family of origin impinged upon her and deeply influenced her work. The loss of several siblings during critical developmental subphases may have produced intense survival guilt in Mary, motivating her to "recreate" her siblings on canvas and to devote her life to care of survivors. Lack of confirmation of Mary's talents by her father may have hindered her development, propelling the child toward a profoundly libidinalized and enmeshed relationship with the mother. Mary's intense relationship with her mother may have led the artist to develop particular stylistic nuances in her productions, contributed to her inability to become a wife and mother herself, and led to frequent episodes of depression. A case was made that Mary suffered from narcissistic disturbance, never completing the recognition of herself as a person outside of the orbit of her mother. Finally, the role of Edgar Degas in the artist's life was described. He seems to have played a major role in the evolution of Mary's style as well as being an important influence in her making a partial separation from her mother in adulthood. In spite of Mary's deep personal suffering, she was able to epitomize in her paintings the most tender and nurturant of relationships. By painting the mother-child theme, she sublimated her own wishes to become a mother as creator of art. Within her family system, she appropriated the position of mother; as the artist, she became the interpreter of this experience. By developing her talent, she communicated her wish to be a mother, and expressed the need to find, if only on canvas, a more truly empathic mother. In essence, her work allowed her to conceive of a life different from the one external reality imposed upon her. It also served as an indispensable adaptive function, allowing the artist to communicate with others, achieve recognition, and play.(ABSTRACT TRUNCATED AT 400 WORDS)     

Sometimes You Feel Like a Nut, Sometimes You Don't: Citizens' Ambivalence About Abortion

Recent research has recognized that many people simultaneously hold positive and negative attitudes about important political issues. This paper reviews the concept of attitudinal ambivalence and introduces a survey measure of ambivalence adapted from the experimental literature. An analysis of two statewide telephone surveys of Florida voters reveals that (1) a number of voters have ambivalent attitudes about abortion rights; (2) the amount of ambivalence varies according to the circumstances (elective versus traumatic) under which an abortion is obtained; (3) ambivalence about elective abortions is essentially unrelated to ambivalence about traumatic abortions; (4) voters who support abortion rights are more ambivalent about elective abortions than about traumatic abortions, whereas the pattern is reversed for abortion rights opponents; and (5) extreme views in support of or opposition to abortion rights can sometimes mitigate the amount of ambivalence felt by voters.     

Mens sana in corpore sano: Psychotherapy with a cerebral palsy child aged nine months

This paper is the acount of the psychoanalytic understanding and treatment of a nine-month-old cerebral-palsy infant and her mother. When first seen, Abigail hung over her mother's arm, and would scream unceasingly if moved from this position. The mother-child relationship seemed to involve their sticking to each other without looking or losing contact. The mother's hidden hate, anger and resentment were communicated non-verbally and Abigail showed signs of finding it difficult or impossible to integrate experiences, given the amount of trauma she had suffered from an attempted abortion and the lack of enough experience of being loved to enable her to grow internally.

The process of assessing the internal world of the infant and her mother, and the thinking and planning of the psychotherapy that followed, are described. In order to promote the secure attachment of the mother-child dyad, and the emotional growth of both, the helping process focused on understanding both the baby's and mother's states in order to make sense of the child's inner world to the mother. Because of the acute pain this process involved for the mother, she was treated individually too, by a different therapist.     

Counseling adolescents with problem pregnancies

The whole gamut of problems involved in counseling pregnant teens, from the national statistics and psychosocial context to the goals of counseling and follow-up are discussed. In the U.S. 40% of women have become pregnant by age 20 (1982 data), making this one of the highest rates of teenage pregnancy worldwide. Many factors contribute to this problem: adolescent development with its unresolved conflicts; teenage cultural myths about sex roles, such as the idea that it is harmful to deny sex to males; cultural roles for women such as being passive and therefore unprepared with contraception. The teen pregnancy, then, evokes a personal, interpersonal, moral and medical crisis. Goals for counseling are to help the young woman mjake a fully integrated, final decision; provide emotional support and referral information; to help her use the experience for growth. The decision often has to be rapid, because many teens delay revealing their pregnancy out of fear, yet prenatal care is essential, while a second trimester abortion should be avoided. Decisions about whether to bear the child, involve the father, the family, where to live, how to get financial support become complex. Even the counselor's background can be counterproductive, especially when the teen chooses STET unlikely to succeed. Issues of client's autonomy and confidentiality regarding family, the male partner, and even local regulations may confuse the process. Follow-up counseling may be indicated, for post-abortion or pregnancy support, for future contraception, for a committed relationship, or for balancing her needs versus her sexual partner's.     

The child's experience of Munchhausen syndrome by proxy

This paper examines the emotional impact of Munchhausen syndrome by proxy on a child aged 6 who had been poisoned by her mother. It describes her treatment in child psychotherapy over twenty months at the Cassel Hospital where the family worked towards her successful rehabilitation home. The work with her showed her experience of dangerous relationships in her family that left her distrustful of any new relationship, and doubtful of her capacity to be close without being destructive. Like her parents, she was terrified of facing the murderous feelings in the family, retreating into denial when life was too painful. The paper describes three phases of treatment: fear of separation and preoccupation with the trauma of poisoning, ambivalence about facing the destructiveness in the family and the move into more appropriate latency behaviour as she prepared to go home with her parents. It concludes with an overview of the impact of Munchhausen syndrome by proxy on the developing child, as shown in this treatment: the delay in emotional and cognitive development, the interference with the capacity to relate, the retreat into illness under stress, and the fear of permanent damage caused by the emotional and physical abuse.     

Barbie and the tree of life: the multiple functions of gender in development

Gender identity is the lens through which people experience being boy or girl, man or woman. It is a complex compromise formation that is not separate from the wishes, fears, and intrapsychic conflicts of other domains. Over the course of development, gender identity becomes layered and reconfigured. This paper looks at one child's experience of gender over several phases in her development in order to learn how gender is integrated into identity. At different times, as different conflicts came to the fore, she used gender to shape and lend definition to these conflicts. Conversely, her experiences in other spheres influenced her experience of gender.     

Abortion and the death of the fetus

Abortion is conceptualized as encompassing two aspects: ending the physical dependency relationship the fetus has to the mother, and terminating the life of the fetus. Analysis of the unique nature of the mother-fetus and mother-child relationship leads to the conclusion that both the act of abortion and the pregnant woman's decision to seek the death of the fetus can be logically justified.     

“A Failure of Curiosity”

ABSTRACT

This essay discusses the clinician's defense against and resolution of the experience of boredom in the countertransference as an incident of projective identification in the treatment of a woman with dissociative identity disorder. The essay details the inner mind of the therapist as she discovers both her own feelings and judgements of those feelings. As the essay progresses, she begins to grasp the significance of her discomfort in informing the therapeutic process. We watch as this material is made use of to move forward a stalled therapy into new territory.     

A clinical contribution to the etiology of lesbianism

Lesbianism may be viewed as an attempt to rectify malfunctioning in the original mother/daughter dyad. This paper discusses how failure of the girl child to establish female identification is preceded by failure to individuate, causing regression to an earlier symbiotic stage, resulting in feelings and desire for merging. It is this failure in development, regression to the symbiotic stage and wish to merge which may be a crucial component in the lesbian personality. The course of treatment of a young woman, who was not sure whether she was lesbian or not, is described with focus on her request for a hypnotic session, which was done by another therapist.     

The consequences of abortion legislation

This article examines the consequences of the 1973 US Supreme Court decision legalizing abortion as well as potential implications of proposed legilation aimed at nullifying this decision. In addition to giving women the right to determine their own reproduction, legal abortion had had beneficial health effects for both mothers and infants. The partial reversal of abortion gains due to restrictions on public funding and limitations on how and where abortions can be performed has produced a slight increase in abortion mortality, but the impact has not been dramatic. Moreover, each year since 1973, women have been obtaining abortions earlier in pregnancy. Abortion may be experienced as a loss by the mother, but there is no evidence of serious psychological sequelae. In contrast, a large body of evidence supports the physical, psychological, and social benefits of legal abortion to women, children, and families. However, proponents of the proposed Human Life Amendment place protection of the rights of the fetus over all other considerations. Their antiabortion actions have challenged the medical tradition of privacy and the confidentiality of the doctor-patient relationship. Most supporters of legal abortion would prefer that there be fewer abortions; such a decrease is more likely as a result of better education and contraceptive methods rather than coercion.     

A NEW READING OF THE ORIGINS OF OBJECT-RELATIONS THEORY

The author presents a reading of Freud's 'Mourning and melancholia' in which he examines not only the ideas Freud was introducing, but, as important, the way he was thinking/writing in this watershed paper. The author demonstrates how Freud made use of his exploration of the unconscious work of mourning and of melancholia to propose and explore some of the major tenets of a revised model of the mind (which later would be termed 'object-relations theory'). The principal tenets of the revised model presented in this 1917 paper include: (1) the idea that the unconscious is organised to a significant degree around stable internal object relations between paired split-off parts of the ego; (2) the notion that psychic pain may be defended against by means of the replacement of an external object relationship by an unconscious, fantasied internal object relationship; (3) the idea that pathological bonds of love mixed with hate are among the strongest ties that bind internal objects to one another in a state of mutual captivity; (4) the notion that the psychopathology of internal object relations often involves the use of omnipotent thinking to a degree that cuts off the dialogue between the unconscious internal object world and the world of actual experience with real external objects; and (5) the idea that ambivalence in relations between unconscious internal objects involves not only the conflict of love and hate, but also the conflict between the wish to continue to be alive in one's object relationships and the wish to be at one with one's dead internal objects.     

Pastoral considerations on abortion and sterilization

Concerns over sterlization and abortion typify our current moral dilemma. These matters begin as individual problems but rapidly expand to become pressing social concerns. The ethical, psychological, and physical factors related to sterilization in men and women are examined and a careful scrutiny of the meaning of the decision to the parties is advised. Abortion is an even more complex issue. The counselor's value system is always a part of the counseling process. Rigidity is not helpful in attempts to adjudicate conflicting rights among the child, the mother, and the father. Four alternative approaches to counseling with persons considering abortion are described.     

The Psychoanalysis Between Sándor Ferenczi and Elizabeth Severn: Mutuality,Unconscious Communication,and the Development of Countertransference Analysis

ABSTRACT

The psychoanalysis between Sándor Ferenczi and Elizabeth Severn was characterized by a controversial counterference analysis, in which the analysand, Severn, took an active lead. She can be seen as the co-creator of the Countertransference Analysis. In the two-person analytic dialogue that Severn and Ferenczi created to resolve the intractable therapeutic impasse in their analytic relationship, a dialogue of the unconscious emerged. Severn believed she was attuned to Ferenczi’s unanalyzed countertransference reaction to her. They had a special kind of relationship where attunement was at an unconscious level. In a sustained analytic encounter, she helped Ferenczi retrieve the experience of being sexually abused, which was the unconscious derivation of his negative countertransference to Severn.     

Self-harm as a sign of hope

The author describes psychotherapeutic treatment with a woman who uses severe forms of self-harm to express her hope that she can find real understanding and an environment that can respond to her. She discusses the significance of the earliest experiences of maternal care and the particular importance of the skin; she describes how traumatic breakdowns in early care are unconsciously re-created in later assaults on the body, which serve to communicate distress, anger, protest and the hope that a real attempt will be made to relate to the person who self-harms. Self-harm is viewed not as a suicidal gesture, but rather, as an attempt to preserve life, and to represent and contain unbearable states of minds. The author outlines ways in which self-harm can create a narrative and embody unbearable feelings and unspoken thoughts. It is seen as a form of self-expression and communication, both conscious and unconscious, which is not wholly destructive but has important hopeful and self-preservative aims.