Unplanned pregnancies and abortion counselling. Some thoughts on unconscious motivations

In a climate where the numbers of abortions and repeat abortions are increasing, it is necessary to improve our understanding of the dynamics that motivate the behavior of abortion seekers. While genuine contraceptive failures do exist, many unwanted pregnancies result from unresolved conflicts carried over from the woman's early relationship with her mother. The management of any pregnancy is often accompanied by feelings of ambivalence, and abortion itself is an expression of ambivalence reflecting a previously unconscious wish for a baby and a conscious wish to end the pregnancy. How these issues are handled also reflects the position the woman occupies in her life cycle. Examination of the early mother-child relationship may shed light on what unconscious needs are being expressed through the "acting out" mechanism of repeat abortion. If the mother-child relationship failed to establish an internal representation of a caretaking function, the child will lack the capacity for self-care and may seek abortion as a deliberate mechanism of self harm. Until such conflicts are resolved, abortions may be repeated. The abortion experience may also reflect a desire for a woman to individuate from her mother. Abortion counseling offers women an opportunity to understand and work through the damage resulting from their relationship with their own mothers. One case study, of a 25-year-old undergoing her fifth abortion, provides an example of acting out psychic pain resulting from a damaging maternal relationship. This woman lacked the capacity for self-care and could only tolerate counseling sessions until she overcame the acute vulnerability imposed by her most recent abortion. Another case study, of a 27-year-old seeking counseling after experiencing overwhelming feelings of guilt, shame, and inadequacy, provides an example of a woman seeking individuation and unconditional love. This woman used counseling successfully to develop a better understanding of herself and a certainty that she could be loved despite her flaws. Such dynamics do not always inform the abortion experience, but abortion is always a distressing experience, and counseling should always be available. Abortion counselors must come to terms with their own ambivalent feelings and unconscious conflicts in order to serve their clients.     

Induced abortion: an ethical conundrum for counselors

Induced abortion is one of the most controversial moral issues in American culture, but counselor value struggles regarding abortion are seldom addressed in counseling literature. This article considers the conflictual nature of the the ethical principles of autonomy, fidelity, justice, beneficence, and nonmaleficence as they can occur within the context of the counseling relationship, particularly with clients considering abortion. In addition, the authors present strategies for counselor self-evaluation, offer recommendations, and provide questions to facilitate ethical decision making.     

Self-blame, self-efficacy, and adjustment to abortion

The causal impact of attributions and coping self-efficacy on adjustment to abortion was examined. Two hundred and eighty-three women were randomly assigned prior to their abortion to 1 of 3 counseling interventions: 1 designed to alter attributions for unwanted pregnancy (ATT-INT), 1 designed to raise coping expectations (EXP-INT), or a control (standard counseling) group. Depression, mood, anticipated consequences, and physical complaints were assessed postabortion. Women in the ATT-INT or EXP-INT group were better adjusted immediately postabortion than women in the control group. The EXP-INT group was also less depressed than the ATT-INT group. Three individual difference factors were also related to better adjustment: high coping self-efficacy, low self-character blame, and low other-blame. Self-efficacy also predicted adjustment 3 weeks postabortion. Implications for theories of adjustment to major life events, therapeutic interventions to assist coping with such events, and public policy on abortion are discussed.     

A Thematic Analysis of Men's Experience With a Partner's Elective Abortion

Research concerning men's experience with a partner's abortion is limited. To foster understanding of this topic, the authors used online surveys to gather data from men whose partners underwent induced abortion. A thematic analysis of men's comments about their experience revealed 3 salient themes: loss and grief, helplessness and/or victimization, and spiritual healing. Findings are discussed in terms of future research and counseling practices as they relate to pregnancy outcome decisions.     

Abortion and Mental Health

Abstract

Unwanted pregnancy and abortion are common life events, and therapists are likely to work with clients who experience them. Legal abortion currently entails little physical or mental health risk; most women currently cope effectively with these life events without need of clinical intervention. But current abortion politics include efforts to make abortion a more threatening, stressful, and stigmatized experience and to create a “postabortion syndrome.” Using a stress and coping framework, we examine how antiabortion activists spread myths and misinformation aimed at women's appraisal processes, and discuss approaches therapists can use to enhance women's strategies for coping with abortion. We also discuss specific issues and useful techniques for counseling about abortion concerns, including cultural sensitivity and strategies for promoting positive sexual health.     

The hidden grief of abortion

This article explores the possibility of dealing with grief reaction when counseling a woman who has undergone an abortion. It first defines what is meant by a grief reaction in this context, then proposes a model for understanding various degrees of grief reaction, and finally examines some of the factors which determine the severity of a grief reaction in the case of abortion.     

Differential impact of abortion on adolescents and adults.

The purpose of this study was to compare adolescent and adult reactions to abortion. A sample of 252 women from 42 states was obtained from a national survey of organizations serving as support groups for women who have had negative reactions to abortion. The age analysis was run using t-tests. Results indicated that the adolescents were significantly more likely to be dissatisfied with the choice of abortion than were the older subjects, to have abortions later in the gestational period, to be dissatisfied with services at the time of the abortion, to feel forced by circumstances to have the abortion, to report being misinformed at the time of the abortion, and to report greater severity of psychological stress. The conclusions suggest that the adolescents' problems may be due to a combination of developmental limitations and the nature of counseling at the time of the abortion.     

Women's self-reported responses to abortion

The legalization of abortion in many states has allowed an alternative for women with unplanned or unwanted pregnancies who do not wish to deliver and raise their children or to place them for adoption. Of 158 women asked to recall their responses to the experience, 21% reported psychosocial satisfaction at the time of abortion, and 45% reported satisfaction several months later; over half reported an improved outlook on life, and nearly half found abortion preferable to other alternatives for future unplanned pregnancies. It may prove important to make counseling or therapy available to about 10% of women who report negative responses (guilt and confusion) to the abortion.     

Genetic Counseling Practices in Germany: A Comparison Between East German and West German Geneticists

As part of an international study of ethics and genetics, we present a comparison between survey responses of 43 East German and 212 West German geneticists to anonymous questionnaires. Both groups indicated that the experience of the Third Reich has impacted the genetics profession in Germany today. East German geneticists reported more directive counseling practices after prenatal diagnosis for 10 of 26 conditions than those from West Germany. When asked to give their personal opinions about pregnancy termination, East Germans were more accepting of abortion than their West German colleagues for 7 of 24 fetal indications. In addition, there were significant differences between the two sample groups for 8 questions on the perception of disability and society. Discussions with German geneticists suggest that, while both groups were affected by Germany's experience of Nazism, different abortion laws, political systems, and ideas about the doctor-patient relationship in former East and West Germany may account for discrepancies in reported genetic counseling practices and in attitudes toward abortion and disability.     

The Experience of Genetic Counselors Working with Patients Facing the Decision of Pregnancy Termination after 24 Weeks Gestation

Prenatal genetic counselors are health care professionals who counsel women making reproductive decisions which include decisions such as terminating pregnancies due to fetal anomalies. Little is known about the experiences and practices of prenatal genetic counselors working with women who have the option of termination after 24 weeks gestation. In this national survey of 168 genetic counselors who have practiced prenatal genetic counseling, we asked about their general practice patterns, including indications for which termination is offered and types of abortion care services that are coordinated by genetic counselors. We report respondents’ self-assessments of level of understanding of federal abortion law and abortion procedures. Seventy-six percent of respondents have offered and counseled on termination after 24 weeks and 93% of respondents believe it is the responsibility of the counselor to discuss this option with patients. However, one-third report that they have some or no understanding of the procedures and three-quarters report that they have some or no understanding of federal abortion law. The results of this study provide insight into knowledge and experiences of genetic counselors working with these patients, allowing for improved genetic counselor training and continuing education to provide better guidance and develop more effective means of assisting patients.     

Emotional response to abortion: a critical review of the literature

Anti-abortion groups in the US cite the existence of a post-abortion syndrome--a sense of loss, emptiness, and grief similar to that reported by trauma survivors. Although research on the longterm effects of induced abortion is marred by methodological errors, most studies have found no adverse psychological sequelae; rather, there appears to be a sense of relief and opportunity for personal growth. Nevertheless, there is a small group of women who do experience emotional distress after abortion and it is important to identify the demographic, social, and psychological factors that place women at risk of such a reaction. In terms of demographic factors, young age (adolescence), low or nulliparity, 2nd-trimester procedures, and Catholicism have been characteristics of women who suffered post-abortion depression. Of the social variables that have been examined, a lack of support from significant others (parents or partner) has been linked in some studies to emotional distress after abortion. A relatively consistent finding is that women who feel coerced to abort or are ambivalent about their decision at the time of the procedure are most likely to experience regret, depression, and anger. Women whose coping style involves avoiding responsibility are also prone to post-abortion distress. As noted, the literature does not support the contention that abortion causes longterm trauma. On the other hand, given the fact that 1.5 million abortions take place each year in the US, the existence of some post-abortion distress in even as small percentage of acceptors is enough to indicate a need for pre- and post-abortion counseling to help women determine the meaning of the experience and own their decisions.     

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.     

“Testing Times,Challenging Choices”: An Australian Study of Prenatal Genetic Counseling

In many countries pregnant women deemed to be at increased risk for fetal anomaly following a screening test may attend a genetic counseling session to receive information and support in decision-making about subsequent diagnostic testing. This paper presents findings from an Australian study that explored 21 prenatal genetic counseling sessions conducted by five different genetic counselors. All were attended by pregnant women who had received an increased risk result from a maternal serum screening (MSS) test and who were offered a diagnostic test. Qualitative methods were used to analyze the content and structure of sessions and explore the counseling interactions. Findings from this cohort demonstrate that, within these prenatal genetic counseling sessions, counselor dialogue predominated. Overall the sessions were characterized by: a) an emphasis on information-giving b) a lack of dialogue about relevant sensitive topics such as disability and abortion. Arguably, this resulted in missed opportunities for client deliberation and informed decision-making. These findings have implications for the training and practice of genetic counselors and all healthcare professionals who communicate with women about prenatal testing.     

Counseling the abortion patient: A pastoral perspective

Unplanned pregnancies are common among women in every congregation. Ministers have an opportunity to offer pastoral abortion counseling to those who wish it that is different from secular problem pregnancy counseling; the minister can offer a value context and facilitate a deep investigation of the decision-making process in a personal way. Concrete information regarding abortion procedures, situational factors important in problem pregnancy decisions, and emotions associated with problem pregnancies are discussed under the headings healing, guiding, and reconciling.She has been involved professionally in the family planning field for six years.     

Selective Abortion for Down Syndrome: The Relation Between the Quality of Intergroup Contact,Parenting Expectations,and Willingness to Terminate

This study examines the links between familiarity with individuals with Down syndrome (DS), perceptions of parenting a child with DS, and willingness to consider selective termination subsequent to a fetal diagnosis of DS. Within a sample of childless young adults (N = 280), those reporting personal familiarity indicated both more positive attitudes toward parenting a child with DS and more certainty that they would not abort following a prenatal diagnosis. In further support of contact theory, the quality of the past intergroup interactions moderated these findings. The potential role of negative stereotypes in selective‐abortion decision making and implications for prenatal counseling protocols are discussed.     

Current Findings Regarding the Effectiveness of Counseling: Implications for Practice

Research on the effectiveness of counseling is reviewed, and conclusions are drawn about the consequences for professional practice. The research literature clearly shows that counseling is effective in relation to no-treatment and placebo control conditions. The effects of counseling seem to be relatively lasting. These effects are attained in relatively brief time periods, with the percentage of clients who show substantial improvement increasing as the number of counseling sessions increases. There continues to be little evidence of specific efficacy for particular techniques or counseling theories, and a small portion of clients seem to deteriorate while undergoing, and perhaps because of, counseling interventions.     

Developmental Counseling in the Elementary School

Some of the fundamentals basic to a theory and practice of developmental counseling with the elementary school child are set forth. Pertinent child development research is cited that implies the need for developmental counseling with normal children. The value of this counseling in the elementary school setting is in facilitating the total learning process. Unique factors of this counseling, including short-term service, focus on developmental problems, and the establishment of goals, are described. Principles for working with children in the counseling process are discussed.     

Career and personal counseling: Comparing process and outcome

Increasingly, there is a call to support the integration of career and personal counseling. However, few empirical studies have examined the overlap between these 2 domains. This study examined how career and personal counseling compared on both process and outcome measures. The participants included real clients who sought career and personal counseling at 3 college counseling centers in the U.S. The findings indicated that except in the area of expectations about counseling, there were no significant differences between career counseling and personal counseling. The implications for counseling practice and training are discussed.