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.     

Indian college students' attitudes toward abortion in different contexts

Two experimental studies used the hypothetical situation of a pregnant woman (the stimulus person) considering the possibility of an abortion and obtained from Bombay college students estimates of the likelihood of an abortion and their own recommendations in favor of abortion. The first study had a 2 (subject's sex) × 2 (reason for abortion: unplanned child vs. female child) × 2 (person more in favor of abortion: stimulus person vs. her husband) × 3 (stimulus person's socioeconomic status: upper, middle, or lower class) factorial design with 15 subjects per cell. Male subjects indicated greater likelihood of abortion than female subjects. Recommendations were stronger for the unplanned rather than female child and for the lower class rather than upper and middle class stimulus persons. The second study had a 2 (subject's sex) × 3 (reason for abortion: unplanned marital pregnancy, premarital pregnancy, or rape pregnancy) × 3 (stimulus person's socioeconomic status: upper, middle, or lower class) factorial design with 15 subjects per cell. Perceived likelihood and strength of recommendation were highest for rape pregnancy followed by premarital pregnancy and marital pregnancy in that order. The interactions in this study suggested a greater vulnerability of the middle class as compared to the other two classes with respect to sexual morality.     

Pregnancy: A social stigma?

Experimental evidence is presented which explores the social stimulus value of pregnancy. It was found that, for men especially, the pregnant woman elicits avoidance and staring and that these responses occur primarily because pregnancy is a novel visual stimulus. For women, avoidance seems to be tied less to the stimulus aspects of the pregnant woman than to role expectations about her behavior. The pregnant woman is expected to be passive, but is simultaneously rejected for being so. It is argued that this constellation of responses may produce discomfort and withdrawal in the pregnant woman herself, since avoidance and staring are easily interpreted as negative reactions. How these reactions fit into the cultural response to pregnancy is discussed.     

Sex education attitudes and outcomes among North American women

Attitudes and outcomes of sex education received by North American women are examined via an Internet survey (N = 1,400). Mean age was 19.5, with 24% reporting one or more unplanned pregnancies. Women were more satisfied with sex education from informal sources than from parents, schools, and physicians. Those receiving sex education from parents or schools reported fewer pregnancies and abortions. In school, women receiving a combination of contraceptive and abstinence education and those receiving primarily abstinence education were least likely to experience unplanned pregnancy. Religious identification was significantly related to unplanned pregnancy and type of sex education received from parents. These factors seem to play a significant role in reducing unplanned pregnancy and abortion.     

Cancer during pregnancy: Two case studies

When a pregnant woman develops cancer, death and life are competing in her body and in her mind. In this article, two cases of pregnant cancer patients are described. The pregnant women were accompanied through their journey toward delivery and during the first months with their newborn. The process of being in intensive cancer treatment during pregnancy, of giving birth, and of building an early relationship with the infant is explored.     

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.     

Prenatal psychotherapy and maternal transference to fetus

The psychodynamics of normal pregnancy include ambivalence, identification with the fetus as an outside object, as a part of self, and, finally, as a separate person. Positive and negative attributes can be projected upon the fetus. In infant-centered maternal psychotherapy, the infant often serves as a transference object. Many disorders of attachment or disorders of early parenting have their origins or manifest themselves in the prenatal period. During prenatal psychotherapy, the fetus can serve as a transference object. Review of the literature reveals conflicting views with regard to the effectiveness of prenatal psychotherapy. The developmental crisis of pregnancy may lead the woman to resolution of underlying problems with early detection and intervention. Review of the literature reveals cases of disorders of attachment and disorders of early parenting starting prenatally related to the mother's difficulties with her own parents or siblings. Case studies of prenatal psychotherapy demonstrate the role that the fetus plays as a transference object in the mother's efforts to rework some conflict from her own infancy or childhood.     

Pregnancy Plans of First‐time Mothers and Their Children's Outcomes: An Examination of Mechanisms

Unintended pregnancy is prevalent in the United States and has been linked to challenges for both mothers and their children over time. However, studies have not yet identified mechanisms through which pregnancy intention is associated with children's outcomes. Identification of mechanisms among families at risk for negative outcomes will inform early clinical intervention. This current study examined the association between mothers' pregnancy plans reported during pregnancy and children's externalizing, internalizing, dysregulation, and social–emotional competence outcomes at 3 years old among an at‐risk sample of 682 first‐time mothers from the Predicting and Preventing Neglect in Teen Mothers Study. Further, this study identified mechanisms in the association that can be targeted in clinical intervention. Mediation analyses revealed that mothers' parenting stress when children were 24 months old served as a mechanism in the association between unplanned pregnancy and children's low social–emotional competence at 36 months. Implications for research and clinical practice are discussed. Specifically, early intervention with mothers experiencing unplanned pregnancies may help to promote healthy outcomes among their children over time. Copyright © 2016 John Wiley & Sons, Ltd.     

Schlafstörung

A 41 year-old woman presented with restlessness and constricting and pressing dysesthesia in both calves and feet. These symptoms bother her especially in the evening while watching TV and later while lying in bed. She has to stand up repeatedly and walk around in her flat to obtain some temporary relief of her symptoms, which first appeared during her pregnancy 6 years ago and have become gradually worse over time. The patient complains that nowadays she lies awake in bed for up to 2 h until she can go to sleep several times a week. She wakes up 2–3 times a night only to find herself fighting to go back to sleep. During the day she noticed difficulties concentrating during work and frequently reacts angrily towards her husband and her daughter.     

The Development of Reflective Functioning in a Mother Traumatized by Past and Present Events: Facilitating Change in the Parent-Infant Relationship

This article presents clinical work with a woman who experienced trauma in both her childhood and adult life and who demonstrated poor reflective functioning. Treatment began during the patient’s pregnancy and continued with dyadic work with mother and baby in an effort to help the patient address and reflect on past and current life stressors and to develop a healthy mother-child relationship. A review of reflective functioning precedes the case material.     

A study of abortion and problems in decision-making

This paper is directed to those individuals who are sufficiently disturbed by the complex realities of problem pregnancies and who are prepared to think beyond the confines of ideology. Rigid ideological positions tend to create distance from the hard complexities surrounding concrete human situations and to limit the realities of pain and helplessness that may exist for each of the parties to an unwanted pregnancy. Pregnancy is more than a biological condition or an isolated emotional entity giving rise to joy or grief. Pregnancy introduces a new relational component to an already existing relational network, and, conversely, abortion is neither simply the evacuation of the products of conception nor an endpoint to emotional stress. It is, in actuality, a broken relationship. In the clinical experience of these authors a sense of sadness frequently accompanies a woman's choice to undergo an abortion. Some problem pregnancy counselors maintain that they have never known a woman who terminated pregnancy without sadness. This information reinforces these authors' observations that facing a decision to have an abortion is not easy, often stressful, and an occasion when a woman should feel entitled to obtain the help of her total relationship system in arriving at a decision. The decision to continue or to terminate a problem pregnancy is rooted in a complex network of relationship factors that have an effect on the decision-making process. Repeated occurrences of unwanted pregnancies in the family are more than individual and disconnected events. Relational strategies that effect decision-making in problem pregnancies are effective in the hands of helping agents who value conjoint, intergenerational reciprocity as a therapeutic paradigm.     

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.     

Dancing Contact Improvisation with Luce Irigaray: Intra‐Action and Elemental Passions

This article takes as its point of departure Luce Irigaray's Elemental Passions, in which a woman‐speaker tries to make her lover and the discipline of philosophy understand that she is not how they have imagined her to be; that she is not at all but that she keeps becoming through perpetual movement. The article investigates Irigaray's investment in a form of materialist difference feminism that offers conceptual links to the posthumanist work of Karen Barad's agential realism, especially her theorization of intra‐action. The link between Irigaray and Barad is established via a diffractive reading that incorporates the dance/movement research practice of Contact Improvisation. Although expressed through written language, Elemental Passions creates the impression of the woman‐speaker dancing, of encountering herself, her environment, and her lover through moved and moving contact, searching for a practice of moving‐together, feeling‐with, and feeling‐between that can be experienced in an improvised dance duet. Exploring how touch and the sharing of weight in Contact Improvisation challenges boundaries and establishes ever‐changing configurations and entanglements between dancers, the article proposes that Irigaray's woman‐speaker envisions herself as a posthuman/ist woman and that improvised dancing offers a practice of intra‐action through which she can encounter the world in her becoming.     

A Living Life, A Living Death: Bessie Head��s Writing as a Survival Strategy

This paper explores Bessie Head's writing as a survival strategy through which she transformed her lived experience into imaginative literature, giving meaning and purpose to a life under permanent threat from the dominant group first in South Africa and later in Botswana. This threat included the destructive effect of the many fixed labels imposed upon her including: a 'Coloured' woman, the daughter of a woman designated mad, an exile, a psychotic, a tragic black woman, and a Third World woman writer. Her endeavours to avoid and defeat such limited, static definitions produced work characterised by contradiction and paradox, through which she asserted her right to survive and determined, like Makhaya in When Rain Clouds Gather, to establish 'a living life' in place of the 'living death that a man could be born into' (Head 1989, 136). Through a combination of Head's personal letters and papers and her published work, it can be seen how her particular preoccupations and experiences including her life in exile, her beliefs about her origins, her relationship to her absent mother, her distress, her madness and her need for love and for work were transformed into writing which expresses not only the destructive circumstances of her life but also its life-affirming aspects. Her writing was also a means by which she could create identities to express the dangers she encountered from the all-pervasive power structures which influenced her life and her sense of self, as well as ways to transcend them, enabling her to say in the last years of her life 'I am no failure' (20.2.1986 KMM BHP).     

Nudging the Responsibility Objection

abstract   The 'Responsibility Objection' to Judith Thomson's famous argument for the permissibility of abortion challenges the relevance of her 'Violinist Analogy' to certain types of voluntary unwanted pregnancy, on the grounds that those pregnancies, even though they may be unwanted, are pregnancies for which the woman can be plausibly held responsible. This article considers the force of a number of recent objections to the Responsibility Objection, advanced by Harry Silverstein, David Boonin, and Jeff McMahan, and judges them to be unpersuasive. It is concluded that, in the absence of further considerations, the Responsibility Objection carries force.     

Baby Think It Over: using role-play to prevent teen pregnancy

This study examined the effectiveness of Baby Think It Over (BTIO; Jurmaine, 1994), an infant simulation program that seeks to modify attitudes toward teen pregnancy and teen parenting. As in the study by Saltz, Perry, and Cabral (1994), the premise was that teens engage in unprotected sex because of a personal fable concerning pregnancy: "It can't happen to me." It was expected that participation in BTIO, a form of role-play, would encourage teens to acknowledge their own personal vulnerability to an unplanned pregnancy, and provide them with some insight into the experience of adolescent parenting. One hundred fourteen eleventh-grade students participated. After two to three days' experience with BTIO, teens in the intervention group were more likely to accurately assess their personal risk for an unplanned pregnancy than were teens in the comparison group. Qualitative analyses revealed that teens in the intervention group were significantly more likely to produce concrete examples of activities and consequences related to child-rearing than were teens in the comparison group. Findings of this study are discussed from the perspective of the health belief model (Rosenstock, 1974), and suggestions for further research with BTIO are made.     

Effects of reviewing risk-relevant behavior on perceived vulnerability among women marines

People generally underestimate their own vulnerability to negative events such as illness or accidents. It has been suggested that this illusion of "unique invulnerability" is due to selective focus on one's own risk-reducing behaviors, to the exclusion of others' risk-reducing behaviors and one's own risk-increasing behaviors. The current study examined the effects of reviewing sexual and contraceptive behavior on perceived vulnerability to unplanned pregnancy. Our results indicated that review of pregnancy-related behaviors decreased perceived vulnerability among two groups of subjects: those who considered unplanned pregnancy to be most undesirable and those who had the most confidence in the efficacy of their contraceptive behavior. The data also support the hypothesis that selective focus is a source of the illusion of invulnerability.     

Sisters of the Heart Along the Way: The Power of the Female Mentoring Relationship

Women's mentoring relationships with other women can have powerful effects on professional development and enrich the lives of both mentor and protégée. Women psychology students and early career psychologists are tasked with integrating their personal and professional identities and overcoming gender-related barriers to professional growth and career success. Mentors provide assistance negotiating these and other challenges to the junior professional's development. The author shares her experience as a woman student and early career psychologist in the context of her relationship with her woman mentor. She discusses her reconciliation of stereotyped beliefs about being a woman and a professional psychologist; processes significantly influenced by powerful characteristics of her mentoring relationship such as supportive encouragement, modeling, transparency, and spiritual connectedness. The author then explores the link between the relational qualities in the mentoring relationship and an enhanced overall approach to clinical work with patients. Last, the benefits of women's intimate relationships are discussed, followed by references that explore benefits and challenges, and models and strategies for women mentoring women. The author concludes that as a sister of the heart relationship, the mentoring bond between women can be a healing and empowering attachment.