The Emotional Journey of an Abortion Decision and How Therapy Can Help

The Emotional Journey of an Abortion Decision and How Therapy Can Help

By: Anikó Blake, LMFT

Grief, relief, uncertainty, and direction. These are only a few of the many coexisting feelings that can arise after having an abortion. This highly nuanced experience is one that thousands of people go through every year—sometimes more than once—and yet many find themselves feeling isolated and alone. Most likely, you or someone you have known has been impacted by an abortion. At a time when narratives that narrowly define and represent the abortion decision-making and recovery process fill the political discourse, it is more important than ever that accessible therapeutic support exists. This includes supportive spaces that allow diverse voices to be safely heard, foster self-compassion and empowerment, and grow community. Someone who has received an abortion will likely benefit from the same mental, emotional, and relational care that we extend to other significant life moments. They will need access to the care that allows us the healing and peace we need in order to develop and thrive. 

There is a human tendency to reduce experiences in order to make sense of or categorize them in one way or another. This rigid, black-and-white thinking offers us a temporary feeling of being in control at the cost of being able to honor the full complexity of being human. This is especially the case when it comes to broader social discourse and political views about abortion. By focusing on one component or fact, we fall into the trap of creating an argument void of empathy and humanity. Singular and narrow talking points overlook or ignore that abortions are not chosen for one specific reason. It is impossible to fully capture all of the unique circumstances that factor into someone choosing to abort their pregnancy. General themes to these factors include the timing in someone’s life, their gender expression or sexuality, their goals and life aspirations, and their own health or the health of the embryo or fetus. In addition, people can feel a myriad ways about their abortion(s) before, during, and after the surgical or medical procedure. This includes emotions that arise immediately afterwards, months later, and years down the line. Some emotional themes are relief and direction from the ability to terminate relationships and pursue goals, self-assurance and ease from greater LGBT+ identity alignment, disappointment and anger from breaks in trust with a partner(s) and support system, and sadness and longing from one’s connection with parenthood and their aborted baby.

Connecting with one’s own abortion story is neither immediate nor linear. And it can be different from one abortion to the next. For many who have had an abortion(s) hearing simplified narratives about abortions on a public level, making claims about the type of people who tend to receive them and how someone should feel about their abortion(s), can feel minimizing; It leaves out the many facets of their abortion(s) experience that are woven into their daily lives.

Grief is a tricky word to use when talking about abortion since it can be misconstrued as regret. While not everyone regrets their abortion decision, transitions and significant life decisions can often bring some type of grief. Abortions are typically a surgical or medical procedure that occur with limited time for preparation and someone may need time to make sense of how they feel about their experience. In fact, generally speaking, not knowing how we feel right away is ok. Some people may not feel any grief about their abortion(s) while others may feel a great amount of it. Abortion grief might be tangible, such as acutely experiencing the physical loss of a pregnancy or ending a relationships with someone in their life due to the abortion. Grief also can be ambiguous, such as experiencing the emotional loss of connection to aspects of one's identity or to their imagined parenthood had they carried to term. And grief might be delayed and complicated, particularly when the abortion happens in tandem with other loss or reconnects us to unresolved loss from our past. For some, abortion(s) can be another teachable moment in acknowledging the legitimate grief we can still feel when we let go willingly. The process of exploring emotional nuance can include sorting through conflicting emotions in order to make sense of each of their origin stories. Then we can build a map for moving forward with mixed or coexisting emotions about the same event. Over time, emotions such as grief, sadness, and anger can be felt harmoniously with relief, peace, and even hope and determination. 

As therapists, we learn that adequate support improves the outcome of a significant life event. On one hand, someone can have a trauma response to the surgical or medical abortion itself, whether it relates to someone’s physical experience during the procedure or how their care was managed. On the other hand, someone’s trauma can be related to the response they receive about their abortion(s) from others, or the non-decision makers: such as partner(s), family, friends, broader communities, and leaders. Abortion stigma, agendas about abortion access, and personal values, beliefs, and goals from non-decision makers can become barriers to helping people who are considering an abortion make an informed decision and identify their own reasons and emotions. These barriers reduce access and availability to support resources and can ultimately create more mental, emotional, and relational complications later on. They can also increase mismanagement of care which can result in health risks. It is common for people having an abortion to receive misleading or incomplete information about the surgical or medical process, to experience ineffective collaboration across their care teams, and to not receive critical follow-up physical, emotional, mental, and relational support afterwards. These issues are heightened by rapidly changing abortion laws and policies and inconsistencies across clinics and states.

Offering someone accurate and comprehensive information about their abortion options and providing non-agenda based listening as they explore their decision are some of the ways that non-decision makers, including partner(s), family, and friends, can support someone who is considering an abortion. 

Therapy is a confidential and carefully structured form of support for aiding people through life transitions. Those who choose to have an abortion, including life-saving or medically necessary abortions, deserve clinically informed and ethically grounded treatment for their emotional, mental, and relational healing. This type of treatment improves self-awareness and empowers someone to make informed and intentional decisions about their lives. Therapy before or after an abortion may be focused on grief, identity development, shame healing, trauma recovery, relationship repairing, and community building all at the same time. Knowing if, how, and when to talk about an abortion(s) with a therapist can be difficult and sometimes scary. If you are currently working with a therapist, ask them if this is a clinical area they have worked with before. You can also ask them about the type of therapeutic model or approach they would use for working with a client who is considering or has received an abortion. If your therapist is unable to support you in processing your abortion options or decision experience they may be able to refer you to another therapist more specialized or familiar in this area. These recommendations also extend to those who did not receive an abortion but were impacted by another’s abortion decision and would like therapeutic support.

Therapy is a form of treatment where client information is protected (with exception to the reasons listed in Illinois law for Mandated Reporters). Your safety is of utmost importance. If you are concerned about risks to your safety by talking with a therapist about an abortion you are considering or have received, collaborate with them on a plan to increase safety. For example, consider working with a therapist without using your insurance, since insurance companies may ask for diagnostic codes and treatment summaries to assess coverage for therapy services. If you are in couple or family therapy and do not want your partner(s) or family to know about your abortion, consider starting individual therapy. If you are looking to process the abortion with your partner(s) or family in therapy, make sure everyone is in agreement about the confidentiality of what is shared in session. Make sure you and your therapist are in agreement about documentation and case consultation, particularly if they have your consent to speak with another clinician on your care team. If you are not open about your abortion with someone in your place of residence, consider working with a therapist who can offer in-person sessions in their office versus attending virtual sessions in your home. Use caution when emailing, texting, or leaving voicemail messages with private information. A phone conversation via a therapist’s confidential and direct number and electronic message sent through their secure HIPAA-compliant software system (EMR) are safer ways to share information about yourself with a therapist. 

If you are looking for additional resources, for you or someone else, you can find them below. Please make sure to assess any resource, clinic, and provider before receiving care to make sure that they are a good fit for you.

• Our Stories: Post-Abortion Support and Processing Group: A group I facilitate at the start of each year, please reach-out via my linked bio for more information. 

• All-Options: Abortion resources and talkline.

• Chicago Abortion Fund: Abortion support resources and monthly group.

• Exhale Pro-Voice: Abortion counseling and textline.

• Faith Aloud: Compassionate and unbiased spiritual and religious support. 

• Planned Parenthood: Abortion facts for those considering an abortion.

Conflict-Resolution and Resilience: “Can we try that again?”

When couples embark on therapy it is often to change patters of conflict that are wound so tightly responses can feel like ‘autopilot’. Yet, courageously they commit to the idea that there is another way to go about conflict: one that is more healthy and productive for everyone involved. Often times this process can become stuck, even when couples have created or acquired excellent new ways to engaged in difficult conversations. Such new options may linger during pivotal moments, but familiar ways sink in and the same pattern unfolds.

       There is a powerful tool that fits well during this time, when new options are emerging but difficult to apply. Sometimes it can feel like unlikeable patters occur quickly and the conflict reaches a point of no return. It may be the case that break is needed. A pause can help shift from patterns of reactivity, and assist with de-escalation of conflict and re-regulation of one’s body and emotions. Moving into a state of positive cognitive regulation can also help expand and integrate one’s awareness to their internal cues and external environment, which supports the brain in finding a empathetic and creative stance towards approaching challenges. Once ready, couples may find it useful to re-approach the difficult conversation and give it another try.

       As a matter of fact, the suggestion can be phrased exactly like that, “Can we try that again?” It emphasizes personal responsibility, honors a shared goal, and suggests an idea to re-direct the interaction in order to stay on course to achieving it. Here is the thing, in order for the suggestion to maintain its useful intent and have an overall positive effect, two steps need to be taken with it:

1.     The receiver must be ready to join-in and see the question as an attempt to improve the quality of the relationship and resolution of the conflict. Intentions must be clear by both parties that it does not ‘erase’ what happened before. Rather, they are acknowledging that what happened before was ineffective, and that another way of communicating might work better.

2.     Both members must be willing to take a creative stance on what happens next. By this, they must be willing to approach the new attempt as ‘explorers’. They can look out for how it feels to engage or be engaged with in this new way, and the result is has on the process and outcome of the conversation. They may even be willing to provide some immediate feedback on how it went.

3.     Then, the suggestion can be introduced. Again, focusing on how it might support the work the couple has committed to. Some options for phrasing it can be (but are certainly not limited to):

“I feel like we fell off course from what we are working on, can we try that again?”

“I really liked that way of responding to each other that we have been talking about doing, and I would like to apply it here, can we try that again?”

“This is an important conversation, and I want to make sure we are able to talk through it, can we try that again?”

         Trying to shift ways of engaging with challenging topics can be a long-term process. It can take patience to see a difference in how conflict is handled and the outcome it produces. Creativity and a willingness to keep trying and applying new skills, even when the ‘usual’ way persists, can be the resilience that makes a difference in creating relationships worth wanting.

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Boundaries and self-esteem: how caregivers can encourage life-long empowerment for their children

Boundaries and self-esteem: how caregivers can encourage life-long empowerment for their children

By: Anikó Blake, AMFT

There's a magical moment when we are infants and discover where another’s body ends and ours begins. More literally the separateness starts when our umbilical cord is cut and we truly become our own bodily mechanism. Our own entity. Early on, we begin to determine what is our touch versus another’s, something that experts call self-world differentiation. In fact, by the time we are four months old we begin selecting what we do and do not want to touch. In an interview with Scientific America, researcher Anne Bigelow describes that, “…early understanding of self and early understanding of other is developed through interaction. It teaches babies basic lessons that they have some agency in the world… as opposed to just being helpless to whatever happens to them.” A crucial form of this interaction is skin to skin contact. Touch is an essential component to overall development, and the mechanism from which we begin to develop our earliest sense of self

Self-esteem is how we define our worth, and developed through knowing that we have a choice in how we treat ourselves and how others treat us. What we need in order to acquire healthy self-esteem is experience making choices about our own bodies and confidence that the choices will make us feel good about ourselves. Even at a very young age, these choices are a matter of both safety and enjoyment in life. If we need that sense of control over our environment early on, in order to feel safe and confident, why is that adults seem to avoid talking about boundaries and consent until children are well into adolescence? And why only in the context of romantic or sexual relationships? Let us back it up a bit, shall we?

The data is clear that encouraging infants and children to create their own boundaries for touch facilitates healthy development and relational success throughout life. And as a bonus, it comes with the relief that talks about consent by parents and caregivers do not have to wait until it has to do with sexual intimacy.  Caregivers can and should facilitate everyday, age-appropriate, and applicable conversations that encourage safety and self-esteem throughout life. These conversations prepare children for making some more challenging decision about touch later in life. Below is a template you can use to give these early conversations a try:

Create a context: Children need to understand the nature of context. For example, here are the situations in which it is acceptable to do X, and here are the situations in which it is unacceptable to do X. Talking about context is preferable to saying that something is always bad. Framing behaviors in terms of contexts also helps kids adhere to social guidelines without experiencing shame. By talking about contexts, children learn that certain types of touch are not allowed in certain locations or with certain people, rather than it is bad to touch or that they are a bad person for touching. 

Provide options: Knowing that there are choices for the types touch that children can give and receive helps children:

1) foster a sense of autonomy and confidence.

2) trust their internal cues for safety and enjoyment of touch.

This also means teaching them how to advocate for options, though developing the language of “can I have a _____ instead” or “I do not like ____ but I do like ____”. Consider talking with children about what types of touch they do and do not like, before they have to decide.

Model your own boundaries: Providing children with insight about how you read your internal cues and preferences can help children learn useful language for describing their own. It can also help them learn empathy through tuning in to another person’s experiences and facial and body cues. For example, offer some commentary when other people touch you or when you touch yourself, such as, “I do like how it feels when my body is held here but not here.”

Stay consistent: Keeping the same messages allows children to know that the rules of personal choice matter regardless of the context or person. For example, children have a right to choose how the say to goodbye to someone (hug, high-five, no touch, etc.) regardless if it is a grandparent or classmate.

A great aspect of encouraging boundaries and self-esteem across a child’s development, and into adulthood, is it follows what they are already doing! From infancy, children are looking to become “embodied bodies”: to be seen, felt, and understood by others. The synergy of helping children experience wanted and enjoyable touch while helping them seek it, as well, is that it promotes self-awareness and a positive relationship with touch. This foundation of empowerment paves the way for children to become better advocates for their needs and their safety throughout life. That way, when the topic of touch becomes about sexual intimacy, children are already well equipped to know how to advocate for their own safety and enjoyment while reading the cues of others, as well.

Above is a great place to start, but if you are looking for more check out the articles below:

“It’s never too early to teach children about consent and boundaries” by Anne Theriault for the Washington Post

“Healthy Sex Talk: Teaching Kids Consent, Ages 1-21” by Alyssa Royse, Joanna Schroeder, Julie Gillis and Jamie Utt for everdayfeminism.com

“5 everyday ways to teach your kids about consent” by Lisa McCrohan for upworthy.com