Reclaiming Our Children: A Blog About Healing After Abortion

Misdirected Therapy for

Post-Abortive Clients

Journal of Christian Healing

Volume 19, No. 4, winter 1997

Jim Benefield, MFCC
P.O. Box 17363 San Diego,
CA 92177 (858) 581-0952.

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The impact of
abortion(s) in relationships is increasingly becoming one area of
inter-relational conflict that is described here as "The presenting
problem." If a therapist sees this issue mainly as "grief and loss,"
then the therapist is missing the mark. If the therapist's "direction
for treatment" is mainly toward treating the abortion as a "grief and
loss" issue, this could result in therapy being psychologically
injurious and pedagogically unsound, especially if the client reveals a
Post-Traumatic history, as revealed by Jenny. An abortion is at least a
grief and loss issue. It is much more for the client who presents this
as an ego-dystonic distress. For her, there is "shame, guilt and fears"
attached to the "grief and loss" which must be worked through in order
to prevent decompensation and future relational difficulties. This
processing of the "total pain" is necessary in order to foster
wholeness and mental, physical and spiritual equilibrium.

     Jenny,
(not her real name) an attractive blue-eyed brunette, came timidly into
my office showing definite signs of caution. She presented her
"problem" at the onset by saying, "I came to you because my best friend
said you really helped her and she recommended you to me. But I must be
honest with you. I'm not sure if I want a male therapist or another
female one. My last therapist was a woman who changed my life, and not
for the better." I just listened as she divulged her story. "I'm 30
years old next month and when I was 20 1 became pregnant by this jerk
who basically told me that there's no way he was willing to settle down
and be a family man. I thought he cared for me. Boy! Was I wrong! But I
still cared for him. I thought that if I went along with his wishes and
his pressuring for an abortion that everything would return to
"normal," that we would get along and that he would see that I really
loved him. I went to the abortion clinic alone after he found excuses
as to why he couldn't go with me. I had the "procedure," but I knew
that "procedure" had just taken the life of my child. I couldn't stop
that hurting inside." When she spoke she kept her eyes turned away from
me, almost as if she expected to find disapproval, criticism and
condemnation from me. Why not? It's only psychologically natural that
she would expect from others what she is feeling about herself. She has
been condemning herself all these years, surely this is what I also
would do.

Initial Therapeutic Response and Analysis

     I commented
after her long pause, "You had high hopes that if you went along with
his wishes that your life and your relationship with him would somehow
resume a semblance of normalcy." I was praying internally for the
Spirit of God to anoint both of us with Wisdom and insight and to bring
comfort to- this client.

     She sadly
responded, "My life would never be "normal" again. After the abortion,
the relationship with him seemed to slip into nothingness. I didn't
have him. I didn't have my baby. I didn't have anything. I didn't even
want to live." As she continued to speak, her eyes welled up. She
didn't bother to wipe away the tears as they rolled down her cheeks.
Here was a client who was accustomed to crying.

     "That
experience still represents a lot of pain for you even ten years later
doesn't it?" I commented. I had several other questions come up
immediately but I resisted because I didn't want to interrupt her. She
instantly began to sob and after a minute or so stated, "The pain has
never gone away. I don't know what normal is anymore…. My family
noticed a definite change in me almost right away and kept telling me
to "to get rid of that "chip" your carrying" and "snap out of it." The
trouble is that they don't know that "it" was an "abortion." Nobody
knows! They (the family) noticed that I seemed to be angry most of the
time, that I was no longer going to Mass on Sunday, that I was avoiding
more and more family functions, that I was eating my meals after
everyone had left the kitchen and spending many more hours in my room.
I was afraid that if my secret got out my family would disown me and my
friends would leave me. Not going to Mass on Sunday was my way of
hiding from God and avoiding my shame. I knew that after that
experience of having an abortion that I could never go through that
again."

     I was thinking as she unfolded her painful story that so much of what she was sharing was common of
many post-abortive women. For this client, this sorrowful account was
new and indigenous to her only, but in my practice I had heard many
similar accounts that reflected much of the same array of distressing
symptoms, along with other symptoms. However, if I had tried to reduce
her trauma down to common grief experiences, this in effect
would have resulted in my minimizing her pain at this early stage of
therapy. This would have been a therapeutic mistake resulting in her,
"shutdown" and would have discounted what she came to me for help about
in the first place. After all, it is natural for us to want to avoid the pain that we must, go through in order to receive healing.

     If someone
helps us minimize our areas of discomfort, we are more inclined to
cooperate with that individual; especially if that individual is a
professional. This is like a patient with a migraine headache: if the
doctor doesn't suspect that this patient has a tumor, s/he may minimize
the pain and give the patient two aspirins to make the headache go
away, instead of the tests and surgery as indicated. The patient,
ignoring the seriousness of their condition, places their trust in the
physician. Also, the patient would much rather take two aspirins and
believe that everything was fine instead of being subjected to more
testing that would reveal a more serious condition, leading to the
traumatic experience of brain surgery. Inasmuch as the patient is
willing to follow through with the advice of the physician and take two
aspirins, the patient also feels deep inside that the "problem" is far
worse then the physician presents with his concerns and medical
remedies. The burden of responsibility for correct diagnosis and
therapy belongs to the clinician for healing, not to the
patient. Similarly, Jenny needed to confront fully her anguish, before
therapy could help alleviate her pain. The cure of the pain is in the pain. Transformation of her distress to grief and loss would come later in therapy.

     She
continued, "After that, I tried to lose myself in the pursuit of a
college degree. Shortly after college, I started seriously dating this
guy. Even though I wasn't planning on getting sexually involved, I did.
I made sure that I was protected. So, how on earth could I get pregnant
again! When I told my boyfriend, he was sad for me; but he conveyed to
me that our relationship was not serious enough for marriage. Sadly, I
agreed. I didn't want to go home, but I did."

     "I hated
the thought of telling, my parents because I knew what I would get from
them. But I also knew that I couldn't go through having another
procedure." I remember it being a "black Friday" when I told my parents
that I was pregnant without a husband. My mom cried. My dad was silent
and withdrawn. I was humiliated. I had let them down. The one thing my
mom would say almost every time we (her three daughters) went out
dating was "Don't come home pregnant"." My mom's worst fear had come
upon her. I hated my dad's withdrawn attitude as much as I hated my
mom's verbal attacks. I wanted to retreat from their verbal and silent
accusations, but I knew I had to face the music."

     She spoke
at length as to what it was like for her to stay in her parent's house
and endure their "initial reactionary response." She stated that "in
spite of their disappointment in me and being embarrassed to have their
unwed daughter come home pregnant, I knew they loved me. I felt that in
time they would come around. I also somehow knew that their anger at me
was because they were scared for me…. I was scared for me!"

     "My hope
was that my parents would "hate" me, for just a little while, but come
to love the baby, their Grandchild, when it came. I hoped that I would
be forgiven. By the middle of the third month I was getting used to the
idea and feeling of pregnancy. My mom was showing little signs of
acceptance and my dad was beginning to lessen up on the silent
treatment. I was hopeful…. In my fourth month I miscarried. "Then I
had all kinds of feelings going on at the same time. I felt empty. I
felt sorrow. I felt relieved. I felt fear. There were so many
questions. Why did this happen? Was God punishing me? Will I ever be
able to have children?"

     "For the
next six years I devoted my time and energy into my career. I dated
casually without involvement. I really was not interested in male
relationships even though some very nice men tried to regularly date
me. However, last year I met this wonderful man, Robert, who was tender
and caring. We moved in together. He would frequently bring up the
subject of marriage, but then he would say "not yet." I was on birth
control pills and figured that I was safe. Well, guess what? I wasn't!
I became pregnant, again! How could this happen to me again? I tested
myself with a home pregnancy test twice and still couldn't believe it.
Before telling Robert, I went to my doctor who confirmed what I was
denying."

     "It took
me a week before I could find the courage to tell Robert that I was
pregnant with his child. I kept asking myself, "why am I afraid to tell
him." I must have known that he would not be very happy with me. When I
told him, he was annoyed and said, "I thought you were protecting
yourself from "that." You know that I wasn't planning on this happening
with us for some time, certainly not this soon." I
told him that an abortion was out of the question when he proposed that
"as the only way out if we were going to have any kind of meaningful
relationship." He insisted. I insisted…. After what I had previously
experienced with my parents, there was no way I could tell them this
time because it would hurt them too much for me to come home pregnant
again. I also knew that I could not endure having another abortion. I
had sacrificed my first child with the hope of happiness with a man and
I had lost my second child. I could not sacrifice another."

     "Just as I
had never told my parents about my first pregnancy and abortion,
neither did I tell Robert. I could not tell him because I felt he would
not accept me with this past. He did know about the miscarriage and the
pain involved from that loss. My world was turning upside down. I felt
I was going crazy. At one point Robert turned on me and screamed, "You
need to see a shrink." I decided to go seek counseling."

Inappropriate Therapeutic Analysis and Response

     "I felt
that only a woman therapist would understand what had happened to me. I
knew there was no way that I could even come close to disclosing my
life to a male therapist. At first my therapist seemed to understand my
predicament and really was able to help me through role-playing which
was instrumental in improving my relationship with Robert. She kept
referring to my problem as a grief and loss issue. By the fourth
session, something was not feeling right in my gut. She knew from the
first session, that my past ten years had been haunted with the painful
memory of my abortion, and that there was no way that I could live
through another. I told her, "I can't do this again, it will kill me!"
I noticed that I was beginning to stiffen-up every time she mentioned
that this was a grief and loss issue. If this was just a grief and loss
problem, why did I hate myself so? I became guarded."

     "It dawned
on me that she was protecting him, and not me. "He's really scared.
He's really not ready to settle down, is he? This doesn't appear to be
the right time for a baby in your relationship with Robert, does it?
It's hard decision making time for you. Your priorities are hard to
figure out, aren't they? You need to explore what is more important to
you at this time, your relationship with Robert, or losing that
relationship by having this baby? What will happen to you and your
career if you decide to have this baby, a career that you've worked
hard for these past years? What will this do to your relationship with
your parents? Have you thought about the possibility that maybe your
stronger than you think you are, and that deep down you realize that
life would be simpler without a child in your life at this time?" She
asked many questions like these, and each one of these began to feel
like a pin in my stomach. At the end of the fourth session she asked,
"You said that you hated having to go to the abortion clinic by
yourself the last time. Well, if you want someone to go with you to the
clinic, I will take you, would you like me to take go and give you
support?" I said, "no," and left her office. I felt sick. I felt crazy
and even more confused then when I came into her office. I felt
betrayed."

     Jenny
realizes now more then ever that desperate people do desperate things
because less than two weeks later, with therapy that was detrimental to
her initial goals, she had her second abortion. She was angry at her
therapist for "protecting him." She was angry at her therapist for
adding to her confusion. She was angry at her therapist for approaching
her predicament without previously disclosing her own prejudices and
biases, especially since she knew Jenny's clear-cut stance concerning
any future abortion. She was angry at her therapist for not revealing
and reviewing with her other available options such as single parenting
or adoption. She was angry at her therapist for not referring her to
someone else, like a priest. (Jenny had disclosed in therapy that she
had left the Catholic Church after her first abortion). Mostly, she was
angry at herself for her fears and being so weak.

Appropriate Therapeutic Analysis and Response

     Jenny
needed her anger to help keep her from spiraling down into deep
depression. Her guilt, shame, and fears coupled with her grief and loss
was too much for her to handle. When shame and guilt become so
monumental, one frequently looks for an outlet from the heavy burden of
shame by blaming someone or something else (in Jenny's case, her
therapist). For a brief period of time, this avoidance defense
mechanism can be helpful in maintaining a sense of sanity before one is
ready to work through one's own guilt and shame. It is referred to as
the Shame-Blame Scenario. Simply put: "I can't tolerate what
I'm feeling about myself with this shame and guilt. If I can find fault
with you and how you hurt me, then I can direct my anger at someone
that is outside of me rather then being angry and hateful within." This
way of responding to shame and guilt may go on for some time, until the
individual gains enough inner strength to face their demons, and with
God's grace look within. This is not to say that Jenny did not have
legitimate right to her anger at her therapist.

     Jenny came
into her therapist's office with a major ego-dystonic problem; she had
violated her own code of life by having an abortion that she knew was
not acceptable to her innermost self. Ego-dystonic behavior
means anguish to the psyche whenever an individual moves against their
ingrained moral life code. This puts the psyche under stress, The
creator the violation of one's moral code, the greater the ego-dystonic
distress to the psyche, which begins to cloak the personality in
clandestine existence. Secrecy about one's ego-dystonic behaviors
becomes a way of life. Isolation often occurs. Countless defense
mechanisms are commissioned to counter the crazy-making input into the
psyche. The psyche guards against receiving, anything, that threatens
or is unacceptable to the ego. In Jenny's case, she experienced the
ego-dystonic anguish, secrecy and isolation for ten years and needed
someone who could hear her confession of guilt and not dismiss her
wrongfulness as a normal life experience of grief and loss. She needed
someone who could gently help her into and through the processing, of
"the shamefulness of her selfishness," instead of validating the
violation of her moral code. She cried, "my first abortion ruined my
life. There is no way I can do this again. It will kill me!"

     If Jenny
had come into her office and said, "I had an abortion ten years ago,
but it doesn't represent any problem for me," then the therapist is
under no obligation to pursue the subject. This would be ego-syntonic which
refers to the acceptability of ideas or impulses to the ego, which
receives the impulses as compatible with its principles. An
ego-syntonic way of living, is no problem for the individual. Of
course, there's also the possibility of a pseudo ego-syntonic
presentation of the personality when a client will come into therapy
with a presenting problem that is masking a real distressing
ego-dystonic painful issue.

     When a
client comes into the office with a specific ego-dystonic presenting
problem (as Jenny did), the therapist is obliged to address this as one
of the main goals of treatment in therapy for this client, or refer to
another mental health professional. It's unfortunate when a client
says, "I cannot do this again, please help me," that the therapist
minimizes, normalizes and side-steps this ego-dystonic problem. It
constitutes poor judgment and gross negligence because the best
interest of the client is also being side-stepped, and may open the
therapist up for a civil suit. The client may have legitimate grounds
for litigation. In this case, because of Jenny's questions about
bringing a lawsuit against her previous therapist, because, "she ruined
my life," I needed to refer her to her lawyer. (Her questions were out
of the scope of my licensure.)

     Jenny is
suffering from what some may refer to as legitimate and genuine guilt
or existential guilt and sorrow. "My guilt has overwhelmed me like a
burden too heavy to bear" (Psalms 38:4). This basically means; I have
executed an act that violates my way of believing and living. I have
gone against my inner-truth. I have done something wrong. As stated
above, this produces dystonic tension where the psyche " or personality
is not in harmony with itself or its environment. This is to be
separated from neurotic or false guilt where a person is feeling guilty
over something that is truly not of his/her doing. Jenny admits, that
when all is said and done, that she is the "owner" of her decisions and
not her therapist. Even though she was greatly influenced by
significant others, as "owner," ultimately she is accountable.

     In
therapy, Jenny has come to recognize that she suffers spiritually as
well as emotionally and physically. She knows where she's been, but in
Jesus we have forgiveness. "In him we have redemption through his
blood, the forgiveness of sins, in accordance with the riches of God's
grace" (Ephesians 1:7).

Therapeutic Progress

     Jenny is
committed to doing her therapy. After 4 months in therapy she is making
lots of headway into the anger that she has towards herself and others.
There's lots of work that she has to do in order to bring resolution
into the unfinished business of her past with its regrets and current
relationships. I subscribe to the Bowenian1
school in one approach to helping Jenny with her emotional reactivity
and working through her pseudo self. A pseudo self is a pretend or
false self which is constantly shaped in reaction to external emotional
pressures in her environment and relationships. If she remains in her
pseudo self for her outward presentation, she would continue to promote
a retarded growth and development in relationships, plagued with
uncontrolled emotionality. As Jenny cultivates an emotional separate
self with the ability to think, feet and act for herself and in her
best interest she will progress towards a healthier differentiated
self. Others will not be able to manipulate her into violating her
inner code. In that context, one of the goals of therapy is to help her
become differentiated without emotionally or physically cutting herself
off from significant friends and family support systems.

     Because of
her Catholic upbringing, I referred Jenny to her parish priest. She is
working hard to accept God's forgiveness and to forgive herself. I also
referred her to a San Diego Catholic woman's workshop that specifically
addresses the issues of a painful abortion(s) – Rachel's Hope: Healing and Reconciliation weekend Workshops for Post-Abortive Women."2 This
added opportunity gives her what she could not receive in individual
therapy, no matter how good that therapy might be, that is, to listen
to the sharing of other women who have been affected by abortion.
Individual therapy and group work are compatible with one another and
not counterproductive to the therapeutic process. The client can bring
into therapy those issues that have surfaced in-group for further
in-depth processing. If Jenny was from another Christian denomination,
or even non-churched, I would have made other group referrals to help
remove Jenny from her isolation.

The Issue of Abortion

     For some
therapists, even Christian therapists, the issue of abortion is a
charged and controversial subject. Undisclosed biases may get in the
way of productive therapy that fails to address the goals and best
interests of the client. Counterproductive psychotherapy is the result
when we fail to disclose our firm biases, thus, failing to provide a
proper informed consent from our clients. In the above case, Jenny came
to her therapist with the understanding that the therapist was capable
of assisting her work through her current situation with a definite
goal in mind – that of avoiding the decompensating experience of the
past. Instead, Jenny met with someone who seemed to be moving against
the "grain of her goals." Jenny specifically asked her over the phone
before she even met with her if she had worked with other women who
have had a regretted abortion. The therapist's response was, "I have
worked with many women who have angry and mixed feelings after having
had an abortion." This indicated to Jenny that this therapist was
knowledgeable about the issues surrounding "after-abortion pain." It
appears that she wasn't knowledgeable because the therapist kept
referring to Jenny's "predicament" as a grief and loss issue. The
therapist did not address the overriding insurmountable issues of
shame, guilt and fears. Did Jenny have proper informed consent from her
therapist as to the direction she, the therapist, would be coming from?
It appears not from Jenny's distressing point of need.

Conclusion

     If we as
therapists give the impression that we can work with every issue that
comes across our path, then we may indeed be delusional about our
ability, resulting in diluting our therapeutic abilities. Any
misrepresentation of our ability or biases could also get in the way of
obtaining a proper informed consent from our client. An improper
informed consent is equal to no informed consent. Therefore,
psychotherapy could become psychologically injurious to the client, as
it was for Jenny. If our own prejudice gets in the way of pursuing the
goals of the client (the pursuits of our own agenda for this client),
then we as therapists are ethically obliged to seek out consultation
and maybe even counseling for ourselves. It may be necessary to refer
to another mental health professional if we cannot come to resolve our
dilemma. In Jenny's case, this was not a matter of wanting help in
getting another abortion but her reaching out for professional help
because of an abortion that was ego-shattering, and for professional
guidance to prevent a repeated ego-splintering performance. I
apologized to Jenny, on behalf of our profession as therapists, for
letting her down. Tearfully, she accepted.

Reference Notes

1. Papero, Daniel V. Bowen Family Systems Theory (1990) Needham Heights, MA: Allyn & Bacon.

2. Rachael's
Hope: Healing and Reconciliation Weekend Workshops for Post-Abortive
Women, Catholic Charismatic Center, 4202 Genesee, Suite #102, San
Diego, CA 92117,(619) 581-3022.

Suggested Reading

Crawford, Dr. Douglas and Father Michael Mannion (1989) Psycho-Spiritual Healing After Abortion. Kansas City, MO: Sheed & Ward.

Dillon, Father John (1990) A Path to Hope. Williston Park, NY: Resurrection Press.

Ney, Dr. Philip and Marie Peeters, M.D. (1997) Deeply Damaged (An Explanation For The Profound Problems Arising From Infant Abortion And ChildAbuse). Victoria, Canada: Pioneer Publishing.

Reardon, Dr. David (1987) Aborted Women, Silent No More (Twenty Women share Their Personal Journey.F from the Tragedy of Abortion to Restored Wholeness). Chicago, IL: Loyola University Press.

Selby, Terry M.S.W. (1990) The Mourning After: Help For The Postaboriion Syndrome. Grand Rapids, MI: Baker Book House.

Speckhard, Dr. Ann (1987) Psycho-Social Stress Following Abortion. Kansas City, MO: Sheed & Ward.
 

     Jim
Benefield, MEd, MPC, MA-MFCC, is a licensed family therapist in the San
Diego area, and a graduate of Trinity College of Graduate Studies in
Anaheim, CA (with an extension campus in San Diego). He openly
advertises himself as "A Therapist with Christian Values."  He is a
member of "St. Brigid Catholic Church where he and his wife Rosemary,
are leaders of the charismatic prayer group. He is a member of the
Association of Christian Therapists and a life member of the California
Association of Marriage and Family Therapists.