Abortion and the Field of Psychotherapy

Frank Bruni wrote the following in an op-ed for the NYT on Wednesday May 4:

When Justice Neil Gorsuch was confirmed to the Supreme Court, I saw the writing on the wall. When Justice Brett Kavanaugh followed him, that writing was neon. And Justice Amy Coney Barrett? We’d entered foregone-conclusion territory. It was only a matter of time.

Now, it seems, the time has come.

And I’m really, really scared.

Over the next couple of months, Julia and I will write quite a bit about the numerous topics that are connected with abortion and the feared rejection of Roe v. Wade in early 2023, including (but nowhere near limited to).

1. Fertility and infertility. In fact, check out our recent podcast episode with certified sex therapist Paula Leech, in which we talk about the personal and relational challenges that arise with infertility.

2. Miscarriage. Did you know that the official medical term for miscarriage is “spontaneous abortion”.

3. Women’s health.

4. Women’s choice. Sadly, items three and four are severely disconnected in our country.

5. Adoption. I’m adopted, and am here because my birthmother chose not to abort me. (She abandoned me at the hospital for a local nonprofit to deal with, but that’s another story.)

6. Poverty and government support. Were my birthmother to receive more effective support from the government, such as Medicaid benefits during/after pregnancy, would she have made a different decision? What about the millions of women like my birthmother?

7. Sex education. I wonder how many abortions and unwanted pregnancies would be avoided if our school systems talked about and provided contraceptives in schools.

8. The Netherlands, our future home (for two years). Guess what country doesn’t have this issue? As Lisa Juanola and Irene de Vries of the Sexual and Reproductive Health and Rights in the Netherlands write, “In our work at the international level, we see that restrictive laws do not reduce the total number of abortions, but only increase the risk of unsafe abortion.” Learn more about how the Netherlands has addressed abortion here, so that it has one of the lowest abortion rates in the world.

9. How is our country going to care for children, mothers, fathers, and communities following these births? Ahh yes, the primary question that the Republican Party refuses to address.

I want to be careful writing this post, because while my emotional reaction—a spectrum from eyerolling to straight outrage—is important to hear, the voices and experiences that need to be highlighted are those of women. We’re excited to use this podcast and blog in the coming year to share some of these stories. There’s far too many men who are making decisions about what happens to women’s bodies; I don’t want to add to that trend.

I want to write about an element of this that’s close to my heart, as co-host of this podcast and executive director of a professional organization for therapists: Mandatory counseling requirements for folks who receive abortion.

Don’t get me wrong, counseling can be extremely helpful for folks who are exploring abortion, given that they make the choice to initiate services.

Thirty three states require that women receive some sort of counseling before an abortion is performed. Two thirds of our country. And twenty-seven of these states require that women must wait (generally 24 hours) between the counseling appointment and the abortion procedure. Fourteen of these states require that said counseling must happen in person.

Let’s have the conversation about what circumstances need to arise in order to make counseling “mandated”, and how abortion gets clumped into other criminal situations like child abuse and domestic violence in a separate blogpost.

The truly scary part of this, as a licensed marriage and family therapist, is that the following mandatory counseling requirements (on top of universal HIPAA standards) exist for counselors who work with folks who receive an abortion.

According to the folks at the Guttmacher Institute:

• 31 states require that women are told the gestational age of the fetus. (Remember, this is most commonly to be told to the patient 24 hours prior to the abortion procedure.)

• 27 states require counselors to provide information about the risks of abortion, often using inaccurate information, such as the suggestion that an abortion may lead to a PTSD-adjacent experience called “post-abortion stress syndrome”, despite the fact that scientists have disproven the existence of such a thing.

• 13 states require counselors to provide information on the fetus to feel pain.

• 5 states require counselors to share the inaccurate connection between abortion and increased risk of breast cancer.

Regarding mental health issues, the authors summarize, “Mental health problems among study participants were associated with being in an unstable relationship when pregnant, experiencing negative life events in the past year, or having a history of mental health problems.”

Again, the above sentence presumes that Republican lawmakers are actually interested in the mental health of women and children. So let’s return to the topic at hand.

At its best, psychotherapy is directed by the needs of the clients. The client establishes the goals, with assistance from the therapist, and the therapist and client participates in dialogue to collaboratively work toward the client’s goals, not the therapist’s goals. The challenge for the therapist is to provide a safe, self-reflective structure for the dialogue while simultaneously not imposing their beliefs and assumptions.

Our jobs as therapists are hard enough. A collection of non-therapists (be that a government or insurance company) that requires therapists to give information that guilts a person into making a decision, especially when that information is also medically and sociologically inaccurate, creates an ethical dilemma: Follow the law, at the risk of participating in a harmful therapeutic process, or follow what we know and have researched about the therapeutic process, human development, and relationships, at the risk of getting sanctioned, fined, or, as Texas is threatening, arrested.

Should the integrity of the field of psychotherapy continue to be challenged by conservative legislation moving forward, count me in as someone who’s willing to get sanctioned, fined, or arrested in the name of protecting the civil rights of all human beings.