Pre-abortion counselling: the difficulty of decisions
Termination often presents an ethical conundrum for clients. Thoughts like: “Should I continue with this pregnancy knowing I cannot or do not want it? Or should I choose to end it and face the judgment of family, friends etc?" are not uncommon. In fact; recent surveys have suggested that (in the United Kingdom) one out of every one hundred women has gone through a termination procedure this year. When you expand on these statistics, you come to the startling realisation that this is equal to around one woman facing this decision every 2.84 minutes. Most face it alone, or worse; face it feeling pressured into a decision by their family, their culture or their religion.
As part of counselling/therapy, a client’s autonomy is paramount. When working with termination, the counsellor may be the only person who’s agenda is purely the clients autonomy. Other various “stakeholders” in the decision may not prioritise the client’s autonomy in the same way that a counsellor might.
Identifying these stakeholders with the client is an important step in helping the client come to a more autonomous decision. Difficult questions like; “If you were alone, and had no one else, no family, no friends and no partner, how would this affect your decision?” help to focus the client’s attention on their own wishes and open lines of discussion about other stakeholder’s positions and whether they’re experiencing pressure.
If they are experiencing pressure from a partner or an overbearing family, then fear of abandonment may play a large decision in their decision worries like “if I keep the child, my partner will leave me”, or the just as common “I want to keep my baby, but my family are very strict about their culture and will disown me”.
In an ideal world, the counsellor would suggest long term therapy to work on the clients fears of abandonment, perhaps looking at self-esteem and healthy relationships, but most clients have a very small window to make a decision regarding a termination, so they may be limited to two maybe three sessions before the client must have made their decision, so the pressure is on.
Lastly, it’s worth remembering that though the client’s autonomy is a therapists end goal, the client may not want autonomy.
The client may be scared about the outcome of their decision, saying things like “What if I make the wrong choice? What if I terminate and then realise I wanted it? Or what if I keep it and realise I can’t do it and have to put it up for adoption?” Having another make that decision for them may feel very attractive for the client as if it doesn’t go the way they want, then they have someone else to blame other than themselves. Medical professionals and family members will often look to clients as being an expert in what they want, so offering a non-judgemental environment where a client can explore these issues in a safe space should never be underestimated.
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About David Borrill
David is a CBT Nottingham based Specialist Sexual health Counsellor working with HIV, Gender/ sexuality, Risky sexual behaviour and unplanned pregnancy.