Rachel's Hope
After Abortion Healing and
Reconciliation for Catholic Women
(or Catholic friendly)
Misdirected Therapy for
Post-Abortive Clients
Jim Benefield,
MFCC
jimbenefield@juno.com
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)
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
Crawford, Dr.
Douglas and Father Michael Mannion (1989) Psycho-Spiritual
Healing After Abortion.
Dillon,
Father John (1990) A Path to Hope.
Ney, Dr. Philip and Marie Peeters, M.D. (1997) Deeply Damaged (An Explanation For
The Profound Problems Arising From Infant Abortion And ChildAbuse).
Reardon, Dr. David (1987) Aborted
Women, Silent No More (Twenty Women share Their Personal Journey.F
from the Tragedy of Abortion to Restored Wholeness).
Selby, Terry M.S.W. (1990) The Mourning After: Help For The Postaboriion Syndrome.
Speckhard, Dr. Ann (1987) Psycho-Social
Stress Following Abortion.
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
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