DIGEST - Volume 9, Issue 2

2 TPC Digest 2 | TPC Digest A bortion involves the removal of an embryo or fetus from the uterus before the age of viability. An estimated 25% of women in the United States will seek abortion care before age 45. Although research does not support a causal link between legal first trimester abortion and mental health problems, emotional distress may arise from both the circumstances surrounding an unintended or unhealthy pregnancy and the decision to seek abortion care. From a cognitive behavioral therapy (CBT) perspective, distress after abortion may be conceptualized as linked to thoughts and behaviors related to one’s abortion experience. Identifying and talking about thoughts and behaviors related to negative emotional states can help patients who are feeling stuck to move forward. This article provides guidance about ways counselors can help to address four different types of thought patterns experienced by abortion patients experiencing emotional distress. First, hindsight bias is the tendency to use current knowledge to re-interpret past situations. Abortion patients who exhibit hindsight bias may believe they knew then what they know now, and they may assume that they have failed in some way by making the decision that they did. Second, belief in a just world involves the simple idea that good things happen to good people, and thus bad things happen to bad people. A third and closely related belief is outcome-based reasoning, a tendency to assume that emotional distress is the natural result of a bad decision. As applied to abortion patients in distress, the end result (distress) may be thought of as reflecting the quality of the decision to terminate the pregnancy (bad). Fourth, all or none thinking may involve a tendency to hold either oneself or another person as singularly responsible for the pregnancy, for a complicated or unhealthy pregnancy, for making the decision to seek abortion care, or for causing the circumstances that led to the abortion decision. In addition to exploring thought patterns associated with emotional distress, this article offers recommendations to promote a respectful, collaborative alliance between counselors and abortion patients. It is recommended that questions be asked in a genuinely open way with the goal of eliciting more information about the events that occurred and how those events are perceived at present. Counselors also are advised to use the terms that patients themselves use to describe themselves, others, and their experiences. Ideally, counselors avoid making assumptions about gender identity and sexual orientation, whether contraception was used, whether the pregnancy was planned or desired, and whether the sex was consensual. It also is recommended to listen carefully for how the patient describes social roles for self and others (e.g., whether abortion patients refer to themselves as “mothers”). In addition, counselors are advised to avoid language with either direct or implied political connotations. For example, the term “decision” can be used instead of “choice” (similar to “pro-choice” activism), and “after–abortion” can be used instead of “post-abortion” (similar to “pro- life” activism). By applying concepts and methods from CBT, counselors may collaborate with abortion patients. Patients may become more aware of their thoughts and connections among their thoughts, behaviors, and feelings. Developing this type of awareness within the context of a respectful counseling relationship may foster adaptation and recovery. Jennifer Katz is a professor of psychology at SUNY Geneseo. Correspondence can be addressed to Jennifer Katz, Bailey Hall, 1 College Circle, Geneseo, NY 14454, katz@genesco.edu. Jennifer Katz Supporting Women Coping With Emotional Distress After Abortion