TPC Journal-Vol 9- Issue 2-Full-Issue

The Professional Counselor | Volume 9, Issue 2 101 and familial values about abortion, parenting, and the concept of forgiveness. Finally, counselors can promote client self-care, potentially by identifying “safe” people to whom patients can disclose. When working within this broader framework, and while drawing upon best practices for pregnancy loss (e.g., Wenzel, 2017), a cognitive behavioral therapy (CBT) framework may help foster recovery. This article discusses (a) different ways to understand abortion-related distress, (b) concepts and methods from CBT that may help counselors support abortion patients, and (c) general recommendations for the respectful use of questions and language. Understanding Emotional Distress After Abortion Counselors may draw upon vastly different ways of understanding how and why abortion patients experience emotional distress after abortion. In the early 1990s, Vincent Rue proposed the existence of post-abortion syndrome (PAS), a variant of post-traumatic stress disorder. According to Speckhard and Rue (1993), “the trauma involved in being both attached to and responsible for the death of one’s fetal child can be emotionally overwhelming, and cause a range of symptoms” (p. 5). Symptoms of distress may manifest as guilt, self-directed blame and anger, sadness, intrusive thoughts about fetal death, and problematic family relationships, among others. Speckhard and Rue suggested that in some cases, distress may fluctuate with the menstrual cycle. In other cases, distress may remain dormant until patients experience subsequent reproductive events such as childbirth or menopause. Although some find PAS to be useful in conceptualizing cases, there have been longstanding debates about its validity (e.g., Dadlez & Andrews, 2010; Edwards, 2009). PAS has not been recognized as a formal medical or psychiatric diagnosis. Furthermore, PAS is often used in political contexts to argue against abortion rights and access (Dadlez & Andrews, 2010; Kelly, 2014). That is, “pro-life” activists use PAS to argue that potential abortion patients are likely to be emotionally harmed by abortion and therefore should be protected from making the decision to seek abortion. In contrast, British “pro-choice” activist Ann Furedi (2016) argued that abortion-related distress may be more strongly related to the circumstances that led to pregnancy and the need for abortion than the actual abortion procedure itself. Although not all abortions occur after an unwanted pregnancy, Furedi wrote that “one of the few generalizations we can make about women seeking to end an unwanted pregnancy is that they are in a place they would rather not be. An abortion is no woman’s ambition, and an unwanted pregnancy is often (although not always) a marker of a lot of unwanted things in her life” (p. 52). Furedi also posited that the right to self-determination is key to psychological well-being, and for individuals who may become pregnant, self-determination involves the ability to plan when and how pregnancy is resolved. According to Furedi, access to family planning services, including abortion, is required for individuals to live as full citizens of society as well as to provide responsibly for their families. As such, restricting access to abortion is emotionally harmful because it denies those who are pregnant autonomy over both their bodies and their lives. This position is supported by research showing that patients who are denied an abortion show greater psychological distress than those who receive an abortion (Biggs, Upadhyay, McCulloch, & Foster, 2017). Importantly, both groups showed either stable or improved symptoms after a 5-year follow-up, indicating that initial distress did not generally lead to long-term or diagnosable conditions. Abortion-related distress also can be conceptualized within a stress and coping framework (Major et al., 2009). Most abortions occur following an unintended pregnancy, and unintended pregnancy itself is a stressor that may increase risk for both short-term distress and longer-term mental health problems (Herd, Higgins, Sicinski, & Merkurieva, 2016). Individuals experience abortion as more or less stressful depending on a number of factors, including the timing of their abortion, their reasons for the decision, the type of procedure, their personal appraisals of abortion and other options, others’