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

102 The Professional Counselor | Volume 9, Issue 2 social reactions, and the broader social and cultural context (Major et al., 2009). Overall, evidence from rigorous empirical studies indicates that legal first-trimester abortion does not increase risk for mental health problems. In addition, patients who have a later abortion for a wanted pregnancy due to fetal abnormality experience similar mental health outcomes compared to patients who miscarry, experience stillbirth, or experience newborn death (Horvath & Schreiber, 2017; Major et al., 2009). Although research data do not suggest that legal abortion typically causes mental health problems (Horvath & Schreiber, 2017), many abortion patients experience symptoms of emotional distress, and in some cases, prolonged distress. Less commonly, some abortion patients experience mental health problems after their abortion procedures. In general, patients with a history of emotional disorders such as depression and those with low social support are at greater risk for mental health problems after a pregnancy resolves either by abortion or childbirth (Major et al., 2009; Russo, 2014). Abortion- specific risk factors for emotional distress include terminating a wanted pregnancy, feeling pressured into abortion by other people, perceiving the need for secrecy, and participating in or identifying with a cultural or religious group that teaches the idea that abortion is wrong (Major et al., 2009). These abortion-specific risk factors for distress warrant attention by counselors who are seeking to support abortion patients. Assessment of these factors may help inform how the counselor understands the sources of evident distress. A Cognitive Behavioral Framework Counselors who rely on a CBT framework help patients to become more aware of their thoughts, to differentiate between thoughts and facts, to objectively evaluate the evidence for their thoughts, and to consider making changes when warranted. For example, patients may change their thoughts after reflecting on the ways in which their thinking is incomplete or inaccurate. Alternatively, patients may change their behaviors or circumstances after reflecting on evidence that shows behaviors or circumstances to be problematic. From a CBT perspective, emotional distress following abortion may be conceptualized as emotions that are linked to thoughts and behaviors related to the abortion experience. Identifying and talking about thoughts and behaviors that are related to strong negative emotional states can help patients who are feeling stuck and not able to move forward. Abortion patients in distress may benefit from becoming more aware of and talking through thoughts that elicit emotional distress and exploring these with a supportive listener. Cognitive behavioral therapists often use an ABC (activating event, belief, consequence) model in working with patients to collaboratively understand how patients are experiencing their lives. To illustrate, an activating event (A) might be scheduling a follow-up appointment after an abortion procedure. A thought or belief (B) might be, “I shouldn’t have had sex if I wasn’t ready to be a mother,” and the consequences (C) of that belief may be emotional (guilt, low self-esteem), behavioral (keeping the abortion a secret), and interpersonal (feeling disconnected from loved ones after an abortion). Behavioral avoidance is another common target of CBT interventions. It can be useful to ask about situations or events that a person has avoided since her abortion. To illustrate, attending a baby shower, interacting with young children, or going to the doctor might all be situations that a distressed abortion patient avoids. Such situations might elicit thoughts and beliefs about having had an abortion that, in turn, elicit aversive feelings. In some cases, avoidance might not be sustainable or healthy in the long-term. For instance, some abortion patients avoid sex because they worry about pregnancy and making another abortion decision. Such patients may benefit from discussing barriers to contraception use. They additionally may benefit from discussing the use of more effective methods of contraception.