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

The Professional Counselor | Volume 9, Issue 2 103 Examining the evidence for ease of use and effectiveness could help prevent a future unintended pregnancy. In other cases, avoidance may be adaptive. In particular, it may be wise to avoid telling certain people about having had an abortion when the costs of disclosure are likely to outweigh the benefits. Genuine collaboration with the abortion patient is necessary to weigh the benefits of maintaining current thoughts and behaviors against the benefits of potential changes. CBT counselors often differentiate between primary (basic) and secondary (manufactured) emotions (Resick, Monson, & Chard, 2017). Primary emotions occur as a direct result of an event. For example, an unintended pregnancy may lead to feelings of shock. The end of a pregnancy may lead to feelings of loss. Being insulted by protestors or denied access to medical care may lead to anger. Primary emotions tend to fade in intensity over time. Secondary emotions, in contrast, arise as an indirect result of an event, based on thoughts about the event. In particular, when an abortion patient thinks about having made the wrong decision, this thought could elicit guilt. When a patient thinks about how others may respond negatively to learning about her abortion, this thought could elicit worry. If different types of abortion-related thoughts are habitual or persistent, these associated emotions also will tend to persist, and the abortion patient may thus feel stuck in negative feelings. Thoughts that may not be fully accurate, constructive, or conducive to recovery, such as those described below, may be potential targets for intervention. Some abortion patients find themselves stuck between multiple conflicting thoughts (and associated feelings). For example, an abortion patient might think, “It hurts to know I’ll never be forgiven by my Lord, but there’s no way that my family could manage another child,” or “I’m a feminist, so there’s no reason for me to feel sad.” In the former case, the patient switches the focus of her thinking between her religious tradition and her perceived family obligations. In the latter case, the patient switches between thoughts about her political views and her actual experience. Regardless of their content, experiencing conflicting thoughts can be confusing and disorienting, which may add to the overall experience of emotional distress. In addition, when thoughts are in conflict, one type of thought can be used to invalidate the other, preventing a full awareness and acceptance of each. Helping the patient acknowledge and accept the existence of conflicting thoughts may reduce confusion and distress. Furthermore, considering the evidence for each thought independently may allow the patient to consider which thoughts are worth holding onto and which might be less accurate, reasonable, or conducive to healing. Common Thought Patterns Associated With Abortion-Related Distress From a CBT approach, several specific patterns of thought may be associated with abortion-related distress. Hindsight bias is the tendency to use knowledge from the current situation to re-interpret past situations. Patients who exhibit hindsight bias 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. One approach to hindsight bias is to ask for more detail about the patient’s life context and specifics of the decision- making process at the time of the pregnancy. Counselors might ask questions such as: “How did you find out you were pregnant? What were your initial reactions? Who did you tell, and why? How did they respond?” Counselors might specifically ask what the patient perceived at the time as the reasons to consider abortion versus the reasons not to. “If you can try to remember during that time of your life, I’m curious, what seemed like good reasons for the decision? What seemed like good reasons not to make this decision?” In making the decision to end a pregnancy, abortion patients tend to consider the impact of pregnancy, childbirth, and parenting on their current and future lives, health, obligations, and goals (Finer, Frohwirth, Dauphinee, Singh, & Moore, 2005). Given that many abortion patients have already given birth, many also consider the impact of pregnancy,