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

104 The Professional Counselor | Volume 9, Issue 2 childbirth, and parenting on children already in the home (Jones, Frohwirth, & Moore, 2008). When this reflection is accurate, counselors could comment that the abortion patient seemed to put a lot of thought into the decision, or they might reflect hearing that the patient had considered multiple important factors. A counselor might observe that it sounds like the patient made the best decision based on the available information at hand, although some important information may not have been accessible at the time. Some patients who are not parenting children might appreciate hearing that this type of thoughtfulness seems like a quality that would allow them to be a loving and effective parent in the future, when they are ready. Another type of thought that may be related to abortion-related distress is belief in a just world. Many people hold the simple belief that good things happen to good people, and thus bad things happen to bad people. For some abortion patients, an unintended pregnancy is bad , an unhealthy pregnancy or fetal anomaly is bad , or an abortion is bad ; thus, the self is bad . When an abortion patient terminates a pregnancy because of outside pressures, such as when parents, a partner, or a workplace would not accept a pregnancy, childbirth, or parenting, this lack of acceptance can also lead to self- blaming thoughts. A patient may perceive herself as having made bad decisions about relationships or workplaces that do not offer her support. An important corollary of belief in a just world is that a person who is bad does not deserve to feel better or to receive support. Some abortion patients feel that they deserve to be punished, and they deprive themselves of intimacy with others. Others may believe they do not deserve to participate in self-care activities or to “indulge” in interventions such as relaxation training, mindfulness meditation, or distress tolerance. To address belief in a just world, it can be helpful to explore how the patient developed this belief as well as to explore both supportive and disconfirming evidence. Upon reflection, many patients are likely to acknowledge that belief in a just world is a common theme in fairy tales and other lessons imparted to very young children. Likewise, patients are likely to acknowledge that accidents sometimes happen, people can make mistakes and still be good and moral, and that sometimes bad things happen to good people. Inquiring about other people who they perceive as deserving and not deserving of distress and hardship may be helpful. For example, counselors might ask patients to identify others who have “gotten away with” crimes without punishment or censure and to identify good, deserving people who have faced unfair experiences or mistreatment. In addition to these explorations, a counselor might empathize with the wish that people would get what they deserve, even if the world does not always work that way. Outcome-based reasoning , a tendency to assume that emotional distress is the natural result of a bad decision, is closely related to belief in a just world. As applied to an abortion patient in distress, the end result (distress) may be thought of as reflecting the quality of the decision to terminate the pregnancy (bad). Outcome-based reasoning reflects an interest in a world that is predictable and orderly. As with belief in a just world, asking questions about the evidence for outcome-based reasoning may be helpful. Counselors could wonder aloud about times that the patient has seen good intentions lead to problematic outcomes, good behavior lead to punishment, or bad behavior lead to reward. In addition, patients using outcome-based reasoning often assume that they would feel better if they had made a different prior decision. As such, the counselor might explore with the abortion patient the possible consequences of decisions other than abortion. Useful questions might include: “What were the other options that you considered? If you instead decided to become a single parent, or to make an adoption plan, what would that look like now? What would be the consequences of these different decisions, emotionally and otherwise?” Thinking through the available options and considering all the different consequences of each may allow patients to consider the possibility that