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

The Professional Counselor | Volume 9, Issue 2 105 alternative prior decisions also might have been distressing, and perhaps even more so. Patients might conclude that each possible option was likely to lead to different types of stress and challenges, some in the short term, and some in the long term. The final type of thought pattern addressed here involves all or none thinking . Some abortion patients hold themselves singularly responsible for becoming pregnant, for experiencing a complicated or unhealthy pregnancy, for making an abortion decision based on reasons that now seem suspect (such as trying to please their parents or a partner, or not having enough money), or for causing the circumstances that led them to decide that abortion was the best option. One approach to this type of thought pattern is to explore what seems to be a reasonable amount of responsibility rather than hyper- responsibility. Some apparently hyper-responsible patients might appreciate hearing a reflection along the lines of, “It sounds like you played a role in the unintended pregnancy, which makes you feel badly, and it sounds like other people and circumstances also played a role.” In other cases, abortion patients assign complete responsibility for the abortion decision to other people who urged them to end their pregnancies. Careful exploration of this thought pattern is needed. Some financially or emotionally dependent abortion patients, particularly younger ones, may have faced strong pressure from parents or a partner to seek an abortion. In addition, pressuring someone into an abortion may be part of a larger pattern of coercive control or intimate violence. If an abortion patient describes being compelled by another person to abort a pregnancy, it may be helpful to screen for intimate violence specifically as well as to ask about other ways in which they feel constrained within their close relationships. In the absence of coercive control or violence, some patients still may blame their abortion decisions on the wishes of other people. Other abortion patients may regret taking the advice of others and may hold extreme negative thoughts about themselves as well as others who influenced their decisions. In both types of cases, counselors might ask questions to help explore boundaries and assertiveness within an abortion patient’s intimate relationships. It could be useful to ask when and under what conditions the patient believes it is useful to take others’ feelings into account when making important decisions. It may be appropriate to reflect that it can be challenging to balance different sources of influence. Abortion patients who feel like they should have stood up for themselves or for their unborn child might benefit from considering what barriers to assertiveness they experienced and what degree of influence they want others to have over their lives. Patients might also develop a plan for acting differently in the future when they are making a personal decision that affects others in their social networks. Collaborative work with a counselor may help to promote assertiveness while also conveying to the patient that she is deserving of respect. Conveying Respect for Abortion Patients This article has focused on ways of understanding abortion-related distress, thoughts that may be associated with abortion-related distress, and topics of conversations that might help promote recovery. Suggestions have been offered about what to listen for, possible questions to ask, and thoughts and feelings that might be reflected. This final section offers suggestions about methods of asking questions and general use of language in order to promote rapport and the patient’s sense of feeling respected, understood, and validated. Most broadly, rapport between the counselor and the abortion patient is essential, and the goal should be for the abortion patient to feel both the presence of unconditional positive regard and the absence of negative judgment on the part of the counselor (e.g., Kimport, Foster, & Weitz, 2011).