“The tipping point,” a concept presented by Malcolm Gladwell in a book by the same name in 2000, occurs when an idea, trend or social behavior crosses a threshold, tips and spreads like wildfire. I believe helping women process the grief they experience after an abortion choice is an idea whose time has come. Currently, very few venues exist in our culture where women have permission to grieve an abortion loss. It has been 40 years since abortion was legalized throughout the United States with the Supreme Court’s decision in Roe v. Wade (January 1973). Yet, in my opinion, most mental health professionals are not informed or equipped to serve an extensive population that is confused by and disenfranchised with their abortion grief.

Dr. Christiane Northrup, a noted author and gynecologist, speaks about the topic of grief after abortion in her newly revised edition of Women’s Bodies, Women’s Wisdom (2010). A former abortion doctor herself, Northrup takes the bold step of agreeing that women need a chance to grieve a voluntary pregnancy termination.

She writes, “Since the first edition of Women’s Bodies, Women’s Wisdom, many women have written to me expressing their gratitude that I have addressed this issue [processing abortion grief]. And they have written about how their willingness to tell the truth about their abortion experience has healed them.” She goes on to say that during the many years she performed abortions, she observed that “not having fully grieved a pregnancy termination can be a setup for pregnancy problems in the future” because of the unresolved feelings surrounding the choice.

Disenfranchised grief

Dorothy, we are not in Kansas anymore! We have spent decades arguing whether abortion “should be.” While we argue, we lose sight of the fact that abortion “is.” According to the Guttmacher Institute, the statistical gathering arm of Planned Parenthood (a good, reliable source of abortion statistics), around 1.36 million women have abortions each year in the United States alone.

Our culture views abortion as a political, moral and legal issue. In doing so, society does not acknowledge the natural grief that many times follows an abortion choice. One of my past clients said the following: “There is a conspiracy among the sisterhood not to tell each other about the sadness they feel about their abortion. We don’t discuss our grief after abortion because it can be so gut-wrenching. The depth of the grief goes to the core of our beings. Our society doesn’t talk about abortion because it is legal. We are not allowed to grieve our loss because there is an implication that we should buck up and get over it — it is legal, don’t complain, that is that.”

It is normal to assume that the abortion provides closure. This is a false sense of resolution, however. At some point after the procedure, most women are caught off guard with a sadness that is often unavoidable.

It is at this stage of the abortion experience that women need a safe place to talk about their decision. Many times, even the most well-meaning professional scrambles to help the client validate the abortion choice. Unfortunately, in doing this, the client’s grief is not acknowledged. Additionally, there will be no pause to consider the abortion as a loss.

The reality is that after an abortion, many women experience grief that is disenfranchised. As with any sort of grief that goes unacknowledged in cultural norms, this can be the deepest, most painful kind of grieving because the person is so alone in it.

In his book Disenfranchised Grief: New Directions, Challenges and Strategies for Practice, Kenneth J. Doka defines disenfranchised grief as a loss that cannot be openly acknowledged, socially validated or publicly mourned. Doka states, “The person experiences a loss, but the resulting grief is unrecognized by others. The person has no socially accorded right to grieve or to mourn it in that particular way. The grief is disenfranchised.”

Disenfranchised grief, whether connected to the loss of an ex-spouse, a gay partner, a pet or even an abortion, can have a profound effect on an individual. Forty years after the legalization of abortion choice in our nation, it is time that mental health professionals get onboard with learning how to respond to a woman experiencing grief after an abortion.

Abortion grief and fear of disclosure

According to a statistic provided by the Guttmacher Institute in 1998, it was expected that 43 percent of women would have an abortion by the time they were 45. Despite this large demographic, women very seldom admit a choice decision to another person. However, choice decisions affect every level of our culture, every race and every religion.

Professionals need to understand how hard it is to self-disclose an abortion choice. Because of the fear of judgment or disenfranchisement over the sadness they feel, women often walk alone in processing their grief after abortion. It is my experience in working with women in this area that it takes an average of nine hours of therapy before they will admit an abortion choice.

Northrup states, “A century and a half of rhetoric designed to make women feel guilt and shame surrounding abortion and the choice of self-development over motherhood (at least for a time) leaves little wonder that abortion is not an easy issue for women to talk about freely. Yet if every woman who ever had an abortion, or even one-third of them, were willing to speak out about her experience — not in shame, but with honesty about where she was then, what she learned and where she is now — this whole issue would heal a great deal faster.”

“Secrets kill” is a therapy concept I refer to often. What I am seeing from my clients is the existence of an intense loyalty to the abortion secret that is driven by an incredible sense of fear of disclosure. With decades of guilt and shame as an emotional backdrop, many women never adequately process the deep grief aspects of abortion. As long as the cloak of shame surrounds this issue in the hearts of women, they will stay loyal to their “dirty little secret.”

Being healthy in mind and spirit means all of us must work through the grief issues of our past. If our human souls do not take this journey into grief in all areas of our lives, we will spend our future days simply managing our sorrow. This can manifest itself as anger, depression, alcoholism, eating disorders and other serious emotional and behavioral problems.

In his writings, Doka says “disenfranchisement is an injury that blocks the possibility of mourning; self is turned inward, wishing repair, but instead it repeatedly attacks itself with its worthlessness.”

Disenfranchised grief should be an important consideration in the lives of our clients, even in cases of abortion. Counseling professionals should be knowledgeable of how to approach this topic with their clients. These clients need to know their grief matters to someone who will safely share in the pain of their loss.

Changing the labels

I believe the best way to create a paradigm shift in processing grief after abortion is to change the labels. Professional therapists can be the trailblazers in the area of abortion grief. We have an opportunity to be part of something bigger than we can ever imagine by bringing abortion aftercare into the 21st century for thousands of women sitting in silence about their grief.

Once you say the word abortion, the conversation gets polarized, paralyzed and/or politicized, inciting passionate emotions on every side. Doka says it best when he notes, “The ideological and political divide between those who accept abortion and those who do not complicate disenfranchisement.”

I began experimenting with changing the labels some years back in my own private practice. In assessing client history, I noticed clients would rarely self-disclose a past abortion. I remembered my own past experiences filling out forms in physician offices. I never checked the box that said “abortion.” One day, I began asking clients if they knew what the “A-word” meant. Surprisingly, most did. It was in simply changing the terminology to A-word that women began to self-disclose.

Eventually, I came across the term voluntary pregnancy termination as a possible way to talk about the A-word in session. After some time, I began using the shortened version, VPT. This process led me to the revelation that the terminology had been causing the glitch in disclosure. I now refer to the procedure as VPT in sessions with my clients and have found it to be a successful way of separating the politics from the issue of grief.

It is my opinion that professional therapists must lead the way in changing the terminology if we are to bring this therapy model into our culture. Given the guaranteed confidentiality processes we have in place, the professional therapist’s office should be the obvious place for women to go to process their grief after abortion.

The need is great

Given the number of women who need confidential dialogue about their abortion experience, I developed a new counseling model for professionals called Choice Processing and Resolution (CPR) therapy. I presented this model at a Learning Institute for the American Counseling Association Conference in San Francisco in March 2012.

Before adding CPR therapy to your counseling practice, however, there are several things to consider. First, make sure this is a subject that interests you. VPT aftercare, being so specialized in nature, is not for everyone. Also, therapist gender is not necessarily important. I believe both male and female counselors can lend support to clients processing abortion grief.

The main consideration should be whether you are a safe and nonjudgmental person for your clients when it comes to this controversial topic. Taking honest self-inventory, if you cannot separate the procedure from the issue of grief after abortion, then you should not get involved in this caring field. Additionally, if you have your own unprocessed abortion grief and hold your own judgment or are suffering your own pain, you have the potential of doing more harm than good for these clients.

On the other hand, you are the right person for this work if you have a natural heart to help clients who are suffering from secret shame and grief and can receive their stories with compassion and grace.

I once had a licensed professional counselor inform me that none of his clients had ever had an abortion. Looking at the statistics in place, this was an ignorant observation. I also had a pastor of a 3,000-member church tell me that no one in his congregation had ever chosen abortion. Realistically, considering the statistics, it is likely that at least 500 of the women in his congregation were secretly struggling with abortion grief.

As a professional counselor, please understand that if you assess for an abortion per se, your client will probably not self-disclose. However, if you note low levels of depression or unexplainable sadness in your clients, you can eventually introduce the possibility of a VPT in their history. Again, changing the labels is the way to assess. Asking clients to self-disclose an abortion will probably get you nowhere.

My journey of helping women in abortion aftercare spans almost two decades now. My own path to healing and helping other women has been my classroom for instruction. Because this is such a specialized topic, it is important to have a very clear understanding of the multifaceted aspects of processing grief after VPT. The combined elements of disenfranchisement, fear, shame and confusion make this a topic worth studying so that counselors will be informed.

Ways to help

Once you have determined that a client is experiencing disenfranchised grief about her choice decision, the best place to start is by offering a safe place to dialogue about her actual experience.

Begin safe dialogue: Just let the client do as much self-expressing as she wants about her entire experience — including before the decision, the procedure itself and after the decision. The mere fact that you are allowing her to share her deep dark secret in a place of safety and nonjudgment will help her release a lot of the grief. I can’t emphasize enough that changing the terminology from “abortion” to “VPT” will be a turning point for clients to share their stories.

Consider this grief therapy: Begin the grieving process by normalizing the grief your clients may feel. Instead of talking about the procedure and focusing on validating their choice to have a VPT, let your office serve as a place of validation for the natural grief that many times follows a VPT, even years later. Explain that attachment is very normal in a pregnancy. The process being interrupted by a VPT doesn’t necessarily stop the feelings of natural attachment that can occur. This simple paradigm shift gives your clients permission to label their experience as a loss. Validation and permission are what every client needs in a disenfranchised grief situation. Therefore, your main focus in therapy will be offering validation of the client’s grief and permission for the client to express needed pain over her loss.

Develop your companioning skills: Companioning is about honoring the spirit, not about focusing on the intellect. It is about respecting disorder and confusion, not about imposing order or logic. Companioning is about being present to another’s pain, not about taking that pain away. The person skilled in companioning will offer a safe place for women to share their secret of a VPT.

John Welshons, in his book Awakening From Grief, says it best: “You should think of yourself as a listening friend that teaches your clients the meaning of compassion. There are no experts in this line of work, only compassionate listeners. Since everyone truly does process their grief differently, it is important for you to let your client be as they walk the valley
of sadness.”

Process the emotions: I have found the best way to help women is to allow them to attach all the emotions to the event of a VPT. Going through the entire experience and letting women label the emotions can be very freeing for them. Supporting clients in writing letters to the people connected to the event and encouraging clients to give full expression to how they felt then and how they feel now can be very helpful in releasing hidden emotions.

If you are serious about adding help for VPT grief to your practice, I offer some free downloadable intake sheets on my website at missingpieces.org/professionals. The intake sheets can serve as a template to walk you through dialoguing about and processing VPT grief with your clients.

In summary, normalizing the grief and giving permission to label the experience as a loss are important components of this therapy. In addition, labeling the emotions will help bring resolution for your clients. Professional therapy offices should become the obvious venue for abortion aftercare in the 21st century.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.