Abortion Privacy
“I’m even afraid to tell my therapist.”
I wish I could say that a decade of abortion support has taught me to encourage you: “don’t worry, honey, she’ll understand.”
As with everything else abortion, it isn’t so simple. Most get it. The vast majority of therapists are competent to handle hearing an abortion story in a session. I should hope so. About 1 in 3 women have an abortion, and we all deserve support integrating this common reproductive experience. Some therapists harbor personal judgment, but show up professionally anyway. That is admirable effort. Straight professional detachment is better than overt judgment, but it is insufficient holding for a bereaved mother. She will feel the distance, and it will create a barrier to care. Worse are the few so deeply lost in their own opinions that they do harm to their clients on purpose: the therapist who draws breath, sits up straight, and says, “I believe what you did was wrong and I won’t work with you anymore.” Ushering you out of the room right then and there without so much as a referral, billing later for the appointment she never finished. Or the therapist who holds a local support group for bereaved parents grinding the meeting to a halt after hearing your share and declaring, “we aren’t a good fit for you. This is for parents who didn’t choose for their babies to die.”
This rare but awful reaction also exists in pregnancy care. Doulas are notorious. I’ve even heard some horror stories from “pro-life physicians” who put their patients’ lives at risk just to stay haughty on their soap box. Obfuscation of information. Threats to call the police if the patient does not do as the doctor demands. Leaks of patient personal information (name, address, etc.) to “pro life” groups with known affiliation to domestic terror. Dangerous games they play, these rare ones.
I need you to know that every single one of these examples dates from BEFORE the fall of Roe v. Wade. Back when personal privacy was a constitutionally protected civil liberty. Back when the law was on our side.
In the past, I generally encouraged sharing with mental health professionals. If it felt too scary, or if instincts felt activated, I encouraged, first, the question: “Before I go into this, I need to know if you support abortion rights, and if you don’t, I need you to find me another therapist who does. I know you’re not supposed to share your politics with me, but I need holding from someone I know supports me, and if that isn’t you, this is your chance to step away.”
I can not tell you how many people I have given this schpiel to. Midwives. Obstetricians. Nurse practitioners. Therapists. Before seeking a trauma-specialist, I left a message at a group practice that is known for its PTSD care in Boston.
“I need a therapist who can support my late term abortion trauma on all levels, including personal. Please pair me with someone competent to hold me who believes I am a good person.” The head doctor at the group called me back. He was my therapist.
Before choosing my care for my subsequent pregnancy, I called a birth center and asked to be paired with a doctor on that hospital campus who was an abortion provider.
“We don’t provide abortions here.” The receptionist said. “The pro-life OBs don’t let us.” I will never be a patient at that hospital or birth center.
In contrast, when I gave a similar ask to a local midwife group,
“I need to know that the entire team is ok treating a third trimester abortion patient and nobody has any subconscious baggage that might hurt me,” they asked my question at a weekly meeting, THEN got back to me that I would be welcome. That was the response I needed. I needed to know nobody would look down at my chart and recoil or, worse, put me in harm’s way. Asking pointed questions directed me to the right care providers.
The world is different now, and my advice has changed.
If you live in a state (or country) where you are LEGALLY protected in your pursuit of abortion care, old advice stands. I can’t promise that you won’t be shamed or blamed or mistreated, but I can promise that nobody can put you under legal scrutiny for your story. Ask for the safety you need to share in more detail. Pick your support carefully. Then take the trust leap and accept help.
If you live in a state (or country) that is actively hostile to abortion patients, my advice is: do not disclose.
I hate this advice. From a mental health perspective, it is terrible advice. But survival comes before thriving, and this is excellent legal advice.
Recently, a friend of mine (a therapist in Texas), described a tizzy in her Texan professional network. Therapists, like teachers, doctors, and nurses, are mandated reporters. When I was a teacher, if I had any reason to believe one of my students was being abused, I was legally required to report to Child Protective Services. I was liable for the harm that came to my students via abuse if I observed but did not report.
So, if a fetus is now a child, and a woman goes and gets an abortion, are therapists mandated to report?
American Psychological Association says: No. A mother’s abortion does not suggest abuse of her living children. HIPPA trumps state law. Keep patient privacy private. However, they also point out:
HIPAA [bars] disclosures, but we caution that some state agencies or courts might apply HIPAA regulations incorrectly or simply choose to ignore federal law. […]
This analysis may change if a state enacts a law that specifically requires psychologists to report that a patient is considering or had an abortion. We have asked state leaders to watch for any such proposals and to contact LSA immediately to discuss patient privacy concerns.
Until state laws on abortion reporting are more settled, and the enforcement of these laws has been tested, one strategy to consider is discussing with your patient the potential limits to your confidentiality and potential “duty to report” obligations in your state. That discussion can empower your patient to decide whether to raise or possibly avoid certain topics that might trigger your reporting obligation.
Laws will get worse. Already, those rare ones who previously used their position to shame my loss moms can now gleefully punish us against the recommendation of APA. The bad seeds are few, but they exist, and the stakes are too high to ignore them.
So, if you live in a hostile or illegal state, do not disclose. Not even to a mental health provider. Not while there is a kerfuffle about what is and what isn’t child abuse (even murder) in the letter of your local law. Do not even disclose to your gynecologist. You can report that you had a miscarriage and that is it. Rehearse until you are fluent about it. Do not change your story. The most likely person to turn you in is your own doctor. The second most likely is your own family.
I hate this truth. Hate it. But I don’t think child protective services showing up on your doorstep to tear your family apart will be very good for your mental health, either.
There is still the possibility for a powerful question. If the trust is there, if you WANT to share your abortion details with your therapist, and you feel safe sharing, instead ask,
“What happens, legally, if a patient dislcoses an abortion to you? What are you required to report and to whom?” Listen carefully to the answer and go from there.
This is where my Texan therapist friend took it. “If it gets bad, we can talk about it in code, the way we do for some other situations to keep minors safe.” She says. Conversations take on this covert tone everywhere governments oppress. Know that is an option for you.
Also an option:
“Send them to me.” I tell my friend. “If you’re ever worried that you can’t hear about an abortion without putting your client or yourself at risk, interrupt her, and send her to me.”
“I can’t.” She says. “You’re not liscenced in Texas.”
I laugh at this.
“Honey, I’m not liscenced ANYWHERE.”
I hate the way the landscape lies, but I love my purpose. How incredible to be able to serve such worthy women in such a moment of need. I’m a coach, not a therapist. I am certified in a methodology of coaching, which only means that I take my work seriously. Legally, it is meaningless. Coaching is an entirely unregulated industry. The wild, wild West. I’m not a mandated reporter. I’m “just” a coach.
Coaching and therapy are not the same thing, but coaches and therapists both support integration of tough life experiences like abortion. There are certainly limitations on what I can do. I can’t diagnose a mental health condition like PTSD. I’m not qualified to do that. I can’t give EMDR. I’m not qualified to do that. I can’t prescribe you antidepressants. I’m not qualified to do that. I also don’t have to report you to your local government. I’m not qualified to do that.
I am qualified to support your ENTIRE SELF as you come to terms with your abortion. I am qualified to hold you in your grief. I am qualified to help you soothe your nervous system in moments of stress. I am qualified to help you love yourself so tenderly in your hardest moments. I am qualified to show up for your marriage, for your body, for your motherhood.
I can’t call myself a healer, but I can let my clients (with permission, of course) explain what this work is in the wake of abortion:
I feel so much lighter. I faced something I was avoiding feeling all the way. I have found resolve, self forgiveness, and understanding. I used to feel haunted by my experience and they feelings that resulted after and now I feel strong in my decision, understand the grief process better and have more courage to lean into it. The biggest thing is I don’t think about it any more and I have much deeper trust with my higher self.
I feel like after these sessions I was able to resolve some resentment I felt towards my partner and the long standing disconnect that happened after our experience. Once I stopped blaming all our problems on this experience we were able to go deeper into the heart of the matter and really resolve why we had grown apart.
I realized (had known, but had forgotten) how deep my grief goes and how my grief is connected to everything else. This is helpful because I used to be worried about being happy -- that if I was happy, then I wasn't remembering my son and honoring him. This is why I didn't want to have an orgasm for a long time after he died. But with the realization that grief is forever imprinted in my body, it helps me recognize that being happy doesn't get rid of the grief (and thus doesn't deny my son).
.
Anger is beautiful; I am a good mother; My body has served me well and gifts me with many beautiful things; I have a Yoni! I love my Yoni!; my parents are human; my husband is allowed to feel the way he does; I am not responsible for others’ experiences; I deserve love.
.
I honestly feel like Kate has saved my life. I am not exaggerating. There were many days I wanted to die before this coaching. Imagine being surrounded by noise, but buried in a deep dark hole. So buried you can’t see any light, your body’s numb, and you’re suffocating. That’s where I was. I see light now. So basically she’s a freakin’ godsend.
If you’ve had to travel from a hostile state to get an abortion, and you need support, please find the right person to give it. Someone who respects your wisdom to the very core. Someone who sees your love. Someone who would never, ever turn you in to your government for your sacred reproductive experience. Think of me as a care-giver or ask me for a referral if I’m the wrong fit — I will never be offended by such a request. I am absolutely committed to helping you find the just-right match for your needs, even if that isn’t me.
You deserve freedom.
You deserve care.
You are already worthy of love and qualified holding.
Special note to the therapists: I am sorry to tell bad therapy stories here. When I was a math teacher, I had to hear a lot of really sad math teacher stories. Sometimes they’d make me feel defensive. Always they made me feel sad. I hope I was clear that I believe therapy is an incredible assett and most therapists commit themselves fully to their clients. I hate that law puts you between a rock and a hard place sometimes. If you are a therapist and you feel that hearing abortion stories will put you at risk of lawsuit or professional persecution, please first consult with the resources in the APA resource I linked to protect yourself legally and get oriented to this ever-changing landscape, then consider me as a referral for those you can’t legally take on. I have friends who are therapists who may be able to help find resources for the mental health care I can’t offer. Together, we can find your client the care she needs.
ADDENDA:
Friend who is my go-to post TFMR care therapist shared that patients in some hostile states may be able to get telemed mental health from practitioners in safer states through PSYPACT. Here’s the map if you’d like to look into that. And if you want someone who is better vetted for abortion care, please do reach out and my friend and I will help find a good match therapist.
Another friend who is a doctor let me know that physicians are currently being advised that, for safety, both physician and patient need to be in safe state, and telemed shouldn’t be used to give safer care to those in unsafe states at this moment.
Physician friend also gives call to action: please ask your therapists and healthcare providers about the legal consequences of disclosing abortion especially if you are NOT an abortion patient. Anyone who wants to support abbortion patients, including and especially men (who I imagine feel their hands are somewhat tied in this arena), this would be a lovely way to help protect women who want to ask the question but don’t want the question itself to be a self-disclosure. The more of us ask, the less information is given when a patient asks.