American Association of Therapists Treating Abortion Related Trauma
Professionalizing the treatment of abortion related trauma
Bridging the gap between research and practice
Bridging the gap between research and practice
Peter Levine (1997) in his book Waking the Tiger, introduces the reader to the concept of Somatic Experiencing. He pioneered the concept by watching animals in the wild. He was curious to find out why animals that were often threatened in the wild, rarely experienced trauma. He then took what he learned and applied it to humans when they experience trauma and what would need to happen in the body in order to recover from that trauma.
I have often wondered about what happens to a man and a woman's body after going through an abortion experience. If that experience is traumatic for either of them, then what is happening to them at a body level. In Peter Levine's work with clients, he helps them let go of energy in their body that has not been discharged from previous trauma. Energy that comes from the body being stuck in a fight, flight or freeze response. By discharging this energy, the body can begin to heal from the trauma symptoms. Millions of men and women may walk into our counseling offices with trauma stuck in their bodies because of a previous abortion decision in their lives. Women are often inhibited in their flight response in the abortion clinic. They are literally trapped in the surgery room. Many will come out of that room having lost their flight response, and appear quite frozen emotionally. Men are often inhibited in their fight response. They are not able to act on fighting to protect their partner and their future child from harm. Many of these men will come out having lost their fight response and frozen emotionally as a result. This month I will be writing an article on how to approach this issue with our clients. Taking what has been learned from Somatic Experiencing, we can help our client's bodies heal by encouraging the release of what the body wasn't able to do prior, during and after the abortion decision for both the man and the women. Being able to effectively help clients who have experienced abortion related trauma in the future should include helping them at the body level and not just the cognitive and emotional. Being no longer stuck in not acting on their fight or flight response may hold the key.
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As a therapist who has been working with clients who present with an abortion in their history since 2004, I have often been curious about how previous trauma in a man and woman's life may impact "The Choice" they have to make when they find out about an unplanned pregnancy. In addition, how is both a man and woman affected in a traumatic way by finding out about that unplanned pregnancy, often in a way that is quite shocking and by surprise? I began to ask the question, "How are each affected psychologically and physically?" I began to wonder why this information is not taken into account when viewing a person's thinking, behavior and ultimate decision? Was this just another example of how our culture views men and sometimes woman based on externalized behavior versus the trauma that might be behind that behavior? These are a few questions I want to address this month. In the end, I believe that a reframe needs to happen, where men and women are not immediately viewed and judged by their behavior, especially as it relates to an abortion decision, but possibly by how previous trauma in their lives affected that decision. The fruit of this reframe could be a new level of empathy and understanding for both partners that ultimately can lead to forgiveness based on that lens of empathy.
In my previous blog last month I mentioned these statistics: 7% of Americans have had or will have PTSD (Kessler,1995) 61% of men and 51% of women have experienced one traumatic event in their lifetime (Kessler,1995) 24.7% of females by the age of 18 will have experienced sexual abuse (Adverse Childhood Experience Study,1998) 16 % of males by the age of 18 will have experienced sexual abuse (Adverse Childhood Experience Study,1998) 56 million abortions in the U.S. since 1973, (O’Bannon, R.K., 2015) Based on these statistics, many men and women will have experienced previous trauma prior to a decision regarding an unplanned pregnancy. That means their brains biologically are already wired based on that previous trauma. For example, their limbic system may be highly reactive which may trigger a fight or flight response, at the same time they may experience a decrease in prefrontal cortex rational thinking. What a woman may experience as abandonment by the man in the decision, may actually be he is acting on a fight or flight response that is highly reactive because of some previous trauma. The woman may have abandonment trauma that has affected her attachment style as an adult. She may fear abandonment by her partner and may go along with her partner's decision to abort, denying her maternal instinct that is developing within her. Finding out about an unplanned pregnancy can be traumatic in itself even if there existed no previous trauma in the man and woman's life. Being caught off guard, fearful, panicked, needing to make a quick decision, to name a few. These are all symptoms that can affect both the man and woman in the midst of trying to make a rational decision. If they are young, it is also possible that the prefrontal cortex has not fully developed, thus making it more difficult to make a rational long term decision that could have long term implications. In both scenarios above I have found that the limbic brain is crying out for relief. This is not unlike an addictive brain that is crying out for relief. It goes into somewhat of a survival mode. Like a person running out of a burning building, the goal is to escape and find relief. Often times an abortion decision is based on this premise...finding relief from the "firestorm" both the man and woman find themselves in. The unfortunate part is later, once the prefrontal cortex kicks back in and the limbic system kicks out, many will experience the title wave of regret and often ask themselves the question, "How could I have done this"? One of the greatest resources I have found in providing marriage counseling, is the resource of empathy that can often then lead to forgiveness. When a man or woman are able to look not just at their partner's behavior but what is possibly behind that behavior, is usually where they can begin to move beyond hurt and anger to empathy and forgiveness. For example, a man may have an addiction that began in childhood as a result of abuse. It is my belief that if men and women could look whats behind "The Choice" and not just the act of the choice, then maybe there would be more people able to heal from the hurt and pain and move to a place of forgiveness. Is it also possible that we as a culture could move beyond our judgement of men and women based on their behavior, and look behind what may have lead to that behavior? If it is possible, perhaps the crazy cycle of conflict around the issue of abortion could end. We could begin to talk not only about the hurt and trauma that fuels that cycle, but begin to reframe our understanding of both sides of the issue in a new way. This cultural reframe could lead to healing and forgiveness on a macro level. Perhaps a greater understanding of trauma prior, during and after an abortion decision holds the key. After many years of working with couples who present with trauma in their interactive history, I finally came to realize that the world is really one big "couple's argument" when it comes to the issue of abortion. What I was seeing every day in my office with couples, appeared to be no different in the world between men and women as a whole. I began to hypothesize that possibly what I see in my office on a micro level is also true on a macro level between men and women in our culture. This month's blog will spend some time reflecting on the similarities. If my reflections are true, then solving the debate about abortion in our country will not come from a rational left brain perspective but from a right brain approach to treating trauma.
I want to start with a few statistics. 7% of Americans have had or will have PTSD (Kessler,1995) 61% of men and 51% of women have experienced one traumatic event in their lifetime (Kessler,1995) 24.7% of females by the age of 18 will have experienced sexual abuse (Adverse Childhood Experience Study,1998) 16 % of males by the age of 18 will have experienced sexual abuse (Adverse Childhood Experience Study,1998) 56 million abortions in the U.S. since 1973, (O’Bannon, R.K., 2015) When a couple comes to counseling and they escalate quickly in their communication, the first thing I look for is whether they have trauma in their history, either as individuals or as a couple. I know from experience that when a person has previous trauma, they are more likely to react and escalate quickly for various reasons. Those reasons can be related to their attachment needs not being met or triggered, deficits in attachment, fear, trust, not feeling safe or loved, fight or flight response, projections etc.These reactions tend to come from the limbic system part of the brain. This is the part of the brain that is affected by survival instincts. I also know from experience that my work with these couples has to take into account this understanding and I can not just try to help these couples from a rational left brain approach. Eventually, I want to be able to help these couples move out of the current cycle of handling communication and conflict to a healthier cycle that doesn't breed more trauma but security, safety and a feeling of being loved. Imagine if I was able to do an intake assessment on our culture. Based on the statistics mentioned above, what would my conceptualization be? What would I guess is behind the reactions between men and women in this culture? Are the reactions to the abortion issue alone coming from from a rational left brain or a emotional right brain rooted in the limbic system. What would my diagnosis and treatment plan be? What theoretical approach would work the best with our culture? As I watch the "macro level" couples's argument in this country over abortion, I can only think about the couples who come into my office who have trauma in their history. I remember a professor in graduate school saying to me, "The problem is not the problem." That appears true about the abortion issue in our country. Abortion is not the problem in terms of reactions, but the possible trauma that is triggered in a person's history when you bring up that word. The trauma may be related to having had an abortion or possibly from other trauma such as prior sex abuse etc. In conclusion, I would say my beginning treatment plan for our culture would need to include assessing the previous trauma in our culture, and the trauma that exists between the genders. Next I would help move our culture out of the crazy cycle it is in. Just like with couples, that will only begin by starting to talk about the deep seated hurt behind the reactions and begin to heal past and present pain. Only then can we begin to approach the legitimacy of abortion as a trauma from a left brain fact based perspective. It's ironic that I decided to write on Trust in the month of February, since those people that experience some form of trauma often have a hard time trusting the world to be a safe place again in the recovery process. The trust that I am wanting to address this month is related to whether we can trust research as to whether abortion is traumatic based on self report versus trying to measure the impact a traumatic event may have on an individual as evidenced by externalized symptoms.
So what do I mean by self report and why may we not be able to trust self report as a measurement. The reasons can be exhaustive but I want to only focus on a few this month. The first one I want to talk about is the role of defense mechanisms. "Defense mechanisms are one way of looking at how people distance themselves from a full awareness of unpleasant thoughts, feelings and behaviors." * Defense mechanism appear to be used as a way of surviving terrible things that happen in our lives or the world around us. We can only think of 911 and the terrible tragedy that it was. Not wanting to believe it was really happening, or did happen, seemed to serve a purpose for many in order to make it through that terrible time. Unfortunately when defense mechanisms are used too often as a way of coping, people begin to experience externalized symptoms of the trauma they have experienced. These externalized symptoms may look like a diagnosis of depression or may be expressed in a process addiction such as the addictive use of pornography to name a few. When a client comes to our office who has experienced some form of sexual abuse, and reports that it was no big deal based on self report, can we as therapists trust that? How do we avoid imposing any agenda onto our client because we think that it should have been traumatic to them. Is it possible that defense mechanisms have come into play such as the use of denial or rationalization etc. Is it possible that they don't trust to share something that personal? Is it possible that maybe for example, a male client has been influenced by both gender and cultural conditioning to "buck it up" and be tough. "Boys don't cry." Author William Pollack describes it this way: "Anger is a man’s way of weeping. It is an expression of underlying pain that women would more likely display with tears or more direct expression of sadness and loss. Men also weep by drinking, withdrawing, acting defensive, blaming others, getting irritable, being possessive, working excessively, becoming overly competitive, suffering somatic complaints and insomnia, and philandering." http://www.psychotherapynetworker.org/magazine/recentissues/2010-mayjune/item/824-shame-o-phobia?tmpl=component&print=1 All of these questions should come to your mind as a therapist who treats abortion related trauma. Perhaps a better indicator of whether abortion was traumatic, or any other trauma that a person has gone through, is by measuring the externalized symptoms that our clients are more likely to present with in our office. It is very unlikely that a client will come to your office as a result of an abortion in their history for a few of the reasons I mentioned. They are more likely to show up in your office because the defense mechanism/s they used as of surviving a trauma are no longer working. Perhaps it is our job as therapists treating abortion related trauma to filter through the cultural rhetoric, gingerly look past the defense mechanisms our clients might present with in a new way. I am not saying that we should impose our agenda on a client and assume that abortion should be any more traumatic than a client that has experienced sex abuse and does't view it as traumatic to them. But I think we could first ask ourselves, "Is it possible that the externalized symptoms our clients are presenting with are related to a trauma such as an abortion in their past?" It has been my experience as time and treatment proceed, we don't have to ask the client this question because they often will begin exploring it themselves with us in therapy. No, I do not think numbers alone can be trusted as to whether abortion is traumatic, just as any other other self report of a past trauma. Gender, cultural conditioning, defense mechanisms alone have a major effect on a person's self report. These same reasons have had a major effect on research in general as to whether abortion is traumatic and can cause symptoms of PTSD. As in all trauma, a better way of measuring the effect may be based on the externalized symptoms our clients will come into our office for. A skilled therapist can take the first step of doing what I call the "fly over approach" in understanding a client's presenting symptoms. Imagine you are peering back over a client's life and flying over that client's life in an airplane. Everything you see that your client has experienced could be related to the current presenting symptoms. I believe it is our job as therapists to be the navigator of that journey with our clients. In the end, the pain and possible trauma of abortion may be best measured by the symptoms we see on an every day basis in our office and world as a whole. *http://psychcentral.com/lib/15-common-defense-mechanisms/0001251 I recently watched the video above titled Validation. It is a wonderful "feel good" story of how just validating someone has a positive impact on their feelings and attitude. I would encourage you to watch it. As I write this first blog, I can only think about the millions of men, women and couples who have experienced abortion related trauma but have yet had the experience of being validated for the impact it may have on them personally and as a couple.
We live in a society that invalidates the pain of abortion related trauma that many feel for various reasons. The reasons may include: gender conditioning, social and cultural conditioning, politics, arguments between pro life or pro choice, trauma between the genders, feminism etc. These are only a few. I also know that many of these people deserve to be validated if they have experienced trauma and /or PTSD, and they also have a right to receive the highest level of professional mental health services, just like with any trauma such as the trauma of sexual abuse, war etc. It is almost the new year, and I am excited about the birth of this new organization. I am also exited that finally, we are able to look at research and develop evidenced based models of treatment that are based on sound psychological theory in treating those with abortion related trauma. Since 1973, the treatment of abortion related trauma has been left out of the mental health field for some of the reasons mentioned above. Unfortunately, there have been millions since then, that could have been properly assessed and received appropriate evidenced based treatment, that didn't. The start of a new year reminds us of new beginnings and goals. I am excited that 2015 brings with it new beginnings. I can only imagine what the millions of those that have been impacted by abortion related trauma would feel if they were told what they are feeling is valid despite a culture of trauma that is well defined by defense mechanisms such as denial and rationalization etc. R.D. Lang said this, "When we invalidate people or deny their perceptions and personal experiences, we make mental invalids of them." The validation of abortion being a potential trauma for men, women and couples could be the first step that is needed toward mental and emotional healing. In the end, breaking through both cultural and personal defense mechanisms may bring the hope that is needed to find recovery from the externalized symptoms they may have developed. These might include, addictions of many kinds, anger, depression anxiety etc. Those of us that work in the mental health field know, when people are invalidated and repress their trauma, it later comes out in externalized symptoms. Unfortunately these externalized symptoms often cause more trauma for those they interact with. As a result, the cycle of trauma just continues and often between the genders. We only have to look at culture to see this. Join me in taking the first step to validate those men, women and couples who may have experienced abortion related trauma and come into your office on a daily basis. The very simple thing of including it as a reproductive loss on an intake form might be your first step as a therapist in the validation process with your clients. It is my hope that in 2015, like the video above, we can be an organization of change. Happy New Year! |
AuthorGregory Hasek MA/MFT is a Licensed Professional Counselor in Oregon. Archives
May 2017
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