Assessing for PTSD in Clients who Present With Abortion Related Trauma by Greg Hasek
In the February article of the month, I focused on the topic of Safety and Security in Trauma Treatment. I emphasized the need for creating safety, a secure base and the assessing of a couple's interactional pattern. These are important first steps to be aware of when working with clients who may present with trauma in their history, whether abortion related or not.
This month I will be discussing the need to assess for Post Traumatic Stress Disorder when clients present with some form of trauma whether current or in their past. Doing a proper assessment for PTSD will have a direct impact on the treatment planning process with the client or clients. It is also important to assess for PTSD symptoms in both men and women who come into your office who have been part of an abortion decision in their past. In a random study of women who had abortions in their past, the research found that 19% of the women met the full criteria for PTSD and half of the women had many of the symptoms but not all, to meet the full criteria (Barnard, 1990). What I have learned over the years in working with both men and women who present with an abortion decision in their past, is that men tend to have more PTSD symptoms as a result of the decision and women tend to have more as a result of the actual abortion procedure. This makes sense in that for men the inability to protect from harm both their partner and child is impacted by the decision. It also makes sense that women may experience a trauma to their body at the same time of being "trapped" or not able to leave the room where the procedure is happening. I often say that men are not able to act on their "fight" response and women are not able to act on their "flight" response during an abortion procedure. Bessel van der Kolk (Van der Kolk, 2014) studied rates of PTSD in both survivors of 9/11 and Katrina. What he found was the rates of PTSD in survivors of 9/11 were about 5% and the rates of PTSD in survivors of Katrina were about 33%. He believes what made the difference is that those that survived 9/11 were able to act on their flight response. In addition, many were able to go home that night and receive loving support from family members. This often didn't happen during and after Katrina. In fact, many Katrina survivors were strapped down and taken by airplanes out of the area and away from their support systems. They were often not able to act on their flight response. I will be addressing what this means for the potential to decrease the level of PTSD for those that have had abortions in a different article. The point I want to make here is the importance of doing a proper PTSD assessment with our clients in order to develop an effective treatment plan.
Another point I want to make is that just because a person hasn't witnessed a near death or death experience, doesn't mean that they might not meet the full criteria for PTSD. In the years of working with spouses of sex addicts, I found that many of them met the full criteria as a result of finding out about their husband's addiction. I think we need to be wise when to assess for PTSD and not just depend on what the DSM may say or be influenced by culture and opinions as to whether abortion can cause trauma and PTSD symptoms in men or women. I would recommend using the PTSD checklist as part of the intake process with clients when you suspect a trauma in a client or client's past may warrant the screening for PTSD symptoms.
In summary, when working with clients who present with any trauma history, including abortion related trauma, it is important to as part of the intake process to assess and screen for PTSD. The knowledge gained from the assessment will then inform the treatment plan. It would seem unethical to begin to work with clients on an issue of trauma without having done this. If we don't, we risk potentially causing our clients to experience more PTSD symptoms. As a therapist, the first step is to find out if your clients meet some or all of the criteria for PTSD. The next step would be helping your clients with those symptoms through the use of proper interventions and theoretical approach that best meets that client's needs and diagnosis. I will be talking about this more in my next article.
References
Barnard, C. (1990). The long-term psychological effects of abortion, Portsmouth, N.H.: Institute for Pregnancy Loss.
Van der Kolk, (2014). The body keeps the score: Brain, mind and body in the healing of trauma , Viking Publisher.
In the February article of the month, I focused on the topic of Safety and Security in Trauma Treatment. I emphasized the need for creating safety, a secure base and the assessing of a couple's interactional pattern. These are important first steps to be aware of when working with clients who may present with trauma in their history, whether abortion related or not.
This month I will be discussing the need to assess for Post Traumatic Stress Disorder when clients present with some form of trauma whether current or in their past. Doing a proper assessment for PTSD will have a direct impact on the treatment planning process with the client or clients. It is also important to assess for PTSD symptoms in both men and women who come into your office who have been part of an abortion decision in their past. In a random study of women who had abortions in their past, the research found that 19% of the women met the full criteria for PTSD and half of the women had many of the symptoms but not all, to meet the full criteria (Barnard, 1990). What I have learned over the years in working with both men and women who present with an abortion decision in their past, is that men tend to have more PTSD symptoms as a result of the decision and women tend to have more as a result of the actual abortion procedure. This makes sense in that for men the inability to protect from harm both their partner and child is impacted by the decision. It also makes sense that women may experience a trauma to their body at the same time of being "trapped" or not able to leave the room where the procedure is happening. I often say that men are not able to act on their "fight" response and women are not able to act on their "flight" response during an abortion procedure. Bessel van der Kolk (Van der Kolk, 2014) studied rates of PTSD in both survivors of 9/11 and Katrina. What he found was the rates of PTSD in survivors of 9/11 were about 5% and the rates of PTSD in survivors of Katrina were about 33%. He believes what made the difference is that those that survived 9/11 were able to act on their flight response. In addition, many were able to go home that night and receive loving support from family members. This often didn't happen during and after Katrina. In fact, many Katrina survivors were strapped down and taken by airplanes out of the area and away from their support systems. They were often not able to act on their flight response. I will be addressing what this means for the potential to decrease the level of PTSD for those that have had abortions in a different article. The point I want to make here is the importance of doing a proper PTSD assessment with our clients in order to develop an effective treatment plan.
Another point I want to make is that just because a person hasn't witnessed a near death or death experience, doesn't mean that they might not meet the full criteria for PTSD. In the years of working with spouses of sex addicts, I found that many of them met the full criteria as a result of finding out about their husband's addiction. I think we need to be wise when to assess for PTSD and not just depend on what the DSM may say or be influenced by culture and opinions as to whether abortion can cause trauma and PTSD symptoms in men or women. I would recommend using the PTSD checklist as part of the intake process with clients when you suspect a trauma in a client or client's past may warrant the screening for PTSD symptoms.
In summary, when working with clients who present with any trauma history, including abortion related trauma, it is important to as part of the intake process to assess and screen for PTSD. The knowledge gained from the assessment will then inform the treatment plan. It would seem unethical to begin to work with clients on an issue of trauma without having done this. If we don't, we risk potentially causing our clients to experience more PTSD symptoms. As a therapist, the first step is to find out if your clients meet some or all of the criteria for PTSD. The next step would be helping your clients with those symptoms through the use of proper interventions and theoretical approach that best meets that client's needs and diagnosis. I will be talking about this more in my next article.
References
Barnard, C. (1990). The long-term psychological effects of abortion, Portsmouth, N.H.: Institute for Pregnancy Loss.
Van der Kolk, (2014). The body keeps the score: Brain, mind and body in the healing of trauma , Viking Publisher.
