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
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."
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.
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Gregory Hasek MA/MFT is a Licensed Professional Counselor in Oregon.