pregnancy and abortion counseling article

pregnancy and abortion counseling article Failure to utilize contraception, especially condoms, is multidetermined
and should be explored whenever discussing sexuality. Many students
eschew condoms for fear they preclude spontaneity or imply promiscuity,
or because their partner insists or they feel less pleasure with a latex barrier.Still others succumb to myths (“I can’t get pregnant the fi rst time”) or believe
they are invulnerable. Sex-positive therapists use motivational interviewing
techniques to explore the benefi ts and liabilities of using condoms while
suggesting methods for increasing emotional comfort and physical pleasure.
For example, students can become familiar with latex by tasting fl avored condoms,
and men can practice masturbating with internally lubricated condoms,
which enhance sensation.
Among undergraduates, pregnancy is oft en considered devastating and
sometimes can precipitate an emotional crisis. Because pregnancy assumes
multiple meanings, therapists should suspend moral judgment and social
expectations and carefully assess motives. For example, while the impregnation
of a promising young academic may seem tragic, some families and cultures
expect and support it, especially if college is considered a place to obtain a relationship
rather than a degree. Some women may consciously or unconsciously
intend the pregnancy to fulfi ll emotional needs or withdraw from school. Others
use pregnancy, real or feigned, to entrap or vent anger toward a boyfriend.
Both men and women sometimes disregard or misrepresent their use of contraception
to ensure impregnation and/or continuation of the relationship.
Th e distressed client who reveals that she is pregnant should be assessed
for lethality and off ered crisis management and medical referral. If a potential
pregnancy is due to rape, police should be notifi ed and the student immediately
referred to the university health center or a hospital—whichever provides expert
postassault examination and specimen collection, aids to criminal prosecution
(see Chapter 13). Prophylactics may then be off ered to prevent impregnation
and HIV infection if too much time has not elapsed. In cases of consensual
sex, couples or individuals can be referred for reproductive health counseling
at the university’s health center or a community clinic such as Planned Parenthood,
and to therapy to explore options and anticipated reactions. For those
considering abortion, therapy can normalize possible postabortion relationship
changes, such as diminished sexual interest in postoperative women and
between partners who experience shame or fear a subsequent pregnancy. It is
important to clarify the rights and responsibilities of each partner, especially
when they disagree about how to resolve the pregnancy, or there may result
substantial anger and hurt that may destroy the relationship. Despite the stereotype
that males covet freedom, it is sometimes men who discourage abortion
or adoption and suff er following the woman’s unilateral decision. Th ey
can profi t from supportive counseling because, as with most issues, men grieve
privately and with minimal social support.
Abortion—which correlates positively with higher parent income and
education and student academic success and educational aspirations—is
usually chosen to conceal sexual activity and permit continuation of education.
Some students would embrace parenthood, however, if they had
the fi nancial resources or a stable relationship. Contrary to conventional wisdom, abortion does not inevitably lead to current or perimenopausal
depression, though stress, violent impregnation (rape, incest), and coerced
abortion, especially when combined with religiosity and past mental illness,
may generate psychological repercussions. Students who elect abortion are
sometimes surprised to fi nd that they ruminate about or grieve the “lost
child.” Romantic relationships that are terminated further complicate the
grieving process. In the absence of parental and peer support, counseling
permits a normalization of reactions and exploration of feelings of loss,
shame, and regret by both partners. However, therapists must recognize
and keep unexpressed their moral and religious values, including bias in
favor of or opposition to abortion, which may confl ict with clients’ values. If
this proves too diffi cult, therapists should seek clinical supervision or make
appropriate referrals.