Having read the article on abortion counselling published in the September 2008 issue of therapy today, I feel compelled to write this letter in response. I believe some of the points made about clients to be misleading, so would like to redress the balance. As an experienced BACP accredited counsellor, I am employed by a large NHS university hospital working with people who experience loss through miscarriage and termination. Working in this specialist field is challenging on many levels so, as a member of BACP, I attend one-to-one and peer supervision regularly, so that I continually monitor my effectiveness at the same time as looking after my own wellbeing. All staff who work within this unit are consummate and caring professionals who treat each client as an individual. All clients are offered pre- and post-termination counselling and, if the issues go beyond our remit, onward referrals are made to the appropriate agencies.

I fervently disagree with the assumption that women who continue with an unwanted pregnancy are at greater risk than those who choose to terminate. In my experience, the majority of women do not choose to terminate a pregnancy on a whim. A myriad of reasons play a part in their decision making process, and making the decision to terminate does not by any stretch of the imagination mean that a woman is ‘happy’ with it. Making a decision to end a potential life can be heartbreaking and often gives rise to a terrible sense of guilt. I regularly hear clients describe themselves as murderers. A large proportion of women also report a connection with their unborn baby. These women struggle with doing what they believe to be the right thing for their baby; this is not a choice that is made out of selfishness but often love.

The decision a woman is about to make is a life-changing one, and has to be an informed one as this often has an impact on their recovery. Pre-termination counselling offers a safe space to explore issues concerning their decision as well as their indecision. At the initial meeting, the counselling contract is discussed and the client is offered five sessions.
At the review session, the client can opt for further sessions if appropriate. Time is often an issue but is no excuse for offering anything less than a professional service. Men are also cared for and they too are offered counselling as they often can be forgotten and left to grieve in silence. Couple counselling is also offered if the issues are pertinent to a termination. In the case of under-18s, they can have counselling either on their own, with a partner or with their parent(s)/carer present.

Post-termination counselling often covers issues such as guilt, increased anxiety, lack of self worth and confidence, longing and grief. It is a desperate feeling for a woman who has made the decision to terminate, they take ultimate responsibility for signing away their pregnancy which for some is heart wrenching. During a medical termination (tablet) there is always a risk of the foetus being visible and recognisable to the woman. This traumatic experience further impacts on the woman’s grief and guilt.

Your article quotes Marie Stopes as saying ‘counselling is less important to the women they see than external opinion believes’. They also suggest that women who make this decision have already talked it over with families, partners or friends. Contrary to this, I see many women who are unable to speak to anyone about their pregnancies. Religious beliefs, mental health issues, concealed pregnancies, fear for their safety, being the victim of a rape; or a student far away from home, family and friends; the discovery of foetal abnormalities of a much wanted baby; are only a few of the emotionallyweighted reasons women may have when they consider their choices.

I feel passionate about my work, and feel that the lasting implications for women finding themselves in this position are still not adequately appreciated or understood. Their hearts may never heal, they may never forget. Men or women affected by loss through termination deserve unconditional positive regard, compassion, love and support through their long painful journey to recovery.