Generational trauma, sometimes called Intergenerational Trauma, can be complicated, messy, and hard to work through, especially if the trauma involved is a past abortion experience. We will be talking here about generational trauma, what it is, how to understand it better, and how to heal from it. 


The American Psychological Association defines generational trauma, or intergenerational trauma, as “the transmission of trauma or its legacy, in the form of a psychological consequence of an injury or attack, poverty, and so forth, from the generation experiencing the trauma to subsequent generations.”

Essentially this means the effect of trauma on a specific person has the potential to impact their children. Fascinatingly, the APA also says that this kind of trauma affects cellular levels: “The transference of this effect is believed to be epigenetic—that is, the transmission affects the chemical marker for a gene rather than the gene itself.”

Symptoms can include anxiety, depression, heightened sense of vulnerability, shame, substance abuse, among others. While these kinds of symptoms can mean challenges with several different kinds of mental health issues, narrowing them down to generational trauma can take some work. 


One of the bigger ways that generational trauma is passed on is when the person dealing with the trauma exhibits behaviors that led to their initial trauma, which their children are observing and copying – leading to them making the same decisions that led their parents or grandparents into trauma in the first place. 

For example, licensed clinician Kali Rowe, MSW, RCSWI, says that for many women who’ve experienced abortion, there’s a child who is observing the patterns and behaviors that led to that abortion and is likely to follow.

“With generational trauma, the child is exposed indirectly to the trauma of the parent which can become a cycle again,” Rowe said. 


Sometimes, kids don’t understand why their parents act the way they do because it is due to the trauma they experienced at some point in their lives. If that parent has not taken steps to heal from their trauma, it will more than likely affect their own children in negative ways. 

“Nobody talks about how hard it is to grow up with a parent who is full of unhealed trauma,” said Rowe. “It’s ok to grieve for that parent and feel for them and everything they’ve been through, but also to be angry towards them and all the time that they’ve had to become better for their children.”

It’s not uncommon for children of parents who have unhealed trauma to have a range of emotions towards them. Yet, when parents don’t take the time to heal, that trauma can be transferred to their children and the cycle continues. 


With abortion in particular, it’s important to heal from that experience. Kids pick up things that parents sometimes think they won’t notice. They will see pain and hurt, and even if they aren’t consciously making decisions to follow in their parent’s steps, it’s very possible they will. 

Here are two personal situations where the parent of the person had abortion experiences and never healed from them: 

The girl I was dating had an abortion and I’m really struggling. I’ve been drinking more and using alcohol to try to cope. I don’t want my abortion to define me like my dad, who is haunted by two abortions. I need help to deal with my grief and emotions in a healthy way. – Male Client

My boyfriend insisted on the abortion. He threatened me and the baby if I kept it. I wish I didn’t do it. I was just so scared of him. I wish I would have just dealt with him legally and kept the baby. My dad’s been in prison for ten years, and he wasn’t a good dad even before that. So I know what it’s like to grow up without a dad, and I felt like the same thing was going to happen with my baby. My mom is supportive, but she had two abortions and bottles up her feelings as well, so I can’t really talk to her about this much. We both act like we’re okay even though we’re not. – Female Client


If you’ve been dealing with generational trauma, there is hope, but it is hard, hard work. 

“I really like this saying: the battles you refuse to fight, your kids will have to fight. Our parents refused to fight those battles, so we were left to do them,” said Rowe. 

It’s up to you now to break the cycle of generational trauma because if you don’t, if you refuse to fight this battle, then your children will. 

Rowe continues: “Your inability to confront this means that your son’s going to have to fight that. Your inability to fight your insecurities means that your daughter is going to suffer. Your inability to fight divorce and addiction means that your kids are going to have to fight that battle.”

The story below, excerpted from Unraveled Roots: Exposing the Hidden Causes of Damaging Behaviors was written by Lisa Rowe, LCSW, who suffered from the generational trauma of codependency: 

From the time I was 15 years old, I was never without a boyfriend. I shifted my choices, opinions, and preferences to whatever I thought would make men want me, whatever I thought would make them happy. When one relationship ended, I looked for my next “fix.” I needed men’s approval to feel beautiful and worthwhile.

My own mother’s long history of failed relationships profoundly affected my life and my view of men. Our relationship was strained and rocky as I entered young adulthood. I felt like she was giving me relationship advice that she had never followed herself. But she is also the person who helped lead me to, and continues to walk me through, my healing. 

When I was pregnant with my second child, my marriage—and my self-esteem—crumbled. My pregnancy prevented me from running to another man. I was forced, for the first time, to be alone long enough to reflect on why my relationships always ended so badly. At the same time, I was watching my mom take steps to get healthier. She was still in an unhealthy relationship, but it was clear that her choices and mindsets were changing. 

So when my marriage was struggling, I reached out to her. And she was there for me. She didn’t try to give me advice. She simply said, “What do you need from me?” That love and acceptance was pivotal for me. I had some knowledge of God; but for the first time, I began to truly pour out my issues and problems to Him instead of looking to another man to make me feel valuable. I also went to a counselor who asked some hard questions that challenged me to consider why I missed the “red flags” in so many of the men that I had dated. At first I was defensive, but I gradually realized how I kept missing obvious warning signs. I began to see how my identity was so wrapped up in meeting men’s wants and needs that I didn’t even know who I was. 

Through that process and finding support through my church, I began to understand how I was repeating the patterns of my childhood. My upbringing had profoundly affected my view of men, of myself, and my view of God as Father. As I began to forgive, my relationship with God began to grow stronger and deeper. My relationship with my mother also began to heal. 

At times, this was an extremely challenging, painful journey. But it has been worth every step. As I let go of looking to men for my value, I began to discover who I am. I began to explore what I liked and found my purpose. The internal battle between being who I am and who I thought others wanted me to be has ceased. I have the peace of living an authentic life. 

While I’m compassionate toward others and their struggles, I no longer feel responsible for “fixing” them because my identity is no longer tied to others. The people in my life now are positive and want to grow, too. They challenge me to continue to grow. I used to run away to a new man or a new distraction to avoid taking a hard look at my choices and behaviors. But when I finally quit running, I found someone valuable and beautiful, someone I grew to love: Me.


Lisa Rowe, LCSW, whose story that was, advises applying the three-part process of change, often called The 3 A’s – cultivate awareness, which evolves into acceptance, that allows us to take action and make change. It can be very helpful to receive support through the steps of this change process.

The first step, Awareness, is where a person recognizes a problem or a need for change. Rowe says awareness “helps you understand where this came from, why you have these certain beliefs, why these behaviors are part of who you are, why you’re in the relationship you’re in, etc.” In this step, support from others can offer differing perspectives and feedback that can highlight patterns, behaviors, or consequences that may contribute to the problem. “It’s not about going backward to blame or shame,” Rowe emphasizes, “it’s about going backward to raise an understanding of awareness.” Resources and talking with someone can provide information, insights, and increased self-understanding.

With Acceptance, a person acknowledges the reality of the issue and its implications. This step is crucial to be able to move forward, to work for closure on the past, and prepare mentally and emotionally for the effort needed to make a change. Support when you’re working on acceptance gives you a safe, non-judgmental space to express your thoughts and emotions. Someone you trust – a friend, counselor, mentor, helpline – can validate your feelings and experiences and make you feel less alone, helping you face your situation and process your feelings.

Action is taking steps to address the problem. It includes setting goals, making decisions, and developing new behaviors and habits that support your goals. Taking action requires motivation and perseverance, so it can be helpful to have someone who can give you encouragement, resources, guidance, and accountability to stay on track.


We all want the best for ourselves and our children, and breaking generational trauma is key to making sure your own children won’t be fighting your battles. Whether abortion, addiction, abuse, or codependency is at the root of generational trauma in your family, we have resources to help you. Our Keys to Hope and Healing series addresses healing from abortion and our Unraveled Roots program helps people deal with the roots of codependency, addiction, abuse, and abandonment in their lives. 

© Support After Abortion



Discover how the journey of healing and personal growth after an abortion can fundamentally reshape and enrich the way you parent in our Parenting After Abortion Roundtable webinar. Join hosts, Greg Mayo, Men’s Healing Strategist, and Amanda Hoff, Relationship Development Specialist at Support After Abortion, along with panelists Marly, Rhonda, Susan, and Treion, as they lead this insightful virtual event. Don’t miss this opportunity to gain valuable perspectives and transform your approach to parenting after abortion!


“Somewhere inside of me, I knew I didn’t protect the two children that I lost, and so I had an unrealistic expectation of how much of a father I could be,” reflected Greg as he began the webinar. 

He candidly shared how his two abortion experiences shaped his parenting style, leading him to become overprotective of his children. Greg also explained how he faced a constant struggle with confidence in his role as a father, admitting to battling anxiety and feelings of inadequacy throughout the first decade of parenting. 

Greg shared that it wasn’t until he embarked on a journey of healing from his past abortion wounds that significant changes began to take place in his parenting. Learning to acknowledge, heal and validate his pain, shame, and guilt transformed him into a more intentional parent. He emphasized that this process not only improved his own parenting skills but also inspired him to assist others facing similar challenges. 

Greg highlighted that unresolved abortion experiences can impact parenting in various ways beyond overprotectiveness and anxiety. These impacts can include creating unrealistic expectations, attachment issues, an authoritarian parenting style, a quest for perfection, feelings of undeservingness, and overall confidence issues. He underscored the need for healing to empower parents to create healthier, more intentional relationships with their children. 

By focusing on the importance of healing, Greg set the stage for a deeper exploration of how addressing past traumas can lead to positive changes in parenting. His insights laid the groundwork for understanding the profound connection between personal healing and the ability to foster nurturing, resilient family dynamics. 


Following Greg’s insightful reflections, Amanda expressed her gratitude for his openness, noting that many people could relate to his experiences, including herself. She then introduced a video featuring Carolyn, who recounted her emotional journey after a previous abortion and how it affected her subsequent pregnancies.

When she discovered she was pregnant again just a few years after the abortion, she initially assumed she would have another abortion. However, her boyfriend, now husband, reacted positively, expressing his support for keeping the baby. This response brought Carolyn immense relief. 

But throughout her pregnancy, Carolyn struggled to connect with her baby, feeling unattached and unable to share in the joy that others often described. This disconnection persisted after the birth of her son, where she found a profound inability to bond with him immediately. The birth brought up unresolved feelings from her abortion, and she faced deep-seated guilt, shame, and pain. 

Carolyn continued to experience these emotions with her subsequent pregnancies, leading to a persistent sense of sadness and disconnection with each of her children’s births. Despite loving her children, she grappled with underlying guilt and the belief that she didn’t deserve to be happy or to be a mother. She explained how the unresolved trauma affected her ability to fully enjoy the milestones of her children’s lives and underscored the long-lasting emotional impact of her abortion experience. 


Amanda highlighted common emotional threads, such as the feelings Greg shared, that many others also experience. She pointed out that while Greg became overprotective due to his abortion experience, Carolyn struggled to bond with her children and feel connected to them, and that others may be impacted differently. 

Amanda reflected on the fact that individuals often don’t realize how profoundly their abortion experiences affect them until they begin the healing process, remarking, “We don’t see clearly how it’s affecting us until we get healing.” She suggested that people may go through daily life and parenting without acknowledging the impact, often claiming they are fine. Amanda observed that it wasn’t until Greg started healing that he could look back and recognize how his abortion experiences had consistently influenced his parenting over the years. 

Greg agreed, “Yeah, 100%,” and shared a poignant analogy from his father: “You don’t know how dirty you are until you hose off.” This comparison resonated deeply with Greg as he reflected on his journey. He explained that prior to beginning his healing process, he had been living reactively, not intentionally. Greg likened his approach to life as playing “emotional whack-a-mole,” constantly responding to challenges from a place of woundedness and pain. 

Greg emphasized that embarking on a healing journey required a newfound level of intentionality that made his previous defensive approach to life challenging. As Greg progressed on his healing path, he began to recognize and appreciate the changes in himself. This introspection brought a sense of realization and growth as he understood the impact of his emotional state on his life and parenting, motivating him to continue his journey towards greater awareness and purposefulness. 


Amanda shared her personal story, reflecting on how her abortion at age 14 deeply impacted her perception of motherhood. She recounted feeling pressured by family and friends to have the abortion, leading to immediate feelings of punishment and worry over her future ability to have children. 

She explained how five years later, at age 19, she found herself pregnant again and chose to keep her child despite feeling unprepared. Her fear of punishment persisted into early motherhood, intensifying with each subsequent child. Amanda described the anxiety and pressure she placed on herself and her children, striving to prove her worth as a mother despite lingering doubts and fears.

Amanda detailed how the fear of punishment due to her abortion continued to affect her during her early years of parenting, explaining that she carried a deep-seated belief that she was undeserving of motherhood and that something bad might happen as a consequence of her past decisions. She described how this manifested in her parenting style, particularly with her first child, who she described as colicky and difficult. 

Amanda felt an overwhelming need to prove herself as a capable mother, often shouldering the responsibility alone and feeling compelled to keep her child close at all times, even to the extent of taking him everywhere, including the bathroom. She also described how needing to prove herself caused her to place unrealistic expectations of perfection on her children. This pressure to excel as a mother stemmed from the messages she had internalized about her worthiness and capability after her abortion experience. 

Amanda stated that after 20 years, she finally sought healing, recognizing the profound impact her unresolved emotions stemming from her abortion had on her parenting. She highlighted the importance of early intervention in healing processes, stressing how unaddressed emotional wounds can affect both parents and children. 


 Amanda introduced the concept of the “relationship funnel,” emphasizing that “life change happens in the context of relationships.” She highlighted the importance of taking the opportunity to guide clients toward healing during their childbearing years, particularly when their children are still young. By fostering relationships through tools and programs like BrightCourse or parenting classes, Amanda noted, support centers can provide more frequent touchpoints with clients and cultivate a supportive community. 

Reflecting on her time as the director of a pregnancy resource center, Amanda explained that in that center, clients received resources – such as diapers, wipes, baby clothes – every three months, making it difficult to build meaningful relationships unless clients participated in regular classes. She advocated for inviting all clients to join these classes, emphasizing their benefits, such as community support and incentives to earn additional resources. 

Amanda encouraged using these sessions not just for education but as opportunities to engage clients personally, asking about their lives and struggles to build trust and rapport. She suggested that this approach may help clients feel comfortable sharing deeper issues, allowing for more effective support. 

She detailed how once clients open up about their struggles, providers could introduce deeper topics related to their issues. Amanda mentioned Unraveled Roots, which addresses root causes of damaging behaviors, and other resources available on BrightCourse, such as those focused on trauma and parenting without shame. Materials like these can help clients delve into more profound topics, setting them on a path to healing. 

After establishing a relationship and exploring deeper topics, Amanda said it becomes easier to address sensitive issues like abortion healing. She noted that clients might initially downplay their need for help with abortion-related struggles, but with a foundation of trust, providers can reintroduce the topic and offer to go through resources like Keys to Hope and Healing, also available on BrightCourse, which serves as an excellent starting point for abortion healing. 

Amanda recommended providing various next steps, such as more in-depth spiritual curricula, retreats, or referrals to clinicians, allowing clients to choose the path that best suits them. She emphasized that by guiding clients towards healing, they could begin to see generational patterns being broken. She noted that this approach would foster healthier parents, which makes healthier children, and healthier communities. Amanda underscored that the ultimate goal for everyone involved was to create positive, lasting change within families and communities.   


Next, Amanda introduced the roundtable panelists, expressing her excitement to hear their insights and experiences on integrating healing into their services. 

She invited Marly, Treion, Susan, and Rhonda to introduce themselves. 

The panelists introduced themselves, sharing their roles and affiliations:

Rhonda manages a pregnancy resource center in the midwest.

Treion has been the director of a pregnancy resource center in the western US for 30 years and also serves as executive director for a regional abortion healing retreat program. 

Susan serves as office manager in a pregnancy resource center in the south and has been involved in abortion recovery for 18 years.

Marly coordinates abortion healing in a pregnancy resource center in the southeast and has been with the center for over 20 years.



Amanda asked how panelists’ abortion experiences had affected their parenting. 

Rhonda shared that her experience paralleled both Amanda and Greg’s, recounting how she had her first abortion at 16 and, six years later, became pregnant with her son. Determined not to repeat her past, she embraced the pregnancy, but continued to think about what she missed out on with her first pregnancy. Rhonda described the overwhelming gratitude she felt upon giving birth, clinging tightly to her son, and feeling fortunate to have the chance to be a mother again after years of promiscuous behavior and substance abuse, which she attributed to her unhealed abortion experience. 

Rhonda explained that she parented very closely, struggling to let go and becoming obsessive-compulsive about every aspect of her son’s life. She detailed how she would control his play and follow him around, fearing for his safety and questioning her capabilities as a mother. This intense need to make up for not parenting at 16 led her to overcompensate with her son. 

When she had another child at 26, the experience was different, marked by physical complications related to her past abortion. While she was less clingy, she still parented closely and controlled everything, a behavior that persisted until she went through a healing process. Reflecting on her journey, Rhonda realized that her need for control and obsessive-compulsive tendencies were deeply tied to her unresolved feelings about her abortion experience. 

Amanda expressed gratitude to Rhonda for her vulnerability and sharing her story, noting the common threads that resonate across their experiences.

She then turned to Susan, asking her to share how abortion affected her parenting. 


Susan shared that she became pregnant at 18 and, for various reasons, chose abortion, which she later regretted deeply. She acknowledged that she didn’t realize how much it had impacted her until she participated in a healing program. 

At the time of her healing journey, her children were 10 and 7 years old. Reflecting on Greg’s and others’ stories, she saw similarities in her own experience of striving to raise perfect children to compensate for her past decisions. Susan emphasized that her healing process allowed her to step back and give her children the freedom to be themselves, which brought them happiness. 

Greg asked Susan whether she had informed her children about entering into a healing program, or if they had noticed a change on their own. 

Susan responded that about a year after completing the program, she decided to share her experience with her children. Intending to share her story publicly, Susan felt it was best to tell them beforehand. Being that her children were only 11 and 8 at the time, Susan shared that she was pleasantly surprised by their reactions and felt a sense of affirmation that it was the right time to disclose the information. She communicated to them that she had realized how much she had expected from them. Now as adults, her children acknowledge that the healing journey was beneficial for their mother and consequently for them as well.  



Susan reflected that one of the significant changes in her parenting style, similar to previous speakers, involved overcoming deep-seated fear that stemmed from her abortion experience – that she didn’t deserve to have children and that God might take them away as a consequence. She expressed that addressing this fear allowed her to let go of the need to control her children’s every move and to embrace allowing them to fail and learn under her guidance. 


Rhonda recounted her journey into abortion healing, which began in 2006 when she surrendered to God. She started working at a pregnancy resource center and was invited to share her story at a local school. Beforehand, she disclosed her past to her children, expecting their dismay but instead received understanding and empathy, especially from her son, who acknowledged having a sister in heaven. This revelation lifted a burden and strengthened their relationship, allowing her to embrace motherhood with newfound freedom from fear and shame. 

Greg thanked Susan and Rhonda and once again pointed out the commonalities and threads among the speakers, suggesting that these shared experiences also reflect what we may encounter with clients. This observation underscores the relevance of integrating healing practices into our centers based on these shared narratives. 



On the topic of integrating healing into pregnancy resource centers, Amanda asked Treion how she’s been able to create a culture that prioritizes healing within her center.

Treion emphasized her approach to prioritizing healing by first acknowledging the ongoing need for personal healing among staff and volunteers, fostering a culture of humility and empathy. 

She explained that with clients, they begin by building relationships through inviting them for informal meetings like coffee or soda, and then tailor their approach based on each client’s preferences before integrating and delving into programs like BrightCourse and Earn while you Learn to cater to various needs.

Treion also discussed a structured progression through programs like Unraveled Roots and Keys to Hope and Healing, followed by deeper emotional exploration and opportunities for biblical engagement and retreats, all supported by ongoing relational connections and always based on the client’s preferences. 

Amanda found Treion’s methods inspiring and commended her for integrating healing into her center’s activities. She emphasized the importance of starting with personal healing among staff and thanked Treion for sharing her insights. 

Amanda then directed the same question to Marly about creating a culture of healing in her center. 


Marly explained that at her center, they prioritize prayer, healing, and then parenting. She said that while evangelism is also important, they focus on sharing their faith and values only after they’ve established a relationship. Marly stated that when clients visit the center for services, their intake process identifies if they have experienced loss through abortion, allowing them to initiate conversations about trauma and healing, focusing on forgiveness and grief. 

She emphasized the use of BrightCourse to educate clients about trauma and its effect on their lives. She noted that many people struggle to connect past experiences to current issues and stressed the importance of addressing past pain to positively influence motivations and relationships. Marly advocated for a holistic approach to healing, encouraging personal growth and transformation through deeper relationships and support networks. 

Amanda stated that she found Marly’s insights inspiring, particularly the notion that parenting information without healing is merely information, a perspective Amanda often quotes. She expressed a desire to continue learning from the panelists due to their wealth of knowledge. 

Amanda then shifted the focus back to Susan, asking her to share some of the unique methods she utilizes for incentivizing healing practices in her center, noting that Susan’s approaches had been particularly effective. 


Susan explained that they recently established a separate facility called the “Parenting Center,” where clients attended classes utilizing BrightCourse. She stated that they are offering significantly more points to parents who attend these classes compared to their regularly offered parenting classes. Clients can use the earned points for vouchers to area thrift stores to shop for baby items. 

Susan shared that they are starting their first in-person Unraveled Roots group. They have promoted the program heavily among their clients and on social media, setting a participant cap and emphasizing limited spots. As a result, they had 15 people sign up, including some dads. She expressed excitement and hope that the group would not only foster healing, but also help build relationships, which could lead to participants choosing to attend additional types of classes. 

Amanda expressed enthusiasm for Susan’s ideas and excitement about the upcoming Unraveled Roots group. She reassured Susan of Support After Abortion’s support and desire to hear about the group’s progress. 

Q & A

Greg expressed his gratitude to the panelists for their insights. He emphasized the importance of offering various options to clients, stating, “We have to provide options that meet clients where they’re at.” He underscored that the key to achieving this is through collaboration, such as sharing ideas and learning from others in settings like these, to “help as many people as possible find healing.”

Amanda then encouraged attendees to submit questions for her, Greg, or the panelists using the chat feature.

Q: How can partners, spouses, parents, or other close individuals support the recovery process of someone who has experienced abortion?

A: Greg responded, saying that he disclosed his abortion experiences to his wife early in their relationship, before marriage. Although she had not experienced abortion herself, she chose to participate in Keys to Hope and Healing to gain understanding. Greg emphasized again that each person’s journey through abortion recovery is unique, mentioning how his wife found value in participating in Keys to Hope and Healing, which provided her with insights into their shared losses. 

Q: How can we assist our clients in seeing that their abortion may be affecting their parenting if they are currently unaware or denying any impact?

A: Greg acknowledged that it was challenging to convince someone of what they needed to know, emphasizing that building a relationship was crucial. He referred to Amanda’s funnel approach as essential, explaining that trust and meaningful conversations with someone who knows, likes, and trusts you were key. He noted that without context, it would be difficult to address the issue effectively. 

Amanda agreed, stating that through relationship building and discussing other issues, clients might come to realize how their abortion may be affecting them. She stresses the importance of having that trust to discuss such sensitive matters. 

Treion added that it was not about convincing clients but asking insightful questions to help them recognize their own issues. By acknowledging their anxieties and fears, clients could see the need for help and be more willing to participate in programs, rather than just being told to join a class. 


In closing, Greg invited participants to email him or Amanda with any further questions or comments. He expressed gratitude for everyone’s attendance and thanked the panelists for sharing their knowledge, stating how much he learns from them daily. 

Greg emphasized his appreciation for being able to share this knowledge with other providers and concluded by thanking everyone again.


Click here to watch the video of this webinar.

Click here to go to the self-guided Unraveled Roots for Men resources

Click here to to to the facilitator Unraveled Roots for Men resources

Click here to register for the next Men’s Healing Matters webinar.

Click here to register for the next Abortion Healing Provider webinar.

Click here to access Support After Abortion’s Resource Library.

Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.

© Support After Abortion

A Better You is a Better Dad


Self-care is essential for effective fatherhood. In our A Better You is a Better Dad Men’s Healing Matters webinar, Greg Mayo, our Men’s Healing Strategist, explored the critical role self-care plays in becoming a better father. He addressed the importance of  father’s prioritizing their own physical, mental, and emotional well-being to set a positive example for their children, aligning with Charles Kettering’s insight that Every father should remember that one day his son will follow his example, not his advice. Greg shared practical advice specifically for fathers on how to integrate self-care into their daily routines, leading to more fulfilling and balanced parenting. Greg also discussed the concept of generational healing, highlighting how fathers who focus on their own wellness can break negative cycles and foster a legacy of emotional resilience for future generations.   


“What is Father’s Day?” Greg opened the session by sharing some interesting facts about how the holiday celebrated in commemoration of father’s in June came to be. “It started in 1910 in Spokane, Washington by Sonora Smart Dodd,” Greg said. He shared how Dodd, inspired by her own father – a single parent and Civil War veteran who raised six children – advocated for a day to honor fathers. Moved by the dedication and hard work of her father, Dodd felt it only fitting to establish a day akin to Mother’s Day celebrating paternal love and commitment. 

Greg pointed out that in the United States, Christmas holds the number one spot as the most celebrated holiday, followed closely by Mother’s Day at number two. Surprisingly, Father’s Day ranks much lower at number 20 in terms of popularity, prompting reflection on the societal emphasis placed on honoring fathers compared to mothers. 


“Let’s talk about some stats,” Greg said. He stated that there are approximately 72 million fathers in the U.S. today over the age of 15. Of those 72 million, about two million are single dads with primary custody raising their children. And 24 million American children live in a home where the father is absent. He went on to remind the audience that one in five men will experience abortion loss by the time they are 45. 

Greg emphasized the crucial role of fathers in child development, stating, “Dads play an important role. Without dad, we have a whole litany of problems.” He referenced Dr. Craig Garfield, MD, highlighting research that shows children with involved fathers experience cognitive benefits such as better linguistic abilities and higher academic readiness. Greg underscored the socio-emotional impact, noting that these children demonstrate better coping skills, maturity, prosocial behaviors, and secure attachments. Greg also linked fatherlessness to negative societal outcomes like school dropouts, violence, and poverty, which have risen alongside declining father presence.   


Greg reflected on his experience as a homebuilder, remodeler, and realtor over the past few decades, introducing the concept of “ugly money” versus “pretty money.” He explained, “The ugly money is stuff that a potential buyer may not see. Foundation, structural work, electrical, things like that.” Greg stressed the importance of addressing these foundational and structural issues first for the safety and health of the house and its occupants. 

He contrasted this with “pretty money,” which includes visible upgrades like new kitchen cabinets, paint, and flooring often showcased. Greg cautioned, “While there’s nothing wrong with spending the pretty money, if you don’t spend the ugly money first, you don’t have a structurally sound house.”

Greg illustrated this point with a personal example from his real estate career, where a seemingly remodeled house revealed significant structural issues that had been neglected. He emphasized the parallel in personal development, stating, “With people, it’s the same thing. We have to spend the ugly money.” Greg highlighted the importance of addressing fundamental aspects before focusing on superficial enhancements to achieve long-term success and well-being.  


“70% of men reported stress, lack of sleep, financial worries, and increased demands upon becoming a father,” Greg said. He discussed how new fatherhood impacts men, highlighting various statistics. Greg noted that 56% of fathers felt judged by their co-parents, with many feeling they weren’t “doing a good job in the other’s eyes.” He highlighted that a little more than 50% of new fathers noticed negative changes in their health habits, such as exercising less, and drinking and smoking more, linking this to his earlier concept of “ugly money” – fundamental issues that need addressing. 

Greg pointed out that about half of new fathers experienced pressure to be a good dad, yet only 39% believed they were succeeding. He remarked, “That should give you pause because if only 39% of men think that they’re succeeding, that means the vast majority don’t,” emphasizing the importance of fathers having the confidence to lead. He also shared a surprising statistic that 25% of men experienced postpartum depression. Moreover, 23% of fathers felt isolated, dealing with struggles they felt others couldn’t understand. 

He stressed the importance of self-care in fatherhood, warning that neglecting it can have significant consequences. He emphasized, “If you’re not sleeping well, if you have high stress and anxiety, the last thing you should do is exercise less and drink and smoke more.” Greg underscored the idea that to be a better dad, you must first take care of yourself. 


“I lost my first child to abortion when I was 18 and my second at 22,” Greg said as he discussed how unhealed abortion experiences can profoundly impact fatherhood. He explained that it wasn’t until he was 39 that he entered abortion healing, having carried a burden of shame, guilt, pain, and regret for over 21 years. By that time he had already been a father for a decade, with three children at home.

Greg noted that while he didn’t struggle with attachment issues, he did have unrealistic expectations of himself as a parent. He felt that he had to be the perfect dad, a drive rooted in his unresolved feelings of shame and guilt over the abortions. He said, “I didn’t feel like I deserved to be a dad.” This lack of self-confidence led him to be overprotective, even becoming a “helicopter parent” despite previously mocking the term. He described his constant anxiety, which he didn’t fully recognize until many years later. This overlap between his unhealed abortion experience and his approach to parenting significantly affected how he raised his children. 

Next, Greg introduced Nyles, the new Men’s Healing Coordinator at Support After Abortion, to discuss how an unhealed abortion experience impacted fatherhood for him. 

Nyles began by explaining that his abortion experience occurred after the birth of his first son, who was born when Nyles was 19 and still a college athlete. He described how he and his partner at the time, after exploring their options, decided to go through with the abortion. Nyles reflected, “Some of the tendencies of being unhealed leaked into my relationship with my son.” He shared that he often felt like he was letting his son down and that he had to make up for the lack of a sibling. Nyles said, “I felt a lack of confidence, but also a feeling that I was undeserving of being his dad.” 

Nyles recounted how his overprotectiveness manifested in behaviors such as never letting his son out of his sight at the park, driven by the fear of losing another child. Nyles expressed that this fear stemmed from his abortion experience and his determination to “never lose a child in any way again.” 

Working at Support After Abortion, Nyles has realized he needed to heal more and build a healthier relationship with his son. He admitted, “I’m still going through my healing journey as well,” emphasizing that his new role was both an honor and a significant part of his own healing process. Nyles saw his employment as another step towards personal healing and an opportunity to support others in similar situations. 

Greg expressed his gratitude to Nyles for sharing his story and welcomed him on behalf of the entire organization. Greg then asked the audience to reflect on the similarities between Nyles’s story and his own, noting, “Nyles’s story has some overlaps with how he felt and acted and things he thought with my own story.” Despite a gap of over two decades in age and about 800 miles between them, Greg emphasized that many men experience similar feelings and struggles. 

Greg highlighted that these shared experiences are profound and real for many fathers. He urged the audience to recognize these common truths when supporting men, as they can deeply impact a father’s life. He concluded by stating, “It is important to be aware of that when you’re dealing with these guys because those things are very real, and as a dad, they can consume you.”


“Children are two and a half times more likely to have poor mental health if their fathers have poor mental health,” Greg said. He discussed findings from The National Library of Medicine, highlighting significant statistics such as “80% of chronic mental health disorders begin in childhood,” stressing the need for early intervention. Greg also pointed out that “25% of U.S. children suffer from at least one chronic health condition,” illustrating the widespread impact on children’s health. 

Greg connected these statistics to the broader issue of fatherhood and mental health, noting, “A lot of it is fatherlessness. Dad is gone or not an intentional dad, right?” He shared personal reflections, mentioning how unresolved issues had previously affected his children. However, he also emphasized the positive impact of his healing journey on his parenting. 

Furthermore, Greg highlighted the increased risk of behavioral and emotional difficulties in children when fathers experience mental illness. He urged fathers to prioritize their mental health, as untreated issues can lead to feelings of ineffectiveness and inconsistency in parenting, perpetuating a harmful cycle. 

“My father didn’t tell me how to live. He lived and let me watch him do it,” Greg quoted Clarence Budington Kelland, emphasizing the profound impact of parental example. Reflecting on his own journey, Greg shared, “When I started my healing journey at 39, I began to address anxiety issues that had been my norm for so long.” He described how seeking help transformed his parenting style, enabling him to be more intentional and less overprotective with his children. 

Greg passionately advocated for generational healing, highlighting how personal growth positively influenced his family dynamics. Sharing tips from a Medibank article, The Keys to Being a Healthy Dad, Greg encouraged fathers to prioritize mental and physical health, recommending habits like reading daily, staying active, cooking meals, and maintaining sensible sleep routines. 

“Reading 20 pages from a book a day may not seem like much, but over time, it can make a significant impact,” Greg explained. It’s a habit that stimulates the mind and broadens perspectives.” He cited Darren Hardy’s book, The Compound Effect, which underscores how consistent small actions lead to substantial personal growth. “Whether it’s learning about classic cars or exploring new management techniques, regular reading can turn anyone into an expert over time.”

Greg also stressed the benefits of staying active. “Even simple activities like walking for 20 minutes a day can add up to over 250 miles in a year,” he noted. “It’s not just about physical health; staying active also boosts mental clarity and overall well-being.”

Discussing cooking meals, Greg emphasized, “Preparing meals at home fosters healthier eating habits for the entire family. It’s a chance to bond over nutritious food and save money compared to eating out.” He highlighted the importance of setting a good example for children, helping them develop lifelong skills and a taste for wholesome foods. 

On the topic of sleep, Greg advised, “Understanding your own sleep needs and ensuring you get adequate rest is crucial. Good sleep habits directly impact mood, energy levels, and overall productivity.” He cautioned against trying to “catch up” on sleep, emphasizing the importance of consistent routines for long-term health. 

Greg made a heartfelt plea for men to reach out when they need support. “Don’t be afraid to ask for help or advice,” he urged. “Whether it’s from friends, family, or professionals, seeking support is a sign of strength, not weakness. It fosters resilience and improves both personal well-being and parenting effectiveness.”


Greg elaborated on the concept of generational trauma and how it profoundly affects individuals and families. “Generational trauma encompasses learned beliefs, behaviors, and patterns passed down through previous generations,” he explained. This legacy influences everything from relationships and parenting styles to coping mechanisms and overall worldview. Greg emphasized that everyone faces challenges in life, and comparing them doesn’t diminish their impact. However, he stressed the possibility of generational healing, highlighting how personal healing from trauma, such as his own father’s experience with alcoholism, can positively influence future generations.   

Greg shared a poignant personal story to illustrate generational healing. He recounted his father’s upbringing in an abusive, alcoholic household, which inevitably shaped his own struggles and parenting style. Despite his father’s early absence and subsequent battles with alcoholism, he eventually achieved sobriety and dedicated himself to healing. Greg candidly described confronting his father about the pain caused by his absence and the turmoil it inflicted on him. Through tears and heartfelt dialogue, Greg and his father reconciled, marking a turning point in their relationship. This healing journey not only transformed their bond, but also ensured that Greg’s children experienced a loving and supportive grandfather, free of the turmoil from Greg’s own childhood.

Greg concluded with a powerful reflection on generational healing’s significance. “Taking care of yourself impacts your children,” he passionately asserted. He urged everyone to consider how their personal healing journeys could resonate through future generations, fostering a legacy of resilience and emotional well-being. 


Click here to watch the video of this webinar.

Click here to register for the next Men’s Healing Matters webinar.

Click here to register for the next Abortion Healing Provider webinar.

Click here to access Support After Abortion’s Resource Library.

Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.

© Support After Abortion




Get an exclusive, first look inside our new book, Unraveled Roots for Men: 4 Causes of Damaging Behaviors, along with accompanying videos, facilitators guide, and more! 

Join Support After Abortion’s Men’s Healing Strategist, Greg Mayo and Karin Barbito, Special Projects Manager, to hear directly from the authors on how to tackle abandonment, addiction, abuse, and codependency head-on.

They’ll take you behind the scenes of the video production, share a sneak peek of the final product, and reveal insights into the writing process. Discover where the book is available, its various formats, and how this men’s edition evolved from the original Unraveled Roots. Plus, learn about exciting upcoming opportunities related to the book. 


“Today we’re talking about something we’ve been working on for a long time,” Greg said as he introduced the new book produced by Support After Abortion, Unraveled Roots for Men: 4 Causes of Damaging Behavior. 

Unraveled Roots for Men: 4 Causes of Damaging Behaviors Book Cover



As background, Karin described the inspiration behind Unraveled Roots. Support After Abortion started as a program in a pregnancy center. At that time Lisa Rowe, our Clinical Strategist, was the Executive Director of the PRC. She previously had worked as a clinical social worker in a high school program for teen moms. Lisa observed that some of the recurring clients the PRC was serving were former students of that high school program. Only these young women were seeking help with second and third pregnancies. And their lives were more chaotic than when she first worked with them in high school. 

Karin shared how a perplexed Lisa questioned the efficacy of how the young women were being served. Karin said, “We were not serving them well, so we started to brainstorm. No one wants to grow up and be a drug addict, but they do. No one wants to grow up and abuse their partner, but they do. No one wants to find themselves pregnant and then choose abortion, but they do.” 

She highlighted how through their brainstorming, they realized that there was something underneath the symptoms that were presenting, root causes contributing to the repeated behavior patterns. 

Karin excitedly declared, “And that’s where the book came from!” She explained that Support After Abortion did all of the production of the original Unraveled Roots client and facilitator video series in house. She enthusiastically shared that the program was then pitched to BrightCourse, a video-streaming curriculum service used by 2,000 social service agencies, counselors, pregnancy centers, and others. They were equally excited and picked it up. “That was one of the first things we got on BrightCourse. And seeing the success of the woman’s book, how different lives have been as a result of that, we just knew that we had to create something for men,” she said.


Karin asked Greg to share a little about why he thinks having a men’s edition is so important. Greg responded, “We have to start with a little bit of the frustration that I experienced, and a lot of men experience.” He explained how, in the past, much of the material related to abortion healing has been geared toward women, highlighting how even material marketed to men was written by women or repackaged for men. 

“There’s nothing wrong with that in this sense, but the idea is that men speak differently and use different phrases. Different ideas and concepts resonate differently with men. And men often find healing in different ways too,” Greg said. 

He explained how the catalyst for developing the men’s book began in a co-ed Unraveled Roots group where he noted the difference in verbiage between the male and female participants. He realized the impact it was already having and strongly believed that more men could be reached with a version specifically for men, written by a man, that touched on the same roots. 

Karin affirmed what Greg shared about the differences between men and women, adding, “When I would ask Greg, how do you feel about that? He would say, Karin, I don’t feel anything about that, but I can tell you what I think,” highlighting it as an example of how they differ. 


Greg shared that when the team began developing the book and the accompanying client-facing and facilitator-training video series, there were specific components they knew needed to be included, beginning with being written from a male perspective. Greg acknowledged himself as the author of the book, and shared that it has been a collaborative project involving a Support After Abortion team over the past year. 

He said that two other important components were the inclusion of real stories of men’s experiences, with names changed for privacy, and using examples that resonate with men. He explained how the Support After Abortion and production teams had many conversations during filming about whether the stories were being portrayed in a way that would speak to men to ensure they were staying true to their purpose. 



Behind the scenes, actors filming real stories from the book

Greg shared how all of the production crew and actors were male, varying in age and backgrounds, which leant itself to having other male voices to consider as they worked through the scenes, affording a greater level of authenticity.

Behind the scenes with all male crew and actors

Greg shared a clip from one of the client-facing videos, highlighting the producer’s narration and actor portrayal of “The Root of Abandonment.”  He emphasized the quality of the production and the resulting companion videos, saying, “It was very important to us to have a high level of quality, because in order for it to be truly effective, it had to be relatable to the men watching the video, and I think we achieved that.”


Next, Greg discussed the various formats Unraveled Roots for Men is available in: paperback and Kindle on Amazon and digital download, and bulk ordering on Support After Abortion’s estore. He was excited to share that Audible would also be carrying the book in audio format in the next few weeks. 

He emphasized the importance of making an audio format available as men have shared they find the convenience of listening on their commutes beneficial. 


Sample pages from Unraveled Roots for Men

Greg showed the audience a few samples taken from the book’s pages. In this example, the subject of the chapter focuses on “The Root of Abandonment.” He explained how the core text centers on the root issue – defining it, talking about it, and going through ways it shows up in real life. From there, he said, you read a Truth Story of one man’s struggle with that chapter’s root issue. Additionally, The Light Through the Branches stories inspire hope through overcoming. 

Karin pointed out that The Light Through the Branches stories are a new feature from the original Unraveled Roots book. She said these secondary stories are also included in the client-facing videos using actor voice overs to B-roll. She felt this addition enriched both the book and the video series. 

Greg concurred, noting that the varied stories allow more men to relate to the content, as issues manifest in different ways. He stated that this approach was aimed at reaching as many men as possible. 

At the end of the chapter, he explained, is the “Digging Deeper” section. This area is meant for thoughtful contemplation and provides space for capturing reflections through writing. Greg recommended that men incorporate journaling into their lives, sharing that he himself journals regularly. 

He noted that in the “Digging Deeper” section, the first step is to acknowledge what happened. Next, it addresses the lies men may have believed about themselves based on the event. Greg explained how it then guides them to recognize the behaviors they chose or engaged in because of those lies. From there, it focuses on finding the truth and changing those behaviors. He highlighted the importance of each of the steps in unraveling the roots of damaging behavior. 

Karin interjected to emphasize the importance of the order of the steps in the “Digging Deeper” section. She explained, “The reason they’re in the order that they are is that awareness is the first step in the change process. If you’re not aware of the roots of the things that happened in your life when you were growing up and how it made you feel about yourself, you can’t change it.” Greg agreed, highlighting that the first step is admitting there’s a problem and acknowledging your current state. 


Companion Journal and Facilitator Guide Covers for Unraveled Roots for Men


Greg introduced the addition of a companion journal to the book as well. Available through the Support After Abortion Estore, it can be downloaded and filled in electronically or printed for traditional use. 

Greg reiterated the importance of journaling, especially at the beginning of a recovery process. He said that he believes journaling is crucial for reflecting on thoughts and feelings over time. Greg explained, “When you hit a benchmark, say you go through an Unraveled Roots group, you can look back on what your thoughts and feelings were when you started. That’s part of the reason I think journaling is so important.”

He shared a personal anecdote to illustrate his point: “When I went to my first Adult Children of Alcoholics meeting at 18 years old, I wrote a letter to myself about that first meeting. I found that letter over this past weekend, and that was 36 years ago.” This experience underscored for him the long-term value of journaling in the recovery process. 


Greg discussed the release of a facilitator guide, which has been in the works for the past several months, describing it as a valuable tool. 

The guide, available through Support After Abortion’s EStore, provides instructions on setting up and managing a group, and includes sample intake forms, welcome email templates, and weekly session guides. It is downloadable and printable right from the website, aiming to ensure facilitators’ success in leading an Unraveled Roots for Men group.


Karin guided the audience on navigating to Support After Abortion’s “Abortion Healing Center” webpage and the new Unraveled Roots section for both men and women, where users can anonymously access self-guided, self-paced resources. Users can choose to order the book from Amazon or download it from this page.  They can also download the fillable journal and view the videos.

Unraveled Roots for Men, client webpage


Karin directed providers to the Provider Training Center, Unraveled Roots section. This area offers both the facilitator-training and client-facing videos, facilitator guide, and options to download or purchase the book and journal. Providers access these resources using a login name and password. 

She highlighted that Unraveled Roots for Men will soon be available on BrightCourse. It will include quizzes on both the facilitator training and the client-facing videos to ensure you “know how to be that client’s advocate.”

Greg thanked Karin for sharing all of the ways to access the content and said, “I’m also thankful that we created so many different things around the book. All the things you just talked about – the videos, the journal and the facilitator guide –  because it really illustrates a commitment to helping men find healing, to helping men find a better path. A path out of their pain, a way to untangle their roots, a way to move forward.”


Greg discussed the various ways to use Unraveled Roots for Men. One option, as Karen mentioned earlier, is to do it independently using the book and client videos, which provide direction and bring the content to life. 

He shared that some pregnancy resource centers have success working with clients one-on-one, especially when they may not have enough clients to form a small group. This approach, involving a “mentor” or “coach,” offers focused attention and is a valuable method for going through the material. 

Greg also highlighted the small group option, typically recommended for six weeks, that can be offered virtually or in-person. He reminded the audience how Support After Abortion could be of assistance in setting up virtual groups, which will enable providers to offer flexible options for healing. He stated that this variety in approaches – independent, one-on-one, and small group, both in person or virtually – underscores the commitment to providing multiple pathways to healing. 


Greg and Karin discussed the structure of each week for small groups. Greg explained that typically, the first week involves introductions and Chapter 1, Why am I here? Greg emphasized the importance of this question, stating, “Each person needs to honestly answer that question because at the end of the group, we’ll revisit those answers.” This reflection allows participants to track their growth and understanding throughout the group. 

Small group weekly structure

He explained that week two focuses on the Root of Abandonment, defining it and exploring its impact through a true story and a series of thought provoking questions. 

Week three, he said, delves into the Root of Addiction, examining its effects from youth into adulthood, and applying the same process as the previous chapter. 

Week four addresses the Root of Abuse. Greg cautioned that while “all of the chapters can be triggering, this chapter can be hard to go through,” especially for those going through the material independently, as different forms of abuse are discussed. As with the previous chapters, the same process is used to guide participants in finding truth and changing behavior. 

In week five, the Root of Codependency is covered. Greg explained how the chapter defines the term in an easy to understand way and uses real life examples to break it down further. 

Karin shared her own experience leading codependency groups, noting how many participants initially deny being codependent, much like she did before her own recovery. She emphasized that almost everyone exhibits some form of codependency and highlighted the importance of recognizing it, allowing participants to decide whether to continue their current behaviors or make changes for personal growth. 

Greg discussed week six, explaining that it was designed to revisit the initial question, Why am I here? He emphasized the importance of reflecting on the reasons for starting the journey, the insights gained, and the behaviors changed through addressing the four different roots. 

Greg noted that this reflection aligns with “finding purpose in your pain,” asking participants to consider their next steps after experiencing healing through the Unraveled Roots process. 

He explained that week one, normally marked by trepidation and anxiety, contrasts with week six, which can be emotionally heavy as participants reflect on their progress and contemplate their future actions. 

Summarizing the six week process, Greg addressed those considering the group, stating, “If you’re thinking this is an entry-level group, it absolutely is by design.” The goal, he explained, is not to delve deeply into each subject but to help participants find some healing, peace, and pathways forward. 


Karin highlighted positive outcomes from people who had been through Unraveled Roots. The first was from a group participant who said, ‘Unraveled Roots’ helped put the pieces together as to why I even got to the point where I was facing the abortion decision in the first place. My trauma was so much deeper than I imagined, and just becoming aware of that is just so healing. Karin emphasized that understanding the abortion decision as a symptom of deeper issues was crucial. 

 A 74-year old coaching client said, ‘Unraveled Roots’ has given me a whole new life. Karin noted how remarkable it was that people could experience such profound changes even later in life. 

And a provider who offers Unraveled Roots to their clients said: After going through ‘Unraveled Roots’ myself, I know it can be an essential tool for helping clients break generational cycles and understand themselves and their decision-making. Karin stressed the significance of this feedback, noting that unhealthy behavior patterns often pass from generation to generation, and recognizing these patterns is key to breaking them.   

Greg agreed with Karin, acknowledging the abundance of positive outcomes. He noted that just as unhealthy behavior patterns can be passed down generationally, individuals also have the power to create generational healing. “You can be the catalyst for that, you can be the jumping-off point for generational healing,” he said. Greg emphasized that it all comes down to a decision, stating, “Am I adjusting my sail this way or that?”


Greg encouraged viewers to prioritize their own healing, emphasizing the importance of self-care with a quote from Lisa Rowe, LCSW: “You can’t pour from an empty cup.” 

He explained that just as you must put on your own oxygen mask first in an airplane emergency, you must also find your own healing before effectively helping others. “It is impossible to truly and effectively help another person on their healing journey until you’ve walked your own,” he stated.

He announced his upcoming Unraveled Roots for Men group starting in July as an opportunity for men who want to lead, to begin their own healing journey. 

Karin emphasized the importance of this opportunity, urging men to sign up quickly for Greg’s group due to its limited capacity of 10 participants. She highlighted that this would be the first Unraveled Roots group exclusively for men – and the fact that it will be led by Greg, the book’s author – and encouraged men to secure a spot. 


Greg shifted the focus to helping clients heal, highlighting the new coaching program for male providers. He noted that Karin has successfully run a one-on-one coaching program for women for nearly a year, and now a similar program is being introduced for men. Greg explained that he would be working with men individually, guiding them through the process of facilitating Unraveled Roots for Men or Keys to Hope and Healing, whether in a group or one-on-one setting. Men can email Greg directly to learn more or to sign up for coaching.


Greg encouraged everyone to “get a copy of the book, read it, and reach out for further discussion.” He invited everyone to contact him or Karin via email, emphasizing the availability of direct communication with the authors, encouraging anyone interested in facilitating to get in touch and seek their assistance.  


At the end of the presentation, addressed questions from the audience. Here are a few highlights related to Unraveled Roots for Men:

Q: Should men do Unraveled Roots for Men first or Keys to Hope and Healing?

A: It depends on the individual. Some men may first need to address childhood issues like abandonment or addiction through Unraveled Roots before tackling abortion-related behaviors with Keys to Hope and Healing. Others may start with Keys to Hope and Healing to clear emotional wreckage from an abortion, which can then reveal deeper issues suitable for  Unraveled Roots. Each healing step can uncover new areas for growth, encouraging ongoing healing efforts. 

Q: What is the sweet spot for Unraveled Roots? Would the 6-7 week group be appropriate for men as a follow-up to an all-day healing retreat?

A:  We have learned that retreats are like drinking from a fire hose. You come out of those on an extreme high note, so a follow-up to that kind of experience is a brilliant idea. At a retreat, you are digging deep for 8-9 hours a day; there isn’t a lot of processing that goes into it. It’s an experience, an encounter, so having it followed by another resource like Unraveled Roots is a really smart idea. 

Q: We are just getting male volunteers into our center and they’ve never facilitated. How do we get them ready to lead Unraveled Roots for Men?

A: The easiest way is to email me and enter them into the male coaching program. Let us walk them through the process of getting ready to facilitate so they can do an impactful job.


Click here to watch the video of this webinar.

Click here to go to the self-guided Unraveled Roots for Men resources

Click here to to to the facilitator Unraveled Roots for Men resources

Click here to register for the next Men’s Healing Matters webinar.

Click here to register for the next Abortion Healing Provider webinar.

Click here to access Support After Abortion’s Resource Library.

Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.

© Support After Abortion



Uncover strategies to engage men quickly and effectively and support them with healing options that meet their needs. This webinar offers insights into stigmatization, men’s perceptions of mental health care, and reasons why they may hesitate to seek the support they desire and need. It explains the 4 Questions Deep by 4 Questions Wide conversation method to maximize the impact of brief interactions. And, it provides tips for effective messaging for social media, advertisements, and literature that resonate with men. 


“A sad soul can be just as lethal as a germ,” Greg Mayo, Men’s Healing Strategist at Support After Abortion, opened with a quote from John Steinbeck and continued, “Many men struggle with a lot of different things that we’re going to talk about, and those lead to their seemingly averse attitude toward  mental health opportunities. So what are we missing?” 

Greg shared a few statistics and information from an article published this year by the Association of American Medical Colleges titled, Men and Mental Health: What are we Missing? According to the article, the suicide rate among men is four times higher than among women. Greg noted that any Google search related to men and mental health will yield results centered around depression and suicide rates.

He mentioned the article’s discussion on how society historically has blamed men for their own issues. It highlighted that modern culture often holds men responsible for their problems, such as feeling depressed or lonely, attributing these issues to personal failings rather than acknowledging external factors. Greg emphasized that this attitude discourages men from seeking help, perpetuating the harmful notion that if a man experiences difficulties, it’s solely his fault. 

Greg highlighted an important statement by the article’s author, Dr. Derek Griffith which states, “Men aren’t the problem. The way that we – society as a whole and health care providers specifically – treat them is.” Greg recalled how that played a role in his own life, saying, “I think back to my early years in therapy. I was encouraged to think and talk in a way that resonates with women, which didn’t work for me.” Greg said that men often feel that providers mislabel and underestimate their needs, appearing to not have a genuine interest in what their real problems are. 

“Confucius once said, Balance is a perfect state of still water. Let that be our model. It remains quiet within and is not disturbed on the surface,” Greg said. He explained that this quote serves as an important personal reminder for him – to be quiet within and not disturbed on the surface. However, he added, “Unfortunately, what a lot of men do is they figure out a way to maintain that still water on the surface, but underneath is a churning mess.”  Reflecting on the quote, Greg emphasized the challenge of achieving balance, noting that for many men, it’s elusive. He remarked that most men have become adept at projecting a facade of composure, masking their inner struggles. 

Greg cited a meta-analysis paper based on nine different studies conducted by The National Institute of Health which found that over 70% of suicide deaths in the U.S. are men. He explained how the disproportionally higher suicide risk for men can be attributed to men being less likely than women to seek help for mental health difficulties, as they hold more negative attitudes toward the use of mental health services and their unwillingness to seek mental health support. Greg validated the study’s findings sharing that in his experience working with men in recovery and healing, the level of despair and depression is substantial. 

He addressed the challenges related to men’s perception of mental health, highlighting their tendency to focus outward and seek solutions. He referenced an article by the Walker Center, titled Why are Men Less Likely to Get Mental Health Help? explaining that women typically focus inward, addressing their emotions and behaviors, while men are inclined to fix external issues. 

Greg also noted that men often act out instead of expressing their emotions directly, resorting to behaviors such as alcoholism, substance abuse, workaholism, and seeking multiple romantic partners. He observed that these behaviors serve to either mask emotional pain or provide a means of feeling something. Ultimately, Greg emphasized that these actions are attempts to address underlying issues without directly confronting them. 

He discussed the stigma surrounding men seeking mental health care, noting society’s expectation for men to be pillars of strength and support for others. He emphasized the importance of men taking care of their own mental health, highlighting the disconnect between societal expectations and men’s needs. Greg shared an experience from earlier in the day from a men’s group he is a part of, where another member discouraged others from discussing their feelings and problems, posting, Why do men come on here and talk about their feelings and problems? Urging them to “man up” instead. Greg pointed out the contradiction in a group designed for support and encouragement dismissing men’s struggles. Greg concluded that the stigma around men seeking mental health care is likely to persist, but optimistically shared that we can do something about it. 

Greg challenged the idea of “toxic masculinity” being the main deterrent to men seeking therapy. He highlighted the lack of substantial research supporting this claim, noting the prevalence of opinion pieces on the topic. Quoting from an article by The Centre for Male Psychology titled, You can’t Help Men by Attacking Masculinity, he emphasized that violence and sexism stem from past trauma rather than masculinity itself. 

Greg then discussed the changing dynamics in today’s society, where a significant percentage of boys are raised by single mothers and taught by female teachers, leading to a lack of male role models. Reflecting on his own journey, Greg underscored the importance of addressing trauma rather than attributing negative behaviors solely to masculinity. 

Greg critiqued the Duluth Model, which attributes domestic violence to patriarchy and toxic masculinity. Greg shared that a meta-analysis found a less than 50% success rate with it and models like it, highlighting its ineffectiveness in addressing underlying trauma and the negative impact on men’s sense of masculinity. 

“Men feel that their masculinity is attacked, they want help, but many believe that nobody cares.” Greg said. he continued, “Men want help, but many men believe that nobody cares.” 

With permission, Greg shared some quotes from men he has worked with to support this idea: 

  • “If a man is suffering, then women will see them as weak, as a weak partner, and avoid him.” 
  • “I’ll never get married if a woman finds out I have pain.”
  • “Help? Who would help? No one gives a (expletive) about what I’m going through. How do I know? Because I’m a man.” 
  • “As long as I’m providing, that’s all that matters. My junk is my own.” 
  • “Seems like every time I try to talk to someone, my feelings end up being my problem, then their response to my feelings ends up being my problem. It’s like, why do that to myself? I’ll just keep quiet.” 


“We can see by what’s been shared to this point, men want help, but they are told they don’t need help, they shouldn’t want help, but they are crying out,” Greg said. 

As discussed in previous webinars, Greg reminded the audience of the importance of messaging and the necessity to be able to reach men effectively. 

He stressed the need for change in various aspects, including advertisements, social media posts, and literature discussing men’s issues. Greg highlighted how crucial it is to tailor these materials to resonate with men, including the colors, pictures, and verbiage used. He pointed out how Support After Abortion’s media posts, aimed at reaching men, were specifically designed to resonate with men’s issues, reflecting how they talk, think, and receive information. Greg clarified that this approach isn’t to exclude women, but rather to create a separate campaign that is aligned with men’s communication preferences and style. 

The chief executive of The American Psychological Association, Arthur Evans, was quoted as saying, “There is clearly a growing recognition that we have to reframe mental health care in our approach to addressing the mental health needs of men.” Greg emphasized the significance of this statement, highlighting Evans’ suggestion to reframe therapy as an opportunity to become “strong and well,” rather than solely as treatment for mental illness. 

Greg discussed the challenge of engaging men in mental health care, noting that traditional approaches may not resonate with them. He contrasted how men and women typically receive offers of support, saying, “When you go to a man and you say, you seem sad, you lost him. We don’t receive information like that. Whereas, I asked my wife how she would receive that and she said, “If a friend said that to me, I would think she cares and I would most likely open up.” Greg highlighted the importance of this difference and understanding men’s communication preferences. 

Greg introduced the concept of “double jeopardy men,” coined by Dr. Sally Spencer Thomas, president and founder of United Suicide Survivors International, who identified a group of men with multiple risk factors for mental health issues. These men, despite facing a higher likelihood of mental health challenges, paradoxically exhibit a reluctance to seek help. He shared a quote from one of Dr. Thomas’s study participants, who remarked, “You know that message you mental health people put out there? If you’re depressed, seek help. Yeah, that misses on both counts,” illustrating the disconnect between traditional mental health messaging and men’s experiences. 

Greg discussed various online groups he found that cater to men’s mental health, noting their emphasis on providing spaces for connection, healing, and personal growth in a way that appeals to men. These organizations prioritize creating spaces where men feel empowered to confront their challenges and take control of their mental well-being. He mentioned how these organizations advertise nonjudgmental environments where men can feel comfortable opening up and seeking support. 

He said that unlike traditional therapy settings, which often come with various requirements and expectations, these groups offer a more relaxed approach. He said they have minimal requirements to get started, allowing men to engage without feeling overwhelmed by paperwork or rigid structures. 

Their messaging is tailored to resonate with men, employing masculine tones and imagery to inspire them. He noted how one of the groups messaging on their website specifically says, We have no requirements, no creeds, no gurus, and no judgment. He said, “If you get a guy to show up to a group and the first thing you do is hand him a 27-question form on a clipboard, you’ll lose him. He doesn’t need a guru, he doesn’t need somebody telling him what to do. He deals with that in other aspects of his life.” He continued, “He doesn’t need a list of requirements that he has to meet to join the group. And the most important thing is, he doesn’t need judgment.”

Greg said that by embracing masculine-friendly approaches and fostering a sense of empowerment, these organizations effectively engage men in addressing their mental health needs. These methods encourage men to open up and seek support in a way that aligns with their preferences and values.


Greg shared an exchange with his son from earlier in the day, where his son asked Greg, who is fighting a cold, how he was doing. Greg’s response was the typical, “I’m fine.” Greg described this as a “padded response,” highlighting how men often use phrases like I’m fine, or I’m OK as automatic replies. Greg referenced a video on a men’s mental health page on social media where the presenter emphasized that usually when a man says, I’m fine, he is anything but. 

Greg then directed the discussion to an article by the Jefferson Center titled, I’m Fine: How to Talk to the Men in Your Life About Their Mental Health. The article explores strategies for engaging men who may be reluctant to open up about their struggles, emphasizing the importance of making a meaningful impact within a limited window of opportunity. He said, “When a man comes into your building, we all know that we have a very limited time to get them to talk, a very small window to get them to open up at all.”

Greg elaborated on the article, noting that it outlined five specific steps, beginning with making observations. He illustrated this with a scenario: a man entering a center. While it’s natural to simply ask him how he’s doing upon greeting him, Greg suggested delving deeper to foster openness. 

He emphasized the importance of first observing body language and considering the circumstances that have brought him there, then using these cues to pose thoughtful conversation starters. He said, “Listening and observing with both our eyes and ears, watching, reading body signals, paying attention to their non-verbal communication. Bob, it’s nice to meet you, you seem a little tired today. Are you good?” Greg explained how that observation is not the same as a generic question because it conveys that you are noticing something about him, stating, “Why is it different? Because what you’re telling him is, I see you, I see something in you right now. You look tired, man.” 

Using the same scenario, Greg shared another strategy for creating a space that encourages openness through observation. He said, “Another thing you can say is, Man, that chair doesn’t look real comfortable at all. We can move somewhere else if you want to.” He then explained the significance of this approach, highlighting the importance of considering the environment’s impact on a man’s comfort level. 

Greg stated that when a man finds himself in an unfamiliar public space, his immediate concern is typically locating the exits. Placing yourself between the man and the sole exit, such as when you’re sitting by the door in a conference room, can exacerbate his discomfort. 

Additionally, factors such as what is behind him, like open windows or foot traffic, can contribute to his unease. Greg underscored that men in such situations are already feeling uneasy, as they are not in their own space, but rather in someone else’s domain. The suggestion to adjust seating arrangements aims to alleviate some of this discomfort, providing him with a more conducive environment for openness and conversation.

 “One of the biggest problems for men is they feel alone. Nobody understands what I’m going through, nobody’s been through what I’m going through, nobody can relate to me. That’s what keeps men in isolation. After abortion loss, they feel alone,” Greg said. He shared that the next thing to consider, according to the article, is to share your experience. He explained how saying things like, I get it,  I’ve been there, or I understand grief conveys that someone relates to them and they are not alone. 

“Being able to relate to them through sharing about your own experience is enough to make him feel comfortable to talk about it.” 

Greg touched on the next idea from the article, getting men moving to foster open dialogue or to “Walk and Talk. He explained how this could be as simple as asking if they’d like to take a walk, when possible, to get fresh air. He suggested that this technique is usually successful for two reasons. First, it alleviates their discomfort of being in an unfamiliar place, and second, it capitalizes on the natural bonding tendency of men, who often find it easier to open up shoulder-to-shoulder rather than face-to-face, as women mostly prefer. By getting them moving, he explained, it helps shift their focus away from their immediate surroundings, allowing them to concentrate more on their thoughts without feeling scrutinized. Additionally, he shared that the benefits of exercise and outdoor exposure, such as fresh air and Vitamin D from the sun, further contribute to creating a conducive environment for conversation. Offering to go for a walk can gradually help the man feel more comfortable and inclined to share, thus fostering greater openness in communication. He said, “Offer to go out and walk and talk, and you might see them start to open up a little bit because they’ll feel more comfortable and they’ll start to let their guard down.”

“The other thing is, acknowledge difficult situations. Don’t dance around it. Don’t try to avoid it. They’re there for a purpose. Acknowledge the difficult situations,” Greg advised. He provided examples of saying to someone who has experienced abortion loss, I know it’s difficult to lose a child. Or, to someone considering abortion, I know it’s hard to think about being a parent right now, not being fearful of saying the wrong thing. 

Instead, he said, “Directly addressing the issue may be giving validity to what they are already thinking or feeling.” He continued, “Maybe the only people he’s talked to have said either, Oh man, she’s gotta have an abortion, or You gotta man up. Nobody has acknowledged where he’s at at the moment.” He explained how giving him that validity will encourage him to open up and talk. 

The last recommendation that Greg shared for talking to men about mental health was to ask twice. He explained, “Most men’s knee jerk reaction to how are you doing? is, I’m fine or I’m good, so ask twice.” Greg recounted an old church acquaintance who followed this practice, squeezing every man’s hand and asking, How are you doing? If the response was I’m fine or something similar, he would persist with, No, really though, how are you doing? 

Greg adopted this approach 15 years ago, not limited to recovery situations, but in general interactions. He shared a story that took place at a restaurant recently, where a flustered server responded with I’m fine initially, but upon Greg asking him again, opened up about feeling tired. Greg engaged in a 30-minute conversation with him, demonstrating that sometimes all it takes is a genuine interest and a willingness to ask twice to foster meaningful connections. 

He emphasized the importance of being open, authentic, and understanding that the initial response may not reflect the true feelings of the individual. He said, “It all boils down to something we’ve mentioned many times in this space: be open, be authentic, be honest. Then understand that the first response is that the man doesn’t trust you yet.”


Greg highlighted the “4×4 Method,” a sales technique he adapted for engaging with men. He explained that it involves asking four questions wide and four questions deep to uncover their underlying issues. 

The method hinges on active listening, letting each answer guide the next question. Greg emphasized the need to avoid scripting the conversation, as authenticity is crucial. By employing this approach, Greg discovered that within a few minutes, men often reveal profound struggles, rooted in fear, hidden beneath surface-level emotions like anger. He shared how this deeper understanding enables him to offer more tailored support, emphasizing the importance of avoiding assumptions. He offered a few sample dialogues to illustrate the benefit of using the 4×4 Method.


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In today’s deep dive webinar, special guest, Amy Vogel, brought us Suicide Intervention Toolbox, Part 2 of Caring for Clients who may be Suicidal

Amy is a licensed Mental Health Counselor, specializing in traumatic grief and disenfranchised bereavement with over 10 years experience in providing crisis counseling and grief support services. Her research and advocacy focus on effective suicide bereavement interventions. Amy has led survivor support groups and serves on boards for Suicide Prevention and Operation Solid 7. She is a certified Clinical Trauma Professional and is certified in Thanatology. She is currently pursuing a PhD in counseling, education, and supervision.




“As helpers, we all know how challenging and emotionally taxing it can be to work with clients who are in such a vulnerable state. We want to do everything we can to support them, keep them safe, and help them find reasons to keep living. But sometimes, it can feel like we’re not quite sure what to do or say,” Amy said as she introduced the idea of the Suicide Intervention Toolbox. Developed and validated by experts in the field of suicide intervention, it covers a range of practical tools, strategies, and resources that can be used when working with suicidal clients. 

Amy took a moment to acknowledge the profound importance of the work, stating, 

“Suicide is a major public health issue, and it devastates individuals, families, and communities. As helpers, we have a unique opportunity and responsibility to intervene, to help our clients find hope and meaning even in their darkest moments,” she continued, “Throughout this presentation, we’ll be focusing not just on the practical tools, but also on the underlying spirit of compassion and empathy that is so essential to this work. Caring for suicidal clients requires us to bring our full selves to the task – our knowledge, our skills, and our humanity.”




When it comes to assessing for suicide, it’s important to understand that traditional methods may not always be the most effective,” Amy said. She explained that in the past, most assessments focused on asking people if they were depressed or thinking about harming themselves, however research has shown that approach may potentially miss some important factors. She stated that instead of just looking at suicidal thoughts as a sign that someone might attempt suicide, the different paths that can lead to suicidal behavior must be considered as well. This involves asking questions that address the emotions and experiences that can make people feel vulnerable, such as the belief that others would be better off without them or the feeling that no one can help them solve their problems. 

Amy also pointed out the importance in recognizing that suicidal behavior can look different among different groups of people. As an example, she said that black teenagers may engage in risky or aggressive behaviors that could lead to harm or death, rather than directly attempting suicide. She stated, “When assessing for suicide risk in these populations, it’s important to ask about these kinds of behaviors and to look for sources of strength and support within their communities.”

She explained that another challenge in assessing suicide risk is that young people might be hesitant to open up about their suicidal feelings because they’re worried about confidentiality. They may fear that helpers will tell their parents about their thoughts without their permission. To address this, helpers should work together with young people to come up with a plan for sharing information with parents when necessary, in a way that makes the teenager feel as comfortable as possible.

Amy highlighted that the way questions are asked about suicide is also important, stating, “If we ask in a way that suggests we expect the answer to be “no,” people might hide their true feelings. Instead, helpers should ask about suicidal thoughts and behaviors in an open, non-judgmental way.”

She reiterated that assessing for suicide risk involves more than just asking about depression and thoughts of self-harm. Amy emphasized the importance of using

evidence-based screening tools and considering the unique factors contributing to suicidal ideation and behaviors in various individuals and communities. She suggested that by adopting a comprehensive and collaborative approach to assessment, those at risk can be more effectively identified and connected with the support they need.




“Attitudes and beliefs about suicide are complex and multifaceted, influenced by various factors such as religion, culture, and personal experiences. Financial situations, religious beliefs, and mental health all play a role in shaping our perceptions of suicide,” Amy said. She highlighted the importance of recognizing that different communities and cultures can have vastly different views on the subject. She gave the example of China being a place where, although religion may not be a significant part of life, opinions on suicide can be mixed. For this reason, understanding the diverse attitudes towards suicide is crucial in supporting those affected by suicide and working towards prevention.

Amy stated that research indicates individuals at higher risk of suicide often hold negative views towards those who attempt or die by suicide. She explained that these stigmatizing attitudes can create barriers, making it challenging for people to open up about their struggles and seek help. Furthermore, the fear of judgment or discrimination may influence how they contemplate ending their lives.

She shared that a recent Australian study discovered that individuals who hold negative perceptions of those who die by suicide, such as viewing them as cowardly or immoral, are more inclined to have negative attitudes towards seeking help for their own emotional issues. Additionally, the study revealed that individuals contending with suicidal thoughts or depression tend to harbor more negative attitudes about seeking help and are less inclined to reach out for support compared to others. This underscores the significance of fostering a supportive and empathetic environment where individuals feel encouraged to seek assistance. 

On the flip side, Amy noted that the research revealed that individuals with higher levels of suicide literacy – understanding warning signs, causes, and risk factors for suicide, as well as its preventability and treatability – tend to have more positive attitudes towards seeking help. 

Amy said the study also pointed out that younger people and men tend to have more negative attitudes about getting help compared to older individuals and women. She stated this suggests that public education campaigns aimed at increasing knowledge about suicide and reducing negative attitudes should focus on reaching these groups.

“While there has been progress in how society views suicide over time, a significant amount of stigma still lingers. This stigma can manifest in various forms of discrimination and prejudice, casting a shadow on individuals’ willingness to seek support and talk about their mental health challenges openly. Certain beliefs about suicide, such as the misconception that most individuals who die by suicide are mentally ill, did not show significant variations based on factors like gender or age, suggesting a potential lack of understanding within the general population,” Amy said. She went on to say that in order to address these issues, it’s crucial to focus on increasing suicide literacy and decreasing the stigma associated with suicide, saying, “By fostering a more supportive and understanding environment, we can create space for open conversations and effective support systems for those grappling with suicidal thoughts and mental health challenges. This can be a powerful step in preventing suicide and supporting those who may be struggling.”




“In assessing the risk of suicidal thoughts, it’s crucial to consider both risk factors and protective factors,” Amy said. She stated that risk factors are elements that can increase the likelihood of suicide. This includes things such as past trauma, triggering events, and feelings of hopelessness or anger. Amy said it’s important to identify which of these risk factors can be changed to reduce the risk of suicide. 

“On the other hand, protective factors are like shields that can buffer individuals from suicidal thoughts and behaviors,” she said. Protective factors include access to support, strong relationships, coping skills, and cultural or religious beliefs that discourage suicide. Amy stated that by enhancing the protective factors, an individual’s resilience can be strengthened, thereby reducing the risk of suicidal ideation.

Amy shared that through addressing and modifying risk factors while increasing protective factors, we can work towards reducing the risk of suicide and promoting mental well-being. She emphasized the essential nature of considering both aspects when assessing and supporting individuals who may be experiencing suicidal thoughts. 




Amy presented a slide with information aimed at understanding the neurological factors that can increase suicidal thoughts. 




She asked the audience to picture the trauma and stress they face over the course of their lives. She stated that those experiences can contribute to suicidal behavior over time. She highlighted how our bodies, when stressed, have a stress response system which involves the hypothalamic-pituitary-adrenal axis, or HPA Axis. The HPA Axis system works in conjunction with serotonin, norepinephrine, and polyamine systems, which are influenced by our genes.  

“So, when we’re under stress, our hypothalamus releases a hormone called corticotropin-releasing hormone (CRH). CRH then triggers the pituitary gland to release another hormone called adrenocorticotropic hormone (ACTH). ACTH then stimulates the adrenal glands to release cortisol, which is a stress hormone. Researchers have discovered that people who have died by suicide or attempted suicide often have abnormal levels of these hormones,” Amy said. 

She went on to explain how serotonin and norepinephrine, which are neurotransmitters, also play a role in suicidal behavior, stating, “Studies have found that people who have died by suicide have deficits in serotonin signaling and increased norepinephrine activity.”

Amy further elaborated that suicidal behavior and the development of psychiatric disorders are not solely determined by hormones and neurotransmitters; rather, the expression and function of our genes also play a significant role in contributing to these phenomena. She said, “Here’s where it gets fascinating. Traumatic events can have lifelong effects on our genes through epigenetic changes. These changes can lead to suicidal behavior. For instance, changes in a gene called FKBP5 can make a person more vulnerable to stress.” Amy stated that epigenetic changes can also impact neural plasticity, which is the brain’s ability to adapt and change. This happens because epigenetics influence neurotrophic deficiencies.

In summary, Amy explained how researchers have proposed the Life Span model. This model combines the Stress-Diathesis Model and the Interpersonal Theory of Suicide, covered in part 1, and tries to provide a neurobiological explanation for suicidal behavior. However, she emphasized that suicide is a multifaceted issue, underscoring the importance of ongoing research to fully comprehend suicidal behavior. She highlighted that there are many contributing factors, and biology should also be considered one.   




Amy reintroduced the Columbia-Suicide Severity Rating Scale or C-SSRS, which was previously discussed in the Part 1 webinar. She reminded us that the C-SSRS is a powerful and widely-used tool designed to help identify and assess suicidal thoughts and behaviors in individuals. Developed by leading universities in the United States, including Columbia University, with support from the National Institute of Mental Health, the C-SSRS has been extensively researched for over 20 years and is considered the gold standard in its field.

She stated that one of the key advantages of the C-SSRS is its simplicity and ease of use. The scale features straightforward questions that can be administered by anyone, even those with minimal training. It is available in more than 150 languages and can be easily integrated into electronic medical records, making it accessible and convenient for helpers worldwide.

Amy explained that when administering the C-SSRS, helpers ask a series of questions about the person’s suicidal thoughts and behaviors. The questions are designed to gauge the seriousness of the individual’s risk and determine the urgency of the needed support. The exact questions asked depend on the person’s answers, creating a personalized assessment tailored to their specific situation.

She said the C-SSRS questions cover various aspects of suicidal ideation and behavior, from passive thoughts like wishing to be dead to active thoughts about specific methods of suicide. The scale also asks about any steps taken to prepare for a suicide attempt, such as collecting pills, obtaining a gun, or writing a suicide note. By asking these direct, clear questions, the C-SSRS helps identify individuals at risk of suicide, enabling helpers to connect them with appropriate support and resources.

Amy shared that studies have demonstrated the C-SSRS’s effectiveness in detecting signs of suicidal thinking, with a sensitivity of 67% and a positive predictive value of 14%. This means that the scale can identify a significant portion of at-risk individuals, and when it does, there’s a good chance they truly need help. Amy suggested that organizations using the C-SSRS can establish their own guidelines for action based on individuals’ responses, which may range from immediate hospitalization to referrals for counseling or other support services.




Next, Amy broke down the C-SSRS questions to provide a deeper understanding of how to use the tool. 

She explained that questions one and two are crucial for gauging a person’s suicidal thoughts and the questions are asked in relation to the past month, as recent thoughts and feelings are often the most relevant when assessing someone’s current risk.

The first question is, Have you wished you were dead or wished you could go to sleep and not wake up? This question is designed to identify passive suicidal thoughts. Passive suicidal thoughts are when a person feels like they don’t want to live anymore, but they don’t necessarily have a plan to end their life. They might wish they could just go to sleep and never wake up again. While these thoughts may not indicate an immediate risk of suicide, they’re still concerning and need to be taken seriously.

The second question is, Have you had any actual thoughts of killing yourself? This question goes a step further and asks about active suicidal thoughts. Active suicidal thoughts are when a person is actually considering ending their life. They might be thinking about specific methods or making plans. This is a more serious level of suicidal ideation and indicates a higher risk of suicide.

Amy said that by asking these two questions, we can get a sense of whether a person is experiencing suicidal thoughts and how serious those thoughts are. If someone answers “yes” to either of these questions, it’s a red flag that they may be at risk of suicide and need support.

Amy highlighted the importance of understanding that asking these questions directly doesn’t put the idea of suicide in someone’s head. If a person isn’t having suicidal thoughts, asking them about it won’t make them start. But if they are having these thoughts already, asking directly lets them know it’s okay to talk about it and that help is available.

She stated that if a person answers yes to the second question, then the C-SSRS directs us to ask a series of follow-up questions. These questions – numbers three through five – are designed to gauge the severity and intensity of the person’s suicidal thoughts. 

The third question asks, Have you been thinking about how you might do this?

She stated, “This question is trying to determine if the person has considered specific methods for ending their life. Have they thought about using pills, a gun, or another method? Having a plan indicates a higher level of risk, as it suggests the person has given serious thought to how they would attempt suicide.”

Question four goes a step further, asking, Have you had these thoughts and had some intention of acting on them? This question is assessing whether the person has not only thought about methods, but has also had some intention to follow through with those thoughts. Intention to act is a serious warning sign that the person may be moving closer to attempting suicide.

Amy explained that question five is perhaps the most critical. It asks, Have you started to work out or worked out the details of how to kill yourself? Did you intend to carry out this plan? This question is looking for concrete steps the person may have taken to prepare for a suicide attempt. Have they collected pills, obtained a gun, or written a suicide note? Have they made a specific plan for when, where, and how they would attempt suicide? And most importantly, did they intend to follow through with this plan?

She shared that answering “yes” to any of these questions is a major red flag. It suggests that the person’s suicidal thoughts are serious and that they may be at high risk of attempting suicide in the near future. She said, “The more “yes” answers a person gives, the higher their risk.”

Amy emphasized the importance of remembering that asking these questions is not about judgment or getting someone in trouble. It’s about understanding the severity of their situation in order to provide the right level of support. If someone is having serious suicidal thoughts, with plans and intent, they need immediate help to stay safe.

Amy said the last question, number six, is one that is always asked, regardless of how the person answered the previous questions. Question six asks, Have you done anything, started to do anything, or prepared to do anything to end your life? This question is looking for any actions the person may have taken to prepare for or attempt suicide. This could include things like giving away possessions, writing a suicide note, collecting pills, or obtaining a gun. Amy stated that if the person answers “yes” to this question, we then ask a follow-up question: Was this within the past 3 months? This helps us understand how recent the action was. A recent action is more concerning than something that happened a long time ago, as it suggests the person may be in a current suicidal crisis.

Amy stressed the importance in noting that this question isn’t just asking about suicide attempts. It’s also asking about preparatory behaviors. She said, “Someone might not have actually tried to end their life, but if they’ve started giving away their possessions or have bought a gun with the intention of using it on themselves, that’s a serious warning sign.” She continued, “Answering “yes” to question six is an emergency situation. It means the person has taken steps to end their life and may be in imminent danger. They need immediate support and intervention to ensure their safety.” She explained that this is why question six is always asked, even if the person said “no” to the previous questions about suicidal thoughts. Sometimes, a person might deny having suicidal thoughts but still have taken action towards suicide. Asking this question directly can uncover critical information that might otherwise be missed.




“Depending on the severity and your organization’s protocol, safety planning is essential,” Amy said as she re-introduced The Stanley-Brown Safety Plan she first addressed in the Part 1 webinar. She reminded us that this tool is a widely used, evidence-based tool designed to help individuals who are experiencing suicidal thoughts or behaviors. Developed by Dr. Barbara Stanley and Dr. Gregory Brown, this plan is a practical, step-by-step guide that clients can use to manage their suicidal thoughts and stay safe during a crisis.

Amy highlighted the beauty of the Stanley-Brown Safety Plan, stating, “It’s not just a generic, one-size-fits-all document. Instead, it’s a personalized plan that the client develops in collaboration with their mental health provider. This collaborative approach ensures that the plan is tailored to the individual’s unique needs, circumstances, and preferences.”

She explained that the Stanley-Brown Safety Plan typically includes six key steps:


  1. Identifying warning signs: The client learns to recognize the thoughts, images, moods, or behaviors that typically precede a suicidal crisis.
  2. Employing internal coping strategies: The plan lists coping strategies that the individual can use on their own to manage their thoughts and emotions, such as relaxation techniques, physical activity, or positive self-talk.
  3. Utilizing social contacts and social settings for distraction: The client identifies people and places that can provide a healthy distraction from their suicidal thoughts.
  4. Contacting family members or friends who may offer help: The plan lists trusted individuals whom the client can reach out to for support during a crisis.
  5. Contacting mental health professionals or agencies: The client includes the contact information for their therapist, psychiatrist, or local crisis line.
  6. Reducing the potential for use of lethal means: The plan includes steps for making the client’s environment safer, such as removing firearms or stockpiled medications.


She said, “What’s powerful about the Stanley-Brown Safety Plan is that it empowers clients to take an active role in managing their own safety. It’s not just about what the helper can do for the client, but what the client can do for themselves.”

Amy stated that research has shown the Stanley-Brown Safety Plan to be a highly effective tool for reducing suicidal behaviors and increasing treatment engagement. She emphasized that when working with clients who are at risk of suicide, incorporating the Stanley-Brown Safety Plan into your organization can be a powerful way to enhance your clients’ safety and wellbeing.




“When working with suicidal clients, it’s crucial for helpers to prioritize self-care. Engaging in regular self-care practices can help prevent burnout, maintain emotional well-being, and ensure that we’re providing the best possible care to our clients,” Amy said. 

She explained that one important aspect of self-care is debriefing. Regularly debriefing and discussing challenging cases and emotions with colleagues can provide invaluable support, perspective, and guidance. These conversations, whether informal or structured, offer an opportunity to process difficult experiences and learn from others.

Amy stated that another key element of self-care is setting boundaries between our work and personal lives. Maintaining a healthy work-life balance involves setting clear boundaries, such as not checking work emails outside of work hours and dedicating time to hobbies and activities unrelated to work. She explained that by creating a clear separation between our professional and personal lives, we can recharge, avoid becoming overwhelmed, and ensure that we have the time and space to take care of ourselves and engage in activities that bring us joy and relaxation.

Lastly, Amy suggested incorporating mindfulness and relaxation techniques into our daily routine as a powerful self-care practice. Techniques such as deep breathing, meditation, or yoga can help manage stress, promote a sense of calm, and improve overall well-being. Taking even a few minutes each day to focus on our breath or engage in a relaxation exercise can help us stay grounded and better equipped to handle the emotional challenges of our work.

She stressed the importance of prioritizing self-care, saying, “Through practices like debriefing, setting boundaries, and engaging in mindfulness, we as helpers can maintain our own emotional resilience and well-being. This, in turn, allows us to provide the highest quality care to our clients who are struggling with suicidal thoughts and behaviors.”




Amy shared a case study to demonstrate how the tools and strategies discussed in this presentation, such as the C-SSRS and Stanley-Brown Safety Plan, can be applied in a real-life crisis situation. She said that it also highlights the importance of empathy, active listening, and self-care when working with individuals experiencing suicidal thoughts.

Sarah, a 25-year-old woman, calls a helpline after having an abortion. She’s been feeling overwhelmed with emotions and has been experiencing suicidal thoughts. The call is answered by Emily.

Emily begins by establishing rapport and creating a safe, non-judgmental space for Sarah to share her feelings. She listens actively and validates Sarah’s emotions, acknowledging the complexity of her situation.

Using the Columbia-Suicide Severity Rating Scale (C-SSRS), Emily assesses Sarah’s risk of suicide. She asks the first two questions:

  1. “Have you wished you were dead or wished you could go to sleep and not wake up?” 
  2. “Have you had any actual thoughts of killing yourself?”

Sarah responds “yes” to both questions, indicating she has been experiencing suicidal ideation. Emily then proceeds with questions 3, 4, and 5 to gauge the severity of Sarah’s thoughts:

  1. “Have you been thinking about how you might do this?”
  2. “Have you had these thoughts and had some intention of acting on them?”
  3. “Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?”

Sarah reveals that she has thought about overdosing on pills but hasn’t made a concrete plan or taken any steps to acquire the means. Emily then asks question 6:

  1. “Have you done anything, started to do anything, or prepared to do anything to end your life?”

Sarah says she hasn’t taken any actions to end her life.

Based on Sarah’s responses, Emily determines that while Sarah is experiencing suicidal thoughts, she doesn’t appear to be at imminent risk. However, she recognizes the seriousness of the situation and the need for ongoing support.

Emily works with Sarah to develop a personalized Stanley-Brown Safety Plan. They identify Sarah’s warning signs, internal coping strategies, social contacts for distraction, family and friends who can offer support, and professional resources. They also discuss steps to make Sarah’s environment safer.

Throughout the conversation, Emily remains compassionate and non-judgmental. She reassures Sarah that her feelings are valid and that help is available. She provides Sarah with resources, including the number for the crisis line, and encourages her to reach out anytime she needs support.

After the call, Emily takes a moment to practice self-care. She takes a few deep breaths, does a brief mindfulness exercise, and then debriefs with a colleague about the emotionally challenging call. This helps her process her own emotions and prepare to continue supporting others.

Through this process, “this person who was suicidal has felt validated, heard, cared for,” Amy said. She talked about the need for, and different ways to achieve, ensuring that at-risk individuals always keep their safety plan with them “because we never know when a crisis might be triggering, and that safety plan is like their light in that dark hole.”




Click here for the Columbia Suicide Severity Rating Scale.

Click here for the Stanley Brown Safety Plan.




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