Intro
Lisa Rowe, licensed mental health therapist and Support After Abortion CEO, discussed foundational principles of ethics for abortion healing providers. The conversation sprang from a participant’s question at the end of the June webinar about when to be mindful that you’re outside your scope of practice. As a result, Support After Abortion developed a Code of Ethics for abortion healing providers. Lisa said abortion healing needs such ethical guidelines just like most other professions and businesses. The Code of Ethics presented today is a starting point. As a living document, it will grow with us.
What are the basic principles of the Code of Ethics for abortion healing providers?
As an organization, Support After Abortion operates based on four core values stemming from the acronym H.O.P.E. – Healing, Ownership, Purpose, and Excellence. Lisa explained that at Support After Abortion, “We hire, evaluate, and train our staff based on these core values.” Lisa continued, “So it made sense for us to focus the code of ethics on these same core principles that we feel should be present in yourself, in the environment at which you’re serving, and in the people that you’re bringing on board to help you with healing.”
Principle 1: HEALING
- Commit to excellence through continued personal, professional and ethical development.
Lisa spoke about the importance of “continuing the journey toward our own healing” when “walking along those seeking healing.” She reminded providers that “Healing is a journey, not a destination.” She suggested some ways of continued development such as “a coaching program, a college class, abortion healing class, spiritual or Bible study class – anything in which you’re continuing to learn and grow in your own journey.”
- “Meet clients where they are at.” Check your motivation in engaging clients. Remain curious to indications that there might be a shift in the value received from the healing relationship. If so, make a change in the relationship or encourage another professional or use a different resource.
Lisa discussed checking our motivation in meeting clients and ensuring that we are always open to what they are trying to say and helping them in the ways they want to be helped. She cautioned that many abortion healing providers come from a faith perspective and are eager to share that faith perspective with clients. However, “Ethically we must be able to meet clients where they are without an agenda,” Lisa said. She offered practical examples, such as focusing on understanding the client and building relationship before embarking on faith conversations and being willing to not pray or share the gospel with every client.
Webinar participant Deborah shared a Transformational Leadership principle called “plain glass v. stained glass messaging.” She explained that while both are speaking the truth, “plain glass” is a client-centered perspective without faith-based dialogue. Whereas “stained glass” is faith-based messaging. Deborah shared that the key is knowing the client and also recognizing that some clients only want “plain glass,” and some need “plain glass” because they have church-related wounds. Deborah said for her, “plain glass” messaging is not only client-centric, it’s Holy Spirit led. “It’s like praying through some of these things, really listening to the client, and seeing where they’re at.”
Lisa also addressed being attuned to each client’s behaviors and words – whether in person or in text. She advised providers to “remain curious as to the indications that might keep a client engaged or not in the healing relationship.” She offered examples of questions providers might ask participants who seem to be disengaged and explained that often “clients are waiting for us to say Hey what’s going on?” when they’ve missed a group session or seem preoccupied. She said addressing these things “will then allow you permission to change the relationship.”
She reiterated the need to be “open to what our client is trying to tell us” and avoiding an I’ve got all the answers or I’m the only person who can help them mentality. She said these can “severely hurt the clients we’re serving, and we will be walking outside of our scope of practice.”
Lisa said it’s important to pause and reflect on a person’s “motive for wanting to lead people through healing, specifically abortion healing.” If their motivation falls outside of wanting to help others “journey through the crisis of their abortion experience and find the freedom they’re looking for” and “if it’s not reflective of the client’s need,” then we should stop and ask questions to “understand what’s going on inside” and what their motivation is.
Digging Deeper
How can I know when it’s okay to engage in a religious conversation?
“Ask,” Lisa said, “My favorite thing is to trust that our participants and clients know exactly what is going on inside of them. So we just need to ask. For example, Would you like this type of curriculum or that type of curriculum? Or, I’d love to share about my faith practice with you, is that of interest to you?”
One attendee, Sherry, agreed, commenting in the chat that “our clients are the best experts on their lives.”
Digging Deeper
When might we need to check our motivation?
Lisa offered two examples:
- I’ve just ended my first abortion healing program and I really want to help others. This is “a beautiful thing,” Lisa said. However she cautioned that we need to pause and assess if they’re truly ready to lead others or could this be an inspiration for their own continued healing before walking with others? “If it’s this newly inspired gift that they have inside of them, that’s beautiful, we want to nourish it,” Lisa said, “But we also want to protect the clients who they’re going to see.”
- I’m only going to offer this one curriculum because … (I’ve met the author, or this is what we’ve always done, or other reasons). Lisa advised providers to assess their motivation or inspiration for a particular program compared to their clients’ preferences and needs. We can “find ourselves married to a curriculum,” Lisa said, “which actually creates a blind spot, because therein lies an opportunity for us to hear from a client, but we can’t hear because we’re motivated by something different.”
Digging Deeper
What might a seasoned facilitator need to check about their own potentially unhealthy motivations?
Lisa shared examples of unhealthy motives, such as leading because no other facilitator is available or out of a desire to feel needed, which “falls in line with codependency.” She noted that “helpers can only help people when they’re helping themselves first.”
She also addressed how to deal with triggering client stories that can lead to unhealthy motivations. Lisa said that as clients unpack their stories, providers can see their own earlier selves in some of their decisions. She recommended keeping that in check by regularly talking with other professionals – “somebody who is more experienced than you in order to discuss what is likely a trigger.” It may be something “you haven’t worked on or that’s really close to home for you.” She emphasized the importance of this professional check-in “because if you lose objectivity with that client or that group of participants, you’re going to lose the ability to stay ethically inclined with that group or that individual.’
One attendee, Sylvia, offered an optimistic way to embrace triggers, commenting in the chat that she “has learned to treasure her triggers because they lead to deeper healing.”
- Use best practices when conducting a group, e.g. employing proper participant screening tools and ground rules for group dynamics.
It’s essential to create safety, structure, and consistency for clients. In previous webinars we have discussed various aspects of best practices such as intake and assessing if clients are group ready or would benefit from clinical care. Ground rules that are communicated well and implemented consistently enhance group dynamics by helping to create a safe environment for all participants to share openly, honestly, and vulnerably. Some ground rules that we use in Support After Abortion virtual support groups include maintaining confidentiality by not sharing outside the group what other participants say within the group, being committed to the group by showing up prepared and on time each session, refraining from trying to persuade another participant to your opinion or view, not monopolizing the conversation, not interrupting, not giving advice, and not using drugs or alcohol while preparing for or participating in the group.
Principle 2: OWNERSHIP
Ownership is one of the core values at Support After Abortion “because we believe that when we each own ourselves, our journeys, our experiences, together the team is better,” Lisa said.
- Recognize the personal limitations or circumstances that may impair, conflict with or interfere in the healing relationship. Commit to reach out for support to determine the action to be taken and, if necessary, promptly seek relevant peer and/or professional guidance. This may include suspending or terminating any healing relationship(s).
Lisa spoke about the need to understand and acknowledge our own stuff and limitations that may affect our client interactions. She emphasized the need to have a list of resources for referrals so that we can connect clients to the help they need if we are unequipped or otherwise unable to help them. Examples she gave included struggling to connect with a client who has had four children removed from her care, has experienced abortion three times, and is considering abortion with her current pregnancy; or a client who reports suicidal ideation and symptoms of depression; or a client who exposes sexual abuse.
In these and other cases, if we are triggered or feel limited in understanding the person or ill-equipped to help them in their circumstance, we need to own that and refer them out to someone more experienced. This is why every provider needs a list of other healing resources and providers. Pushing forward on our own “might even make this situation worse,” Lisa said.
Lisa encouraged all providers “to have a team of professionals around them, whether they’re advisory members or just there for a phone call, someone who is credentialed in these spaces [such as unique client situations, suicidal ideation, etc.] that can help guide and answer.”
Walking in an ownership mindset is recognizing that you are “in charge of a very serious relationship” and acknowledging when you “feel like you cannot continue to facilitate that relationship” and knowing what to do and where to refer them.
Digging Deeper
Can you speak more about advisory members or mentors?
Lisa encouraged providers to look to advisors, board members, or mentors who have substantially more experience and can offer wisdom and insight that “you haven’t yet had access to in your own growth and development.” They may be in a different profession, have more life experience, or been personally affected by whatever it is you need help with, she said.
Digger Deeper
Given our role in abortion healing, should Board members be people who have experienced abortion?
“I am actually helping to eradicate” that expectation, Lisa said. “While personal experience is valuable and can add to the conversation,” Lisa said, “I believe that we are all more alike than we are different.” She discussed how experiences like abortion, divorce, infidelity, addictions, etc. all start with roots and that all of us have roots of loss and being hurt. “If we can resonate with that understanding, we are likely able to find a space where we can walk with compassion with people who have very different symptoms, but similar roots.”
- Resolve any conflict of interest or potential conflict of interest by working through the issue with relevant parties, seeking peer and/or professional assistance, or suspending temporarily or ending the professional relationship. This includes political and religious perspectives that would hinder you from providing the type of care the client prefers.
Lisa offered a few examples of potential conflicts of interest to caring for some clients such as a someone you met at church or a friend who calls asking you to speak to someone for them. “Hold yourself ethically accountable,” Lisa said. She again urged providers to have relationships with other providers and agencies and resource lists to be able to make referrals.
Digging Deeper
What is a good way to do this self-reflection and recognize where my experience ends and someone else’s should begin?
Lisa offered four ways to delve into self-reflection: personality assessment, God’s purpose (for religious people), purpose from pain, and what ignites you.
Lisa suggested starting with personality tests and strengths assessments such as Enneagram, Disc, Myers Brigg, or others. She recommended answering these test questions quickly without reflection for a better understanding of your gifts and talents and to confirm the direction you should be going in.
For those who are religious, Lisa encouraged them to listen for God’s speaking their purpose for them through other people and experiences.
“Purpose often comes from pain,” Lisa said, “so after you find healing, those painful parts of life are often going to be used for a greater purpose.
Be mindful of “what ignites you,” Lisa said, “that’s often your special superpower.” She also encouraged people to be attentive to what drains them and to “start getting curious about where that heaviness is coming from.” She gave examples from her own life where she is ignited by teaching and engaging with others and drained doing detail work or sitting at the computer.
Digging Deeper
How can we form these referral relationships?
Lisa encouraged providers to look for and network with social service people and nonprofit organizations. “It’s likely that your clients have received services from a lot of these folks already,” she said. She also suggested providers ask their clients about their experiences – “they’ll likely tell you about positive and negative experiences with case workers, nurses, parenting educators, and others.” Lisa continued, “Abortion is a social service issue, and if we’re not going into the social service spaces, we’re not going to be finding those clients that need our support.” Kylee Heap, Support After Abortion COO, reminded providers to “look for professional counselors and therapists in your area.”
Digging Deeper
How can we vet them to know they are going to care for our clients?
Lisa suggested looking for resource and referral lists from people you network with and agencies you trust, as well as from those you network with. Lisa shared that because social service agencies are “constantly changing and evolving,” she looks through resource lists with her clients and calls together to identify the services and follow up care offered.
Principle 3: PURPOSE
For our team, our Purpose core value means that “we are living out our God-given purpose through Support After Abortion and through the space that we serve and other parts of our lives,” Lisa said. It could include “how we walk through abortion healing,” “how purposeful you are in your journey,” “how purposeful you are as you execute things,” etc.
- Identify accurately your qualifications, level of competency, expertise, experience, training, and certifications. Do not provide services that exceed competency.
Lisa explained this point in the Code is not to limit providers, but to “stay objective about who we are and what we’re doing and not get out of our lane.” She acknowledged that our clients may be struggling with many life circumstances, but advised providers to be “very clear about the role we are serving in our client’s life.” She emphasized the need to identify our qualifications and competencies because “we do not ever want to provide services that are outside of our competency.”
Lisa gave an example of a provider whose client came in for abortion healing but kept mentioning “3-4 different areas of her life that were spinning out of control.” The provider asked Lisa how she should move forward to help her with everything. Lisa’s advice then and to all providers is to not try to serve all client needs. Those that are in areas outside our competence or qualifications, we should refer to providers who can meet those needs and keep our focus on abortion healing.
Digging Deeper
How do you know when to refer to a different professional?
We need to ask our clients directly so they can articulate what they need, which will determine the next steps in their journey, Lisa said.
Some of her favorite questions are:
- What do you think is most important to you right now?
- On a list of 1-5, which one is the heaviest?
- Where do you think you’re receiving the most harm?
- If one of these things could be removed and relieved, what would help you the most?
Lisa illustrated why it’s important to ask and not assume we know what clients need by using scenarios of two people seeking abortion healing who live in homeless shelters. For the first person, the shelter is the first safe space they’ve ever been. They have permission to live there for six months. Life is consistent. They’re looking for a job. But their abortion experience has been one of the most traumatic things they’ve experienced, and they feel like now is a good, safe time to delve into that. For the second person, abortion is the last thing on their list. When asked, they say they need food and bills paid.
Digging Deeper
Why is it important to ask how and what questions?
Lisa explained that how and what questions are focused on moving forward, which is the goal of coaching and motivational interviewing. Whereas why questions aim to get to the roots of something, which is the goal of counseling.
She said, “That’s not our space. What and how questions are very powerful, and really what our clients need in abortion healing.” She said what and how questions “bring you to a new and different landing place,” while why questions “find you back in the quicksand. And that’s not our space.”
Some examples of what and how questions:
- What about your abortion experience has been so difficult?
- How does this particular incident harm you or hurt you, or reflecting on it, serve you?
One attendee shared her favorite question, What is the issue you wake up and go to bed with? Lisa agreed saying this is another way to say What is on your mind all the time?
- Honor your group’s purpose, objectives and timeline.
Trauma-informed care reminds us how important it is for the vulnerable people we serve to be in control of their yeses and nos. Therefore, we need to honor their expectations from our stated or advertised purpose, objectives, and dates and times for the group. For example, if your participants signed up for 1-hour per week abortion healing via the xyz program for 8 weeks, stick to that program timeline, topic, and curriculum. Don’t go 90 minutes, or 10 weeks, or switch or significantly alter the curriculum (e.g. adding religious content to a secular program, or deleting religious content from a religious program). If we “bait & switch” clients who have been through trauma or struggle with codependency or other dysfunctions, they may go along, but we may do harm to them, or they may feel mistrust and abandon the program or stop their healing journey altogether.
- Respect all parties’ right to terminate/or refer to another healing relationship at any point for any reason during the healing process.
Lisa spoke about the importance of respecting the client’s right to end the healing relationship and for us “not pursue them beyond what they want. She mentioned often being asked how many times is okay to message a client. Lisa’s advice is that your second message should say This will be my last text if I don’t hear back from you. Please know that I’m always here for you – or here’s a contact for you (if you’re offering information for a referral). Then respect that boundary and don’t reach out again.
Principle 4: EXCELLENCE
“Excellence is not to be mistaken for perfection,” Lisa advised. It’s striving to be the best versions of ourselves and “trying to deliver excellence at every step.”
- Hold responsibility for being aware of and setting clear, appropriate and culturally sensitive boundaries that govern interactions, physical or otherwise. Avoid discrimination by maintaining fairness and equality in all activities and operations, while respecting local rules and cultural practices.
“These are basic ethical standards,” Lisa said, “The biggest way I see this showing up in abortion healing is in faith and politics.” She urged providers to be mindful that all clients are treated equally whether they are pro-choice or pro-life; protestant, Catholic, atheist, or other; male or female; white, Black, or other races or ethnicities, etc.
One way “this could be showing up in your space as ethically irresponsible,” Lisa said, is having materials that only illustrate white people or only women. Another way she pointed to is having only materials for religious healing journeys. “This is where most of us are limited – having only one curriculum.” She elaborated that it’s typically a Protestant curriculum for women, which is okay for those seeking that. But often providers don’t have secular materials, materials for Catholics, resources for men, etc.
In terms of cultural competency, Lisa spoke about the importance of being able to serve or refer clients who speak languages other than English. This is another example of the need to build relationships with other providers and have referral lists.
- Create a space of confidentiality and/or anonymity, according to the client’s preferences. Within healing groups, establish norms of privacy and respect.
Our research shows that 69% of women and 77% of men value anonymity when seeking abortion healing. “In person programs,” Lisa said, “are not going to serve the clients we need to reach.” She added that some clients are afraid of legal ramifications of sharing their identity if they live in states where abortion is restricted or banned. She offered suggestions for easy ways to begin shifting to maintain a confidential and anonymous environment:
- Offer options to connect with you beside in person.
- Add a text line in addition to your phone call line.
- Add an email option for your referral program.
- Add social media messaging where clients can use aliases (such as Instagram and Facebook).
- Allow clients not seeking referrals to choose not to give their real names.
Digging Deeper
How can we build rapport with clients seeking anonymity?
Lisa acknowledged that virtual spaces present challenges. Participant Kirk commented that “there’s way more benefit [in allowing cameras to be off] for a person who is too scared to reach out any other way.”
Kylee shared that while presenting in a Heartbeat Academy webinar last week a participant from Texas said that “even facilitators are scared to have their cameras on because they’re afraid of repercussions or criminal prosecution.” Some said it’s “more comfortable for everyone to have their camera off.”
Participant Veronica shared that she finds it challenging when clients in virtual support groups leave their cameras off. There are concerns that someone may have ulterior motives or that someone else might be present while people are sharing confidential information. “But from what you said, this is about their comfort and need for anonymity, not mine. So I appreciate you bringing up that point. We don’t want this to be a deal breaker. We’re glad they are showing up.” Veronica also shared that her organization has a contract clients sign that deals with confidentiality, respecting others’ opinions, etc.
Lisa noted the importance of establishing camera and anonymity expectations upfront. She suggested facilitators explain that while participants may opt to be off-camera, all need to be committed to protecting this as a safe space for each other. One expectation is that each participant is in a space where nobody else can hear or see the participants. Facilitators may point out that some participants are off camera because they feel safer that way, and that if others feel concerned with that, they may opt to change their name on screen, only show their forehead or the ceiling, etc. to feel safe themselves.
- Maintain, store and dispose of any records, including electronic files and communications, created during my professional interactions in a manner that promotes confidentiality, security and privacy, and complies with any applicable laws and agreements.
“If we’re trying to elevate who we are as abortion healing providers,” Lisa said, “we need to maintain best practice standards and that has to do with our records as well.” We need to keep and destroy records appropriately.
- Make proper use of emerging and growing technological developments that are being used in healing services and be aware of how various ethical standards apply to them.
“With the growth in medication abortion,” Lisa said, “more people are reaching out for help right away.” The use of Zoom meetings has skyrocketed since Covid. And the preference for texting instead of calling has grown considerably. These technological trends all tie in well with the need to offer anonymous options. They also are more likely to be desired by those in the 20-29 year old age group, which has the highest abortion rate.
Summary
“I know this is a lot to digest. This is not meant for you to memorize,” Lisa said. Rather, this Code of Ethics document is “a framework for us to begin our practices. Many of you are already practicing within a framework, and perhaps you can adopt some of these for yourself.” She also recommended that providers consider additional ethics policies based on the work their organization does and that they might benefit from looking at other Codes of Ethics such as Heartbeat International’s that deal with pregnancy tests and ultrasounds, and those for faith-based organizations, and clinical practices.
“A code of ethics is not just how you personally operate,” Kylee said, “it’s everything that you do.” She encouraged providers to “check your policies and practices, talk to your marketing people to make sure that your external-facing communications, social media, everything is consistent with all of the language and code of ethics that we’ve talked about today.”
“Whatever code your organization develops,” Lisa said, “every person should operate by it regardless of their department or role.”
Click here to access the Code of Ethics for Abortion Healing Providers in pdf format.
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Click here to register for the next Abortion Healing Provider webinar.
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