Recap of May 18, 2022 Abortion Healing Provider Webinar
“Answering the questions was like getting undressed in front of someone,” Jane Abbate said as she described what it felt like when she first reached out for support after her abortions. “Each question was like taking off a different piece of clothing. My anxiety increased as the questions got more personal.”
Jane has succeeded as an Executive Director and entrepreneur. She is the author of Where Do Broken Hearts Go? Healing and Hope After Abortion, and currently serves as part of the after care teams with Rachel’s Vineyard in St. Louis. Her passion is to support people on their abortion healing journeys. She leads small groups to explore the emotional aftermath of abortion and to grow beyond that painful experience. She also offers mentoring to build the mindset, skills, and habits that lead to a life of purpose and happiness.
Her own healing journey began in 1999 with a phone call to Rachel’s Vineyard. She had seen advertisements for a few years before finding the courage to make that call. It was the first time she had told anyone about her abortion experiences other than her husband. She recalls the advertisement read Are you suffering from an abortion?
Jane said, “I was suffering from abortionS – and not just two, but three. I was mortified to have to say I had had more than one.”
Jane recounted how after taking that first frightening step of calling, she had to muster up the strength to drive into the parking lot. She had to summon the courage to get out of her car and walk inside. She had to push past feeling intimidated and fearing judgment and condemnation. She was relieved the staff members were compassionate and welcoming. They provided emotional care and support to help her through filling out the paperwork.
Reaching out, getting support, and finding healing after her abortions “changed my life, saved my life. It was the most important thing I’ve ever done,” Jane declared.
Eventually Jane wrote a book, Where Do Broken Hearts Go? Healing and Hope After Abortion, about 19 different emotions she experienced – from numbness, anger and fear to freedom, joy and peace. She explained, “I wrote it that way because I didn’t experience my abortions in my head. I lost my children – the only children I would end up having – through my emotions and the bouts of anger, loneliness, and guilt I was drinking away.”
Jane served on the Rachel’s Vineyard team in Pittsburgh for nearly 15 years. Now she leads after-retreat groups in St. Louis that meet for 4-6 weeks using her book as a basis for discussion and support.
How to Ensure Your Intake Process Prompts Truth
Based on her lived experience as someone who sought support and her expertise gained as a leader in providing abortion healing to others, Jane offered several tips on how to ensure your intake process prompts truth. She emphasized the need to create a safe space for clients to open up and share their stories.
Use Language to Ease Client Fears
Her first suggestion is to use language that eases the client’s fears of the unknown by gently explaining what you’re doing and why. Jane said it would have been helpful and less scary if she knew what to expect. For example, she suggests starting an initial phone intake with a statement such as I’m going to ask you some general questions about your abortions. I won’t ask you to share your story, yet. We’ll do that later when we meet in person.
“That would have relieved the tension I was feeling not knowing what was coming, when I would be asked about my story, or how deep the questions would be.” Jane said.
Jane suggested pausing periodically during the intake process for “you are here” type updates and to affirm the client with words such as I know this has been tough. Thank you for sharing. Now we’re going to _______. Jane shared, “it would have been helpful to know I wasn’t going to have to tell it all in that first conversation.”
Lisa Rowe, LCSW and CEO of Support After Abortion, agreed and advised abortion healing providers that “It’s not just the abortions. Clients are exposing the vulnerable places they’ve traveled, so don’t do that all at once.” Lisa also discussed the need to help clients distinguish between shame (I am bad) and guilt (I made a bad decision).
Create a Safe Space for Trust and Sharing
Continuing with her tips for intake that prompts truth, Jane recommended providers reflect on what our purpose is – providing a safe space for clients to trust and share. She explained, “There are so many things you [providers] want to know and that are important to know, but consider if they all have to be asked at the same time.” She talked about the discomfort that many providers have felt “moving from being the compassionate, caring caregiver to the data-collector” and how it’s possible to blend both necessary roles.
Jane encouraged providers to recognize the difference in how questions that require more sensitive and vulnerable responses may affect clients, for example benign answers such as my email address is _____ compared to I’ve had five abortions to I was abused as a child. She discussed how by adjusting our language and intake process and mindfully listening and empathetically engaging with clients, we will put clients more at ease, foster trust, and elicit truth.
Practical Suggestions to Create Space to Prompt Truth During Intake
Karin Barbito, Director of Special Projects at Support After Abortion and a former pregnancy center program director, then shared practical suggestions to create space to prompt truth during intake. She recommended examining your agenda noting, “Barring anything else, you want them to connect with healing, and they’ll know that if you focus on them, not judging. Time during intake is just to be present with them, to normalize their feelings. They’re sharing stuff with you they may not have shared with anyone before. We want them to know they’re not being judged, they’re being loved, and we’re here to serve them. Create that space.”
Tip 1 – Let Clients Know Why We’re Asking Questions
Karin echoed Jane’s advice to let people know why we’re asking these probing, personal questions. For example, “I’m going to ask you about the type of abortions you’ve had, so we can help you with what you’ve been through because the type of abortion often affects people differently. Similarly, we ask the date of the most recent reproductive loss because someone whose loss was only two weeks or two months ago presents much differently than someone 20 years removed from their experience.”
Karin said her purpose for the questions she asks is always “to understand what the client is going through, so I can serve them well. We ask questions in order to offer better support.”
She asked, “How many of you lied when asked about reproductive losses or abortions? I did because I was ashamed and I didn’t want to talk about it.”
Karin said to keep it very relational and create a safe place that will help them to be honest with us, so we can help them find healing.
Tip 2 – Review and Revise Your Intake Regularly
Karin started with saying, “Let me be completely transparent. We did it wrong, and we’ve changed our questions and language along the way because we learned. There’s no shame in pivoting the questions you ask because of personal experience – yours or ours.”
Lisa shared, “We’ve discussed intakes at least once a month for several hours since starting Support After Abortion because we’re constantly learning new things. We’re always open to new understanding. I encourage you, if you haven’t taken a look at your intake in a while, to do so. It’s one of the most important things to begin a conversation and start the relationship on solid footing. It needs to be something you review regularly.”
Karin recommended providers allow clients anonymity during the initial call. She noted that at Support After Abortion, we only need one thing at that point – some form of contact information they’re willing to share so we can follow up. We also try to get a zip code, so that we can connect them with resources near them or in their time zone.
Tip 3 – Use Gentle, Non-Judgmental Language
Karin spoke about using gentle, non-judgmental language. A key example is not to use the term post-abortive because “it’s a label with some really negative connotations.” She shared her personal experience saying, “I had my abortion in 1977, I don’t want to be labeled by that for the rest of my life.”
Another critical language term to avoid is using abortion singularly, as it stigmatizes those who have had multiple abortions. Instead, always use the plural, such as abortions and reproductive losses.
A third language change is to move away from only asking about abortions – or only about miscarriages and stillbirths – rather asking about reproductive losses you’ve experienced including miscarriages, stillbirths, infertility, infant/child death, adoption placements, children removed from the home, abortion pill reversal failures, and abortions. This better captures client experiences and enables us to refer them to organizations and agencies that can support them.
Support After Abortion also recommends using the terminology experienced abortion instead of saying someone chose abortion or decided to have an abortion. Many women say they didn’t feel as if they didn’t have any real choice – often because of their circumstances or pressure from other people. And our research shows that nearly half of men report they had no voice or choice and a majority report they were not part of the decision. The words chose and decided can have a triggering effect or a negative, judgmental connotation. There is also value in focusing on the experience, which includes many factors and more than one point in time, rather than the singular focus of an assumed choice or decision.
Tip 4 – Meet Clients Where They Are
Karin said, “Politics aside, religion aside, I just want to help people find freedom and walk into their destiny.” She explained that “not everyone wants to start with religion. They may feel judged and condemned.” She encouraged providers to use and provide clients with Support After Abortion’s beginning abortion healing resource Keys to Hope and Healing, which is available in secular or faith-centered editions for men and women, in English and Spanish.
For more conversation about meeting clients where they are and why beginning with religious messaging may not be helpful for the majority of those with abortion experiences who reported preferring a secular approach to healing, providers may want to review the March 16 Abortion Healing Provider Webinar, Is God Necessary for Healing?
Tip 5 – Use a Likert Scale to Assess Emotions
As she continued offering practical suggestions for prompting truth during intake, Karin suggested using a Likert scale instead of the usual How are you doing emotionally? Noting that clients often simply respond fine, Karin shared that we can elicit more genuine responses if we instead ask, How are you doing emotionally on a scale of one to five, with one being “feeling bad most days” and five being “feeling good most days”? It validates the range of emotions clients may be feeling and encourages conversation.
Jane affirmed the value of Likert scales, stating that “it helps give the client something to focus on.”
Additional Likert scale questions on a client’s emotional and mental health well-being were made available to participants after the webinar by sharing the Intake Questions presentation.
Karin suggested following up one month after the client’s retreat, one-on-one, or group and asking the same questions in the same way to see if there has been progress – if healing helped. Karin said this helps us further support the client and capture information confirming that “If someone goes through healing, the likelihood of their choosing abortion again for a future unexpected pregnancy goes down.”
Tip 6 – Determine If Clients are Ready for Support Groups or Therapy
Karin then addressed how to determine if a client is ready for a support group or is in need of clinical therapy.
Karin emphasized the importance of assessing a client’s risk of suicide and encouraged providers to ask the question directly, Are you currently, or have you in the past, had suicidal thoughts? with answer choices being Yes Currently, Yes in the past, and No. If you are having the client complete the form independently, we recommend you include If you are having suicidal thoughts now, please call 800-273-8255, which is the number for the National Suicide Prevention Lifeline. This question is essential to determine whether to refer a client to a support group or therapy and to immediately connect clients with current suicidal thoughts or ideation to effective help.
Karin affirmed the need to ask Are you currently in therapy? and If you’re in therapy, has your therapist approved your participation in this group? Karin stated, “Many groups aren’t professional clinical help, so we want to make sure their therapist is okay with their participation.”
Additionally, Support After Abortion encourages providers to use the Likert scale emotional assessment responses to help determine how to best direct clients. For example, if a client were to answer “1” to all four emotional assessment questions, they should be referred for clinical support. If a client answered “1” to several questions, providers should discern together with the client if clinical support or a support group is best for their needs.
Tip 8 – How to Respond to “I’m Fine”
Lisa urged providers to “see that 20-30 year old man or woman who’s going to expose their deep selves to you, or that 60 year old self who feels like they’re undressing in front of you.” She also addressed providers in pregnancy centers engaging in conversations about previous reproductive losses with pregnant clients, who aren’t expecting these questions.
Karin added, “The client comes into a pregnancy center because they’re pregnant and they’re either happy about it or not. They’re looking for an ultrasound, maybe an education program, maybe gestational age to pursue abortion. We need to slow them down. As people in crisis, they’re not thinking about or hearing what you say.”
If a client indicated they had reproductive losses, Karen shared she would ask them about their losses, and they’d say “I’m fine.” She would ask ‘Can you spend another 10 minutes with me after your pregnancy test to circle back to how you’re doing after your losses?’”
“Then, for example after a negative pregnancy test and sexual avoidance test, I’d say, ‘I’d like a few more minutes, please.’ I made sure I was completely available to them in that moment.”
Her voice softening with compassion, Karin said, “I would then share, I had an abortion, and I thought I was fine, but I really wasn’t. So, tell me, how are you really doing?” She added, “Usually, they started crying because someone was asking about them. Give the opportunity to let people share those secrets that are eating them up. Invest our time in them. In order to love and help them, we need to have the conversation. Consider that when that person leaves your center, you may not see them again. Seize every opportunity.”
Lisa encouraged providers to have someone on their team who has experienced abortion and found healing. Support After Abortion’s consumer research shows that a majority of people would like to speak to someone who has walked in their shoes.1
For providers who have not experienced abortions, Lisa recommended using wording similar to what she says, “That is a very common response. I understand this isn’t an easy place to travel to, but would you mind sharing with me a little bit about your story? The minute their brain is engaged in sharing that story, that’s when the tears come and there is something that then presents. When those tears come and their story generates emotion, I’ll say, I’m so glad you shared that with me. We have support programming for that.”
Lisa encouraged providers, “Don’t stop at ‘I’m fine.’ Start the conversation. Ask more in-depth questions, encourage greater understanding. This is a conversation, not a fill-in-the-blank.”
Tip 9 – Focus on the Client
One provider reflected, “It isn’t about the process so much as the person.
I have to put aside all of my preconceived notions about who she is, and where she is, and what she ought to be, so she can heal. She needs to know that we see her as she is – or he is – in that moment.”
In closing the training session, Lisa said, “We want to be that soft landing place. It’s about her and what she needs, or about him and what he wants to do next.”
She continued, “It’s not about pro-life or pro-choice or about what numbers you need to report to your board. It’s about the client in front of you and what they need and want to do next.”
Jane concluded by urging providers to approach clients from their viewpoint: “I’m not a program participant or member, I’m a woman (or man) – at whatever stage of life – who has come to you at great expense of my shame, guilt, experience, and I need your help and support.
Click here to register for the next Abortion Healing Provider Webinar.
Explore Jane Abbate’s YouTube channel, My Mentor Jane, and
download helpful resources at her website www.mymentorjane.com.
1, 2 2021 Men’s National Post Personal Abortion Study and 2021 Women’s National Post Medical Abortion Study, Support After Abortion / Shapard Research.