Lisa Rowe, licensed mental health therapist and Support After Abortion CEO, and Karin Barbito, Support After Abortion Special Projects Manager and long-time support group facilitator discussed how to assess if clients are ready for a support group or if they need professional clinical care.
What is a Support Group?
Karin shared that support groups are always more than one person, originally were always in person, and typically were religious. Since Covid, virtual groups have grown in availability and answer people’s desire for anonymity. Karin noted that “it can be intimidating to enter into a room with people you don’t know.” Our research has shown that both men and women prefer anonymity and secular healing options.
Why Talk about Group Readiness?
“Support groups can be emotional,” Lisa said, “participants need to be able to hear other people’s stories” and respond appropriately. She added that “facilitators are responsible for creating safe spaces.” Managing group dynamics and the various personalities, expectations, and needs can be challenging. However Lisa shared that groups are one of her favorite things. “We gain from each other and realize we’re not alone on a journey that often feels isolating.”
Lisa also advised that “It’s important to offer options. They may not need professional therapy, but also may not want group support. They may simply need a more individualized approach. Support After Abortion encourages providers to offer options that meet clients where they are with the type of help they prefer.”
Facilitating Support Groups
“When facilitation is done well,” Karin said, “people feel safe and transformation happens.”
Lisa urged facilitators to participate in groups of a more personal and healing nature so you “understand the vulnerability and what happens inside of that experience” to “get into your right brain, where you have stored experiences, maybe positive or negative, where you can work on those in the dynamics of a group.” She continued, “It takes courage to show our vulnerability in front of other people, but it is also relieving.”
Assessment Tool Scoring System
The scoring system provides guidelines to help you determine whether a client is ready for a support group, should be referred for clinical care, or if you need to have a deeper conversation with them to complete your assessment.
“If something doesn’t feel right and they still scored as group ready,” Lisa advised, “listen to that intuition and reach out for help from us or from other colleagues, to help you make a good decision.”
CLIENT GROUP READINESS ASSESSMENT TOOL QUESTIONS
Question 1: Have you had, been a part of, or been affected by your own or someone else’s abortions?
Lisa pointed out that “by asking this question, it allows the facilitator and the client to “get comfortable negotiating the conversation” about abortion. She made an analogy to a doctor needing to know what they’re treating in order to provide the right prescription. After-abortion healing groups include participants who have experienced or been impacted by abortion. They may also include someone learning how to facilitate an abortion healing group. It’s important to recognize – and include in healing groups – people who have been impacted by someone else’s abortion(s), for example a mother who went with her daughter to the abortion clinic – or the parent who learned later of a son’s or daughter’s abortion experience, or a friend who lent someone the money for an abortion, etc. Many times they are focused on supporting the person who directly experienced abortion and may not have considered the impact of the abortion on themselves.
Question 2: Have you attended counseling, abortion healing, or other programming to address the impact it has had on you?
Lisa discussed the importance of looking at the whole person to know what they’re working through, what kind of support they’ve had along their journey. “Is this their first group or support after their abortion or are they continuing to unpack their abortion experience.”
Question 3: Are you now or have you in the past had thoughts of harming yourself or others?
Lisa and Karin emphasized that is a critical point for assessing group readiness. The tool includes three possible answers that have different weights for assessing group readiness.
CURRENT = CLINICAL CARE
“If a person has current thoughts of harming themselves or others,” Karin said, “then we think that it would be much better for them to see a clinician, to talk about that and talk through that before we get them into a group where those suicidal thoughts and ideation may be triggered by what other participants share.”
PAST = FOLLOW UP QUESTIONS
If an individual discloses prior thoughts of harming themselves or others, “we want to better understand what that means,” Karin said. She shared follow up questions, depending on how people answer some of these questions.
Lisa and Karin discussed approaches for facilitators when a participant shares thoughts of suicide during a group. Lisa advised lay facilitators and others who are not therapists that “if being in the group is providing greater harm to that individual” then best practice in recovery therapy is to “suggest a time out” and to “enlist different professional support to help that person as they’re walking through it.” Lisa continued, “It’s never a best practice to try to navigate that alone. You should have somebody that you can lean on that has the qualifications to help navigate something like that.”
Question 4: Are you currently seeing a mental health therapist?
Karin and Lisa shared that this is important in order to ask question #5.
Question 5: Does your therapist support your participation in an abortion healing support group?
Lisa added, “My experience has been that abortion is sometimes the reason why people reach out. But more times than not, it’s been a secondary reason.” She said some people can do both simultaneously. “They’re in a place that they just want to get to the root of all of their stuff and heal.” She emphasized the importance of therapist buy-in. Lisa offered an example of a situation in which a therapist might suggest waiting to work on abortion healing in which a person is going through a divorce and dealing with their child’s recent overdose. The therapist’s role is to “look at where this conversation fits into their healing journey, as they’re negotiating all of the opportunities for healing.”
Question 6: Are you currently experiencing any other symptoms or stressors in life like depression, anxiety, addictions, domestic violence, relationship issues, homelessness, unemployment, or recent trauma or loss other than your abortion experiences?
Karin explained this question is designed to prompt conversation to assess “how able are you to do life? We really need to meet clients where they are, listen to what their preferences are, and then assess their readiness.” Clients who respond no to all of these are likely a fit for a group. However, if they say yes, then “we need to engage in a conversation and ask follow up questions to really get to the bottom of how much these different kinds of stressors are influencing them on a daily basis.”
She suggested, for example, that someone with an active addiction may have limited or no ability to engage in a support group depending on the severity of their addiction. Experiencing domestic violence is another situation in which “if clients are not in a safe place it would be really difficult to be able to participate in a support group.” On the other hand, we may incorrectly assume – like Karin shared she did – that someone experiencing homelessness would first need to work on living arrangements. Karin recalled one client who said, “No, I really want to work through my abortion experience. I’m homeless. Nobody’s going to be around me. I won’t be interrupted, and I have nothing but time.” Likewise unemployment could fall either way. Someone may feel they have the time to work on abortion healing. On the other hand, “If you don’t have the means to provide for yourself, or you don’t have food to feed your children, and you’re spending your day trying to source food,” participating in an abortion healing group probably isn’t the top priority right now.
In talking about the importance of taking the time to properly assess clients, Lisa shared that sometimes even clinicians such as herself jump in with both feet because a client says I’m ready to dig into this when the professional reality is that we need to “take it one step at a time.”
She also encouraged providers to consider Maslow’s Hierarchy of Needs – that basic necessities need to be met before beginning a journey to your higher self. As an example, she shared that when she worked with sex trafficking survivors abortion may be asked on intake, but it wouldn’t be addressed until their basic needs were met, they were sober, they’d been in a healing environment for a while, they were getting regular meals, having good sleep hygiene, and had been receiving therapy for the trauma.
Question 7: On a scale from 1 to 4, with 1 being rarely to 4 being most of the time, how are your activities of daily living impacted by the symptoms or stressors of life mentioned in question 6?
Lisa said this question addresses the degree to which their stresses are “impacting their activities of daily living: bathing, cooking, making the bed, doing laundry, taking out the garbage, etc. So if you take your children to daycare or drop them off at school, then you curl up in the fetal position on your bed and sob all day long, set an alarm and have it go off a half hour before you have to pick up your kids. Then maybe this isn’t the right time for you to be in a support group. [Rather] you need some individualized care to get to the bottom of what it is that you’re grieving so heavily over.”
Question 8: Are your parents/spouse/partner/friends supportive of your interest in receiving abortion healing services?
It’s so important that we know who’s on board,” Lisa said. “If you’re inviting this healing journey in and you’re healing and growing and the rest of your family or support system isn’t, that’s a necessary part of the conversation for us to know as the facilitator and to invite that conversation for the client.”
Karin shared that one resource had a support letter clients could give to their spouse/partner or other family members. “The emotional pain is real,” she said, “and one thing that we find so difficult with an extended period of healing is coming to the group for an hour or two, you get emotional and in touch with these sources of pain, then you have to go back” to your everyday life. She explained that the support letter is a way for clients to tell their support system “I’m not going to be the [mom / wife / friend…] that you’re used to me being right now because I’m working through some stuff so that I can become healthier. Will you support me in this?”
How to Use the Client Group Readiness Assessment Tool
Lisa encouraged providers to see this as a tool offering suggested questions to facilitate conversations with clients to assess group readiness. She said it isn’t meant to be a list of questions providers read to the client and check off the boxes. “It is a guide for you to help better understand your clients,” she said, “to unpack their experiences so that you can help serve them in the very best way that you know how.”
“This is really where you have the opportunity to be present with your client,” Karin said, “to not only listen with your ears, but listen with your eyes. To see their reactions, their facial expressions, their body language. And when you have a pause or gut check, that’s when another question needs to be asked.”
One attendee agreed saying that in her center they engage the client to hear their story first. “As they’re telling their story during intake,” she said, “some of these questions are answered, and other times we can do a follow up for it. So it doesn’t sound like you just went through all these questions and answers.”
Lisa encouraged providers to support one another, to rely upon their teams, and to build relationships with local clinicians and other support people.
- How long does therapy last or is it ongoing for life?
- LISA: We look at healing as a journey, not a destination. Where we are today is not where we’ll be three years from now. The experiences that are rooted in early childhood traumas come out in different seasons and spaces in our life. So perhaps the 20 year old that’s getting ready to launch into their career might feel triggered by insecurity and goes to therapy looking to find their courage and why don’t they feel secure? Then at 28, they’re looking to get married and have different insecurities and reasons for therapy. And all along, there’s an abortion experience under the surface. It will be different for each client.
- How would you approach a person who is suffering and unwilling to get any help?
- LISA: We can’t force people to be ready. Oftentimes a conversation will plant seeds and then maybe some fertilization will happen from other people. Then over time, the sprout will come out and they’re ready to begin talking to somebody. It’s a very individualized experience, based on that person’s ability to say, Yes, I’m ready. And sometimes it takes a very real, significant life experience for them to say, I’m ready for help.
- How can you help someone lost in addiction?
- LISA: Addiction will fog everything. It is a symptom to much deeper roots. But until the addiction is addressed, we can’t get any deeper. So, the addiction has to be addressed first.
KARIN: My addiction was to numb the emotional pain I was feeling. So it was not the right time for me to enter into something where I would feel that pain. Each person is different. Some questions to consider: Are you working a program? Do you have a sponsor? Are you just not drinking or using drugs? There’s a lot to go into assessing that.
- Have you noticed any differences in assessing the readiness of women who have experienced medication abortion versus surgical abortion?
- LISA: We’re seeing that medication abortion provides a complex level of trauma. Our experience is that women and men are reaching out a lot sooner because they can’t forget or dismiss what they saw. They’re in so much pain and are willing to do almost anything to get out of that pain. They’re looking for support right away.
JANE ABBATE (attendee and Life Coach) shared that she has experienced group dynamics challenges as a group leader stemming from having both clients whose surgical abortions were long ago and medication abortion clients whose trauma is fresh.
LISA: “Jane is an expert in her space, too.” Lisa suggested that facilitators could ask clients what type of abortion(s) they experienced and how long ago in consideration of group cohesiveness.
- Do you recommend a woman who is currently pregnant and who had a previous abortion go through healing during pregnancy?
- LISA: I would submit to you that we need to become more client-focused and less rigid about rules. If a pregnancy center client is ready to receive support in a healing program for a prior abortion, there should be no reason why we can’t support them on that journey. If you provide wrap-around services with mental health services and parenting support, etc., it is only going to help them attach to their next living child in a way that they wouldn’t be able to attach with that trauma connected to it from their abortion experience. But there again, we need to go back to that assessment and say, where else are you? What other things do you have going on? Because if you have other things going on, this might not be the right time.
- How long after someone has experienced abortion do you recommend they be connected to healing? Some suggest they should wait until after the due date of the terminated pregnancy.
- LISA: Do we have to wait one year after abortion? Absolutely not. We have found that some people are ready right away. Why would we wait a year to have somebody go through all of that pain and all of that trauma, find another numbing mechanism, rather than meet it head on in that moment? Now, the group that they start a month after their abortion is not likely the same group that they will experience five years from now. But remember, healing is a journey, not a destination. So we’re going to meet clients right where they are and then grow into a deeper healing program as they’re ready. I have found, working with clients, that we don’t do any harm if a client is ready and willing and wants to start the process. In fact, in those cases, when the due date comes, they’re more ready to embrace that experience with a healing mentality instead of in a devastated, depressive state.
Comment: We need to let therapists know that when they think it might be a sexual issue, don’t overlook abortion. Long before I ever admitted or sought help from my abortion experience I was in therapy. My therapist constantly asked if I had experienced childhood sexual abuse even after I said no. Years later it occurred to me that she was close. It was a sexual issue. She just never asked about abortion. I contacted her and let her know, You did a great job trying to help me. And I did have a sexual experience that was causing my struggle. You just never asked about abortion. And I certainly wasn’t raising my hand to talk about it at that time in my life. When I’m working with folks, I let them know, if you’ve worked with a therapist and you have found [abortion] healing, go back and tell your therapist.
LISA: Thank you for sharing. Time and again, our industry is not doing a great job in training licensed professionals about abortion. It’s still falling in the political and religious narratives. It has yet to fall deeply into the clinical space. We have an industry that is lacking the training on how to approach this topic.
- Is there a difference in assessing readiness for different programs? For example, weekly or biweekly support groups with participant interaction compared to an individualized weekend retreat?
- LISA: There are different ways in which we support people, but we really have to assess when and if somebody is ready to be with others. Can they respect that environment or are they so focused on their experiences that they won’t be able to be in an environment that really requires empathy for others.
- What’s the next step for someone who has some formation and preparation for spiritual or inner healing to be ready to facilitate abortion healing without becoming a licensed therapist?
- LISA: I think it starts with understanding where your strengths lie and where your weaknesses are. As a clinician, the biggest thing I hear in my training to become a life coach is to know what you’re there for with your client and what you’re not there for. As a coach, you’re there to help them move forward towards a goal. You’re not there to go into the past pain (like a therapist would). So I think the first step is to assess the gifts and talents that you bring to a client situation. For anything that falls outside of that, you’ll want to have a team of people you can refer to. For example, a client has past sexual trauma and that’s not a space I’m ready to be involved in, I have a person for that. Or this is an addiction issue, or pornography issue. Also there are things in our lives that we have yet to deal with, and if we’re walking with a client and we haven’t dealt with it ourselves, we can do more harm than good. So we need to assess our own healing needs.
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