Opinion | How to Properly Counsel Patients Post-Roe

For 2 years I counseled patients seeking abortion care at a local independent clinic in Kentucky. It was an honor to help connect patients with the care they needed to achieve their goals for if, when, or how to grow their family. For some of our patients, they only ever told those of us who worked at the clinic about their abortion, so the counseling experience created a unique space to share their stories. For many, this was incredibly soothing.

It was gratifying to see the spark of recognition in patients’ eyes when they realized I would care for them and support them, unlike the anti-abortion protestors they often had to pass by to enter our clinic, or the potentially unsupportive family or friends they may have encountered before. Patients’ body language relaxed as they realized the stigma and harassment they faced outside the clinic was over, and that I was there to help them, without judgment.

Often, my work as a counselor started with unpacking the traumatizing experiences my patients faced when they sought abortion care. Anti-abortion protestors would frequently station themselves outside the clinic to try to intimidate and coerce visitors into continuing a pregnancy they didn’t want or that wasn’t healthy for them. Many of these protesters aren’t peaceful demonstrators — they scream at patients, insult them, follow them closely and aggressively, and invade their personal space, all while claiming to want to “counsel” patients and provide advice about pregnancy options. This couldn’t be further from the truth.

These extreme protestors are co-opting the language of counseling to try to legitimize their efforts to politicize basic healthcare and impose their personal religious beliefs on all of us. Now, protestors are even more emboldened to harass clinic staff and patients after the Supreme Court overturned Roe v. Wade this summer. As state politicians and special interest groups seize the chance to push new abortion bans based on politics, instead of medical expertise and science, anti-abortion harassment in the form of so-called “sidewalk counseling” will continue to intensify and inflict serious harm on patients across the country.

We’re facing a health crisis, and it’s time that we, as social work professionals, set an example for what real counseling looks like: compassionate care, without judgment, that provides accurate information and helps all people thrive and empowers them to make decisions about their futures.

As counselors, we have a duty to our patients to affirm and validate their decisions about whether they carry or end a pregnancy, regardless of what we personally would decide in the same situation. Protecting our patients’ right to privacy, self-determination, religious freedom, and their ability to make decisions in the best interest of their mental and physical health and well-being should be an ethical priority for every counselor. You don’t need to be an advocate or an expert, but you can’t be afraid or ashamed to discuss abortion and build trust with clients who make the decision to end a pregnancy.

For some people, abortion can be a challenging decision, but for many it’s a simple one. In fact, research shows that the most common emotion associated with abortion is relief. Many patients are confident about their decision, and are only looking for compassion and validation. So, if your patient isn’t struggling with their decision, there’s no need to pathologize what is not there.

Let’s not forget that when people are denied a wanted abortion, they experience increased stress, lower levels of life satisfaction, decreased work productivity, and decreased mental well-being. They are subjected to the potential dangers and costs of pregnancy and childbirth, and exposed to the threat of workplace discrimination and harassment. To combat this, we can talk to our clients (or patients for doctors, nurses, etc.) openly and compassionately about all of their pregnancy options, so they can arm themselves against misinformation. We can also help our clients or patients navigate the hostile political landscape by taking time to educate ourselves about the basic laws in our state and helping them understand this information. In states with steep barriers and near-total bans, we can stay informed and seek opportunities to resist political interference in the confidentiality of our counseling. When we stay true to our profession and serve as a resource for patients, rather than another obstacle, we can help shift the needle in people’s ability to fully participate in their relationships, friendships, workplace, and life.

The ability to talk about their abortion, to normalize this healthcare for people who are unfamiliar or have only heard misinformation, is one of my favorite parts of counseling. I hope you’ll join me and the growing movement of mental health care professionals working to build a world where all of our patients have the freedom to build the families they choose.

Madeline Dyer, MSSW, is a former counselor and Safety Zone Enforcement Coordinator for EMW Women’s Surgical Center in Louisville, Kentucky, and a fellow with the Feminist Majority Foundation, National Clinic Access Project.