Who should do the counselling: doctor – non doctor?
Karen Schlie , Family Planning, Hamburg - Germany
The first question arising in this connection is the question of what is at issue in the counselling. As a counsellor having graduated in pedagogic with additional therapeutic qualifications I have to focus on the client’s issues.
What are her needs and wishes concerning counselling prior to an abortion.
- Does she need support in taking her decision or rather an opportunity to reflect whether she has taken the right decision?
- Does she require information about abortion: medical information, the selection of the right method, the procedure, framework conditions or the steps to go – just to mention a few examples?
- Or does the client rather wish information about social/financial support in order to reconsider whether this would influence her decision?
- Are there any specific legal conditions concerning abortion to be observed in different countries?
- Are there any legal conditions for the physician such as her duty to inform about complications?
- Does the client wish any counselling at all?
This range of questions shows that different qualifications are required to provide adequate and professional help for the respective problem.
Therefore I would not ask who should do the counselling prior to an abortion but rather which qualifications the physician or other professional should have.
I work as a counsellor at the family planning centre in Hamburg/Germany. I have a university degree in pedagogics with additional qualifications in social work and psycho-therapy. These are qualifications from which I benefit in my pre-abortion counselling work.
As counselling prior to an abortion is compulsory in Germany, we often have to deal with resistance and fear. Frequently, our clients are insecure and don’t know what they have to expect from the counselling.
In our counselling work we distinguish between clients who have already taken their decision to have an abortion (which is the case for about 80 % of our clients) and those who rather seek support in their decision-taking process (some 20 %). The latter need a therapeutically trained counsellor.
Mostly, both types of clients wish to also receive medical information.
Therefore, medical knowledge about the performance of an abortion and any potential complications is required. In our team at the family planning centre, we have physicians and perform abortions ourselves. If the client has any questions I cannot answer, I can refer her to a physician or can acquire the relevant knowledge myself. Vice versa, the physicians can refer to me or one of my colleagues, if they become aware that the client has not yet taken her decision or is in a crisis due to an inner conflict.
Of course, these opportunities are not available at every institution or clinic; and therefore it is essential to try to establish a good network of cooperation and, if necessary, to take part in specific training.
Regardless of your profession, I think it is important to reflect your own inner processes as well as your practical work. Counselling competence, such as certain communication techniques, might also be of help in the medical context.
Thus, in supporting the client in her choice of the appropriate abortion method you should also talk about her personal situation taking into account her particular needs.
- Are there, for example, small children but nobody who could take care of them?
- Is she afraid of surgical abortion because of past bad experience with operations?
- Does she consider Mifegyne to be a more self-determined way which she would prefer while a surgical abortion might give her the feeling of being in someone’s hands (“there’s someone doing I don’t know what to me”) – possibly due to a history of sexual abuse?
- In case the pregnancy is too advanced for medical abortion so that she has to choose the surgical way, it may be important to reflect whether it is more appropriate for her to get local anaesthesia as she could then participate consciously in the entire process.
- Or would she rather prefer not to live consciously through the surgical abortion process because it might lead to retraumatization due to past experience with violence? Then general anaesthesia might be her choice.
For all these questions it is useful if I as a counsellor can reflect my own feelings while I inform the client about the various methods. Am I able to go with the client and her decision even if I would choose a different method in a similar situation? And by the way, what is my way of informing? Do I conduct the dialogue in a way ensuring that the client can take a self-determined decision about the method she considers most appropriate? Am I the one determining what is “self-determined” or am I rather able to put aside my own concepts of what might be best for the client.
Summarizing I come back to the one central question: What are the qualifications required by a counsellor to deal with abortion, no matter whether she is a physician or another health professional?
In my opinion we are not looking for an either-or solution but rather for an as-well-as solution. This means that physicians and other professionals should cooperate and support each other in order to participate from each other’s competence in striving for the greatest possible benefit for the client.