psychobabble

pontificatrix

pontificatrix
Bio
I am a resident in psychiatry at an academic medical center. My blog posts describe patient encounters I have had in the course of my training, both past and present. Names and identifying details have been changed. My blog conforms to the information-privacy standards detailed on http://medbloggercode.com. If you believe you have been a patient of mine and have concerns about the effects of this blog on the privacy of your medical record, please let me know and I will be happy to withdraw any offending material.

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AUGUST 25, 2010 3:11PM

to be or not to be?

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The young woman who sat before me seemed childlike in her baggy sweatshirt, her gaze inscrutable beneath long lashes.  Her story was a common one, though, like all human stories, unique in its details.  In her case: The long-distance relationship.  The unexpected visit.  The empty box of condoms.  And then, the two pink lines.  The girl torn, attached already, her emotions wrapping themselves tightly about the thought of that small cluster of cells that slept deeply buried in her body.  The boyfriend scared, unready.  The girl’s parents disappointed, disapproving, pushing for a swift and discreet end to this shame.

 

Knowing only the bare outlines of her tale, the thought, “Don’t let them push you around!  You can make it!” rattled around in my head.  I had been where she was, staring at two wholly unexpected pink lines.  I’d reacted with a stream of unprintable words.  I’d agonized over a seemingly impossible choice.  And ultimately, I’d found myself grateful a thousand times over for having chosen a family.

 

            Patients often have an intense curiosity about their therapists.  They want to know if the therapist can truly, truly understand them.  They yearn to know that the empathy is coming from a place of knowledge and commiseration, not just imagination and formulaic response.  I felt this girl’s despair, along with a powerful urge to reach out by revealing more about myself and my own unplanned and much-loved child. 

 

But such a move would make our session about me, not about her.  And the last thing she needed was a counselor who would make her patient’s problems all about herself.  She needed to have her own thoughts and values reflected back at her with compassion, maturity, and with some degree of objectivity and distance.  I couldn’t help her reach a decision if I imposed on her my own values and desires. 

 

At first I offered mostly a listening ear.  She was leaning towards having the child.  Her thoughts centered on her fear of having an abortion, and worry that she might regret the abortion in the future.  Her friends and parents had emphasized the difficulties of caring for a young child, which paradoxically only made her more determined that she could do it.  I reflected these thoughts for her, offering support for her feelings without any judgement or opinion.

 

            After some time, I began to probe gently to uncover her imaginings about the other possible future.  What were her plans for raising a child, should she keep it?  I was surprised to see that she had given this aspect little thought.  One one point she was clear: She was certain she wanted to finish her graduate degree.  So then, about the baby.  At first she’d thought she could give the child to her mother to raise… but it turned out her mother had refused.  She paused.  It seemed her thoughts hadn’t moved past that point.

 

            I encouraged her to continue.  Well, perhaps she could send the child to day care and continue on in school.  All right, and how soon would she be willing to do that?  Would she take any time off from school at all?  Maybe a few weeks, she thought. 

 

            What about support?  Would she and her boyfriend marry, or at least move in together?  She thought not.  He was in school elsewhere and wasn’t any more interested than she in dropping out of his program.  Her parents also lived a plane flight away. 

 

            And the financial issues, then?  She was living on her student loans.  Her boyfriend was as deeply in debt as she.  Her parents had other children to launch and were not in a position to help her. 

 

                 She spoke slowly as we worked through these concerns, as if they were entering her thoughts for the first time.  It was becoming clear that this young woman was terribly unready for the task she faced.  If she chose to have the baby, she would have to do an enormous amount of growing up in an extremely short time.  She didn’t realize it, but her life would change radically, in ways that she couldn’t now imagine.

 

            Of course, she would also do a lot of growing up if she chose to terminate.  Perhaps she would, as she feared, regret it forever.  If it happened that way, it would be something she’d have to live with.  Either way, she wouldn’t again be an unencumbered girl.

 

            I didn’t offer my opinion.  I did continue to reflect the girl’s own thoughts on both sides of the issue.  On the one hand the thought of being scraped hollow and empty of life felt horrific, nauseating, something one might regret in a thousand different ways over the years to come.  On the other loomed overwhelming logistical concerns, the total responsibility for a new life when one was only beginning to imagine the direction of one’s own.

 

            She thanked me for having given her a lot to think about.  She didn’t reach a decision that day, but I heard from her later that she had decided to terminate.  It was a decision to close the door on this baby, in order to give future babies a better shot at life with stable, loving, and present parents.  It wasn’t the decision I’d made for myself; but it was a decision I might have made had I been in her shoes, with an unwilling partner and no means of financial support.  She and I were not alike, and I was glad I hadn’t pushed my experiences onto her.

 

I felt some relief knowing that she wouldn’t have to undertake the struggle of raising a child alone, and also some sadness for the process she faced and the repercussions it might have on her relationship and her psyche.  I invited her to come back anytime to discuss these or other issues, but I didn’t hear from her again.  Perhaps she hadn’t connected with me or hadn’t found our work helpful, or perhaps life just got in the way.  Either way I wish her well: success in her career, stability in her love life, and all the babies she wants to have whenever she is ready to have them.

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leaving the whole morality out of it. I think it is a great post. This is maturity. Making decisions--hard ones, regrettable ones. They should have a class in making decisions--glad you were there to teach her.
Yes, even-handed and well written. But also sad. My kids were both adopted as infants . . . that's not an easy choice either, though, and not necessarily any more moral than the other options.
Pitch perfect, ponti. It's so good to have you back. I love how you wend your wisdom throughout, and you're so right about people being curious about their therapists. I even drove with a friend to the other side of town so she could scope out her psychiatrist's house. It felt both wrong and completely natural to me. But this is so true: They yearn to know that the empathy is coming from a place of knowledge and commiseration, not just imagination and formulaic response.
Wonderful post, I think the compassion to allow a person to make a decision based on their experiences, beliefs and needs is the key to this issue. There is difficulty in making a decision like this but there is always difficulty in life, no matter how you go at it. We are positioned to make choices in our lives, not just about abortion or other reproductive issues. We must be able to make thoughtful decisions, ones that we understand and can live with as best we can. You gave this process a prominent place in the ongoing debate by demonstrating while not your own choice, the understanding and compassion for another person, who is unique and in a completely different place than you, respect can be shown for their right to make their own choice. R
First of all, I support the right of choice. But, in your story you didn't mention the choice of adoption. It isn't a two-way choice but, at least, a three-way choice.

I'd also suggest that it's important to document (anonymously) a lot of choices that have to be made. For one, I think it would help any women who has the making of the choice thrust upon her. I suspect that many who face the choice act as if they are the first person in history to face the choice. So, a wide array of stories of what choice was made and why would be of benefit.

Secondly, I'd suggest that the anti-choice folks regard the choice to always be made casually. It's important to document the serious thought that has gone into making the decision. If there are, in one place, documentation of a 100 (or a 1,000) decisions would put the lie to that claim.
Beautiful post. Our of curiosity, did she ever consider adoption (open or closed)?
Well done, Pontificatrix. It is so important for any person in a position to counsel to remain as objective as humanly possible.

Lezlie
It wouldn't be expected for you to be a pregnancy counselor, the role of a therapist is that of a listener, using conversation to help guide someone to their own discoveries and conclusions as they share their thoughts. Sounds like that is exactly what you did. Approval is not needed in psychotherapy, an open mind is the goal.
Sounds like you handled this one quite well. Having one was never an easy decision for any woman I know.
A female blogger asked me on May 5th:

"I just have a simple question for you-- if you are so attracted to promiscuous women because it increases your chances of getting laid, if you impregnated one of these women, would you help take responsibility for the child because you are against her aborting it?"

I responded:

YES! This goes without saying. And this almost happened. In October 2007, I spent a weekend with a beautiful woman from out of town, kind enough to visit me here in the San Francisco Bay Area, whom I met online through e-harmony.com. The second time we made love, the condom slipped. We were both worried about a possible pregnancy and are both opposed to abortion. Late in the evening, she got her period, and our fears were diminished. But had she gotten pregnant, I would have married her in a heartbeat!

And the thought of marrying her anyway crossed my mind afterward. In the months that followed, she was the one who ended communication with me. So you can hardly accuse me of being "love 'em and leave 'em," i.e., an exploitative male, in this regard!

(And actually, I don't wish to imply that the woman in question is or was "promiscuous"... With her looks, if all she was after was casual sex, there would have been no need for her to travel hundreds of kilometers -- I refuse to say "miles"! -- just to see me. I'm certain there are plenty of men in her immediate vicinity who would have loved to have satisfied her. I'm not averse to casual sex, but I'd like to think that what we had was the start of an actual relationship.)
...sometimes, steve cross, the choice is made casually... and that's a choice too.... this isn't a huge deal to every woman.... you know, the egg and sperm, even before they connect, are living cells.... so do we mull that over with every sexual connection? i don't think so....

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Regarding adoption: That seems like it would be a good option for someone who was strongly opposed to abortion on moral grounds but didn't want to raise a child. And even then it would have to be unimaginably painful to gestate and birth a child only to have to give it up.

For this young woman, the problem was that she *did* want to raise a child but wasn't in a position to do so. Given that, carrying the baby to term, giving birth and then having to *give it away* sounds completely unbearable.