Monica* entered my abortion clinic counseling room and dropped her body into a chair furthest from my desk, body language that told me something was wrong. I instinctively grabbed a box of tissues, ready to listen and comfort her as best as I could. Instead of looking at me, she looked at the floor and held her arms close to her chest, behavior I’d expect from a frightened teenager, not a 30-something woman dressed in polished office attire. I braced myself and opened with what I thought was a simple question.
“How are you?” I asked tentatively, hoping that would start a productive conversation about whatever it was that was clearly bothering her. Her eyes stayed on the floor, feet shuffling back and forth between the chair legs. I waited a beat and was ready to try again with something different, when I heard a few words whispered from her mouth.
“How am I?” It was as if this was the first time someone had asked her the question. I nodded, unsure if she could see me since her eyes were still looking down, not knowing if I should ask again, ask something else, or back off entirely.
Before I had time to consider my options, she exploded with rage, frustration, depression and anxiety. With eyes now darting all over the room, she yelled pieces of her story in no particular order. She told me of being violently raped at her job, of being subsequently fired for not showing up the next day, of not being able to leave her house, of denying the pregnancy for months and having no one to help her with her rent, her bills, much less her mental health. She told me about a history of depression, of suicide attempts, of unhappy pregnancies and no money for abortions.
I couldn’t take my eyes off this woman having a break down in my office and started to panic myself. How could I help a woman in such obvious pain with so many issues to tackle, especially when the only one I was really qualified to tackle, the abortion, seemed like the last thing on her mind?
I let Monica talk as long as she needed to, which ended up being several hours. For the first time in my counseling career, I didn’t have to say anything. I realized that what she needed was someone to listen, nod, hand her a tissue, and let her keep going. Her story, her venting came to a natural end and with her permission, we discussed her current pregnancy. We figured out how to get her abortion funded through state insurance, where she could go for free or low-cost counseling afterwards, and a friend she could talk to for support after her procedure.
This experience taught me more than anything I learned in my counseling training. I learned to meet the patient where she’s at, to give her what she says she needs, not what I think she needs. I learned to operate on the patient’s timeline, not on mine, and to let her set the agenda and tone of the session. I learned not to interrupt with questions no matter how confusing the story and to let the patient direct the conversation. I also learned that even the most basic questions can be triggering for certain patients.
Working in abortion care is not always about politics or advocacy. Patients don’t always want to talk about ways to combat anti-choice harassment or the stigma of abortion. Abortion care is always about giving women a safe space to talk about the reality of their lives in a compassionate, non-judgmental way.