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What Therapists Need to Know about Abortion and Termination for Medical Reasons: An Interview with Jane Armstrong

Curt and Katie interview Jane Armstrong, LCSW, a clinical social worker in Texas, about terminating a wanted pregnancy for medical reasons. We look at the impacts of the overturn of Roe v Wade on reproductive care. We also dig into what termination for medical reasons (TFMR) is, how society stigmatizes these parents, and what therapists can do to effectively support clients facing this decision and the outcome of TFMR.

Transcript

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An Interview with Jane Armstrong, LCSW-S, PMH-C

Photo ID: Jane Armstrong, LCSW-S, PMH-C Jane is a termination for medical reasons (TFMR) mom, native Texan, & clinical social worker certified in perinatal mental health. Following the birth & death of her first child, Frankie, through TFMR, Jane opened Both/And Therapy, PLLC to provide individual therapy & support groups to other TFMR parents. These services aim to support clients through the unique barriers & grief of ending a wanted pregnancy, particularly in the state of Texas where such care is no longer accessible. She’s passionate about building community, eliminating shame, & honoring grief for TFMR families.

In this podcast episode, we talk about Termination for Medical Reasons (TFMR)

In the wake of Roe v. Wade being overturned, we reached out to Jane Armstrong, LCSW-S, PMH-C who specializes in TFMR and is based out of Texas, a state with some of the biggest barriers to this type of medical, reproductive care.

What are the clinical impacts on individuals who are considering or who have had an abortion?

  • Trauma related to pregnancy as well as abortion
  • The differences between ending wanted and unwanted pregnancies
  • The shame – societal and internalized

What therapists can get wrong when interacting with the topic of abortion

  • Unexamined bias related to abortion
  • TFMR – is baby loss and TFMR parents are entitled to grief
  • Disenfranchised grief and traumatic loss

The impact of anti-abortion legislation on patients considering abortion and TFMR

  • Lack of access to all types of medical care
  • Logistics related to getting access to medical care
  • The emotional impact of continuing to carry a pregnancy when it is known that the baby will die
  • How late parents can find out about medical concerns that mean that TFMR is indicated
  • The lack of time to make a decision

What is Termination For Medical Reasons (TFMR)?

“These are things [a health issue with the pregnant person or with the baby leading to TFMR] that may be fatal, it may not be. A lot of them you may not know, but you do know that there is the potential for tremendous suffering.” – Jane Armstrong, LCSW

  • Terminating a pregnancy due to health issues with the pregnant person or with the baby
  • For the pregnant person: fatal Hyperemesis Gravidarum, requirement for treatment, mental health conditions
  • For the baby: 12 week genetic screenings or subsequent testing, scans, etc. can point out chromosomal abnormalities, neural tube deficits

“In my own experience, we did do an amniocentesis, but we knew that we likely wouldn’t get the results until after my pregnancy had ended, because it would be typically about two weeks, which would have pushed us over the limit in our state. So, there is a very loudly ticking clock over most of these parents on what should be – and is – the most important decision they’ve ever made. And it leaves very little room for compassion for the time these parents need to research and get second opinions and really understand what this diagnosis means.” – Jane Armstrong, LCSW

How can therapists work with TFMR clients?

  • The conflict between the laws and a clinician’s own ethics
  • Make sure your clients know you will be a support resource to them
  • The importance of the client being able to tell their story
  • Recognizing that TFMR is typically not talked about and opening space for these clients
  • Trauma, grief, loss – sitting with the client with their hard stuff
  • Helping clients to make this impossible decision
  • Affirming parenthood and the challenge of the decision
  • Decision versus “choice” and the ways in which bias can enter the conversation about decision-making

Our Generous Sponsor for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code ‘moderntherapists’ for 1 month of no credit card fees or payment processing fees! That’s right – you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Jane on Instagram: TFMR Social Worker  Both And Therapy

Jane Armstrong, LCSW TFMR Social Worker – Both And Therapy Website

Resources for TFMR

Statement from Planned Parenthood:

Attributable to Dr. Meera Shah, Chief Medical Officer of Planned Parenthood Hudson Peconic & National Medical Spokesperson at PPFA 

The Supreme Court has taken away our constitutional right to abortion. Any person who believes in and values a person’s inherent right to control their own bodies, their lives, and their futures recognizes this decision for what it is: a disgrace to our society, to our health care system, and most importantly, to patients.

This decision robs our right to control our bodies and personal health care decisions, giving it to lawmakers and leaving millions without access to safe, legal abortion. Overturning Roe means dozens of states could swiftly move to ban abortion — including 13 states with laws that will go into effect immediately or shortly thereafter. That’s half the country where people may no longer have power over their own bodies and their own lives.

We know the harm that will come from this decision because we’ve seen it play out in Texas: People who do not have access to the financial resources and support they need to travel out of state are forced to carry pregnancies against their will, and some will seek abortion outside of the health care system. Where you live should not determine your ability to control your reproductive future.

There’s no one way that a person feels emotionally before, during, or after having an abortion — their feelings are unique to them. But we know that being denied an abortion can cause physical harm. And we also know that being forced to continue an unintended pregnancy can cause financial, mental, and emotional harm. People from Black, Latino, Indigenous, LGBTQ+, and other communities historically targeted by racism, bias, and discrimination will disproportionately feel the effects of abortion bans and restrictions.

This might feel like a scary and confusing time. But while we are devastated, we are not deterred. Abortion is health care, and as the nation’s leading provider of sexual and reproductive health care for all, Planned Parenthood is committed to meeting the health care needs of as many people as possible.

This is a crisis moment for abortion access. Organizers, advocates, providers, and patients need supporters and fellow providers across broad disciplines to channel outrage into action and send a clear message: We won’t back down. Here are some specific ways listeners can take action in the fight to protect our right to control our own bodies:

  • Attend a Decision Day Mobilization by visiting bansoff.org and clicking “events”
  • Give to Planned Parenthood organizations and abortion funds, and
  • Share why you fight for abortion access with #BansOffOurBodies and #WhateverTheReason by visiting bansoff.org and clicking “get involved”, then “share your story”

Relevant Episodes of MTSG Podcast:

Infertility and Pregnancy Loss

Therapy for Intercountry Transracial Adoptees

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm 0:00
This episode of The Modern Therapist’s Survival Guide is brought to you by Thrizer.

Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session just by billing your clients through Thrizer. You can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.

Curt Widhalm 0:23
Listen at the end of the episode for more information on a special offer from Thrizer.

Announcer 0:29
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:44
Welcome back modern therapists. This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists where we get outraged about things going on in the news media and spin that into the ways that that’s going to show up with your clients in the room, some calls to actions for what you can do. We are talking about Supreme Court overturning Roe v. Wade, and the broader impacts that that has on mental health. A whole lot of other things. I’m sure that this has already been in discussion in many people’s offices, especially since the leak that this was going to happen a couple of months ahead of the official announcement here. We did reach out to Planned Parenthood as part of this episode hoping to get some people just beyond Katie and myself talking about things. They were nice enough to give us a statement to share with you and I’m going to share that now. So from Planned Parenthood, this is attributable to Dr. Meera Shah, the Chief Medical Officer of Planned Parenthood Hudson Peconic and National Medical spokesperson at PPFA. Quote, “The Supreme Court has taken away our constitutional right to abortion. Any person who believes in and values a person’s inherent right to control their own bodies, their lives, and their futures recognizes this decision for what it is: a disgrace to our society, to our healthcare system, and most importantly to patients. This decision robs our right to control our bodies and personal health care decisions, giving it to lawmakers and leaving millions without access to safe, legal abortions. Overturning Roe means dozens of states can swiftly move to ban abortion including 13 states with laws that will go into effect immediately or shortly thereafter. That’s half the country where people may no longer have the power over their own bodies and their own lives. We know the harm that will come from this decision because we’ve seen it play out in Texas: People who do not have access to the financial resources and support they need to travel out of state are forced to carry pregnancies against their will, and some will seek abortion outside of the healthcare system. Where you live should not determine your ability to control your reproductive future. There’s no one way that a person feels emotionally before, during or after having an abortion. The feelings are unique to them. But we know that being denied an abortion can cause physical harm. We also know that being forced to continue in unintended pregnancy can cause financial, mental and emotional harm. People from Black, Latino, Indigenous, LGBTQ+ and other communities historically targeted by racism, bias and discrimination will disproportionately feel the effects of abortion bans and restrictions. This might feel like a scary and confusing time. But while we are devastated, we are not deterred. Abortion is healthcare, and as the nation’s leading provider of sexual and reproductive health care for all, Planned Parenthood is committed to meeting healthcare needs of as many people as possible.” So we are thankful for the statement from Planned Parenthood and helping us to expand on this conversation is Jane Armstrong LCSW, from Texas. So, very much in the space of one of the states that has these trigger laws going into effect and working with a number of clients who get abortions for medical reasons. So we are thankful to have somebody here. Thank you, Jane, for joining us and sharing your expertise with us as well.

Jane Armstrong 4:15
Thank you so much. I’m pleased to be here and disappointed for why we’re here and what we’re here to talk about.

Katie Vernoy 4:22
Thank you so much for being here. You and I have had a couple of conversations that I think will be important to share with this audience. And just for folks who want to take a look at that Planned Parenthood statement and some of the calls to action that they have there. We’ll put that in the show notes over at mtsgpodcast.com. But shifting into our conversation with you, Jane, the first question we ask all of our guests are: Who are you and what are you putting out into the world?

Jane Armstrong 4:48
Well, I’m Jane as they said, I am a clinical social worker in Texas. I’m also certified in perinatal mental health. I’m also a bereaved mother myself and went through a termination for medical reasons or TFMR with my first pregnancy with my son, Frankie. And after that opened a private practice here in Texas to support other parents through ending wanted pregnancies for medical reasons, and have been grappling with legal barriers ever since.

Curt Widhalm 5:22
Just as far as the structure of this episode goes, we’re going to talk about abortion very briefly as kind of an overarching concept and keep this episode focused mostly on termination for medical reasons due to Jane’s expertise in this area. We’re going to continue to work as far as finding some guidance as far as documentation and some of the legal aspects for those therapists in states where some of these laws are rapidly changing. That is not going to be a part of this episode, but continue to follow what we’re doing as we can provide some updates for all of you on that. So framing this episodes here for what it is. But Jane, what are some of the clinical and mental health considerations when we’re providing mental health treatment to individuals considering an abortion or who’ve had an abortion.

Jane Armstrong 6:15
The biggest things that come to mind are the impact of trauma trauma can play a part in seeking abortion care, kind of from all angles, whether a pregnancy is intended or unintended, the circumstances around that, you know, we have this law in Texas now that is coming up that will not have exceptions for rape or incest. So if we’re talking about compounding trauma, you have sexual assault, and then being forced to continue a pregnancy if you don’t have the means to get out of the state to access care. There’s also a tremendous amount of shame heaped on abortion care, again, kind of no matter the circumstances. The narrative in our country around abortion is incredibly damaging, and internalized by many, even those who support access to abortion care, if they find themselves needing abortion care, sometimes can be grappling with a very deep seated, internalized sense of shame around that. Because it’s very easy to say, I support folks making decisions for themselves, whatever they need to do, I would never and then if you find yourself needing that care, that can be a really complex line to walk and to incorporate. There also can be grief around abortion, care of all kinds. Maybe it’s an unintended pregnancy, and you want to be a parent someday, and today is not that day. And it’s perfectly okay to feel sad about that. Or maybe like the clients I work with, you’ve desperately wanted to be a parent and you’ve prepared for this baby and bonded with them, and are now finding yourself in a position where you may end a very wanted pregnancy and there’s tremendous grief connected there. And then with TFMR, our parents are termination for medical reasons parents. Lost parents of all kinds are at an increased risk for things like postpartum depression, PTSD, and that can be increased further when someone has ended a wanted pregnancy through abortion care.

Katie Vernoy 6:17
One of the questions we ask towards the beginning of the episode as kind of a learning lesson is kind of what a therapist get wrong. And I’m assuming there’s a lot of folks who are really wanting to make sure they can be there for all the individuals that are grappling with this really hard decision, but may not really know what they’re doing. And so what can an uninformed therapist miss or what harm can uninformed therapists do around abortion or TFMR?

Jane Armstrong 8:57
One of the first things that comes to mind is just not examining their own internalized messaging around abortion, or not really spending time with that, you know, we might say, again, like, I’m pro choice, I support my clients with whatever but maybe there are some unexamined pieces inside of us that could come out sideways in our therapeutic relationships with clients. With specifically termination for medical reasons, I think the biggest thing that I want therapists to take away is that it is absolutely 100% baby loss. This is in the same category as stillbirth. It is in the same category as miscarriage. There are lots of areas of overlap in terms of grief, in terms of loss, in terms of processing and it is this stigma inside of a stigma. So already our society doesn’t really talk about pregnancy and infant loss or when we do, it tends to be in the context of, oh, yes, that was very sad. But now she has two healthy children. And that’s all better. And that may not be the case. They will likely be grieving that baby all their lives. What complicates things for termination for medical reasons parents is that they may not know themselves, that they’re entitled to the grief they feel or that what they’ve experienced is baby loss. And I think in terms of therapists supporting them, they may not know that either. So that can come out in the therapeutic alliance in a few ways that might be more damaging than supportive. So I think disenfranchised grief comes up a lot. And letting parents know that while legally defined what they experienced was abortion, or they did have a decision that they made, no parent chooses for their baby or themselves to be so sick, that they cannot continue a pregnancy that they’ve desired and that they’ve prepared for. I think too these legal restrictions that are coming up in the fallout of overturning Roe can really compound the trauma of that loss. You know, we’re looking at now, Texas has SB 8 on the books that’s been there since September 1st of last year, that is not enforced by the state. So that was how it was able to go into effect under Roe v. Wade, it’s a civil instead of a criminal context. So if someone is found to be aiding or abetting someone seeking abortion care in Texas, past the point of the detection of cardiac activity, they could be sued for $10,000 and be out all their own legal fees and the legal fees of the person who successfully sues them. And that has scared a lot of people. So perhaps a doctor doesn’t feel comfortable presenting abortion care as an option to a parent because they don’t want to be sued or lose their license. Maybe they can’t refer to a provider even out of state because they don’t know if that protects them. That would mean then that parents are sent home after receiving the worst news of their lives to then figure it out all on their own. If they have to travel for care, lots of folks I’ve worked with have talked about the pain and upset of having to get on a plane and go to a strange place and recover in a hotel. They may be further along in their pregnancies because of these restrictions. If I have to organize travel, and maybe I have living children and need childcare, I need to take time off work, maybe I need to save because my insurance won’t pay for this procedure. They may be staying pregnant, knowing that their baby is going to die. And that is a really intensely traumatic experience many of the parents that I’ve worked with, and from my own experience, I would say that limbo in between making a decision to end your pregnancy, and actually ending the pregnancy is one of the worst times in someone’s experience with termination for medical reasons. There can also be further restrictions in terms of how your baby’s birth and death go. Maybe you’re not given options around Labor and Delivery versus surgical or being in a hospital setting versus being in an abortion clinic. It may literally be where you can find care. And in a circumstance where parents already feel like so much control and agency has been taken from them that can really just layers and layers and layers of trauma that can be heaped on these parents at a really intensely vulnerable moment. So that’s something I want therapists thinking about is, you know, asking those questions and giving space to process and reminding parents that they are parents, and that they made an incredibly difficult if not impossible decision for their babies, their families and themselves. And they deserve to grieve that decision.

Curt Widhalm 14:17
I have to imagine that there’s almost two separate groups of people within this those clients that are already working with a mental health provider who is there along this process, but also just is typical for a lot of people who by the time that they recognize that they need mental health treatments, that they’re even much further along in this process and facing even a lot more of those time periods that you’re talking about.

Jane Armstrong 14:44
Absolutely, yes, I would say that. Most parents going through a termination for medical reasons are finding out something is wrong either around a 12 week scan and blood test or an anatomy scan which is usually about halfway through it, about 20 weeks. So when we talk about restrictions on abortion, I mean Roe protected it below viability, which was interpreted a lot of different ways and a lot of different states. But, for example, my experience, I found out the absolute earliest I could, and I was still at about 18 and a half weeks and at the time, before SB 8, Texas had a 20 week abortion ban. And there were several other legal barriers already in place like needing an ultrasound 24 hours in advance of the procedure with the same doctor who would perform the procedure. There is no medical reason for that ultrasound. The reason for the ultrasound was to put up barriers, to intimidate patients, to misinform them, to manipulate their emotions. We also I had to have state mandated counseling, which was a script from legislature that contained a bunch of lies like that going through an abortion would impact my fertility negatively, that it would increase my risk of breast cancer. That is not true. In fact, the procedure I went through is often safer than a full term vaginal birth. But knowing from that moment, again, at the same time, you’re trying to absorb what you’ve just learned. And maybe you’ve already named your baby, maybe you’ve started buying things and setting up a nursery. Maybe you’ve announced and friends know that you’re pregnant, and you’re showing already. At that point, you’re also thinking, I don’t have time, I can’t really spend the time I might need to make the most informed decision I can. Because if I’m going to end this pregnancy, there is a very hard stop. And now with having fewer places to go, and more people, you know, I mean, the entire country is going to be accessing care in very limited places, that’s going to push people a lot further into pregnancy. And some people are going to have abortions far later than they might want to because that’s when they can get an appointment, or that happens to be when they found out. And there are outliers on either end, there are folks who maybe have a health issue of their own that they might find out about earlier, there are folks who don’t find anything out until third trimester. That’s the nuance that is missed in these laws. And that puts these parents in really devastatingly precarious positions.

Katie Vernoy 17:48
So just to kind of frame the conversation a little bit more, because you’re talking about a lot of different reasons that someone might terminate for medical reasons. Can you kind of broadly talk about what termination for medical reasons is and what therapists should be aware of related to that?

Jane Armstrong 18:03
Absolutely, yes, it tends to be, like I said before, kind of either a health issue with the pregnant person or health issue with baby. With the pregnant person that may be things like hyperemesis gravidarum. So people tend to talk about that as like really intense morning sickness that does not touch on how serious that can be. There have been parents we’ve talked to who have been in the ER three or four times a week, because they’re dehydrated, they are literally starving because they can’t hold anything down. It can absolutely be fatal, and it is absolutely miserable, even if it’s not fatal. And whereas morning sickness for most people goes away after the first trimester, there’s not the same guarantee with hyperemesis. It can also be other physical issues that may come up. Maybe a parent finds out that they have cancer and they need treatment immediately and that would impact their pregnancy. So if they’re going to seek treatment, they need to end the pregnancy. There can also be mental health conditions that might lead to a parent ending a wanted pregnancy. And this is a I would say another layer of stigma and side of stigma, or parents may not feel like they have a right to grieve or that they made the right decision or whatever else but if you are depressed and suicidal, there are, you know, of course, very serious implications for your own health and your family if you’re continuing a pregnancy that is making you sick. In terms of conditions that might come up with baby, these typically might first show up, like I said around 12 weeks. Many parents now are doing genetic testing or screening. Most people think of that as is a way to learn the sex of their baby early and it does screen for certain chromosomal abnormalities, things like Trisomy 13, 18 and 21. Then you might go on to testing so more diagnostic things. A screening just tells you what risk level there is. And then something like an amniocentesis or a CBS might tell you definitively if there is a diagnosis. There’s also a scan at around 12 weeks that looks at something called the nuchal fold at the back of baby’s neck, if that’s enlarged, that can point to some of these chromosomal abnormalities. Neural tube defects are also a common reason for termination for medical reasons. So that would be things like spina bifida and anencephaly. These are things that, again, may be fatal, it may not be. A lot of them, you may not know, but you do know that there is the potential for tremendous suffering. And then heart conditions also come up frequently. Things like hypoplastic left heart syndrome and I mean, you could come up with a list as long as your arm that come up. I would say those are the most common. And I think one of the things that is important to point out here is that this is a direct result of our more advanced testing capabilities and our more advanced technologies. These are things we can spot during pregnancy, that maybe in the past, these babies would have been born, and that’s when we might find out something is wrong, or they’d be stillborn. Or, you know, we wouldn’t be able to have medical intervention to extend their life or save their life. Even now, though, when you consider the impact of life saving medical intervention, take neural tube defects, for instance, like spina bifida, they do have fetal surgery now which if you qualify, you can have a surgeon go in repair lesion on baby’s spine while they’re still inside of your womb and that sounds amazing. And it is an elective surgery, it restricts you to bed rest from that point on, you are then scheduled for a cesarean delivery, basically as soon as baby is term. And that’s all before a lifetime of brain surgeries and other medical intervention for baby to be able to survive. So it is not as cut and dry as if it’s fatal or not fatal, if we’re not sure you know, there’s these are really intensely complex decisions often made with what could never feel like enough information.

Katie Vernoy 18:03
Or enough time.

Jane Armstrong 22:46
Absolutely. Yes, that’s a big one. So for instance, in my own experience, we did do an amniocentesis, but we knew that we likely wouldn’t get the results until after my pregnancy had ended, because it would be typically about two weeks, which would have pushed us over the limit in our state. So there is a very loudly ticking clock over most of these parents on what should be and is the most important decision they’ve ever made. And it leaves very little room for compassion for the time these parents need to research and get second opinions and really understand what this diagnosis means.

Curt Widhalm 23:34
Practically speaking, for therapists listening to this, what is this look like in the room as far as how you’re working with clients, making these considerations? What kinds of adjustments are you making here since Roe was overturned? What is this look like in the room now?

Jane Armstrong 23:54
I think the biggest thing is that as therapists we’re not really sure what is allowable under the law and how to hold that next to our ethics because those two, especially in a circumstance like this are at odds in several ways.

Katie Vernoy 24:11
Yes.

Jane Armstrong 24:12
You know, we want to provide the best care we can for our clients just like their doctors do and our hands are are kind of tied. I think the biggest thing is, this is you know, I’m not an attorney, so I’m not going to advise anyone how to operate their practice. I would say this is not an area where if you are someone, as a clinician who is comfortable with something other than a blank slate, I think this is a really important point to make sure your clients know that you will be a supportive resource to them navigating this new reality in which they find themselves. In terms of how that shows up in the room, I think giving space for a client to tell their story that can potentially feel risky for them as well, especially if they don’t know where you stand or if they might be in danger sharing that with you, which is why I think it’s important to be very clear, but I think this is something that is so in the shadows, or in terms of the debate around the subject of abortion, the rhetoric is so divisive and intensive, and very intentionally, emotionally jarring. And I think that’s something that comes up for TFMR parents a lot is that we’re often left out entirely of the debate on either side. I think, in that Planned Parenthood statement, which on the whole, I thought was great, there was something about unintended pregnancies, and that is not the only reason someone gets an abortion. So I think making space in the room for someone to process their experience, to talk about what options they did have, or were given. What resources they had, or had access to. What could have been different, or what could have made things better, who showed up for them? Who didn’t? There, there’s a lot of processing that can go on and support that can go on, that is not the practical side, the aiding and abetting side of things.

Katie Vernoy 26:31
Sure.

Jane Armstrong 26:32
And those are things that many many people will I think benefit from just to have someone who is willing to sit with them and that hard stuff, which as therapists were great at. That’s our wheelhouse.

Katie Vernoy 26:49
I think the question I have, and I’m very comfortable sitting in California saying I’m okay with aiding and abetting. But but assuming that you were in a space to be able to have that conversation around decision making, I’m reflecting on a client that I was trying to help with this decision. And I think I really messed it up. Thinking back. And so it’s hard for bias not to come into that conversation. How would you recommend if someone’s received the news that there is this decision, you know, whether it’s their own health or the health of the baby? Like how would you help someone to grapple with this decision? What needs to be said? What needs to not be said? I just I found myself in a really weird space when I was trying to help someone with this. And I personally would love some advice on how to open this space and hold the space for someone to make this as you called it: Impossible decision.

Jane Armstrong 27:47
Yeah. I really appreciate that, your authenticity, with that, Katie. I think all of us can think of a time where we thought sure, you know, if I had a time machine, I’d love to go back and do that differently. I think the biggest thing would be giving them a space to talk it out and talk it through. Because there aren’t many people who folks either feel like they can trust or if they can trust, it feels too big to put on someone else. So you know, maybe your clients mom is someone they really lean on for emotional support. Exploring the concept of either bringing a very sick grandchild into the world, or having a stillbirth later, versus ending a pregnancy with that grandchild is maybe just not something your client is able to do with mom.

Katie Vernoy 28:42
Sure.

Jane Armstrong 28:42
So having that space. I think, though otherwise, one of the most powerful things anyone can say to a parent faced with termination for medical reasons, is affirming their parenthood. Many people talk about not feeling like they have a right to call themselves, mom or dad or a parent following a termination for medical reasons, especially if they don’t have other living children. And there can be a lot of guilt with that. I’ve heard so many clients talk about one person, whether it was their doctor or a nurse at their clinic or a friend, somebody who said this is a decision that only you as a parent can make and you are going to make the best and most loving decision that anyone can because you are that baby’s parent. And that can be so powerful for folks to hear. It can also be overwhelming and maybe they’re not ready to hear that and that’s okay too. But I think hearing that you are a parent. This is a decision that only you can make. And I think otherwise affirming that it’s really hard to make a decision this big and important when we don’t feel like there’s one, quote, right decision. That’s part of why a lot of in fact TFMR parents struggle with the word choice. That tends to make it sound like there’s a right choice and a wrong choice or like a good and a bad. I tend to prefer the term decision because there’s weight to it. There may not be a best one. There’s a beautiful TFMR community on Instagram called TFMR Mamas and Emma, who runs that talks about the least worst decision. And that’s the best description I’ve ever heard of it, because it doesn’t feel like necessarily this, you know, relief of like, okay, this is what we’re going to do. And this is the right thing to do. And I’m never going to second guess this or question it. So, yeah, I think contextualizing that they are the ones who are the only ones who can make this decision. That they are in an impossible situation, choosing the least worst of a lot of really shit options. Sorry, am I allowed to curse?

Curt Widhalm 28:42
You’re allowed to cuss.

Katie Vernoy 29:09
And I think we’re talking about something that’s got us really fucking pissed.

Jane Armstrong 31:13
Yeah, so. And then otherwise, I think, validating for them that they deserve community. And even if we cannot aid and abet the accessing care part, what we can do is connect them to communities of people who have been through something similar. And I think that’s one of the most powerful things that can happen for lost parents of any kind. But certainly for termination for medical reasons where other pregnancy or baby loss communities may not be welcoming, or maybe outright hostile to TFMR parents. But there are several online communities that I’d be happy to share for the show notes or whatever. So folks can have that in their tool belt. But that can be a huge relief, because you do feel like I’m the only one before this has ever happened to and that can increase all of that shame as well.

Katie Vernoy 32:20
Thank you. Thank you. I think the thing I’m taking away from that, as well as what you said earlier as and just reflecting on the time that I kind of messed it up. I was thinking back through the questions I was asking and the way that I was asking them and I thought this the next day, so like it was something where I immediately I knew I messed it up and I was able to do a repair. Don’t worry everyone. But it’s something where it’s holding space, really making sure that the decision is firmly in the TFMR parents spot, right or potentially TFMR. Parent. But what I realized later was able to really come to terms with my own stuff, because I think what you’re you’re talking about is I’m pro choice, but I wouldn’t do it for myself. And that truly gives a bias around what the reasons are. Whether it’s earlier on and it’s an unintended or unwanted pregnancy or whether it’s just a wanted pregnancy with this horrible decision for my own health or the health of the baby. I think it’s really making sure I’m addressing and understanding if there’s any bias in the way I’m asking questions, because I think that’s what I did. I was like, well, if everything in your life was perfect, would you want this baby? And I’m like, wait a second, but that’s not true. And that’s not practical. And it speaks to the heartache in the decision, but it doesn’t help make the decision. Am I, Am I catching it? Am I, Am I figuring out what I did wrong here?

Jane Armstrong 33:43
Absolutely. I think that’s that’s you’re crushing it? Yes.

Katie Vernoy 33:47
Thank you. Thank you.

Jane Armstrong 33:48
Yeah. Yeah, it’s I think, too, inside of those moments, there are parents too, who would love for somebody who knows more than they do to say, here’s what you should do. And some people have had doctors say that to them and with varying impact or success, because you you don’t necessarily feel like you know what you’re talking about. Because you can’t see into the future.

Katie Vernoy 34:17
Yeah.

Jane Armstrong 34:17
But I think having someone holding that space with you, who has checked in with their own stuff, because you’re you’re right, that attitude of everybody should make decisions for themselves though I would never personally do that. There’s a judgment inside of that. Right.

Katie Vernoy 34:35
Yeah. Yeah.

Jane Armstrong 34:35
And that’s often for our own comfort of like, I’m different from from those, those people.

Katie Vernoy 34:43
Kind of that internalized societal bias and how we talk about it and how the laws are now being written or what’s been happening. Like it seems like it’s really hard being a person in this country and not having strong feelings about abortion, especially if you’ve never experienced it or you have the this internalized bias. It’s like it’s so it’s so validated by what’s being said, even if you’re like, I consciously I agree with it, but subconsciously, I’m taking in all of this vitriol and all of this shame, all of this stuff. And I hadn’t even really thought about it that way that really is very helpful to kind of contextualize that for me.

Jane Armstrong 35:20
I think, too, with a lot of TFMR parents, when they do share their stories will sometimes be met with a response like, Oh, well, that’s different, or That’s not abortion. And I think a lot of TFMR parents also hold on to that for a long time, because they’re also battling those internalized narratives of like, well, this isn’t what they’re talking about. I didn’t do that.

Katie Vernoy 35:48
Yeah.

Jane Armstrong 35:49
And another important thing, maybe for therapists and just folks to realize is that legally, that’s exactly what it is. And when we put limits on abortion of any kind, often, these are the folks who lose, really critical access first. So if we’re saying 15 weeks is the limit, but I find out at a 20 week anatomy scan, what am I supposed to do? And if a compassionate response is, I understand why you would want to end this pregnancy. It’s, again, it’s just a symptom of it being left out of the conversation entirely, no matter what point of view. So that’s something to consider, too, that while it’s uncomfortable, because of the societal narratives we have around abortion, that is what we’re talking about with TFMR and these parents deserve compassionate and full spectrum medical care. Just like everybody.

Curt Widhalm 36:57
You are a phenomenal resource for people. And we want to give you an opportunity to share where our audience can find you and find more resources. Where can they find you?

Jane Armstrong 37:10
Yeah, so I am on Instagram at tfmrsocialworker. I also have an account there for my private practice that’s at bothandtherapy. And you can find me at my website, bothandtherapy.com. The TFMR social worker page, I post a lot about resources that are out there, as well as commentary and updates on legal things around abortion. So that’s been very busy the last few weeks. And then for anybody listening from Texas, I will be opening back up for individual therapy clients and a TFMR for Texas parents support group this fall. So we’d love to connect with you and connect you with more support and community.

Curt Widhalm 38:04
And we will include links to all of Jane’s stuff in our show notes. You can find that at mtsgpodcast.com. Follow us on our social media, join our Facebook group, the Modern Therapists Group. And if you liked the show and want to continue to support us, please join us on our Patreon or Buy Me a Coffee and that helps Katie and I continue to do what we do in all of this. And we will have some continuing information for therapists across the country about how this affects our practices and our clients. And we’ll be posting those as we get that information straightened out. And until next time, I’m Curt Widhalm, with Katie Vernoy and Jane Armstrong.

Jane Armstrong 38:48
Thanks so much.

Katie Vernoy 38:51
Thanks again to our sponsor, Thrizer.

Curt Widhalm 38:54
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinician should earn what they are worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the client’s insurance. From there Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.

Katie Vernoy 39:34
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer lets you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code moderntherapists if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

Curt Widhalm 40:08
Once again, sign up at bit.ly/moderntherapists and use the code moderntherapists if you want to test Thrizer completely risk free.

Announcer 40:19
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