Q&A with therapist specializing in abortion support

Q&A with therapist specializing in abortion support

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By Rachel Crumpler

Kelsey Reep, an Asheville-based therapist specializing in abortion support, has counseled clients over the past year through the changing restrictions around the procedure. But when she opened her private practice, Aligyned Counseling, in 2021, she had no idea how drastically the legal landscape would change.

Just over a year later — on June 24, 2022 — the U.S. Supreme Court overturned Roe v. Wade, eliminating the constitutional right to an abortion that had been in place since 1973 and handing the decision on regulating abortion back to states. Subsequent court cases have created uncertainty about long-term access to the medication abortion drug mifepristone

Since then, North Carolina lawmakers have passed new abortion restrictions in the state over both Gov. Roy Cooper’s veto and objections from medical professionals.

NC Health News gender health reporter Rachel Crumpler spoke to Reep about her work, the impact of the changing legal landscape on her work to support people who have had abortions. The conversation has been edited for length and continuity. 

NC Health News: How did you get into therapy, and what was your journey of deciding to specialize in providing abortion support? 

Reep: I originally specialized in substance use. I did that for six years. Then when I left agency work and started my own private practice, I knew I wanted to work with women — and then the personal experience that I had with my own abortion and just kind of looking around and realizing the most valuable interactions were with the people in my life who had had their own abortion experience. Not that other people in my life weren’t helpful — it just was different. 

In looking at that, I just started researching what’s out there for people who want support through the process. There wasn’t much. What I found was there were more offerings from a pro-life standpoint. There weren’t very many options of support from a pro-choice, empowerment perspective out there that I could find in North Carolina and in my area.

NCHN: How does your own abortion experience influence your work and approach with clients?

Reep: I try to be very intentional about what I share about my own experience. Part of the reason is I aim to model that for other people — that it’s your story, and so you get to share the who, what, when, where, why and determine what feels right, what feels safe to share. 

Personally, I don’t need to know why someone chose [an abortion], so I really try to model that. I share that I’ve had my own abortion experience. I will share what was most helpful and valuable for me, depending on who I’m chatting with. If people want to share their why, I’m not against that, but a lot of people can feel they need to. It can create a weird power dynamic, like “Let me tell you why and get your approval.” 

So that very much influences how I approach someone. They get to decide what it is that they tell me. And if I ask questions that they don’t feel comfortable with, I always let them know, “This is your story, and you don’t have to share it. You get to choose with me what you’re sharing and what you’re not sharing.”

NCHN: What does your support look like? 

Reep: I really treat it very similar to what my other counseling sessions look like but from a reproductive justice–oriented and feminist lens. With abortion being a highly stigmatized and controversial topic, simply providing people with a safe place to share their abortion experience is a big part of the process. A lot of people don’t have that. I would say almost 100 percent of my clients have someone or people in their social circle that they are not able to share this with, and that’s really hard to navigate. I think just giving people a space that they can come in and share is huge.

It’s important to process the emotions that come up. People can experience relief, and then they can also experience sadness. It’s very complex, and feelings can contradict each other. Processing those emotions, rather than suppressing them, and giving space to work through them is really important. 

We start with an assessment because that information is important. I really hone in on things that can potentially impact an experience with abortion. Are there any current challenges, social supports, current or past religious beliefs, views on parenthood? 

The length of time working with a client varies. The best predictor of mental health after someone experiences an abortion is their mental health before the abortion. It’s not necessarily about the abortion. 

NCHN: When Roe v. Wade was overturned, did you see increased outreach? 

Reep: There was a lot of outreach. I feel like almost 100 percent of people were wanting to talk about it. I really let them lead the way.

After Roe was overturned that Friday, that Monday I took the day off. I was very transparent with my clients and told them, “I need a day to kind of process what’s going on, and that I hope that this models that you can do the same.” Of course I really wanted to be there for my clients, but I also had to show up for myself. 

NCHN: What trends have you seen with your clients, and what they are reaching out to you about in this year since Roe v. Wade was overturned?

Reep: Most of my clients are in the age range where they haven’t reached menopause, so no wonder I saw the impact of nervousness and helplessness around what’s happening.

Everyone has a relationship with abortion — whether they’ve experienced one, whether that might be something they need or if it’s something they wouldn’t choose. Across my whole practice — my whole practice isn’t abortion-specific support — I saw people wanting to discuss how the changing landscape was impacting them.

The biggest trend I saw was people reaching out after the overturn of Roe for support around reproductive justice and feeling like that’s being threatened. Folks reaching out for abortion-specific services remained steady. 

NCHN: How do you expect increased abortion restrictions may affect people seeking abortions? 

Reep: I think stressors will increase due to more restrictions and less access to the procedure. Based on research, being denied an abortion is worse on mental health than being able to access it.

Something I try to convey and always reiterate both professionally and personally is that having an abortion does not increase the risk of psychological disorders, according to the American Psychological Association. However, the absence of positive social support such as understanding, appreciation, dialogue and empowerment, as well as the presence of negative social support such as criticism, misunderstanding and stigma, are significant risk factors to overall well-being.

NCHN: How did you find support through your own abortion experience?

Reep: My experience was really eye-opening to me. I would say that I come from a more privileged place than other people. I’m tapped into the counseling community and a great social support system. And even for someone tapped in like me, it was still hard. I leaned on social support, and some of that support included therapists. I also will say that I am in therapy now and not explicitly for this experience, but it comes up sometimes, you know, so it’s still something that comes up. I process on my own and process with others — personally and professionally.

NCHN: How do you think therapists and other medical professionals can better support people who have had abortions?

Reep: Self-disclosure used to be a no-no. But what we’re learning is, there needs to be a sense of safety for people to heal and process. There was this really big movement for the LGBTQIA+ community and ways how you can communicate to clients that you are an ally. It can be little things like having a rainbow flag in your office. 

I believe everyone has a different level of comfort with self-disclosure. I think therapists and medical providers need to think about how you are letting people know that it’s safe for them to share that they’ve had an abortion and safe for them to share with you.

NCHN: Is there a way you think society could be better at supporting people who have had abortions?

Reep: Everyone has the right to their own opinions. But we do have the choice of being empathetic toward someone, even if it’s different than what we agree with.

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