Counselling in the Time of COVID-19

15 May 2020

For more than 30 years I have sat with, listened to, and talked with people accessing abortion services. In that time, I have learned that no two people are the same, no matter how they may present.

People approach ending their pregnancy in a variety of ways, and it has been my role to help meet their needs and ensure that they have the best abortion possible, as many don’t feel they deserve the kind, compassionate service that I have been involved with for all this time.

Sitting with someone at a time when they may be struggling to work out what is best for them has been a privilege. To hear their dilemma and talk through what they feel is going to be the best outcome for their pregnancy can take a lot of patience and is about recognising that it is not about me, my values or ideas, but all about them, and this is where it takes experience to see the uniqueness of the situation.

Sometimes, as I sit talking with and listening to the person who didn’t want ‘counselling’ I need to be reading the person in front of me to get the clues as to how they are feeling, as they can be too afraid to express their distress out loud. This is my job’s greatest reward: allowing someone to be their own person and giving them unconditional positive regard whatever their story.

Six weeks ago, all of this changed for me and in the blink of an eye I am now doing all of this on the telephone. Remote counselling has taken off in a big way and the demand is high.

We are delivering most of our treatment to clients under 10 weeks’ gestation completely remotely and it is possible to have an abortion without seeing either a clinician or a counsellor face to face. The upside of the service we are providing is that anyone who does want to talk is able to access the opportunity very quickly and in some cases on the same day. The downside is that both the client and I do not have an opportunity for a face-to-face interaction at all – we are not using any video media that provide face-to-face interaction remotely and I think that is for the best.

This makes all my previously acquired skills of visually reading my client redundant, and I have had to adjust to using my ears as my eyes have nothing to go on. I have previously done some telephone work; however, I prefer face-to-face interactions for all the reasons mentioned above but I am now developing a new set of counselling skills and in some cases the conversations are changing too.

I have a heightened awareness of any pauses in the conversation, and am no longer able to offer the tissues to wipe an eye; I check the client has these to hand before we begin. ‘Are you alone in the room?’ is a new question in my repertoire, and I do not always get an honest answer and never really understand why.

On the telephone it seems I may not always be given the full attention I am used to – I hear a kettle boiling or an oven door shutting as dinner is being made or occasionally the flushing of a loo!

Many of the dilemmas remain the same – ambivalence about the pregnancy, being not ready, too young, too old and family complete. Now, there is a new underlying anxiety as we are all in a period of such uncertainty due to the pandemic.

Being a bad person and feeling guilty are still high on the list of reasons why making the decision to end a pregnancy can be difficult, and as much as I would like to be able to take away the stigma of abortion it still remains very much in place for a lot of people.

The opportunity to offer some counterarguments for reassurance is very important; this is now a straightforward part of my day and they are often received as revelations by my clients. An explanation that ending a pregnancy can be as much a part of being a good mother as continuing one in the right circumstances often gives people some relief.

I have noticed an increased need for support for those anxious about going through the treatment alone when either no one else knows or because no one can be there with them on account of the lockdown. I have been talking through all sorts of strategies for people to feel safe and secure during treatment; reassurance has been a large part of the reason for the call.

My work has changed; I look forward to having some face-to-face interaction again but I am certainly learning that there are many effective ways to look after people seeking termination of their pregnancy and those who are exploring the options. As long as the opportunity to talk through their feelings remains a part of the process for those who need it, I know we will adapt our services to meet those needs.

Jane Calvert, Lead Client Care Coordinator, British Pregnancy Advisory Service (BPAS); jane.calvert@bpas.org

Note on the Author

Jane Calvert is passionate about ‘well-delivered’ abortion care, and is an advocate within her organisation for the best service possible. Jane has worked for BPAS for 29 years and has recently taken on the Lead role for Client Care Coordinators and those delivering the organisation’s Counselling Services. She is proud to work for BPAS, a forward-looking reproductive health provider.