She’d been out of the psychiatric hospital only four months when she learned she was pregnant. Just 21 years old and struggling with bipolar disorder, her mental health had collapsed after losing her job as a waiter.
She wanted to keep the baby, but realized she would need to stop her psychiatric medication — putting herself at risk of dangerous mood swings — and couldn’t financially support a child without a job. So she ordered abortion pills online in October.
The abortion was successful, but months later, she is still grieving the loss of the pregnancy. At the end of December, a pregnancy tracker notification reminded her she would have been 23 weeks by then.
“Stuff like that makes me kind of sad,” she said. “Just to think of what it would have been like.”
For that, however, she was on her own. As a resident of Texas who lives in the Fort Worth area, she was too scared to tell her therapist about it because of the state’s stringent abortion laws.
“I have this fear of bringing this subject up to my therapist because lines can get very blurry with mandated reporting,” said the woman, who asked to remain anonymous out of fear of repercussions. “Maybe I am a little paranoid, but I just try to not even bring it up.”
Now, a new nationwide directory, Pro-Choice Therapists, of vetted, pro-choice mental health providers, is helping women like her find a safe space to talk about abortion. The directory includes more than 300 providers across the United States, including 31 who are licensed to work in Texas.
“To have to hide a medical procedure from your state, that is so terrifying,” said Dr. Ashley Sweet, a licensed psychotherapist who launched the directory in 2023. “That, in and of itself, can be traumatizing and worthy of talking about with a therapist.”
Climate of Fear
More than a dozen states have passed laws restricting abortion since the U.S. Supreme Court’s landmark Dobbs decision in 2022, which overturned the 1973 Roe v. Wade decision and granted states the authority to restrict abortions.
By then, Texas legislators had already passed two laws that effectively banned abortions in the state.
The first, Senate Bill 8, known as the Texas Heartbeat Act, passed in May 2021, banning abortions after cardiac activity was detected in a fetus. It also allowed the filing of civil suits against anyone “aiding or abetting” an abortion. Under the law, the person who sues would be awarded at least $10,000 if they win the case.
A few days later, the Texas Legislature passed House Bill 1280, known as the Human Life Protection Act, that prohibited all abortions with exceptions for the life or health of the mother but not for rape or incest. The law makes it a criminal offense to perform, induce or attempt an abortion but specifies that the pregnant woman would not face criminal charges. Physicians can also face civil penalties and loss of their medical licenses in Texas.
HB 1280 also included a so-called “trigger” provision allowing it to go into immediate effect if and when the U.S. Supreme Court overturned Roe v. Wade, or if some other actions allowed states to legally ban abortions. It formed a blueprint for other states to set up automatic abortion restrictions before the Dobbs decision was handed down.
Similar laws soon followed in other states, sparking fear among physicians, mental health practitioners, genetic counselors and other health providers that they could face criminal charges or civil actions. For therapists, it also created a climate of distrust among their patients, even though mental health providers are not required to report their discussions about abortions.
“Part of the reason that people come to therapy is to have really honest conversations about what they are going through,” said Janet Leese, a licensed clinical social worker in Austin who is listed in Sweet’s pro-choice directory.
“When you are in a state of fear about how that might be used against you, you don’t feel like you have the freedom to be open and honest,” she said.
Women have had good reason to be concerned. In April 2022, Starr County prosecutors charged a 26-year-old South Texas woman with murder after she took misoprostol and mifepristone pills to end her pregnancy.
Although pregnant women weren’t supposed to be prosecuted for abortion under Texas law — the law centers on those who facilitate the abortion — the woman was arrested after hospital staff reported her to the Starr County District Attorney’s Office. She spent three days in jail before posting a $500,000 bond. The charges were dismissed a day later, according to court records.
“People who get pregnant in Texas and don’t want to be pregnant really have difficulty in terms of who they can trust,” said Julie Bindeman, a psychologist listed in the directory who is based in Maryland but has a license to work in Texas.
Konika McPherson, a licensed marriage and family therapist in North Texas who is also included in the directory, said women are worried.
“I have had people ask me, ‘Will you report me?’” McPherson said. “People need to know where you fall, where you stand and if they are safe with you.”
Stoking Confusion
Therapists are often confused about what is safe to say to clients and whether they can get in trouble for helping someone decide to have an abortion. It’s often not their clients they are afraid of, but the people around them.
If a client is not in a healthy relationship, for example, and the partner learns that an abortion was discussed with a therapist, “that partner could go after the therapist in terms of the bounty law,” Bindeman said.
In March 2023, a Galveston man sued his ex’s friends — and a local abortion activist — after they allegedly helped her obtain abortion pills. The lawsuit was recently dropped, but Texas pro-life groups are now reportedly looking for other men willing to sue their partners.
Lauren Paulk, senior research counsel at If/When/How, a nonprofit network of abortion lawyers, said protections for therapists are built into the health-care system.
“Talking about abortion does not break Texas law; it is protected by the First Amendment,” said Polk, who added that notes taken by psychotherapists have “very strong protections” under the federal Health Insurance Portability and Accountability Act, or HIPAA.
Still, Texas laws have left enough room for confusion to prompt all types of health providers — including therapists and counselors — to call If/When/How asking what they should or should not say.
The confusion is intentional, said Lucie Arvallo, executive director of Jane’s Due Process, a Texas nonprofit focused on teen reproductive rights.
“Anti-abortion opponents want that chilling effect,” she said. “The intention behind these laws is to stoke confusion and fear so that people don’t seek abortion care and that providers are afraid to provide abortion care and that functionally people stop talking about it altogether out of fear.”
The If/When/How organization worked with Sweet to put together training for mental health providers about what they can and can’t do to help their clients navigate reproductive choices. The training is part of the process therapists must go through to be listed in the Pro-Choice Therapists directory.
Finding Help
Sweet started to think about creating a directory during the 14 years she worked as a mental health counselor with Planned Parenthood in Florida. She found it difficult to find mental health providers she could trust for her Planned Parenthood clients.
Abortion itself wasn’t a traumatic experience for most of them, but their cases sometimes came amid other traumas, such as domestic violence or substance abuse. Sweet found it challenging to find the right provider.
“The challenge with abortion is that there is so much misinformation about it that a clinician can do harm simply by their own ignorance or by not understanding how common that it is or how safe that it is,” she said.
Sweet experienced this herself in 2013, when Planned Parenthood started to scan for intimate partner violence. Sweet was overwhelmed by the stories she heard and decided to talk to someone, but she was disappointed by the questions her therapist asked.
The therapist was overly curious about Sweet’s experiences working at an abortion clinic and didn’t focus on the intimate partner violence cases that were troubling Sweet.
“You are not meeting me where I am right now. This is not helpful,” Sweet remembers thinking.
Seven years later, in 2020, Sweet started working toward her doctorate and as part of her dissertation began to finally invest time and effort into the pro-choice directory.
When Roe fell in 2022, she realized it was time to give the project her full attention.
“I totally changed course and was like, ‘Now is the time,’” she said.
Initially, her goal was to create a directory with at least one telehealth provider in every state. She began scanning Psychology Today magazine for providers that met certain criteria, such as those specializing in “women’s issues.” She sent out initial inquiries to about 300 providers across the U.S.
“‘Hey, I am creating this directory. Are you interested?’” she asked.
She developed a vetting process among the therapists she was recruiting, and created a 90-minute training course for members about abortion stigma and how mental health providers can support their clients.
The site launched in 2023 with 191 providers across the 50 states, and is continuing to expand.
The directory remains a volunteer organization.
“This has all been grassroots activism,” Sweet said. “We have zero funding. This has all been our time, our talent, and our treasure of just trying to put this together because it feels so important.”
“A Terrifying Year”
Acknowledging that women may need mental health support after an abortion is an underlying issue that has split some abortion advocates, with many leery of feeding an anti-abortion narrative that the procedure is traumatic.
Sweet said the issue has created a “huge divide” among reproductive and mental health communities. Reproductive rights activists maintain that the main emotion for many women following an abortion is relief, but Sweet believes patients’ experiences are generally more complex.
“The multitude of feelings one can feel is essentially infinite and most of us are not feeling solely one thing at a time, right? It’s messy,” she said.
Sandra, a 31-year-old contractor who lives in Austin and ordered abortion pills this past September, said the first thing she felt when she found out she was pregnant was guilt. She is active in an online forum where women discuss their abortion experiences.
“I am telling other women on Reddit, ‘It’s not your fault,’” she said. “But it feels like sometimes I am telling myself.”
While research has consistently found that the abortion procedure itself is not traumatic, patients, especially those with underlying mental health conditions, may still need help processing their emotions, Sweet said.
In the current atmosphere in the U.S., it is often not the abortion but the abortion experience that is most damaging, Sweet said. And that can be true for women with wanted pregnancies as well as those with unwanted pregnancies.
Tiffany Wicks, another therapist listed in the directory, remembers the struggles she faced in 2022 when was pregnant in Texas. She now lives in the Washington, D.C., metro area. Wicks decided to move out of state after the fall of Roe and the Uvalde school shooting, but she is still licensed to practice and has a clinic in Texas.
“That was a terrifying year for me,” she said. “I couldn’t help but think, ‘What if something were to happen?’ And my clients were having those same fears. ‘What if I were to have an emergency?’”
Jennive Henry, a sex therapist in San Antonio, has seen the same concerns among her patients who want to be pregnant.
“Suddenly their catastrophic thoughts are a reality,” Henry said. “It’s true — you might not get the help you need.”
For her, as a therapist who promotes body autonomy, the laws often seem at odds with her professional goals.
“I am trying to tell my clients that you have consent over your body, that you have boundaries over what you want and what you don’t want,” Henry said. The law is “counterintuitive to body autonomy, and to human rights.”
Looking Ahead
The 21-year-old woman who was reluctant to talk to her therapist is better now. She has a job and is working with another therapist, but still hasn’t mentioned her abortion during their sessions.
“I am not sure about her yet,” she said. “It’s just that process of figuring out if they are right for you or not and it’s a hard one, especially in Texas.”
Little reminders of her pregnancy still make her sad, but she has mostly accepted the loss. Still, she thinks her experience could have been different.
“There is definitely a lack of support for women going through this in Texas,” she said. “ I hope that the things that I’ve gone through can help another woman in Texas, even just to feel like she’s not alone.”
This article was originally published by Public Health Watch, a nonprofit investigative news outlet. Find out more at publichealthwatch.org.
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