Exhale started out as a Bay Area hotline for women who wanted or needed someone to talk to about their feelings after an abortion. It is funded by foundations that have abortion rights as part of their political agenda.

On June 1, the hotline went national and Exhale was successful at garnering a fair amount of media attention. For example, this Associated Press article ran in a number of newspapers around the country.

My co-blogger Annie wrote this entry about Exhale's political agenda.

A number of post-abortion ministries are funded by groups with political agendas about abortion. For example, individual Project Rachel offices are supported by Catholic dioceses, and most of those Catholic dioceses have political agendas about abortion.

An important question to ask of a particular post-abortion support group is whether it is good at meeting its goal. The goal is something like, "When someone has used our services, we want her to feel comforted, supported, to have a sense of hope about the future, to feel reconciled in her relationship with herself, others and God (if she believes in God), and to have some new resources and coping skills."

That's a big ticket--obviously, only a minor version of this could happen as a result of a phone call.

I'm the intake person for a local post-abortion ministry and no doubt, some women have called me and I have not been helpful. I've heard complaints over the years--from women who eventually entered actively into the abortion recovery programs we offer--about unfortunate phone calls they experienced in the course of seeking help after abortion.

God knows it's important that we make allowances--even though we all want people who call for support to get that support at the highest possible level. Looking at a particular phone call that may not have gone well from the point of view of the caller, that could be because of a number of factors--

--a lack of chemistry between the caller and the phone counselor.
--unfortunate accidents or diversions during the call.
--a problem with the basic model of counseling in use at a hotline.
--the counselor doesn't successfully apply that basic model of counseling.

According to Exhale, their goal on their talkline is:

The talkline is staffed by volunteer peer counselors who have successfully completed more than 50 hours of training. Counselors are trained in Exhale’s Empowerment Model, which is a lens for understanding people’s unique experiences with abortion. The Model is based on three key principles:

:: Each caller is a whole, complex person

:: Counselors respect each caller’s belief system (social, cultural, political and religious)

:: Counselors work with callers to build or extend existing support networks

As I mentioned on the blog yesterday, over the weekend, I got an email from someone who had called the Exhale hotline. She wrote up an account of her experience with the hotline, and sent that along to me.

She gave me permission to post her notes here. When I suggested that I write to Exhale with a copy of the notes to ask if what transpired during the call was representative of what one might expect of such a call, she was fine with that.

Here are her notes, slightly edited (the notes mention specific times, and I removed those.)

"I was answered by a machine that told me I was on hold in many different languages. Then a man came on the line and asked me if I wanted to speak to a counselor. I said "yes.... I think so". I was put back on hold, five minutes later the man came back and said he had a counselor I gave my name and a young sounding woman came on the line.

I said that I had been given this no. by a friend and told that I could talk about my abortions. She replied in the affirmative and then was very quiet. Which I always hate because if you donna ask me stuff I'm not very likely to tell you anything but I was gonna really try.

SO I said "I've had two abortions and last year we decided not to have kids and I'm really sad because I keep thinking that those were my kids."

C: "yea that sounds sad"

ME: " I keep thinking I did the right thing because I was so young, I mean I was only 15 and just didn't know what to do...."

C:" well that sounds like the right thing"

ME: "and the other one I was older, I was 21 but the guy he beat me a lot and abused his nephew. He was real evil I donno how I would have protected a kid from him"

C: "well then not having the child was definitely the right thing"

ME: "yea but I'm still sad. I miss my kids and now I won't be having any. I thought it was ok when we decided not to a year ago... but sometimes I'm still sad

(now I start hearing a baby crying in the background...... yes a real live baby no bones about it)

C: "well have you talked to your partner?"

ME: "yea but you know he didn't know me back then it was a different life and sometimes I find it hard to talk to him about what I was like. I mean it was all about surviving and getting out"

C: "yea well you know you should maybe talk more to him"

ME: "yea but I just donno, I mean he is great but I mean he never got a girl preg. or

C: "REALLY?"

ME: "well not that he knows about.... I mean it could have happened but no one has ever said that he did. But you know I just donno I mean he is a guy so I donno how well he relates to the whole thing................ (long silence with baby still in the background) Is it normal you know to still be thinking about this so many years
later?"

C: " oh yea I mean everyone heals in their own time"

Then loud buzzing sound and I get hung up on. It was about a 20 min. conversation. If I had been in dire trouble I donno how this young lady could have possibly helped me. She seemed very clueless and I thought the baby in the background could be very painful for anyone that has just gone thru' an abortion."

Okay, then.

I sent this off to Aspen Baker at Exhale and asked her if it was generally speaking representative of what someone could expect who calls Exhale. (Or to put it in another way--does this call follow the model of counseling you want your volunteers to follow, or is this an example of a volunteer who however kind-hearted she is, needs more training to understand and apply your model.)

First things first, though. There were several diversions in the call--some awkwardness at the beginning, the baby crying in the background, and the disconnection of the call.

Aspen's response is:

I do appreciate the information about the background noise, in this case a baby, which felt distracting to the caller. Our volunteer counselors take calls from home (hence the first man who picked up the phone works for the answering service that connects callers to the counselor on call) and are trained to take calls in a quiet, confidential space. Unfortunately, this caller wasn't provided with this, and I will definitely check in with the counselors and remind them about the importance of this. And...there is no time limit on the calls. I don't what happened, but getting cut off is obviously very frustrating, and not the norm. Perhaps it was a lost call on the cell phone being used by the caller or counselor?

That's a reasonable enough explanation of the beginning of the call and the unfortunate abrupt end. (My correspondent wondered if the buzzing sound followed by the disconnection meant that callers were only allowed to talk for a limited amount of time after which they automatically got cut off. It's certainly good to know that's not the case.) From the way Aspen writes {"background noise, in this case a baby"), it sounds as if she isn't giving an inch on the caller's sense that a baby crying in the background is an unusually unfortunate form of background noise on this kind of call. Or, to put it another way, she's not willing in this case to validate the caller's experience, or the caller's sense of distress about the specific kind of background noise. That doesn't seem very caller-sensitive to me.

My correspondent expressed the belief that "If I had been in dire trouble I donno how this young lady could have possibly helped me. She seemed very clueless".

To this, Aspen responds:

I completely trust that if a caller expressed more critical needs or was in crisis that the counselor would respond appropriately.

I have to strongly disagree here. In therapy (and hotline calls are a truncated version of this), the client gradually decides, based on early and cumulative interactions with the therapist, whether the therapist has the capacity and nerve to hear and absorb how bad things really are. People don't tell you any raw, urgent, unmediated, painful feelings until and unless they decide that you can handle it. (Thus, a recent study showed that of women who enter to therapy to recover from sexual abuse, only 30% ever end up telling the therapist that they were sexually abused.) It's not fair for Aspen to say that the phone counselor would have picked up on any feelings of crisis or sense of strain had there been any, when our correspondent is clearly signalling that her sense of the phone counselor is that the phone counselor couldn't have handled strong, raw emotions or expressions of crisis.

On the main question of whether the counsel received on this call is generally speaking representative of what one might expect, Aspen writes:

From the summary, it sounds like the counselor did what she was trained to do - listen, reflect back emotions expressed by a caller and respond to the issues presented by the caller. It seems that the caller in this scenario was telling her story, talking about what was going on for her, what she was thinking about, worried about, etc... The counselor did a good job in being a listening ear and holding a safe non-judgmental space for the caller to express those things.

It's also true that some callers want something different than that, yet, because the needs of each caller are different, counselors are trained to not make assumptions about what each caller needs. For example, some callers just want a space to cry, many want confirmation that what they're feeling is normal, and others are looking for specific ways to process their grief. So, because the issue this caller presented with was wanting to tell her story, the counselor responded by listening and affirming.

I don't see it. The phone counselor did do a good job of hearing our correspondent's sadness ("yea that sounds sad") and of encouraging our correspondent to seek help from her social support network (her husband).

However, her surprised overreaction when our correspondent said that her husband had never been involved in a pregnancy is pretty strange and would seem to represent a significant distraction from the flow of the conversation. (I wonder what the phone counselor's emotional reaction was all about?) The surprised reaction by the phone counselor puts our correspondent into the defensive posture of having to defend her assertion that her husband had never been involved in a pregnancy.

Beyond that, it looks to me as if the phone counselor did not follow Exhale's Empowerment Model...except, Aspen thinks she did, so perhaps I don't understand what Exhale's Empowerment Model means when it says:

Counselors respect each caller’s belief system (social, cultural, political and religious)

Twice, the phone counselor directively asserts that our correspondent was definitely right to abort those two pregnancies. I don't see how these directive assertions are examples of respectful listening, responding to emotions of the caller, respecting the caller's belief systems, not making assumptions about what the caller needs, and "holding a safe non-judgmental space". I'm just not seeing that. It sounds like the phone counselor proactively jumped in with her value judgments, without having any idea about our correspondent's beliefs.

So, there you have it.

My thanks to both our correspondent and to Aspen Baker for their time, care and responses.

I realized in working on this that although there are a number of post-abortion ministry hotlines (such as 1-800-5-WE-CARE and 1-877-HOPE-4-ME and 1-800-395-HELP), these numbers are primarily referral numbers. You talk to a person, but the basic thrust of the call is to figure out where you can get serious help. As far as I know, there is no post-abortion ministry exclusively devoted to being a place where someone can just call and get it off their chest, or call when they are in crisis, or call when they are feeling sad, just to talk, without the phone call being all about referring you. It would be a real blessing if there were a hotline number with volunteers who were just there to listen and talk at that point in time, whenever you needed someone to talk to.