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Aug 1, 2022

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.

Transcripts for this episode will be available at!

An Interview with 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

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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 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 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:

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:

Katie 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:

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.

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