No one expects to face the decision to end a wanted pregnancy. Yet, for many families, termination for medical reasons (TFMR) becomes a devastating reality. A severe prenatal diagnosis. A life-threatening complication. An impossible choice that no one ever wanted to make.
For perinatal mental health therapists, understanding TFMR means being there for clients during their most isolating moments. As Mara Tesler Stein, PsyD, PMH-C poignantly states, “Nobody’s prepared for this.”
Unfortunately, TFMR remains widely misunderstood, even among well-intentioned professionals. Many therapists never receive formal training on this sensitive topic. Some fear legal repercussions, while others grapple with personal discomfort. But for families navigating this path, the need for informed, compassionate care is urgent.
TMFR in 2025: A Changing and Confusing Landscape
Since the Dobbs v. Jackson Women’s Health Organization decision in 2022, abortion access has become increasingly fragmented. Some states protect it, others ban it, and many fall somewhere in between. But for families facing TMFR, these laws aren’t just political—they’re deeply personal.
16 states currently enforce total abortion bans, even in cases involving severe fetal anomalies or significant maternal health risks (Guttmacher Institute, 2025).
Medical professionals fear of legal consequences for providing necessary care, sometimes delaying life-saving treatment (ACLU, 2025).
Many families must now travel out of state for TFMR care, facing financial, logistical, and emotional burdens (ACLU, 2025).
Julie Bindeman, Psy-D underscores the dire consequences:
“We are seeing people dying in pregnancy that don’t need to die in pregnancy, but because the physicians are too afraid to lose their licenses…they’re not getting the treatment they need in a timely kind of way.”
For therapists, this evolving landscape necessitates an understanding of where clients can legally access care, the risks within their state, and how to ethically support decision-making amidst increasing restrictions.
The Psychological and Emotional Toll of TMFR
TFMR is more than a medical procedure—it represents a profound emotional loss. Yet, unlike miscarriage or stillbirth, TFMR often carries additional layers of trauma, stigma, and isolation.
Clients may experience:
Intense grief—Mourning a child they deeply wanted (Antunes et al., 2025).
Medical trauma—From rushed decisions, insensitive care, or legal barriers.
Persistent guilt—Even when they know there was no real choice to make.
As Julie explains, “It wasn’t a decision. No one wants to make these choices.”
Mara adds, “For many clients, the trauma of TFMR isn’t just about the loss itself—it’s about the rupture of trust. Trust in their bodies, trust in the medical system, trust in the idea that pregnancy is supposed to be safe.”
Beyond the grief, legal restrictions in some states force clients into distressing, drawn-out experiences. Some are denied care until their lives are at risk. Others must endure state-mandated waiting periods or multiple appointments that extend their suffering. Some even face legal threats for seeking essential medical care.
For therapists, knowing how to navigate this complex emotional terrain is essential.
What Therapists Need to Know About TMFR
Even if TFMR isn’t your specialty, a client will likely turn to you for support. How you respond matters.
For foundational competency, consider:
Learn the laws in your state. What access does your client have? What legal risks exist for therapists providing information? (Guttmacher Institute, 2025).
Understand the medical realities. TFMR can result from conditions like severe fetal anomalies, maternal health complications, or life-threatening hyperemesis gravidarum (Antunes et al., 2025).
Use affirming language. Many parents reject terms like “choice” or “decision” when discussing TFMR.
For advanced fluency, go deeper:
Integrate trauma therapies. Many TFMR clients benefit from EMDR, somatic processing, and grief-focused work.
Recognize systemic barriers. Access is shaped by race, income, and legal restrictions.
Build a referral network. Know where to send clients for accurate legal and medical information.
Ethical and Legal Considerations for Therapists
Many mental health providers feel a responsibility to help clients access the care they need, but may now face legal risks for doing so. Understanding state-specific regulations is crucial.
“Clinicians are navigating a minefield. We have to provide the best care for our clients while also ensuring we are legally protected. And that’s a tension many therapists never expected to have to manage,” explains Mara.
Legislation like Texas’s Senate Bill 8 (SB8) empowers private citizens to sue anyone who “aids and abets” an abortion—which may include therapists who provide information about out-of-state clinics (ACLU, 2025).
Clinicians in restrictive states must carefully document TFMR discussions. Julie advises, “Do we use the word abortion in our notes? Or do we say ‘thinking about pregnancy decision-making’?”
Building Community for Clients and Clinicians
Clients navigating TMFR often feel alone in their grief. They may hesitate to talk about their loss for fear of judgment. As a therapist, you can:
Help them find peer support groups. Many parents find validation in connecting with others who have had similar experiences.
Assist in navigating family and social dynamics. Clients may struggle with what to disclose.
Offer grief-informed therapy. Medical trauma and guilt can complicate healing.
Clinicians also need support. Julie highlights the importance of professional networks: “I have a couple of text threads that are my lifeline when it comes to stuff like this.”
Addressing Systemic Barriers and Inequities in TFMR Care
Not all families experience TFMR the same way. Marginalized communities face even greater obstacles.
Black women are three times more likely to die from pregnancy-related complications than white women in the U.S., largely due to medical racism and reduced access to care (ACLU, 2025).
Low-income families often cannot afford to travel for care, leaving them with no options (Guttmacher Institute, 2025).
Undocumented and mixed-status families fear deportation if they cross state lines for care.
Leslie Pertz, LMSW, PMH-C, NIC, highlights another critical issue:
"It’s not just the experience, but the access and systemic issues that are wounding people."
Leslie, who worked as a sign language interpreter before becoming a therapist also stressed the impact of language barriers in medical settings, “If providers don’t know where to find an interpreter, we’re only talking about a couple of weeks where everything has to happen—finding an interpreter, scheduling a second opinion, getting into a clinic. That delay can make the difference between accessing care or not.”
TFMR is a deeply complex experience, and therapists need comprehensive training to provide the best support possible. In the conversation below, Dr. Mara Tesler Stein, Dr. Julie Bindeman, and Leslie Pertz, LMSW discuss the realities of TFMR, the legal and systemic barriers clients face, and the role of therapists in providing trauma-informed care.
Deepening Clinical Competency
For therapists committed to offering the highest standard of care to clients experiencing TFMR, specialized training is key.
Termination for Medical Reasons: A Clinical Guide
🗓️ March 2-3, 2025
Equip yourself to support clients facing the immense grief of reproductive loss with skill and empathy.
This training equips mental health professionals with the necessary tools to support clients facing one of the hardest losses of their lives. You'll cover:
The intersection of medical, legal, and emotional factors in TMFR.
How to provide trauma-informed, nonjudgmental support to clients.
Case discussions and clinical frameworks to navigate grief, trauma, and medical decision-making.
How to navigate ethical and legal considerations in an increasingly restrictive environment.
Showing Up When It Matters Most
TFMR is not just a medical event—it’s a deeply personal, highly politicized, and often invisible loss. By expanding your knowledge and staying attuned to the evolving reproductive healthcare landscape, you can be the steady presence your clients need in their hardest moments.
TFMR is one of the most complex forms of perinatal loss. Your clients will look to you for guidance. With the right training, you can offer the care, clarity, and compassion they need.
Join us, and be the therapist who turns isolation into understanding.
References
American Civil Liberties Union (ACLU). (2025). The high costs of abortion bans. Retrieved from https://www.aclu.org/news/reproductive-freedom/the-high-costs-of-abortion-bans
Antunes, B., Carvalheira, A., & Moura-Ramos, M. (2025). Psychological distress after termination of pregnancy for medical reasons: A systematic review and meta-analysis. Journal of Psychiatric Research, 163, 10-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794216/
Guttmacher Institute. (2025). Interactive map: US abortion policies and access after Roe. Retrieved from https://states.guttmacher.org/policies/
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