Counselling in the case of the unplanned pregnancy has to be brief and to the point. Psychosexual counselling is usually more open ended, allowing patients time to understand their unconscious feelings which may block their fulfilment and allowing a gradual move towards change in attitude. However, psychosexual doctors are trained to listen not only to what is said but what is not said, and to understand what is going on in the consulting room. The specific techniques associated with understanding the doctor-patient relationship and the genital examination can give rapid insight to the patient’s feelings which may have nothing to do with a detailed history of her circumstances, as in the case of Miss D. (p. 53) who had enormous financial problems but who still wanted a baby. The genital examination can give the trained doctor an insight into how the woman feels about her sexuality, as in the case of Mrs H. (p. 58), which was important in helping her to understand her feelings about her pregnancy and her contraception. This ability to perform a genital examination in a psychotherapeutic way is a skill which nonmedical counsellors may find difficult to accept or understand.
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