Facilitating the Genetic Counseling Process Practice-Based Skills, Second Edition

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ence (e.g., “It sounds like you’re angry because your parents never told you about

your risk for this condition”).

• Be thorough. State all sides of your patient’s message, including conflicting and
  contradictory parts. For some situations where your patient is mixed or con-
  flicted, try saying something like, “You’re torn between these two very different
  feelings.”


• Respond empathically and then STOP! Patients will almost always respond.
  Beginning genetic counselors frequently make the mistake of giving a great
  empathic response and then immediately following it with a question, not allow-
  ing the patient an opportunity to respond.

4.5 Primary Empathy Responses

Primary empathy responses vary on a continuum from head nods, silence, and mini-
mal encouragers to more complex responses that reflect the content and feeling of
patients’ experiences. Pedersen and Ivey ( 1993 ) identify six major types of primary
empathy responses shown on the following continuum:

The primary empathy continuum

<Simple Complex>

Minimal

encourager

Paraphrase Summary Reflect

content

Reflect

feelings

Reflect content and

feelings

Minimal Encouragers: Minimal encouragers prompt patients to continue talk-
ing, but do not interrupt the flow of the session. They may include occasional
head nods, hand gestures, brief comments such as “uh-huh” and “mm-hm,”
repeating a few key words, and even silence. A minimal encourager response is
“...the simplest of the listening skills – but it is also one of the most powerful.
Research indicates that effective and experienced counselors use this skill signifi-
cantly more often than ineffective and inexperienced helpers” (Pedersen and Ivey
1993 , p. 121).

Example Pt: “It’s my first baby, and I’m afraid something’s going to go wrong.”

Co: “You’re afraid?”
Paraphrasing: Paraphrases reflect back to patients the essence of what they said.
In order to paraphrase, you use your own concise words, while including some of
the patient’s key phrases (Pedersen and Ivey 1993 ). Be careful, however, not to par-
rot the patient’s statements—do not repeat verbatim.

Example Pt: “We want to adopt a child, but we’re worried about how this genetic
condition will affect the baby we’ve been offered.”
Co: “You want to know what you’d be taking on if you adopted a child?”

4 Listening to Patients: Primary Empathy Skills