86
Note that paraphrase and summary responses will be similar to content responses
if they contain no feeling words (other than feeling words the patient already stated);
and they will be similar to affect responses if they contain feeling words a patient
has not said. Paraphrase and summary responses tend to be lengthier and use more
of the patient’s words, however.
The following is an example of the different types of empathy responses to the
same patient statement:
Patient Statement: “I’m so upset about this diagnosis. I feel like crying all the
time. I can’t eat. I can’t sleep. I haven’t been able to keep my mind on my work.”
Minimal
Encourager:“[Head nod] Mm-hm.”Paraphrase: “You’ve been so upset that you’re having difficulty eating, sleeping, and
working.”
Summary: “This diagnosis has really upset you. Not only do you feel like crying all the
time, it’s getting in the way of your daily activities like eating, sleeping, and
working.”
Content
Response:“This diagnosis seems to have turned your world upside down.”Affect
Response:“You seem very distressed.”Content +
Affect:“You seem very distressed by this diagnosis.”A number of genetic counseling studies illustrate the essential role of counselor
empathy. For example, Runyon et al. ( 2010 ) surveyed genetic counselors about the
most important learning they acquired about themselves in their practice as well as
advice they would give to novice genetic counselors. A prevalent theme concerned
cultivating empathy “...defined as listening, determining the patient’s specific
needs, and being comfortable with silence [emphasis ours]” (p. 380). Multiple
respondents mentioned the importance of “being with patients” “...as opposed to
either talking, demonstrating one’s knowledge, or assuming one knows best what
patients need or want” (p. 380).
Zanko and Abrams ( 2015 ) reported a genetic counseling case in which the patient
was affected by both Wilson’s disease and Huntington disease (HD). When they
counseled the patient and his wife, they noted, “Tears repeatedly punctuated the
discussion, requiring time for silence and reassurance” (p. 42).
Miranda et al. ( 2016 ) interviewed master genetic counselors in order to explore
their personal and professional characteristics. One of their participants expressed
the following perspective: “After you’ve done [genetic counseling] for a while, you
get good at it, and you’re not really afraid of silence in a session, and you’re not
really afraid if people start crying, or even if you cry yourself...It may not be as
professional as you want...but it happens. It’s OK. I think genetic counselors some-
times don’t feel like sharing their personalities, being authentic. If you pull out your
little diagrams and all you want to do is point to things, you’re just hiding behind all
that science. That’s really not what it’s all about” (p. 775).
4 Listening to Patients: Primary Empathy Skills