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

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4.6 The Importance of Attending to Patient Affect

Feelings are a universal human experience. Izard ( 1977 ) identified 10 universal
emotions: interest, enjoyment, surprise, distress, anger, disgust, contempt, fear,
shame, and guilt. These feelings can be broadly categorized by domain and by
intensity:

• Domain—The type of emotion. Feelings are either pleasant (e.g., happy) or
  unpleasant (e.g., sad).


• Intensity—The degree or level of emotion. Feelings can range on a continuum
  from mild (e.g., irritated) to moderate (e.g., angry) to extreme (e.g., furious).
  Although feelings may be experienced universally, the ways in which patients
  will express their emotions is very culture-specific. Also, the types of events and
  situations that trigger specific emotions have a strong cultural component.
  Patient feelings are a critical part of the genetic counseling process (Kessler
  1999 ). Some patients may use feeling words frequently, but not hear them. When
  reflected back to them, they may be able to hear their feelings and come to terms
  with them. Furthermore, patients often “...have mixed feelings and are not sure
  themselves about what they feel. This confusion can interfere with an interview
  unless the feelings are clarified” (Pedersen and Ivey 1993 , p. 150).
  Primary empathy allows you to recognize and label patient feelings. When you
  tentatively reflect patient feelings, you help to clarify them. However, be sure to
  observe patient reactions, as their responses may indicate the accuracy of your
  reflections. In order to recognize and label feelings accurately, Pedersen and Ivey
  ( 1993 ) suggest that you:


• Listen for feeling words.


• Watch for clues about feelings in patient nonverbals.


• Reflect feelings back to the patient in your own words.


• Use a basic sentence stem that reflects the way the patient talks (e.g., “It looks
  like...” for a visual patient, “It sounds like...” for an auditory patient, “It feels
  like...” for a tactile patient).


• State the situation in which the feelings occurred (e.g., “It looks like you feel...
  because....).


• Check for accuracy (e.g., “Am I correct in thinking you’re scared to make this
  decision alone?”).

4.7 Cultural Empathy

“Basic counseling skills such as attentive listening, empathy, and respect form the
foundations of successful cross cultural communication. Genetic counselors should
also explore the varied worldviews, beliefs and values of each client, as relevant to
the situation at hand...By taking the culturally humble approach and learning from

4.7 Cultural Empathy