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kinship and their implications for cancer genetic counseling and education regard-
ing hereditary cancer. They found level of acculturation was not associated with an
individual’s beliefs (be they either Western or traditional concepts); members within
families may hold differing beliefs; the family plays a role in decision-making; and
a patrilineal concept of kinship, common in the Chinese-Australian community, can
affect family history taking. The authors recommended gaining awareness of these
factors, adopting a nonjudgmental attitude regarding cultural beliefs, and making
efforts to avoid stereotyping individuals.
Charles et al. ( 2006 ) compared culturally tailored genetic counseling versus stan-
dard genetic counseling in a sample of African American women at risk for BRCA
1/2 mutations and found women who received the culturally tailored counseling
reported greater satisfaction and a greater reduction in their worries than women
who received the standard counseling. Specific to cultural empathy, the culturally
tailored approach included questions that invited discussion of the women’s cultural
beliefs and values and how they apply to health-care decisions and coping with
medical concerns. The questions addressed three aspects of worldviews common in
the African American community—communalism, spirituality, and a flexible tem-
poral worldview.
In sum, “Before counselors can respond in a culturally empathic manner, it is
essential that they perceive each client as a unique individual with his or her own
particular experiences” (Chung and Bemak 2002 , p. 156). Cultural empathy requires
you to see the world the way your patients see it, rather than imposing your own
take on the situation. You must be able to step out of your own frame of reference to
view a situation the way the patient views it and seek information about your
patient’s beliefs (Brown 1997 ).
4.8 Common Empathy Mistakes
Empathy mistakes tend to be due either to genetic counselors’ covert processes
(their beliefs, assumptions, attitudes, etc.) or to overt processes (their actual
behaviors).
4.8.1 Mistakes Due to Covert Processes
- Over-identifying—When you over-identify, you feel too much with your patient.
Empathy involves sensing “...the client’s world as if it were your own, but with-
out ever losing the ‘as if’ quality...[and sensing] the client’s anger, fear, or con-
fusion as if it were your own, yet without your own anger, fear, or confusion
getting bound up in it” (Rogers 1992 , p. 829). If you lose the as if quality, the
result is not empathy but identification with the patient (Barrett-Lennard 1981 )
or what some authors (e.g., Kessler 1998 ) refer to as countertransference (we
4 Listening to Patients: Primary Empathy Skills