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will probably be negative,” “You’ve really thought this through and can do it,”
“Most people find this easier to deal with as time passes”). Although well-
intentioned and likely related to a belief that you are empowering patients, we
caution you about using these types of statements. Unless you include a specific
reason to support what you say, patients may feel your comment is gratuitous, and/
or not believe you. Before offering reassurance, ask yourself, “Why am I doing
this? Whose needs am I addressing? Am I trying to make the patient feel better?”
We further caution that it is not always possible to make patients feel better.
- Focusing too much on either content or affect—Beginning counselors tend to
emphasize content and overlook affect. In addition, Western cultures tend to
stress intellect, often at the expense of feelings. To further complicate matters,
patients might avoid expressing feelings because they are afraid of losing control
and/or are not sure discussing feelings is appropriate in genetic counseling
(McCarthy Veach et al. 1999 ). On the other hand, sometimes counselors empha-
size patients’ feelings at the expense of content. Too much attention to feelings
can prevent you and your patient from moving to goal setting and decision-
making. Ultimately, the issue is whether and how their feelings are either facili-
tating or impeding their ability to hear biomedical information and make
decisions. Effective genetic counseling includes a balance of attention to content
and affect.
- Making a content response when you intended to reflect feelings—If you wish to
make an affective reflection, then be sure you identify a feeling. If your response
begins “You feel like...” or “You feel that...,” it is probably reflecting the
patient’s actions or thoughts and not feelings. Often, we think we are stating a
feeling when we are actually stating a behavior (e.g., “You feel like you gave this
condition to your child”) or stating a thought (e.g., “You feel that it’s your fault”
[actually, you are saying the patient believes it is her/his fault]).
- Prematurely using advanced empathy—Even if your remark is on-target, it may
be too threatening unless you have established an initial rapport with your patient,
and your patient is ready to hear your interpretation.
- Using empathy responses inappropriately—Reflections can encourage patients
to continue talking. So, when you are trying to change topics, want a patient to
stop talking, or wish to end the session, you should generally avoid reflections.
- Inaccurate labeling/distorting—You make statements that are wrong or miss the
mark with respect to either the feelings or content of your patient’s experience
(e.g., reflecting to a patient that she seems to have made a decision when she has
stated that she can’t decide or telling a furious patient that he seems a bit
irritated).
- Pretending to understand—This is not genuine, and patients will pick up on your
pretense.
- Parroting—Primary empathy is not simply repeating patients’ words verbatim.
You should communicate the core or essence of patient expressions and do so in
your own words.
- Being long-winded—Long, rambling primary empathy statements confuse
patients. Remember to keep your responses concise and to the point.
4.8 Common Empathy Mistakes
