235- Discredit the source: A common genetic counseling patient response might be,
“You don’t understand. After all, you don’t have Huntington’s disease in your
family.” - Try to change your mind: Your patient might try to argue you into believing her
or his point of view (e.g., “Oh, if you knew me better, you’d realize I really can’t
handle this type of news!”). - Devalue the topic: For example, “I’m only kidding when I say our daughter’s
genetic condition is my husband’s fault. I don’t really mean anything by it.” - Seek support elsewhere: “Well, all of my family members and friends agree with
me!” - Your patient may pretend to agree with you: “You’re probably right. Of course,
you have more experience than I do with this disease.”
Pedersen and Ivey ( 1993 ) identify several additional ways patients might
respond: - Patient is willing to admit to part of what you have confronted.
- Patient agrees with the confrontation but refuses to do anything about it.
- The patient chooses to compromise or accommodate the problem.
- The patient hears the confrontation and uses the insight to change the behavior.
It is important to realize that it may take time for patients to respond fully to
confrontation. Their full reactions may not be evident in the genetic counseling
session.
Prior to using confrontation, it is important that you assess your patient’s general
demeanor. Research suggests that you should generally avoid confronting patients
who are high on reactance (resistant to giving up control in interpersonal interac-
tions) and/or angry patients (Karno and Longabaugh 2005 ; Schema et al. 2015 ).
Confrontation may intensify their emotions.
8.2.5 Challenges in Using Confrontation
Confrontation is not an easy intervention. If you look up “confrontation” in a the-
saurus, you will see terms such as challenge, oppose, antagonize, provoke, meet,
threaten, defy, tackle, face, encounter, handle, face up to, deal with, and meet head-
on. Some of these terms sound quite negative, suggesting behaviors to avoid doing.
Moreover, when confrontations are about difficult issues, we may want to avoid
them because we fear patient’s negative reactions, and/or it makes us feel bad or
uncomfortable to think we’ve caused someone else’s pain. Moreover, “Beginning
counselors tend to avoid confronting...because it deviates from what they have been
taught is polite behavior; therefore, they fear that doing so might damage the rela-
tionship” (Hackney and Bernard 2017 , p. 29).
Similarly, in genetic counseling you may avoid using confrontation with your
patients because: