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common in genetic counseling, and it is a normal reaction, especially when patients
perceive an issue as important (Weil 2010 ). Resistance, often an unconscious pro-
cess, indicates a patient is not fully committed to the genetic counseling relation-
ship/session. Resistance arises whenever patients oppose any aspect of genetic
counseling processes and/or outcomes.
9.1.2 Causes of Resistance
Resistance “serves an important self-protective function...[For instance, it may be
prompted by] “...a desire to avoid conflict – internal and/or with others. The resis-
tance may also involve ambivalence, an inability to make a decision in the face of
mutually conflicting possibilities, each of which has value to the patient” (Weil
2010 , p. 159).
Resistance may occur for many reasons, such as opposition to testing, termina-
tion, communicating with family members, the legitimacy of genetics services, and/
or the information you aim to provide. Weil ( 2010 ) notes several reasons for resis-
tance including inadequate referral in which the purpose and possible outcomes of
genetic counseling/testing are unclear, the information and/or diagnosis a patient
receives creates anxiety, the patient feels overwhelmed by the amount/complexity
of information, the patient has expectations you are unable to meet, and the patient’s
feelings such as guilt and shame. Resistance also often occurs when patients per-
ceive genetic counseling and testing as contrary to their religious/spiritual beliefs
and/or their personal/familial/cultural values (Weil 2010 , p. 158).
Below we elaborate on some reasons for patient resistance in genetic counseling.
These reasons involve fear, resentment, misunderstanding, and/or disconnection
from the counselor.
Fear
Some patients:
- Are afraid to take personal responsibility for their situation and resulting deci-
sions (e.g., patient who always lived as if she had the Huntington disease (HD)
gene and did not want to find out she does not have the gene as it would “invali-
date” the way she has lived her life). - Feel demoralized because of the genetic condition and also view their privacy
and independence as threatened (e.g., late-onset progressive neurological disor-
der, such as spinocerebellar ataxia). - Feel a loss of control and use resistance as a way to hold on to some power and
self-esteem. Also, they may be ambivalent about making a decision that has
important benefits but also significant restrictions (e.g., having genetic testing for
breast cancer to better plan monitoring for the disease, but not wanting to learn
they have the gene).
9 Patient Factors: Resistance, Coping, Affect, andfiStyles