2539.1.3 Behaviors That May Indicate Resistance
Resistance may occur when patients:
- Do not seem to know what they want from genetic counseling
- Present themselves as not needing any help
- Are only there because of someone else’s urging, referral, etc.
- Express resentment about being there
- Talk only about safe or low-priority issues (e.g., focus on the risk numbers and
not on the condition itself) - Are directly or indirectly uncooperative (e.g., refuse to discuss certain issues or
selectively forget important aspects of their family history) - Unwarrantedly blame others for their situation
- Show no willingness to establish a working relationship with the genetic
counselor - Are slow to accept responsibility for the decisions they need to make
- Are abrasive or actually hostile toward the genetic counselor
- Seek to get support for a decision they’ve already made rather than being open to
exploring and engaging in a decision-making process - Fail to complete requested forms, arrive late for the appointment, exhibit a closed
body posture, and/or give minimal responses to the counselor (Schema et al.
2015 ) - Use one or more defense mechanisms (discussed later in this chapter)
9.1.4 Mimics of Denial as Specific Types of Resistance
In discussing what he defines as “mimics of denial,” Lubinsky ( 1994 ) described
three patient behaviors that Weil ( 2010 pp. 162–164) classifies as specific types of
resistance: disbelief, deferral, and dismissal.
Disbelief involves accurate patient perceptions of the information but a refusal to
accept or believe it because it does not make sense to them given prior information
and expectations (e.g., “But my daughter is so healthy”). Disbelief also allows
patients to remain hopeful, especially early in the adjustment process.
Deferral occurs when patients accept information as correct but the implications as
incorrect (e.g., parents accept the diagnosis of Down syndrome in their child but are
convinced their child will only be mildly affected because they will be vigilant about
seeking developmental interventions for him). Deferral helps prevent the emotional
impact of information from overwhelming patients’ psychological resources and
gives them time to adapt and cope before fully acknowledging the consequences.
Dismissal occurs when the patient denies or attacks the genetic counselor’s pro-
fessional competency or the competency of someone/something else. (For exam-
ple, patient challenges the genetic counselor who reports abnormal NIPT results
because their obstetrician has assured them the pregnancy is normal based on a
9.1 Patient Resistance