257when the counselor asked her why she came, she responded, “My doctor made
me come down here because he thinks it would be terrible if I had a child just like
me. He thinks I would want an abortion if the chances are high. Well, my mother
gave me a chance at life, and I intend to do the same for my child. I’m doing just
fine.” By the end of the session, it was clear she had come not for the counseling
but to make a point. In this situation, the genetic counselor effectively attempted
to see the issue from the patient’s perspective. She was willing to hear her out,
established a working relationship, and allowed the patient to leave with the
understanding that genetic counselors are not gatekeepers to abortion but indi-
viduals trained to help patients meet the challenges presented by any given sce-
nario/diagnosis.
Strategy: Help patients see how their resistance is impeding the genetic counsel-
ing relationship, if it is. Advanced empathy and confrontation (Chap. 8 ) may be
helpful responses.
Example:
- A patient came to learn more about her chance of having a baby with a birth
defect. Her sister had a baby that died, and she did not know the cause. She
refused to talk to her sister even after the genetic counselor explained that she
needed the baby’s medical records to determine if there was any familial risk.
The patient, however, kept calling the counselor to ask if there was any prenatal
test or other kind of test she could have. The genetic counselor tells the patient
that she cannot help unless the patient talks to her sister.
Strategy: Search for incentives for moving beyond resistance, but use these
sparingly.
Example: - A 38-year-old woman who was 18 weeks into her first pregnancy came for
genetic counseling because her second trimester maternal screening (quad
screen) showed her risk for trisomy 18 was 1 in 100. She could not decide
whether to have an amnio. She was insistent on having the maternal serum
screening test repeated despite the genetic counselor telling her this would not
provide her with useful information. The genetic counselor steered the conversa-
tion toward a discussion about what the patient would do should she find that her
baby had trisomy 18 syndrome. The counselor pointed out that if the patient
would consider a termination, then repeating the maternal serum screening
would not be a realistic option because of time constraints. The counselor was
also able to offer an ultrasound.
Strategy: Do not take patient resistance personally.
Example: - McCarthy Veach et al. ( 2001 ) found that a major challenge for genetic counsel-
ors and primary care providers was addressing diversity issues. In their focus
group study, they heard accounts of Mexican immigrants who believed that if
they discussed the possibility of a genetic condition with a health-care provider,
9.1 Patient Resistance