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the provider would “give” the condition to them. It was important for the health-
care providers to recognize that this resistance was not due to their own compe-
tency or personality. Rather, it resulted from a deeply held cultural conviction.
Strategy: Avoid getting into power struggles, which you will almost never win.
Plus, this would damage your relationship with your patient, making effective coun-
seling impossible.
Examples:
- A patient states that he does not want to have a genetic counseling student
involved in his care. The genetic counseling supervisor honors this request. - After explaining the genetic counseling process, the patient is adamant that she does
not want to proceed. Tell her that is fine, but leave the door open for future contact. - It can be very frustrating when patients don’t listen to what you are saying. You
may find yourself becoming visibly agitated. Periodically, tune in to your body
language, especially when you feel your “buttons” are being pushed. First, you
need to know what your buttons are (see countertransference in Chap. 12 ) and
then practice checking on your reactions during the session. Finally, step back
and ask yourself why the patient is not listening before deciding how to respond.
Strategy: Use less threatening terms.
Example: - If your patient is reactive, use “consultation” or “discussion” rather than “coun-
seling,” “we are going to talk about some available options” rather than “testing
procedures,” “testing options in pregnancy” rather than “prenatal diagnosis,” and
“changed” or “altered” gene rather than “mutation.” Listen to the words your
patients use to determine terms that may be acceptable to them.
Additional strategies involve keeping in mind that cultural differences may lead
to patient resistance. Shaw and Hurst ( 2008 ) recommend: “...when counseling indi-
vidual patients, regardless of their ethnic background, it may be valuable for genetic
counselors to elicit patients’ prior understandings of the causality and inheritance of
the condition they have come to discuss. This might be done by providing patients
with opportunities to describe their own perception of the condition and their under-
standing of its inheritance or etiology. Genetic counselors would also need to be
prepared to challenge mistaken beliefs because mistaken beliefs may influence an
individual or couple’s reproductive decision-making and risk communication in the
family in clinically significant ways” (p. 382).
Weil ( 2010 ) recommends considering whether there might be alternative expla-
nations before concluding patient behaviors are a sign of resistance; asking yourself
how you are feeling, as resistance can feel like an attack on your competence; and
trying to talk about the resistance if the patient seems open to doing so. He further
suggests “...whenever possible, affirm the patient’s dignity, integrity, and sense of
responsibility...support the patient’s feelings of control and autonomy...[For exam-
ple] ‘I can see that you have been doing your very best to try and deal with this
difficult situation...’ [as well as] providing relevant information, promoting
informed decision making, and facilitating the patient’s role in planning and imple-
mentation...” (p. 163).
9 Patient Factors: Resistance, Coping, Affect, andfiStyles