263diagnoses. For example, “Professionals need to recognize that both avoidance and
active problem solving are valid ways of coping for parents” (p. 159).
Another consideration when you wish to promote coping behaviors is that, in
many cases, patients’ coping and adaptation do not really begin until they leave your
office. They face a lifetime of adaptation to their risk and/or their genetic condition.
Having a conversation with them about the changing nature of their needs and pos-
sible resources as they go forth in their lives may be warranted (Arnold et al. 2005 ;
Hallowell et al. 2017 ; Ramdaney et al. 2015 ; Vos et al. 2013 ).
9.3 Patient Affect
Patients experience a myriad of emotions. These feelings are central to many genetic
conditions/situations, and you should address them in genetic counseling. Direct
expression of feelings may provide insight, reduce their intensity for patients, and
result in more effective problem-solving and decision-making. To help patients
express their feelings, you should be accepting and encouraging and invite them to
fully describe what they are experiencing.
Patient Anger
Patient anger is relatively common in genetic counseling. Schema et al. ( 2015 )
interviewed genetic counselors about experiences of patient anger directed at them
and found, “Nearly every participant expressed that [patient] anger (justifiable or
not) functioned as a coping mechanism in one or more ways: a cover-up for other
emotions, allowed for expression of a socially-acceptable feeling, a form of cathar-
sis, a way to gain control and/or attention. A few mentioned some people are ‘angry
by their nature’” (p. 723).
Anger is a complex emotional reaction that may mask deeper feelings such as
fear and despair (Baty 2010 ; Djurdjinovic 2009 ; Schema et al. 2015 ). Anger may be
an expression of frustration about one’s situation (e.g., that a diagnosis has not been
possible or encountering one obstacle after another when attempting to obtain
appropriate health care), or it may mask feelings of vulnerability (e.g., extreme fear
about the implications of a genetic condition). Patients may be more likely to feel
anger when a genetic condition is uncommon in their family and respond with state-
ments such as, “Why did this happen to me?” or “What did I do to deserve this?”
(Djurdjinovic 2009 ). The more important or meaningful an issue is for a patient, the
more likely the patient is to be angry. Positive aspects of anger include that it gives
patients emotional energy to deal with problems and it “clears the air,” allowing
patients to release pent-up feelings (Schema et al. 2015 ). Visible clues that a patient
may be angry include breathing more rapidly, sweating, clenching muscles (for
instance, in the jaw or the hands), becoming flushed, and raising one’s voice.
9.3 Patient Affect