267so much pain.” After your patient responds to your statement, you could follow up
with a statement such as, “Grief takes a long time, so don’t feel you have to get
through it quickly.”
Allow patients to discuss their grief, even if it’s a story they’ve told before. It may
be helpful to let patients repeatedly discuss their loss because grief is a repetitive
and ongoing process (Gettig 2010 ). This may help them experience some accep-
tance of their loss (Gettig 2010 ).
It’s a mistake to try to falsely reassure grieving patients that everything will be
fine or to try to cheer them up. You must let them freely express their feelings, some
of which may be quite intense. One problem, however, is that beginning counselors
often are uncomfortable with intense patient emotion. If this is the case for you,
acknowledge your discomfort internally, and later discuss it with your supervisor or
a colleague.
When genetic counseling involves prenatal or perinatal loss, it’s important to
attend to the partner’s grief as well as to the mother’s. The literature emphasizes
maternal attachment and mourning, which has led to some fathers/partners feeling
marginalized, invisible, and as if they are responsible for the mother’s well-being
(LaFans et al. 2003 ; Rich 1999 ).
Attention to cultural variations is also important (Helm 2015 ): “...every ethnic
group and religion has its own grief traditions...Grieving and death rituals vary
widely across cultures and are often heavily influenced by religion...These [rituals]
include the degree of openness in discussing family history and health problems in
a medical setting, the way in which different types of mental and physical disabili-
ties are viewed in terms of their impact on individuals and families, and barriers to
receiving services, such as language and health care beliefs at variance with Western
medicine... Any counselor who is unsure as to what to do should consult the family
or their traditions expert: rabbi, priest, minister, elder family member, anyone who
understands the traditions” (Gettig 2010 , p. 118).
Work on becoming comfortable with patient expressions of strong emotion, but
“...know your own limits; set boundaries; nurture yourself. You will witness great
pain but you will also assist families at a critical point in their lives and affirm the
resilience of the human spirit” (Gettig 2010 , p. 119). Read firsthand accounts such
as those describing “...intense reactions to having a baby with a disability: numb-
ness, disappointment, isolation, withdrawal, defensiveness, protest, despair, shock,
denial, sadness, anger, self-doubt, humiliation, confusion, disbelief, and guilt”
(Douglas 2014 , p. 696).
In closing this section on grief, we ask you to consider this description by a can-
cer genetic counselor who worked with the wife of a young man who died from
gastric cancer:
Listening to her grief about missing her husband, her anxiety regarding her children grow-
ing up without a father and being a single parent, financial concerns, and her support sys-
tems...has helped me remember that every person who I see may be experiencing the
hardest days of their life. Every person has a story, and I must anticipate that some patients
will only need me as a knowledgeable resource while others will need much more long-
term support. (Flynn 2012 , p. 186)9.3 Patient Affect