269Behavioral clues include shaming others (“If you had taken better care of yourself
you wouldn’t have lost this pregnancy!”), being critical or blaming (“This whole
process wouldn’t be so awful if you had been clearer about how severely affected our
child would be”), focusing outside of oneself (talking about everyone else’s feelings
and reactions except one’s own; keep in mind, however, that in some cultures exter-
nalizing is a typical behavioral pattern), forgetting or lying about critical informa-
tion, and overcontrolling another person (e.g., the overprotective parent of a child
with hemophilia).
As with other emotions discussed in this chapter, unexpressed guilt and shame
impede the genetic counseling process. If you have developed rapport with patients,
you may be able to invite a discussion of their guilt and shame by using primary
empathy and by maintaining an accepting, nonjudgmental attitude. You might also
try addressing guilt and shame by using advanced empathy to reframe the issue for
patients. This may help them see things from a different perspective (Kessler 1997 ).
For example, parents whose child has Down syndrome were struggling with guilt
and shame because they came into the session believing they had caused this to hap-
pen. The genetic counselor explained the simple mechanics of meiosis and empha-
sized that it was no one’s fault—no one can make it happen or prevent it from
happening. She reinforced this message by saying this is a simple error in the divi-
sion of the genetic material, which can happen to anyone.
9.4 Patient Styles xvi
No two patients will behave exactly alike. They will have stylistic differences. A
style suggests a certain degree of consistency in the way a given individual behaves
across different situations. For instance, a person who expresses emotions easily
and intensely may be very emotional in most situations, including genetic counsel-
ing. On the other hand, individuals who typically are controlled would be less likely
to express strong emotions during genetic counseling. Patient stylistic differences
influence how they respond during genetic counseling sessions. Additionally, coun-
selors have preferred intellectual and emotional styles that affect how they approach
their patients. To the extent possible, counselors should vary their approach to effec-
tively work with different types of patient styles.
Cheston ( 1991 ) identified patient styles for two major dimensions: emotional
and intellectual.
9.4.1 Emotional Styles
- Spontaneous style: These types of patients are active communicators, who
respond easily and expressively. Often, they have a good sense of humor which
they will use even when they are sad (e.g., joking while crying). They will tend
9.4 Patient Styles