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to use both humor and denial as defense mechanisms. You must attend carefully
to these patients because they may portray everything as being fine when it is not.
Also, you can help them “own” their reactions by gently encouraging them to
express their true feelings.- Nonexpressive style: These types of patients are very articulate but in a highly
intellectual way. Although they feel their emotions, they deny their feelings have
any importance. They may even express some annoyance or disregard for indi-
viduals who do show their emotions. They appear to be confident and in control.
You should try to moderate the intensity of your own emotional expression,
because these types of patients tend to shut down even further when other people
are very emotive. - Reserved style: These patients express their feelings to a limited extent, but do
not allow their full expression. You can usually draw out these patients a bit with
primary and advanced empathy reflections of feelings and with questions (e.g.,
“Please tell me more about what it’s like for you to be so sad”). Then, after your
patient discloses, you can ask what the patient will do to cope with her or his
feelings. - Explosive style: These patients express everything they are feeling, sometimes in
overly intense ways. They can be demanding, histrionic (dramatic), and may lack
good interpersonal boundaries. You need to set clear limits (e.g., regarding ses-
sion length, physical contact, what you will and will not provide, etc.). It is also
important that you remain calm if they have outbursts, such as crying
uncontrollably.
9.4.2 Intellectual Styles
- Inductive reasoners gather a large amount of data and then make generalizations
based on these data. Inductive reasoners may display a fair amount of confusion
until they can find the patterns in the data (i.e., draw a conclusion from the facts).
Then they may have “light bulb” experiences as the data suddenly fall into place
for them. Inductive reasoners may also provide you with a great deal of detail.
You must not allow yourself to get bogged down in these details. The most effec-
tive counseling strategy is to sort through the details to identify common threads
and patterns and then share these patterns with your patient. - Deductive reasoners tend to have a rigid framework from which they view real-
ity. They may disregard important information that does not fit into their frame-
work (e.g., “I can’t have this condition, I’m a healthy person!”) and only take in
information that supports their view. You will need to be tentative with patients
who have rigid frameworks, helping them to see that reality is not so clear-cut.
Deductive reasoners may be particularly frustrated with the uncertainty that is
inherent in genetic counseling (e.g., “What do you mean you can’t tell me how
severely affected my child will be?”).
9 Patient Factors: Resistance, Coping, Affect, andfiStyles