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( 2007 ) recommends a brief spiritual assessment in which you might ask: “It sounds
like your faith (religion, spirituality) is important to you. Have these beliefs been
important to you at other times in your life? Have these beliefs helped you reach
other important decisions?” (D’Souza 2007 , as cited in Seth et al. 2011 , p. 670).
We suggest you directly inquire about the importance of religion/spirituality. For
example, you could ask patients:
- What religious/spiritual beliefs do you hold, and how do they relate to your
concern? - What values do you hold?
- Would you want your beliefs to be part of your decision-making process?
To use a cardiovascular setting as an example, you might ask: In the past 2 weeks,
have you frequently worried about your future due to genetic testing or your cardiac
condition? Had concerns about your sense of purpose in life? Felt as if you were
getting down on yourself? Had difficulty setting meaningful goals for yourself?
(Adapted from Rhodes et al. 2017 , p. 228). When a patient endorses these types of
items, a referral to mental health professional, chaplain, or spiritual counselor might
be in order (Rhodes et al. 2017 ).
We recommend the following article that describes a tool for assessing patient
spirituality and general social functioning: Peters et al. ( 2006 ).
10.3 Closing Comments
In the other chapters in this book, you read about and practiced several basic helping
skills. Part of the art of being an effective genetic counselor involves timing and
choosing, that is, knowing when and how to intervene. “Genetic counselors should
remind themselves not to stereotype a given patient on the basis of ethnicity or reli-
gion, and to consider the beliefs and preferences of individuals” (Ahmed et al. 2008 ,
p. 569). Different patients require different choices on your part. This chapter described
a few of the ways in which patients differ stylistically, discussed some of the patient
emotional issues you will encounter, and considered how patients may resist, defend,
and cope when they feel threatened. Patients differ in many other ways, more than we
could adequately cover in one chapter or even one book. As you gain supervised expe-
rience, you will increase your sensitivity to patients’ individual and cultural differ-
ences and learn to more effectively tailor your counseling approaches, accordingly.
Finally, we wish to stress that even the most skillfully crafted and implemented
responses on your part may not have a positive effect. Despite your best efforts at
assessing patients and applying the other skills you are learning, you sometimes will
feel as if you did not make a difference. You are only one of the individuals in the
genetic counseling relationship. The patients play just as critical a role. They must
be “ready, willing, and able” to engage in the process. Some patients will lack one
or more of those critical elements because of diminished intellectual and/or psycho-
9 Patient Factors: Resistance, Coping, Affect, andfiStyles