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of Ethics which states that “The counselor-client relationship is based on values of
care and respect for the client’s autonomy, individuality, welfare, and freedom” and
that genetic counselors therefore work to “Enable their clients to make informed
decisions, free of coercion, by providing or illuminating the necessary facts, and
clarifying the alternatives and anticipated consequences” (NSGC 2017 ). This is also
a major tenet of the Reciprocal-Engagement Model of genetic counseling—that
“patient autonomy must be supported” (McCarthy Veach et al. 2007 , p. 719).
Historically, the term “nondirectiveness” has been used to describe the approach
used by genetic counselors to protect patient autonomy, specifically in decision-
making. Strict, narrow definitions of nondirective genetic counseling emphasize
what the genetic counselor should not do. This terminology is problematic, how-
ever, because it implies that genetic counselors never provide advice of any sort to
a patient. This is not only inaccurate but also unachievable and, in many cases, inap-
propriate. A better way to conceptualize this approach is to consider how genetic
counselors protect patient autonomy by providing balanced information, using
value-neutral terminology, and responding to questions in a manner that addresses
patients’ underlying emotions and concerns (Weil 2000 ). Genetic counselors also
use their counseling skills (e.g., primary and advanced empathy) to promote patient
autonomy. As discussed by Resta ( 2010 ), although respect for patient autonomy
should be maintained as an important value in genetic counseling, the extent to
which autonomy is possible varies across patients. Active counseling strategies can
also be used to address situations in which autonomy is limited due to economic,
social, political, or cultural realities that confront patients (Resta 2010 ).
In this chapter, we discuss two genetic counseling skills that involve more directive
behaviors: advice and influencing responses. Advice refers to the genetic counselor’s
professional recommendations, while influencing responses express the genetic coun-
selor’s opinions. Included in this chapter are several examples of genetic counselor
responses obtained by Kao ( 2010 ) in a survey study of genetic counselor empathy in
clinical practice. She asked genetic counselors to read slightly modified excerpts from
actual patient statements reported in five qualitative studies published in the Journal
of Genetic Counseling (Andersen et al. 2008 ; Gibas et al. 2008 ; Nusbaum et al. 2008 ;
Phelps et al. 2007 ; Quaid et al. 2008 ). The patient statements reflect a variety of
genetic disorders (long QT syndrome, Huntington disease, cleft palate, Fabry disease,
and BRCA risk). Respondents were asked to pretend they were the genetic counselor
in each scenario and then to provide a response as if they were actually speaking to
the patient. Participant responses included advice and influencing statements.
10.1 Advice Giving
10.1.1 Definition of Advice
Advice is a type of response in which the genetic counselor attempts to direct
patients by offering suggestions or recommendations about what they should do.
Advice is intended to offer recommendations, to help advice seekers sort through
10 Providing Guidance: Advice andfiInfluencing Skills