285the options they have already decided on, and/or to help them implement their deci-
sions successfully (DeCapua and Dunham 1993 ). As opposed to information giving,
which involves the communication of knowledge (see Chap. 7 ), advice involves a
suggestion about a particular course of action and “...the counselor overtly attempts
to shape and influence the counselee’s behavior” (Kessler 1992 , p. 10).
As Vehvilainen ( 2001 ) notes, advice involves “...a recommendation toward a
course of action that the advice giver prefers, and it is given with the expectation
that the recipient will treat it as relevant, helpful, or newsworthy and accept it.
Advice implies that the adviser has knowledge or insight that the advisee lacks”
(p. 373).
Advice varies along a continuum from directly expressed recommendations of
what a patient should do [e.g., “You should share your test results with your adult
children”] to indirect or implied suggestions [e.g., “Have you talked with your hus-
band about your desire to have presymptomatic testing for HD?”]. Several authors
propose that a less direct approach may be more effective because it can decrease
resistance and promote patients’ autonomy and authority over their actions. For
instance, Couture and Sutherland ( 2006 ) suggest using collaborative, co-constructed
advice. Specifically, genetic counseling practitioners frame advice within the
patient’s perspective and preferences and together figure out what to do. Consider,
for example, a patient with a BRCA mutation who is indecisive about prophylactic
surgery. Pt: “If I have the surgery I won’t be very appealing to my husband.” GC:
“He’s told you that?” (closed question) Pt: “No, but it just stands to reason.” GC: “Is
that something you’d like to know?” (closed question) Pt: “Yes, it would help me
feel more certain about what to do.” GC: “What do you think about discussing it
with him?” (advice) Pt: “I could do that.” GC: “What do you think you would say to
him?” (open-question).
Butler et al. ( 2010 ) similarly suggest an indirect approach, using implied advice
or questions that ask patients to evaluate the relevance or applicability of certain
actions to their own situation. These questions allow the genetic counselor to avoid
directly telling patients what to do, respect their experiences and perspectives, and
allow them to retain authority over their own decisions and actions. An example of
implied advice in genetic counseling is asking a patient, “What have you done in the
past to make a major decision?” This question implies the patient may wish to con-
sider taking similar actions about her or his current situation.
10.1.2 Advice Giving in Genetic Counseling
Genetic counseling patients may expect you to provide advice because they view
you as an expert on genetic and medical topics and therefore assume you will give
advice as you know what is “best” to do in a particular circumstance. As Kessler
( 1997 ) cautions, however, the provision of advice “is often a vote of no confidence
in the client’s own ability to sort things out for themselves and arrive at their own
conclusions. It needs to be remembered that most of the people seen for genetic
counseling are experienced decision makers; they have already made multiple
10.1 Advice Giving