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enact respect and gratitude, yet recipients reserve the right to make their own deci-
sions” (Goldsmith and Fitch 1997 , p. 454).
Based on family therapy literature, when you give advice successfully, you may
offer suggestions that patients perceive as helpful, you may present a new idea they
had not considered before, and your advice may give permission to take an action
they wanted to take anyway (Silver 1991). Advice may provide informational sup-
port and directive guidance, and it may demonstrate caring and give the impression
that a problem is manageable (Goldsmith and Fitch 1997 ). Advice may also instill
hope and confidence that the patient is capable of following a particular recommen-
dation. In this regard, however, you should be sure your advice recommends actions
the patient is capable of doing (that is, has the skills, resources, and opportunity to
follow through on your recommendation). For instance, if you are advising patients
to share relevant genetic test results with at-risk relatives, you might provide
resources (e.g., a letter they can share with relatives) or engage in activities that will
help patients build their skill or confidence in following through on the recommen-
dation (e.g., role-play a conversation they might have with a relative).
Feng ( 2009 ) noted, “As research has shown, unwanted, irrelevant, or redundant
advice is counterproductive in the sense that it tends to meet resistance from the
recipient (e.g., Feng and MacGeorge 2006 ; Goldsmith 2000 )” (p. 118). Patients
may feel criticized because advice indicates they should be doing something differ-
ently, they may feel constrained to consider only the options you raise, they may
feel pressured to follow your advice, and they may become oppositional (i.e., resist-
ing everything you say for the remainder of the session) (Silver 1991). Additionally,
your advice may imply patients lack the ability to come up with their own strategies
or solutions, especially when given before you have sufficiently explored their situ-
ation. Advice may also be seen as an imposition of your values (Couture and
Sutherland 2006 ). Finally, some advice may backfire because your patients are
privy to reasons why it may not be feasible from their perspective, whereas you have
only what they’ve told you so far, as well as more generic knowledge of how patients
react and what they do (cf. Hepburn and Potter 2011 ).
10.1.5 Suggestions for Giving Advice
- Make it clear that certain types of advice are not routinely part of genetic coun-
seling. At the beginning of the session, when you explain the process of genetic
counseling, state that while you will provide information and relevant clinical
recommendations, you otherwise tend to refrain from telling patients what to do
because you prefer to help them come to a decision for themselves. This approach
will tend to limit your advice giving and requests for advice from your patients. - Give advice later in the session. You should offer advice only after you have
demonstrated some expertise on the topic, after you’ve established rapport and
have shown that you care, and only when the advice is appropriate to the situa-
tion. You should also wait until you have listened fully to the patient’s situation
10 Providing Guidance: Advice andfiInfluencing Skills