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where we are right now, which is [trying to determine your actual risk for devel-
oping breast cancer]...” (p. 53).- To express a medical opinion. In the Kao ( 2010 ) cancer scenario, one counselor
said: “... Having surgery is a big step that may or may not be appropriate, and it
is not a decision that should be made rashly...” (p. 54); another counselor said
“... Everyone on the team is interested in getting you the medical care you need.
It is as important to go about this in an orderly fashion as it is to do everything
quickly” (p. 54). - To normalize patient experiences. In the Kao ( 2010 ) scenario involving a patient
with Fabry disease, the patient described her intensely painful symptoms of the
disease. Examples of differently nuanced genetic counselor influencing responses
include normalizing responses—“We go through life wanting to live and be
happy, but this can be a very complicated thing to do when we are suffering
through chronic and intense pain...” (p. 70); “... Pain is one of those things that
you can’t accurately imagine experiencing until it happens to you...” (p. 70); and
“I think it’s very normal to feel scared of the pain and to not know what will hap-
pen after you pass out...” (p. 70). - To acknowledge the patient’s resiliency and ability. In the Kao ( 2010 ) Fabry
disease scenario, some counselors said, “... It really is an act of bravery to get
through it each and every time you have an episode of pain” (pp. 70–71); “You
must be a very strong person to be able to endure that kind of pain...” (p. 71);
and “... You have actually done a very good job of explaining the pain...” (p. 71).
11.3 Closing Comments xvii
Keep in mind that medical recommendations and advice are necessary and appro-
priate in genetic counseling. In this chapter, we focused on other situations in
genetic counseling where you might consider using advice and influence. These are
powerful skills because they can be quite directive. Therefore, we recommend that
before using either advice or influencing responses, you ask yourself: “How can I
best be responsive to this patient’s needs?”
11.4 Class Activities
Activity 1: Advice (Think-Pair-Share Dyads)
Students think about a time that someone gave them advice that was very ineffective.
What was it like? How did the person present the advice? Now, think about a time
when they received advice that was very effective. What was it like? How did the
person present the advice? Have students discuss their experiences with a partner.
10 Providing Guidance: Advice andfiInfluencing Skills