305avoided disclosure they judged to be highly directive, either because of its content
(e.g., personal opinions and pregnancy decisions) and/or because of perceived
patient motives for asking the question (e.g., wanting the counselor to make their
decision)” (p. 370).
Self-disclosure is not always a response that you will initiate, as patients will
often ask you to disclose. Some research suggests patient requests comprise a preva-
lent reason for genetic counselors to self-disclose. Peters et al. ( 2004 ) investigated
the effects of being a recipient of genetic counseling services on genetic counselors’
own practice. A large percentage of their survey respondents reportedly had self-
disclosed about their experiences to their patients, and the most common reason was
because their patients asked them to disclose. Thomas et al. ( 2006 ) interviewed
practicing genetic counselors who had previously received genetic counseling ser-
vices about their general self-disclosure practices. Similar to Peters et al. ( 2004 ),
they found that the most prevalent reason to self-disclose was because patients
asked them to do so, although not every counselor disclosed about her or his receipt
of genetic counseling services.
We believe self-disclosure, when used strategically and sparingly, is acceptable
to some patients. You must always make a conscious decision of whether to disclose
and how much and in what ways to directly share yourself in the genetic counseling
relationship (McCarthy Veach 2011 ). Moreover, “an ‘immutable rule’ regarding the
use of self-disclosure (e.g., ‘never disclose,’ or ‘always disclose’ certain informa-
tion) is not feasible. Genetic counselor self-disclosures and non-disclosures should
be done skillfully and only in the patient’s best interests” (Balcom et al. 2013 ,
p. 371).
11.1.2 Indirect versus Direct Self-Disclosures
A certain amount of self-disclosure is always present in genetic counseling sessions,
as it’s impossible to avoid revealing some information about yourself. Every behav-
ior you engage in with a patient (your facial expressions, posture, voice tone, etc.)
reveals something about you (McCarthy Veach 2011 ). Furthermore, patients may
read into your behaviors. They may determine (not always accurately) whether you
approve or disapprove of their actions, whether you would or would not make the
same decision, etc.
Your personal characteristics also communicate information that patients will
actively interpret:
- Gender (e.g., a prenatal patient may believe you can understand her situation if
you are a woman, and question your ability to understand if you are a man). - Age (e.g., you appear to be too young to know what it’s like to have experienced
years of infertility.) - Race/ethnicity (e.g., the patient may feel some distance if you appear to be of a
different racial or ethnic group).
11.1 Self-Disclosure