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reducing your own anxiety or to avoid disappointing, frustrating, or angering the
patient (Dewane 2006 ; Henretty and Levitt 2010 ; McCarthy Veach 2011 ). Before
disclosing, ask yourself: Will my disclosure help the patient open up, see a different
perspective, or move toward a decision?
Thomas et al.’s ( 2006 ) genetic counselor participants identified certain situations
in which they felt “obliged to disclose” including when they were obviously preg-
nant, when they strongly identified with the patient, when patients requested them
to self-disclose, and obvious counselor characteristics (e.g., an accent).
Menezes et al. ( 2010 ) interviewed prenatal genetic counselors about the personal
impact of their work and similarly found that genetic counselors were faced with
“inadvertent” or “unavoidable” self-disclosure about their pregnancy. Nine of 11
counselors who had been pregnant while working in the prenatal setting reported
having disclosed the type of testing they had during pregnancy. Yet, the counselors
experienced conflicts about self-disclosure, including feeling “forced” to disclose
about their very personal experience of pregnancy. The authors concluded the coun-
selors “...were aware that they were relating to clients differently, perhaps more on
a personal level, and realizing the need to keep a professional distance. This seems
to be where the worry of self-disclosure lies, as counselors were more aware of how
their client may be relating to them because they too were pregnant” (p. 649).
Be intentional. Keep your disclosure brief and focused. A useful technique is to
make a disclosure and then immediately follow it with a question, “Is that how it is
for you?” or “What do you think (or how do you feel) about what I just said?” This
brings the focus back to your patient and helps the patient use the information for
his or her own situation (McCarthy Veach 2011 ).
Choose an appropriate intimacy level. As self-disclosures range on a continuum
from demographics to highly personal experiences, you must be sensitive enough to
choose a level that will not overwhelm or alienate your patient. For example, Balcom
et al. ( 2013 ) found that prenatal genetic counselors’ use of self-disclosure was
sometimes unsuccessful when patients viewed it as “oversharing” personal infor-
mation. One way you might gauge the intimacy of a disclosure is to ask yourself
how many other individuals you have told this information to in the past (McCarthy
and Oakes 1998).
Choose an appropriate time. If you disclose too soon, you allow patients to avoid
the painful work of making decisions for themselves. You risk having them grab
onto your experiences and solutions or those of your previous patients. They do not
work it through, and they risk selecting an option that is not the best for themselves.
For example, some patients know exactly how they are going to handle a situation;
others will tell you they don’t know what they would do. Well-timed self-disclosure
in decision-making situations ideally is after patients have described where they are
in the decision-making process and directly or indirectly ask for help in making a
decision.
Be conservative. When disclosures are too frequent, too intense, and/or too
lengthy, they can shift the focus to you, burden your patient with your problems, be
11 Counselor Self-Reference: Self-Disclosure andfiSelf-Involving Skills