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the profession. Conversely, the patient may be trying to deflect the discussion away
from more sensitive topics.
When the patient’s question is about a relatively low-intimacy topic, you could
answer the question, observe the patient’s nonverbal reaction, and then decide
whether to follow up with a question such as “Can you tell me more about why you
are asking?”
When patient questions are about more highly intimate topics, try to determine
the “latent question” behind their request before deciding whether to self-disclose.
Does your patient really want the information? Is she hoping for a particular answer?
Is the patient looking for your support? Is your patient actually saying she doesn’t
trust her own judgment? Is she questioning your ability to be helpful? Questioning
whether you can truly understand her situation? Wanting you to tell her what to do?
Wanting to know what your other patients do so she can do the same? Wanting to
make you responsible for the outcome of her decisions? Wishing to “lighten the
tone”/take a break from her intense feelings by shifting the focus to you? Hoping
you will side with her when she disagrees with her partner or other family member
who attends the session?
Sarangi et al. (2004) noted that “Typically the clients’ framing of the question to
counselors—“what would you do if it were you”—is often referred to as the ‘infa-
mous question’ in genetic counseling. It is very likely that whatever the counselor
says in response to such a question may be heard as potential advice... This means
that the counselor has to work hard—interactionally speaking—so as to avoid an
advisory role if s/he did not want it” pp. 137–138).
Depending on the patient’s question and motivation for asking, one of the follow-
ing responses might be appropriate:
- “I’d be happy to tell you what my experience has been, but first, I’d like to know
a little bit more about why you’re asking.” - “What are you hoping I will say?”
- “Perhaps you’re hoping that I’ll be able to give you the right answer? What I
would do in your situation may not be appropriate for you. Let’s try together to
figure out which option is best for you.” - “Many of my patients ask this question. Here are some of the issues they con-
sider in making their decision. Let’s see if any of these apply to you.” - It seems that by asking what my other patients do, you’re wanting to know if
your decision makes sense. - This is such a difficult decision. In some ways, it would be nice if someone could
just tell you what to do.
Thomas et al.’s ( 2006 ) genetic counselor participants suggested genetic coun-
selors should follow up self-disclosure by “...variously asking, ‘What were you
hoping I would say?’; ‘I’m guessing that’s not the response you were hoping for’;
‘Do you think my answer means I can’t understand you?’; or, ‘What does my
answer mean for you and your situation?’...[and] when genetic counselors dis-
close, they should clarify differences between their and the patient’s situation”
(p. 178).
11 Counselor Self-Reference: Self-Disclosure andfiSelf-Involving Skills