313Observe patient reactions. Bonovitz ( 2006 ) stresses the importance of “hearing
the personal impact” (p. 298) of your self-disclosure on the patient, rather than
assuming you know what its effect will be.
Consider patients’ individual characteristics. Some patients are dependent
decision- makers who rely on others to make their decisions for them. Be watchful
for this motivation if a patient asks you what you would do. If you decide not to
disclose, you might try using a strategy recommended by Kessler ( 1992 ). He sug-
gests that genetic counselors avoid answering questions about what to do by redi-
recting attention to process issues (e.g., a young genetic counselor responded to
questions about whether she had children by saying that perhaps the patient was
wondering if she would be able to understand). If you do choose to disclose, con-
sider not only saying what you would do, but also describing your decision-making
process in order to help patients understand (and possibly use) a similar process. For
example, “When I decided to have BRCA testing, I first discussed the decision with
my sisters and my daughters, because I knew the results could directly affect them.
I found it helpful to have their perspective, even though it may not have changed my
decision to be tested.” Relatedly, patient cognitive functioning may be an important
consideration. Individuals with intellectual disability may be more inclined to imi-
tate the behaviors of the expert.
Additional individual characteristics include the patient’s age. Peterson ( 2002 )
notes that in psychotherapy, self-disclosing with adolescents “...can model open-
ness and authenticity” (p. 27).
Consider patients’ cultural characteristics. You should consider answering some
direct questions if you think it will help to build a trusting relationship. Conversely,
self-disclosure may be contrary to the basic values of some cultural groups. Try to
familiarize yourself with the disclosure norms of different cultures. When you sense
there is a cultural “disconnect” between you and the patient, self-disclosure that
acknowledges the differences may help to build rapport/trust (Burkard et al. 2006 ).
Also, disclosing your own “unique cultural influences and ethnicity is one example
of self-disclosure that demonstrates willingness to include and respect diverse cul-
tural influences” (Dewane 2006 , p. 556).
Glessner et al. ( 2012 ) surveyed genetic counselor attitudes and practices when
counseling GLBT patients. Forty-six counselors (23.6%) reported having disclosed
their own orientation to a patient, either directly or indirectly by mentioning a part-
ner or displaying a wedding photo. The most common reasons to disclose were
patient inquiry, normalization of patient feelings and reactions, rapport building,
and trust building. The GLB counselors in the sample also mentioned helping the
patient to not feel alone, conveying that they understood the patient, and decreasing
patient anxiety as motivations for self-disclosure.
Be honest. Tell the truth when you share information about yourself and why you
are sharing it with patients as well as why you do not share certain information
(McCarthy Veach 2011 ). Skillfully explaining your behavior seems to have a stron-
ger effect on the counseling process than whether you actually disclose or refrain
from disclosing (Balcom et al. 2013 ; Hanson 2005 ; Redlinger-Grosse et al. 2013 ).
For instance, Balcom et al.’s ( 2013 ) prenatal genetic counselor participants noted
11.1 Self-Disclosure