315amniocentesis and asked the genetic counselor either “What would you do if you
were me?” or “Have you ever had an amniocentesis?” Participants wrote a response
to the patient as if they were the genetic counselor and then explained their response.
Rates of self-disclosure were significantly higher for “What would you do if you
were me?” than for “Have you ever had an amniocentesis?” Similar to Balcom et al.
( 2013 ), responses included personal disclosure, professional disclosure, or a mix-
ture of the two. Prevalent reasons to self-disclose were to promote decision-making,
remain patient focused, build the relationship, enhance counselor credibility, and
counselor comfort with disclosure.
Nondisclosure responses included declining to answer [e.g., “This is an indi-
vidual situation and what would be best for me may not be what is best for you.
What information have I given to you today that has you questioning your original
plan?” and “I understand that you are struggling with this decision, but whether or
not I’ve had an amniocentesis isn’t important. We should discuss what your thoughts
and feelings are and what I can do to help you make the decision” (p. 462)], and
redirection [e.g., “I am wondering if you are asking what I would do because you
are feeling unsure about wanting an amniocentesis?” and “How do you think that
knowing if I had underwent [sic] amniocentesis may or may not influence your
decision?” (p. 462)]. Prevalent reasons for not disclosing were nondirectiveness, to
remain patient-focused, to support/empower the patient, to maintain the counselor’s
privacy, and self-disclosure was not relevant.
The researchers categorized both disclosure and nondisclosure responses accord-
ing to their emphasis. Some were corrective and literal responses, in which partici-
pants took the patient’s questions at “face value” without attempting to get at the
motivation behind her questions. Other responses were interpreting statements in
which participants tried to explore the patient’s motivations. Redlinger-Grosse et al.
( 2013 ) also noted some responses were nondirective self-disclosures. Nondirective
self-disclosures are responses that avoided influencing the patient’s decision (e.g.,
disclosing that they had never been pregnant and therefore could not answer the
patient’s question; or disclosing that they did not wish to influence the patient’s
decision). The researchers noted that nondirective disclosures have a potential
drawback “...patients could easily shift their question to, ‘But what if you were
pregnant?’ Thus, nondirective self-disclosure of this sort might lead to further
patient self-disclosure requests” (p. 465).
Here are several additional examples of the types of self-disclosures genetic
counselors have made to their patients:
- “I think that, too. Sometimes all the technology we have today just makes things
more difficult. It sure would have been simpler to be pregnant 100 years ago.” - “I think that I would also have a difficult time deciding what to do.”
- “I am also a very fact-oriented/information-seeking person, so I can understand
your need to know everything possible before making a decision.” - “I don’t have children yet, so I don’t know first-hand what it’s like to have to
make a pregnancy decision. But I have walked through similar situations with
my patients in the past.”
11.1 Self-Disclosure