319- “I’m sorry this conversation is making you very uncomfortable. I know that
you’ve been given a lot of information all at once.” - “I can see now that termination of your pregnancy is not an option for you, and I
apologize if my bringing it up has made you uncomfortable. I just wanted to be
sure you were aware of all of your options.” - “I’m terribly sorry to hear that your son died.” (This was not related to the con-
sult; he did not die of a genetic condition. You should comment on issues that are
extremely important to the patient but are unrelated to the topic at hand). - The genetic counseling session involved a prenatal patient and her partner. The
ultrasound revealed a neural tube defect. Her partner was very hostile and dis-
trustful. The counselor said, “I sense that you’re having difficulty believing the
information I’m giving you.” - The patient and her partner were seen for genetic counseling to discuss prenatal
diagnosis. Her partner was reading a magazine during the session. The counselor
said, “I feel somewhat uncomfortable with your reading a magazine. Your input
is important in this discussion.” - “I’m worried that you’re blaming yourself for your child’s condition.”
- “I’m concerned that you are not willing to share this information with your sister.
I know you do not want to upset her, but I worry about how she might feel if she
develops breast cancer and learns that she could have prevented it or found it
early. Is there something I can do to help make this easier for you?” - Regarding cancer testing: I’m sorry the process takes a long time. I can see why
you would be anxious” (Kao 2010, p. 60). - Regarding a patient with Long QT: “... I wish we had a window into knowing for
you if it would all work out fine....” (Kao 2010, p. 86).
12.5 Closing Comments
Self-disclosure and self-involving responses are powerful skills that occur less
frequently than many of the other counseling skills we’ve discussed in this
text. Because self-referent responses can be quite directive, we recommend
that before self-disclosing or expressing your here-and-now reactions to the
patient, you ask yourself two questions: “Whose needs are being served by my
response?” and “Could I achieve the same results with a less directive
intervention?”
Self-referent responses are advanced helping skills. You can expect to become
more comfortable and more effective using these skills after you have established
solid attending, primary empathy, and questioning skills. Also, your self-refer-
ence skills should improve as you see more genetic counseling patients. As with
all counseling skills, the most important thing is to genuinely care for your
patients.
11.3 Closing Comments