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- A 33-year-old patient was referred because her prenatal screening showed that
her risk for Down syndrome was 1 in 44. The risk for Down syndrome in her last
pregnancy was 1 in 180, but she reported that everything “turned out perfect.”
Although she had never met with a genetic counselor before, she assumed the
genetic counselor was a “spoiler” of her experience. She hardly listened during
the session and kept saying, “Those blood tests are always wrong anyway.” She
even refused to have an ultrasound because she didn’t want to be told any more
“fake bad news.” - A fairly common transference situation involves patients who come to the clinic
completely exhausted or enraged due to a difficult commute or difficulty parking
at the clinic. Although the travel experience is not without tribulations, the
patients usually have transferred their concerns about undergoing a genetic con-
sultation. They may later say that getting to the office was not that big of a deal;
they were just nervous about the visit.
12.1.2 Responding to Patient Transference
There is no single way to respond to patient transference. Depending on the situa-
tion and patient, you might try one of the following strategies:
- Simply accept it. Handle transference feelings as you would any type of patient
feeling. Let patients express the feelings and allow them to either take back their
feelings or continue to express them (Schema et al. 2015 ). - Recognize it. Recognizing that transference may be happening allows you to
understand it and avoid overreacting to patient distortions (Djurdjinovic 2009 ;
Schema et al. 2015 ). Clues that transference is happening include your feelings
of confusion and discomfort and your belief that the patient’s behavior contains
some amount of distortion and misperception (Djurdjinovic 2009 ). - Decide whether to address it. You should be careful about drawing patient atten-
tion to transference because, “A hasty decision to correct can be disruptive to the
working relationship...the resulting confusion may elicit a more intense response
from the counselee” (Djurdjinovic 2009 , p. 145). Given your time constraints
and the scope of what you must accomplish, genetic counseling may not be the
appropriate venue for dealing with transference. You might, however, choose to
gently address mild expressions of transference in order to decrease their impact
on the session. For example, a patient says she’s angry that you cannot absolutely
ensure a healthy child based on prenatal test results. You might respond, “I won-
der if part of what you’re angry about is that you think I’m giving you the run-
around, just like the other medical professionals you’ve seen.” - Ask clarifying questions. For example, “You seem really angry. Can you tell me
what’s bothering you?” This response is a prelude to advanced empathy (see
Chap. 8 ), but first explore the patient’s attitudes and give the patient the opportu-
nity to do her or his own interpreting.
12 Genetic Counseling Dynamics: Transference, Countertransference