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they are working repeatedly with a patient population that is very needy and for
whom there is little room for change in the system (e.g., a medical assistance
population, new immigrant populations).
Reeder et al. ( 2017 ) conducted the first comprehensive study solely focused on
clinical genetic counselors’ countertransference tendencies. They found three types
of countertransference:
- Control: “counselor reactions motivated by a desire to exert undue influence over
ambiguity, affect (patient’s emotions or one’s own emotions), and/or the genetic
counseling process” (p. 938) - Conflict Avoidance: “counselor actions motivated by a desire to prevent conflict
due to emotions that might be triggered in patients (e.g., anger) and/or in the
counselor (e.g., insecurity)...the genetic counselor may avoid being direct,
respond defensively to perceived criticism, omit certain topics, skip over certain
topics, and/or minimize certain topics” (p. 938) - Directiveness: “pertaining to actions motivated by a counselor’s desire to ‘push’
patients regarding how quickly to decide or what to decide, and to either press
them to decide on their own or to step in and do some of the decisional work for
them” (p. 940)
They also found one type of strategy for managing countertransference: - Self-regulation: “counselor actions motivated by a desire to manage [counter-
transference] through intentional self-reflection/awareness of ones’ [counter-
transference] and through setting boundaries” (p. 940)
12.1.4 Behaviors that May Indicate Countertransference
Countertransference (and transference) can be very difficult to identify and resolve,
especially because it occurs primarily at an unconscious level. You may have to care-
fully observe and explore your overt and covert behaviors to detect its occurrence.
The following genetic counselor behaviors may indicate countertransference,
especially if you exhibit more than one of them:
- Engage in compulsive advice giving (Weil 2010 ).
- Have unusually strong feelings toward a particular patient (Reeder et al. 2017 ;
Weil 2010 ). - Have “rescuer” fantasies, that is, believing you will be able to help a patient, even
when others have failed (Weil 2010 ), or when there is no resolution for the situ-
ation (e.g., patient is at risk for a familial cancer). - Dread a session or are overly eager for a session with a particular patient (Hofsess
and Tracey 2010 ). - Feel sleepy during the session (Hofsess and Tracey 2010 ).
- Avoid or dislike patient feelings, especially negative feelings directed toward
you. You may avoid feelings by showing disapproval (frowning, interrupting,
etc.), using fewer reflections, and/or giving excessive information (Weil 2010 ).
12 Genetic Counseling Dynamics: Transference, Countertransference