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The genetic counselor also had a 14-year-old daughter and a 10-year-old son. The
counselor felt very strongly that this patient should not be tested, but she tried to
present the pros and cons objectively. She felt a need and desire to protect this
14-year-old girl. The patient’s mother was clearly still struggling with her grief and
was very fragile. The mother’s reasons for testing all seemed to relate to her own
needs rather than to her daughter’s needs.- A genetic counselor with a history of infertility met with a patient who went
through infertility treatment, and the counselor asked the patient several ques-
tions about procedures, feelings, and how the patient got pregnant—all unrelated
to the indication for genetic question but of interest to the genetic counselor. - A genetic counselor who recently had a baby met with a patient who had a
6-month-old baby and was pregnant again. The genetic counselor commented
that it must be a shock to be pregnant again and that the patient must be very
tired. The patient informed the counselor that this was a planned pregnancy and
that she was not shocked. - The genetic counselor had a patient who was a 23-year-old single woman whose
fetus had just been diagnosed by ultrasound as having Achondroplasia. The patient
struggled with the decision about whether or not to continue the pregnancy. The
genetic counselor had an abortion as a teenager and now regrets that decision. The
genetic counselor viewed the patient’s indecision as wanting someone to tell her
that it’s OK to keep the baby and to raise it as a single mother. The patient repeat-
edly asked the genetic counselor if she should keep her pregnancy. The counselor
explained that the baby would most likely still have a very good quality of life. - A genetic counselor who had struggled with 18 months of active infertility treat-
ment believed her patient’s attitude toward pregnancy was all wrong. The
16-year-old patient, who came to clinic with her mother, was immature, naive,
and afraid of needles, so she refused to have any of the available screening/test-
ing options that might help identify if there was a genetic problem in the preg-
nancy (anomalies had been seen on the ultrasound). The genetic counselor
shifted her focus and talked primarily with the patient’s mother. - Whenever patients have refused to have a student attend a counseling session, the
supervising genetic counselor suspects a transference issue is present. For
instance, the patient wishes to exert control over the session, as a reaction to pos-
sibly feeling powerless in the exchange. The genetic counselor’s countertransfer-
ence in these situations is sometimes to assess the patients as manipulative even
though she has not explored their reasons for limiting student contact. Maybe
they have had a bad experience with students in the past, or are simply private
people, or any variety of other explanations. - The genetic counselor has a bit of a problem with authority, so counseling law-
yers and judges is a challenge for her. She comes to these sessions with some
uneasiness. She had one judge offer to examine her clinic’s consent form outside
of the session, and he produced a three-page brief on the form’s merits and limi-
tations. This simply confirmed her uneasiness in these sessions. - The genetic counselor had a particularly grueling session discussing first trimes-
ter screening results with a patient who was a statistician. The algorithm for
12 Genetic Counseling Dynamics: Transference, Countertransference