Facilitating the Genetic Counseling Process Practice-Based Skills, Second Edition

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value calculation was dissected, and the issue became the process, and not the

implications of testing. It was as if there was no baby in the equation, just a risk

assessment problem. Since this session, the genetic counselor found herself

dreading sessions with statisticians.

• Some pregnant prenatal counselors worry about self-disclosing in ways that
  would unduly direct their patients’ decisions (Menezes et al. 2010 ).


• Lafans et al. ( 2003 ), in a study of genetic counselors’ experiences of problematic
  paternal involvement in prenatal counseling, noted this example: “One partici-
  pant finds it difficult to deal with a father’s over-involvement that elicits counter-
  transference due to her own family of origin issues (...hardest for me are the
  really domineering [fathers]—“I’m going to tell the little wife what she should
  do”—because that kind of is the setting I grew up in, and it’s kind of hard to deal
  with—to get him to back down a little bit...My tendency is to just say, ‘Would
  you just shut up a minute!’ and, obviously, we can’t do that)” (p. 239).


• In some instances, your patients’ behaviors may provide you with a clue that you
  are experiencing countertransference (Cerney 1985 ). For example, your patient
  says, “You sound just like my mother...”; or “You look so upset! I’ll be OK”; or
  “I know you want me to make a decision, but I just can’t yet!” (One caution in
  interpreting these patient comments as signs of your countertransference is that
  they may be due to the patient’s transference!).

12.1.5 Management of Countertransference Feelings

There are several strategies you can consider using to recognize and manage your
countertransference:

• Accept the inevitability of countertransference. It happens to everyone some-
  times. It does not mean you are a bad genetic counselor or a bad person. An
  accepting, nondefensive attitude is essential.


• Locate the source of feelings. Weil ( 2010 ) describes three potential origins of
  one’s emotions: “(1) it is a normal response to the situation [this is not counter-
  transference]; (2) it involves the counselor’s personal issues; and/or (3) it is a
  response to the patient’s emotions and behaviors” (p. 189). To locate the source,
  ask yourself, “I wonder why this is so. Why did I make this particular response
  to this person’s remark? What was behind it? What was I reacting to when mak-
  ing this remark? Why did I ask that question? Was it really to help my patient?”


• Practice self-regulation, that is, intentional self-reflection and awareness of your
  countertransference, and set and maintain appropriate boundaries in genetic
  counseling (Reeder et al. 2017 ).


• Seek supervision assistance/consultation/feedback (Geller et al. 2010 ; McCarthy
  Veach 2006 ; Peters et  al. 2004; Reeder et  al. 2017 ; Weil 2010 ; Zahm et  al.
  2008 ). As countertransference can be mostly unconscious, it may not be detected
  until after it has happened (Reeder et  al. 2017 ). Therefore, self-reflection and

12.1 Transference and Countertransference