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supervision are so crucial. You might realize after a genetic counseling ses-
sion that you were acting out of character, or your supervisor or another col-
league might comment on the intensity of your feelings about a patient or
situation (either intense liking or dislike, intensely defensive, etc.). These are
clues to countertransference. After a challenging genetic counseling session,
it may be useful to ask yourself what, if anything, was out of character for you
(Cerney 1985 ).- Analyze sessions with your supervisor. Seek personal counseling/psychotherapy
if your countertransference is fairly pervasive and you are unable to manage it
with the preceding strategies (Hyatt 2012 ; Reeder et al. 2017 ; Weil 2010 ).
12.2 Distress and Burnout
12.2.1 Distress
Genetic counseling requires intense involvement with patients on a highly personal
level. Both technical expertise and sound emotional health are necessary to meet the
demands of the profession. The practice of genetic counseling can be very stressful.
Often patients have genetic conditions and situations for which there is no remedy.
Additionally, whether you are at the beginning of your career or have been in the
genetic counseling profession for many years, you face the continuing challenge of
remaining involved and satisfied with your work (Miranda et al. 2016 ; Zahm et al.
2016 ). This can be difficult because distress and burnout are common in the genetic
counseling profession (Bernhardt et al. 2009 ; Johnstone et al. 2016 ; Werner-Lin
et al. 2016 ).
What is distress? It is physical, emotional, and cognitive reactions to overload.
There are several signs and symptoms, including feeling emotionally drained, over-
whelmed, and out of control; physical, mental, and emotional fatigue; feeling reluc-
tant or dreading going to work and seeing patients; physical reactions such as
headaches, stomach complaints, and back pain; having a cynical attitude toward
patients and/or feeling too detached from them; lack of satisfaction; and questioning
whether you are being helpful or are doing anything meaningful (Geldard and
Anderson 1989 ).
One factor that leads to distress (and burnout) is taking on too many commit-
ments to the point where you feel as if you are always working and always behind
(Volz 2000). Another common risk factor is working alone or in isolation from oth-
ers (Lee et al. 2015 ; Udipi et al. 2008 ; Volz 2000). The less time you make for
yourself and the more isolated you become in dealing with your reactions to your
work, the more likely you are to develop symptoms of distress. Another factor
involves difficulties maintaining appropriate boundaries in your counseling work.
Although you must develop an empathic connection with patients in order to be
effective, you must be careful about becoming overly involved: “With experience
you will learn how to walk beside the client with empathy and also how to protect
12 Genetic Counseling Dynamics: Transference, Countertransference