372.2 The Reciprocal-Engagement Model of Genetic
Counseling Practice
“Genetic counseling is directly concerned with human behavior. Thus it must be based on a
knowledgeable understanding of psychodynamics and of the principles of interpersonal
functioning. Also needed is an understanding of the psychological meanings of the issues
with which genetic counseling is involved, namely the issues of health-illness, procreation,
parenthood, as well as the complex processes by which the goals of genetic counseling are
achieved” (Kessler 1979 , p. 21).Although written in 1979, Kessler’s appraisal of the factors that are critical to
genetic counseling hold true today. As the profession has progressed and practice
has matured, it became clear that genetic counseling is a specific practice with a
definite and unique guiding model that is not best defined by borrowing aspects
from other professions. Defining the model of practice for genetic counseling was a
goal that many have grappled with for quite some time.
2.2.1 What Are the Components of a Model of Practice?
A model of practice is not the same thing as a scope of practice (which defines what
activities are involved in a service) nor is it a model of service delivery (which
describes how a population accesses services). A model of practice defines the
tenets, goals, strategies, and behaviors that guide the practice (McCarthy Veach
et al. 2007 ). It embodies the underlying values of the practice, and it clarifies “the
complex processes by which the goals of genetic counseling are achieved” (Kessler
1979 , p. 21). A model of practice directly addresses these questions: “(a) What is the
theoretical framework for the practice? (b) What are the goals of practice? (c) How
do we know when we have met those goals? (d) How do we evaluate the service?
(e) How do we improve services? and (f) How do we teach the practice?” (McCarthy
Veach et al. 2007 , p. 714). A model of practice is critical in that it provides the
framework for teaching the skills necessary for practice, and a model is the basis for
generating the methods used to evaluate the service. Without a model, it is difficult
to teach others how to practice, and it is impossible to measure the impact of the
service and improve the practice.
In 2005, McCarthy Veach et al. convened a consensus conference bringing
together leaders in the profession and educators representing most genetic counsel-
ing graduate programs in North America with the goal of defining the elements of
the genetic counseling model of practice. Educators and leaders in the profession
were able to describe five primary genetic counseling tenets. In addition, some fore-
most goals, strategies, and behaviors that comprise genetic counseling practice were
identified. From this consensus process, the Reciprocal-Engagement Model (REM)
of genetic counseling practice was generated.
2.2 The Reciprocal-Engagement Model of Genetic Counseling Practice