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

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Table 2.1 Reciprocal-Engagement Model (REM) of genetic counseling practice—preliminary
strategies and behaviors corresponding to REM tenets and goals

Goala Strategya Behaviora Additional strategiesb

Tenet: Genetic information is keya

Patient is informed Assess patient

educational level

Assess patient

decision-making

style

Open and closed

questions to gather

history and to

determine what

patient understands

Open and closed

questions

Information giving

Use psychosocial

counseling skills/strategies

Establish working alliance

Counselor knows

what information to

impart

Assess medical

literacy

Listen for

inaccuracy

Ask questions

Open and closed

questions to

determine patient

understanding; repeat

or rephrase

information

Information giving

Use psychosocial

counseling skills/strategies

Assessment

Counselor presents

genetic information

Two-way

communication

Use visual aids

Explain materials; use

language patient can

understand

Information giving

Assessment

Use psychosocial

counseling skills/strategies

Patient gains new

perspectives

Assess patient

understanding

Open and closed

questions to learn

what the information

means to the patient

Assessment

Use psychosocial

counseling skills/strategies

Information giving

Tenet: Relationship is integral to genetic counselinga

Counselor and

patient establish a

bond

Active listening Sit quietly; reflect

patient thoughts and

feelings; summarize

patient statements;

rephrase; use similar

body language

Establish working alliance

Use psychosocial

counseling skills/strategies

Information giving

Good counselor-

patient

communication

• – Information giving
  Use psychosocial
  counseling skills/strategies
  Establish working alliance
  Counselor
  characteristics
  positively influence
  process

Behave ethically

Recognize impact

on session

Maintain objectivity

Maintain boundaries

Self-care

Peer supervision

Self-disclose; request

feedback; provide

feedback

Use psychosocial

counseling skills/strategies

Information giving

Establish working alliance

Practice self-awareness

Provide pre-and post-GC

session care

(continued)

2.2 The Reciprocal-Engagement Model of Genetic Counseling Practice