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patient satisfaction. Philippot et al. ( 2003 ) similarly report that clients who perceive
their psychotherapists as in tune with them feel positively about their therapists and
the relationship.
Some authors theorize that the positive effects of attending skills are due to “per-
ceived responsiveness” (Dowell and Berman 2013 ; Lemay et al. 2007 ; Murray et al.
2006 ; Reis et al. 2000 ) or the extent to which an individual believes the other person
“understands, values, and supports key aspects of the self” (Dowell and Berman
2013 , p. 159). We believe perceived responsiveness is an essential aspect of effective
genetic counseling, and therefore all genetic counseling practice relies upon a solid
base of attending behaviors. Effective psychological and physical attending can con-
vey your involvement and understanding; build rapport; encourage patients to self-
disclose; increase patient perceptions that you are expert (competent and professional),
socially attractive (warm, likeable), and trustworthy; and build a foundation from
which you may understand and assist patients in their decision-making.
Good attending, however, can be difficult to achieve for any number of reasons.
A genetic counselor may find it difficult to focus on a patient if she/he is aware of
other pressing clinical responsibilities or time constraints. A genetic counselor’s
pager may be vibrating, the patient may be late for another scheduled appointment
or procedure, other health-care team members may interrupt the session, etc.
Sometimes, factors inherent to the session, such as the presence of small children
and patients who are experiencing physical symptoms (e.g., nausea in a pregnant
woman), may make it difficult for both the genetic counselor and the patient to
focus their attention. In some cases, student or novice genetic counselors may have
difficulty fully attending to a patient if they are anxious about their own
performance.
3.2 Effective Genetic Counselor Psychological Attending
Skills
Effective psychological attending consists of three major activities: observing and
responding to patient nonverbal behaviors, understanding patient body and facial
movements, and noticing subtle cues. We suggest the following strategies as general
guidelines:
3.2.1 Observing and Responding to Patient Nonverbal
Behaviors
- Pay attention to patient nonverbals and think about their possible meaning (e.g.,
if the patient is gripping the arms of the chair, it may indicate that she/he is
anxious). - Notice incongruences between patient nonverbal and verbal behaviors (e.g., say-
ing “yes” while shaking one’s head “no”). In general, you should go with the
3 Listening tofiPatients: Attending Skills