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what we term synchronicity]) between patients and therapists. Higher levels of
synchrony were associated with more positive therapy processes and outcomes,
including clients rating the relationship as higher in quality and reporting an
increase in their self-efficacy.
So, for instance, if your patient is very sad and speaking in a slow, barely audible
manner, you will have synchronicity if you also slow the pace of your speech and
speak more quietly. Or, if a patient is crying, you would not want to smile; instead
your nonverbals should convey caring. If you are tuned in to your patient’s emo-
tions, synchronicity will happen automatically, with little or no conscious effort
on your part. Be careful, however, not to carry this mirroring too far. For instance,
if a patient is very anxious, talking rapidly and loudly, you would only foster
further anxiety if you were to respond in a similar fashion.
- Relax physically. You will be more open to hearing patients if your body is
relaxed and you are breathing regularly and deeply. Try to take a few minutes
before a genetic counseling session to calm yourself and focus your attention. - Do an internal process check. Genetic counselors sometimes become aware that
they are moving too quickly through a session or skipping over important content
in response to patient verbal or nonverbal cues. For example, they may respond
by talking faster or louder when a patient is nodding vigorously or saying “yes,
yes” to content the counselors are providing. Watching for these behaviors may
offer insight into how the patient is feeling and how you are responding (syn-
chronicity) and allow you to “regroup,” that is, sit back, take a deep breath, slow
your pace, and relax your body. - Use eye contact. Eye contact helps you focus on the patient and indicates you are
listening. It’s generally a good idea to look at your patient even if she/he is not
looking at you and is instead staring at the floor or looking at the wall. Eventually
most patients will venture a glance at you, and when they do, it’s important that
they can see you are looking at them. One disclaimer, mentioned later in this
chapter, is to decrease your eye contact if it appears to be making a patient
uncomfortable. - Convey sensitivity. Your nonverbals should communicate concern, alertness, and
vigilance.
3.5 Challenges in Attending
In our experience, challenges in attending are more likely to occur when a genetic
counselor generally has either too much or too little involvement or has an intensity
that is too low or too high. Moderation is key to effective attending. Consider the
following challenges:
- Enthusiasm—In this situation, a genetic counselor displays too much enthusiasm
and energy, to the point of practically violating the patient’s personal space;
talking loudly, quickly, and too cheerfully; nodding excessively (think of a
3 Listening tofiPatients: Attending Skills