61bobblehead doll); and saying “uh-huh” after every patient utterance. At best,
these behaviors can be tiring and, at worst, seem intrusive and patronizing.- Anxiety—A genetic counselor who is feeling overly anxious may avoid eye con-
tact, fiddle with a pen or paper, or exhibit one or more distracting mannerisms
that suggest self-protection. - Detachment—Sometimes, a genetic counselor may seem to be too much of a
blank screen, for instance, using a piercing stare; taking a cold, clinical stance
(facial expression does not change); displaying little or no emotion; and sitting
completely still with no hand or arm gestures. The counselor comes across as
analyzing and/or judging the patient. - Overly Concerned—In this case a genetic counselor displays too much concern
through sad facial expressions, deep sighs, and furrowed brow. These behaviors
suggest the genetic counselor feels the patients’ problems almost more than the
patient does. Patients may even say, “Don’t be so worried! I’ll be ok.” - Low-Key Involvement—When a genetic counselor is too laid-back during a ses-
sion, slouching in the chair, yawning, and dressed unprofessionally (e.g., blue
jeans, low-cut top, short and/or tight clothes), this can be misperceived as a lack
of concern about the patient.
These attending challenges can arise for any genetic counselor at any time. They
are usually prompted by certain aspects of the genetic counseling situation or by
events in one’s personal life. Therefore, it is important to recognize the types of
patient characteristics, genetic conditions, and/or personal life events that may pro-
voke these challenges for you.
3.5.1 Silence or the “Space Between”
Silence is a critical part of psychological and physical attending, and yet it is one of
the more challenging skills to cultivate. The difficulty is due in part to common
misperceptions such as the following: silence is the “absence” of skills (“If I’m
silent, then I’m not doing anything”); silence will make patients (or my supervisor)
think I don’t know what to say or do; silence is a waste of the limited time I have to
engage with patients (“Why be silent when I can always tell patients more of the
ever growing biomedical information?”); and silent patients are simply waiting for
my next question or directive. These perceptions probably make you feel anxious,
and usually they are untrue. We maintain that when you make an effort to challenge
your misperceptions, you will become less afraid of silence and will be able to use
it with greater intentionality. We suggest you work on gaining comfort with silence
and think of it as “part of the interaction rather than the absence of the interaction”
(Sharpley et al. 2005 , p. 158). As you become less afraid of silence and more able
to fully attend to the patient “in the moment,” you will find silence occurs naturally
and appropriately. We also suggest you try to discern the meaning of silences that
you initiate and those that are patient-initiated, as “no two silences are the same.”
3.5 Challenges in Attending