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

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Patient Anger

Schema et al. ( 2015 ) interviewed genetic counselors about patient anger directed
at them. Their participants noted that patient expressions of anger range from
“yelling or screaming” to more subtle, indirect nonverbal behaviors “such as act-
ing uninterested in the information shared” (p.  723). One of the counselors
described typical indirect expressions as “‘walking in, arms folded, short answers
to questions, not smiling, and tense tone’” (p.  723). Baty ( 2010 ) similarly
describes nonverbal expressions of patient anger as disengagement during a
genetic counseling session, characterized by not listening closely and/or not
thinking critically about information the counselor presents. Additional nonver-
bal clues of possible anger include failure to complete requested paperwork
before coming to the session, arriving late, and responding minimally to genetic
counselor statements (Smith and Antley 1979). Good psychological attending
skills will allow you to recognize these clues and consider whether they indicate
patient anger.

Couple Interactions

Schoeffel et  al. ( 2018 ) interviewed genetic counselors about their experiences
with couple conflict in prenatal sessions. Every counselor noted the couples’
nonverbal behaviors provided clues that they were in conflict. These clues vari-
ously included turned or leaning away from each other, crossed arms, lack of
participation, physical/facial reaction to what partner is saying, sighs of exas-
peration, looking away, rolling their eyes at partner, glaring/scowling, tone of
voice, sitting apart in the waiting room, leaving the room, energy/tension in the
room, fidgeting, not talking to partner, and not touching partner when in a diffi-
cult situation.
Lafans et al. ( 2003 ) interviewed prenatal genetic counselors about their experi-
ences of paternal involvement during prenatal sessions. They identified a number of
nonverbal behaviors suggesting:

1. Appropriate paternal involvement: appears to be attentive and gives eye contact
   to the counselor, sits close to partner, touches her and/or holds her hand, leans
   forward to observe visual aids, faces the counselor, and nods at the counselor
   (pp. 222–223).


2. Paternal under-involvement, that is, “disengaged, distracted, uncooperative, and/or
   defensive” (p.  235): looks away/stares into space, appears passive/disinterested/
   yawns, engages in other activities (reads magazine/newspaper, uses cell phone/com-
   puter), slumps/slouches/leans back in chair, and falls asleep during the session.


3. Paternal over-involvement, that is, “exhibiting behaviors that control the content
   and flow of sessions, ignore their partner’s needs or feelings, and/or promote
   their own agenda” (p. 235): one of these behaviors could be considered nonver-
   bal, namely, interrupts the genetic counselor.

3.5 Challenges in Attending