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3.5.3 Genetic Counseling Modalities
The format for genetic counseling may pose attending challenges. Goodenberger
et al. ( 2015 ) note that a majority of a laboratory genetic counselor’s communication
takes place by telephone and often involves brief interactions with health-care pro-
viders or patients. They stress that the way in which lab genetic counselors present
themselves “...is especially important because the [recipient of the communication]
has only verbal cues to react to as opposed to the nonverbal cues present in a face-
to- face encounter” (p. 8). Moreover, counseling over the phone precludes physically
attending to the sorts of patient body language available in face-to-face interactions
and does not allow the genetic counselor to mirror that body language. They further
note restrictions on the use of visual aids to inform and educate. They recommend a
laboratory genetic counselor adapt to these limitations by “increasing his or her
sensitivity to vocal cues, such as listening carefully for key words or phrases that
can be used to assess understanding or needs... For example, he or she may try to
counter a client’s hurried pace if it is felt that more time is needed for adequate
understanding. The specific words a genetic counselor chooses when describing
technologies and discussing test results over the phone become very important
because of the inability to use visual aids and nonverbal cues” (p. 15). These recom-
mendations are also useful if you work as a clinical genetic counselor as you often
engage with patients by phone (e.g., to call out test results, answer patient questions
that arise outside of the session).
Telehealth, such as telephone counseling, also limits the available nonverbal cues
(Peshkin et al. 2016 ; Zilliacus et al. 2010 ). Research demonstrates that key differ-
ences between telephone genetic counseling and face-to-face counseling involve
ways in which counselors go about “establishing rapport through verbal and non-
verbal interactions...recognizing factors affecting the counseling interaction...
assessing client/family emotions, support, etc....and educating clients about basic
genetic concepts [e.g., in the absence of visual aids]” (Burgess et al. 2016 , p. 112).
Participants in the Burgess et al. ( 2016 ) study “...pointed to the inability to read
the patient’s body language and assess nonverbal cues as factors that adversely
impacted their ability to build rapport, assess understanding, and make psychosocial
assessments” (p. 116). Several of their participants described modifying their
genetic counseling approach in the absence of nonverbals. For example, “At the
beginning of the conversation I usually explain to the patient that since we are not
in the same room I cannot read their non-verbal cues and need them to speak up if
they have questions or get confused. I am almost never this blunt during in-person
discussions”; “...counseling when not in person requires much more verbal check-
ing in to ensure and confirm understanding”; and “Evaluating a client’s risk percep-
tion and response and modifying counseling requires closer attention to verbal cues
in telephone counseling since facial expressions and body language cannot be
assessed” (p. 118). One participant mentioned an approach for addressing patients’
psychosocial needs: “I have actually said to people ‘I know this is an emotional
topic, and since I can’t see you, I may miss a sign that the information is upsetting
3 Listening tofiPatients: Attending Skills