65to you. This can be helpful information to me, so that we can address your concerns,
so please feel free to stop me and tell me if something is upsetting to you’” (p. 121).
Many participants suggested “...tailoring training in psychosocial assessment skills
to include asking more direct questions and identifying different nonverbal patient
cues (like inflection, pauses or sighing) to determine a patient’s emotional status”
(p. 124).
Video telehealth may also require modifications with respect to nonverbal attend-
ing. Some of the genetics practitioners in Zilliacus et al.’s ( 2009 ) study described
focusing the camera on facial expressions in order to promote rapport. For example,
“I focus in fairly sharply on me so that they can see the expression on my face and
I’m trying to see the expression on theirs and so I feel as though there’s a reasonable
contact and communication link with them” (p. 602).
3.6 Cultural Considerations in Attending
As with any clinical encounter, cultural differences are important to consider in
genetic counseling. It’s impossible, however, to be an expert on issues relevant to
genetic counseling for every cultural group. Even when you have cultural knowl-
edge, cultural sensitivity, and cultural skills for certain populations, a constant inter-
play of individual characteristics and prior life events interacts with culture to make
every patient unique. As Steinberg Warren ( 2011 ) notes, cultural competence is a
complex mixture of “...the client, the counselor, the multiple cultures to which they
each belong, the verbal and nonverbal interactions between the two [emphasis
ours], their respective family, educational and social backgrounds, their respective
past and current living and working environments, the communities in which they
live, the health care system in which they meet, and, of course, the genetic and fam-
ily history, diagnosis, testing, and/or decisions that bring the two individuals
together in a genetic counseling setting” (p. 545).
Nonetheless, learning about communication preferences in different cultures can
be helpful. It can also be helpful to develop an appreciation of how culture affects
health beliefs and practices. That said, as Lewis ( 2010 ), referencing Gelman ( 2004 ),
states, “Culture is dynamic, so the contents of a single culture can change over time
and location. Members of a culture add new ideas, values and behaviors and become
disenchanted with prior beliefs and behaviors, thus transforming culture over time.
People are also members of multiple social groups, many of which generate a coher-
ent set of beliefs and expectations. Within a technologically sophisticated, multicul-
tural society, it is clear that (1) individual decisions about cultural values, (2)
exposure to and membership in multiple cultures, and (3) rapid change in the con-
tents of culture itself make it difficult to invest in a static model of culture. To base
our understanding of others solely or largely on our perceptions of their ethnocul-
tural profile (e.g., Latinos are Roman Catholics and thus do not wish to consider
pregnancy termination) without further investigation ignores the diversity in indi-
viduals as well as in their ethnic and racial groups” (p. 205).
3.6 Cultural Considerations in Attending