67Kim et al. ( 2003 ) report findings from the literature that Asian-Americans “...in
general tend to value emotional self-control and tend not to openly display their
feelings, even if the feelings are positive... [They are] often taught to limit their
emotional expressiveness even with family members...because traditional Asian
cultural values consider the ability to control emotions as a sign of strength. In con-
trast, European Americans tend to believe that individuals should openly and
directly express their affection for each other” (p. 205). Thus, some Asian-American
patients may present in a calm manner, smiling less frequently, sitting more still
with fewer shifts in posture, being less vocal, and so forth. You should be aware they
may be experiencing a range of emotions internally (e.g., distress, confusion,
shame). One strategy for assessing their internal reaction is to normalize it and
invite direct expression. For example, “Sometimes when patients hear this informa-
tion they feel frightened. I wonder what you’re thinking right now”; or “Sometimes
when patients hear this information they feel confused. Could you please tell me
about any confusions you are having?”
3.6.2 Nonverbal Communication
Individuals who are deaf “tend to be highly attuned to messages delivered through
facial expressions and body language when communicating with others. As Corker
( 1996 ) pointed out, 90% of communication occurs in a nonverbal way, and these
unspoken conversations are vital to establishing and maintaining a therapeutic rela-
tionship with a client” (Williams and Abeles 2004 , p. 644).
Sagaser et al. ( 2016 ) explored prenatal genetic counselors’ strategies for assess-
ing patients’ religious/spirituality beliefs. Several of their participants noted the util-
ity of psychological attending, in particular, looking for “nonverbal or contextual
clues” (p. 930) including patient clothing that implies ministry, jewelry suggesting
a religious affiliation (e.g., crosses, other religious images), and bringing a prayer
book to the session. The researchers concluded that genetic counselors could easily
use this type of psychological attending to assess the importance of religion/spiritu-
ality to their patients and suggested they make mention of these sorts of clues as “a
helpful starting point for initiating discussion of spiritual matters in pregnancy
decision- making” (p. 930).
3.7 Closing Comments
Although attending is the lynchpin to effective genetic counseling, it is not always
an easy process. Attending is complicated by the fact that you must simultaneously
focus on the patient and yourself. We would like to close with two caveats:
- Attending to Your Patients. Remember that universally valid statements about
effective physical and psychological attending and the meaning of nonverbals
3.7 Closing Comments