83- Read the genetic counseling literature. You can gain an intellectual understand-
ing of what it might be like to be a genetic counseling patient by reading about
different genetic conditions, family challenges, and patient experiences with
genetic counseling and decision-making. - Read books or articles written by patients and their family members to learn
more about their firsthand experiences with genetic conditions or risks. There are
movies that address these themes as well. - Draw upon your intuition. Play a hunch. If you suspect your patient is feeling or
thinking something, tentatively suggest it. - Become comfortable with your patient. If you feel threatened or defensive, you
will have difficulty experiencing and expressing empathy (Barrett-Lennard
1981 ). - Focus on your patient rather than on yourself. With practice and experience you
will gradually become less self-conscious and more patient-focused. If you find
yourself becoming overly self-conscious, try taking a couple of deep breaths, and
relax in your chair. You will be in the flow when you are no longer thinking,
“How do I sound? What am I going to say next? What do I do if my patient
cries?” - Acknowledge and set aside your biases. It’s virtually impossible to communicate
authentic empathy when you feel judgmental. - Communicate acceptance. Fine and Glasser ( 1996 ) wisely point out that
“Feelings belong to the person who has them and are neither right nor wrong...
Feelings are useful, even negative and painful feelings. They cannot and should
not be argued or debated away” (p. 60). They further state that communicating
acceptance means “...not debating, not arguing, never using the b word: but”
(p. 60). - State your understanding of your patient’s experience concisely and in your own
words. You should highlight the essence of what your patient has expressed,
rather than giving a verbatim account. For example, the patient says, “I just found
out that my sister’s baby has this genetic condition. I can’t believe that my baby
is at risk. I’m afraid of what the prenatal tests are going to show. If only I’d
known this before I became pregnant!” You might say: “It sounds like you’re
very worried about your baby.” This response emphasizes what you believe to be
the most salient aspect of her concerns. - State your empathy tentatively. Tentative statements give the patient room to cor-
rect you if you are off-target. For example, “Is it possible that...?”; “Maybe
you’re feeling...?”; “Perhaps you feel...?”; and “So it seems you might be
feeling...?” - Aim for the ballpark rather than the bulls-eye. Although it’s always gratifying
when a patient responds to your statement by saying, “That’s exactly it,” it’s suf-
ficient if your words have approximately the same intensity and are close in
meaning to your patient’s. A ballpark goal reduces some of the pressure on you
and frees you to focus on your patient. - Reflect content and affect. Aim for responses that tap both the feeling (emotional
empathy) and content (intellectual empathy) dimensions of your patient’s experi-
4.4 Effectively Communicating Empathic Understanding