91discuss countertransference in greater detail in Chap. 12 ). Feeling as angry or as
sad as patients do about their situations usually is ineffective. You no longer
understand your patient’s experience, but rather you become caught up in your
own feelings and perceptions. Another problem with counselor identification
occurs when your emotional reaction to the patient is too intense, what Gladstein
( 1983 ) calls empathic distress. In this situation, you are likely to psychologically
move away from the patient (e.g., avoiding a discussion of patient feelings, offer-
ing false reassurance that everything will be ok). An important aspect of empathy
is the ability to maintain some boundaries between yourself and your patient’s
experience. You must be able to step back after sensing a patient’s feelings, thus
giving yourself some distance from the affect (Barrett-Lennard 1981 ; Rogers
1992 ). One way to understand and address over-identification is to discuss it with
your clinical supervisor.- Making assumptions—You should be careful about assuming your patients will
feel exactly what you would feel, as this may not be the case. For example, sup-
pose you have a baby with a cleft lip and palate and you quickly come to view
this as a minor and treatable condition. Some of your patients may be devastated
by the same condition in their child. - Being afraid of patient feelings—During genetic counseling, patients may expe-
rience a range of emotions, some of which are frightening. Your fear of certain
emotions may be due to mistaken beliefs. For instance, you (and your patients)
may think that if certain feelings are identified (e.g., grief, anger), you will both
be overwhelmed by them (Schema et al. 2015 ); or you might believe that only
some feelings are acceptable (e.g., sadness), while others are not (e.g., anger,
despair). In addition, you may mistakenly believe you must fix your patient’s
feelings, or if they are expressed, you won’t know how to handle these emotions
(Schema et al. 2015 ). It’s important to remember there are no right or wrong
feelings. People feel what they feel. Furthermore, when patients express emo-
tions, they usually end up feeling more in control. Until patients can get out their
sadness, anxiety, anger, etc., they will be less able to digest the information you
provide and less capable of making decisions (Schema et al. 2015 ). - Thinking you can’t understand if you have not had your patient’s experience—
Although you may never have had a family member with a genetic condition,
you do have experiences in your own life of loss, disappointment, grief, etc. Your
own experience will help you empathize with patient feelings. Of course, you
will not have a specific understanding of what it’s like to be in every patient’s
situation (e.g., what it’s like to live with a parent who has Huntington disease). In
those cases, you might say, “Please tell me about what this is like for you so I can
try to understand.” - Thinking patients are different from non-patients—They aren’t. Patients have the
same hopes, fears, anxieties, and beliefs as anyone. Although they might differ
from most other people because they have come for assistance with a possible or
known genetic condition, the empathic process is the same for genetic counsel-
ing patients as it is for all people. As we stated earlier, empathy is an essential
ingredient in all human relationships (Duan and Hill 1996 ). Ask yourself, if you
4.8 Common Empathy Mistakes