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were sitting with a friend who thought she/he might have a genetic condition,
what would you say to empathize? Try using a similar response with your
patients.- Assuming all patients will respond in the same way—People may have very differ-
ent reactions to similar events. One patient may be angry, another sad, and another
disbelieving. Patients will also respond in unique ways to your interventions.
Therefore, you cannot give a cookbook response and get positive results with
every patient. There is no answer key in genetic counseling, because patients differ
in subtle and not-so-subtle ways. For example, consider a prenatal patient who has
four children and discovers her current pregnancy is affected with trisomy 18.
How might her experience be similar to and different from a prenatal patient who
has undergone several years of infertility treatment, has no children, and discovers
her pregnancy is affected with trisomy 18? Or, consider the case of a couple who
will be returning to their home country of China. They have one daughter, and
their second baby is a boy with a fatal disease. In Chinese culture male children
are valued highly. The hopes of many Chinese parents rest in having a son to sup-
port them in their old age and to carry on the family name. Consider how this
couple’s experience might be different if they were White and from the USA. - Assuming all patients desire the same type and amount of primary empathy—
Patients will vary in their preferences for counselor empathy (Duan and Hill
1996 ; Gladstein 1983 ; Ridley and Udipi 2002 ). Some patients, wanting a close
relationship, will desire more affective empathy from you, while others, who
wish for a more neutral emotional relationship, will prefer less affective empathy
(Gladstein 1983 ). One clue about the type of relationship a patient wants is his or
her reactions to your initial affective empathy statements. If patients do not elab-
orate and/or seem nonverbally taken aback, these may be indications they do not
wish you to verbally express a lot of empathy. You should not take this personally
or as a sign that something went wrong. Not every patient wants the same type of
relationship, and not every patient will share no matter how many different ways
you try to engage them emotionally.
4.8.2 Mistakes Due to Overt Processes
- Not replying—Failure to respond may suggest what your patient said is not worth
a response or is not relevant to genetic counseling (Weil 2000 ). It’s a matter of
common decency to display some understanding of your patient (Kessler 1999 ). - Using clichés—Although they often have an element of truth, clichés (e.g., “You
can always try to have another baby,” “Time heals all wounds,” “New treatments
are coming along all the time”) may seem dismissive of the patient’s experience,
sound “canned” or trite, and/or suggest you don’t want to make an effort to fully
engage with them. - Offering false reassurance—Some beginning counselors use a fair number of
reassuring statements (e.g., “You seem like you are great parents,” “The test results
4 Listening to Patients: Primary Empathy Skills