123a flexible way, adapted to each counselee needs and expectations” (p. 444). This
study serves as a reminder about the importance of strategic and sparing use of
questions in combination with primary empathy.
You must be sure that your questions are focused on your patient’s needs and
reasons for seeking genetic counseling and not from your own personal interest. For
example, “So, what’s it like to have a baby with a birth defect?” sounds like a ques-
tion intended to satisfy your own curiosity. Compare this question with the follow-
ing: “Please tell me how you’re dealing with raising a child with cystic fibrosis.”
The latter question is more appropriately focused on the patient’s situation and
needs. Similarly, when asking patients about their cultural backgrounds, it should be
on a “need-to-know” basis, namely, for its relevance to the genetic counseling goals.
Avoid being a “cultural tourist.” Consider the difference between these two ques-
tions: “Why do people in your culture think that having a child with a cleft lip and
palate is caused by something the mother did during her pregnancy?” versus “Tell
me how the beliefs in your culture might affect your family’s reaction to your child’s
cleft lip and palate?” The latter question invites the patient to share her or his own
cultural experience. If the patient tells you that this is an issue, then you might fol-
low up by asking, “How can I help?”
Patients can become defensive if they are bombarded with a string of questions,
especially if the questions appear to challenge something they have just said
(Wubbolding 1996 ). Consider the following example of excessive and challenging
questions. In this example, the questions imply judgment:
Pt: I don’t want to have a baby with Down syndrome.
Co: What do you mean?
PT: I just don’t think I could handle it.
Co: Are you telling me that you’d want to terminate the pregnancy?
PT: Well, I’m not sure...
Co: Where does this feeling that you “couldn’t handle it” come from?
Cl: I don’t know what you mean.
Co: Well, is it coming from you or from your family?
Cl: Well, I guess from them.
Co: Do they have to live with the consequences of this decision or do you?
Cl: Well, it will affect them, too.
Co: But can they really tell you what to do?
Cl: No, I guess not.
Co: So, let me ask you, what do you want to do?
In this example, the counselor overwhelmed the patient with a series of questions
that were quite presumptive and seemed to demand a certain answer. These ques-
tions raised a barrier between the counselor and patient as the patient became
increasingly defensive and distressed.
5.1 Obtaining Information from Patients