Facilitating the Genetic Counseling Process Practice-Based Skills, Second Edition

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6.3 Obstacles to Goal Setting and Goal Attainment

Tryon and Winograd ( 2011 ) assert that, “Patients, particularly those who are new to
psychotherapy, may have an inaccurate perception of the role they are expected to
play in the treatment process. In their experiences with other health professionals
such as physicians, patients tend to play a relatively passive, submissive role, pre-
senting their symptoms and receiving treatment. The goals of such treatment typi-
cally do not involve much discussion, and there may be little collaboration regarding
treatment beyond patient compliance in following professional directives” (p. 55).
This is arguably true for genetic counseling. Thus, a common obstacle to patients’
active engagement in setting goals is their misperceptions about the nature of
genetic counseling.
Danish and D’Augelli ( 1983 ) identify four major obstacles or roadblocks to
patient goal setting and attainment, which we define in Table 6.1, along with exam-
ples and possible genetic counselor interventions. These obstacles, either alone or in
combination, can prevent patients from achieving their desired outcomes. So, you
need to assess patient roadblocks and take steps to reduce or remove them.
Here are additional examples of specific obstacles to setting and achieving
genetic counseling goals:

• Some patients and genetic counselors may lack experience stating problems in
  positive, goal-oriented terms.


• As we said earlier, some patients have limited familiarity with the nature and
  scope of genetic counseling and therefore lack an understanding of appropriate
  goals. You can acknowledge their confusion and invite them to express goals at
  any point during the session. For example, “Don’t feel that you have to come up
  with something right now. Why don’t we begin with...Please let me know if you
  think of more goals as we go along.”


• There are other competing goals (Mann et al. 2013 ). For example, by avoiding
  setting a goal of deciding whether to have genetic testing, the patient may believe
  she can make the issue go away, avoid responsibility for the decision, and/or
  maintain an illusion that everything will be OK.

Table 6.1 Roadblocks to patient goal attainment

Roadblock Patient example Counselor intervention

Lack of

knowledge

Patient does not know that there is a risk of

passing a gene onto her child

Provide patient with genetic risk

information

Lack of skills Patient does not know how to approach his

family members to persuade them to

participate in genetic testing

Practice various scenarios for

approaching family members

Fear of

risk-taking

Patient fears that she could not handle a

positive test result

Discuss fears and refer for mental

health counseling if appropriate

Lack of social

support

Patient has no supportive family members

or friends, no religious/spiritual base, etc.

Refer to a support group or to

mental health counseling/

psychotherapy

6.3 Obstacles to Goal Setting and Goal Attainment