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Strategy: Examine the quality of your own responses. Ask yourself if you are
doing anything to generate resistance from your patient.
Examples:
- The patient was a young woman with Turner syndrome who was extremely anx-
ious. She had numerous misconceptions about genetic counseling. The counselor
realized toward the end of the session that the patient had imagined all sorts of
horrible procedures that were going to be done to her. The counselor told her they
would not be doing any tests that day, and the patient immediately calmed down
and began to listen to the counselor. Picking up on this earlier in the session
would have allowed the counselor to address the patient’s anxiety and misper-
ceptions even sooner.
Strategy: Accept and work with the patient’s resistance. Start with your patient’s
frame of reference. Let your patient know you understand how she/he might feel.
Accept your patient’s right to think differently.
Examples: - A patient referred for genetic evaluation of his family history of colon cancer
said, “I don’t want to hear any numbers or anything that is scary.” The counselor
responded, “Genetic counseling can be scary; sometimes we tend to give too
many numbers in the hopes of helping patients make informed decisions. What
kind of information can I give you that may make you more comfortable with
this situation?”
Strategy: Invite patient participation in every step of the process. Share your
expectations, and discuss your patients’ reactions to being referred for genetic coun-
seling. Give patients as much power as possible; focus first on their reasons for
being there (Weil, 2010 ). Ask them what you can do to help make their situation/
decision easier.
Examples:
- Sometimes it’s apparent that the patient has a need to be in control of what hap-
pens during the session. It’s sometimes possible to accommodate this type of
patient depending, of course, on the circumstances. For instance, a genetic coun-
selor was counseling the mother of a boy with developmental delay. The mother
said she wanted an appointment for fragile X syndrome testing only. She was
initially reluctant to agree to a complete evaluation, but once it was made clear
that the fragile X test would be done and the other components were necessary
for completeness, she became a willing participant. She had also initially refused
to consent to follow-up counseling if the results were positive, but at the end of
the session, she agreed to it, in part because she felt she had maintained some
control. - A genetic counselor had an emergency session with a woman who had spastic
cerebral palsy and was pregnant with her third child. She was in a wheelchair,
and although she appeared to have some cognitive impairment, she was actually
quite sharp. It was clear from the beginning that she did not want to be there, and
9 Patient Factors: Resistance, Coping, Affect, andfiStyles