261technology and our interpretation [displacement].... So, it was just difficult because
I’ve never been pushed that hard on the technical aspects by a patient before and I
was trying to just remember what were my main goals for her to walk away with...’”
(p. 165).
Klitzman ( 2010 ) found evidence of denial among individuals who had or were at
risk for HD, breast cancer, or alpha-1 antitrypsin deficiency: “A therapeutic miscon-
ception about testing appeared: that testing would be helpful in and of itself. Many
believed they could control genetic disorders (even HD), yet these beliefs were
often incorrect, and could impede coping, testing, and treatment. Misunderstandings
about statistics and genetics often fueled each other, and reflected denial, and desires
for hope and control. Emotional needs can thus outweigh understandings of genet-
ics and statistics, and providers’ input. Individuals often maintained non-scientific
beliefs, though embarrassed by these...” (p. 430).
Another patient in the Klitzman ( 2010 ) study “...did not think that the fact that
her grandmother and aunt had breast cancer might increase her own chances of
developing the disease. ‘One of my siblings said: It’s good you’re having aggressive
treatment because of the history in our family. I was a little startled, because I had
never thought of it that way. I didn’t think it was related to their cancer. I knew my
maternal grandmother died of breast cancer. But I didn’t know how it was related
genetically. I was in incredible denial, and didn’t really want to know too much
about it...’ Individuals may have little desire to counter such minimization of
genetic risk. Yet such avoidance, if challenged by external events, can prove devas-
tating. This woman continued, ‘When it did hit me, it hit me like a ton of bricks...I
was a wreck—angry, frightened, crazed’” (p. 439).
Alluding to denial, Shiloh ( 2006 ) states that “...illness representations have an
important role in clients’ coping efforts. Cognitive coping strategies are often used
by genetic counselees, especially if behavioral acts to control the condition are not
available. Therefore, holding on to misconceptions in the face of contradictory
information provided by counselors may result from defensive coping functions that
these beliefs serve...” (p. 332).
9.2.3 Addressing Patient Defenses
Patients need coping strategies to deal with intense experiences, and some patients
may need to engage in a certain amount of defending before they can move on to
more positive coping strategies that support effective problem-solving and decision-
making. Thus, defense mechanisms are not always negative coping strategies. In a
study of couples coping in prodromal HD, Downing et al. ( 2012 ) concluded that the
defense mechanism of denial “...can be helpful in coping with an illness that is
severe and has a poor prognosis (Lazarus 1999 ). Another way to characterize denial
as a positive coping strategy is to view it as normalization (Deatrick et al. 1999 ),
which occurs when people living with chronic illness attempt to construct their lives
as normal (Robinson 1993 ). While this can have a positive effect by allowing people
9.2 Coping Behaviors