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Anger can be a difficult emotion to address, especially for beginning counselors
(Schema et al. 2015 ). Nevertheless, it’s important that you do so because unex-
pressed anger will impede the work of genetic counseling. You must be prepared to
be the target of patient anger, and you should respond nondefensively (Schema et al.
2015 ). First, realize you usually are not the real target (Baty 2010 ; Schema et al.
2015 ); the patient may be displacing anger (e.g., about abnormal test results) onto
you. You may, however, want to check with the patient to see if you have perhaps
done something to elicit anger and then apologize when at fault: “...say, ‘You’re
right, that was a mistake on my part. I’m not going to let it happen again. Thanks for
bringing it up, and I’m really sorry’” (Schema et al. 2015 , p. 725). Be honest with
yourself about how you are feeling and what you’re thinking—you may be thinking
you’d like to retaliate, but it’s essential that you not do so. Use basic primary empa-
thy instead: “I can see you’re very angry right now.” This type of reflection indicates
that you respect the patient’s feelings. Finally, you should talk about what’s making
your patient angry (e.g., “Can you tell me what you’re angry about?”) (Schema
et al. 2015 ).
Examples of empathy from Schema et al.’s ( 2015 ) participants include: “I usu-
ally acknowledge their anger and the situation is basically not of their doing, they
must feel out of control, and all they want to do is protect the people they love,
and...they just can’t do that” (p. 724); and “normalizing and validating patient
anger and then working towards opening a space to allow the patient to express it:
‘You’re a human being, why wouldn’t you be angry? It’s a normal emotion’”
(p. 724). Some participants further suggested proactive responses: “‘How can we
make this better? How can we help you become more comfortable with the
situation?’...‘I see you are angry. I’m not sure where that’s coming from; can you
tell me a little more about that?’...; and ‘I’m going to do everything I can to help
you’...” (p. 725).
Grief
“As we held our son in the delivery room the day my wife and I became parents, he looked
too beautiful and peaceful for us to believe there could be much of a problem. Three hours
later, the pediatric cardiologist surprised us with the diagnosis. He discussed “single ven-
tricle,” “congestive heart failure,” and “palliative surgery,” but the words simply floated in
and out of our heads without comprehension. There was a vague notion that his life would
be different because of his heart, but it didn’t register that ours would be as well. In fact,
nothing registered. Time stopped, sounds became muffled, and it seemed as if we were
always walking sideways and uphill. It wasn’t just that we were emotionally numb; our
world was suddenly thrown off course and we were totally unprepared. We lost confidence
in our thinking and had difficulty making even simple decisions. It became hard to know
what to say or do.” (Batton 2010 , p. 1303)
Gettig ( 2010 ) asserts that “the [genetic counseling] profession makes us bereave-
ment specialists. The literal meaning of the word bereavement is ‘robbed’...Whether it
is the physical loss of a family member, the loss of an anticipated child, or experiences
in life that are now altered due to genetics, it is a genetic counselor who guides the
9 Patient Factors: Resistance, Coping, Affect, andfiStyles