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

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11.2.1 Counselor-Patient Situations that May Prompt Self-

Involving Responses

There are several situations in which a genetic counselor may consider using a self-
involving response:

• Session is losing direction. “I’m concerned we’re getting off track here. Can we
  stop for a minute and see if we can figure out what’s going on?”


• Tension exists between patient and counselor. Anxiety is a very contagious emo-
  tion, that is, it’s easy to become anxious when you are with an anxious patient.
  First, recognize the anxiety, second remain as calm as possible, and then talk
  about it in a composed and accepting manner. For example, a patient may become
  very anxious in response to the information you are sharing. In this situation you
  might say, “I’m concerned that this information is making you very anxious. Can
  we talk about what’s going on?” Some signs that the patient may be tense include
  behaving dependently, seeking continual reassurance from you, repeating the
  same questions, shifting the topic when you raise sensitive issues, making jokes,
  and frequently interrupting you.


• Trust has not developed. “I’m concerned that you seem reluctant to talk with
  me.” In cases where trust issues may be due to cultural differences: “I’m con-
  cerned that because we are from different cultures, I might unintentionally say
  something offensive. Please tell me if that happens or if there are other things I
  can do to help you.”


• There are conflicting agendas. “I know your sister is here to provide you with
  support, but right now, I’m concerned that I cannot meet both of your needs at the
  same time. I wonder if we might speak privately for a few minutes.” Or, for
  example, a patient may be expressing a lot of anger at his primary care provider
  for failing to recognize early symptoms of cancer. The counselor may say “I can
  understand your frustration that your cancer was not diagnosed early. But I feel
  like we’re getting stuck here, and I’d like to take some time to talk with you about
  how genetic testing can help you move forward.”


• You have just given the patient bad news. After allowing them some time to react
  initially to the news, say, “I’m sorry. I know this is not what you wanted to hear.”
  This is a time when there’s nothing you can say that seems to be adequate for the
  situation. Let your patient regain some composure and then ask, “Is there some-
  thing I can do right now?”


• You sense the patient is under pressure to decide. “I’m concerned that you may
  be rushing into a decision before you’re ready.”


• The patient seems angry. “It seems like you might be angry, and I’m concerned
  that it’s getting in the way of our talking right now.”


• The patient shares a painful experience. For example, a patient is describing her
  perinatal hospice experience. You may find yourself becoming tearful and could
  say, “I feel myself tearing up as I listen to you. You must have been in so much
  pain.” In an example from the Kao (2010) study, in which a mother learned in a
  traumatic way that her baby had clefting, two counselor participants, respectively,

11.2 Self-Involving Responses