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The five tenets of genetic counseling practice include (McCarthy Veach et al.
2007 ):
- Genetic information is key: This is the first tenet because it recognizes the pri-
mary reason patients seek or are referred for genetic counseling. This tenet
reflects the conviction that information is critical to understanding and coping
with a condition and for informed decision-making. It assumes that “being
informed is better than being uninformed” (p. 719). - Relationship is integral to genetic counseling: This tenet refers to the critical
nature of the patient/genetic counselor relationship and the role this relationship
plays in furthering the patient’s ability to understand genetic information and use
that information to her or his benefit. This relationship is central to genetic
counseling. - Patient autonomy must be supported: This tenet reinforces the long-standing
value in genetic counseling that patients best understand their situations and are
in the best position to make personal decisions about how to use their genetic
information. This tenet reflects the belief that patients must be supported in their
ability to self-direct. - Patients are resilient: This tenet acknowledges that most people have the capac-
ity to learn and to cope with their situation when provided with the appropriate
psychological support and relevant information. - Patient emotions make a difference (also referred to as patient emotions matter):
This tenet recognizes the important role emotions play in the genetic counseling
process. Emotions are a critical part of dealing with a genetic condition; they are
a significant factor (both positive and negative) in understanding information and
making decisions, and they affect relationships and coping ability.
McCarthy Veach et al. ( 2007 ) proposed 17 goals for genetic counseling sessions
corresponding to the five tenets. These goals, along with examples of genetic coun-
selor strategies and behaviors, are presented in Table 2.1.
The REM is a model that demonstrates how the patient/genetic counselor rela-
tionship is central to the genetic counseling process. Through this relationship,
information is communicated in a way that supports the autonomy of the patient,
takes patient emotions into account, and supports the natural resilience of the
patient. “The term reciprocity reflects that each element of the model is complemen-
tary and completes the other, while engagement refers to counselor and patient
mutual participation in genetic counseling. As shown in Fig. 2.1, the model is rep-
resented visually with a triangle that embodies the five tenets articulated by confer-
ence participants: Education primarily represents the tenet of genetic information.
Individual Attributes reflects the tenets of patient autonomy, resiliency, and emo-
tions. Relationship embodies the tenet of counselor patient relationship” (McCarthy
Veach et al. 2007 , pp. 724–725).
The REM is specific to genetic counseling practice. It is grounded in the underly-
ing values of the profession and was developed by examining the components of
practice. As mentioned earlier, the central foundation of the model is the patient/
genetic counselor relationship. Through this relationship, information critical to the
2 Overview offiGenetic Counseling