47In comparing the models, Kessler ( 1997 ) states, “The net psychological impact of
this strategy [the teaching model] is to enrich the authority, status, and ego of the
professional at the expense of the client. The purpose of any counseling strategy is to
reverse this process and leave the client psychologically enriched even if it is at the
expense of the professional” (p. 291). Maturation into the profession requires students
to grow away from being the content-oriented counselor utilizing the teaching model
into the psychologically oriented counselor who makes use of the counseling model.
“Counselors strive to perfect their ability to understand clients, give them a sense of
being understood, and help them feel more hopeful, more valued, and more capable
of dealing with their life problems. Because genetic counselors work with people
filled with uncertainty, fear of the future, anguish, and a sense of personal failure, they
have unusual opportunities to accomplish these tasks” (Kessler 1999 , p. 341).
3.7 Closing Comments xiii
Genetic counseling is a unique medically based health-care practice. Genetic coun-
selors help patients and their families navigate a wide variety of situations. In one
session, a patient is told her baby has a disorder that will limit his or her ability to
experience life fully, and in another session, parents are given a long-awaited diag-
nosis for their child that helps them finally understand what happened. In still
another session, a young woman is relieved to learn she has not inherited a gene that
would have increased her risk for cancer, and therefore her children are free of that
increased risk as well. Regardless of a patient’s circumstances, the process of
genetic counseling is dynamic and complex. The REM provides a theoretical frame-
work and defines the tenets of genetic counseling that apply to all areas of clinical
practice. The empirically derived REM goals are identifiable and measurable.
Understanding the model allows us to teach, assess, and improve practice over time.
When we look at the history of genetic counseling, clearly, the core underlying
values have remained constant and are evident in the five tenets of the Reciprocal-
Engagement Model of genetic counseling practice.
2.7 Class Activity
Activity: Identifying Goals, Strategies, and Behaviors in Genetic Counseling
(Dyads)
Students select a partner. They can either select one of their own cases or use one of
the following situations:
- Case #1: A 40-year-old woman who is 16 weeks into her first pregnancy comes
to clinic in follow up to an abnormal ultrasound. She had the ultrasound because
her doctor thought the baby was small for gestational age. Her doctor suspects a
chromosomal anomaly.
2.7 Class Activity