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

55

nonverbal behavior when there are incongruences. Nonverbal behaviors are more

spontaneous and less under a person’s conscious control, and therefore they may

be more indicative of patients’ psychological/emotional state than are their ver-

bal behaviors.

• Consider pointing out nonverbals to the patient (e.g., “You say you’re fine with
  this decision, yet you look tearful”).


• Comment on nonverbals when a patient is silent (e.g., “You are very quiet right
  now. I wonder what you’re thinking?” [or, depending on the context, “...what
  you’re feeling?”])


• Look for patterns of behavior that together suggest the patient is feeling or think-
  ing a certain way. Beware of over-interpreting a single nonverbal behavior (e.g.,
  sighing by itself might indicate any number of feelings from impatience, fatigue,
  regret, and hopelessness. Sighing in combination with eye rolling and crossed
  arms is a stronger clue that the patient feels frustrated or misunderstood).


• Observe the following patient characteristics as these may give you clues about
  a patient’s traits and/or emotional state, attitudes about genetic counseling, and
  motivations: activity level (agitated or lethargic), speaking slowly or quickly,
  manner of dress (sloppy or careful, appropriate to the situation or haphazard),
  movements (easy or difficult, fluid or staccato), state of health, tension behaviors
  (swallowing, nervous laughter, excessive throat-clearing), voice (firm or shaky,
  loud or soft), and patient projection of self (mature and in control or childlike,
  submissive or aggressive) (Fine and Glasser 1996). Of course, it’s important to
  always consider the extent to which patient behaviors reflect symptoms of a
  genetic condition. For example, a patient being seen in neurology may be exhib-
  iting symptoms of a neurodegenerative disease.

3.2.2 Understanding Patient Cues

• Attend to the face because it is a very rich source of nonverbal communication
  (Batty and Taylor 2003 ). As much as 55% of a person’s feeling messages come
  through the face (Egan 1994 ). Over 1000 facial expressions have been identified,
  and many of these expressions appear to have similar meanings to people from
  all countries and cultures (Ekman and Friesen 2003 ). Moreover, facial expres-
  sions can provide clues about cognitive processes such as attention (based on
  where a person is gazing) as well as how they are evaluating events that are trig-
  gering their emotions (Sander et al. 2007 , p. 470).


• Facial muscles can be controlled in all areas but the eyes (Hill 2014 ), thus reveal-
  ing more of one’s true self. Watch a patient’s eyes for signs of fear and anger;
  frightened or anxious people will have dilated pupils, and angry people will have
  constricted pupils. Additionally, anger, distress, and fear can be communicated in
  the temples (the pulse will quicken), in the carotids (blood visibly pulses to the
  head), in the upper and lower jaw muscles (clench together), and in the nostrils
  (dilate and constrict).

3.2 Effective Genetic Counselor Psychological Attending Skills