Guiding Models

Question 1

NSGC definition of genetic counselling

Answer 1

GC ing is the process of helping people understand and adapt to the medical, psychological, and familial implications of the genetic contributions to diease

Question 2

3 principles adapted from Carl Rogers

Answer 2

Respect -acceptance of clients
Genuineness (the agreement between the counselor’s inner and outward response is congruence
Empathy -ability to accurately understand the clients experience and to communicate this understanding

Question 3

Tenets of patient centered care

Answer 3

• Dignity and respect
• Information sharing - complete and unbiased information in ways that are affirming and useful
• Active participation : patient/family goals and preferences, clinical evidence and expertise, psychosocial support
• Collaboration: institution wide basis. Health care leaders collaborate with patients in policy and program development, implementation, and evaluation in the delivery of care. GCs often support patient advocacy

Question 4

Nondirectiveness

Answer 4

Aims to explain facts as clearly as possible, giving the client and their family accurate information regarding their options in a way in which they can understand. The ultimate goal is to allow clients to make up their own minds

Question 5

Nondirectiveness; Seymour Kessler’s definition

Answer 5

Describes procedures aimed at promoting the autonomy and self-directedness of the client.

It is a way of interacting and working with clients that aims to raise their self-esteem and leave them with greater control over their lives and decisions

Advice giving is a vote of no confidence in the clients own ability to sort things out for themselves and arrive at their own conclusions

Question 6

Seymour Kessler teaching model

Answer 6

1. Primary goal is to educate the client
2. Based on perception that clients come for information
3. Model assumes that if informed, client should be able to make their own decisions
4. Assumptions about the clients reactions and emotions are simplified and minimized; cognitive processes are emphasized.
5. Counselling task is to provide information as impartially and as balanced as possible
6. Relationship with client is based on authority rather than mutuality

Question 7

Psychotherapeutic counselling model

Answer 7

Goals:

1) to understand the other person
2) to bolster their inner sense of competence
3) to promote a greater sense of control over their lives
4) to relieve psychological distress if possible
5) to support and possibly raise their self esteem
6) to help them find solutions to specific problems

Based on the perceptions that clients come for counselling for complex reasons

Question 8

Psycho-education definition

Answer 8

Genetic counselling is a dynamic psycho-educational process centered on genetic information.
Within a therapeutic relationship established between providers and clients, clients are helped to personalize technical and probabilistic genetic info to promote self determination and enhance their ability to adapt over time
Goal is to facilitate clients ability to use genetic information in a personally meaningful way that minimizes psychological distress and increases personal control

Question 9

Reciprocal engagement model

REMS

Answer 9

A mutual process in which the GC and patient participate in an educational exchange of genetic and biomedical information shaped by their unique psychological identities. The GC-patient relationship is the medium in which these activities can occur

Question 10

Transference

Answer 10

The unconscious way that a client relates to the genetic counsellor based on his or her history of relating to others

Often the clients reactions do not match the situation; generally there is an overreaction

Question 11

Counsellor countertransference

Answer 11

The genetic counsellors unconscious ways of relating to clients based on the counsellors history of relating to others.

Counsellor can either overidentify or disidentify with the client. Giving rise to either negative or positive interactions with the client

The counsellor may not have an empathic response, or may overidentify, having an overly emotional response

Question 12

Associative countertransference

Answer 12

when the counsellor shifts focus from the client to their own personal reaction

Question 13

Projective countertransference

Answer 13

When the counsellor has the misperception that he or she understands exactly what the client is going through because he/she had a similar experience

Question 14

How to identify countertransference

Answer 14

Becoming overly involved with a client
Dreading a session or being too eager to see the client again
Having strong feelings about a client
Having rescuer fantasies that you will be able to get through to a client where others have failed

Question 15

Uses of self disclosure

Answer 15

Builds trust in the relationship 
Reinforces the client's disclosure 
Reassures the client that he/she is not alone 
Provides reality testing 
Generates a new perspective 
Elicits strong feelings 

Personal disclosure - “when I was…”
professional disclosure- “ many of the clients that I work with…”

Question 16

Advanced empathy

Answer 16

Counsellors response goes beyond what the client has expressed and includes new insights into their thoughts and behaviours.

Used to help clients express their underlying or less conscious thoughts and feelings

Highly therapeutic, often allowing clients to express their feelings.

Reflect on feelings not expressed, ex verbal cues. Point our recurring themes. Make connections between feelings expressed at different parts of session. Point out alternatives for the client. Develop a logical progression for the client.

Question 17

Confrontation

Answer 17

Technique used by a GC to directly challenge a client’s view of themselves and their situation
Goal is to elicit greater self-understanding in the client
Used to help clients understand their behaviours, thoughts and feelings or actions
Should be used when a good rapport has been established and after thoughtful consideration

Begin with empathy, choose right time, speak tentatively “I wonder…”, introduce gradually and move deeper, anticipate the reaction
Behaviours to confront: ambivalence, avoidance, distortions, evasions, non verbal contradictions, smoke screens

Question 18

Defence reactions to guilt

Answer 18

Repression- personal responsibility may be forgotten
Intellectualization and rationalization- good reasons and excuses
Isolate or separate feelings- so badness is kept in bounds

Ex: mom dotes on a disabled child to repress her feelings of disappointment and shame, purging her guilt through behaviour

Question 19

Guilt relieving strategies by Kessler

Answer 19

• authority: use professional role to tell patients they are without guilt (only after a patient has said they feel guilty)
• normalization: point out that other families would feel the same way (reduce social isolation)
• reframing: help patients develop a new frame of reference, so perceptions take on a new, less distressful meaning
• limiting liability: GC helps patient set limits on their personal responsibility in a situation “you are responsible for a but not for b”

Question 20

Shame

Answer 20

The painful feeling arising from the consciousness of something dishonourable, improper, ridiculous, etc, done by oneself or another

• often it is the perception of how we will be viewed by others, an external response
• usually related to low self esteem

Genetic diagnoses can lead to feelings of personal deficiencies

Question 21

Shame relieving tactics

Answer 21

Develop a working alliance
Evoke feelings- counsellor helps patients express their feelings and responds empathetically
Accentuate positive- point out areas where the patient is doing well
Bolstering the ego- counsellor emphasizing how good the counselees are as parents, how clever they are to find positive solutions to problems and other ego enhancing techniques

Key step is confession. It is important to allow the client to verbalize their feelings before utilizing normalizing statements.

Question 22

Other counselling techniques

Answer 22

1) Scaling questions: “on a scale of 1 to 10 right now, where is your anxiety at?” Then use scenarios to help lower anxiety
2) empty chair technique: visualize or practice telling their family about the results. Practice dialogue or fantasy dialogue (within themselves going through the scenario)