Guiding Models In GC and Empathy Flashcards
Rogers Person-Centered Counseling
-Respect
-Genuineness
+b/c of respect we don’t want to change client, just have to understand where our thoughts and feelings lie
+congruence
-empathy
*Unconditional positive regard
Congruence
Agreement between inner thoughts and outward expression of GC
Nondirectiveness
Presentation of accurate info in a way that is applicable and comprehendable to them and allows them to make informed decisions
Kessler on non-directiveness
Aimed at promoting autonomy and self-directedness in order to build self-esteem and return control to them
-advice giving would undermine this
Advice giving in GC
- standard of care
- medical recommendations
- practice guidelines
- but this isn’t giving our opinion it’s a means of providing tools for decision-making
Value free language
Promotes importance of individual above their diagnosis
Narrative medicine
Giving patients the time to tell their story and actively listening and engaging, being moved by them
Kessler teaching model
Main focus is education, based on assumption clients are coming for new info to make their decisions
- underestimates reactions, opinions, beliefs, etc and emphasizes cognitive processes
- still meant to give info in an unbiased manner
- relationship with client is based on authority not mutuality
Kessler Psychotherapeutic Model
Goal is to understand the client, bolster their inner sense of competence, reduce psychological distress, raise self esteem and promote them gaining back control
-also want to help them solve specific problems when possible
-based on assumption/perception that client comes for counseling for complex reasons
-emotions, reactions are factored into how education should be provided
+this is more complex and requires Counselor to use different skills to obtain information about the client, their skills, needs, limitations, etc in order to tailor education and be flexible
+education is used as a means to achieving these goals
Biesecker and Peters Psychoeducation Model of GC
GC is a dynamic psycho-educational process based on genetic info
- within a therapeutic relationship a client helps counselor to tailor technical and probabilistic information to them in a way that promotes their self-determination and adaptation over time
- goal is to facilitate client ability to use genetic information in a personalized way that increases control and reduces psychological distress
Reciprocal Engagement Model
- Veach et al 2007
- client and counselor participate in a mutual process of educational exchange of genetic and biomedical information, based on their psychological identities
- GC-client relationship is a medium in which this can occur
Reciprocal Engagement Model Tenets
-education-genetic info is key
+biomedical info is essential, but not sufficient in ensuring patients learning, understanding and application of it to their situation
-relationship and rapport building are critical
-patient autonomy is supported
-patients are resilient
-patient emotions make a difference
+genetic info loaded and can cause cognitive and behavioral reactions in patients and families-emotional impact can make understanding difficult
Genetic Counseling Outcomes
- make a decision
- manage condition
- adapt to situation
Transference
Unconscious way client relates to GC based on his/her history of relating to others
-sometimes can see overreaction to situation due to this
Countertransferance
Unconscious way GC relates to client based on history of relating to others
-could overidentify (more of a concern) or under/deidentify with client which can cause positive or negative interactions with patients due to the level of empathy in response
Kessler and countertransferance
No one is immune to suffering, but the GC experience with suffering is what can cause countertransferance
Associative countertransferance
Counselor shifts focus from client to their own reaction
Projective Countertransferance
When the counselor has the misperception they understand exactly what the patient is going through because they have had similar experiences-does not account for differences in how the same thing may impact someone differently
Rescuer Fantasy
Sign of countertransferance where you believe you are the only one who can reach the patient when others have failed
Self-Disclosure
Communication about oneself by GC to the client
-rule of thumb is not to do so, but really should be done situationally
Uses of self-disclosure
-builds trust in relationship
+by GC sharing it makes client not feel alone and maybe more open to sharing
-reinforces something the client shared
+shows you’re listening and relate
-could generate new perspectives
-could elicit strong emotions that may be important in aiding the GC to delve deeper and help client cope more effectively
Personal self-disclosure
Counselor shared something personal about themselves or their experiences in dealing with a situation
Professional disclosure
Sharing of experiences with other clients and of working with others to help give the client more info and perspective
Advanced empathy
Goes beyond information provided by client and includes new insight into thoughts and behaviors
- used to help clients express underlying thoughts and feelings
- can be highly therapeutic and allows for greater expression
- requires strong foundational rapport to be established
Confrontation
- technique used by GCs to directly challenge client on their view of themselves or their situation differently
- goal is to help patient understand themselves more deeply
- can only work when relationship has been established
- start more tentatively and ease into this gradually to help gauge how patient will feel about it-remember patient may not react as expected
Behaviors to confront
- ambivalence
- avoidance
- distortions-twisted or unrealistic thinking
- evasions
- discordant non-verbals
- smoke screens-deflection of topic
Guilt in genetics
- real or imagined internal response to a feeling of responsibility or remorse
- more frequent in AD or XL conditions because it’s one parent, with AR conditions it still exists, but it’s shared
Defense reactions to guilt
- repression and forgotten personal responsibility
- intellectualization or rationalization
- isolation and/or dissociation of feelings
Guilt relieving strategies
- authority-use of knowledge and professional role to explain why they don’t need to have guilt
- normalization-reducing social and psychological isolation
- reframing-helping perceptions take on a new less stressful meaning
- limiting liability-setting boundaries to what an individual can and cannot have a role in
Narcissistic wound
- supplies theory that guilt is actually shame
- particularly with patients who may feel they have failed their child
shame
painful feeling arising from the consciousness of something dishonorable, improper or ridiculous done by oneself or another
-external response to your perceptions of how others see you; usually related to self-esteem
shame relieving tactics
-develop working alliance \+help proactively identify potential issues and aid patients in finding responses -evoke feelings-using advanced empathy -accentuate positive -bolstering ego
Kessler and overcoming shame
patient has to express their feelings and confess that they have the belief they are to blame, before they can become receptive to normalizing responses
scaling questions
allowing patient to rate or rank their level of feeling about something or how they anticipate an outcome would effect them and why
-allows patients to uncover their emotions and thoughts about different scenarios so as to predict changes in those and help them make decisions
empty chair technique
creating imaginative setting for patient to role-play and practice a conversation
-allows for feedback, trouble-shooting from self or counselor
fantasy dialogue
individual having an internal conversation
-helps patients predict scenarios with themselves and how they might react or how they want to be told info or how their perspective of themselves might be altered
unconditional positive regard
- part of Rogers client-centered model
- idea that a person is valued as doing what is best for them to move forward constructively and respecting their self-determination
challenges to giving bad news
- GC feels unprepared or is unprepared
- many clients perceive it to be a poor delivery
breaking bad news
- planning
- assessing what is known
- assessing what is wanted from the client
- give a warning
- share the news
- respond to reaction
planning
- place: privacy both physical and emotional
- time: asking permission, adjusting
- people involved: patient, supports, who should not be there
assessing what is known and what is wanted
simple questions are useful, give them the space to change their minds
give a warning
don’t belabor it, inform them to allow them to adjust and ask permission
share the news
be kind and be clear, no connotative terms (ex: not positive or negative about a result)
respond to reaction
allow time for silence and processing from client because you cannot predict it; reflect what you’re seeing, being empathic, giving space if needed, clarify if needed
- also assess possible need for further intervention without overdoing it
- do not try to do too much; make yourself available to client, plan follow-up and discuss immediate next steps to give back control and normalcy
anger response
- apologize
- give some explanation for your decision
- may require confrontation or advanced empathy
- provide space and ensure necessary follow-up will occur
unexpected responses
- place ourselves in the position of client
- provide empathy and aid
theory of chronic sorrow
parents of children with ongoing needs may be thrown for a loop when something that happens reminds them of earlier challenges or reminds them of ways their child is different than other children
crisis
stressful event that threatens the psychological equilibrium of a client that overwhelms the normal coping response
ACT model of crisis intervention
-Acknowledge
+name issue
+acknowledge feelings and normalize
+dispelling false information or beliefs
-Communicate
+demonstrate our versatility in understanding how to manage the situation
+providing confidence in client abilities
+creating a safe space for discussion
-Transition
+breaking down into steps
+providing alternatives and offering continued support
goals in suicidal client management
- assess adequately regarding suicidal ideation
- decrease immediate danger
- stabilize and triage
three components of risk
- haplessness: feeling of ill-fatedness
- hopelessness: feeling that nothing can get better
- helplessness: nothing can make a difference and no one can help change circumstances
assessing ideation
- understanding intent, asking about plans and extent or imminence
- provide support dependent upon threat level, then discuss alternatives
- create safety to diminish threat
- transfer of care can require bringing in additional departments or personnel or feeling as though the client is able to manage independently
moral conviction
influenced by personal individualized beliefs (cultural, religious, philosophical, etc)
ethical convictions
driven by deliberate considerations, sometimes professional standards such as those that guide course of action (guidelines, position statements, evidence-based research)
Laws and ethics
Laws set a minimum standard for conduct of care, so failure to follow is punishable if the clinician does not follow those laws
Ethics of care
Focuses on the values of interpersonal relationships (ie trust, love, compassion, empathy)
-idea is that genetics professionals act upon their need to care for the patient in the provider-client relationship
Principle-based ethics
-used by modern medicine in overseeing clinical cases
-emphasis on moral reasoning and analysis
+how would a virtuous person respond?-principles of beneficence, nonmaleficence, autonomy, justice
Code of ethics
Ideals set forth by professional organizations for clinicians to follow; can be superseded by state and federal laws
-For NSGC it’s based on our relationships and interactions and how we uphold those
For themselves in code of ethics
Standards we uphold ourselves to (continuing education and staying up to date, yet recognizing our limitations also)
GCs and clients in code of ethics
Upholding standards of autonomy, beneficence and nonmaleficence with our clients
GCs and colleagues in code of ethics
Idea is to treat one another with respect and support each other
Projection
Defense mechanism in which an individual denies the existence of feelings or emotions within themselves by perceiving or attributing them to others
Displacement
Defense mechanism that involves taking out frustrations, feelings and impulses on less threatening people and objects
Reaction-formation
Defense mechanism in which a person acts in opposition to their true thoughts or feelings, which may be socially unacceptable
-tends to be exaggerative, impulsive and inflexible
ethic boards and committees
- governing bodies without binding laws
- goal and purpose is to aid in the resolution of dilemmas
repeating or reflecting
use of words or phrases from client in GC response; using part of their statement as yours, sometimes as a question
paraphrasing
response is a rephrase of what we believe we heard from client
-counselor words capture essence of what was shared
summarizing
combining thoughts and feelings stated by the client into a clearer, more poignant statement
-longer than paraphrase
empathetic breaks
change in focus or dynamic of the session
empathy
understanding someone’s lived experience and sharing in that understanding with them
shared language
promoting partnership by mirroring the phrasing of the patient
-mirroring, modelling and contracting are all ways of implicating this
compassion fatigue
lacking emotional strength, loss of energy
- causes reduced ability to provide empathy
- function of bearing witness to the suffering of others
burnout
emotional exhaustion, depersonalization and reduced feeling of personal accomplishment related to prolonged exposure to demanding interpersonal situations
-related to the negative impact of systemic problems over time
working alliance
stemming from mutually agreed upon goals and tasks
redirect
refocusing when client has gotten off track
riskiness of the gamble
risk as a combination of magnitude of uncertainty and level adversity
-factors and the amount, consistency and clarity of information regarding them will influence the judgement of adversity
embodied knowledge
integration of personal beliefs and experiences into presented biomedical information that has been transformed by identifiable processes in order to make a decision
adapting the message
requirement of facts to be communicated in a credible, comprehensive way
- an effective risk formulation and presentation characterizes the needs of the intended audience and their current beliefs
- ongoing process
engagement
the cognitive and emotional involvement risk has for the client
- fluctuates over time in a client
- level predicts risk perception
- higher level of this predicts better adaptations to a positive result
experiential knowledge
derived from empathetic knowledge and connectedness to others experiences
-integral to understanding and risk perception
Heuristic systematic model
systematic processing of information, beliefs, experiences, etc leads to an effortful tactic of informed decision making and improved understanding of risk over time
-promoting factors: personal relevance and self-affirmation opportunities, lack of time pressure, perceived accountability need, high perceived amount of information, personalized expression of risk and graphical presentation of risk
availability heuristic
how easily examples of an outcome come to mind, based on “experience” (ex: knowing an affected individual)
representative heuristic
interpretation of risk, based on prototypes or samples-inferring from a small sample to a large group
-ex: patient feeling as though their risk to have a BRCA mutation is higher than 50% based on family history
anchoring heuristic
prior beliefs serve as a frame of reference, in which new information and risk figures are evaluated
-bias introduced by the first concept or risk figure discussed
cognitive and emotional factors
- optimism v. pessimism
- attitude towards taking risks
- preference for numerical format
prior beliefs
client beliefs about level of risk; may be influenced by information from other providers, research, etc
complexity
intricacy of risk figures
uncertainty
associated with perception of the risk figure
math ability
capability of the client to understand numerical values and probability
competing values
importance of something else conflicts with the presented risk
consequences
expected range of outcomes related to the presented risk
binarization
tendency to view risk in only two categories
-ie risk will occur or not occur
need for uncertainty reduction
emotional need to reduce uncertainty
risk v. burden
occurs in light of the concepts of uncertainty and undesirability
-causes competition or weighing of the two in comparison with the other
reactions to bad news
- denial
- anger
- grief or despair
- questioning
denial
inability to acknowledge information, buys time
- disbelief: heard not accepted
- deferral: accepted, not implicated
- dismissal: devalues legitimacy of info
anger
seeks to blame, GC should help patient elaborate on the underlying feelings
grief or despair
intense sadness regarding results, GC should discuss this with the patient and why the reaction is so strong
questioning
asking “why me?”, GC should understand the driving question and address the emotion behind it
interventions to patient reactions
- continued support
- time
- empathy
- acknowledgement
- normalization
confronting
coping by trying to change opinions of person in charge, combative
distancing
coping by acting as if nothing happened
seeking social support
coping by taking news with other people in hopes of learning more, engaging in conversation
self-controlling
coping by keeping feelings to oneself
accepting responsibility
coping by criticizing or blaming oneself
escape-avoidance
coping by hoping for a miracle
planning
coping by identifying and following next steps of an action plan
positive reappraisal
coping by identifying an existing or potential positive outcome(s)
repression
defense mechanism that stops emotions and memories from reaching consciousness
denial
defense mechanism in which an emotional response is repressed and cannot be consciously expressed or recognized
intellectualization
emotional response is repressed in this defense mechanism, and situation is attempted to be addressed through cognitive processes
sublimation
“unacceptable” emotions are redirected into acceptable activities as a defense mechanism
projective identification
a client’s defense mechanism behavior induces a repressed or unacceptable behavior in another, could be the GC
identification
assumes the identity or behavior of another person
regression
reverting to a less mature behavior as a style of defense mechanism
undoing
defense mechanism that attempts to cancel out a distressing experience by doing something that signifies an opposite feeling
Self-Psychology
self is dependent on shaping relational experiences
relation theory
how connections foster coping and relational skills
Family systems theory
- adaptation of families as a whole to critical life events
- individuals best understood through family dynamics
health belief model
fear or threat of a disease will motivate behaviors
stages of change model
- pre contemplation
- contemplation
- decision
- action
- maintenance
consumer information processing theory
patients process and use information in small, manageable chunks
social learning theory
behaviors and environment are reciprocal systems
theory of reasoned action
attitudes and social norms are important in behavioral intention
common sense model
fear control is parallel to decision-making, so coping may interfere with positive behaviors
transactional model of stress and coping
- if something feels controllable, action is problem-focused
- if something feels uncontrollable, action is emotion focused
