Like other patients attending a genetic counseling appointment to discuss an abnormal ultrasound, Bianca may be emotional and sensitive. Initiating the appointment by asking questions about drugs and alcohol abuse may cause Bianca to feel guilty and defensive. It is important to use neutral terms when counseling imprisoned women. Explain to Bianca that you are using standard forms and protocols for documenting prenatal exposures to drugs and alcohol and that you ask all patients these questions. When counseling a pregnant woman who is an inmate, the genetic counselor should focus on building trust, eliciting medical history while providing psychosocial support, completing a mental health assessment, and locating resources that are available at the specific correctional facility.
Bianca may feel uncomfortable having her medical information disclosed to the prison staff. The genetic counselor may wish to explore with the guard whether there would be any personal safety concerns if you met with Bianca privately. The guard could wait outside the genetic counseling room, with the door kept open. If that seemed sensible, the genetic counselor could offer Bianca a choice to ask the guard to wait outside. Giving Bianca this personal choice is an act of respect that builds trust for your conversation to follow. To gain the inmate's trust, confidentiality should be discussed at the outset of the genetic counseling session. The genetic counselor may wish to explain to Bianca that according to the HIPAA regulations for inmates, there is no need to disclose the details of the genetic counseling discussion to others unless she or someone else is in danger, or if the institution needs to know for the sake of her own healthcare.
By informing Bianca of her rights and options, the genetic counselor is more likely to engage her trust. In general, when the counselor is genuine and truthful clients will understand a situation more clearly, leading to increased autonomy (Veach, Leroy, Bartels, 2003). Building an alliance with your client is ideal. Relationships in health care and medical research are based on trust, because patients are especially vulnerable (Wynia, 2003). Unlike individuals from majority groups who are likely to trust their counselor until they feel the trust has been abused, individuals from minority groups may be inclined to distrust their counselors until the trust is earned (Cormier & Cormier, 1991). Building trust with Bianca is especially important to promote her participation in the genetic counseling sessions.
However, trust is more difficult to achieve in short-term counselor-client relationships (Kessler, 2000). Whatever the venue, the genetic counselor should strive to create an open and honest environment. If Bianca's verbal and non-verbal communications express disengagement, suspicion and/or distrust, it is important for the counselor to remain non-defensive. Bianca's actions may be attributed to previous experiences of discrimination or exploitation (Weil, 2001). After initiating the session, the genetic counselor should continue to build rapport and begin eliciting the medical history.
When Bianca disclosed personal information during the session, the genetic counselor had an opportunity to provide short term counseling and support. By failing to engage the client in further discussion about her life, the genetic counselor marginalized Bianca's expressed concerns. When patients disclose personal information, they may be "testing the waters" to see how safe it is to discuss sensitive issues with you (Cormier, 1991). When the counselor avoids further discussion of this information, the patient may feel that she is being judged, and she may put up an emotional shield. The genetic counselor can contribute to the client's well-being by helping assess her mental and physical environment. For example, it is important to consider that an inmate may or may not eventually have custody of her child in prison and how these concerns may affect Bianca's mental and emotional health. The genetic counselor can help Bianca take stock of medical, emotional, and mental health issues and direct her to resources that she can access while incarcerated, and after release.
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