The Genetic Counseling Session
An initial step for effectively counseling a GLBT person is to become aware of your own perspectives. The American Psychological Association Guidelines (2000) encourage psychologists to acknowledge their opinions and understanding of gay, lesbian, and bisexual issues. Similarly, each genetic counselor needs to be aware of his or her limitations and how they might affect individual clients positively or negatively. Some may have conscious objections to homosexuality while others have more unconscious aversions (e.g., always assuming that people are heterosexual). Others are completely aware of and open to people of different sexual orientations. It is important to be continually self aware of your beliefs, and to challenge yourself, your biases, and your limitations in working with GLBT clients (Szymanski, 2008). It is essential to respect the client’s choices, despite your own personal feelings.
Using culturally appropriate language is critical to developing trust between a client and a genetic counselor. Counselors need to make language inclusive, avoiding terms that assume heterosexuality. When interviewing clients for intake information, a genetic counselor should always ask questions such as “Do you have a partner?” rather than “Are you married?”. It is also important not to assume that previous partners have been of the same gender as a current partner (Szymanski, 2008). During a counseling session, take note of the language the client uses. For example, listen whether the client mentions a partner versus a spouse or a partnership versus a marriage, or two mothers instead of a mother and a father, or other variations on parenting and family relationships. Whenever possible, the genetic counselor should use the basic interviewing technique of promoting shared language by mirroring the client’s language (Baker, 1998).
Given the lack of acceptance individuals may have experienced from their families and others, genetic counselors can serve as a role model by expressing acceptance of our clients within the counseling session. For example:
Brittany (Genetic Counselor): “Do you have a partner?”
Lisa: “Yes, I do. Jamie and I have been together for five years and we are so excited about becoming pregnant!”
Brittany: “Congratulations! It’s wonderful to see your enthusiasm for becoming parents! Let’s talk about your family and this current pregnancy.”
This is a liberal response that can lead to more discussion of the client’s sexual orientation, only if is the wish of the client. The liberal response includes the necessary element of being open to the client’s sexuality. Lisa is seeking information about advanced maternal age, but her case is unique and individual approaches are needed in order to provide effective client-centered genetic counseling. As with any genetic counseling session, let your client set the agenda. The genetic counselor wants to keep the focus on the reason for referral without ignoring cues from the client.
Culturally inclusive language should be used in both written and oral communications with the client. When a client first arrives for an appointment, an intake form is completed by the client in the waiting room or during the appointment as part of the client interview process. The intake form is a crucial communication tool, and it may determine the client’s first impression of your office. Reviewing and completing this form can ease the client’s concerns about the reason for referral or it may exacerbate her worries (Gay, 2006). The intake form should be free of heterosexual bias and use neutral language (Sue & Sue, 2003). One of the first details asked on an intake form is typically regarding the client’s gender. In order to be inclusive of all people, we recommend that the options include: Female, Male, Transgender, and Intersex (Gay, 2006). Instead of questioning someone’s marital status, the intake form should inquire about relationship status. The suggested options are: Single, Married, Domestic Partnership/Civil Union, Separated from Spouse/Partner, and Divorced or Permanently Separated from Spouse/Partner (Gay, 2006). Some institutions include sexual orientation on the intake form. The development and use of intake forms that are culturally inclusive sends the message to clients that your center will respect and accept everyone (GLBT, 1999). Changes in office procedures may take some time to implement, but when interviewing and counseling the client, the genetic counselor should always use inclusive language.
