Psychosocial Assessment, Support and Counseling

Family and Couples Counseling

It is not unusual for a spouse or other family members to attend a genetic counseling session with the client. The presence of other individuals may affect the communication, content, and interaction dynamics of the psychosocial assessment, support, and counseling portion of the session. It is therefore advisable to be adept at handling a genetic counseling situation when multiple family members are present. The support of another close individual in a time of need can be invaluable. However, times of adversity can also put extra strain on family and especially couple relationships. For most couples and families, the intimate fabric of their relationship is deeply private (Roland, 1994). Yet, issues that arise during genetic counseling often lead to stepping into this private zone. Couples dealing with chronic conditions often present distinct issues for each member of the couple. These issues may need individual attention and may be most effectively handled separately. Otherwise, it can be difficult to assess what issues can be openly shared and those that are closely guarded. If handled correctly, counseling a couple can provide the opportunity to nurture trust, promote feelings of closeness, and encourage introspective, intimate conversations that strengthen the couple’s mutual appreciation and understanding (Berg-Cross, 2000). However, as Berg-Cross (2000) also points out, intimate conversations do not occur naturally in most relationships. Furthermore, the role of the genetic counselor in exploring these relationships varies among practice settings and is often practitioner-specific.

There are many ways that counselors can help families and couples promote intimate communication. We provide some ideas below. No matter which ideas seem relevant to a case and most comfortable for you as the counselor, it is important to explain to the family why a technique may be useful. It may be helpful to incorporate role playing into the session to help families and couples articulate their concerns and begin to problem solve.

Seven Aspects of Skillful Intimate Communication

  1. Validation - reassure the other person that you truly understand the depth and scope of what is said.

  2. Responsibility - take responsibility for one’s own feelings and thoughts.

  3. Precision - avoid being too vague and precisely communicate the concern.

  4. Rationale - provide rationale for the concern to begin a successful discussion.

  5. Sense of humor - a couple’s ability to laugh at a situation together creates a bond between them and makes expression of disagreement less threatening.

  6. Ask questions when more information is needed - a sign of objectivity which creates a climate of cooperation.

  7. Create a climate of safety - people need to know that their boundaries will be respected.

    Source: Berg-Cross, 2000

 

Sharing-A Family Exercise

This exercise can help clients and the counselor gain insight into existing family communications, and reveal areas that individuals consider satisfactory or areas that they might like to change. Have each member of the family rate himself or herself with respect to the following statements. Choose Always (A), Sometimes (S), or Never (N). It may be helpful to have family members compare their responses.

____ As a family, we get together and make important decisions.

____ As a child, I feel free to talk over serious concerns with my father.

____ As a child, I feel free to talk over serious concerns with my mother.

____ As a mother or father, I feel I can talk over important issues with the children.

____ As a husband or wife, I feel a certain restriction or constraint in talking over important things with my spouse.

____ Brothers and sisters in our family rarely talk to each other.

____ The members of my family all like to sit and talk at the dinner table or in the front room.

____ We find time for private talks between a parent and each child.

____ I usually plan very carefully before I will discuss anything of real importance with anyone in the family.

____ I often wish that our family would share more with each other.

     Source: Adapted from Dyer, 1975

 

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