Summary: Psychosocial Assessment and Support
Current genetic counseling job tasks were determined by the American Board of Genetic Counseling as the outcome of a Genetic Counseling Practice Analysis (Hampel et al., 2009). The following lists the Psychosocial Assessment and Support tasks:
A. Psychosocial Assessment
1. Recognize factors that may affect the counseling interaction
2. Assess client and/or family
a) Emotions (e.g. grief, guilt, anger, depression)
b) Support systems
c) Defense mechanisms and coping strategies
d) Cultural/religious beliefs and values
3. Evaluate social and psychological histories
4. Assess clients’ psychosocial needs and recognize need for referral
B. Psychosocial Support/Counseling
1. Address client emotion and/or behavior using:
a) Utilize reframing to broaden counselees’ perceptions
b) Employ anticipatory guidance
2. Utilize cross-cultural genetic counseling techniques
3. Promote competence and autonomy with direct, supportive statements
4. Address family communication issues
5. Facilitate client decision-making
6. Promote client/family coping and adjustment
In light of the increasing diversity in America, it is not uncommon for a genetic counselor to meet with clients who have different cultures and values. These differences can be perceived as unusual or backwards if one does not take the time to understand the client’s background. It is our responsibility as health care providers to identify major concerns and respond to emerging issues of a client or family in a culturally responsive manner. Culturally competent genetic counseling is an ongoing process that begins when the counselor actively attempts to establish rapport with the client and continues through taking the family and medical history, explaining the natural history and testing options, and providing individualized client-centered psychosocial counseling.
In the case of Yunhua and Biao, Michele left the session feeling that she did not know how Yunhua and Biao felt and she didn’t know how to help them. When you encounter clients who do not open up to you, for whatever reason(s), you may need to utilize a range of interviewing techniques, assessment tools, and counseling skills. Michele could have asked both Yunhua and Biao what they believed was the cause of the Amniotic Band Syndrome and/or how they thought this diagnosis would affect their family, including their couple relationship. Michele would need to listen carefully for words the couple uses when they talk about the abnormal fetal limb development. Their words may reflect guilt (feeling of failure due to actions - “I shouldn’t have…”) or shame (feeling of personal flaws - “It is my fault….”). Once these feelings are identified, counselors can use their collection of strategies to explore and alleviate feelings of guilt or shame. In this case, after gaining insight into cultural, or other, factors that might impact the couple’s individual perspectives, Michele could have tried to reframe negative perceptions to help Yunhua and Biao see the Amniotic Band Syndrome from a different perspective (“The baby appears to be growing well and there is no reason to expect other health or learning challenges.”) Michele could have asked if the couple would like to return for another genetic counseling appointment with other family members. Asian American culture is rooted in the family and decision-making is often a group process. If Michele extends an invitation to the whole family, the couple may become more trusting since she is making a concerted effort to help them feel comfortable.
The prenatal diagnosis of a fetal limb anomaly is unexpected news. Clients in this situation are vulnerable, and they often experience many, intense emotions. They literally may not be able to express how they feel. Instead of exploring previous family experiences, behaviors, emotions and perceptions that could have helped clarify how the diagnosis affected Yunhua and Biao, Michele focused only on the diagnosis and asked the couple to directly state their feelings.
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Was Michelle so worried about cultural differences that she couldn’t focus on the basics of establishing rapport and trust?
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Could Michelle have tried using empathy, advanced empathy, indirect questions, and other counseling strategies to help the clients gain insight into their feelings and needs?
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Has this couple ever talked about their feelings in a health care setting?
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Did the couple expect to see a doctor and not a young female genetic counselor?
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Did the couple need time with each other, or other family members, before further discussion with the genetic counselor?
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Would it have been better to meet the next day?
There are a number of techniques that Michele could have tried to enhance the effectiveness of the genetic counseling session with Yunhua and Biao.
