Case Study
Michele is a genetic counselor working in a medical center that provides prenatal genetic services. Today, Michele is meeting with a couple, Yunhua and her husband Biao, to discuss the prenatal diagnosis in their fetus of a full left upper limb amputation, which is likely due to Amniotic Band Syndrome. The couple knows that the ultrasound was abnormal, but they do not know what the particular findings are yet. From the intake forms, Michele learns that Yunhua and Biao are both in their mid-twenties and self-identify as Asian American. Michele can tell that neither Yunhua nor Biao has any problems understanding her; they both speak English very well. As Michelle explains to the couple that their son appears to be very healthy but his left arm did not form properly, Yunhua hangs her head. Yunhua turns to Biao and says, “I’m so sorry - I didn’t mean for this to happen.” Michele tries to address the emotions of the couple by asking them, “How do you feel about your son’s diagnosis?” The couple remained quiet. Finally, Biao asked Michelle to explain exactly how this could have happened. Michelle felt that she had no choice but to review the medical facts and accept that the couple would not share their feelings. Michele left the session feeling that she really didn’t know how Yunhua and Biao felt, what issues they might be considering, or how she could have been more helpful to them.
Personal Reflections
What are your first reactions to this situation?
Have you ever experienced a situation like this? What were the similarities to this session? What were the differences?
What could be the potential personal and/or cultural and religious reasons for Michelle’s feelings of helplessness?
What thoughts and emotions do you have about further exploring this couple’s cultural context?
Are you a member of a couple? If so, how does this couple’s relationship compare to your couple relationship?
Perspectives
Now, approach the situation from the clients’ point of view. Consider what personal experiences or beliefs may have caused Yunhua and Biao to feel or respond the way they did.
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If you were Yunhua during this encounter, list 3 feelings you might have felt.
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If you were Biao during this encounter, list 3 feelings you might have felt.
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What do the couple’s verbal cues tell you?
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What do the couple’s nonverbal cues tell you?
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How would you describe the dynamics of the relationship between Yunhua and Biao?
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Do you detect signs of guilt? If so, list these signs.
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Do you detect signs of shame? If so, list these signs.
The Counselor’s Background
Knowingly or unknowingly, our own cultural beliefs and experiences affect the care we provide. Our background and beliefs may lead to over-identification with clients, exaggerated emotional responses or opposite responses, such as blind spots, which can cut off one’s emotions and create distance between one’s self and the client (Borders et al., 2006). An honest assessment of one’s own cultural awareness is necessary to avoid imposing a personally biased cultural viewpoint on the client.
According to the National Society of Genetic Counselors Professional Status Survey, only 7% of practicing counselors identified themselves as belonging to an ethnic group other than Caucasian (Smith, Freivogel and Parrott, 2008). Ethnic/racial minorities predominantly encounter genetic counseling providers who do not share their culture and language (Mittman et al., 1998). Therefore, it is important for genetic counselors to take active efforts to understand a client’s perception of and response to the situation in the effort to appreciate the patient’s reality.
Reflections
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How do you define differences between people? Give a few examples.
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How do you define similarities between people? Give a few examples.
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What differences between you and your clients are you most aware of? What similarities between you and your clients are you most aware of?
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Can you identify differences and/or similarities between you and your clients that tend to evoke “positive” reactions on your part? Can you identify differences and/or similarities between you and your clients that tend to evoke “negative” reactions?
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Describe patterns of communication between couples that you have seen in your genetic counseling sessions.
- In a peer supervision setting, share the range of couples’ communication patterns you have noted in your sessions with those noted by your colleagues in their sessions.
