Psychosocial

Question 1

Define Transference

Answer 1

transference – unconscious way that a client relates to the genetic counselor based on his or her history of relating to others; how the client perceives the counselor and how the client behaviors toward the counselor

clients project attitudes, roles, and expectations onto the counselor based on their previous encounters with others

result of misperception of the counselor leading to overreaction to the reality of the situation

may be positive or negative

Question 2

What are the five transference reactions a client may have?

Answer 2

Counselor as an ideal – client views the counselor as perfect
Behaviors: excessive compliments, agreeing with everything said

Counselor as seer – client believes the counselor has all the right answers
Behaviors: repeatedly asking what the counselor would do

Counselor as nurturer – client views the counselor as a source of strength
Behaviors: acting helpless, excessive crying, urgent demands

Counselor as frustrator – client views the counselor as spoiling their experience
Behaviors: excessively defensive, blaming the counselor

Counselor as nonentity – client views the counselor as an inanimate figure with no feelings, wishes, or needs
Behaviors: topic shifting, dismissing counselor’s interpretation

Question 3

Define Countertransference

Answer 3

countertransference – unconscious way that a genetic counselor relates to the client based on his or her history of relating to others

can include emotional reactions and projections toward clients that may not be particularly appropriate to the current relationship

involves misperceptions and overreactions

may be positive or negative

can occur due to overidentification or disidentification with a client

Question 4

Define projective identification.

Answer 4

projective identification – the genetic counselor mistakenly believes that their feelings are the client’s feelings; misperception that one understands exactly what a client is going through because the counselor has had the same or a similar experience

results in shallow empathy because the counselor will not go deeply into feelings that are upsetting to them

Question 5

Define Associative Countertransference

Answer 5

associative countertransference – the client’s experience taps into the genetic counselor’s inner self, and the counselor begins to focus on their own thoughts, feelings, and sensations

results in loss of focus during a session because attention shifts from the client to oneself

may be triggered by past or current problems or situations that are similar to the client’s

counselor does not believe that their feelings are the client’s feelings

Question 6

Define overprotective countertransference.

Answer 6

overprotective countertransference – the genetic counselor regards clients as childlike and in great need of care and protection, so the information given to a client is cushioned (ex. “This risk isn’t really so bad.”), qualified (ex. “It was just a guess.”), or protects clients from experiencing and expressing their painful feelings (ex. “It will be fine.”)

Question 7

Identify signs of an overprotective GC

Answer 7

• Talking in a low voice
• Using physical gestures that are infantilizing to a client
  
  • examples: patting on the back, hugging, patting on the hand
• Excessively worrying about a client, possibly to the point of obsession

Question 8

Define Benign Transference

Answer 8

benign countertransference – the genetic counselor has an intense need to be liked by clients or has a fear of strong client affect, especially anger

• Results in a shallow exploration of emotions or a preponderance of optimistic information or issues
• Session may be full of extraneous small talk or personal chatting, as the genetic counselor is trying to be more like a friend to the patient

Question 9

Define Rejecting Countertransference

Answer 9

Rejecting countertransference – the genetic counselor acts aloof or cold and behaves in ways that create distance in the relationship, such as use of blunt language (ex. “Your risk of having a child with a birth defect is high because you drank during your pregnancy.”) or being dismissive of clients (ex. “That’s your decision, I’m not you.”)

-perceive clients as needy or dependent, resulting in the counselor feeling personally responsible for the client’s welfare or fearing that the client may have excessive demands

Question 10

Define Hostile Countertransference

Answer 10

hostile countertransference – the genetic counselor dislikes something about the client, and in an attempt to be as unlike the client as possible, the counselor distances themselves in both overt and covert ways, such as making harsh statements (ex. “You sure have gotten yourself into a mess with this nonpaternity situation.”)

• reasons for disliking the client may include: mannerisms, beliefs, values, attitudes, or physical characteristics
• counselor’s attitude is that the client is getting what he or she deserved

Question 11

What is morality

Answer 11

morality – a common code of conduct or an agreed-on view of what behavior is acceptable and what behavior is not acceptable by a society or a community of people

• in certain situations, society can justify immoral actions
• moral convictions provide a stand by which to evaluate one’s own and other people’s conduct and character
• goal of moral behavior is to decrease the harms suffered by members of that society

Question 12

What are the four principles of principle-based ethics?

Answer 12

Beneficence
Nonmaleficence
Autonomy
Justice

Question 13

Define Beneficence

Answer 13

beneficence – promotion of personal well-being in others; when benefits have been balanced against harms and costs, the outcome should be of net benefit

• health care providers should be acting as advocates for the patient and acting in good faith for the benefit of that patient
• interpreted as paternalism when a provider’s view of benefit does not agree with the views of a patient

-refusal to acquiesce in the patient’s wishes, choices, or actions can result in neglect and violation of patient autonomy

Question 14

Define nonmaleficence.

Answer 14

nonmalficence – involves restrictions on behavior as opposed to actions that promote behavior; duty not to inflict harm

duty to remain the protector of the life and health of a patient

frequently an issue surrounding medical research or vulnerable populations

Question 15

Define autonomy.

Answer 15

autonomy – represents an individual’s personal rule of self, remaining free form controlling interferences that prevent the making of meaningful choices

-truth telling, confidentiality, and informed consent are all obligations applied to an individual

Question 16

Define justice.

Answer 16

justice – treating “like” people in a “like” manner and giving all individual’s their due rights

Question 17

What are the four values of justice with

regard to the provision of health care?

Answer 17

Equality: Provision of equal care for all
Liberty: Freedom of choice for both the provider and the patient

Excellence: Provision of the best possible care for everyone
Efficiency: Containment of health care costs

Question 18

Define attending

Answer 18

attending – observing client verbal and nonverbal behaviors as one way of understanding what clients are experiencing, and displaying effective nonverbal behaviors to clients during genetic counseling sessions

Question 19

Identify and define 2 types of attending

Answer 19

psychological attending – sensing experiences through the eyes of the client rather than through one’s own perspective—-involves being sensitive to client feelings and experiences and perceiving and processing various client messages

physical attending – using one’s body to communicate understanding to a client

Question 20

Identify three effective psychological attending skills.

Answer 20

• -Observing and responding to client nonverbal behaviors
• -Understanding client body and facial movements
• -Attending to subtle cues

Question 21

Identify five effective physical attending skills

and give at least one example of each.

Answer 21

1. Face and eyes
   Examples: occasional head nods, looking but not staring at client
2. Body
   Examples: relaxed but alert, comfortable distance from client
3. Voice
   Examples: adequate volume, use of words the client understands
4. Distracting behaviors (avoid using these)
   Examples: fidgeting, shuffling papers, excessive use of “filler words”
5. Touch: Be very careful about using touch; may be misinterpreted or culturally unacceptable
   Example: shaking hands in Western culture is generally appropriate

Question 22

Define Empathy

Answer 22

empathy – understanding what another person is experiencing and communicating that understanding to that person; capacity to put oneself in another person’s place to understand from his or her frame of reference

	empathy is not feeling what the client is feeling, which may result in identifying with the client and countertransference

Question 23

Identify and define 2 types of empathy

Answer 23

primary empathy – communicates initial understanding of what a client is experiencing; responses convey an understanding of the surface of the problem

–important for rapport building and problem exploration

advanced empathy – communicates an understanding of underlying, implicit aspects of client experience; responses are additive and go beyond the surface of the problem or issue

–important for assessing a client’s deeper and less obvious feelings and experiences

Question 24

What are four components of a genetic counseling session?

Answer 24

1. Initiating the session: Includes preparing the case, introductions, and setting the agenda
2. Contracting:Clients set their goals for the session
3. Ending the session and/or relationship
4. Making referrals