Benkendorf J L, Prince M B, Rose M A, De Fina A, Hamilton H E
Department of Obstetrics and Gynecology at Georgetown University Medical Center, Washington DC 20007-2197, USA.
Am J Med Genet. 2001 Fall;106(3):199-207. doi: 10.1002/ajmg.10012.
To date, research examining adherence to genetic counseling principles has focused on specific counseling activities such as the giving or withholding of information and responding to client requests for advice. We audiotaped 43 prenatal genetic counseling sessions and used data-driven, qualitative, sociolinguistic methodologies to investigate how language choices facilitate or hinder the counseling process. Transcripts of each session were prepared for sociolinguistic analysis of the emergent discourse that included studying conversational style, speaker-listener symmetry, directness, and other interactional patterns. Analysis of our data demonstrates that: 1) indirect speech, marked by the use of hints, hedges, and other politeness strategies, facilitates rapport and mitigates the tension between a client-centered relationship and a counselor-driven agenda; 2) direct speech, or speaking literally, is an effective strategy for providing information and education; and 3) confusion exists between the use of indirect speech and the intent to provide nondirective counseling, especially when facilitating client decision-making. Indirect responses to client questions, such as those that include the phrases "some people" or "most people," helped to maintain counselor neutrality; however, this well-intended indirectness, used to preserve client autonomy, may have obstructed direct explorations of client needs. We argue that the genetic counseling process requires increased flexibility in the use of direct and indirect speech and provide new insights into how "talk" affects the work of genetic counselors.
迄今为止，有关遵循遗传咨询原则的研究主要集中在特定的咨询活动上，比如提供或不提供信息以及回应客户的咨询请求。我们对43次产前遗传咨询 session 进行了录音，并使用数据驱动的定性社会语言学方法来研究语言选择如何促进或阻碍咨询过程。为了对包括会话风格、说话者与倾听者的对称性、直接性和其他互动模式在内的新兴话语进行社会语言学分析，我们准备了每次 session 的文字记录。对我们数据的分析表明：1）以使用暗示、模糊措辞和其他礼貌策略为特征的间接言语有助于建立融洽关系，并缓解以客户为中心的关系与咨询师主导议程之间的紧张关系；2）直接言语，即照字面意思说话，是提供信息和教育的有效策略；3）在使用间接言语与提供非指导性咨询的意图之间存在混淆，尤其是在促进客户决策时。对客户问题的间接回应，比如那些包含“有些人”或“大多数人”等短语的回应，有助于保持咨询师的中立性；然而，这种旨在维护客户自主性的善意间接性可能阻碍了对客户需求的直接探索。我们认为，遗传咨询过程需要在使用直接言语和间接言语方面增加灵活性，并为“谈话”如何影响遗传咨询师的工作提供新的见解。
