Kashmola-Perez Iman, McCarthy Veach Patricia, Schema Lynn, Redlinger-Grosse Krista
Maternal-Fetal Medicine, M Health Fairview, Minneapolis, MN, USA.
Department of Genetics, Cell Biology, and Development, Institute of Human Genetics, University of Minnesota, Minneapolis, MN, USA.
J Genet Couns. 2021 Dec;30(6):1598-1612. doi: 10.1002/jgc4.1426. Epub 2021 May 2.
Self-involving responses are direct expressions of genetic counselors' here-and-now feelings about/reactions to patients. Strategic, sparing use of self-involving responses may enhance practitioner genuineness, likeability, and trustworthiness, decrease patient anxiety, and increase patient trust and engagement. Conversely, they may threaten patients who are uncomfortable with emotional expression or confuse them about the counselor's intentions. Despite theorized benefits and risks, no study has explored genetic counselor self-involving responses. This study explored whether clinical genetic counselors use self-involving responses with their patients, reasons for doing so, and their perceptions of when and why the responses work well versus poorly. Two-hundred sixty-eight genetic counselors, invited via a National Society of Genetic Counselors e-blast, completed an online screening survey. Eighty-nine percent reported using self-involving responses with patients, and 17 were purposively selected to participate in semi-structured phone interviews. Thematic analysis yielded themes regarding potential benefits, risks, counselor factors and context, and patient factors related to using self-involving responses. Benefits include conveying counselor conditions for facilitating counseling process (e.g., genuineness, building rapport, focusing the session, and encouraging the patient to open-up), and counseling outcomes by validating decision-making. Risks of use include hindering counseling processes and outcomes by misperceiving patient feelings, boundary crossing, and being unduly directive. Factors, both from the counselor and the context of the session, include comfort with the technique, mastery of clinical skills, minimal knowledge of patient emotions, type of counseling session, and counselor practice specialty. Patient factors include prior rapport with the counselor, and patient emotionality and cultural background. Findings underscore the need for training about this technique. Future research could examine patients' perceptions of self-involving statements and differences in self-involvement across practice specialties and counseling modalities.
自我卷入式回应是遗传咨询师当下对患者的感受和反应的直接表达。策略性、适度地使用自我卷入式回应可能会增强从业者的真诚度、亲和力和可信度，减轻患者的焦虑，并增加患者的信任和参与度。相反，它们可能会威胁到那些对情感表达感到不适的患者，或者使他们对咨询师的意图感到困惑。尽管有理论上的益处和风险，但尚无研究探讨遗传咨询师的自我卷入式回应。本研究探讨了临床遗传咨询师是否会对患者使用自我卷入式回应、这样做的原因，以及他们对这些回应何时效果良好或不佳及其原因的看法。通过美国国家遗传咨询师协会的电子邮件邀请了268名遗传咨询师，他们完成了一项在线筛选调查。89%的人报告对患者使用了自我卷入式回应，其中17人被有目的地挑选出来参加半结构化电话访谈。主题分析得出了与使用自我卷入式回应相关的潜在益处、风险、咨询师因素和情境以及患者因素等主题。益处包括传达咨询师促进咨询过程的条件（如真诚度、建立融洽关系、聚焦咨询环节以及鼓励患者敞开心扉），以及通过验证决策来实现咨询结果。使用的风险包括因误解患者感受、越界和过度指导而阻碍咨询过程和结果。来自咨询师和咨询环节情境的因素包括对该技巧的舒适度、临床技能的掌握程度、对患者情绪的了解有限、咨询环节的类型以及咨询师的执业专长。患者因素包括与咨询师先前的融洽关系、患者的情绪状态和文化背景。研究结果强调了对此技巧进行培训的必要性。未来的研究可以考察患者对自我卷入式陈述的看法，以及不同执业专长和咨询方式下自我卷入的差异。
