Duke Adult Cardiovascular Genetics Clinic, Durham, North Carolina, USA.
The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.
J Genet Couns. 2022 Jun;31(3):663-676. doi: 10.1002/jgc4.1533. Epub 2021 Nov 26.
A personal or family medical history is inherently part of a genetic counselor's life story. Yet, the degree to which this history influences counselors' clinical specialty choice and professional psychosocial practice is unexplored. A medical diagnosis may foster capacity for greater empathy, understanding, and rapport-building self-disclosure. Conversely, it could lead to disruptive countertransference, compassion fatigue, and eventually burnout. Research, however, has not specifically investigated this intersection. The aim of this study was to explore the impact of genetic counselors' personal and/or family medical history on choice of practice area and self-perceived impact on their psychosocial work within sessions. Members of the National Society of Genetic Counselors were recruited to complete an online screening survey. Of the 69 survey respondents that met inclusion criteria, 23 volunteered for and completed a telephone interview. Interview questions explored counselors' medical narratives and their consequent influence on specialty choice and clinical interaction with patients. Inductive analysis yielded nine domains within three major themes: Medical Story, Specialty Impact, and Psychosocial Influence. Participants were more likely to be attracted to a specialty possessing overlap with their medical history and attributed many of their psychosocial strengths to personal and/or family medical experiences, such as increased empathy or a more expansive scope in how they cared for patients. Many counselors, however, noted their medical history did not frequently influence their clinical practice, with most initially denying or downplaying use of self-disclosure about their history. Contradictory to their statements, the majority gave at least one example of self-disclosure, whether indirect, prompted, or direct. Importantly, almost all participants named or demonstrated countertransference. This study highlights that while medical history can be a valuable asset in providing care for patients, it requires a genetic counselor's diligent attentiveness and commitment to honest self-reflection.
个人或家族病史是遗传咨询师生活经历中固有的一部分。然而，这种病史对咨询师临床专业选择和专业心理社会实践的影响程度尚未得到探索。一个医学诊断可能会增强同理心、理解和建立融洽关系的能力，并促进自我披露。相反，它也可能导致破坏性的反移情、同情疲劳，最终导致倦怠。然而，研究并未专门调查这一交叉点。本研究旨在探讨遗传咨询师个人和/或家族病史对实践领域选择的影响，以及他们在咨询过程中自我感知对心理社会工作的影响。国家遗传咨询师协会的成员被招募来完成在线筛选调查。在符合纳入标准的 69 名调查参与者中，有 23 名自愿参加并完成了电话访谈。访谈问题探讨了咨询师的医疗叙事及其对专业选择和与患者临床互动的影响。归纳分析得出了三个主要主题下的九个领域：医疗故事、专业影响和心理社会影响。参与者更有可能被与他们的医疗史有重叠的专业所吸引，并将他们的许多心理社会优势归因于个人和/或家族的医疗经验，例如增加同理心或更广泛地关心患者。然而，许多咨询师指出他们的医疗史并没有经常影响他们的临床实践，大多数人最初否认或淡化使用自我披露他们的历史。与他们的陈述相反，大多数人至少举了一个自我披露的例子，无论是间接的、提示的还是直接的。重要的是，几乎所有的参与者都提到或展示了反移情。这项研究表明，虽然医疗史可以成为为患者提供护理的宝贵资产，但它需要遗传咨询师的勤奋关注和对诚实自我反思的承诺。
