Psychoeducational genetic counseling: Toward an integrated model
Genetic counseling, a dynamic psychoeducational relationship, embraces counseling and teaching models. Yet these approaches differ in their methods and outcomes. To foster development of an integrated model for genetic counseling and to evaluate its effectiveness, consensus is needed on the desired outcomes of genetic counseling. Needs of clients provide a valuable source for identifying outcomes. Dual processing theories hold that there are two tracks of cognitive processing, rational and experiential. The former is more deliberate and the later more rapid and intuitive. These theories provide a framework for assessing how clients understand genetic information and how they respond to it emotionally. Goals of genetic counseling should incorporate both an understanding of important facts, such as chances of recurrence, and an affective exploration of the meaning and consequences of that information. Recent research suggests that genetic counseling in the U.S. may not be addressing such goals. There appears to be an emphasis on a teaching model with the presentation of extensive information. Such practices fall short in addressing the emotional context or consequences of the information for the client. At the 2005 ASHG conference, Kessler presented transcripts of genetic counseling sessions where risk information was delivered to clients who spoke of their fears and worries, without attention to these emotions by the counselors. He argued for compassionate genetic counseling that attends to the more complete needs of the client and addresses both types of cognitive processing, rational and experiential. Overall, theories and empirical evidence can inform future studies into client needs and the effectiveness of genetic counseling in meeting those needs to gather evidence toward consensus on desired outcomes. In the meantime, it makes good sense to practice more of the counseling model inherent to a psychoeducational relationship.