A family systems approach to genetic counseling: Development of narrative interventions

Abstract

To what extent are family systems approaches relevant in the genomics era? What difference does it make to remember the wider social context within which ‘problems’ associated with a genetic diagnosis reside? How does this influence the conversations we have with our patients? These questions will be considered in relation to systemic approaches to genetic counseling practice. Narrative therapy with an emphasis on people's strengths, wishes, and ways of resisting the effects of a problem may be a particularly useful framework for genetic counselors. Narrative practice views people as multi‐storied and is concerned with the question of how we encourage people to tell their stories in ways that make them feel stronger. Increased uptake of genomic testing and the number of people seeking genetic counseling present opportunities to consider new ways of working, particularly around support following a new genetic diagnosis. One option is to realize the potential of group interventions. Family therapy and narrative practices have the potential to encourage communication and for families to learn from each other.

Implementing genomics in the neonatal period: An assessment of parental decision making and anxiety

“…One strategy that has been suggested to help manage this stress during the pre‐test process is to harness the crisis counseling skills and model which have been used extensively in the prenatal genetic counseling and testing setting (Ayres et al, 2019). Keeping pre‐test counseling brief and integrating this with a family systems approach (MacLeod et al, 2021) can be very useful in a time‐limited situation and to enable decision making for parents who experience decisional conflict or moderate‐to‐severe anxiety. In this way, the essential information necessary for decision‐making purposes can be prioritized upfront, while ensuring that there is a pathway to ongoing and dynamic engagement with the family over time including provision of resources (information and support).…”

Experiences of living with Lynch Syndrome: A reflexive thematic analysis

“…A viable method of delivering such supports may be family systems therapy. Family systems therapy refers to an approach that deems the family to be one emotional unit (MacLeod et al, 2021), and that the interactions that occur within this unit can be explained using a systems approach. This standpoint considers that a change in one family member, such as being identified with a genetic predisposition to cancer (i.e.…”

“…This standpoint considers that a change in one family member, such as being identified with a genetic predisposition to cancer (i.e. Lynch Syndrome), will then impact the whole family unit (Gaff & Bylund, 2010;MacLeod et al, 2021). This method has therefore been suggested in a report on unmet needs in cancer genetics by the Irish Cancer Society as a feasible means of helping familial units to learn to cope with the knowledge of a genetic predisposition to cancer being present in the family (Hegarty et al, 2021).…”

Genetic counseling for prion disease: Updates and best practices

“…Unless genetic counselors take the time to allow their clients to grieve before diving into the genetics of the disease, little will be heard or retained. 39 When the clients are ready, a detailed pedigree should be taken noting cause and age of death, disease duration, and neurologic and psychiatric history in at least 3 generations. Targeted questions should focus on cognitive impairment, movement disorders (eg, parkinsonism, ataxia), seizures, insomnia, depression, anxiety, personality change, and psychosis.…”

“…The genetic counselor should validate their feelings and can also mirror and reinforce signs of strength, resilience and proactiveness that emerge in discussion. 39 They may also need to challenge misconceptions. If serious concerns arise, including signs of significant anxiety or depression or discrepant views that could influence the outcome of testing, the genetic counselor can raise for discussion the options of deferring testing, or providing referrals for individual or couples counseling.…”