Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Abstract

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals.In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new-in 1979 Seymour Kessler explicitly described genetic counseling as a "kind of psychotherapeutic encounter," an "interaction with a psychotherapeutic potential"-we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple "conduit for information" function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.

Response to A Different Vantage Point Commentary: Psychotherapeutic Genetic Counseling, Is it?

“…Whether genetic counseling is a form of psychotherapy is open for debate (Austin et al 2014; Biesecker et al 2016; Grosse-Redlinger 2016). Too few studies of the process of genetic counseling have been done to determine the degree to which it is psychotherapy (Biesecker & Peters 2001).…”

“…Studies demonstrate that sessions are dominated by provision of technically challenging information with little time spent on processing its meaning or impact with the client (Lobb et al 2004, Roter et al 2006, Roter et al 2007). In a laudable effort to draw attention to this alarming state of practice, Austin et al (2014) draw parallels from psychotherapy to genetic counseling to highlight the importance of the relational aspects of genetic counseling that Grosse-Redlinger refers to in her commentary (2016), referencing the Reciprocal-Engagement model.…”

The Greatest Priority for Genetic Counseling: Effectively Meeting Our Clients’ Needs 2014 NSGC Natalie Weissberger Paul National Achievement Award

“…I concur with President–Elect, Jehannine Austin’s plea in this journal (Austin et al 2014) that the relational aspects of the genetic counseling profession are critical to our survival as a profession. We need to make a break from a practice of imparting information and embrace the working alliance based on eliciting, listening, inquiring and reflecting back to our clients our impressions of what they are thinking and feeling to ensure we understand them.…”

Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men?

“…Therefore, informing this group of patients of the importance of attending regular physical and mental health checks, and encouraging them to report any negative mood changes can be important. Genetic counseling has been described as a time-limited, highly circumscribed form of psychotherapy in which effective communication of genetic information is the main therapeutic goal (Austin, Semaka, & Hadjipavlou, 2014). Individuals with hypertrophic cardiomyopathy (i.e., a heritable condition associated with an increased risk of sudden cardiac death) who attend specialized cardiac genetic clinics, providing genetic counseling, have shown to be better adjusted, 16 less worried, and less depressed compared with those who do not (Ingles, Lind, Phongsavan, & Semsarian, 2008).…”