Genetic counselor and proxy patient perceptions of genetic counselor responses to prenatal patient self-disclosure requests: Skillfulness is in the eye of the beholder

Veronica Greve, Patricia Mc Carthy Veach, Bonnie S. LeRoy, Ian M. MacFarlane, Krista Redlinger-Grosse

Research output: Contribution to journalArticlepeer-review


Research demonstrates some genetic counselors self-disclose while others do not when patients’ request self-disclosure. Limited psychotherapy research suggests skillfulness matters more than type of counselor response. This survey research assessed perceived skillfulness of genetic counselor self-disclosures and non-disclosures. Genetic counselors (n = 147) and proxy patients, women from the public (n = 201), read a hypothetical prenatal genetic counseling scenario and different counselor responses to the patient's question, What would you do if you were me? Participants were randomized either to a self-disclosure study (Study 1) or non-disclosure study (Study 2) and, respectively, rated the skillfulness of five personal disclosures and five professional disclosures or five decline to disclose and five redirecting non-disclosures. Counselor responses in both studies varied by intention (corrective, guiding, interpretive, literal, or reassuring). Participants also described what they thought made a response skillful. A three-way mixed ANOVA in both studies analyzed skillfulness ratings as a function of sample (proxy patient, genetic counselor), response type (personal, professional self-disclosure, or redirecting, declining non-disclosure), and response intention. Both studies found a significant three-way interaction and strong main effect for response intention. Responses rated highest in skillfulness by both genetic counselors and proxy patients in Study 1 were a guiding personal self-disclosure and a personal reassuring self-disclosure. The response rated highest in skillfulness by both samples in Study 2 was a redirecting non-disclosure with a reassuring intention. Proxy patients in both studies rated all literal responses as more skillful than genetic counselors. Participants’ commonly described a skillful response as offering guidance and/or reassurance. Counselor intentions and response type appear to influence perceptions, and counselors and patients may not always agree in their perceptions. Consistent with models of practice (e.g., Reciprocal-Engagement Model), genetic counselors generally should aim to convey support and guidance in their responses to prenatal patient self-disclosure requests.

Original languageEnglish (US)
Pages (from-to)894-909
Number of pages16
JournalJournal of Genetic Counseling
Issue number6
StatePublished - Nov 2020

Bibliographical note

Funding Information:
This study was conducted by Veronica Greve as part of her training to fulfill a master's degree requirement. This project was funded in part by the National Society of Genetic Counselor's Prenatal Special Interest Group's 2017 Spring Grant.

Publisher Copyright:
© 2019 National Society of Genetic Counselors


  • attitudes
  • counseling techniques
  • genetic counseling
  • genetic counselor perceptions
  • genetic counselor self-disclosure
  • non-directiveness
  • patient perceptions
  • prenatal genetic counseling
  • response skillfulness


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