Evaluating a Session—Punitive vs. Reflective

Abstract

A defining moment in my career as a genetic counsellor was when I fully appreciated the difference between being “punitive” and being “reflective” in evaluating a genetic counselling session. I am both a practising genetic counsellor and trainer/mentor/supervisor of genetic counselling students. My role as a trainer has resulted in frequent self-evaluation of my own performance as a counsellor as if I was one of my students. In assessing my own counselling sessions, I was highly critical, with a tendency to focus on indentifying all that “should have been done” in the session, instead of considering what I did and how that impacted the outcome of the genetic counselling process. Over the course of my career, and on reflection, I realised that it was not a particular incident or case that enlightened me, but rather a gradual process of becoming aware that finding mistakes and shortcomings was easy. With this focus on what was not done well or left out of a session, it is easy to forget that evaluation was also about accepting that the best was done for that patient at the time. Over time I become very conscious of my critical attitude and realised I was sometimes overly critical when evaluating my own performance. I suppose this is a natural tendency, especially if you have an evaluative role such as supervising and mentoring students and younger colleagues in counselling skills. Genetic counselling is a complex interaction. It cannot only be evaluated by how much information you impart. In fact, I think that is the easy part of the evaluation. A much more difficult area to evaluate is the way you conducted the session. For example, why did you give the information you did? Why did you feel anxious? Why did you ignore the husband? How do you evaluate the process and how do you know that you did the best you could? One effective way is through self-reflection about a counselling session. Reflection however, should not be a punitive process. The supervisory space is meant to be a holding, containing environment conducive to supporting growth and feeling supported and valued so that growth in the depth and understanding of the work can be facilitated (Kennedy 2000). Through my own experiences with supervision (I have access to a clinical psychologist) I learned to create a space to think about the session dynamics by talking through my emotions relating to the case in a safe, accepting, non-threatening environment. I experienced reflection on the genetic counselling session as an enlightening, learning process, not a critical, punitive self-evaluation and scientific dissection. I realised that by shifting the focus from specific actions that I need to perform to attuning to and responding to the patient’s needs, allowed me to be more fully present and open with patients. Thinking through how the dynamics in the session could have contributed to what was said, how it was said and when it was said, is crucial in making the shift from a punitive to a reflective process. This shift from a punitive, critical view to an open thinking space helped me to create T.-M. Wessels (*) Division Human Genetics, National Health Laboratory Service and the University of the Witwatersrand, PO Box 1038, Johannesburg, South Africa e-mail: tina.wessels@nhls.ac.za